Sobre nosotros

Claims administration ~ When a plan contracts with a third party, such as Florida Blue, to review and manage claims, making sure they align with plan documents.

Consolidated Omnibus Budget Reconciliation Act (COBRA) ~ A federal law that allows you (and your family) to temporarily continue your employer-sponsored group health insurance coverage after a qualifying event.

Coinsurance: A percentage of costs you pay after meeting your deductible.

Copayment ~ A fixed dollar amount you pay for specific services, like a doctor visit.

Deductible ~ The amount you pay for covered services before insurance starts paying.

Eligibility ~ Requirements (like hours worked)  as a prerequisite to begin, or continue to receive coverage.

Hour Bank ~ A simple account of accrued hours that an employee may use when they work fewer than the required hours in a month for coverage. MCASF Local 725 Health coverage requires 100 worked hours per month.

In-Network Provider ~ A doctor or facility contracted with your health plan for lower costs.

Out-of-Network Provider ~ A doctor or facility not contracted with your health plan, usually having higher costs.

Out-of-Pocket Maximum ~ Yearly cap on what you pay for health care services.

Preferred Provide Organization (PPO) ~ A plan, such as this Health Plan, that offers lower costs for in-network providers but allows out-of-network care.

Pre-Authorization/Prior Authorization ~ When plan approval is required before certain services or treatments are received by you.

Qualified Medical Child Support Order (QMSCO) ~ A state ordered decree under ERISA requiring an employer-sponsored health plan to cover a child, usually following a divorce or separation.

Self-Insured ~ When a plan, such a this Health Plan, pays for all claims using the plan's assets and the plan controls the plan design.

Fully Insured ~ When covered services are insured by a third party, like Blue Cross, United Health, etc. that pays for all claims and limits plan design changes.