What if I receive an email saying the insurer will cancel my coverage?
If you have received an email stating “ACTION REQUIRED NOW: If you do not provide these documents, your coverage will be canceled by your insurer.” please reach back out to us with the information requested, which may ask for proof of U.S Citizenship and proof of Social Security Number. The reason this happens is that the information that […]
What do I do when I have a child dependent turning 26?
Once a child under a parent’s plan turns 26, they will need to enroll in their own plan. If they don’t, they can lose coverage when turning 26. You will typically also lose their contribution amount from your employer when they turn 26 if applicable. Here are a few options that they can take to […]
What’s the difference between an HMO, PPO, and EPO?
There are three types of health plans: HMO, PPO, and EPO plans. These plans primarily vary in accessibility and size of physician network. In order to pick the right plan, you should know the differences. An HMO is generally the most affordable, but least flexible network type You are required to select a primary care […]
What’s the difference between co-insurance and co-payment?
Both terms refer to your share of the costs of a covered healthcare service. “Co-insurance” is a portion of the allowed amount of the service. For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, then your coinsurance payment of 20% would be $20. “Co-payment” is a […]
What is an out-of-pocket limit?
An out-of-pocket limit (or max) is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, co-payments, and co-insurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. Here’s how co-insurance and out-of-pocket max works: Imagine you have […]
What is a premium?
A premium is the monthly cost of your health insurance. You’ll pay your premium every month, on a set date, regardless of if you go to the doctor or not.
What is a deductible?
A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay. Here’s how a deductible and co-payments work: If you go to the doctor, you might pay $30 at the front desk when you check in (co-payment) and then have a checkup and some tests that cost $425. […]
What’s always covered in my health insurance plan?
Under the Affordable Care Act, individual plans must cover preventative care — which includes your annual check-ups, preventative tests, and immunizations — at zero out-of-pocket cost to you. Additionally, all individual plans must cover the following essential benefits: Ambulatory patient services (outpatient care) Emergency services (trips to the ER) Hospitalization (inpatient care) Maternity and newborn […]
What happens if I see a doctor outside of my network?
It depends on your plan. Generally, Preferred Provider Organizations (PPOs) will pay a portion of any care you receive from an out-of-network provider while Health Maintenance Organizations (HMOs) will not. Exclusive Provider Organizations (EPOs) may or may not. For more information about your plan’s out-of-network coverage, consult the plan’s summary of benefits.
What is Open Enrollment? What if I miss it?
Open enrollment is a specific time period each year when you can enroll in, change, or waive your health insurance benefits. There are two types of open enrollment periods to be aware of: ACA Open Enrollment: This is the nationwide enrollment window for individual health insurance, typically running from November 1 to January 15. Employer […]