Answers To The 7 Most Frequently Asked Benefit Questions

Date: August 24, 2022 Author: Rinehart Insurance

When it comes to benefits, such a health insurance, many can agree that it is confusing. Unless you are involved in health insurance or Human Resources it can be hard to make sense of everything. We have compiled a list of some of the 7 most frequently asked benefit questions and their answers. We hope this makes things a little easier to understand.

What is a Deductible?

A deductible is the amount of money you or your dependents must pay toward a health claim before your organization’s health plan makes any payments for health care services rendered. For example, lets say you have a $1,000 deductible. You would be required to pay the first $1,000, in total, of any claims during a plan year.

What is Coinsurance?

On top of your deductible, coinsurance is a provision in your health plan that shows what percentage of a medical bill you pay and the percentage a health plan pays. This usually starts after your deductible has been satisfied.

What is an Out-of-pocket Maximum (OOPM)?

An OOPM is the maximum amount (deductible and coinsurance) that you will have to pay for covered expenses under a plan. Once the OOPM is reached the plan will cover eligible expenses at 100 percent.

What is an Explanation of Benefits (EOB)?

An EOB is a description your insurance carrier sends to you. It explains the health care benefits that you received and the services for which your health care provider has requested payment. It will explain what your insurance carrier will pay and an cost your will be responsible for. This would include Deductible, Coinsurance, Copays, etc.

What is a Preferred Provider Organization (PPO)?

A PPO is a group of hospitals and physicians that contract on a fee-for-service basis with insurance companies to provide comprehensive medical service. If you have a PPO, your out-of-pocket costs may be lower than in a non-PPO plan.

What is Utilization Management (UM)?

Utilization Management is the process of reviewing the appropriateness and the quality of care provided to patients. UM may occur before (pre-certification), during (concurrent) or after (retrospective) medical services are rendered.

For example, your health plan may require you to seek prior authorization from your UM company before admitting you to a hospital for nonemergency care. This would be an example of pre-certification. Your medical care provider and a medical professional at the UM company will discuss what is the best course of treatment for you before care is delivered. UM can reduce unnecessary hospitalizations, treatment and costs.

What is a High Deductible Health Plan (HDHP)?

An HDHP is a type of insurance plan that offers a low premium offset by a high deductible. Because of the low cost of the plan, the insurer will not cover most medical expenses until the deductible is met. As an exception, preventive care services are typically covered before the deductible is met. HDHPs are often designed to be compatible with heath savings accounts (HSAs). HSAs are tax-advantaged accounts that can be used to pay for qualified out-of-pocket medical expenses before the HDHP’s deductible is met.

We hope you found this list of 7 most frequently asked benefit questions and their answers helpful. If you did, please take a moment to share this post.

Would you like to know more about health insurance? Click here for Individual or Click here for Employee Benefits.

7 Mental Health Benefits of Exercise

Date: August 5, 2022 Author: Rinehart Insurance

While physical exercise is known to be good for your body, it also can help your mind. Research continues to validate that exercise can improve mental health by reducing anxiety, depression and a negative mood. When you include exercise as part of your everyday routine, you’ll be reaping both physical and mental well-being benefits.

This article explores the connection between your body and mind and the mental health benefits of physical activity.

The Connection Between Body and Mind

People who exercise regularly often report having better mental and emotional well-being. Consider the following mental health benefits of exercise:

Mood boost—Exercise triggers the production of endorphins, serotonin, dopamine and oxytocin, mood-boosting chemicals in the brain. Those four chemicals are responsible for feelings of happiness.
More energy—Increasing your heart rate and boosting oxygen circulation in your body can make you feel more energized. It may seem counterintuitive, but expending energy can actually provide a spark of vitality you may need to get through the day.
Better sleep—Exercise can help regulate your sleep patterns and reduce the time it takes to fall asleep. The more active you are, the more your body pushes you to sleep and reset at night. Try to exercise for at least one to two hours before bed so your brain has enough time to wind down.
Reduced stress—Physical activity reduces the levels of your body’s stress hormones (e.g., adrenaline and cortisol). It’s also linked to lower physiological reactivity toward stress, so exercise can also be a coping strategy for stress.
Improved memory—Endorphins can help you concentrate and feel mentally sharp for work or other tasks.
Higher self-esteem—When exercise becomes a habit, you may feel more powerful or confident. You may also feel accomplished when you meet your fitness goals.
Stronger resilience—Exercise is a healthy way to build resilience and cope with mental or emotional challenges instead of turning to negative behaviors, alcohol or other substances.

