We understand that benefits and insurance can be very confusing, especially if this is your first time having to be insured or offer insurance to your employees.  We have provided answers to a few of the common questions we receive.

What happens if I leave my company?

    Depending on the size of your employer, you may be eligible to continue your benefits for a period of time under the federally mandated COBRA guidelines.  If you are disabled, this time frame came be extended further.  Your HR representative will provide the legal notices and premium notifications so you can make an informed decision.

How can I found out if my doctor is participating in my network?

    There are many ways to confirm that your doctor is participating in your plan.  You can call the phone number on the back of your medical card, go to the medical carrier website also listed on your medical card or simply ask the doctor’s office when you book your appointment.  Be sure to ask them again when you arrive at your appointment in case anything has changed since you made your appointment.

Is there an app for that?

    If you like your smart phone and use it for every day tasks then you’ll appreciate that most medical and dental carriers now have apps for your smart phone that can provide you with your group number, deductible information , past claims information and more.  You can now have your medical information at your fingertips!

How does Primary & Secondary work when Coordinating benefits?

There are guidelines set forth by the state and insurance providers that help the patient’s insurance company determine which health care plan will be considered the primary and secondary health insurance plans.

The Primary plan is established that Primary plan will pay what it is supposed to pay regardless of the existence of any other Secondary plan that may be available, just as if the Primary plan was the only plan the patient had. Once the Primary plan has paid what expenses they should pay as determined by the coordination of benefits provision, then the Secondary plan may be used.

The Secondary health insurance plan, unlike the Primary health insurance plan under the coordination of benefits, can take into consideration what health insurance benefits were provided to the patient in the Primary health insurance plan. The remaining allowable health care costs due will then be considered for payment under the Secondary health insurance plan.

What is a deductible and when does it apply?

The amount you pay for covered health care services before your insurance plan starts to pay. Typically, the deductible will apply to major services i.e. Hospital services etc.  However, depending on the carrier and plan design, the deductible could apply on all services. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

What’s the difference between a PPO plan and a EPO plan?

PPO stands for Preferred Provider Organization & EPO stands for Exclusive Provider Organization.

 PPO plans give you flexibility. You don’t need a primary care physician. You can go to any health care professional you want without a referral—inside or outside of your network.  However, again based on the carrier and plan chosen, referrals could be required.

Staying inside your network means smaller copays and full coverage. If you choose to go outside your network, you’ll have higher out-of-pocket costs, and not all services may be covered.

 EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. You won’t need to choose a primary care physician, and you don’t need referrals to see a specialist.

But you’ll have a limited network of doctors and hospitals to choose from. And EPO plans don’t cover care outside your network unless it’s an emergency.

It’s important to know who participates in your EPO plan’s network. If you go to a doctor or hospital that doesn’t accept your plan, you’ll pay all costs.