Coverage and Benefits
What are the 10 Essential Health Benefits?
IBC offers which types of plans?
Catastrophic, Bronze, Silver, Gold and Ancillary plans.
Are Adult Vision and Dental plans embedded in IBC plans?
No, they are add-ons.
What types of services does Personal Accident Insurance cover?
• ambulance (once per covered accident, per covered family member)
• initial services (received within one week of covered accident in a hospital, urgent care center or physician’s office)
• hospitalization, including intensive care unit (ICU)
• major diagnostic exams: CT, MRI, EEG, diagnostic X-ray (covered up to $750 per exam; one per covered accident*)
• tests and X-rays, other than diagnostic X-rays:
(one test or one set of X-rays within 90 days of covered accident)
• surgery (up to two per covered accident, per covered family member; performed within six months of covered accident)
• drugs (administered in a hospital, urgent care center or physician’s office at time of initial care of a covered accident)
• prosthetic devices (must be received within one year of covered accident)
• physician follow-up services, including chiropractic
(up to one visit per day, with a maximum of three visits per covered accident, within 30 days of covered accident)
• rehabilitative therapy: physical, occupational and speech therapy, or chiropractic services (one visit per day, with a maximum of 10 visits per covered accident, per covered family member; visits must begin within 90 days of covered accident and occur within six months of covered accident)
• durable medical equipment (rental or purchase of qualified equipment prescribed within 30 days of covered accident)
* Per covered family member; within 30 days of covered accident.
What is Form 8962?
Form 8962 is a form you must file with your federal income tax return for a year if you received an advanced premium tax credit through the Marketplace during that year
What are examples of services EXCLUDED from coverage for the treatment of autism spectrum disorder (ASD)?
Applied Behavioral Analysis and rehabilitative care, psychiatric and psychological services, speech/language therapy, occupational therapy, physical therapy.
What is the difference between an HMO, an EPO, and a PPO?
HMO
EPO
PPO
What are the differences between Adult Dental Premier and Preferred?
Premier has two cleanings a year, prosthetics are covered, coinsurance is 80% after deduct rather then the 50% of Preferred.
What kind of conditions does Critical Illness pay for?
Heart Attack 100% 30 Days
Stroke -
(cerebrovascular accident) 100% 30 Days
Coronary Artery Disease 25% This is needed
Invasive Cancer -
(sometimes referred to as infiltrating cancer) 100% 90 Days
Carcinoma in Situ -
(Stage 0 and/or TisN0M0) 25% 90 Days
Prostate Cancer 25% 90 Days
Skin Cancer 5% 90 Days
End Stage Renal Cancer -
(Stage 5 Chronic Kidney Disease) 25% 30 Days
Major Organ Failure 100% 30 Days
What is Form 1095-B?
If I switch from Adult Premier Dental to Adult Preferred Dental (or vice versa), will my waiting periods start over?
No.
Waiting periods are for new members or when there’s a break in coverage. If there is no break in coverage, waiting periods do not have to be met again.
What plans offered are OFX only?
Keystone HMO Silver Proactive VALUE and Keystone HMO Silver Proactive SELECT.
What are the plans IBC offers for Dental/Vision?
Vision 100, Vision 180, Adult Preferred and Adult Premier, Pediatric Vision, Pediatric Dental.
What are the optional Riders available for Hospital Recovery?
• Optional Benefit riders offer additional protection against other expenses you might face.
• You may add one or more of the benefits listed below to your Hospital Recovery Insurance policy for an additional premium.
• These benefits are payable in addition to the policy’s Daily Benefit Amount.
Emergency Room & Ambulance Benefit:
Emergency Room visit (one per calendar year): $300 Benefit Payout*
Ambulance Services (one per calendar year):
• Ground transportation: $150 Benefit Payout*; or
• Air transportation: $500 Benefit Payout*
Major Diagnostic Exam Benefit:
$500 Benefit Payout* for a major diagnostic exam (one per calendar year):
• Computerized Tomography (CT); or
• Magnetic Resonance Imaging (MRI); or
• Electroencephalogram (EEG)
Rehabilitation Facility Benefit:
$100 Benefit Payout* for each day in a rehabilitation facility, immediately following a qualified hospital stay (up to 15 days per calendar year).
* Available per covered family member
I have obtained other coverage, can I cancel?
Yes, subject to the applicable cancel effective date. Call customer service.
What are the metallic levels and what do they mean?
Each plan is assigned a "metal level" based on the average percentage of healthcare paid by the plan. This makes it easier to compare similar health plans across health insurance companies. The metal levels are as follows:
Platinum: Your health plan pays 90% on average. You pay about 10%
○ Best when you plan to use a lot of healthcare services OR if you prefer the SECURITY of knowing you have the highest level of coverage
○ Higher monthly premium, lower out of pocket costs
Gold: Your health plan pays 80% on average. You pay about 20%
○ Best when you want to save on premiums and still keep out-of-pocket costs low
Silver: Your health plan pays 70% on average. You pay about 30%
○ Best when you want to balance your monthly premium without-of-pocket costs
Bronze: Your health plan pays 60% on average. You pay about 40%
○ Best when you don't plan to need a lot of healthcare services
○ Lower monthly premium, higher out of pocket costs
Which plans include Blue Cross Blue Shield Global Core access?
Most EPO and PPO plans (excluding PPO Bronze Basic and Catastrophic) include access to the Blue Cross Blue Shield Global Core program.
What is the Benefit Period for an Adult Vision Plan?
Contract year.
When is LifeSecure's effective date?
The next day
If a dependent calls in to check possible subsidy, what system would you use?
You would not use pennie.com because they are a dependent and not the primary.
What plan can you pair with an FSA?
IBC does not offer FSA, we offer HSAs with an EPO Bronze Reserve.
If a customer is enrolled OFF-EXCHANGE and switches to another carrier, is their IBX plan automatically terminated?
No, the customer will need to contact IBX to terminate their coverage. They can do this by calling the customer service phone number on the back of their ID card.
What Benefit Period does Adult Dental have?
Contract year
How can we use the cash from a LifeSecure pay out?
Cash benefits can be used for the following: