Know Your Health Insurance Coverage

The face of health insurance is changing. Many employers are offering High Deductible Health Insurance plans as a way to provide employees with health insurance coverage with a lower premium cost.

High Deductible Plans, also known as HRA and HSA plans, encourage employees to share more responsibility for how health care dollars are spent. This means that the employee has to pay a larger portion of health care costs. Employee-only and family deductibles vary from plan to plan, but typically minimum deductibles are $1,100 for an individual and $2,200 for a family. The maximum out of pocket expense is usually less than $5,500 for employee-only coverage and $11,000 for family coverage.

What this means to you?

Gone are the days of $20 co-pays. If you have a High Deductible Plan, you are responsible for payment of allowable health care costs until you have reached your deductible. Effective January 1, 2008, ESD Pediatric Group is requiring a minimum payment of 35% of billed charges at the time of service for any patient participating in a High Deductible Plan.

If either HUMANA or UNITED HEALTH CARE (UHC) provides your high deductible plan, your claim will be processed at check out and an Explanation of Benefits (EOB) will be generated. You will be responsible for payment of 100% of the allowable charges at check out.

Should you have additional questions about your High Deductible Insurance Plan, please contact your employer’s Human Resources Department. If you have questions about ESD Pediatric Group’s 2008 Financial Policy, please contact our billing department at (513) 248-3063.