General Questions

Medical Questions

WHAT IS OPEN ENROLLMENT?

 

Open Enrollment is a once-a-year opportunity to make changes to your current benefits and to review which dependents you will be covering during the new plan year.  All changes you request during Open Enrollment will take effect October 1, 2015.

 

 AM I ELIGIBLE FOR BENEFITS?

 

Full-time employees working at least 30 hours per week and their eligible dependents may participate in the Atento Benefits Program. Generally, for the purpose of the Atento benefits program, dependents are defined as:

- Legal Spouse, Dependent “child” up to age 26, Your disabled children of any age


CAN I MAKE CHANGES TO MY BENEFITS AFTER OPEN ENROLLMENT?

 

In most cases, your medical, dental and vision benefit elections remain in effect until the next annual open enrollment period.  You will not be able to make any plan changes unless you experience a change in family status.

 

WHAT IS A FAMILY STATUS CHANGE EVENT?

 

Events described in IRS regulations may allow you to make a change to your medical, dental and vision benefit coverages if you experience any of the following:

- Marriage or divorce

- Death

- Birth or adoption of a dependent

- Change in employment status

- Dependent satisfying or ceasing to satisfy the plan’s eligibility requirements

- Loss of or significant change to your current coverage

- Judgment, decree or court order

- Enrollment / ceasing to be enrolled in Medicare or Medicaid

- Ceasing to be enrolled in Children’s Health Insurance Program (CHIP)

 

You have 31 days from the date of the event to report and update your benefits with the Human Resources Department.  Changes to your benefits need to be consistent with the change in family status.

 

 

 

 

 

 

WHAT IS A DEDUCTIBLE?

 

A deductible is the amount of money you or your dependents must pay toward a health claim before your insurance company makes any payments for health care services rendered. For example, if you have a $1,000 deductible, you would be required to pay the first $1,000, in total, of any claims during a plan year. The deductible excludes Copayments where applicable. 

 

WHAT IS COINSURANCE?

 

Coinsurance is the amount expressed as a percentage of covered health services that you must pay after you have satisfied your plan deductible.

 

WHEN DO I PAY A COPAYMENT?

 

If you are enrolled in the medical plan expect to pay a Copayment for doctors visits, emergency room visits and urgent care center visits. 

 

HOW TO CHOOSE BETWEEN AN URGENT CARE CENTER VS. EMERGENCY ROOM?

 

If you need medical care when your regular doctor is not available, think about going to an urgent care center. The urgent care center should be used for minor emergencies (fever, cough, pain, etc.) when your physician’s office is closed and your symptoms are too severe to wait until the office reopens or when you are out-of-town. The Copayment is less for the urgent care center than the ER and getting care at the urgent care center will most certainly be faster than an ER visit.  Emergency rooms should only be used for true emergencies such as broken bones, vigorous bleeding or severe pain. The next time you are faced with decidingwhere to go, be sure to evaluate all your options and choose the setting that best suits your illness or injury. Of course, in a true emergency, seek the appropriate care without delay. For more helpful information about your decision to seek emergency or urgent care, please refer to the next page.

 

WHAT IS OUT-OF-POCKET LIMIT? 

 

The maximum amount (deductible and coinsurance) that an insured will have to pay for covered expenses under a plan. Once the out-of-pocket limit is reached, the plan will cover eligible expenses at 100%.

 

WHAT IS AN EXPLANATION OF BENEFITS (EOB)?

 

An EOB is a description the insurance company sends to you explaining the health care charges that you incurred and the services for which your doctor has requested payment. You should compare your EOB to the bill you receive from the doctor. All data on your EOB should match the information that appears on the statements you receive from your doctor.  If it doesn’t, contact the doctor’s office immediately.  

 

WHAT IS PREVENTIVE CARE?

 

Preventive care is proactive, comprehensive care that emphasizes prevention and early detection. This care includes physical exams, immunizations, well woman and well man exams. Be sure your child gets routine checkups and vaccines as needed, both of which can prevent medical problems (and bills) down the road. Also, adults should get preventive screenings recommended for their age to detect health conditions early. Remember all preventive care benefits are covered 100% when you visit an In-Network provider.  

 

WHAT IS THE DIFFERENCE BETWEEN GENERIC AND BRAND NAME DRUGS?

 

The difference between generic and brand name medications lies in the name of the drug and the cost. Generic drugs cost much less than brand name drugs, save you and your employer money, and provide the same health benefits as brand name drugs. 

 

WHAT IS THE BENEFIT OF MAIL ORDER DRUGS?

 

Mail order drugs are perfect for patients who take medication on an ongoing basis. Examples are high blood pressure medication, high cholesterol medication, insulin and birth control. Mail Order drugs are convenient because they are delivered to your door step which relieves the stress of standing in line at the pharmacy.

 

WHAT SHOULD I ASK MY DOCTOR?

 

Amazingly, many patients do not ask their doctor basic questions. “How much will my treatment cost?” “Can I be treated another way that is equally effective but less costly?” “What are the risks?” “What are the side effects?” Having a dialogue with your physician can help you better understand how his or her care decisions affect your health plan costs. It will also help your doctor get to know you better, and consequently prescribe treatment that is more effective.