What is COBRA?
January 3, 2009 by admin
Filed under FAQ 6 of 10
What is COBRA?
The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) requires most employers with group health plans to offer qualifying employees and/or their spouses and dependents the opportunity to temporarily continue their group health care coverage under the employer’s plan if their coverage otherwise would cease due to termination, layoff, or other "qualifying event". This coverage, however, is only available when coverage is lost due to certain specific events. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves. It is ordinarily less expensive, though, than individual health coverage.
There are three elements to qualifying for COBRA benefits. COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:
Plan Coverage - Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time.
Qualified Beneficiaries - A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event who is either an employee, the employee’s spouse, or an employee’s dependent child. In certain cases, a retired employee, the retired employee’s spouse, and the retired employee’s dependent children may be qualified beneficiaries. In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.
Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.
Qualifying Events for Employees:
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Voluntary or involuntary termination of employment for reasons other than gross misconduct
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Reduction in the number of hours of employment
Qualifying Events for Spouses:
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Voluntary or involuntary termination of the covered employee’s employment for any reason other than gross misconduct
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Reduction in the hours worked by the covered employee
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Covered employee’s becoming entitled to Medicare
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Divorce or legal separation of the covered employee
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Death of the covered employee
Qualifying Events for Dependent Children:
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Loss of dependent child status under the plan rules
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Voluntary or involuntary termination of the covered employee’s employment for any reason other than gross misconduct
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Reduction in the hours worked by the covered employee
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Covered employee’s becoming entitled to Medicare
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Divorce or legal separation of the covered employee
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Death of the covered employee
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FAQs
Answers To Your Health Insurance FAQs
What is health insurance? How does health insurance affect me?
What are my health care options? I don’t have health insurance. What are my options?
What does HMO,PPO,POS Mean? What is COBRA?
What is a Deductible? What is Coinsurance?
What is Group Insurance?
What do I need to know about Managed Care Insurance: HMO, PPO, & and POS plans? What is the difference between the Student Health fee and the Student Insurance Plan fee? What are these monies used for? What does "three outside referrals" mean? How should they be properly used or protected?
How do you define "outside"? Does it cost me more to deal with an agent than it would if I dealt directly with an Insurance Company?
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What is an/a PPO,HMO,POS,HSA,INDEMNITY PLAN
January 2, 2009 by admin
Filed under FAQ 5 of 10
HOW DOES INSURANCE WORK?
PPO stands for Preferred Provider Organization. This type of insurance will normally require you to visit doctors within a certain network in order to receive insurance coverage.
This type of plan normally will have a deductible and may include a co-payment for doctor visits.
HMO stands for Health Maintenance Organization. While this type of insurance is generally much more affordable, there are more restrictions than a PPO plan. The network of available health care providers may be smaller and you will need to select a Primary Physician. However, there are usually no deductibles and co-payments for HMO plans are normally lower than PPO co-payments.
POS stands for Point of Service. This type of health insurance is a hybrid between a PPO and an HMO. You will still need to have a primary care physician, but you will have access to more health care options within your network. As with an HMO, there are normally no deductibles and co-payments are lower.
An Indemnity plan will allow you much more freedom in health care choices. This freedom comes with some drawbacks and will normally require you to pay a deductible and may also require you to pay for health care visits and submit your claim for re-payment from the insurance company.
A UCR (usual, customary and reasonable) rate will be paid out on your claims. This rate will be predetermined by your health insurance company before you purchase your policy.
You will not need to have a primary care physician with this type of insurance plan.
HSA stands for Health Savings Account. This type of plan was introduced in January of 2004. Basically, you set up a “savings account” and this account is used in conjunction with an HSA insurance plan to pay for your medical costs.
Contributions to your HSA savings plan are made at pre-tax and you may invest these funds however you would like.
Unused funds in your account are tax free and may accrue interest year-to-year.
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I don’t have health insurance. What are my options?
January 2, 2009 by admin
Filed under FAQ 4 of 10
I don’t have health insurance. What are my options?
