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If they are enrolled in a High Deductible Health Plan (HDHP) and have ANY part of Medicare, or are collecting social security benefits, they CANNOT contribute to an HSA any longer. This can be a huge disadvantage given the pretax benefits.

The ACA looks back at your size in the previous year, so generally not. However, keep in mind issues like counting part-time employees toward full-time equivalent employees, and common ownership concerns. If you’re not sure, call Bond and we can help.

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
• Immunizations
• Counseling/anticipatory guidance/risk factor reduction interventions
• Review of age/gender appropriate screening tests

If your physical focused exclusively on this type of service and you think you were billed in error, call Bond and we can help.

You will want to let your HR department know of any changes and complete an enrollment/change form. This way, HR can submit the enrollment/term/name change to us at Bond. 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

• Marriage
• Divorce
• Birth of a child
• Spouse’s loss of employment
• Death of a dependent
• Adoption

Time Limit

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.

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. If you need any assistance choosing the right benefits plan, call your team at Bond.

If you need any assistance choosing the right benefits plan, call your team at Bond.

You can appeal claims denied by your medical insurance provider, and Bond can help! In order to get started, you’ll want to gather the following information.

1. Your Explanation of Benefits (EOB)
2. Your receipt from the provider
3. Your insurance card
4. Any other information regarding the service provided

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. For example, the provider billed $100 for a standard office visit, but the insurance company only pays up to $75 for that type of service. The difference is often written off due to their contract with the insurance company.

   Some insurance companies also list the percentage covered (coinsurance) 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

Call Bond Benefits Consulting and ask for the help of your Account Manager and Healthcare Coordinator to guide you in the right direction.