What Happens if I am Terminated, Get Married or Divorced or Die?
Following certain life events, such as divorce or death of an employee and certain other events, or termination of employment, federal law (COBRA) and State law (Cal-COBRA) allow the employee to continue or add coverage for a spouse. COBRA covers groups of 20 employees or more and Cal-COBRA generally covers groups with 2 - 19 employees. Cal-COBRA only applies to companies headquartered in California. The initial period of coverage under both laws lasts for up to 18 months. Cal-COBRA coverage may be extended for an additional 18 months for any California headquartered company, regardless of size. COBRA and Cal-COBRA are technical laws and you should speak with your COBRA administrator for more information. Generally, COBRA and Cal-COBRA coverage is fairly expensive as the employee is paying the entire premium. When an insurable employee terminates employment, he or she may seek individual coverage at a lower cost.
What is a PPO Plan and How Does it Work?
"A preferred provider plan (PPO plan) gives you freedom of choice of medical providers, including physicians, hospitals and medical laboratories. If you have a PPO plan, you do not need a referral from a primary care physician to see a specialist.
Network Provider vs. Non-Network Provider
Under a PPO plan, a health care provider who contracts with an insurance company to provide services to subscribers of the company's plans at negotiated rates (the fee schedule) is called a network provider. Any provider who has not contracted with an insurance company is called a non-network provider.
What is the Deductible?
The deductible is an amount that you will pay out-of-pocket for medical expenses before the insurance company will make any payment for medical services. The insurance company will credit your medical expenses at the network negotiated rate against the deductible amount before it will pay any amount to a medical provider. Some...