Frequently Asked Questions


[apane title=”What is the best way to select a primary care physician?“]If you do not have a physician you are familiar with to select as your primary care physician, you will probably want to base your selection on geography (closer to home or work), specialties and/or availability to take new patients. This information is normally found in the provider listing for the corresponding medical insurance carrier (click here to access carrier provider listings). Otherwise, talking to friends, family and coworkers to get a recommendation is another suggestion.[/apane] [apane title=”Should I get a pre-authorization for dental care?“]A pre-authorization is always a good idea if you are going to be requiring extensive services for your teeth. A true pre-authorization requires your dental office to submit a summary of all suggested services with verification (usually X-Rays) to validate the necessity. The insurance carrier can then respond to either authorize services or explain why the procedure would not be covered. In most cases, with a secondary explanation, the dental services will be authorized. However, it is much easier to have the services approved before the care is provided. If you do not have a pre-authorization done, you may end up paying a higher out-of-pocket expense.[/apane] [apane title=”If I have an emergency while I am out of the area, will my HMO cover my care?“]The answer is “Yes”, however there are some important rules to keep in mind. If your medical needs are life threatening, you should go to the nearest medical facility immediately. All services will be covered as if they were provided in-network. If your medical needs are not life threatening, you should first contact your primary care physician to explain your situation and they can then authorize services for you. If they are not available, contact the customer service number for your health insurance provider and explain your situation and they will then instruct you on how to receive services. If you do not follow these rules, your HMO provider can decline payment for services.[/apane] [apane title=”What is the difference between a co-pay and a deductible?“]A copay is a an amount that you must pay each time you receive the corresponding service (example: office visit copay). A deductible is an amount that you must pay out of pocket before coverage applies to services. If your plan has a deductible, you must satisfy that amount during the coverage year before the insurance plan will begin to pay any expenses.[/apane] [apane title=”If my employer offers both an HMO and a PPO, how should I choose?“]Choosing between medical plan types is a very personal decision. You must decide which of the plans work best for yourself and your dependents based on your anticipated medical needs. If you or your dependents have specific physicians or medical facilities that you want to continue using, you should first verify which plan includes those providers in their network. Keep in mind, for the HMO, if they are not in the network, services will not be covered. If providers are not an issue, another consideration is accessibility to care. With a PPO, you can “self direct” your care and you are not required to get a referral to see a contracted specialist. With the HMO, in most cases, you will need to get a referral from your PCP before seeing a contracted specialist. Lastly, you may want to evaluate which plan best fits your budget objectives. Traditionally, the HMO will have a  lower out of pocket expense as you access services with contracted providers.[/apane] [apane title=”When can I make changes to my insurance?“]There are only certain times that you are allowed to make changes to your benefit plans. When you are initially hired, you have a specified time period to select a plan and enroll yourself and your dependents. Outside of this initial enrollment, you are not able to make changes until your employer’s “open enrollment” period. The timing of the open enrollment usually corresponds to your companies annual contract renewal with the insurance carriers. During this specified time, you can change between plans and add or delete dependents from coverage. Outside of your initial enrollment and open enrollment, you can only make changes if you have a qualifying event. (example: marriage, new child, loss of coverage) Traditionally, you will have 30 days from the qualifying event to make the requested changes. Additionally, you will be required to provide documentation to validate the event. (example: birth certificate, marriage certificate, Loss of coverage document).[/apane] [apane title=”What is an HSA plan and should I try one?“]An HSA plan (Health Savings Account) is a type of medical insurance plan where you take responsibility for the “first dollar” coverage by putting money into a designated savings account. In other words, the insurance plan has a higher than normal deductible and outside of preventive care, all of your medical expenses must exceed the deductible before coverage begins. The benefit of this type of plan is that you are able to set aside money in a qualified account on a tax deferred basis and earn interest on the money you do not use. Your employer can also elect to contribute to your HSA account and the money is yours to use for qualified health expenses once it has been deposited. You must enroll in a qualifed HSA insurance plan with an eligible deductible to participate.[/apane]