Any movement helps since physical activity is what can be beneficial to mental well-being. Exercise can take your mind off problems or negative thoughts by redirecting them to the activity at hand.

Getting Started

The U.S. Department of Health and Human Services recommends that adults get moderate-intensity aerobic activity for at least 150 minutes each week and muscle-strengthening activities two times per week. It may seem like a lot at first, but if you break it down, that’s 30 minutes of moderate exercise five times a week.

Even if you don’t have time for 30 minutes to exercise, find something that works for you. Any physical activity is better than none. Understandably, motivating yourself for a workout can seem more challenging if you’re battling depression, anxiety or other mental health issues. Consider these tips for incorporating exercise into your routine:

Start with short exercise sessions and slowly increase your time. The goal is to commit to moderate physical activity and build it into your daily routine.
Find an activity you enjoy and incorporate it into your routine for a body and mind boost.
Schedule workouts when your energy is the highest.
Exercise with a friend. Companionship can make it more fun, so work out with a friend or loved one to make it more enjoyable or help you stick to the routine.

It comes down to making exercise a fun part of your everyday life so you can gain both physical and mental health benefits. Talk to your doctor if you have any questions or concerns about incorporating exercise into your day.

Disability Insurance; What You Need To Know

Date: August 4, 2021 Author: Rinehart Insurance

For most adults having a job and making a paycheck is crucial to make sure you have a roof over your head and food on the table. Unless you are a lottery winner or have a large savings, you most valuable asset is your ability to earn an income. But what happens when you are unable to work? That’s where disability insurance comes in.

Disability insurance is coverage that provides you with income protection, should you lose time on the job due to an injury or illness.

Is there different types of disability insurance?

Yes, the 2 most common are Short Term Disability (STD) and Long Term Disability (LTD) Insurance.

Short Term Disability (STD) Insurance coverage is designed to cover you for a short period of time. Coverage usually starts within 1 to 15 days of the injury or sickness and typically lasts for about 10 to 26 weeks. STD coverage allows you to receive a fixed weekly amount or a set percentage of your income.
Long Term Disability (LTD) Insurance coverage is designed to cover you for a longer period of time. Coverage usually starts 3 to 6 months after the injury or sickness begins. The length of coverage varies, but can range from 2 to 10 years or until you reach age 65. LTD insurance pays a set percentage of your regular income after a specific waiting period. Most LTD plans are designed to start after the STD plan has been exhausted.

You can purchase one or both to fit your specific needs.

Why is it important?

The risk of disability is greater than most employees realize. When you become disabled and loose time at work, your source of income is lost. Nearly 1/3 of employees will miss more than one month of pay due to injury or illness. In addition to lost income, you are likely to experience an increase in medical expenses due to your injury or illness.

Disability insurance can be purchased on your own or sometimes through your employer. If you and your family count on your income to pay bills disability insurance is something you should consider. Let the professionals at Rinehart Insurance help you select a plan that best fits your needs.

Click Here to contact your agent today.

The Difference Between An Emergency Room And Urgent Care

Date: May 19, 2021 Author: Rinehart Insurance

In the case of a sudden emergency, obtaining quick medical attention is crucial. Choosing the appropriate place of care ensures prompt medical attention and lower costs. Making the wrong choice can result in delayed medical attention, and may cost hundreds, if not thousands of dollars. If you or someone you know suddenly falls ill or becomes injured, how can you determine which facility is most appropriate? Do you know the difference between an emergency room and urgent care? What services does each facility provide? If you don’t know the answers, don’t worry, we can help explain the difference.

Emergency Room

The emergency room is equipped to handle life-threatening injuries and illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately. Patients are seen according to the seriousness of their conditions in relation to the other patients. Go directly to the nearest emergency room if you experience any of the following:

Chest pain
Shortness of breath
Severe abdominal pain following an injury
Uncontrollable bleeding
Confusion or loss of consciousness, especially after a head injury
Poising or suspected poisoning
Serious burns, cuts or infections
Inability to swallow
Seizures
Paralysis
Broken Bones

Urgent Care

Urgent care facilities are not equipped to handle life-threatening injuries, illnesses or medical conditions. These centers are designed to address conditions where delayed treatment could cause serious problems or discomfort. Some examples of conditions that require urgent care are these:

Ear infections
Sprains or strains
Urinary tract infections
Vomiting, diarrhea or dehydration
High fever or the flu
Controlled bleeding or cuts that require stitches
Diagnostic services (X-ray, lab tests

Choosing the wrong facility

If you go to the Emergency Room with a relatively minor injury or illness, you will most likely have to wait to be seen. Depending on the severity of the other patients’ conditions, you may have to wait more than an hour to be seen. Most often you could have been seen more quickly at an urgent care facility. And, you will also end up with a higher bill by visiting an Emergency Room. Most insurance plans offer a discounted co-pay if you go to an urgent care vs going to the emergency room. For example a plan may have a $250 Emergency Room co-pay vs a $75 Urgent Care co-pay. If your plan does not have a co-pay and your visit is subject to your deductible and co-insurance you will still most likely have a lower charge from an Urgent Care facility vs an Emergency Room.

