The healthcare industry has many acronyms to keep track of.

 

For example, HIPAA for the Health Insurance Portability and Accountability Act, CDC for Centers for Disease Control and Prevention, and more. When it comes to keeping your personal records as secure as you want them to be, let’s dive into PHI, what it stands for, and why it’s important for you.

What Does PHI Stand For?

PHI stands for Protected Health Information. PHI is part of HIPAA regulations that protect patients’ personal health information. Under the act, patients have the right to disclose or withhold their information as they see fit.

What is PHI?

PHI is a national standard that any entity—businesses, covered entities, etc.—must uphold if they have private records. They must protect PHI, both physical and electronic, from unauthorized access.

PHI includes an array of personal information that makes a person identifiable, including:

  • Name
  • Birthday
  • Phone number
  • Social security number
  • Photos
  • Medical records
  • Address
  • Unique identifiers

ePHI is any type of protected health information that is stored electronically.

Why is PHI Important?

PHI should stay personal and private. The patient should be the one who can disclose who they want to grant access to their personal medical records. This helps keep hackers and identity thieves away from patients’ private information.

What is the Difference between PHI and ePHI?

ePHI, as mentioned earlier, is electronically protected health information. Electronic data is more easily accessed and shared, which makes ePHI more protected by federal law. ePHI must meet the HIPAA Security Rule, HIPAA Privacy Rule, and the HITECH Act. All are set in place to protect patients’ personal information from the wrong hands.

What is HIPAA?

The Health Insurance Portability and Accountability Act was created in 1996 to keep patient health information safe and secure. Under HIPAA, PHI can only be given with patient consent. Covered entities must always follow and enforce HIPAA law. Different types of covered entities include:

  • Health care providers
  • Business associates
  • Health care plans
  • Health care clearinghouses

Maintaining HIPAA compliance keeps personal information secure and builds trust between patients and covered entities.

How Does HIPAA Protect Your PHI?

The HIPAA Security Rule requires covered entities to protect against reasonably anticipated threats to the security of PHI. Covered entities must implement safeguards to ensure the confidentiality, integrity, and availability of PHI. However, HIPAA is not technology-specific and the exact safeguards implemented are left to the discretion of the covered entity.

HIPAA requires physical, technical, and administrative safeguards:

  • Physical safeguards: Keeping physical records and electronic devices containing PHI under lock and key.
  • Technical safeguards: Implementing technologies such as encryption software and firewalls.
  • Administrative safeguards: Access controls to limit who can view PHI information. It is a requirement that staff are provided HIPAA security awareness training.

How to Maintain HIPAA Compliance

Maintaining HIPAA compliance is an ongoing process. Here are some best practices:

  1. Regular Training: Ensure all employees are regularly trained on HIPAA compliance and updates.
  2. Risk Assessments: Conduct regular risk assessments to identify and mitigate potential vulnerabilities.
  3. Access Controls: Implement strict access controls to limit PHI access to authorized personnel only.
  4. Incident Response Plans: Develop and maintain incident response plans to address potential breaches swiftly.
  5. Encryption: Use strong encryption methods for both stored and transmitted PHI.

The Role of Technology in Protecting PHI

Technology plays a critical role in protecting PHI. Here are some technological measures to consider:

  • Encryption: Encrypt data both at rest and in transit to protect against unauthorized access.
  • Firewalls: Use firewalls to prevent unauthorized access to your network.
  • Anti-Malware Software: Install and regularly update anti-malware software to protect against malicious attacks.
  • Secure Communication Channels: Use secure channels for communication that involves PHI, such as encrypted emails or secure messaging platforms.

Common HIPAA Violations and How to Avoid Them

HIPAA violations can result in significant fines and penalties. Here are some common violations and tips on how to avoid them:

  1. Unauthorized Access: Ensure only authorized personnel have access to PHI.
  2. Improper Disposal: Dispose of PHI properly, using methods such as shredding paper records and securely deleting electronic files.
  3. Lack of Training: Provide regular HIPAA training for all employees.
  4. Data Breaches: Implement robust security measures to protect against data breaches.
  5. Unsecured PHI: Always secure PHI, whether it is stored physically or electronically.

Final Notes

Understanding and adhering to PHI and HIPAA regulations is crucial for any entity handling health information. By implementing stringent safeguards and regularly updating your practices, you can protect your patients’ information and maintain their trust.

