When it comes to benefits, we know you have questions. Our knowledgeable staff has been extensively trained to help answer all of your questions and can educate your employees on issues regarding benefits.
Have a question about Bond Financial Network or their services? Fill out the form below and you will be contacted
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Most Commonly Asked Questions
Q. Why do people waive Medicare Part A when it's free (for most individuals)?
If they are enrolled in a High Deductible Health Plan (HDHP) - and have Part A OR ANY part of Medicare they CANNOT contribute to an HSA any longer. This can be a huge disadvantage given the pretax benefits.
Q. How do I know if I am an Applicable Large Employer for PPACA?
An Applicable Large Employer has an average of 50 or more Full-Time Equivalent employees during the preceding calendar year. To determine the number of FTE’s, for each month of the year, first add the number of employees working an average of 30 or more hours per week. Then, for employees working less than 30 hours, add all of the hours worked and divide by 120. Add this to the number of employees working 30 or more hours per week and Round down to the next whole number.
Example: 40 employees working 30+ hours per week. 25 employees working a total of 500 hours per month. 500/120 = 4.16. 4.16+40=44.16. Round down to 44.
Q. I just reached over 50 employees this year. Am I required to file the 1094C/1095C?
No. Unless you were over 50 employees in the prior calendar year, you are not required to file the 1094C/1095C this year.
Q. Why was my routine physical not covered in full?
If your doctor addressed anything beyond what qualifies as “routine” during the visit, you may incur a charge for the visit. A routine visit focuses on a preventative evaluation and includes the following:
-Past medical, social and family history
-Complete physical exam and review of body systems
-Review of medications
-Counseling/anticipatory guidance/risk factor reduction interventions
-Review of age/gender appropriate screening tests
Q. I've had lifestyle changes, how does that impact my benefits?
You will want to let your HR coordinator know of any changes and complete an enrollment/change form. This way, HR can submit the enrollment/term/name change to us at Bond Financial.
Several lifestyle changes are seen as qualifying events, an occurrence that would dramatically change your health insurance needs and will allow you to change the status of your medical coverage outside of your standard open enrollment period.
Types of Qualifying Events
• Birth of a child
• Spouse's loss of employment
• Death of a dependent
Generally, you must report the qualifying event to your insurance company and make any necessary changes within 30 days of the event.
Changes in Premiums
Premium changes will typically be made retroactively. That is, to the date the event occurred. You may be responsible for any unpaid changes in premiums between the occurrence date and the date you reported the qualifying event.
Q. Which benefits plan is right for me?
Assess your needs, taking into account your current use of healthcare and your medical expenses for the near future, and decide what services are most important to you and your family. Ask about dependents' coverage. Factor in how much you can afford to spend on monthly premiums and copayments. If you're single and healthy, your health plan needs will be very different from those of a family with three young children.
Compare benefits and coverage of key items like monthly premiums, deductibles, copayments, co-insurance rates, and costs for seeing out-of-network providers, preventive care, physical exams, immunizations and the like.
Q. Why was my claim denied?
You can appeal claims denied by your medical insurance provider. It will take familiarizing yourself with the facts and staying on task.
1. Read Your Policy
This is the most important thing to do and it should be done first. Having a firm grasp on what your insurance policy says about your coverage will help you appeal a denied insurance claim.
2. Get Help
If you are having problems understanding the fine print, call the insurance company directly or talk to your benefits representative if it is a policy through your employer. Remember, you can always call Bond Financial for assistance in navigating the process.
3. Gather Information
Call and get all of the information from the insurance company regarding what you will need to appeal the claim. Make sure to document with whom you spoke, write down every step and record all pertinent information.
4. Write a Letter
With all of the information you have gathered, send a letter to the insurance company stating that you would like to appeal your denied claim. Be sure to include copies of all medical bills, documents required for the appeal and records of the steps you have taken before writing the letter.
5. Keep Track of the Appeal Process
Some larger companies can take weeks, even months, to process your appeal. Continually call and check up on the progress with the insurance company.
Q. I received a provider bill or EOB I don't understand.
1. Find the Claim Summary section on the EOB.
The subscriber is the primary person eligible for benefits. The patient (who is receiving the services), can be the subscriber or a dependent. The group name and number identify the specific plan under which the subscriber is covered.
Each service or visit has its own unique claim number to help with tracking of the individual claim. The provider is where, or from whom, the services were rendered (e.g. name of doctor, clinic or laboratory). Covered medical supplies are also included on EOB forms.
2. Find the payment summary section.
Dollar amounts are listed for charges submitted to the insurance company and for out-of-pocket costs. Examples of out-of-pocket costs include the deductible, coinsurance and copay, all of which are also known as the patient responsibility.
The deductible is the amount of money a consumer needs to spend before the insurance company starts paying benefits. (Example: The deductible for Mary's plan is $300 per year. Mary needs to spend $300 of her own money before insurance will start paying for other covered services).
The copay is a flat fee designated by the insurance company that the patient pays for certain services, such as office visits or prescriptions.
The coinsurance amount includes charges for services not covered at 100 percent. The patient responsibility (coinsurance, copays or deductible amounts) is the amount a provider may bill the patient after all payments and deductions are made on the claim. Payment would be made directly to the provider, not through the insurance company.
3. Find the Claim Details section.
Each claim has a corresponding type and place of service, as well as a specific date when the service was provided.
The amount a provider billed to the insurance company is often known as the charged amount. Each insurance company also has an allowed amount, which is the maximum they will pay for a particular service. (e.g. the clinic billed $100 for a standard office visit, but the insurance company only pays up to $75 for that type of service).
Some insurance companies also list the percentage covered for that type of service. (e.g. X-rays covered at 100 percent, and wheelchair rental at 80 percent. The insurance company pays the provider 100 percent of the x-ray charge and for most, but not all, of the wheelchair rental charge).
Tips & Warnings
- If there is anything on your EOB that you don't understand, contact your insurance company.
- If the charge is non-covered or was not paid due to a lack of documentation, you are usually not responsible for the charge.
- Save all EOBs for at least one year.
- File all EOBs with the corresponding statement you receive from your doctor.
Q. I called the insurance company and they couldn't help me.
Call Bond Financial and ask for the help of your Account Manager and Healthcare Coordinator to guide you in the right direction.