Shasta-Trinity Schools Insurance Group

Slides:



Advertisements
Similar presentations
Open Enrollment for 2013 Benefits AACPSAACPSAACPSAACPS Introduction to the BlueChoice HMO Plan CareFirst BlueCross BlueShield is an independent licensee.
Advertisements

What I need to know about health insurance.. Introduction to Health Insurance Basics Terms Scenario Mandated covered services Plans Identify Explain Pros.
© 2010 Wittenberg University Springfield, Ohio New Health Care Plan For Retirees Under 65 Effective Oct. 1, 2010.
THE STANDARD PLAN SHBP Standard Plan for HRA, HMO and HDHP.
Center School District Qualified High Deductible Health Plan (QHDHP) with HSA Effective July 1, 2009.
Glastonbury Public Schools May 6, 2013 Presenter: Josh Steffenson All sample values and calculations are according to GEA negotiated benefits. Dollar amounts.
Nicholls State University Human Resources Annual Enrollment Overview.
2010 Plan Information State Personnel Department Enroll online Nov. 2 through Nov. 23, 2009 at noon (EST)
Garden Grove Unified School District
Types of Health Plans. The practice of medicine is complicated and expensive Medical insurance often covers routine care, such as annual physicals, and.
© 2009 Corporate Executive Board, All Rights Reserved. Health Plan Dictionary How to Understand Your Plan and Make Cost- Effective Choices.
Employee Health Benefits Indiana State Personnel Department Benefits Division.
September Purdue’s Goals Give more choices in medical plans Support efforts to maintain/improve health Better manage health care costs for Purdue.
H.B. Fuller Company 2009 Open Enrollment: Helping you Buy Well, Use Well, Be Well October, 2008.
 Indemnity or Fee-for-Service coverage- -allow you go to the doctor of your choice and pay for services at the time of the visit. -The amount that your.
HOW DOES THE HRA WORK? SHBP Health Reimbursement Account.
Health Care. HMO: Health Maintenance Organization Group insurance that entitles members to services at participating hospitals. – Traditionally lower.
Healthcare Finances HS II Unit 1.03.

