The Patient Protection and Affordable Care Act (PPACA) dictates that preventive care be covered at 100 percent. This is a great start to motivating Americans to get the regular check-ups they need; however, much confusion lies around what is covered and what is not. There is a fine line between what physicians code as “preventive” and what they code as “diagnostic”. It is helpful to know the difference between the two, so you can better plan for, or prevent, surprising and unexpected charges.
Preventive care is defined as routine check-ups undertaken without any indication you are sick. For example, if you are scheduled for your annual physical, and you indicate to the doctor you’ve been experiencing an ear ache, that check-up would turn into a diagnostic appointment. What that means for you is the appointment is no longer covered at 100 percent and may be subject to a deductible or copayment. To be sure an appointment is preventive, you would need to come to the doctor’s office not experiencing any symptoms and no reason to think you were unhealthy.
Diagnostic care is defined as someone exhibiting symptoms that point to a health problem. Examples include a persistent cough, pain or trouble breathing. It is important to keep the line of communication open between you and your doctor. Asking questions such as, “will this be covered as preventive care?” may be uncomfortable at first, but it can save you a lot of expense in the long run. Making sure you understand what is covered and what is not before you leave the doctor’s office will eliminate unpredictable bills.
Important Preventive Care Considerations:
- Grandfathered Plans: If your employer’s health plan is “grandfathered”, preventive care may not be covered at 100 percent. You will need to check with your company’s Human Resources Department for more specific information.
- Network Providers
- Office Visit Fees: Your doctor may provide a preventive service for you; however, if another test is done, or a problem is found, during that same visit that is not considered preventive, then you will be charged.
Health care can be costly and confusing. Keeping yourself educated will benefit tremendously and hopefully give you the confidence you need to have these important with your physician.
Please share any experiences you have had ¾ good or bad ¾ relating to preventive care. Or post your questions below.
Click here for a full listing of preventive services as defined by the Department of Health and Human Services.
When Benefits Selling magazine approached me about doing a follow-up to my 2003 interview, it had me reflecting over the past 14 years since I started Benefits & Incentives Group.
There is something completely satisfying in nurturing a company and watching it grow. In the past ten years, we have grown nearly 300 percent in revenue and more than doubled our staff. I’m proud of what we’ve accomplished while staying true to our core values and having fun along the way.
I believe I learned a great recipe for success through the past 14 years while raising this fine company.
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Make Great Hires: We take our time and use resources to identify “A” players.
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Invest in Resources: We have purchased resources and affiliations to augment our personal touch.
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Be a Joiner: We are in the people business and we need to stay in front of people, clients and prospects to maintain and grow. Getting involved helps us create strong relationships and partnerships.
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Make it Fun: It is important to create an environment that is positive, energetic, and a culture that fosters teamwork and laughter. Loving your job, your co-workers, and clients will mean a successful business.
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Share the Wealth: I provide monthly updates to all staff on our financial progress and annual objectives. We have a very competitive compensation program and at year end I like to see profits go to our staff as well as to charity.
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Create Incredible Client Experiences: We exist because of our clients. We always go above and beyond for our clients and that relationship is priority with our firm.
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Value Your Relationships: Our relationships with our partners, carriers, competitors, prospects and clients are all vitally important. When a tough situation comes our way we know exactly who to contact to ensure we make a good business decision.
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Know your Place: Know your place and maintain a spirituality that keeps you humble.
I have guided the business in the direction I wanted it to go, but I couldn't have done it had I not surrounded myself with wonderful talent.
Our firm is filled with intellectual capital, fresh ideas and people who want to make an impact. I thank my team for making our company a continued success and such an enjoyable place to come to work each day. After all, I am just the cover boy — it’s my team that makes the place run like a fine machine.
P.S. Congratulations to Benefits Selling magazine for eight years (and counting) of their own success.
Above photo by Benjamin Rasmussen
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Your 2012 Limits for Benefits Plans Reference Guide
Can you believe we are almost through January?!
Here's our not-so-New Year's treat for you — our annual Cheat Sheet of tax rates and benefit limits. This two-page guide outlines all the 2011 and 2012 Health Savings Account limits, retirement plan limits, Medicare rates, tax rates and more!