Have more questions? Visit our Frequently Asked Questions page here. 

Article originally published on SBMA Benefits

Healthcare providers have been offering remote services for years, which have allowed patients to receive healthcare from the comfort of their own homes.

However, following the COVID-19 pandemic, telemedicine services became a necessity and are now a common tool utilized by many patients and healthcare professionals.

Why? These phone and video calls help patients protect themselves and others as well as provide a host of other benefits (but more on this later!) 

In this article, we’ll discuss what telemedicine is, the types of telemedicine, and when patients should be using these services. Let’s dive in.

What is Telemedicine?

Telemedicine allows healthcare providers to connect with patients without an in-person visit. Telemedicine services are provided primarily online or via smartphone through video chats or phone calls.

What is the Difference Between Telehealth and Telemedicine?

The terms “telemedicine” and “telehealth” are often used interchangeably, though the two have a few key differences: telemedicine refers specifically to remote clinical services and telehealth can refer to remote non-clinical services. 

Telemedicine, as stated by the World Health Organization, is “healing from a distance.” You receive treatment without an appointment or visiting the office.

Telehealth uses electronic information to support long-distance clinical healthcare, education, and administrative activities. It improves patient care and physician education rather than providing a service. Telehealth involves scheduling appointments, medical education continuation, and training for physicians.

In short, all telemedicine is telehealth, but not all telehealth is telemedicine. 

Types of Telemedicine

Using telemedicine, you can discuss symptoms and medical issues, receive a diagnosis, learn treatment options, and get prescriptions. There are a few common types of telemedicine which include:

Real-Time or Interactive Medicine

Interactive telemedicine, also commonly referred to as real-time or live telemedicine,  involves a physician and patient communicating in real-time.  

Real-time telemedicine involves any two-way communications –such as video conferencing and phone calls – that let providers and patients talk and allows healthcare providers to offer medical care. 

Some common services provided via interactive telemedicine include assessments of medical history, basic visual examinations, psychiatric evaluations, and even ophthalmic tests.

Remote Patient Monitoring

Remote patient monitoring gives caregivers the ability to monitor patients who have medical equipment that collects information like blood pressure, blood sugar levels, and more.

Through technology, information is sent to healthcare professionals and allows them to provide care and keep an eye on patients without the patients needing to visit in person. 

Remote patient monitoring can result in benefits such as reducing the time a patient needs to be in the hospital, reducing a patient’s exposure to other illnesses present in a healthcare building, as well as giving the patient time to recover at home. 

Remote patient monitoring is especially effective for chronic conditions such as heart disease, asthma, and diabetes.

Store and Forward Practices

In telemedicine, store and forward practices allow providers to share their patient’s information with other healthcare specialists and professionals.

The most significant advantage of these practices is that it doesn’t require the simultaneous attention of the delivering and receiving parties.

Many healthcare professionals—such as field technicians, caregivers, or specialists, for example—can collect the necessary data and upload it for use by other healthcare professionals.  

When Should You Use Telemedicine?

Telemedicine is for straightforward questions and issues, and any follow-up consults. It also can be helpful with psychotherapy and teledermatology. Some examples of straightforward issues include cold and flu symptoms, insect bites, diarrhea, pink eye, and sore throats.

Telemedicine has advanced our current health care options by offering several new benefits. It is making healthcare accessible for more patients, whether they live in a remote location, have a packed schedule, or any number of other reasons.

When Should You NOT Use Telemedicine?

Telemedicine is not for emergencies. For anything that requires urgent, primary care, you should go to a doctor in person. 

Benefits of Telemedicine

Telemedicine Saves Time

These services also help people avoid unnecessary hospital visits, which helps healthcare professionals give advice at a distance, save time, and reduce costs for both patients and doctors. Not only will it help avoid hospital visits when they aren’t necessary, but it will also give patients in the hospital the ability to discharge sooner by monitoring their vitals with telemedicine.

Telemedicine is Affordable

A recent study found that the average telemedicine visit is around $79, whereas an average doctor’s appointment is $149, and a trip to the emergency room costs, on average, $1,734. As telemedicine continues to grow, health insurance providers are offering coverage for telemedicine visits. Some states even require that health insurance plans reimburse patients for telemedicine visits.

Telemedicine is Accessible

Telemedicine offers a more accessible opportunity for healthcare and changes the way we visit the doctor. At Innovative HIA, we offer the most competitive limited benefit plans in the industry, including virtual health options! Check out our services for more information!

