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PDF Editor FAQ

What is the difference between travel insurance and a full global health plan like Cigna International?

The short answer: One, Travel Medical Cover, is primarily for illness and emergencies only and the other, Global Medical Insurance Plans, will cover that and much more, include inpatient, outpatient, health and wellness, vision and dental, and more.Travel medical plans also include some travel insurance components like trip interruption and coverage for lost luggage that global medical plans do not.Both provide options for you to be able to go to the doctor and have the insurance company pay the bill directly. Otherwise, with both, depending on the doctor you go to, you may have to pay yourself and file a claim to be reimbursed.Travel medical plans are typically for a year or less. Global Medical Plans are annually renewable plans for longer term coverage.Read more at: Choosing and Buying International Insurance Plans

I work at a small financial firm (<40 people). What is the best way our firm can find high quality / affordable health and dental insurance?

I don't know what state you are in so it's tough to say. I would start with whatever state association that represents your business line. They likely have companies that they work with and recommend to their members. Likely you will get a discounted rate. If you don't like what they have to offer or you aren't a member, then you should probably reach out to one of the Blues, United Health Care, Cigna and Kaiser. In California, Delta Dental is your best option. For Dental insurance you need to get a PPO and not a HMO plan. People are usually tied to their dentists for a long time and are pretty fussy about the person that digs around in their mouths. Go figure! Before you start contacting health insurance companies, you need to make a list of the types of benefits that you would like to provide. You also need to do a little research on what benefits are mandated by the affordable care act and your state. For example, unless you are religious organization, you pretty much have to be willing to cover birth control and even abortions depending on the state. The other thing to consider is whether you want a preferred provider organization plan (PPO) or if you want a HMO or even both. Kaiser is an excellent HMO and isn't quite so pricey. PPO's tend to be fairly expensive. The other issue is to get some idea of how your company plans to pay for it. Do you want to pay the entire cost? If not, how much will the employee pay? Some of it or all of it? Another consideration is whether or not you will allow spouses and children to be on the plan. Will you pay some of the costs for those individuals or will the employee have to pay all the costs for family members? Dental Insurance is pretty reasonable but health insurance not so much. You should also think about whether you will offer these benefits on the first of the month following the first day of employment or do you want to wait until the employee passes probation which is typically 3 months. Health insurance plans can be very tricky. Insurance companies will try to sell you lower cost plans with high deductibles. They like these plans because it discourages people from seeking care and running up big bills. I would stay away from these if you can afford to. The other alternative is to reimburse the employee for all or part of the cost for whatever they can get under the affordable care act. I would insist that they get either the silver or gold plans. The bronze plan is worthless. They could submit an expense report along with a canceled check. That will guarantee that they spent it on health insurance. There are all sorts of tax implications on what you decide to do so check in with your tax accountant. Also, remember that once you start providing benefits that this becomes part of the financial package that you are offering to your employees. So take that into consideration when determining your salary package. This has gone on way longer than I anticipated. I hope I didn't bore you. Good luck!

What is the best option for a young person to get dental care? I’ve got insurance, but don’t know how to really use it and I need a lot of work done.

