The Rundown

MAY 2023 | Issue #004

We're back with our Spring edition of The Rundown!

With warmer weather here and Summer just around the corner, we've got a packed newsletter for you! Below, we're going to talk about:

Knowing when to visit the Emergency Room vs. Urgent Care
Where to find Carrier and Plan Resources
Explain what Evidence of Insurability (EOI) is, and
Discuss the in's and out's of your medical insurance while traveling

As always, our experts are here to help! For more information or questions on accessing and using your benefits, you can reply to this email and be in touch with one of our helpful advocates.

Emergency Room vs. Urgent Care: When to visit one versus the other

With the upcoming season, holidays, and increased engagement in outdoor activities, being prepared for potential injuries or illnesses becomes crucial. Understanding when to visit the Emergency Room (ER) or Urgent Care can not only save you time and money but also ensure that your medical needs are appropriately addressed.

Let's talk about a real-life scenario where one member made the right decision in seeking medical care for an injured family member, and the significance of his informed decision:

While enjoying a dinner outside in their backyard with friends, Oliver's daughter experienced a fall and potentially broke her arm. Unable to reach his Primary Care Provider after regular working hours, Oliver made a smart decision to drive to an in-network urgent care facility, despite the additional 20-minute drive. This choice resulted in a flat rate of $20 under his PPO plan, while a visit to the ER would have cost $150, plus 20% coinsurance after meeting the $500 deductible. (It's important to note that specific plan details may vary, but this experience highlights the relevance of making informed choices!)

What Oliver did for his family was smart, and his daughter was still able to get the proper treatment she needed at a very reasonable price. How do you make the smart choice in this situation? In those moments of emergency, there are three options for care to be received: your Primary Care Doctor, an Urgent Care, and the Emergency Room, with each option comes three drastically different costs.

So, what facility should you use? How do you know when to use each of them? It's easy to panic in these moments and make the more expensive choice without realizing how much it will cost you later.

There is a lot to consider when choosing a facility. Some key questions you should ask yourself are:

What time of day is it?
Is it a weekend or holiday?
How serious is the injury?
How fast is the bleeding?
Am I on a PPO or an HMO insurance plan?
What is the pain level of the injured/ill?

If an injury takes place during normal business hours and not on a holiday or weekend, you should contact your Primary Care Provider first. Your Primary Care Provider can cast a bone, prescribe antibiotics, run basic test, etc. and will charge you their normal visit rate which could be hundreds of dollars cheaper than going to an emergency room. When you call your Primary Care Provider, give them a description of what is going on. If they cannot assist you, they will refer you to an urgent care or emergency room that can. Whether you are on an HMO or PPO, this is an important step because it can help make sure that the urgent care or emergency room are in-network which helps keep cost down.

If there is an emergency on a weekend, a holiday, or the middle on the night, urgent cares are the next best places to go. It's good to know on hand what urgent cares are in-network around you. Our Advocacy Team is here to help if you need assistance in locating your nearest-in-network urgent care. But if you don’t know and it's late, you can always call the "Members Services" number on the back of your insurance ID card and they can provide a list. Another option is use your Medical Carrier's App to find in-network urgent cares near you. (For example, Anthem's Sydney Health App, is free to download and offers great resources for members.) Urgent cares can handle just about anything and if not, they can refer you to an emergency room. For most plans, urgent cares have a set copay amount this is a great way to keep costs down.

Emergency rooms should only be used in the most extreme situations. For most plans, emergency rooms have a set copay amount as well as coinsurance once your plans deductible is hit. This means that you pay a flat rate just for walking in the door and then, after meeting your deductible, are responsible for a set percentage of the bill. These can become very expensive very quickly. While they serve a vital role in communities, ERs should be reserved for the most desperate of medical cases.

If you have more questions about specific situations do not hesitate to contact your Primary Care Provider or our Advocacy Team by replying to this email or calling our office at 855-662-1029.

Do you know where to find

Carrier and Plan Resources?

Ever wonder where to find your medical plan details, or if there are any FAQs about insurance terminology? Well, the answer is YES!

We have added these types of resources into your Benefit Administration portal, where they can be easily accessed anytime.

Once logged in, you will see a "Document Library" on your employee dashboard. Listed in the library are helpful carrier and plan resources available 24/7 for your convenience.

What is an EOI and when do I need one?

An Evidence of Insurability (EOI) is a health questionnaire that helps your insurance carrier determine whether you qualify for Voluntary Life coverage.

The carrier will set a Guaranteed Issue amount of coverage, and an EOI will be required if you elect above that amount. It will also be required if you previously waived, but are now enrolling, or if you are already enrolled and change your benefit amount during your annual Open Enrollment to one above the Guaranteed Issue amount.

You will be able to download an EOI during your enrollment process on your Benefit Administration portal. Complete the form and submit to your insurance carrier for processing.

How does my health insurance plan work when I'm traveling?

Let's talk about Medical Insurance while traveling: How does it work when you're away from your regular doctors? Some simple research can help you plan ahead.

Summer is nearly here, and whether staying near or going far — it's travel season! But before you pack your bags and hit the road, let's talk about something important: your medical insurance while traveling.

It's always a good idea to know where you stand with your coverage when you're far away from home. Depending on your plan, your experience with travel can be very different.

If you're on a PPO, you've got it easiest! You can find in-network providers for primary care, urgent care, and emergency rooms all over the United States.

If you're on an HMO and traveling outside of your home state, you'll likely only have access to urgent care or emergency rooms in case of a true emergency. This is because HMOs limit you to your medical group's network, which is based on geographical locations.

Now, if you're planning to travel outside the country, it's important to do some research before you go. If you're on a PPO with Anthem or Blue Shield, head over to the Blue Cross Blue Shield Global page to see if you have access to the BCBL core network. Simply enter your ID information and it will tell you whether there are in-network providers in the area you're headed to.

But what if there are no in-network providers at your destination? Don't worry, Anthem offers a buy-up plan for international insurance called Geo Blue private insurance. You can check out more information about it on the GeoBlue website. Keep in mind, this is a reimbursement program and should be used as secondary insurance. Claims may take a while since the international provider needs to bill primary insurance first. Also, if you have any pre-existing conditions, any medical needs related to them might not be covered under the bought plan. For an estimate based on location and dates, you can go online or give Geo Blue a call at 855-282-3517.

We hope this information helps you have a safe and enjoyable trip, wherever you may go! Remember, it's always better to be safe than sorry when it comes to your health. For more questions or help, you can reply directly to this email.

Featured Resources

When to see Primary Care, Urgent Care, or the ER

Watch it here | Español

HMO vs. PPO Plans

Watch it here | Infographic

Wellness Tip: Make time for movement!

It's reported that 85% of Americans sit for most of their workday. Research shows that regular movement is essential for both a healthy body and mind.

By incorporating simple strategies, you can increase physical activity during work hours, such as standing up whenever possible, engaging your core by sitting on an exercise ball, or scheduling walking meetings with coworkers.

Additionally, technology such as health or fitness apps can be used to your advantage, allowing you to work while moving and reminding you to take regular breaks from the desk.

By incorporating movement into your day, you can improve your focus, creativity, and problem-solving skills, leading to a more productive and healthier workday.

Brought to you in part by United Benefit Advisors -- M&G is a partner firm of UBA, providing access wellness resources.

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