Health Insurance Law and You Mr. Blais. Managed Care Plans These involve arrangements between the insurance companies and a certain network of health-care.
What is a High Deductible Health Plan? City and County of Denver
Presented by State Health Benefit Plan State Health Benefit Plan 2010 Active Employee Open Enrollment Presentation For Plan Year January 1– December 2010.
1 Health Insurance Briefing 22 July 2010 CHANGES IN THE HEALTH INSURANCE PROGRAMMES
SmartSense PPO Plans New Plan Design Launched December 2007.
UNA MEJOR OPtion PARA SU SALUD TOTAL [Employer group name] City and County of Denver High Deductible Health Plan (HDHP)
Medical Benefit Overview.  Health Care Reform  Employee Benefit Plans  Health Savings Accounts (HSA’s)  Open Enrollment.
An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal & Enhancements Andrea Rossbach 10/11/2012.
This presentation is a high-level summary and for general informational purposes only. The information in this presentation is not comprehensive and does.
Health Plan Options Informational Sessions November 2012.
High Deductible Health Plan (HDHP) Is it a good option for you?
Insurance Terms and Concepts Medical Insurance involves a contract in which a business agrees to pay a portion of a patient’s medical expenses in exchange.
Medical Insurance. Overview  Many people in the US are uninsured – they assume all responsibility for health care costs.  The number of uninsured is.
Understanding your Explanation of Benefits (EOB) 1.
Triple Choice Enrollment THE BASICS DEFINITIONS HMO (Health Maintenance Organization): A form of health insurance combining a range of coverage.
Individual & Family Medical, Dental & Life Plans March 2009.
HEALTHCHOICE PLANS 1. Available Plans HealthChoice High Option HealthChoice Basic HealthChoice S-Account HealthChoice USA 2 Using a HealthChoice Network.
“Just Stay In”. Advantages of Using a Contracting Provider Less Coinsurance Less Out of Pocket Contracting Providers will write off anything they charge.
Consumer-Driven Health Plans HSA and HDHP Overview A Health Savings Account (HSA) is a special account owned by an individual where contributions to.
HSA Seminar PreferredOne HSA Plan 2013 ®. What is an HSA Health Plan? High Deductible Health Plan + Health Savings Account 2 Health Savings Accounts (HSAs)
Wellesley College PPO Plus HSA Plan for © 2009 Harvard Pilgrim Health Care Components of the PPO Plus HSA Plan  Two parts: A qualified High Deductible.
MIIA - Blue Cross Blue Shield Proposed Benefits. Plan Offerings HMO Blue New England (HMO) Blue Care Elect Preferred (PPO)
1 Benefits effective 2/1/ Lifetime maximum of up to $5 million RX Card Wide choice of plans Family Flex ® – Each family member can apply for a.
State of Maine Employee Health & Benefits Insurance Update Revised 02/06/20131.
0 Disclaimer - This presentation is brought to you by Aetna Life Insurance Company and/or its affiliates to educate you on the Aetna plan options available.
EHA Early Retiree Plan Benefit Options.
 Both fee-for-service and managed care cover medical,surgical, and hospital expenses  Can also cover prescription drugs and dental  Both pay premiums.
RESURRECTION HEALTH CARE PHYSICIANS’ HEALTH INSURANCE INITIATIVE Presented by: Steve Guarino PBT Health Insurance Program.
Agribusiness Library LESSON: HEALTH INSURANCE. Objectives 1. Determine the function of health insurance, and define common health insurance terms. 2.
Insurance. Health Insurance  Many people in the US are uninsured – assume all responsibility for health care costs.  Insurance decreases out of pocket.
State of Indiana Employees 2010 Plan Information State Personnel Department.
Roswell Independent School District 1.  (a)NMPSIA doesn’t care about its members  (b) NMPSIA loathes 89% member satisfaction  (c) NMPSIA staff pocketed.
Peace of Mind Insurance can give you financial security and peace of mind, especially in case of unexpected expenses. When do people use insurance?
3/7/20161 Health Insurance New International Student Orientation – Spring 2012.
Shelby County Government 2014 Benefits Annual Enrollment: 11/01/2013 – 11/15/2013.
HEALTH BENEFITS 101 Lucia Mar Unified School District Presented by Michelle Rogers Human Resources Technician May 11th, 2016.
HSE STANDARD 5.  Calculate the costs of a range of health insurance plans, including deductibles, co- pays, PPO’s and HMO’s. For a selected disease/disorder/injury,
MGT 4543: Compensation Management Chapter 10 Part II Employer-Sponsored Health Insurance Programs.
OPEN ENROLLMENT 2017 McLaren Health Plan MOTT COMMUNITY COLLEGE Logan Suttmann SET SEG Employee Benefit Services Account Executive Christine Morse.
Health Insurance Key Definitions & Frequently Asked Questions
NETWORK CHANGE – BENEFITS OPEN FORUM
Types of Health Plans.
HEALTH INSURANCE HSE STANDARD 5.
BRIEF PLAN OVERVIEW FOR JULY 1, 2018 – June 30, 2019
Health Insurance in the USA
Health Insurance Premiums & Benefits
DACHSER USA/Americas 2019 Benefits.
2019 Health Plan ASU is a self-insured health plan. Employees and ASU pay premiums into the plan, and those premiums are used to pay claims, administrative.
Health Insurance Premiums & Benefits
Consumer-Directed Health Plans (CDHP)
Presentation transcript:

Shasta-Trinity Schools Insurance Group EOB/Benefit Training

Agenda Key terms to know How to read your Explanation of Benefits (EOB) Real world claims example/comparison Comparing HMO, PPO, and HDHP plans

Key Terms Participating Providers: Doctors, hospitals, and other health care providers/facilities that have contracted with Anthem Blue Cross to provide services at a discount rate Non-Participating Providers: Doctors, hospitals, and other health care providers/facilities that have NOT contracted with Anthem Blue Cross, and have not agreed to provide services at a discounted rate

