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north carolina health insurance Glossary & Terms

 

Q: What is open enrollment and why is it crucial?

Answer: Typically, employers set aside an open enrollment window for employees to go over, compare and choose from the health services offered by the company. In most cases, open enrollment comes once a year, so it's important to take advantage of this time period to comparison-shop and ask your benefits administrator about specific questions you may have about coverage. Separately, life-changing events – like the birth of a child or loss of a loved one – may qualify you to make changes outside of the open enrollment window. Learn more about changing your medical insurance policies.

Question: Will I have to select a new doctor during open enrollment? And what if my employer has switched insurance carriers?

Answer: During open enrollment, you can compare health services and make changes to your coverage. If you stay with your current medical insurance carrier, it's not likely that you'll be required to select new physicians – unless your provider is dropped from the plans network, retires, etc. Should you elect a new health insurance carrier – or your employer discontinues its previous plan – you may have to do some research. In any case, you'll want to double-check whether your physician falls in the programs provider network. Follow these pointers in choosing a doctor.

Question: What should I look for in a plan?

Answer: Good question. A health insurance plan generally offers coverage for a mix of health care services ranging from traditional medical (e.g., office visits and hospital/emergency room treatment) and preventive care to rehabilitation and alternative or complementary medicine. The key is knowing the total amount you can expect to spend for care. A insurance broker may be able to offer money-saving tips.

Question: How do I evaluate prescription drug coverage? How do I find out if a particular prescription is covered?

A: It's important to understand your insurer's prescription drug benefits before you purchase your medication. You may pay by using in-network pharmacies, asking for generic drugs or using mail-order services that deliver to your door. Keep these prescription drug facts in mind.

Question: Are dental benefits included in my coverage?

A: Don't assume that your insurance includes dental, vision, mental health or other services at the same level – or at all – until you review the fine print in your health programs. If your coverage does not look adequate for your family's needs, you may need to consider supplemental insurance. A supplemental health plan may offer you some limited benefits to complement your primary programs.

Question: What are deductibles and co-pays? How do they work?

A: insurance deductibles and co-pays are out-of-pocket expenses for which you're generally responsible. For a listing of common expenses, review our health expense chart. You can, however, take steps to limit your costs with a tax-free account for future expenses.

Question: I have a pre-existing condition. Can I get insurance coverage? How will my pre-existing conditions impact my policies and rates?

A: As you apply for insurance – even an employer's group policies – keep in mind that pre-existing conditions may lead to higher premiums and, in some states, denial of coverage. Here's what you need to know about pre-existing conditions and insurance premiums.

Q: Will my doctor accept this plan? How do I make sure my doctor is in a specific insurance plans network? What does it mean to be in-network or out-of-network?

A: An out-of-network provider is not in your insurance company's preferred network. You may be required to pay your physician at the time of service and file a claim with your insurance company separately for reimbursement. In the end, consumers typically pay more for out-of-network services. Consult with your benefits administrator, review your programs provider network booklet or website, or double-check with your provider for network status. If your plan has changed and you're shopping for a provider, search by specialty, condition, treatment or procedure.

Question: How do I know if a particular service or procedure is covered by my insurance?

A: Your benefits administrator or insurance carrier should be able to give you a complete breakdown of coverage for office visits, diagnostics and testing, emergency care and a host of other services. Not satisfied with your plan? Get a medical insurance quote from another carrier or consult with a medical insurance broker to find the best health insurance plan for your needs.

Q: What is COBRA?

A:COBRA is a law that may offer you some protections – and extend your health care coverage – if you lose your job or a spouse's insurance benefits. Find out about COBRA qualifications and costs.

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[Guidance Overview] Centers for Medicare and Medicaid Services Guidance on Mandatory Medicare Secondary Payer Reporting of HRA Coverage (PDF)

08/29/10 3:11 am

2 pages. Excerpt: “Information about HRA coverage must be submitted by Responsible Reporting Entities . . . starting in the fourth quarter of 2010.” (Buck Consultants)like our content consider our rss feed!

[Opinion] Should We Raise the Retirement Age?

08/29/10 3:11 am

Excerpt: “On the face of it, lifting the retirement age [for Social Security and Medicare] makes sense. Americans are living longer, so they could retire later and still enjoy their golden years. Except??’only some of us are living longer.” (The Century Foundation)more to read in our archives

[Guidance Overview] Centers for Medicare and Medicaid Services Updates HRA Coverage Reporting

08/29/10 3:11 am

Excerpt: “Among the issues addressed in the updated guide are references to changes in reporting for Health Reimbursement Arrangements (HRAs). CMS has removed all references from the updated guide that previously referred to reporting only for ‘free-standing’ HRAs.” (Fisher & Phillips LLP)I like this:)

[Opinion] The Latest on Medicare and Social Security

08/29/10 3:11 am

Excerpt: “According to the reports, the date of insolvency for Medicare’s hospital fund was pushed back, from 2017 to 2029, because of cost-saving measures in health reform. As for Social Security, without any changes, it will be able to pay full benefits until 2037 and partial benefits after that, the same estimate as in last [...]

[Opinion] Will Health Savings Trickle from Your Paycheck to Social Security?

08/29/10 3:11 am

Excerpt: “The theory is that the health law will help the financial viability of Social Security because employers will shift money they now spend on health insurance into higher wages. That, in turn, will mean more taxes collected on fatter payrolls to support Social Security and Medicare.” (National Public Radio)does anyone know when this will [...]

Dealing with Medicare Part B and COBRA Coverage

08/29/10 3:11 am

Excerpt: “The Social Security law allows people to postpone enrollment in [Medicare] Part B without penalty only if, and for so long as, they have group health insurance coverage that is provided by an employer for whom they (or their spouses) are still working.” (Ford & Harrison LLP)it should be interested what change will this [...]

July 14, 2010 | Sharon Jones to lead Southcoast’s system-wide VNA, home care and hospice programs

08/29/10 3:11 am

Sharon Jones FALL RIVER, Mass. — Southcoast Health System has named Sharon Jones as the new leader of its region-wide home care and hospice services that serve Southeastern Massachusetts and East Bay, R.I. Jones holds the dual positions of Chief Executive Officer of the Visiting Nurse Association of Southeastern Massachusetts, part of Southcoast Health System, and [...]

July 20, 2010 | Media Advisory: News Conference with Westport man struck by lightning and his doctor

08/29/10 3:11 am

Media Advisory: News Conference with Westport man struck by lightning and his doctor WHAT: James Gallant will speak with the media at a news conference today at 4:30 p.m. today at St. Luke’s Hospital in New Bedford. Mr. Gallant’s physician will also speak to the media about Mr. Gallant’s care, what happens to the body when someone [...]

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