Frequently Asked Questions
- What about confidentiality?
- What are the ways I can obtain health insurance protection?
- Do health insurance plans cover dental care?
- How is vision care covered?
- Are prescription drugs covered under health care plans?
- Are there different types of drug plans?
- What are the advantages of group insurance over individual insurance?
- Who is an eligible employee?
- What is a base plus plan?
- What is a comprehensive plan?
- What is co-insurance?
- What is a covered expense? Are there limits?
If you have a question not answered in our list of FAQs, please use the “Instant Answer” form to e-mail your question to us or simply call us at (888) 897-1001 and one of our customer service representatives will answer your question over the phone.
Q: What about confidentiality? A: The Ashley Group maintains your documented personal health information, whether obtained orally or in writing, in the strictest confidence. Every Ashley Group employee is required to adhere to its confidentiality policy as a condition of employment. Except when required by law, The Ashley Group will not release any identifiable personal health information to a third party (including your employer) without first giving you the opportunity to approve or deny the request through written authorization. Regulatory agencies and any organization performing quality reviews for accreditation purposes are also required to maintain confidentiality.
Q: What are the ways I can obtain health insurance protection?A: Besides participating in employer sponsored group insurance plans, individuals may also be covered under federal and state government-sponsored programs such as Medicare and Medicaid, service-type plans such as Blue Cross/Blue Shield or so-called alternative health care systems such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Insurance may also be purchased privately on an individual basis, or through mass purchasing groups such as credit unions and professional or trade associations.
Q: Do health insurance plans cover dental care? A: Dental care is not automatically included in health insurance plans. Some plans include dental coverage as part of the medical plan; others include dental coverage as a separate plan. Many health insurance plans provide coverage for non-cosmetic dental work necessary as the result of an accident. Other plans include limited coverage for hospital room and board expenses related to dental procedures, such as removal of impacted wisdom teeth, performed in a hospital.
Q: How is vision care covered? A: Most health insurance plans provide coverage for medical care related to eye injury or disease, but do not cover the costs of periodic eye examinations or corrective lenses. Like dental care, vision care (examinations, lenses and frames) is not automatically included in health insurance plans. Some plans include vision care coverage as part of the medical plan; others include vision care as a separate plan. Vision care is most often covered on a scheduled basis that pays a fixed dollar amount for examinations, lenses and frames.
Q: Are prescription drugs covered under health care plans? A: Generally, only prescription drugs that are for treatment of an illness or injury are covered, subject to applicable deductibles and coinsurance. Many plans do not cover contraceptive prescription drugs, for example, or nicotine chewing gum prescribed for smokers who are trying to quit.
Q: Are there different types of drug plans? A: Typically prescription medication plans fall into two categories: Open Networks, and Closed Networks. Open networks allow you to choose where you want to have your prescriptions filled (as long as the pharmacy will honor the plan you have). Closed networks have a list of pharmacies that you must use. Most closed network plans do not allow you to use out-of-network pharmacies to fill your prescriptions.
Q: What are the advantages of group insurance over individual insurance?A: For an employer that intends to provide insurance protection to its employees, the group approach ensures that all employees, regardless of health, can be covered. Those with known health problems, who might otherwise be unable to obtain individual insurance, can be covered automatically upon “full-time” employment without evidence of insurability. Group insurance offers a lower cost per unit of protection than individual health insurance, because the economies of scale resulting from servicing one plan covering many individuals.
Q: Who is an eligible employee? A: An eligible employee is any employee who meets the definition in the plan for participation. Definition of an eligible employee can vary widely from employer to employer, though they may be influenced by legal considerations and company structure. Check your employee manual for details.
Q: What is a base plus plan? A: A base plus plan is a two-part health insurance plan. Basic medical coverage — for such expenses as hospitalization, surgery, physician’s visits, diagnostic laboratory tests and x-rays — is provided under the first part. There may be limits on these expenses, such as a limited number of hospital days and a surgical schedule, but no deductible or coinsurance applies to the covered expenses. The employee is reimbursed starting with the first dollar of expenses. The second part is known as “major medical,” which covers other health expenses. The coverage is broad, with fewer limits; however, a deductible is required before the employee is reimbursed for expenses.
Q: What is a comprehensive plan? A: A comprehensive plan provides coverage for most medical services using one reimbursement formula. In a pure comprehensive plan, a deductible must be met before reimbursement for any covered expenses begins, and coinsurance applies to all covered expenses until the maximum employee out-of-pocket expense limit is reached. Additional covered expenses are paid in full. Because employees share from the beginning in the cost of their medical expenses when they are incurred, a comprehensive plan encourages them to use more cost-effective health care. The patient is more likely to be cost-conscious and to seek out more cost-effective health care services and providers.
Q: What is co-insurance? A: Co-insurance is a feature found in most group health insurance plans. It sets forth the percentage of covered expenses that the employees and the health insurance plan will pay. The most common coinsurance level is one in which the employee pays 20 percent of the expenses and the insurer pays 80 percent.
Q: What is a covered expense? Are there limits? A: A covered expense is an expense incurred by a covered individual that will be reimbursed in whole or in part under a health insurance plan. For example, under most health insurance plans, doctors’ visits are a covered expense. That is, a doctor’s fee up to the amount provided by the plan will be reimbursed by the insurer. Just because an expense is covered does not mean that the coverage is unlimited. Both base plus and comprehensive plans have limits on the expenses for which they will reimburse. In addition, some form of deductible and coinsurance is often applicable. Insurers limit covered expenses in a variety of ways. One way is to cap allowable payments for a certain procedure or service. Insurers also restrict covered expenses by limiting the number of visits or days for home health care or skilled nursing care.
If you have a question not answered in our list of FAQs, please use the “Instant Answer” form to e-mail your question to us or simply call us at (888) 897-1001 and one of our customer service representatives will answer your question over the phone.?