Answers to our most commonly asked questions.
What is the Affordable Care Act?
The Affordable Care Act (ACA (often called “Obamacare”)) is part of the Patient Protection and Affordable Care Act, the comprehensive health care reform law enacted in March 2010 aimed to improved access, affordability, and quality in health care.
What is Covered California?
In 2010, California was the first state in the nation to enact legislation to implement the provisions of the federal Affordable Care Act by creating a health care marketplace — Covered California.
What is a Deductible?
The amount you owe for health care services your insurance covers before your health plan begins to pay. For example, if you have a $500 deductible, your plan won’t cover any costs until you meet that $500 deductible.
What is the difference between a Co-Payment and Co-Insurance?
Both are forms of cost sharing, meaning that you pay part of the cost of your care and the health insurance company pays part of the cost of your care.
What is Co-Insurance?
Co-insurance is your share of the cost of a covered health service. You pay co-insurance plus any deductibles owed; your insurance plan pays the rest of the allowed amount.
What is a Co-Payment?
A co-payment is a fixed amount that you pay for a covered service, typically when you receive the service.
What is an Out-of-Pocket Limit?
The most you pay during your policy term before your plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care not covered by your plan. It may also not include all of your co-pays, deductibles, co-insurance payments, or out-of-network payments.
What is the Difference between Short-Term Disability and Long-Term Disability?
Short-term disability insurance pays a percentage of your salary (often between 40-60%) if you become temporarily disabled, meaning that you are not able to work for a short period of time due to illness or injury* that prevents them from performing their job duties.
Long-term disability insurance covers a portion of an employee's income (around 50-70%) when the employee has become seriously injured* or ill and will be unable to work for an extended period of time
NOTE: This excludes on-the-job injuries, which are covered by workers compensation insurance
What is the difference between HMO and PPO
An HMO is a Health Maintenance Organization. If you are enrolled in an HMO you will need to receive most or all of your health care from a network provider. HMOs require that you select a primary care physician (PCP) who is responsible for managing and coordinating all of your health care. You must choose doctors, hospitals, and other providers that are in the HMO network.
A PPO (Preferred Provider Organization), is a health plan that has contracts with a network of "preferred" providers from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network.
What is a Network?
The facilities, providers and suppliers your health insurer has contracted with to provide health care services.
What is a Preferred Provider?
A Preferred Provider is one who has contracted with your health insurance to provide services to you at a discount.
What is a Non-Preferred Provider?
A non-preferred provider is a provider who doesn’t have a contract with your health plan. You’ll pay more to see non-preferred providers.
What is a Section 125 Premium Only Plan?
The Section 125 Premium Only Plan is, also known as a POP or Cafeteria Plan, allows employees to purchase health insurance and other ancillary benefits tax-free. By using a Section 125 Plan, employees avoid paying any income tax on qualifying premiums. Instead, the premium is deducted before the taxes are calculated, making qualifying insurance premiums more affordable for employees.
What is a Flexible Spending Account?
A Flexible Spending Account (FSA) is a reimbursement plan that allows employees to set aside pre-tax dollars to pay for out-of-pocket health care expenses. The most common FSAs are those offered through a Cafeteria Plan, meaning the employee pays the entire premium for coverage through pre-tax salary reductions.
What is a Dependent Care FSA?
A plan that can be used by employees to pay for the daily care of an eligible child or adult dependent.
What are Voluntary Benefits?
Voluntary benefits are optional supplemental products—such as life, disability, critical-illness and accident insurance, as well as pet coverage, ID theft protection, legal services and financial counseling—offered through an employer but paid for partially or solely by workers through payroll deferral.
What are Executive Benefits?
This supplemental insured medical reimbursement plan enables businesses to protect top talent with enhanced coverage and access to top physicians.
What is COBRA?
COBRA is a federal law that may let you keep your employer group health plan coverage for a limited time after your employment ends or after you would otherwise lose coverage. This is called "continuation coverage." COBRA coverage is generally offered for 18 months, 36 months in some cases