We hope you find this tool to be a useful desk-side reference. If you would like a printed cardstock copy that will endure a little more abuse throughout the year, please let us know.
Enjoy!
Click here to get your 2012 Cheat Sheet.
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Colorado Commissioner of Insurance Jim Riesberg spoke with the Colorado Group Insurance Association (CGIA) Thursday. His message was one of an open door policy with the insurance industry. Although the focus of the Colorado Division of Insurance is to “protect the consumer”, Riesberg said he understood the ever-growing importance of insurance consultants as Colorado works to build its exchange in 2012 and 2013.
“You will be heard, and
you will be welcome,” Riesberg said to CGIA attendees . “But come with solutions, not only complaints.”
As the legislative session kicked off a week ago on Wednesday, January 11th, Benefits & Incentives Group is hopeful that it will be a relatively quiet session as it pertains to health insurance. However, we expect to see some bills relating to the Colorado Health Benefit Exchange (COHBE), which was created in 2011 by Senate Bill 200. How COBHE and the Division of Insurance will partner to address upcoming requirements from the Patient Protection and Affordable Care Act will be some of the key developments during the legislative session.
One of the earliest issues they’ll have to tackle is essential health benefits that many states were expecting the Department of Health and Human Services to address with further guidance. In a rather unexpected move, the U.S. Department of Health and Human Services gave the states the authority to determine these themselves. While having more state control is welcome, it provides a forum for a lively debate on what to do with the health insurance mandates which have been passed in recent years by our state legislature.
Benefits & Incentives Group will take an active role in the 2012 session and will continue to keep you informed as things progress.
Have a thought or comment on the future of health reform for employers? Please take a moment to write your thoughts below, or contact Todd Krapf privately at tkrapf@bigroupinc.com or (303) 645-4720.
Learn more: http://doraapps.state.co.us/Insurance/Consumer/pages/main.aspx
Read about the Insurance Commissioner’s background here: http://www.dora.state.co.us/insurance/about/comm.htm
Did you know that 55 percent of Colorado adults are overweight or obese? That’s probably why losing weight and getting healthy is one of the most popular New Year’s Resolutions. However, studies have shown that most New Year’s Resolutions are given up by day nine! Thankfully Kaiser Permanente has started the Weigh and Win program that will help you stay on track by offering incentives along the way.
How does the program work?
The Weigh and Win program is completely FREE for Colorado adults age 18 and over! Funded by Kaiser Permanente Community Benefit, Kaiser wants the public to have access to an effective healthy living program, which is only usually offered in worksite settings. Participants will weigh-in at a private, automated kiosk located in their community every 90 days. In between your kiosk check-ins, you will receive a daily email or text program from your coach motivating you with healthy eating and active living tips. These messages are tailored to your results during your kiosk assessment.
How do I enroll?
You can either enroll online or at your local kiosk. (See below for kiosk locations) Enrolling is easy. Simply fill out a quick questionnaire to get started. You can then choose what types of text messages you would like to receive, if any, and also the time they are sent to you! Weigh and Win then provides a calendar in which you are to check-in at your local kiosk. Maps and locations are provided on the website as well.
What are the incentives?
During your weigh-in sessions at the free kiosk stands, your results will determine the money you receive. If you experience a 5 percent weight loss, you will receive $15 and a 10 percent weight loss will earn you $30, and so on (see table below). You may also earn rewards from local retail partners for achieving and maintaining a healthy weight and participating in program activities such as keeping a weekly journal.
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Weight Loss
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Quarterly Reward
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5%
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$15
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10%
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$30
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15%
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$45
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20%
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$75
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25%
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$105
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30%
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$150
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How can I make this more challenging?
Consider creating a team with your colleagues, friends or family! This will further motivate participants as well as allow your team to earn additional awards.
Get your employees involved!
At a time when budgets are tight, this program has all the financial incentives built in — all you have to do is spread the word and keep the enthusiasm. Your human resources department can be extremely important in getting employees motivated to lead a healthier life style. We encourage you to create teams with your employees and colleagues to get healthy today! Start your own team, and pass this flyer around your workplace to start the trend of a healthier lifestyle.
For Kiosk locations, and to learn more, go to http://weighandwin.com/. Post your experiences with Weigh & Win below!
