06.15.09
Posted in Health Plan at 3:50 am by admin
Generally two main categories of health insurance plans, the level of service (compensation) and managed care. Policies of each category can vary widely in terms of coverage and cost, and the difference between the price of service plans and managed care plans that are not clear.
Service Fee Plans
With this plan, an invoice will be sent to the insurance, which pay some (eg 80 percent) and patients pay the balance or co-insurance “(for example, 20 percent), usually one year after the deductible is completed. This type of health plan offers the best opportunity for doctors, hospitals and other health service providers, although they can not pay for preventive care such as vaccinations or well child care. To receive a payment claim, it may be to fill the form by shareholders, and send it to the insurance. Some providers, however, akan do it for you. Most of the cost of service plans CAP - the maximum amount that you pay the bills in one year.
Managed care plan
This health plan to negotiate prices with doctors, hospitals and other care providers for various services to members in terms of cost. You or your employer pay the fixed monthly amount, you can choose a doctor who participated in the plan, together with payment and pay for doctor visits and other services. There may be cutting, but you usually do not need to fill out forms or paper files. There are three basic types of treatment plans: choice of provider organizations (PPOs), point service (post) and the Health Maintenance Organization plans (HMOs).
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08.18.08
Posted in Uncategorized at 5:52 pm by admin
The Department of Labor’s Employee Benefits Security Administration (EBSA) administers the Employee Retirement Income Security Act of 1974 (ERISA), which governs retirement plans (including profit-sharing and 401(k) plans) and welfare plans (including health, disability, and life insurance plans). ERISA also includes the health coverage continuation and portability provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Insurance Portability and Accountability Act (HIPAA). This information sheet focuses on job loss and its effect on workers’ health benefits and retirement benefits.
When facing job loss or a reduction in hours, workers need to know their options ahead of time to prevent loss of health coverage. There may be several options available to individuals who are losing their health coverage when they lose their jobs:
Special Enrollment in Another Group Plan. If other group health coverage is available (for example through a spouse’s employer provided plan), special enrollment in that plan should be considered. It allows the individual and his/her family an opportunity to enroll in a plan for which they are otherwise eligible, regardless of enrollment periods. However, to qualify, enrollment must be requested within 30 days of losing eligibility for other coverage. After special enrollment is requested, coverage is required to be made effective no later than the first day of the first month following your request for enrollment. This type of coverage is usually the most cost-effective of all the options.
COBRA Continuation Coverage. If the individual’s employer continues to operate and offer a group health plan, COBRA continuation coverage may be available. COBRA, which generally applies to employers with 20 or more employees, allows the individual and his/her family to continue the same group health coverage at group rates. An individual’s cost for coverage may be higher than what the individual was paying before (and is usually higher than the cost for coverage under special enrollment in a spouse’s plan), but generally the cost is lower than that for private, individual health insurance coverage. The plan should send a notice regarding the availability of COBRA coverage. After this notice is provided, the individual generally has 60 days to elect coverage and it is then available retroactive to the loss of coverage. (Note: Once an individual has elected COBRA, he/she won’t be eligible for special enrollment in another group health plan, such as a spouse’s plan, until all COBRA coverage available is exhausted. Therefore, it is important to consider special enrollment in another plan promptly.) COBRA coverage typically lasts 18 months, but may last longer in certain circumstances.
Health Coverage Through a Government Program. Health coverage may be available to certain qualified individuals through the State or Federal Governments. Information on government programs such as Medicaid (for low-income individuals and individuals with special needs), State Children’s Health Insurance Program (for children of qualified families), or Medicare (for people aged 65 and over, and for certain people who are disabled or have end-stage renal disease), is available through your State insurance department or the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services at 1-800-MEDICARE. Read the rest of this entry »
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