Read on for the pros and cons of telemedicine.

School is back in session!

As a parent, we’re sure you’re excited that the summer chaos, coordinating camps and activities, and simply having your children around 24/7 have ended!

As you know, going back to school typically means your child gets sick more frequently. So, how can you safeguard your child and the rest of your family’s wellness this back-to-school season?

Below are a few tips.

Stay Up-to-Date on Immunizations and Vaccines

Vaccination requirements typically vary on a state-by-state basis or even in a school-specific district. To find out precisely what immunizations your child needs, contact your local school board.

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a few specific vaccines based on your child’s age. These are as follows:

By Age Two

A vaccination series of the following vaccines should be completed in all children by age two:

  • Hepatitis B
  • DTaP (diphtheria, tetanus, and pertussis)
  • Hib (Haemophilus influenzae)
  • Polio
  • Pneumococcus
  • MMR (measles, mumps, rubella)
  • Varicella (protects against chicken pox)

In addition, annual flu vaccines are recommended for infants from six to 24 months, as this age group is at high risk of complications from contracting the flu.

Hepatitis A vaccines may also be recommended starting at age 2 for those in high-risk groups or areas.

Age Four to Six

Typically, boosters are recommended between ages four to six for DTaP, Polio, and MMR. Those who are younger than nine and have not received the flu vaccine, need two doses of the vaccine given more than one month apart. After age nine, annual vaccination is recommended.

Children with asthma or lung diseases, sickle cell anemia, HIV, diabetes, and heart or kidney disease should receive the influenza vaccination annually.

Age 11 to 12

At around age 11 to 12, a pediatrician visit is recommended to review vaccinations and ensure all necessary immunizations have been provided. At this age, a hepatitis B, MMR, or varicella vaccine may be given if missed or incomplete at earlier ages.

Your child may also receive a combination of boosters for tetanus and diphtheria (if five years have passed since the last Td vaccine). Children with a high risk of complications from the flu should receive an annual vaccine. 

Attend Annual Checkups

Annual doctor’s office visits and check-ups can help prevent greater health issues later on down the line. These check-ups can help identify hearing and vision issues, malnutrition, and other lifestyle imbalances.

Hearing and Vision Issues

Vision and hearing losses are often overlooked in children at a younger age. These issues are difficult to identify if your child is not getting tested in their annual check-up for vision and hearing ability.

Identifying these issues early on can make a huge impact on your child’s ability to learn and engage both in school and at home.

Malnutrition

A child’s development depends on proper nutrition, both physically and cognitively. Malnutrition is an issue that impacts children globally, including in the U.S.

Annual checks and doctor’s visits can help give you greater insight into how your child is developing compared to other children of the same age. A slight change in nutrition can have a huge impact on your child’s ability to learn.

Infographic for "Safeguard Your Family's Wellness This Back-to-School Season"

MEC Covered Services for Children

To make sure your child can receive the care they need to remain healthy during the school year, you need proper insurance coverage.

Minimum essential coverage (MEC) offers an affordable coverage option to keep you and your family healthy at all times.

Some of the services covered for children include:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Bilirubin concentration screening for newborns
  • Blood Pressure screening for children at 0-11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age three
  • Dyslipidemia screening for children at higher risk of lipid disorders at one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screen for all newborns; and for children once between 11 and 14 years, 15 and 17 years, and 18 and 21 years
  • Height, weight, and body mass index measurements for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years of age
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk.
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns

These services in combination with preventative measures taken at home can help keep your family and your children safe during the back-to-school influx of sickness.

Looking to start a family or grow your current family? Take a look at one of our recent articles to learn about pregnancy and minimum essential coverage.

During the COVID-19 pandemic, telehealth services, such as Zoom diagnoses, became a necessity. These phone and video calls help patients protect themselves and others by quarantining and remaining safely in their homes.

However, after years of visiting healthcare professionals in person, many patients can’t help but ask the question: Can a doctor really diagnose over Zoom?

The short answer: Yes, doctors can absolutely provide accurate diagnoses and medical assistance over a video call. Telemedicine services help patients receive the care they deserve at the right time and place.

Read on to learn more about how to utilize telehealth services. Let’s start with a definition.

First, What Are Telehealth Services?

Telehealth, also commonly referred to as common medicine, allows healthcare providers to connect with patients without an in-person visit. Telehealth services are provided primarily online or via smartphone through video chats or phone calls.