Know the difference between an Emergency Room and Urgent Care

Knowing the difference between an Emergency Room and Urgent Care will help you determine the best facility for you or a loved ones medical emergency, as well as saving you time and money if it is determined that care can be received at an Urgent Care. Understanding your health insurance plan is also important. Co-pays, deductibles and coinsurance are all very important parts of your plan.

Click here to learn more about health insurance benefits.

Please share if you found this information helpful.

Important Information About Your Health Plan and COVID-19 Vaccine

Date: December 23, 2020 Author: Rinehart Insurance

On Dec. 12, 2020, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended use of Pfizer Inc.’s COVID-19 vaccine for individuals 16 years of age and older. The Food and Drug Administration (FDA) approved the vaccine one day earlier.

The ACIP recommendation triggers the requirement for non-grandfathered group health plans and health insurance issuers to cover the vaccine without cost sharing. Grandfathered plans may choose to cover the vaccine, and could be required to do so under state law or applicable insurance policies.

Coverage of COVID-19 Preventive Care Services

Non-grandfathered group health plans, and health insurance issuers offering group or individual health insurance coverage, must cover coronavirus preventive services, including recommended COVID–19 immunizations, without cost sharing. During the COVID-19 public health emergency, covered services may be provided by in-network or out-of-network providers.

Coverage of these immunizations must be provided, even if not listed for routine use on the CDC’s Immunization Schedules. Plans and issuers subject to Section 2713 of the Public Health Service Act must also cover, without cost sharing, items and services that are integral to the furnishing of recommended preventive services, including immunization administration.

Coverage Effective Date

Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), plans and issuers must cover the vaccine within 15 business days. It is widely understood that coverage of the COVID-19 vaccine must begin no later than Jan. 1, 2021. Plans and carriers may choose to cover the vaccine before this date. As additional forms of the vaccine are approved by the FDA and recommended by ACIP, they will be required to be covered as well.

Highlights:

Non-grandfathered group health plans and insurance issuers must cover coronavirus preventive services without cost sharing.
Preventive care services include recommended immunizations.
During the COVID-19 public health emergency, this coverage must be provided for both in-network and out-of-network providers.

5 Strategies You Need To Know To Reduce Benefits Costs In 2021

Date: September 2, 2020 Author: Rinehart Insurance

Health benefits costs are almost certainly going to rise in 2021. They’ve been trending upward for years—over 50% in the last decade, according to the Kaiser Family Foundation—and the current state of economic uncertainty over COVID-19 won’t slow things down. Realistically, after enduring months of business closures and managing exhausted workforces, many employers will be lucky to maintain uninterrupted operations.

That’s why it’s critical for employers to think about reducing health costs right now—figure out cost-effective benefits first so money can be shuffled as needed later. Having a solid plan going into 2021 will better position organizations facing limited budgets.
Here are five strategies employers should explore when looking to reduce benefits costs:

1. Dig Into Health Costs

Employers don’t let themselves overpay for the materials they use during production, so why is health care any different? Employers should look into every health care figure they can, from overall premium costs to individual employee expenditures. Understanding where money goes can help focus cost-cutting efforts.
For instance, if employees are going to the emergency room for every health visit, employers know they must promote more health literacy among their workforce.
Speak with Rinehart, Walters & Danner for details about digging into your health plan cost data.

2. Embrace Technology

The health care landscape of today is starkly different than the one of even a few years ago. Now, the name of the game is virtual health care or “telemedicine.” There are numerous ways for individuals to take charge of their health care without the hassle—and added cost—of in-person consultations.
For example, there is tech that can monitor glucose levels to help diabetic employees without test strips; there are virtual visits available for doctors, psychiatrists and other health professionals; and there are countless wellness apps that can help individuals make proactive health choices.

3. Consider Alternative Plan Options

Not every plan option will work for every organization. For years, PPOs were the standard, but now high deductible health plans with savings options are having their moment. These plans enable greater heath consumerism and put the decision-making power into employees’ hands. Employers should consider offering mechanisms like HSAs, FSAs and HRAs to help shift costs without compromising health care quality.

