Benefits 360
Understand your benefits from every angle. Learn how to save money, make money and save time by using the tips provided here.
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Health, Dental & Vision
Your health benefits are in place to keep you and your loved ones happy and healthy. Learn more about the different types of health, dental and vision plans.
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Health Insurance
In today's world of employee benefits, health care is changing rapidly. Twenty-five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital or other provider (which would bill for each service given), and the insurance company and the patient would each pay part of the bill. You may have heard this kind of health insurance referred to as comprehensive or major medical policies, refering to the broad protection they offer.
A variety of health insurance plans exist today, from traditional "fee-for-service" plans to managed care options. 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 offer some coverage for prescription drugs, and some include coverage for dentists and other providers. The following sections are designed to acquaint you with the basics of both types of plans.
Types of Health Insurance
Your employer may offer one or more of these types of health insurance plans.
Managed Care Options
Managed care options generally provide comprehensive health services to their members, and offer financial incentives for patients to use medical providers who belong to the plan. In managed care plans, instead of paying separately for each service that insureds receive, their coverage is paid in advance. This is called prepaid care.
The health care industry's solution to the high costs of providing quality coverage has been managed care. This system of health delivery and financing has experienced phenomenal growth.
There are several managed care options:
- Health maintenance organizations (HMOs).
- Preferred provider organizations (PPOs).
- Point-of-service (POS) plans.
- Exclusive provider organizations (EPOs).
HMOs
HMOs are the oldest form of managed care plan. They offer members a range of health benefits, including preventive care, for a set monthly fee.
HMOs have contracts with doctors, hospitals and other providers. They have negotiated certain fees with these providers—and, as long as insureds receive care from these providers, they should not be asked to make additional payments. With some HMOs, insureds pay nothing when they visit doctors. With others, there may be a copayment, like $10 or $20 per visit or for various services.
During an enrollment in an HMO plan, insureds receive a list of doctors from which to choose a primary care physician. Primary care physicians may be family practice doctors, internists, pediatricians or other types of doctors. The primary care physician is responsible for referring them to specialists when needed. Most of these specialists will be “participating providers” in the HMO.
PPOs and POS Plan
With a PPO or a POS plan, unlike most HMOs, insureds will get some reimbursement if they receive a covered service from a provider who is not in the plan. Of course, choosing a provider outside the plan's network will cost them more than choosing a provider in the network. These plans charge higher coinsurance when they go outside the network.
What is the difference between a PPO and a POS plan? A POS plan has primary care physicians who coordinate patient care. In most cases, PPO plans do not.
EPOs
In an exclusive provider organization (EPO), participants receive care from a network of providers that have agreed to provide services on a discounted basis. They typically do not need to receive referrals to obtain care within the network, but if they see a provider outside of the network, they will not be reimbursed for the cost.
Fee-for-Service Plans
This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient. With fee-for-service insurance, insureds go to the doctor of their choice and then either they or the doctor/hospital submits a claim to the insurance company for reimbursement. Insureds only receive reimbursement for “covered” medical expenses listed in their benefits summary.
When a service is covered under their policy, insureds can expect to be reimbursed for some, but generally not all, of the cost. How much they will receive depends on the provisions of the policy on coinsurance and deductibles.
Dental
Dental Insurance
Dental insurance provides coverage for routine dental work/treatments and for preventive and corrective dental procedures. Most dental plan benefits are divided into the following categories. The benefit amounts payable under each category vary by company and plan.
- Preventive care: Cleanings, x-rays, fluoride treatments, and sealants for children.
- Basic restorative services: Fillings, root canals, periodontics, repair of dentures and bridges, and oral surgery.
- Major restorative services: Crowns, dentures, and bridges.
- Orthodontia: Braces to straighten teeth.
In addition, the majority of dental policies have deductibles, coinsurance provisions, and overall benefit maximums. Providers of such policies include insurance companies (state dental service plans or Blue Cross/Blue Shield) and some HMOs and PPOs.
Vision
Vision Insurance
Eye care provider networks contract with vision insurance organizations to provide eye care services at discounted rates for participants in a vision insurance or benefits plan. This arrangement can take several forms:
- If vision insurance is linked to an HMO (health maintenance organization), participants usually are required to obtain services only from network providers.
- If vision insurance is joined to a PPO (preferred provider organization), participants usually are allowed to access out-of-network providers - but at a greater cost.
- If vision insurance is added on to an indemnity insurance plan, participants can use any provider they wish.
- If the vision plan is purchased directly from a vision insurance company, it likely will function like a PPO plan.
Source: http://www.allaboutvision.com
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Financial Protection
Financial protection benefits provide protection for you and those who matter most. Learn more about how these types of benefits can help should you ever become injured or ill.
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Financial protection for your income is important. The money you earn now helps fund your lifestyle and enables you to prepare for the future. Disability insurance helps protect your income should you have an illness or injury and can't work.
Like to do risky things? Financial Protection is an inexpensive way to help pay for any costs that may arise from an accident. Like that time you decided to climb that five-foot rock.
Family history is important. If you know your family health issues, you can prepare yourself for the future. Look for critical illness insurance.
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Retirement
Retirement will arrive sooner than you think. Make sure you're making the most of your money by using these tips.
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Be aware of your company match policy and learn how to maximize your 401(k). The money you set aside grows tax-free!
If college is in the future for the kids, look into 529 plans as soon as possible. In some states, the money you place into an account will grow tax-free and can be withdrawn tax-free when used for tuition.
Ask an expert. If your company offers a 401(k) option, then it most likely offers access to financial counselors. These people can help you make better financial decisions with your goals in sight.
Diversify your investments depending on your life stage. Take risks only when appropriate for your financial picture. If you don't know how much you should invest, ask an expert.