Review of online insurance broker::The Best Places to Buy Life Insurance Online
Review of online insurance broker::The Best Places to Buy Life Insurance Online
What is open enrollment? Open enrollment is the time period where an employee can sign up for the health care insurance. It generally doesn't last long; just a couple to three weeks. Some companies offer only one plan, others offer several. Who pays for the plan(s)? The employer pays the insurance company for the plan. The employer also chooses the provisions (copays, coinsurance, deductibles, what is/isn't covered). Some companies work with the employees to determine what benefits will and will not be included, others do not. It just depends on the employer. Sometimes a union is involved, other times the union pays for the plan (as well as choosing the provisions). The insurance company becomes the administrator for the plan chosen. The employee might pay a premium out of their paycheck; this is paid to the employer. How to get information on the plan(s) offered This is a question I hear a lot. Some insurance companies have agents prepared to answer questions on the particular plan/provisions their employer has chosen; others do not. The best source of information for these questions is the Human Resource Benefits Office/Officer. Most companies will have packets to give out to their employees to explain the different plans and provisions while some will simply have the HR representative explain the plan(s) to the employees. It's worth the time to find out from one's own employer what system is used during open enrollment. Ask for the packets- if the HR representative says "I don't have any, the insurance company didn't give me any", tell the person to call the insurance broker and get some. The insurance company doesn't have a problem providing them. It's part of the service the employer paid for. Read the Information in the Packets Here's the part I almost never got around to in the past, but now read ardently when the time comes. Read the information package! I know it's boring, but this is the health insurance that will be in place for the employee and their family for the entire following year. Learn what's covered and what's not. Make a list of questions to ask and to look up in the packet. Here are some suggestions based on questions I answer the most: 1. Are routine preventative exams/lab work covered? How much? Are there any restrictions? Limits (exams per yr/2 yrs)? 2. Diagnostic procedures (mammograms, colonoscopy, etc.) - are they covered? How much? Restrictions? Limits? 3. Does the plan have a network of Doctors, Hospitals, etc.? Are there out of network benefits? How much? 4. How are emergency room visits covered? (Fewer insurance companies will cover non-emergency visits to the ER). What happens when the person truly believes there's an emergency? For example, a person goes to the ER for crushing chest pain, and finds out it's heartburn? Good news, but the insurance company may not cover it at first. This situation will be covered later. 5. School shots? Covered or non-covered? Sports immunizations? 6. How are dependents covered, and to what age? Any special provisions for college students? Handicapped dependents? Are grandchildren covered? 7. How about smokers vs. non-smokers or drinkers vs. non-drinkers? The plan provisions can vary, along with the premiums. Does the plan cover helping the person give up smoking/alcohol? How? 8. Weight loss surgery. This is another big question. Many plans are specific about how the surgery will/will not be covered and if so, what criteria needs to be met before the surgery can be approved. Read this part carefully. 9. Does the doctor or patient need to notify the insurance company about a procedure or hospital admission? What happens if that notification isn't made? 10. Does the procedure need to be approved before it's done? Some insurance companies allow the Doctor to send in a letter (called pre-determination) along with medical documentation showing the medical need for the procedure. While there is no guarantee that the insurance company will say yes, although if approved, the procedure will be covered. Both the Doctor and member will receive letters stating the outcome. 11. Appeals. What is the process? How long does it take? Remember the ER visit in number four? An appeal, along with the medical notes, will give the insurance company the reason for the visit. Although the out- come was not life threatening, the patient went to the ER with good cause. This instance would be covered. The pre-determination letter will also come in handy if the initial claims for a covered procedure is denied. There are many, many more instances and questions that can be asked when researching a plan. These are among the top questions I answer every day. Sit down with the family, go over each provision carefully and decide which plan to choose. If school/sport immunizations aren't covered, call the doctor's office to find out how much is charged. Will the school provide them? Will there be a low-cost or free clinic for the shots? Or take the time to carve out the money in the budget ahead of time. Does the insurance company have a website where information can be found? Some do. Some websites are truly comprehensive; claim forms, explanation of benefits forms (EOB's), appeals forms, benefits listing, ID cards, and much more are available online. Have a question on something you read? Call the insurance company. Receive a bill (from a Doctor or Facility) and have a question? The insurance company has people ready to help you understand your benefits, and answer questions. Learning from the benefits packet can also prepare a person for any bills or EOB's that come with their medical care. Does the plan offer a HSA (Health Savings Account), an HRA (Health Reimbursement Account) or an FSA (Flexible Spending Account)? These will be outlined in the benefits packet. Depending on the company, the HR representative should have a meeting with employees to explain each (if offered) in full and how they work. These are often managed by an outside company, usually a bank, separate from the insurance company. Finding this out ahead of time can save time on the phone and the frustration that comes with being told to call someone else. Learn how the process at the Doctor's office works. If the insurance company says there is no copay, but the member has a deductible, the member may have to pay something at the Doctor's office. The Doctor's office is responsible for filing honest claims. If the member has paid at the office, then learns that the Doctor's office has also been paid by the insurance company through a benefit program for the deductible, the member is entitled to a refund. If the Doctor's office says "sue me," then do it. Most Doctor's offices are honest and will report to the insurance company any money received from the patient. It never hurts to double check. (The author went through this- even before the refund was received, the author found a new Doctor's office.) Asking questions of the HR representative, the employer, reading the insurance packets, discussing benefits with the family before making a decision is the best way to go. Not knowing what benefit's a particular plan has and doesn't can wind up costing a person money they don't have to spend. If something isn't covered in a person's plan and it's a procedure that the person sees as a medical necessity or real possibility (weight loss surgery, for example), perhaps a rider (a specific benefit purchased separately in addition to the main policy, like covering antiques in a home policy) could be purchased. If not available through the employer, the person could consider a second policy purchased on their own through another insurance company. There are limited policies available through different insurance companies; calling/emailing and asking will hunt them down. One more thing on health insurance plans, Cobra isn't the only interm insurance available. When someone is laid off, loses their job through attrition or other means, federal law requires the employer to offer Cobra coverage. It is the same policy that the former employee had, only the employee has to pay full price. And it has time limits, usually 18-36 months, according to state/federal mandates. There are other short term insurance plans available on the market. Research, asking friends, relatives and insurance companies can lead the right person to the right product for their needs. Many people know more about their car or homeowners policies than they do their health plan. No mention is made of specific plans or insurance companies because there are hundreds of companies with thousands of possible plans/provisions available. This information is basic to the industry, and individual plans may vary. |
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Labels: Broker Car Insurance Quotes, Car Insurance Brokers, Group Health Brokers, Home and Auto Insurance Brokers, Individual Health Insurance Broker, Insurance Brokers and Obamacare, Sell Obamacare Insurance, Selling Obamacare Health Insurance Policies
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