4. Require Active Enrollment

Some organizations allow employees to passively enroll in their health benefits. This may seem like a nice timesaver, but it can actually hinder employee health literacy. Instead, employers should require active enrollment among employees. This approach would force employees to review all their benefits options each year before making selections. Not only does this make employees consider important life events, it also affords them an opportunity to reevaluate the benefits they’re paying for and potentially not using. Ultimately, active enrollment can make employees wiser health care consumers, improve proactive health care and lower overall health expenditures.

5. Change the Funding Structure

Another, more drastic, cost-cutting strategy is changing how health plans are funded. Most organizations use a fully insured model, where employers pay a set premium to an insurance provider, but that’s not the only option. For some employers, self-funding, level-funding or reference-based pricing models may be more attractive solutions.

Let us help you review your options to reduce benefits costs

Suffice it to say, there are a variety of ways that employers can structure their health plans—even if that means requiring employees to seek insurance in the individual health market.

Whatever your needs, know that Rinehart, Walters & Danner is here to help. Contact us today to discuss your 2021 benefits and ways to reduce benefits costs.

What All Newlyweds Need To Know About Insurance

Date: January 29, 2020 Author: Rinehart Insurance

Choosing insurance may not be as romantic as deciding where to go on your honeymoon, but it is one of the most important things you can do as newlyweds. Although most couples are aware of the need to readdress their insurance needs when they get married, there is a disconnect between that awareness and whether they take action.

Use the considerations in this article as a way to start a discussion about your insurance needs. Rinehart, Walters & Danner can then help you narrow down your options.

Auto Insurance

If you and your spouse have separate auto insurance policies, it may be wise to combine them. Get quotes from each of your carriers, and shop around to see if any others offer multivehicle discounts.

Life Insurance

Newlyweds who both have jobs and are not yet dependent on their spouse’s income may not see the need for life insurance. However, as they build their lives together, that dependency grows. If you’re young and healthy, you can benefit from getting life insurance early in your marriage. Typically, you can lock in better rates than if you were older. Remember that the older you get, the higher the rates, so don’t put it off for too long.

While life insurance is less urgent for young couples who are both working and don’t have children, it is important for newlyweds with only one working spouse or those who have children from a previous marriage to purchase life insurance early in their marriage.

If you already had life insurance prior to tying the knot, don’t forget to add your new spouse as a beneficiary.

Disability Insurance

Young people are more likely to become disabled than die prematurely. In fact, more than half of Americans identified as disabled are in their working years—between ages 18 and 64— according to the Council for Disability Awareness.

Disability insurance is historically inexpensive, and can pay you between 50%-70% of your regular monthly income if an accident, illness or injury prevents you from being able to work. If your employer doesn’t offer disability insurance, you can purchase it on your own. This coverage can be critical for you and your loved ones.

Health Insurance

Don’t make the mistake of declining health insurance, even if you and your spouse are healthy. An illness or emergency can cause newlyweds financial hardship that could have been prevented with health insurance. If you and your spouse both have health insurance through your employers, you can maintain separate plans, but it may be cheaper to be on the same plan. Doing so can help you reach your annual deductible more quickly.

Certain life events, such as marriage, allow you to join your spouse’s plan as long as it is within the required time frame. If you decide to share a plan, compare both employers’ coverage and costs to determine which plan best fits your health needs and finances. Be sure to consider each plan’s deductibles, coinsurance, copayments, coverage limits, prescription coverage and choice of health care providers. Remember that if you have a preferred doctor, you’ll want to make sure he or she is in your network.

Don’t panic if employer-sponsored health insurance is not an option for you. Coverage is available to everyone through the Affordable Care Act. You can visit https://www.HealthCare.gov to review and select a plan through the health insurance marketplace, either during open enrollment or within 60 days of getting married. Or, you can contact one of our health insurance specialist and they can assist you with this process. Timing is restrictive so it is important you check into this promptly.

Renters Insurance

If you rent your living space, you should consider renters insurance to cover the value of your possessions. If you already have renters insurance, don’t forget that you have more to lose now that you have combined belongings, such as furniture, electronics and jewelry. Consider increasing your limits on personal property coverage, which pays to replace or repair items that are stolen or damaged.

Homeowners Insurance

Homeowners insurance is similar to renters insurance, but it covers more than just your possessions. It also covers your home in case of fire, theft or other perils. Both renters insurance and homeowners insurance also provide liability coverage.

Shop Around for Coverage

Addressing your insurance needs early provides a solid foundation for your marriage. Review your financial situation and objectives with your spouse. Then contact Rinehart, Walters & Danner to help you find sufficient coverage within your budget.