Penny has given some good advice. Let me just add to what she has said.BACKGROUNDIn the US, dental services are delivered outside of the medical care system; dentists are trained and licensed separately from medical doctors. Some, understandibly, find this, as well as the US dental insurance system, difficult to navigate. Keep in mind, however, that, as confusing as our system might be, dental delivery and financing systems and markets are highly developed in the US, with specially trained and licensed dentists—this began in 1840, when the first dental school opened in Baltimore. About 20 years later, the American Dental Association was created.SELECTING YOUR DENTAL INSURANCE PLAN (“plan” for short)There are basically 3 possibilities for most types of dental insurance. (You may or may not be given a choice; large employers usually offer more than one choice):Least expensive: Dental HMO, or DHMO, refers to a closed “panel” network-based Plan; dentists are contracted with the insurance company; you must select, or be assigned to, a dentist office; you can see any Network dentist you wish, but you MUST go in-network—there are no out of network benefits. There’s also no deductibles, and no annual maximums. These features can save you money, but the trade off might be longer appointment wait times, and a potential for dentists to under-treat. (They get paid a fixed monthly capitation fee per patient per month, whether or not patients have treatment.) Many common services, such as exams, x-rays, cleanings and some fillings and extractions, have Zero Copays, meaning no out of pocket cost to you. If your insurance booklet lists virtually every dental procedure and code, with corresponding dollar amounts, you’re likely in a DHMO. If there’s an issue with your care, the insurance company may be able to help.Mid-range price: Dental PPO (PPO=preferred provider): there’s a network of contracted dentists in place, but you have the choice to see a network dentist (referred to as “in network”), or to go out of network. Visiting a network dentist could save you money. I tend to favor this option, as it provides the best of both worlds: cost savings, while maximizing choice. Also, for #1 and #2, dentists are contracted with the Insurance Company. The existence of a contract between insurer and dentist, provides Common US dental insurance companies include Delta Dental, United Concordia, MetLife, Aetna, Cigna, to name a few. If your insurance booklet talks about how you may save money by seeing a network dentist, you’ve probably got a PPO. Again, the insurance company may be able to help if a dispute arises. One big benefit of using a contracted dentist, is a process called “predetermination”, whereby you can find out, before you have the work done, exactly what your total out-of-pocket cost share will be. I highly recommend this—-especially if you need a lot of work done.Most expensive: a traditional, old-fashioned, dental insurance plan with no network. No contracted dentists. See any dentist you wish, pay them, then submit an insurance claim form (the office will complete this for you), submit it to the insurance company, and receive reimbursement for a portion of the cost. The insurance company has little to no leverage, when it comes to resolving disputes.USING YOUR INSURANCEThink of an insurance policy like a savings account, only instead of dollars, you’ve got dental procedures expressed in dollars. Your insurance “bank” renews every year. There’s also an incredible amount of terminology to understand, so let me explain the basics:Annual maxim: the dollar amount of dental care the Plan will cover (pay) in any given year. Typically ranges from $1,000 - $2,000. If you need a lot of work, you can maximize the benefits to you by spreading your work out over more than a single year. Example/Pro Tip: Say, you needed $3,000 work of work done, and let’s further assume your annual maximum is $1,000 and, for simplicity, that there are no deductibles or copayments. If you:-have all the work done in year 1, you get $1,000 paid by insurance, and you pay the other $2,000.*-have the work spread out over three years, you get $3,000 paid by insurance, and you don’t owe anything *Clearly, it’s well worthwhile to understand your dental insurance plan and how to use it in the most cost-effective way for you.Deductible: the amount you must pay out-of-pocket in any given year, before the Plan will begin paying.Allowed charge: that procedure-specific dollar amount allowed by the Plan. All deductibles and cooays occur in this context. You could receive an additional bill, called a Balance Bill, for any amounts in excess of allowed charges. (I know, it’s confusing, but stick with me…)Coinsurance/copayment: the share of the cost the Plan pays for a given procedure; procedures are grouped into categories. Preventive/diagnostic services usually have zero copayment, with copayments increasing as a percentage of cost, as the cost and complexity of the procedure increases. Example: your booklet may say something like: “the Plan pays 100% of allowed charges for preventive/diagnostic care, 80% for basic restorative (fillings, extractions, possibly some periodontics and endodontics), and 50% for major services.”Lifetime maximum: If orthodontics are covered, there’s a dollar limit per person per lifetime, usually between $1,000 and $2,000. This means that once insurance payout reaches this amount, you’re responsible for the rest.*For simplicity, this example assumes there are no deductibles or copaymentsNow, armed with this information, and what Penny has explained about how to interact with dental offices, you’re ready to visit the dentist!Cathye L Smithwick, RDH, MAAuthor: Dental Benefits, A Guide To Managed Plans, 3rd Ed

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