Archive for the ‘Health Insurance Definitions’ Category

Reducing Employee Medical Cost with Telemedicine

Monday, March 25th, 2013

Telemedicine is receiving a great amount of attention as an effective means to lower employee health care costs, both from having to take time off work and for office visit bills.   Employers who are looking for ways to help employees save time and money on health care would do well to look into telemedicine as a valuable employee benefit.  At the same time, these employers have an opportunity to lower their own business costs for employee absences and medical costs paid by the employer.

What is Telemedicine?

Telemedicine, according to the American Telemedicine Association, is the use of telecommunications technology for medical, diagnostic, monitoring and therapeutic purposes when distance separates the users. Telemedicine makes use of computer and communications technology to capture and transmit text, audio and video information as a substitute for face-to-face contact between patient and doctor.

Telemedicine Options

Telemedicine options can vary from simply using a validated 24/7 telephone service to get a medical doctor’s advice on things like sore throats or influenza or non-narcotic prescriptions, to a real-time mode, where live video  and audio allows the physician, patient, and specialist to communicate interactively.   A third option, called the store-and-forward mode, is used when parties are not available at the same time, enabling medical information, including video, to be emailed or placed on a server for the specialist to view.

With real-time consultation, the physician can do an examination with the use of ENT medical peripherals,[1] so that one’s condition can be viewed by both the physician and the specialist.  This enables the specialist to diagnose and recommend the proper treatment immediately.  This method also provides training for the provider in providing diagnostic, treatment, and follow-up care.

What this does is enable a person to consult a specialist anywhere in the world and not have to travel to the specialist’s office.   This type of medicine can offer huge savings to both employer and employee. Reduction of travel time and the stress of battling one’s way through organizational paperwork and red tape are added benefits that cannot be overlooked.

Americans also like to get medical information online, and many medical providers provide access to helpful medical information that people can research online.   Patients can often get advice from their own physicians through these portals.  Information on specific symptoms may motivate one to obtain treatment sooner.

Successful Monitoring

Telemedicine has been shown to reduce not only the cost of health care, but to provide better care of chronic conditions and fewer or shorter hospital stays.   Self-monitoring/testing devices allow physicians to monitor or test patients at their homes or other places.   Pro-active self monitoring devices for chronic conditions may achieve better disease management success and allow physicians to detect any developing problems.

In Summary

Telemedicine provides a cost effective means to give medical care and access to doctors and specialists that can save both the employer and the employee valuable time and money.

[1] http://www.telemedicine.com/whatis.html Retrieved March 17, 2013

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The Importance of Voluntary Benefits

Monday, March 18th, 2013

Employers who understand voluntary benefits realize these are more than a sprinkling of niceties in the benefit package. Employees are concerned about these benefits and may often choose to work for the employer who offers more. Thus, small businesses can use voluntary benefits as an inducement to draw talent as well as avoid losing talent to competitors who offer a stronger portfolio of benefits.

In these difficult economic times, many employers view these ancillary benefits as things to cut first to stem a diminishing cash flow. However, smart employers are using voluntary benefits to enhance their benefit package while keeping the costs of employee benefits stable.

Employers are doing this in several ways.

  1. Adding voluntary benefits to complement existing employer-paid benefits. For example, an employer can add on voluntary benefits to things like life-insurance and long-or-short term disability benefits. This takes the burden of paying for the benefit off the employer’s shoulders and allows employees the opportunity to buy coverage for themselves and their dependents, suited to the employee’s own needs.
  2. Restructuring an employer-paid benefit to include an employee buy option. An employer may pay for the base-level benefit and the employee could have the option to upgrade to a richer benefit and pay the difference.
  3. Replacing an employer-paid benefit with a voluntary one. Instead of the employer paying for the benefit, such as disability, life, or dental insurance, the employee bears the cost.
  4. Offering discount cards through affinity partnerships allow employees to enjoy discounts on things like auto or home insurance at no direct cost to the employer.

The most frequent types of offerings in the voluntary insurance market are short-term and long-term disability, supplemental life, critical illness insurance such as cancer or heart policies, accident, and hospital indemnity policies. Other types of voluntary benefits might include things like a prescription drug card, pre-paid legal, dental, or discount offerings from various kinds from many companies.

Several advantages for both employer and employee are derived from the use of voluntary benefits.

“Not only does offering voluntary benefits cost small employers virtually nothing and help level the benefits playing field with larger companies, it also affords employees access to various type of insurance coverage, typically with looser underwriting requirements and at group rates that are ‘lower than if they went out and got coverage on their own,’” says Bernard DiFiore, President of BenefitMall, a Texas-based benefits wholesaler.

One key to helping employees make the adjustment from paid to voluntary benefits is to find a vendor that can ensure that products are competitive priced, administratively simple, and easily explained to employees. Another key is flexibility. The “one size fits all” package doesn’t work anymore. The needs of a 25-year old single individual are not the same as a 40-year-old married person. Voluntary benefits allow each to decide what is best and affordable for them.

Voluntary benefits will undoubtedly play a crucial role in the workplace of the future, where employees will be able to choose from an extended list of benefits for which they will pay for wholly or in part.

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15 Keywords To Understand Your Health Insurance – Part 2

Thursday, January 20th, 2011

Here you can find 15 more keywords that will help you when you are speaking with your benefits consultant.

To finish off the alphabet.

1. Medicare: This is a federally-sponsored healthcare program that offers coverage for medical and hospital care primarily to those over the age of 65.

2. Network: This refers to the groups of doctors, hospitals and other medical professionals who have been contracted to provide discounted healthcare services to your insurance carrier’s customers.

