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Health Insurance
Health insurance covers medical expenses for illnesses, injuries and conditions. But, unlike a plan through an employer, individual health insurance is something you select and pay for on your own. So, what’s health insurance for and why do you need it?
– Because accidents or health problems can happen at any time, Medical expenses can be high — they’re the number one cause of bankruptcy.
– To gain access to a network of doctors and hospitals that have negotiated lower rates with insurance companies.
– To pay and keep track of medical payments quickly and easily.
– To safeguard your way of life and your family’s physical and financial well being.
Health Insurance Types
There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.
Medical Insurance
Plan Options
Copay and high-deductible plan options are available for our Health Maintenance (HMO) products. We also offer a Young Adult Essential plan using our HMO network.
Copay Plans
If you want fixed costs for things like office visits, prescription drugs and more, a copay plan may be right for you. We offer gold, silver and bronze copay options. Please note: our gold plan is only available on the Health Insurance Marketplace at Healthcare.gov.
High-deductible Plans
High-deductible plans have lower monthly premiums and higher deductibles compared to Copay plans. Most of our high-deductible plans can be paired with a Health Savings Account (HSA), which gives you tax benefits and more control over your healthcare expenses. Medical Mutual offers silver and bronze high-deductible health plan options.
Vision Insurance
Regularly scheduled vision exams are important to you and your family’s health. Eye exams can help prevent or detect cataracts, diabetes, glaucoma and macular degeneration.1 Medical Mutual offers an affordable vision plan with a large network of quality eye care providers.
Medical Mutual Vision Plan
– Save with the EyeMed® Vision Care Network
– EyeMed’s vast network of optometrists and opticians can provide you with quality vision care and prescription eyewear. – Your annual benefits include a routine vision exam and a pair of eyeglasses or contact lenses.
Additional advantages include:
– No claim forms to file
– No waiting for reimbursement
– Unlimited pairs of glasses and contact lenses at special discount prices after your benefits are exhausted
Dental Insurance
Your dental health has a big impact on your overall health. Taking good care of your mouth can help prevent a variety of diseases and conditions. That’s why it’s important to brush and floss regularly and to see a dentist twice a year.
Medical Mutual Dental Plans
Medical Mutual offers a variety of quality dental insurance options to help meet your dental health needs. With more than 2,300 dentists in the Super Dental network, you’ll get the care you deserve with a dentist you trust.
– No need to select a primary dentist
– You and your family members can select different dentists
– No need for referrals for specialty care
Short-Terms Insurance
A short-term health insurance plan, also known as temporary health insurance, is a medical plan with a limited duration. They are designed to bridge gaps in your health care coverage during a period of transition, like graduating from college, or starting a new job where you may have to wait for new coverage to begin.
Medical Mutual’s short-term plans offer the security of comprehensive coverage and provide protection from catastrophic and unexpected healthcare emergencies for 364 days. They also cover well child services (to age 9), well child care exams, immunizations, labs, routine mammograms and routine pap tests.
Important Things to Keep in Mind
Short-term plans are not compliant with The Affordable Care Act (ACA) and do not have coverage requirements. Pre-existing conditions are not covered and applicants are subject to answering medical questions and receiving Underwriting approval.
Short-term plans may work for you if you are:
– Between jobs
– Waiting for an employer’s group coverage to begin
– A temporary or seasonal employee
– A recent graduate
– Waiting for the next open enrollment period
Critical illness insurance
Critical illness insurance is a type of insurance product that helps you pay for expensive illnesses that impact you and your ability to earn money for multiple years. For example, Alzheimer’s disease, cancer, and stroke are three diseases that a critical illness insurance policy may cover. Each critical illness policy has its own list of illnesses that it will cover.
If you are diagnosed one of these illnesses while you’re a policyholder, your insurer will typically pay you a lump sum cash payment. If you own a term life insurance policy, you can also get a critical illness rider attached to your life insurance policy for less money than a separate critical illness plan.
The 10 essential benefits every health insurance plan must provide
The Affordable Care Act, also known as Obamacare, made covering certain health care services a requirement for all health insurance plans available to consumers. These required services are known as the 10 health essential benefits. These 10 categories of services are:
- Ambulatory patient services (outpatient care that you can receive without being admitted to a hospital)
- Emergency services
- Hospitalization for surgery, overnight stays, and other conditions
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services, as well as chronic disease management
- Pediatric services, including dental and vision coverage for children
Frequently Asked Questions
What is the difference between a deductible and a co-pay?
A deductible is a dollar amount that the covered member must pay out before the health insurance will begin benefits for services subject to the deductible. The provider submits the claims to the insurance carrier and the insurance carrier discounts are applied. The member only pays the contracted rates and will receive an invoice for the patient responsibility from the provider as well as an explanation of benefits from the health insurance carrier. A co-pay is a fixed dollar amount a member is expected to pay at the time of service.
What is the difference between a calendar year deductible and a plan year deductible?
A calendar year is when the deductible and/or other benefits accumulate on a calendar year basis which is January 1 – December 31 of each year. An employer’s renewal date may not coincide with a calendar year deductible; it may differ. A plan year is when the deductible and/or other benefits accumulate on the employer’s renewal date, for example, May 1 – April 30.
What is an ‘explanation of benefits’ from the insurance carrier?
An explanation of benefits (EOB) is a written explanation from the health insurance carriers of how your benefits will be paid for a specific date of service. This applies to deductible expenses only. The EOB will indicate the patient responsibility for that specific claim; it is not a bill. The invoice for the patient responsibility will come from the provider. The amount due on the invoice and the patient responsibility amount on the EOB should match. If it does not; contact your provider.
How does a Flexible Spending Account (FSA) work?
This program is offered through the employer. A FSA is a pre-tax savings vehicle where employees set aside monies through payroll deduction on a pre-tax basis for IRS eligible medical, dental and vision expenses. Effective January 1, 2011, over-the-counter medications are not covered unless prescribed by a physician.
What is ‘step-therapy’ when referred to for a medication?
Step-therapy is a cost effective measure an insurance company may take to keep costs down. If a drug is considered ‘high-end,’ and less expensive alternative drugs are available, you may be required to try those drugs first. In the event those medications do not treat the condition or have side effects, your physician can submit a form to your insurance carrier to request the ‘high-end’ drug allowed to be dispensed for medical purposes. They must indicate that alternative medications have been tried.
Are all the providers at a network facility always network providers?
Not all healthcare professionals offering services at a network facility are network providers. For example, an anesthesiologist, pathologist, radiologist or an emergency room doctor working at a network hospital might be a non-network provider. If you see a non-network provider—even if you have no choice in the matter—the non-network provider’s services will be paid at the non-network benefit level.
