Health Insurance FAQ

Health Insurance FAQ


What are the cheapest plans?

Most, if not all, of the insurance companies in the market include as one of their plans the combination of a health savings account and a high–deductible plan. EmblemHealth, for instance, offers a plan for $170 a month. These plans are very bare bones. The EmblemHealth plan has a deductible of $5,000. That’s not anyone’s idea of a rich benefit plan. When coupled with a health savings account, which gives the business and the employee the chance to make tax–free contributions toward expenses below that deductible, such plans do help employees with routine expenses and cover workers in case of a catastrophic illness.

Why do my rates keep going up?

Some plans raise rates sharply in the first few years of a plan because expenses were higher than actuaries predicted. But the big reason that costs for health care keep rising for small and large businesses is that people are using more health care services.

What will happen if I have a catastrophic claim?

Nothing. New York law prevents insurers from raising your rates based on your claims history.

How can I make sure the plan I choose has a good network?

You have to look at the fine print and decide what you want. There’s no guarantee that the doctor, or even the hospital you want, will be in–network. Memorial Sloan–Kettering Cancer Center, for instance, is not included in the networks of some low–cost plans.

How much will health care cost?

Most businesses we talk to that offer health insurance offer plans in the range of $350 to $450 a month and pay a part of the premium for employees.

Do I have to buy dental and vision insurance from the same company that I buy my major medical plan from?

No. In fact, it pays to shop around.

Are rates going to keep increasing?

There’s no real end in sight, unless health reform in Washington radically changes the market. Annual increases in the small business market have been in the mid– to high double–digits for several years.

What are my competitors in the labor market offering?

According to the National Federal of Independent Business, about 60% of small businesses offer health insurance to their employees and typically pay a greater share of expenses than big businesses.

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is the form that is sent to the patient from the carrier to explain the charges that have been assigned to the carrier and the amount that the carrier has indicated that they will pay for the services rendered.

I have received an Explanation of Benefits (EOB) from the Carrier, what do I need to do?

The employee should contact the insurance carrier first to verify if the bill has been submitted to the carrier and processed.

I have received a bill from the provider but the services should be covered by my insurance plan, what should I do?

The employee should contact the insurance carrier first to verify if the bill has been submitted to the carrier and processed.

  • If it has been received and processed, the employee will need to ask how the claim was processed to be sure that it was paid correctly.
  • If the claim has been received but not yet processed, the employee should ask the carrier if any additional information is needed to process the claim.
  • If the claim is not on file, the employee should contact the provider and request that they resubmit the claim to the carrier for processing.

What do I do if I have just enrolled in my insurance plan and have not yet received my ID card but need to see a doctor or get a prescription?

Contact a KYBA Benefits Account Manager who will contact the carrier and check the status of the application and see if ID cards have been mailed.

  • If the employee is listed in the system, the employee should schedule an appointment with the provider and provide them with a Social Security number and Group number so the provider can call and verify benefits in order to treat the employee and/or fill a prescription.
  • If the employee is not listed in the system, the employee can still see a provider by giving the provider the Social Security number and Group number, however, the employee should request that the provider not file the claim until the application is in the carrier system. If a prescription is needed prior to being in the system, the employee will need to pay for the medication and submit a claim form in order to get reimbursement up to the copay amount. In the mean time, the KYBA Benefits Account Manager will be working to get the application expedited in to the carrier’s system.

What should I do if my address has changed?

The employee should contact the HR Administrator at their employer to notify them of the change AND contact the customer service department of the insurance carrier to notify them of the address change.

How do I add or delete a dependent from my plan?

If there is a qualifying event or if the necessary change is during open enrollment, the employee will need to complete a change form for each carrier that is affected by the change and submit the form to the appropriate carriers.

What is Initial Enrollment for a New Employee?

Initial Enrollment is the first opportunity when you and your eligible dependents can enroll in your benefits. There are certain advantages of enrolling in benefits during your Initial Enrollment that are never offered again.

Examples of this include but are not limited to:

 

  • Dental Insurance plans have Late Entrant Penalties. If you add Dental Insurance to your coverage after your Initial Offering you will have to wait for certain benefits to take effect. Please review your Benefits Kit for the specific Late Entrant Penalties timetables.
  • Supplemental Life Insurance plans offer guarantee issue limits offered during your Initial Offering. You are able to enroll up to these limits without evidence of insurability. If you do not take advantage of this initial offering, your next opportunity would require you and your dependents to provide evidence of insurability where you and your dependents may be declined coverage.
  • Supplemental Disability Insurance plans offer guarantee issue limits offered only during your Initial Offering. You are able to enroll up to these limits without evidence of insurability. If you do not take advantage of this Initial Offering, your next opportunity would require you to provide evidence of insurability where you may be declined coverage.

How do I enroll as a New Employee?

Carefully review all the information in your Benefits Packet before making any decisions.

Make your benefit elections by completing the enrollment form(s) provided by your HR Administrator.

Return your completed enrollment form(s) to Human Resources right away but no later than the effective date of your benefits.

By waiting until your effective date to submit enrollment form(s) you may experience several problems, which include but are not limited to:

  • Inability to access benefits on your effective date
  • Delay in receiving your ID Card for up to 3 weeks from the date you submit your form(s) will create several problems.
  • Not have ID cards on your effective date

When is the next opportunity to enroll or make changes in my benefits?

The next time you can make changes or enroll is the next Open Enrollment or Qualifying Event. Outside of Open Enrollment, the only time you or your eligible dependents can make a change in your benefits is during a Qualifying Event.

What is a Qualifying Event?

A Qualifying Event is a significant change in a person’s life that creates the need to add, drop, increase or change coverage. Outside of Open Enrollment, the only other time you can enroll, change or delete your benefit options is within 30 days of a Qualifying Event.

Examples of qualifying events include, but are not limited to, the following:

  • Marriage or Divorce of the employee
  • Death of the employee’s spouse or dependent
  • Birth or Adoption of a Child
  • Start or End of employment of the employee’s spouse
  • Change in status or employment of the employee or spouse
  • Significant change in health coverage of the employee or spouse due to the spouse’s employment

ONCE AGAIN…You MUST submit your request to change within 30 days of the Qualifying Event or it will be DECLINED!

What is Open Enrollment?

Open Enrollment is the annual event, for certain benefits, where you and your eligible dependents can request changes in your election and apply for coverage.

When can I drop benefits?

Benefits can be dropped ONLY during the Open Enrollment period OR if a Qualifying Event occurs.