SPECIAL INFORMATION FOR PARSONS
Make Your Health Benefits Work for You in PARSONS TENNESSEE
The Department of Labor´s Employee Benefits Security Administration (EBSA) administers several important health benefit laws covering employer-based health plans. They govern your basic rights to information about how your health plan works, how to qualify for benefits, and how to make claims for benefits.
In addition, there are specific laws protecting your right to health benefits when you lose coverage or change jobs. EBSA also oversees health care laws covering special medical conditions. For more information on the laws that protect your benefits, see EBSA´s Website. Or call the agency toll free at 1-866-444-3272 to reach a regional office near you. These 10 tips can help make your health benefits work better for you.
1. Explore Your Options for Health Coverage
You have options for health coverage. There are many different types of health benefit plans. Find out what your employer offers, then check out the plan (or plans). Your employer´s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. Or consider a health plan through the Health Insurance Marketplace. Visit HealthCare.gov to see the health plan options available in your area. Get information about all of your options and review it. The more information you have, the better your health care decisions will be.
2. Review the Benefits Available
Do the plans offered cover the benefits that are important to you, such as mental health services, well-baby care, vision or dental care? Are there deductibles? What are the out-of-pocket expenses you may face? Determine your needs and priorities. Compare all of your options before you decide which coverage to elect. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
3. Read Your Plan´s Summary Plan Description (SPD) for the Wealth of Information It Provides
Your health plan administrator should provide a copy. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the Federal law that protects your health benefits. It also should contain information about the coverage of dependents, what services will require a co-payment or coinsurance, and the circumstances under which your employer can change or terminate a health benefits plan. You also can find many of the answers to your questions in the Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and what it costs. You should receive a copy with your enrollment materials. Save the SPD, the SBC, and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits.
4. Use Your Health Coverage
Once your health coverage has started, use it to help cover medical costs for services like going to the doctor, filling prescriptions or getting emergency care. Using your benefits will help you and your family stay healthy and reduce your health care costs. The Patient Protection and Affordable Care Act (ACA) provides many valuable protections for people enrolled in employment-based health plans including prohibiting preexisting condition exclusions and annual and lifetime limits on essential health benefits. What’s more, many plans cover certain preventive services for free, including routine vaccinations, regular well-baby and well-child visits, blood pressure, diabetes and cholesterol tests, and many cancer screenings. You also can keep your children on your health plan until age 26. Take advantage of your benefits, especially free preventive care if your plan covers it. If you were required to pay cost-sharing for a preventive service, check your Explanation of Benefits and ensure that the provider billed the service properly.
5. Understand Your Plan’s Mental Health and Substance Use Coverage
Many health plans provide coverage for mental health and substance use disorder benefits. If a plan does offer these benefits, the financial requirements (such as co-payments and deductibles) and the quantitative treatment limits (such as visit limits) for the mental health and substance use disorder benefits cannot be more restrictive than the financial requirements or treatment limits applied to medical/surgical benefits. Plans also cannot impose lifetime and annual limits on the dollar amount of mental health and substance use disorder services, including behavioral health treatment. Some plans cover preventive services like screenings for depression and child behavioral assessments for free. Check your SPD and SBC to find out what your plan covers.
6. Look For Wellness Programs
More employers are establishing wellness programs that encourage employees to work out, stop smoking, and generally adopt healthier lifestyles. The Health Insurance Portability and Accountability Act (HIPAA) and the ACA encourage group health plans to adopt wellness programs but also includes protections for employees and dependents from impermissible discrimination based on a health factor. These programs often provide rewards such as cost savings as well as promoting good health. Check your SPD and SBC to see whether your plan offers a wellness program(s). If your plan does, find out what reward is offered and what you need to do to receive it.
7. Know How to File an Appeal if Your Health Benefits Claim is Denied
Understand your plan’s procedures for filing a claim for benefits and where to make appeals of the plan´s decisions. Pay attention to time limits – make sure you timely file claims and appeals and that the plan makes decisions on time. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact EBSA for assistance if you are unable to obtain a response to your complaint.
8. Assess Your Benefits Coverage as Your Family Status Changes
Marriage, Porce, childbirth or adoption, the death of a spouse, and aging out of a parent’s health plan are life events that may signal a need to change your health benefits. You, your spouse, and your dependent children may be eligible for special enrollment into other employer health coverage or through the Health Insurance Marketplace. Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans. If you’re considering special enrollment, act quickly. You have 30 days after the life event to request special enrollment in other employer coverage or 60 days to select a plan in the Marketplace.