Why is the American Medical Association Maximizing Telemedicine Service Options?

The American Medical Association is working to maximize telemedicine service options to revolutionize healthcare. While the highly contagious nature of the COVID-19 virus drove this change, telehealth can help patients facing other medical issues or illnesses as well as those who may struggle to get to the doctor in person.

How Can Telehealth Help Patients Who Struggle Going to the Doctor?

Patients may struggle to attend in-person visits to the doctor for many reasons. For example, many patients may have difficulty getting time off work or may be responsible for watching children at home and find it challenging to find a sitter.

Additionally, telemedicine services can also help those who have had non-urgent medical care postponed due to the pandemic or patients whose medical resources are greatly limited in their area.

Patients should not have to receive less than the medical care they deserve because of these difficulties. Telehealth services allow patients to easily hop on a video visit and get the same results as going to the doctor.

So, How Exactly Does Telemedicine Work?

Drs. Francavilla Brown and Boyd told AMA that telemedicine “is easier than people think it is to incorporate into a practice.”

With technological advancements typically come progress and challenges. Physicians who have tried implementing telemedicine have identified these challenges, and have come up with a few solutions.

One challenge is patients may not have a good signal to support their doctor’s visit. The trouble with a weak signal may make the appointment longer, or impossible for someone who really needs it. Another challenge physicians have identified is booking appointments to be a televisit for doctor’s offices. The patient must call the office to ensure their appointment is virtual.

What Medical Issues Can Telehealth Services Best Help Patients With?

While telehealth services may not be the best option for detecting major issues, it has been great for reassessing and monitoring patients who have known problems. It can also be used to adjust medications, answer questions, and share information.

These services also help people avoid unnecessary hospital visits, which helps to give advice at a distance, save time, and reduce costs for both patients and doctors. Not only will it help avoid hospital visits when they aren’t necessary, but it will also give patients in the hospital the ability to discharge sooner by monitoring their vitals with telemedicine.

Looking for Telehealth Services?

Virtual visits with your doctor may begin to become the new normal in a post-COVID world. At Innovative HIA, we offer telemedicine services at competitive prices. Learn more about our services.

Infographic of "Can a Doctor Really Diagnose Over Zoom?"

Read on for the pros and cons of telemedicine.

The No Surprises Act (NSA) went into effect January 2022. This new law addresses surprise medical billing and requires new disclosures for employers, third party administrators (TPAs), brokers, and all participants in the healthcare industry including, but not limited to:

  • Hospitals
  • Hospital outpatient departments 
  • Ambulatory surgical centers  
  • Payors
  • Providers
  • Facilities 
  • Ancillary providers performing emergency and non-emergency services 

“[Surprise medical bills can] arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Surprise medical bills might also arise when a patient receives planned care from an in-network provider (often, a hospital or ambulatory care facility), but other treating providers brought in to participate in the patient’s care are not in the same network.  

These can include anesthesiologists, radiologists, pathologists, surgical assistants, and others.  In some cases, entire departments within an in-network facility may be operated by subcontractors who don’t participate in the same network.  In these non-emergency situations, too, the in-network provider or facility generally arranges for the other treating providers, not the patient.”*

*Surprise Medical Bills, Karen Pollitz (Mar. 17, 2016). 

Now, patients are federally protected against surprise billing for the following services: 

  • Emergency Services *not including ground ambulance* 
  • Post Emergency Stabilization services 
  • Non Emergency Services provided at in-network facilities 

What are the Implications of the No Surprises Act? 

The Consolidated Appropriations Act (CAA), 2021 made major changes in the way that group health plans are regulated and operated. The addition of the No Surprises Act of 2022 adds complex new rules aimed at protecting against surprise billing and beefs up overall group health plan transparency. The many provisions require that plans provide:

  • A robust online price comparison tool
  • Advance explanations of benefits (EOBs)
  • Report claims information to state “all-payer claims” databases
  • Improve the accuracy of plan provider directory information
  • Remove gag clauses in vendor contracts
  • Examine and document compliance with mental health and substance standards
  • Report on pharmacy costs.

In addition, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year. 

Collectively, these new rules impose potentially significant new regulatory and litigation risks on sponsors of group health plans. They also raise the standard for advisors who must keep their clients up to date on, and in compliance with, these new rules.

