Health Insurance


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Employee Benefits Consulting and Brokerage Services

Objectives Include:

  • Plan Strategy
  • Data Analysis
  • Health Care Reform
  • Plan Administration and Legislative Compliance
  • Human Resources Support
  • Wellness Services

Saving money on employee benefits while still attracting and retaining the best and the brightest is a must in today’s economy. The cost of providing benefits is rising significantly, while employees consistently see more and more from their benefits package. Many employers struggle to balance employee needs with their own capabilities and bottom lines. At Newtek, we will help you meet these divergent objectives. Using our advanced technology and consulting expertise, we provide a variety of value-added professional services to our clients that reduce customer costs, increase efficiency, and improve employee satisfaction.

Individuals
Small Business

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Allowed Amount

Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.)

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Appeal

A request for your health insurer or plan to review a decision or a grievance again.

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Balance Billing

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

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Co-insurance

Your share of the costsof a covered health careservice, calculated as apercent (for example,20%) of the allowedamount for the service.You pay co-insuranceplus any deductiblesyou owe. For example,if the health insurance or plan’s allowed amount for anoffice visit is $100 and you’ve met your deductible, yourco-insurance payment of 20% would be $20. The healthinsurance or plan pays the rest of the allowed amount.

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Complications of Pregnancy

Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a nonemergency caesarean section aren’t complications of pregnancy.

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Co-payment

A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

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Medically Necessary

Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

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Network

The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

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Non-Prefered Provider

A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.

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Out-of-network Co-insurance

The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Outof- network co-insurance usually costs you more than innetwork co-insurance.

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Out-of-network Co-payment

A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network copayments usually are more than in-network co-payments.

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Out-of-Pocket Limit

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.



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