9. Be Aware that Changing Jobs and Other Work Events Can Affect Your Health Benefits
If you change employers or lose your job, you may need to find other health coverage. If you have a new job, consider enrolling in your new employer’s plan. Whether starting or losing a job, you may be eligible to special enroll in a spouse’s employer-sponsored plan or through the Health Insurance Marketplace. Under the Consolidated Omnibus Budget Reconciliation Act – better known as COBRA – you, your covered spouse, and your dependent children may be eligible to continue coverage under your former employer-sponsored plan. This coverage is temporary (generally 18 to 36 months) and you may have to pay the entire premium plus a 2 percent administrative charge. Get information on your coverage options and compare. Be aware of the deadlines for deciding on coverage and find out when your new coverage will be effective.
10. Plan For Retirement
Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer´s human resources office, your union, or the plan administrator. Check your SPD and other plan documents. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. If you want to retire before you are eligible for Medicare and your employer does not provide health benefits in retirement, consider what you will do for health coverage. Your options may include enrolling in a spouse’s employer plan or in a Marketplace plan or temporarily continuing your employer coverage by electing COBRA. Planning for retirement includes planning for your health coverage in retirement. To find out more, read Taking the Mystery Out of Retirement Planning.
These Laws Can Help
- The Employee Retirement Income Security Act – Offers protection for inPiduals enrolled in retirement, health, and other benefit plans sponsored by private-sector employers, and provides rights to information and a claims and appeals process for participants to get benefits from their plans.
- The Patient Protection and Affordable Care Act – Creates the Health Insurance Marketplace and provides protections for employment-based health coverage, including extending dependent coverage of children to age 26; prohibiting preexisting condition exclusions and prohibiting lifetime and annual limits on essential health benefits.
- The Consolidated Omnibus Budget Reconciliation Act – Contains provisions giving certain former employees, retirees, spouses, and dependent children the right to purchase temporary continuation of group health plan coverage at group rates in specific instances.
- The Health Insurance Portability and Accountability Act – Allows employees, their spouses and their dependents to enroll in employer-provided health coverage regardless of open enrollment periods if they lose coverage or in the event of marriage, birth, adoption or placement for adoption. Also prohibits discrimination in health care coverage.
- The Women´s Health and Cancer Rights Act – Offers protections for breast cancer patients who elect breast reconstruction in connection with a mastectomy.
- The Newborns´ and Mothers´ Health Protection Act – Provides rules on minimum coverage for hospital lengths of stay following childbirth.
- The Genetic Information Nondiscrimination Act – Prohibits discrimination in group health plan premiums based on genetic information. Also, generally prohibits group health plans from requesting genetic information or requiring genetic tests.
- The Mental Health Parity and Addiction Equity Act and the Mental Health Parity Act – Requires parity in financial requirements and treatment limitations for mental health and substance use benefits with those for medical and surgical benefits.
- The Children´s Health Insurance Program Reauthorization Act – Allows special enrollment in a group health plan if an employee or dependents lose coverage under CHIP or Medicaid or are eligible for premium assistance under those programs.
For More Information
Visit the Employee Benefits Security Administration’s Website to view the following publications. To order copies or to request assistance from a benefits advisor, contact EBSA electronically or call toll free 1-866-444-3272.
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The situation of health coverage in in PARSONS TENNESSEE
1. After five years of the Affordable Care Act, more than 16 million people have health coverage.
That's more people than the populations of New York City, Los Angeles, and Chicago combined. This number includes parents who can finally afford to take their kids to the doctor, families who no longer risk losing their homes or savings because someone becomes ill, and young people who are now free to pursue their dreams without worrying about losing access to health care.
2. Medicaid is helping millions.
The Affordable Care Act allows states to expand eligibility for Medicaid, and 28 states and the District of Columbia have done so. Across all 50 states, there are 11.2 million additional Americans enrolled in Medicaid compared to a baseline period in the fall of 2013.
While not every state expanded Medicaid, those that did are seeing especially strong coverage gains. In Medicaid expansion states, the uninsured rate among families with incomes below 138 percent of the federal poverty line declined by 13 percentage points, nearly double the decline in non-expansion states.
3. Those with pre-existing conditions can no longer be denied health insurance.
Prior to the Affordable Care Act, health insurance companies could deny you coverage or charge you more because of a health problem that you had prior to applying for insurance. Thanks to the Affordable Care Act, health insurance companies can’t refuse to cover you just because you have a pre-existing condition and they can’t close you out of coverage by charging you more than someone who doesn’t have a pre-existing condition.
This key provision means that up to 129 million Americans with pre-existing conditions are no longer at risk of being denied coverage. This includes the parents of over 17.6 million children with pre-existing conditions who no longer have to live with that worry.
4. The uninsured rate for young Americans is at its lowest point since at least 1997.
Thanks to the Affordable Care Act, the uninsured rate for young Americans has declined by more than 40 percent over the past five years. Since 2010, more than 5 million young adults have gained coverage. This includes 2.3 million young adults who have gained coverage by being able to stay on their parent's health plan. Under the Affordable Care Act, young adults can stay on their parent’s coverage until age 26. With all that can happens in a young person's life, this provision helps ensure that those who are just starting out in college and work careers can plan with the assurance that they have access to quality and affordable coverage.
