Health Plan Terms
This accumulator is what members will pay towards for their insurance plans to begin splitting their healthcare costs.
What is a deductible?
This tool is what FHA's use to locate member information including demographics, claims information, and rewards.
What is Care Console?
What is labcorp?
This is a benefit that is provided to members in which they can connect with a counselor. These services are usually free for a limited amount of visits and can support members with their mental health.
What is an Employee Assistance Program (EAP)?
This is a type of care that members receive for services such as an annual physical, wellness check, etc. This is always covered at 100% per a members plan.
What is preventive care?
This is what members pay to have their insurance. This does not contribute to a members accumulators.
What is a premium?
This tool is what FHA's use to keep track of their schedules. You can view your adherence, schedule PTO, and so much more.
What is Community?
This wellness program allows Koch members to continue to pay their lowest premium options in the next calendar year. If they do not complete the appropriate steps, they will pay a monthly surcharge.
What is Steps for Health?
This type of insurance covers the risk of life and pays out an insured sum upon death.
What is life insurance?
Typically, in network providers will submit these on behalf of a member for a health plan to review the medical necessity of a service. These can usually take some time to process.
What is a prior authorization?
This is what some members will pay for going to doctors visits or other office and specialist visits. This will only contribute to a members out of pocket maximum. This will never contribute to a deductible.
What is a copay?
This tool allows FHA's to locate all sorts of information based on vendors, client specific information, etc.
What is knowledge?
What are GP Union Spouses?
This federal law guarantees up to 12 weeks of job protection for certain employees who need time off due to serious illness or disability, having or adopting a child, or to care for another family member.
What is the Family Medical Leave Act?
Members always have the right to submit these in case they feel that there is a discrepancy with their claims. These can be submitted prior to a service and after a service.
What is an appeal?
This is what members will receive from an insurance carrier once a claim processes. Typically, these are received via the mail.
What is an explanation of benefits?
This is a carrier specific website that FHA's can use to locate provider options for members. This tool allows you to filter exactly to what the member is looking for.
What is Anthem Find Care?
This vendor provides MSK support for members who are experiencing joint pain. They receive a free tablet and wearable trackers in which they can track exercises for physical therapy support.
What is Hinge Health?
Members can use this benefit to help pay for medical expenses. Often times work in combination with a high deductible health plan. This benefit does not expire.
What is an HSA?
As FHA's we are encouraged to use this approach when discussing CHA with a member. This approach allows us to believe that the member is already aware and interested in CHA.
This is when a member has two insurances at the same time. Some members will call in asking up to support them with updating their account as they may not have two insurances.
What is a coordination of benefits?
This tool allows FHA's to view members claims for prescriptions, find in network pharmacy options, and check drug costs.
What is Client Care Access?
This is a pharmacy copay assistance program that allows members to pay little to no costs for prescriptions if enrolled in the program.
What is Prudent Rx?
This benefit allows a members insurance to step in to receive payments from an at-fault third party who may have caused an auto accident. We can support members by conferencing them to this department within their insurance.
What is subrogation?
This is a federal law which allows members to have a temporary extension of their current medical plan. It is required for employers to provide this opportunity to enroll in case the member does not have other insurance options.
What is COBRA?