The new regulation takes the employee out of covering the cost of unexpected medical bills and puts processes in place for employers, insurers, and hospitals to resolve payment responsibilities for out-of-network medical bills. The goal of the No Surprises Act is to support individuals who receive emergency or needed medical services, but end up with a heavy medical bill that puts them in high unexpected debt. 

The new NSA regulations will create increased transparency in medical billing by providing coverage price lists, and potentially creating flat and/or set rates for medical services. The result of the NSA will be that insured individuals who receive medical treatment will not receive higher than expected bills for the treatments they are given. 

What Will the No Surprises Act Mean for Patients? 

Let’s frame the story: 

Andrew falls off the roof cleaning the gutters, the ambulance comes and takes him to the hospital where he is treated for emergency care by an anesthesiologist, a surgeon, and then, post-surgery receives rehabilitation care from a physical therapist.  The anesthesiologist is out of network, the surgeon is in-network and the PT is out of network. The hospital sends a bill to the insurer for $7,100.00.  

The insurer will have an agreed-upon contractual rate that is less than the billed amount, in this case, let’s set that at $4,600.00.  Andrew has insurance with a $1,000 deductible and a 20% co-pay, so he owes $1,720.00. The insurance pays the difference between Andrew’s responsibility and the agreed-upon amount (Contractual Rate) of $4,600.00, so the insurer pays the hospital $2,880.00.  

Before the NSA, the hospital would then bill Andrew not only the $1,720 of his deductible + 20% co-pay but also the additional $2,500.00 to make up the difference between their billed amount and the agreed-upon Plan Recognized amount of $4,600.00. This brings Andrew’s total payment burden to $4,220.00. 

The No Surprises Act would eliminate the ability for hospitals to collect the difference between the Plan Recognized amount and their higher bill.

 

What Does the No Surprises Act Mean For Employers? 

Employers should have monthly internal governance meetings to go over:

  • Health plans
  • Broker commissions
  • What plans cover
  • What the percentage of enrollment is
  • Every aspect of the health plan design 

Does the No Surprises Act Include Telehealth Services? 

In short, yes, the No Surprises Act does include telehealth services. Patients who see a healthcare provider through a telehealth visit are expected to be charged the in-network rate. 

The Covid-19 pandemic brought on greater demand for telehealth providers, especially in emergency services. As healthcare systems continue to lean on virtual patient services, providers must be aware of preset rates negotiated between insurance contracts and the healthcare network. 

Healthcare finance says it best, “Independent physician groups, which include telehealth docs, must now accept a rate that someone else has negotiated.”

Patients are protected from costly, unexpected fines, however, experts believe these new changes will result in cost shifts in other areas to account for funds. 

 

What are the Transparency in Coverage Requirements? 

CAA Section 114  dictates that insurance carriers and self-insured plans allow policyholders/participants to compare the amount of cost-sharing they would be responsible for paying for a particular medical item or service.  This tool is to be provided by phone or on a website. 

The Transparency in Coverage (TiC) Regulation permits policyholders/participants to request their cost-sharing liability for a particular medical item or service through an online tool or in paper form. 

Both of these requirements are in place to provide clarity around medical billing for insured individuals.

What does the No Surprises Act Mean for Insurers? 

The transparency in coverage requirements necessitate that group health plans and health insurance issuers in the group and individual markets disclose on a public website in 3 separate machine-readable files the following:

  1. In-Network Rates: Payment rates negotiated between plans or issuers and in-network providers (excluding information related to prescription drugs that are subject to a fee-for-service reimbursement arrangement [reported separately].
  2. Out of Network Billed Charges: Historical pricing information showing unique allowed amounts and billed charges for covered items and services furnished by out-of-network providers.
  3. Prescription Drugs: In-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level

These files must be updated monthly and must be made available without login, email, password, or other gated requirement to access the information.

What Does the No Surprises Act Mean For Brokers? 

Brokers must make sure they are fully informed about every aspect of the healthcare plans they are selling in order to comply with EOBs.  Additionally, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year.

What Does the No Surprises Act Mean For Plan Sponsors/ Employers?

Internally, increased governance requirements mirror those for 401ks as dictated by the 1974 ERISA Act.  Employers and plan sponsors will be required to have monthly internal governance meetings of their Boards to review plan coverage.  Plan sponsors must know what their plans cover, what their broker fees are and they must provide access to the price comparison tools offered online by insurers.  