More than 46 million people in the United States are uninsured, and most are in working families. The government is looking for ways to provide more affordable health insurance and greater access to health care. Right now, there are a number of resources for women without health insurance. There are government-sponsored “safety-net” facilities that provide medical care for those in need, even if they have no insurance or money. Safety-net facilities include community health centers, public hospitals, school-based centers, public housing primary care centers, migrant health centers, and special needs facilities. The U.S. Department of Health and Human Services (HHS) recently awarded more than $19 million to expand and strengthen these facilities. To find a facility near you, contact your local or state health department or visit the Bureau of Primary Health Care.
Other government-sponsored programs for uninsured women include:
* Special Supplemental Nutrition Program for Women, Infants, & Children (WIC). Provides healthy foods to supplement diets, nutrition education, and referrals to health care for low-income women, infants, and children up to age 5. Contact: http://www.fns.usda.gov/wic.
* National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Provides free or low-cost mammograms and pap tests for women over age 39 who cannot afford breast exams or Pap smears. Contact: http://www.cdc.gov/cancer/nbccedp or 1-888-842-6355.
* Maternal and Child Health Services. State programs provide health care services for low-income women who are pregnant and their children under age 22. The federal government funds these programs and establishes general guidelines regarding services. Each state determines eligibility and identifies the specific services to be provided. The Title V State MCH Toll-free Hotline Directory can help you find services in your state.
* Indian Health Service (IHS). Provides public health care services to American Indians and Alaskan Natives. Generally, one must be an enrolled member of a Federally recognized tribe to be eligible for health services from the IHS. Non-Indian women who are pregnant with an eligible Indian’s child also may receive health care service from the IHS. Contact: www.ihs.gov.
* Projects for Assistance in Transition from Homelessness (PATH). Federal grants are provided to states and territories that partner with local organizations to provide a variety of health services for homeless people who have serious mental illness. Contact: http://www.pathprogram.samhsa.gov.
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What are my health care options?
January 2, 2009 by admin
Filed under FAQ 3 of 10
What are my health care options?
Health insurance can be complicated and confusing. There are different types of plans:
Private Health Insurance
There are two major types of private health insurance:
1. Fee-for-service. The provider (such as a doctor or hospital) gets paid for each covered service. With this type, you go to a doctor of your choice, then the doctor or hospital submits a claim to your insurance company for payment. The insurance company will only pay the provider for “covered” services. Most fee-for-service plans have a deductible amount that you must pay each year before the insurance company will begin to pay for medical services. Many plans also require you to pay a portion of the medical expense—called “coinsurance.”
2. Managed care. Managed care plans have contracts with certain doctors, hospitals and other providers to provide medical services to plan members. The three main types of managed care plans are:
* Health Maintenance Organizations (HMOs). They provide health services for a fixed monthly payment, called a “premium.” This monthly premium is the same whether you use the plan’s services or not. The plan may charge a copayment for some services—for example $10 for an office visit or $5 for a prescription. HMO plans usually require you to select a primary care physician (PCP), who manages your care. As long as you use the doctors and hospitals that participate in the HMO, your out-of-pocket costs should be very small. The HMO Act of 1973 created this alternative to traditional health plans as a more affordable option.
* Preferred Provider Organization (PPO). This option offers more choices than an HMO, but premiums often are higher. Most PPO plans do not require you have a PCP to manage your care. You can keep your out-of-pocket costs low by using “in-network” providers.
* Point of Service (POS). This plan is similar to a PPO, but your care is managed by a PCP. For example, with a POS plan, you would need a referral from your PCP to see a specialist.
People who have private insurance either buy it themselves or get it through their employer, called “group insurance.” Group insurance obtained through an employer typically requires the employee to pay some of the overall policy cost.
Public Health Insurance (Please prefer video top of this FAQ)
The government also provides health care coverage for qualifying women through Medicaid, Medicare, and special interest programs. These plans serve those who meet certain financial, age, or situational requirements. Government health insurance programs include:
* Medicare. This is the national health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure. How you get your health care coverage depends on the Medicare plan you select. The Original Medicare Plan has three parts:
* Part A (hospital) covers inpatient hospital, skilled nursing, home health, and hospice services. Everyone over age 65 is entitled to Part A.
