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Copyright 2009,  prescription drug insurance coverage

prescription drug insurance coverage Glossary & Terms

 

Question: What is open enrollment and why is it crucial?

Answer: Typically, employers set aside an open enrollment window for employees to review, compare and choose from the health policies offered by the company. In most cases, open enrollment comes once a year, so it's important to take advantage of this time period to comparison-shop and ask your benefits administrator about specific questions you may have about coverage. Separately, life-changing events – like the birth of a child or loss of a loved one – may qualify you to make changes outside of the open enrollment window. Learn more about changing your health insurance programs.

Question: Will I have to select a new doctor during open enrollment? And what if my employer has switched insurance carriers?

A: During open enrollment, you can compare health programs and make changes to your coverage. If you stay with your current health insurance carrier, it's not likely that you'll be required to select new physicians – unless your provider is dropped from the plans network, retires, etc. Should you elect a new medical insurance carrier – or your employer discontinues its previous plan – you may have to do some research. In any case, you'll want to double-check whether your physician falls in the policies provider network. Follow these pointers in choosing a doctor.

Q: What should I look for in a plan?

A: Good question. A insurance plan generally offers coverage for a mix of health care services ranging from traditional medical (e.g., office visits and hospital/emergency room treatment) and preventive care to rehabilitation and alternative or complementary medicine. The key is knowing the total amount you can expect to spend for care. A medical insurance broker may be able to offer money-saving tips.

Q: How do I evaluate prescription drug coverage? How do I find out if a particular prescription is covered?

Answer: It's important to understand your insurer's prescription drug benefits before you purchase your medication. You may pay by using in-network pharmacies, asking for generic drugs or using mail-order services that deliver to your door. Keep these prescription drug facts in mind.

Q: Are dental benefits included in my coverage?

Answer: Don't assume that your medical insurance includes dental, vision, mental health or other services at the same level – or at all – until you review the fine print in your health services. If your coverage does not look adequate for your family's needs, you may need to consider supplemental insurance. A supplemental health plan may offer you some limited benefits to complement your primary policies.

Q: What are deductibles and co-pays? How do they work?

A: insurance deductibles and co-pays are out-of-pocket expenses for which you're generally responsible. For a listing of common expenses, review our health expense chart. You can, however, take steps to limit your costs with a tax-free account for future expenses.

Q: I have a pre-existing condition. Can I get insurance coverage? How will my pre-existing conditions impact my programs and rates?

Answer: As you apply for health insurance – even an employer's group services – keep in mind that pre-existing conditions may lead to higher premiums and, in some states, denial of coverage. Here's what you need to know about pre-existing conditions and insurance premiums.

Question: Will my doctor accept this plan? How do I make sure my doctor is in a specific insurance policies network? What does it mean to be in-network or out-of-network?

A: An out-of-network provider is not in your insurance company's preferred network. You may be required to pay your physician at the time of service and file a claim with your insurance company separately for reimbursement. In the end, consumers typically pay more for out-of-network services. Consult with your benefits administrator, review your services provider network booklet or website, or double-check with your provider for network status. If your plan has changed and you're shopping for a provider, search by specialty, condition, treatment or procedure.

Question: How do I know if a particular service or procedure is covered by my insurance?

A: Your benefits administrator or insurance carrier should be able to give you a complete breakdown of coverage for office visits, diagnostics and testing, emergency care and a host of other services. Not satisfied with your plan? Get a health insurance quote from another carrier or consult with a medical insurance broker to find the best health insurance plan for your needs.

Question: What is COBRA?

Answer:COBRA is a law that may offer you some protections – and extend your health care coverage – if you lose your job or a spouse's medical insurance benefits. Find out about COBRA qualifications and costs.

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Trainee Publication Highlights Success Of USA-China Agricultural Injury Research Training Project

07/29/10 6:14 pm

As a collaboration of the Colorado Injury Control Research Center, the Center for Injury Research and Policy at Nationwide Children’s Hospital and the School of Public Heath, Tongji Medical College at Huazhong University of Science and Technology, the USA-China Agricultural Injury Research Training Project was created in 2004…prescription insurance

Child Abuse Education, Elderly Care, Nursing Students To Benefit From Grants

07/29/10 6:14 pm

Texas-based Scott & White Healthcare has received three grants that provide education support to working nursing students, set up a senior health research center, and establish systems for treating child abuse and educating those who treat it. The three grants, totaling nearly $2 million, include: Nursing education…prescription insurance comparison

Abbott Fund-Sponsored Laboratory Training Initiative Helps Stem Critical Shortage Of Medical Professionals In California

07/29/10 6:14 pm

Imagine needing a critical test at your local hospital, but having to wait days to be tested because there was no laboratory professional available to run the tests…Rome wasnt built in a day!

GCU Forms Partnership With India To Enhance Life Sciences

07/29/10 6:14 pm

Glasgow Caledonian University and Fergusson College in Pune, India, have signed a Letter of Intent that will see them collaborate on key academic partnerships in the field of Life Sciences…this is bogus, who would think

OIG Site Recognizes MFCU’s

07/29/10 6:14 pm

Many Medicare Fraud cases are jointly worked by the feds and the states, as often the cases  are national in scope and involve Medicaid utilization as well as Medicare. To display  the often important role played by State Medicaid Fraud Control Units (MFCUs), the OIG has developed a new section on its website specifically concerning [...]

Hospitals in Seven States to Pay more than $9.4 Million for Unnecessary Inpatient Kyphoplasties

07/29/10 6:14 pm

Nine hospitals in seven states will pay the U.S. more than $9.4 Million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced May 17, 2010. The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat [...]

GAO Identifies Five Strategies to Fight Medicare Fraud, Waste, Abuse

07/29/10 6:14 pm

On June 15, 2010, the U.S. Government Accountability Office (GAO) released a report identifying five important areas for preventing Medicare fraud, waste and abuse. The strategies in this new report, “Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments,” are: (1) Strengthening the provider enrollment process and standards; (2) Improving the pre-payment [...]

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