These increased internal governance requirements place a burden on the employer/ plan sponsor to be knowledgeable about the coverage offered and create increased liability for failure to implement required internal governance structures, policies, and procedures. 

How Do I Prepare for the No Surprises Act? 

With the NSA in full effect as of January 1, 2022, employers, insurers, and brokers must prepare for its disclosure requirements, internal governance requirements, and adherence to these new, stricter standards. 

 

As you prepare for the new year, refresh your memory on why millions of Americans enrolled in health insurance this enrollment season, and what it means for you, here. 

 

Article originally published on SBMA Benefits.

New Year’s resolutions are known to fall by the wayside just as quickly as they begin. Old habits die hard. The exercise routines, juice cleanse, and promises of a healthier fresh start can easily be put on the backburner. In a recent study, researchers found that in 2022:

 

  • 26% of people planned to lose weight
  • 24% of people wanted to exercise more
  • 21% of people want to eat healthier 

 

No matter where you are on your health journey – you can still use your health insurance to meet your health goals. But how? It’s simpler than you’d think. Let’s dive in. 

MEC Coverage 

Minimum Essential Coverage (MEC) plans meet the minimum requirements for an insurance plan to be considered compliant with the Affordable Care Act (ACA). All applicable large employers (ALEs) with 50 or more full-time employees must offer 95% of their full-time employees ACA-compliant benefits. If they don’t provide this coverage, ALEs are liable for fines and penalties by the Internal Revenue Service (IRS). Read more here on why offering MEC benefits is more affordable than not.  

 

The three tiers of MEC options available are: 

 

  1. Standard MEC plans are ACA compliant and include coverage for wellness, preventative services, prescription discounts, and telehealth services. 
  2. Enhanced MEC plans take coverage one step further than standard plans and are aimed at attracting and retaining top talent by also including primary and urgent care visits with low copays, and discounted specialist and laboratory services. 
  3. The highest-level MEC plans include the enhanced MEC plan benefits along with added coverage such as prescription coverage and low copays. 


How To Use Health Insurance to Meet Health Goals

Your health insurance can lead you toward the right steps to keep yourself healthy. Preventative care can help keep you and your healthcare team ahead of potential chronic illnesses. Catching diagnoses such as high blood pressure, or other similar conditions early can help avoid them becoming more serious down the road.

 

By using your health insurance resources, you are actively using the tools readily available to you to meet your health goals. Let’s unpack how a basic MEC plan can help you achieve your health goals. 

 

Annual Physical 

One of the best ways you can support your health goals is by visiting your primary care provider annually. This appointment helps you consistently monitor your physical health year over year. During a physical, your healthcare provider will examine you to check for any underlying conditions you may not be aware of before they become more serious or potentially deadly. 

 

In a poll taken by Kaiser Health, 92% of Americans do believe in the importance of an annual physical, but only about 62% of Americans actually take advantage of their annual physical. 

 

If your healthcare provider identifies an issue during your visit, they can then help you identify the best course of action for treatment or refer you to a specialist. 

 

Vaccinations 

Routine vaccines are another great way to help your body stay healthy and strong against viruses and bacteria that cause illness. 

 

Vaccines help develop the body’s immunity and create stronger defenses to fight against disease. According to the CDC, “Every year thousands of adults in the U.S. become seriously ill and are hospitalized because of diseases that vaccines can help prevent.” 

 

Receiving your routine preventative and wellness vaccinations can:

 

  1. Lower your chance of getting certain diseases, like how the Hepatitis B vaccine lowers your risk of liver cancer 
  2. Lowers your odds of spreading disease to others 

 

Click here to see the CDC’s recommended vaccine schedule. 

 

Telehealth 

Virtual visits are a great way to speak with a healthcare professional to continue making the healthiest decisions for yourself. Seeking expert advice can help you know how to best care for yourself, and know when it is a good idea to see a physician in person. 

 

Having a telehealth visit before an in-person exam can help the healthcare provider prepare for your visit, and understand what you may need in case you do need to go into the office. It also reduces the time you take to physically go to the appointment, wait in the waiting room, and return home. 

 

Your health journey isn’t yours alone. Use resources like telehealth visits to maximize physician resources. 

 

For more information on how to make the most out of your telehealth visit, read our article here. 

 

Prescription Discounts  

Medication can be expensive. Let your health insurance support the cost of necessary medications that keep your body healthy and functioning properly. Using your insurance prescription discount can help save hundreds, if not more, dollars on medications that some may not be able to live without.

