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Copyright 2009,  north carolina health insurance

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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Medicare Secondary Payer Reporting for Health Reimbursement Arrangements Clarified

07/29/10 7:45 pm

Excerpt: “Generally, employers don’t file with CMS, but must give information to insurers and TPAs. Reporting will help CMS identify which Medicare-covered individuals have group health plan coverage that should pay claims primary to Medicare.” (Mercer LLC)this is so true

Changes in Part D Gap Coverage Add Burden, Confusion for Health Plans

07/29/10 7:45 pm

Excerpt: “The consensus among industry stakeholders is that the new 50% Medicare Part D coverage-gap discount on brand-name drugs is confusing for all involved.” (AIS Health.com)how doe this impact my state

Joint Commission Delays Telehealth Requirements for hospitals Until March 2011

07/29/10 7:45 pm

Excerpt: “Prior to the announcement, Joint Commission-accredited hospitals were expected to implement by July 15 new elements of performance to conform to Medicare’s credentialing and privileging requirements for telehealth services.” (California HealthCare Foundation)this is bogus, who would think

Potential Loophole Closed in Drugmaker Agreement for Part D Doughnut Hole

07/29/10 7:45 pm

Excerpt: “Beginning in 2011, beneficiaries will receive a 50% discount on brand-name drugs in the coverage gap from manufacturers.” (AIS Health.com)arizona health insurance

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

07/29/10 7:45 pm

2 pages. Excerpt: “Information about HRA coverage must be submitted by Responsible Reporting Entities . . . starting in the fourth quarter of 2010.” (Buck Consultants)wonder what this really means

[Opinion] Should We Raise the Retirement Age?

07/29/10 7:45 pm

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

July 7, 2010 | Southcoast shares tips on how to beat the heat: St. Luke’s ER physician offers advice on how to prevent heat exhaustion

07/29/10 7:45 pm

NEW BEDFORD, Mass. — Hot weather and humidity raise body temperature and make it difficult for the body to cool down, increasing the risk of heat-related illness. While there are many factors and certain groups are more at risk, heat exhaustion is mostly preventable. “People who are particularly at risk and should be closely monitored for [...]

July 12, 2010 | Eileen Sugrue-McElearney named as VP of Clinical Services for Southcoast Centers for Cancer Care

07/29/10 7:45 pm

Eileen Sugrue-McElearney FALL RIVER, Mass. — Southcoast Hospitals Group has named Eileen Sugrue-McElearney as Vice President of Clinical Services for Oncology for Southcoast Centers for Cancer Care in Fall River and North Dartmouth. Sugrue-McElearney joins Southcoast from Hallmark Health System Cancer Center in Stoneham, Mass., where she served as Interim Service Line Director. She has 25 years [...]

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