| Health
Insurance Summary The term health insurance refers to a wide variety of health care coverage options. These range from plans that cover the cost of doctors and hospitals to those that meet a specific need, such as paying for long-term care. But when people talk about health insurance, they usually mean insurance that covers medical bills, surgery, and hospital expenses. You may have heard this kind of health insurance referred to as comprehensive or major medical plans, alluding to the broad protection they offer. Today, when people talk about broad health care coverage, they are more likely to refer to fee-for-service or managed care plans. Moreover, you'll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans. While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most plans offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences among plans. Accordingly, you should review a list of benefits prior to choosing a plan. |
Chiropractic
Care coverage
A health care plan usually bundled with a major medical plan, which may
cover all or part of the cost of office visits and procedures from a Chiropractor.
COBRA
Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal
law that extends your current group health insurance when you experience
a qualifying event such as termination of employment or reduction of hours
to part-time status. The extension period is 18 months and some people
with special qualifying events may be eligible for a longer extension.
To be eligible for COBRA, your group policy must be in force with 20 or
more employees currently covered.
Indemnity policies, PPOs, HMOs, and self-insured plans are all eligible
for COBRA extension; however, federal government employee plans and church
plans are exempt from COBRA. Individual health insurance is also exempt
from COBRA extension, which may be another reason to pursue participation
in group health plans, if possible. It is important to note that COBRA
does not apply to individual health insurance.
COBRA is regulated by the DOL-PWBA. This agency can provide further information on the time frames employers and insurance companies/health plans must follow to offer COBRA extension coverage for eligible employees and their dependents. Also, information can be furnished on the actions and responsibilities required by employees to participate and elect continuation of benefits under COBRA.
Important Points to Remember About COBRA:
- COBRA is federal law that extends your current group health coverage after a qualifying event. Individual policies do not qualify for COBRA.
- COBRA law applies to group policies in force with 20 or more employees covered.
- Indemnity
policies, HMOs, PPOs, and self-insured plans are COBRA eligible. Federal
government employee plans and church plans are COBRA exempt.
- You can contact the DOL-PWBA for questions regarding COBRA law.
Creditable
Coverage
The purpose of creditable coverage is to give you credit for prior health
care coverage. You will generally be deemed to have creditable coverage
if your prior health care coverage was under one of the following:
- A group health plan
- A governmental or church plan
- Health insurance coverage (care under any hospital or medical service policy or certificate, hospital or medical service plan contract, or HMO contract)
- Medicare
(Parts A and B)
- Medicaid
- CHAMPUS
- A
military-sponsored health care program
- A
medical care program of the Indian Health Service or of a tribal organization
- A
state health benefits risk pool
- A
health program offered under the Federal Employees Health Benefit Program
- A
public health plan, such as one provided by a state or local governmental
political subdivision
- Health benefit plan provided for Peace Corps members
- Coverage only for accidents
- Disability income insurance
- General or auto liability insurance
- Workers' compensation
- Auto medical payment insurance
- Credit-only insurance
In general, you should receive a certificate from your current plan or issuer when your coverage ceases, such as when you leave or change your job. The certificate should contain information demonstrating that you have creditable coverage.
If you do not receive a certificate and your new plan or issuer wants to apply a pre-existing condition exclusion, ask your new plan or issuer to help you get a certificate from your old plan or issuer. If you still cannot get a certificate, you can use a variety of evidence to prove creditable coverage. Acceptable documentation may include: pay stubs that reflect a premium deduction, explanation of benefit forms (EOBs), a benefit termination notice from Medicare or Medicaid, and verification by a doctor or your former health care benefits provider that you had prior health coverage.
You may request a certificate from your plan or issuer at any time, free of charge. In fact, you can request a certificate ahead of time if you know you will be changing jobs.
Generally, a significant break in coverage is 63 days or more without any creditable coverage. Any coverage occurring prior to a break in coverage of 63 days would not have to be credited against a pre-existing condition exclusion period. For example, John Doe had coverage for two years followed by a break in coverage for 70 days, and then resumed coverage for eight months. He would receive credit against any pre-existing condition exclusion only for eight months of coverage; no credit would have to be given for the two years of coverage prior to the break of 63 days or more.
Dental
Care coverage
A health care plan which may cover all or part of the cost of dental examinations,
procedures and appliances.
Healthcare savings programs that give you access to reduced, pre-negotiated healthcare rates on services from physicians, pharmacists, dentists, vision specialists, and chiropractors. eHealth Savings Cards are not health insurance policies. They are strictly discount programs that give you and your family preferred rates from selected health care providers. There is no waiting period and everyone is automatically accepted regardless of his/her prior health history.
Exclusive Provider Organization (EPO)
A type of preferred provider organization where individual members use
particular preferred providers rather than having a choice of a variety
of preferred providers. EPOs are characterized by a primary physician
who monitors care and makes referrals to a network of providers.