 

Certain providers may be able to offer generic options for brand-name drugs to save you money while still getting you the medications you need.

 

Screenings/ Bloodwork 

Take advantage of the screenings and bloodwork panels included in your preventative care and wellness insurance plans. These screenings and bloodwork exams were created for a reason– to flag any potential illness before it becomes an issue. 

 

The Bottom Line

Catching a chronic illness or disease before it becomes more difficult to manage is one of the best outcomes of preventative care. 

 

Use to resources that your health insurance offers to keep yourself healthy. Taking advantage of these preventative care services are small manageable opportunities for you to implement your New Year’s health resolution throughout the year.  

 

Looking for more information on minor medical coverage? Read our article here

health insurance can be used to meet health goals

Article originally published on SBMA Benefits.

Preventative care is the measure you take to prevent illness or disease before it grows into a more difficult problem. It can include:

  • Physical exams
  • Immunizations
  • Screenings

Preventative Care 

Encouraging preventative care benefits your company short and long term. When employees have access to resources to support their wellbeing, they are able to utilize them to continue on a healthier trajectory to be more present and engaging during day-to-day tasks.

If an employee uses the benefits and goes to their annual physical exam, they have a baseline of health. This results in employees becoming aware of chronic issues that need to be monitored. Physical exam visits are opportunities for your employee to ask their healthcare provider questions about their health, along with gaining tips on how to live a healthier lifestyle.

If said employee is diagnosed with high blood pressure at this office visit, their healthcare team will take preventative measures to ensure they stay healthy. If this same employee did not attend the preventative visit, the undiagnosed high blood pressure will continue to go unnoticed and could lead to a heart attack or stroke.

If your employee attends the visit and receives proper care, you have an employee who takes less sick leave down the line. On the other hand, if your employee was not encouraged to take preventative healthcare measures, they could end up suffering from a heart attack or stroke. This case ends up requiring your employee to take time off to heal and recover and less time at work. Preventative care increases overall productivity in the workplace.

Preventative care also covers immunizations and vaccinations like:

  • Influenza
  • COVID-19
  • Tdap

This promotes overall wellness for employees because they will be less susceptible to diseases and illnesses. This allows them to spend more time continuing the success of your business.

Around 50% of people without health insurance plans went to an annual physical. Without insurance, physicals can cost up to $300. Imagine half of your employees falling ill and needing to take leave due to worsening unseen underlying conditions.

Benefits for You 

Providing affordable healthcare for employees reduces the stress associated with healthcare, like expensive medical bills. Additionally, when employees and their families are healthy, they miss fewer workdays to tend to their medical conditions, resulting in overall increased productivity for your business.

Employees who are supported through covered preventative care gain access to resources that combat preventable illness and are more likely to be positive, engaged, and determined to do their best at their place of work.

Investing in your employees is a critical entity in the ongoing success of most businesses. Offering a comprehensive health plan to employees not only helps attract and retain talent but supports their general well-being.

Employees that are taken care of are more likely to invest themselves in your business. If you’re looking for a great health care benefits plan to offer your employees, look no further.

At Innovative HIA, our goal is to provide affordable health coverage to help keep your employees healthy and promote their overall well-being. If you’re interested in offering our benefits to your team, call or contact us today.

Navigating insurance policies can be challenging for anyone. There isn’t a way to predict the future, so how can you know what you will need? There are so many options available, how can you decide?

Voluntary benefits can help supplement insurance policies that may not cover all of your employees’ needs. There are many options when it comes to voluntary benefits with a few differences. What’s the difference between hospital indemnity policies and accident insurance? Here’s a breakdown.

Accident Insurance 

Accident insurance is an option to help supplement out-of-pocket expenses for potential expenses incurred when an accident occurs. This insurance is used to cover expenses that your standard health insurance plan cannot cover.

Typical medical insurance directly pays the medical provider, and you receive the bill later. Accident insurance, on the other hand, pays the cash directly to you, then you choose the best way to use that money.

What Exactly Does an Accident Insurance Policy Cover? 

There are quite a few expenses accident insurance covers that your traditional health insurance plan may not. These can include:

  • Emergency room visits
  • Ambulance rides
  • Helicopter transportation
  • Hospital admission charges
  • Diagnostic exams
  • Follow-up treatments
  • ICU and rehabilitation unit care
  • Physical therapy

Ambulance transportation can be extremely expensive. Investing in accident insurance could save you thousands of dollars.

