Employees need to pay all the costs up to the deductible amount before the selected plan begins to pay for the covered services they use. The policy/plan document needs to be checked for when the deductible starts over. The plans & package table provide details about how much an employee needs to pay for covered services after meeting the deductible. There are no other deductibles for specific services and the employee does not need to pay for the same.
We offer flexible insurance plans to our employees, wherein they can avail the benefits through a network of participating healthcare providers including doctors, hospitals, labs & outpatient facilities. Employees can use in-network providers for cost-effectively availing benefits, while they also have the option to opt for out-network providers. If you use an in-network provider, this plan will pay some or all of the costs of covered services. However, in certain cases, the in-network provider may use an out-of-network provider for some services. See the plans and packages table for how this plan pays different kinds of providers.
There is an out-of-pocket limit on expenses. This is the maximum amount an employee could pay during a coverage period (usually one year) for his share of the cost of covered services. It helps employees to plan for health care expenses in a better way. This limit varies according to the plan. However, even though employees pay these expenses; various components such as penalties, premiums, and balance-billed charges are not included in the out-of-pocket limit.
There is no overall annual limit on what the plan pays. The plans & package table describes any limits on what the plan will pay for specific covered services, such as office visits.
According to the Affordable Care Act, it is required for most people to have health care coverage qualifying as “minimum essential coverage”. Our plans and policies follow the required ACA guidelines and ensure minimum essential coverage is provided to the employee.
The Affordable Care Act has established a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). Our plan and health coverage meet the minimum value standard for the benefits they provide.
A Copayment or copay is an amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage.
For example, you might pay $10 or $20 for a doctor's visit, lab work, or prescription. Copayments are usually between $0 and $50 depending on your insurance plan and the type of visit or service.
A Premium is the amount that must be paid for your insurance plan. It is not included in your deductible, your copayment, or your co-insurance. If you don’t pay your premium, you will lose your coverage.
Out-of-Pocket maximum is the most you pay during a policy period (usually one calendar year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit includes deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual for a qualified medical expense. This limit does not include premiums or spending for non-essential health benefits.
An EOB is a summary of healthcare charges your health plan sends after you share an inquiry with a provider or receive a service. It’s not a bill but a record of services provided, what your provider charged, and what your health plan covers. If there is a remaining amount you owe, your provider will send you a separate bill. Understanding your EOB helps you track your healthcare expenses and verify insurance payments.
All U.S.-based full-time employees working at least 30 hours per week are eligible for insurance benefits.
Yes, there is a 30-day waiting period, and insurance coverage begins on the 1st of the month following the completion of 30 days.
The insurance coverage begins on the first day of the month following the completion of the 30-day waiting period.
- Example 1: If an employee starts on January 1, 2025, their insurance coverage will begin on February 1, 2025. The last date to enroll will be January 31, 2025.
- Example 2: If an employee starts on January 4, 2025, their insurance coverage will begin on March 1, 2025. The last date to enroll will be February 28, 2025.