Tag Archives: Essential Health Benefits

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

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Summer Relaxing with a SEP

What’s So Special About Summer?

Didn’t buy health insurance by the deadline? Had some unexpected changes since then and need a plan, fast? A Special Enrollment Period (SEP) might be right for you. We have just what you need this summer to take a little of that heat off.

Dog Days

  1. Ice Cream
  2. Humidity More Ice Cream
  3. Getting a Special Chance to Buy Health Insurance

Every year, as summer turns to fall, and fall to winter, millions of Americans buy health insurance. During that season, the government gives everyone a chance to buy the plan they need, but by early spring, time’s up!

But here’s some good news, everyone knows the world doesn’t stop turning during the summer months. That’s why some special rules help you out when life gets interesting.

Special Enrollment Periods (SEPs) are special chances to buy or make changes to your health insurance plan the rest of the year. Here’s a quick Q&A on how they work.

Interested in signing up or need to learn more? Give us a call at 1-888-382-9771! We’re here to help.

Q:  What’s an SEP?

A: After March 31, only people with a qualifying life event can change their individual or family plan or enroll in a new plan. That’s called having an SEP.

Q: What’s a qualifying life event?

A: Events include:

  • Getting married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area with different health plan options
  • Losing other health coverage because
    • You lost your job
    • You don’t work enough hours to stay on your employer’s plan
    • Your employer stops paying for your plan or stops paying as much
    • Your plan doesn’t cover the essential health benefits as required by the Affordable Care Act (ACA)
    • A big increase in how much you pay for your plan

Q: Is a change in my income a qualifying life event?

A: For people who already have a qualified health plan, a change in income or household status can be a qualifying life event. Both of these events might change how much government help you can get to pay for your plan.

Don’t forget, you can apply for Medicaid or the Children’s Health Insurance Program (CHIP) any time.

Q: Why don’t I always qualify for an SEP if I lose my coverage?

A: Some events don’t count as a qualifying event:

  • Losing your plan because you didn’t pay your premiums
  • Choosing on your own to quit other health coverage
  • Losing coverage that’s not minimum essential coverage, like a short-term plan or (in some cases) a catastrophic plan

Q: What if I don’t have a qualifying life event?

A: You have to wait until the next Open Enrollment Period (OEP), which will begin during the fall. The government sets the start and end dates of OEP, not Health Alliance.

You can enroll in a Short-Term plan at any time. But remember, they don’t meet the requirements of the ACA for being a qualified health plan, which means you’ll have to pay a tax penalty in 2015.

Q: How long do I have to enroll in a plan after a qualifying event?

A: 60 days.

Q: How do I enroll?

A: You get to choose how you’d like to enroll. Find what works best for you, and if you need help along the way, call us at 1-888-382-9771. Or if you’re in the Champaign area, stop by our office at 206 W. Anthony Drive (near Alexander’s Steakhouse) for help!

Q: When will my coverage start?

A: Your start date depends on your qualifying event.

If you have questions about an SEP or about your situation, give us a call at 1-888-382-9771 or stop by our office—we’re more than happy to help you find the answers.

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Essential Health Benefits: Get More for Your Money

Upgrading to the Meal

That glorious moment when the server at a restaurant clarifies that your meal comes with a drink … not for an extra cost, but with. Wow, what a moment. As of January 1, 2014, your health insurance plan comes with Essential Health Benefits.

If you’ve been a Health Alliance member before, we’ve covered many of these benefits for years, so you won’t see or feel much change. But if you’re new to us, welcome and enjoy!

Essential Health Benefits stretch across 10 categories. By law, no matter your age, gender, or medical history, you’re covered in these 10 areas.

Essential Health Benefits

Details

Ambulatory Patient Services Care you get at a doctor’s office, clinic, or outpatient surgery center, including home health services and hospice care.
Emergency Services Care provided in an emergency situation where you believe your health is in serious danger, like chest pain, a broken bone, or unconsciousness.
Hospitalization Care from doctors, nurses, and hospital staff, room and board, surgeries, and transplants you receive during your hospital stay, or care in a skilled nursing facility.
Laboratory Services Testing to help a doctor diagnose an injury, illness, or condition, or monitor how well a treatment is working.
Maternity and Newborn Care Prenatal care through newborn care.
Mental Health Services and Addiction Treatment Inpatient and outpatient care to treat a mental health condition or substance abuse.
Rehab Services and Devices Services and devices to help you regain mental and physical skills lost because of injury, disability, or a chronic condition.
Pediatric Services Wellness visits and recommended vaccines and immunizations for infants and children, as well as dental and vision care for children under 19 years old.
Prescription Drugs Antibiotics and medicines to treat an ongoing condition, like high cholesterol.
Preventive and Wellness Services and Chronic Disease Treatment Physicals, immunizations, preventive screenings, and care for chronic conditions, like asthma and diabetes.

*Some services do have limits.