Deductibles for many medical insurance plans can also cost thousands. Other insurance simply doesn’t cover hospital stays, ambulance rides, or other non-preventative care. Accident insurance can be a great backup plan.

How Much Does My Insurance Go Up After an Accident?  

Unlike claims filed for car insurance or homeowner’s insurance, the premiums on accident insurance do not increase after an accident or diagnosis of an illness. In other words, covering an ambulance ride with insurance will not impact the premium.

The Affordable Care Act (ACA), created in 2010, halted any insurers’ ability to adjust insurance rates due to medical history or gender.

Now, once you are insured, your premiums will not increase as a result of filing a claim. However, premiums increase steadily over time due to healthcare inflation, increased prescription costs, and rises in chronic illnesses. Many insurance policies implement a fixed annual rate increase that in no way is based on claims filed on accidents.

As Verywell Health explains, “the overall rates for everyone on the plan will typically go up from one year to the next, based on the total claims that were filed by everyone on the plan. But they’ll go up by the same percentage for people who filed big claims, people who filed small claims, and people who filed no claims at all.” Rates reflect the usage of the group, not the individual.

What is Hospital Indemnity Insurance? 

Hospital indemnity insurance is very similar to accident insurance. Whether you choose one over the other or get both will depend on your lifestyle, expenses, and savings. It is also used to supplement any expenses incurred outside of your health coverage.

Hospital indemnity insurance provides a set cash payment to use for any bills you need to pay. This is especially helpful for paying housing, bills, and living expenses if you are unable to work.

What Does Hospital Indemnity Insurance Cover? 

Hospital indemnity insurance coverage depends on the plan and coverage options you choose. Some things covered under a typical hospital indemnity plan include:

  • ICU stays
  • Critical care unit stays
  • Outpatient surgery
  • Continuous care
  • Outpatient x-rays
  • Laboratory procedures
  • Outpatient diagnostic imaging procedures
  • Ambulances
  • Emergency rooms
  • Physician office visits

Generally, hospital indemnity plans have lower premiums compared to other insurance, but depending on your coverage that can increase.

Is Hospital Indemnity Insurance Worth It? 

It’s important to consider your own personal health and wellbeing when deciding on purchasing hospital indemnity insurance. Since this insurance does not cover typical doctor’s visits or prescription medication, it really depends on you and your lifestyle.

Keep in mind:

  • Your personal health—are you or your family members more likely to be hospitalized?
  • What level of coverage does your current health insurance plan cover?
  • Are you financially able to cover unexpected health costs?
  • How much would a hospital indemnity plan cost over time vs. the cost of benefits received?

This plan may give you peace of mind, and the support you need during an unexpected accident. However, if the plan does not seem like something you need, or if you are able to cover the price of an emergency out-of-pocket, you may not need hospital indemnity insurance.

So, How Do You Decide Which Coverage to Invest in? 

The important distinction between the two types of insurance is how often you frequent the hospital. If you have hospital indemnity insurance and do not go to the hospital, you will not get paid benefits. However, accident insurance plans apply to both hospital stays and treatment from your primary care doctor. Consider a few things before you make your decisions.

Consider Your Lifestyle

Do you enjoy running, hiking, and other activities that may be more prone to accidents? Accident insurance might be your best choice.

Do you have kids who play sports or are constantly playing outside? Accident insurance may be for you. If you lead a relatively healthy, active lifestyle, accident insurance might be a better option for you.

If you have a chronic health issue or have dependents with chronic health issues, hospital indemnity insurance may be a better bet for you.

How Much Money Do You Need to Get By?

If you live alone or if you are a relatively young person with fewer financial responsibilities, accident insurance is a great option to ensure you are covered for whatever comes your way.

 

Sometimes, the best solution may be to have both coverage options. If you have children, own a home, own a car, and have other expenses, purchasing both will give you the best coverage.

Consider How Much You Have Saved for Emergencies

If you don’t have a large amount of savings, (e.g. enough to cover three months of expenses), a small monthly premium for accident insurance may make sense for you. On the other hand, if you have enough money to cover potential accident expenses or medical expenses, and support your lifestyle, but a large hospital bill might drain your savings, hospital indemnity insurance may be the smarter option.

Curious about other benefit plan options available to you? Read our article about voluntary affordable benefits here.

Article originally published on SBMA Benefits.