5. Americans no longer have lifetime and annual limits on their coverage.
The Affordable Care Act has lifted the lifetime health benefit caps for 105 million Americans. Previously, many plans set a lifetime limit on how much they would spend for your covered benefits during the entire time you were enrolled in their plan. If you went over, you’d be paying out of pocket. Annual limits also constrained families and inpiduals by restricting how much they could receive per year. That's not how it should be. That’s why the Affordable Care Act prohibits health plans from putting annual or lifetime dollar limits on most benefits.
These are just five of the core ways in which the Affordable Care Act has helped Americans get quality, affordable health care. See for yourself: Click here to meet inpiduals who have benefited from health care, read their stories, and then pass them on so others can see what getting covered -- and staying covered -- means.
Health Insurance Market in PARSONS TENNESSEE
From January 2014 is effective Health Insurance Market , which is designed to help you find the insurance that best suits your budget and needs of health coverage suits. Each health plan included in the new market will provide comprehensive coverage: doctor visits, medicines, hospital services, preventive services and more. It will also be possible to compare all the health insurance options based on price, benefits and other features that may be important to you.
Who is eligible to use the Health Insurance Market?
Anyone can use the Health Insurance Market to explore their options for health coverage, even if you have insurance.
The following are the only requirements to obtain insurance through this new market:
Live in America
-become naturalized US citizen or native, or lawful permanent resident
-not be in jail
Learn more about who may register in the Health Insurance Market.
Each state will have its own insurance market. Some states already provide information on the Health Insurance Market. See if it is the case in your state .
Learn about the 10 essential health benefits plans offered all Market.
Registration Process in Medical Insurance Market
From October 2013 you can get information about all the plans available in your area. You can also register directly online or by phone toll-free hotline to be appointed for this service.
If you have difficulty finding a plan that fits your needs and budget, there will be people available to help you explore your options for coverage. The help you receive from these people is completely unbiased. These wizards are not related to any particular plan or receive any commission (compensation) in relation to health plans available.
Learn more about how to prepare for the registration process .
Free or low-cost care
If you do not have or can not afford health insurance, there are options for you to receive free or low-cost care. Learn about the resources available to meet the health care options you need.
Options private health insurance with low premiums
Medicaid and Medicare
Community Health Centers
Know where to receive care if you have no health insurance
Free health insurance or affordable for children
The Health Insurance Program for children provides low-cost health coverage for children of families who earn too much to qualify for Medicaid coverage and who can not afford health insurance revenue Private. The CHIP program is a state and federal partnership that works in conjunction with Medicaid.
Each state operates a CHIP, but most states have unique names for their programs as Child Health Plus (New York), Healthy Families (California) and Hoosier Healthwise (Indiana). In several states, the CHIP and Medicaid are combined into one program.
What you need to know about CHIP:
Basic requirements for eligibility for CHIP : children up to age 19 in families with incomes up to $ 44.100 per year (for a family of four) are likely to receive coverage. In many states children from families with higher incomes may also be eligible.
Eligibility and Pregnancy : Pregnant women may be eligible for CHIP. Coverage for Moms generally includes laboratory tests and costs of labor and at least 60 days post-partum care.
States citizenship and immigration : the CHIP covers US citizens and certain legal immigrants. States have the option to cover children and pregnant women residing legally in EE. UU. The undocumented immigrants are not eligible for CHIP.
For information about health coverage programs Medicaid and CHIP in your state, visit the programs in your state , or call 1-877-543-7669.
It charges: health coverage option if you lost your job
If you do not already have medical coverage that gave your employer may have the option of keeping it through the program "continuation coverage", better known as COBRA.
This program allows you and your family to maintain health insurance he received while employed for a limited time after it stopped working time. When your employer stops paying COBRA is likely that you need to pay the full cost of the monthly premium.
What you need to know about COBRA coverage:
-Overall COBRA requirements apply only to employers with 20 or more employees. Many states have laws similar to COBRA that apply to employers with fewer than 20 employees. Contact the Department of Insurance in your state (in English) to find out if the "continuation coverage by the state" applies to your case.
-If your family was under the employer coverage, this coverage may also be eligible for COBRA.
-In most cases you should receive a notice of benefits administrator or health plan from your employer stating that your coverage is ending and offering the right to COBRA.
-In most cases you have 60 days after your last day of coverage to enroll in COBRA.
-Generally the program lasts 18 months but could last up to 36 months.
For more information about call COBRA benefits administrator of your employer and learn about their specific through this program options.
-If the coverage of your health plan was through a private employer (not a government employer), you can visit the website of the Department of Labor or call 1-866-444-3272.
-If the coverage of your health plan was through an employer state or local government, you can call 1-877-267-2323, extension 61565.
-If the coverage of your health plan had as an employee of the federal government, you can visit the website of the Office of Personnel Management (in English).