Insurance Basics
This is what the cost of the insurance is called.
What is premium?
This is the most your dental insurance covers for qualified expenses, per person per year.
What is Calendar Year Maximum or CYM?
Responsible for distributing the wrap documents (SPD's).
Who is the plan sponsor?
The most you will spend per person per calendar year in the worst case scenario (for covered expenses).
What is OOPM?
You can pair this with an HSA.
What is a High Deductible Health Plan?
Your provider is contracted with your insurance carrier (i.e. Delta Dental is contracted with your dentist). This is called....
What is an In-Network Provider?
Responsible for going to market to ensure competitiveness of offerings and ensuring rates are inline with the industry.
Who is the broker?
Your deductible has to be a minimum of $1,650 for individual coverage and $3,300 for family.
What HDHP?
This is the amount you pay out-of-pocket for covered expenses before your insurance company starts to contribute to the cost.
What is a deductible?
This is the largest vision network in the country.
What is VSP?
Responsible for choosing which plans to enroll in and adding dependents.
Who is the employee?
If you have 50 or more full time equivalent employees.
This is a predetermined, flat fee you pay for a specific service, like a doctor's visit or a prescription.
What is Copay?
12/12/12
What is the frequency of an eye exam, lenses and new frames for vision?
Responsible for processing claims and providing SBCs.
Who is the carrier?
If your employer or employees cannot afford traditional insurance, you must offer this type of insurance at a minimum.
What is a MEC?
This is the most you will pay for covered medical care in a single calendar year. Once you reach this limit, your health insurance plan covers 100% of your qualified healthcare expenses for the rest of the year.
What is out of pocket maximum?
This occurs when a healthcare provider bills a patient for the difference between the amount the provider charges and the amount the insurance company pays.
What is balance billed?
Responsible for managing employee deductions in payroll
Who is the plan sponsor?
These are the 4 largest health insurance companies that dominate the market.
What is BUCA?