* Part B (medical) covers outpatient hospital, doctor, lab, and other services. Part B also covers preventive services important to women, such as yearly mammogram, Pap smear, bone density scan, and flu shots. Part B is optional. You have to purchase Part B.
* Part D covers prescription drugs. Part D is optional. You have to purchase Part D. Private companies approved by Medicare run these plans. Plans cover different drugs, but drugs that you must have to treat a health problem are covered.
Some people also choose to purchase a “Medigap” policy to help pay for medical services and supplies not covered by Part A and Part B. Costs for this type of private insurance vary by policy and company.
Medicare also offers Medicare Advantage Plans. These are health plans like HMOs and PPOs that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” These plans provide all of your Part A and Part B coverage. Many also include Part D drug coverage. Your costs may be lower than in the Original Medicare Plan, and you may get extra benefits.
For more information, call 1 (800) 633-4227 (MEDICARE) or go to http://www.medicare.gov.
* Medicaid. Medicaid provides health care to certain low-income individuals and families with limited resources. Medicaid does not pay money to you. Instead, it sends payments directly to your health care providers. Medicaid is a state and federally funded program. Although the federal government sets general program rules, each state defines its own eligibility rules and runs its own program services. Qualification in one state does not mean you will qualify in another state. You must be a U.S. national, citizen or permanent resident alien in order to apply for benefits. For more information, call 1 (877) 0267-2323 or go to http://www.cms.hhs.gov/home/medicaid.asp
Note: Many states have become more flexible in their ability to serve families in need, especially if you fall into any of these categories:
* Pregnant—Both you and your child will be covered if you qualify.
* Children/Teenagers—May cover sick children or teenagers on their own.
* Aged, Blind, and/or Disabled—Nursing home and hospice care available.
* Leaving welfare—You may be able to get temporary assistance.
Call your local social security office for more information.
* State Children’s Health Insurance Program (SCHIP). This is a joint state and federal program that provides insurance for children of qualifying families. Families who make too much money to qualify for Medicaid but cannot afford private health insurance may be able to qualify for SCHIP assistance. Eligibility and health care coverage varies according to each state. For more information, contact http://www.insurekidsnow.gov or call 1 (877) 543-7669 (KIDS NOW).
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How does health insurance affect me?
January 2, 2009 by admin
Filed under FAQ 2 of 10
How does health insurance affect me?
More than 17 million women (nearly one in five) age 18 to 64 are uninsured in the United States. As health insurance costs soar, employers cut benefits, or jobs disappear, millions of people slip through the cracks and lose their coverage. These are working Americans who make too much money to qualify for Medicaid, but don’t have enough money to buy health insurance. Also, women are twice as likely as men to be insured as a “dependent” on a spouse’s plan. So, she risks losing coverage if she divorces, is widowed, or if her spouse loses his job.
Uninsured women are more likely to suffer serious health problems. They tend to wait too long to seek treatment, and many don’t fill needed prescription drugs because of cost. Also many don’t get preventive care, including lifesaving screening tests such as mammorgrams and Pap tests. The lack of health insurance can even be deadly as research has shown that uninsured adults are more likely to die earlier than those who have insurance.
The rising costs of health insurance also affect insured women. According to one national survey, one in six privately insured women postponed or went without needed care because she could not afford it. In 2005, a typical insurance premium for individuals cost $4,024 and $10,800 for families.
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what is health insurance
January 2, 2009 by admin
Filed under FAQ 1 of 10
What is health insurance?
Health insurance is a formal agreement to provide and/or pay for medical care. The health insurance policy describes what medical services are “covered” by the insurance company. There are medical services that are not “covered” and will not be paid by your insurance company.
There are a variety of private and public health insurance programs. Most women obtain health insurance through their employer or as a “dependent” in a family plan. There also are public health insurance plans funded by the federal and state governments.
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