3. Out-of-Network: This term typically refers to any doctors, hospitals or other healthcare providers considered to be non-participants by your insurance plan (HMO, POS, or PPO). Depending on your plan’s guidelines, services provided by out-of-plan providers may not be covered, or only covered in part.

4. POS: Point-of-Service Plan. A POS is a managed healthcare plan that combines the features of a Health Maintenance Organization and a Preferred Provider Organization. These plans allow you to decide whether or not you’ll use an in-network provider or an out-of-network provider.

5. Pre-existing Conditions: This refers to any healthcare issues you had prior to your insurance plan’s effective date. Many policies will refuse to cover pre-existing conditions, while others do so only for a short time.

6. PPO: Preferred Provider Organization. PPOs are networks of healthcare providers who have negotiated discount contracts with health insurance carriers. Your healthcare provider decisions will be up to you, but there are generally financial incentives for you to select providers within your PPO network.

7. Preventative Care: Health services that focus solely on preventative care measures such as physical exams, immunizations, diagnostic tests and mammograms.

8. Premium: The dollar amount you’ll pay on a monthly basis in exchange for your insurance coverage.

9. Primary Care Physician: Most HMOs and POS plans will require you to select one family physician, pediatrician or internist to monitor your health, treat most of your health problems, and refer you to specialists when necessary.

10. Provider: This term refers to any individual (nurse, physician, or specialist) or institution (clinic, hospital, or laboratory) that provides you with care.

11. Rider: This refers to any policy attachment that makes additions or changes to your original insurance plan.

12. Short Term Health Insurance: This type of healthcare plan is purchased to provide you with benefits during coverage gaps between jobs, after a move, or while you’re traveling overseas.

13. Small Business Health Insurance: This is a type of healthcare coverage that is available to businesses employing between two and fifty employees. It offers discounted premiums to employees and tax advantages to small business owners; also in most cases, the coverage cannot be denied.

14. Travel Health Insurance: This insurance is purchased to provide you with coverage when you’re traveling abroad.

15. Waiting Period: This refers to a pre-specified time period during which you will not be covered by your insurance (for a particular healthcare issue).

Reference: www.ctindividualhealth.com/glossary.html

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20 Keywords To Understand Your Health Insurance – Part 1

Tuesday, January 18th, 2011

When your benefits consultant talks about your health insurance are you confused because of the terms they use? If so, this blog post will help you make sure that when they use an acronym you know what it means. As an employer or an employee it’s important to understand the terms in order to make the right decisions and be knowledgeable about your health insurance.

Here is a glossary to help you when you speak with your benefits consultant.

1. Additional Insured: Anyone covered under your health plan that is not named as “insured” in your documentation from the insurance company.

2. Benefit: The dollar amount your insurance carrier will pay when you file a claim for a covered loss.

3. Benefit Period: This is the interval during which you will be eligible for benefits. Generally, your benefit period will begin with the first medical service you received for a specific illness and end after you have not been treated for that condition for 60 days.

4. Carrier: The insurance company you receive your health plan from.

5. Certificate of Insurance: This is the printed description of your benefits and coverage limits that forms a contract between you and your carrier. It spells out precisely what will be covered, what won’t, and the dollar maximums.

6. Claim: This refers to any request to your insurance company for benefits.

7. COBRA: This acronym refers to the Consolidated Omnibus Budget Reconciliation Act of 1985. The law requires group medical plans covering twenty employees or more to offer participants the option to receive continued healthcare benefits for up to eighteen months after the cancellation of their group plan.

8. Co-payment: This is a cost-sharing arrangement in which you will be responsible for a specific charge for a specific medical service ($20.00 per office visit, or $10.00 per generic prescription).

9. Covered Expenses: The various medical procedures that your insurer has agreed to provide you coverage for.

10. Deductible: The amount you’ll be required to pay for healthcare expenses before your insurance plan will begin to reimburse you.

11. Exclusion: A specific circumstance or condition that is not covered by your policy.

12. Effective Date: This refers to the date on which your insurance coverage will actually begin to cover you.

13. Fee-for-Service: This is a payment system for healthcare where your provider is paid for each service after it is performed. You receive reimbursement after you file a claim.

14. HMO: Health Maintenance Organization. HMO’s are popular health benefit programs in which you’ll pay monthly premiums in return for managed coverage for your checkups, hospital stays, doctors’ visits, surgery, emergency care, preventive care, lab tests, and X-rays. If you join an HMO, you will have to select what’s called a “Primary Care Physician” who will be responsible for coordinating your healthcare and making any referrals to specialists that you require. You’ll also have to use doctors, hospitals and clinics who are members of your HMO plan’s network.

15. In-network: Healthcare facilities or providers who are members of your health plan.

16. Lifetime Limit: This refers to the cap (or maximum level) on benefits available through a policy.

17. LOS: This is an acronym for the term “length of stay”. It’s used by insurance carriers, case managers, and other healthcare professionals to describe the length of time any individual spends in a hospital or an in-patient care facility.

18. Maximum Out-of-Pocket Expenses: The most you will have to pay during one year — in the form of deductibles and coinsurance fees.

19. Managed Care: This term refers to an increasingly broad assortment of health plans that manage healthcare costs and usage. There are three major types of managed health plans: HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations) and POS (Point-Of-Service plans).

20. Medicaid: This is a joint state/federal health insurance program that is administered by the state. It provides health coverage for low-income individuals, especially pregnant women, children and the disabled.

Stay tuned for part 2 with more terms.

Reference: www.ctindividualhealth.com/glossary.html

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