Key Terms Calendar Year Deductible: This is the amount that you are responsible for paying each calendar year before your plan begins to make payment for most services you receive. The Calendar Year Deductible does not apply to/is waived for certain services (ie., office visits, preventive care services) Out-of-Pocket Maximum: This is the maximum amount of Coinsurance that you will have to pay for services you receive during the calendar year. The following services do not apply toward the satisfacton of the Out-of-Pocket Maximum: Calendar Year Deductible, Copayments, and Amounts Not Allowed (Non-Participating Providers). After reaching the Out-of-Pocket Maximum, you are still responsible for paying Copayments (where applicable) and any Amounts Not Allowed.

Key Terms Copayment: A flat dollar amount that you are responsible for paying for certain services (ie., office visits, physical therapy, chiropractic). The Calendar Year Deductible is waived for some services (ie., office visits). In addition to the copayment , you are also responsible for Coinsurance, where applicable. Coinsurance: This is the percentage that you are responsible for paying for services you receive, after you have satisfied your Calendar Year Deductible (where applicable) and paid any applicable Copayment

Key Terms Total Billed Amount: The amount billed by a provider for services rendered Patient Savings: For services rendered by a Participating Provider, this is the amount that is discounted from the providers Total Billed Amount. You are not responsible for this amount Amount Not Allowed: For services rendered by a Non-Participating Provider, this is the difference between the provider’s Total Billed Amount, and Anthem’s allowed amount. You are responsible this amount when you receive services from a Non-Participating Provider.

Example Claims Scenario *assumes Premier PPO Wellness plan Service Amount Billed Anthem/ Provider Contracted Rate Deductible Co-pay 20% Coinsurance 80% Anthem Pays Office Visit $125.00 $100.00 $0.00 (waived for office visits) $25.00 $15.00 $60.00 Strep Test $12.00 $0.00 Blood Work $650.00 $325.00 $238.00 $17.40 $69.60 Total Patient Responsibility for this date of service: $307.50

Claims Analysis Summary: Cardiac incident (chest pains) resulting in visit to urgent care, Ambulance transport, ER admit for overnight hospital stay. TOTAL CHARGES Anthem Discounted Rate Urgent Care Office Vist and Service $225.00 $127.59 Ambulance Transport $2,344.21 $1,447.21 ER Physician Services $580.00 $396.19 Radiology Services $274.00 $254.00 ER and Inpatient Hospital Services $20,819.42   $7,940.00 TOTALS $24,242.63 $10,164.99 Premier (80/20) Standard (70/30) Consumer Choice (70/30) Uninsured Urgent Care Copayment $25.00 N/A Deductible $250.00 $1,000.00 $3,750.00 $0.00 Co-Insurance $1,978.00 $2,742.00 $2,749.50 *Total Member Out of Pocket Expense: $2,253.00 $3,767.00 $6,499.50 *Assumes Wellness Incentive Credit, Family Deductible Annual Premium (Tiered/Family) $16,476.00 $15,912.00 $14,808.00 Total Annual Expenses: $18,729.00 $19,679.00 $21,307.50

Questions? Problems? Who do you call? 1st: Anthem Customer Service: I’m not sure my claim was processed/paid correctly. Who are preferred providers in my area? Is this procedure/service covered on my plan? Have I met my deductible? 2nd: Shasta Trinity Schools Insurance Group: Claims issues that were not resolved to your satisfaction with Anthem Customer Service.

Comparing Plan Types HMO PPO High Deductible Health Plan (HDHP) PPO Referral required for specialists Yes No Non-Participating Providers Covered? Deductible Deductible applies toward Out-of-Pocket Maximum Not Applicable Copayments/Coinsurance applies toward Out-of-Pocket Maximum Copayments: No Coinsurance: Yes Prescription Drug Copayments apply toward Out-of-Pocket Maximum