We need to do the math to determine the most cost-effective health insurance plan for you and your family. You have three options- COBRA, enrolling through the Health Insurance Marketplace, or enrolling directly with an insurance company. We will help you evaluate your options.

Health insurance is the most requested employee benefit, and a quality plan can help retain & attract good employees. That said, it can be an expensive undertaking for a business. With our experience and knowledge we can design a plan that offers valuable benefits to your employees while maintaining affordability for the employer. Don’t continue to lose good employees because you think you can’t afford health insurance!

This is a growing issue with the low unemployment rate that Nebraska is currently experiencing.

A Summary Plan Description (SPD) and Summary of Benefits of Coverage (SBC) are different documents required by the ACA. The SBC is a document intended to help people understand their health coverage and compare plans. The SBC must be provided to all eligible employees. The SPD is the main vehicle for an employer to communicate plan rights and obligations to participants and beneficiaries. The SPD must be provided to all enrolled employees.

An out-of-network provider has the right to charge you the full-billed amount instead of accepting the discounted rate that in-network providers accept. However, we will negotiate with the ambulance provider and ask them to accept a lesser amount than the full charge, even accepting payment for the in-network rate as payment in full. Give us a call and we will help you through this process.

Typically your plan will extend to employees in other states using a wrap around network. Provider networks are usually regional but the wrap around network can provide nationwide coverage. Check your ID card for network information or call Kayla. Your Plan may offer a national or regional network.

This is not an unusual situation for doctors offices and pharmacies to deal with at the beginning of the year. Call ComPro we will help you get the information that is necessary for you to go ahead and get your medical services taken care of.

An EOB is an Explanation of Benefits. It explains how the insurance company processed your claim.

Those who have dental insurance are more likely to see their dentist on a regular basis than those who do not.  The dental insurance plans that are available to individuals offer more limited benefits than group dental plans.  The decision to have dental benefits should be based on your desire for good dental health and the cost / benefits of the insurance.  One popular plan offers coverage for $27 per month.  Annually that is $324.  Preventive care (A services) is paid for at 100%.  B services (extractions, fillings, etc) require a 6 month waiting period and are then paid at 80%.  C services (crowns, root canal, etc) have a 12 month waiting period and are paid at 50%.  The maximum benefit is $1000 per year.  Compare the annual cost to what you would pay if you did not have dental insurance and consider how likely it is that you will need more than preventive services.

Give our office a call and we can assist with researching the formulary of your prescribed medication.  Also suggest to contact your prescribing doctor to find other alternative medications that may be covered.

You can cancel your policy at any time.  However, you can only purchase a new policy during the annual Open Enrollment (November 1 through January 31) or when you are eligible for a Special Enrollment Period after a qualifying event has happened.  An example would be getting married, having a new baby, losing coverage from an employer plan or moving to a new state.  If you cancel your policy, you would be subject to paying a penalty for not having health insurance when you file your tax return. Not having ACA compliant coverage will cause you to be accessed the penalty on your tax return for the months you did not have compliant coverage. Penalty is $325 per person or 2% of income, whatever is greater.

Coverage can vary from one insurance company to another, so check it out before you travel. It is typical for US based coverage to provide benefits for emergency services only when you are out of the country. It is wise to purchase a travel policy that provides additional medical insurance benefits plus coverage for other expenses you might incur if a medical event happens while you are traveling. Benefits such as emergency travel home or evacuation expenses may be available on travel policy. The cost is minimal and provides valuable benefits when something unexpected happens.

When you make a permanent move from one state to another, you will need to change your health insurance to a plan that is based in your new home state. You have a 60 day Special Enrollment Period to select a new plan.

A formulary is a list of prescription medications that are covered by an insurance plan.  The medications are categorized as Tier 1 through Tier 4 with Tier 1 being the least expensive and Tier 4 being the most expensive.   Some insurance companies use more than 4 tiers.  If your pharmacy tells you that a drug is not covered, then the first step is to call the customer service number of your insurance company to find out why the medication is not covered. The most common reasons are that a drug is new and not yet on the formulary, has been replaced by a generic medication, or requires that you try less expensive medications before the more expensive one will be approved.  There is also a process where your doctor can submit a request that the medication be approved because of special circumstances.

Every insurance company offers benefits through a specific network of physicians, hospitals and other providers. Your benefits will be reduced if you use a provider that is not in the network. Each insurance company’s website offers a “Provider Search Tool.”  You can also contact your doctors’ office to find out if they are in your network. Look on your insurance card to find the website URL.

Closely check into the benefits for your health plan’s Pediatric Dental coverage before you cancel the dental insurance. Most health plans don’t cover any pediatric dental benefits until the health plan’s medical deductible is met. You will likely get much better benefits through the dental insurance policy, at least until you meet the deductible on your health insurance.

ACA plans are not always more expensive.  Even though they include benefits like maternity coverage and pediatric dental, those plan designs and rates should be considered.  The ACA compliant plans can be less expensive for groups that have an older population or high claims experience.

Small employers are not required to provide health insurance, however we are seeing a trend towards small employers adding group health insurance.  Group health insurance is an important component of an employee benefits package and helps to retain quality employees.  Previously individual health insurance was less expensive than group insurance but that has changed with the ACA.

The employee can keep their individual policy but there may be consequences depending on the policy type.  If the employee receives premium tax credits and the group policy meets the affordability test they are no longer eligible to receive the premium tax credits and will be responsible for the full premium amount of the individual policy.  If the employee does not receive premium tax credits they are free to keep the existing policy without negative consequence.

No, we offer many other employee benefits – dental, vision, life, long term disability, short term disability, Section 125 plans and voluntary benefits.

Under IRS Notice 2013-54 these arrangements are considered an employer payment plan and do not satisfy the reforms under the ACA.  Such arrangement can subject the employer to an excise tax of $100 per employee per day.   The IRS issued Notice 2015-17which provided transitional relief from the penalties, through June 30, 2015, for small employers that had continued to offer such plans.  With the expiration of the transitional relief the penalties are now in effect.  Please refer to your tax preparer for additional information.

Children can stay on their parent’s policy through age 26 regardless of school status, marriage, employment status or financial dependence on parents.

All policies include first dollar Preventive Care benefits, which means FREE to you. As long as the visit is billed as Preventive by the physician’s office and falls within the approved category you will have no charge.

Most insurance companies have Member portals where you can view claims, see benefits, find an in-network doctor and print an ID card. Many sites also include options for viewing the cost of different procedures and finding the best priced facility for a certain service.

An increase in premium is not a qualifying event.  That employee will have to wait for Open Enrollment.

If you misplaced your card you can visit your carriers website to print out a temporary card. To get a new card you may contact us or your carrier to replace the old one.