Frequently Asked Questions
What is a Preferred Provider Organization (PPO)?
A Preferred Provider Organization (PPO) is a network of providers and
hospitals that offers services at discounted rates. The PPO pays most
expenses after you pay your required deductible, coinsurance and/or any
copayments.
The plan usually has an out-of-pocket feature. With this, once you have
paid the maximum amount, the plan pays any following allowable claim at
100 percent. Under the PPO, network and non-network providers are available.
However, when you receive your medical care from network providers, the
plan pays a greater percentage of covered expenses. If you use non-network
providers, the plan pays a lower percentage of usual, customary and reasonable
charges.
What is a copay?
A copay or copayment is a set charge you must pay before receiving a service
such as a doctor's appointment. For example, you may be required to pay
a $15 copay to see your general practitioner or a $25 copay for a specialist.
What is a deductible?
A deductible is a set annual amount you must pay before a plan pays for
some services. For example, you may be required to pay a $250 deductible
before an inpatient surgery. Services such as an office visit do not require
you to satisfy the deductible.
What is coinsurance?
Coinsurance is a set percentage you pay for a service after you pay your
deductible. Once you pay your percentage of the cost, the plan pays the
remainder. For example, you select a network physician for an exam. The
exam costs $100. Because the plan pays 70%, you pay $30.
What is an out-of-pocket maximum?
The maximum amount (of coinsurance) you will pay for the year. This usually
does not include deductibles.
When am I eligible for benefits?
Only full-time associates, who have worked for Holsum Bakery for at least
90 days, are eligible for healthcare benefits.
What if I decline coverage?
You have the option to waive any benefits offered to you by Holsum Bakery.
You may enroll at a later time if you have a qualifying event, however,
you may face penalties such as waiting periods or need to show proof of
insurability.
What is AD&D insurance?
Accidental death and dismemberment insurance pays you or your beneficiary
a benefit if you are injured or die in an accident. The plan pays varying
amounts depending on the injury. For example, the full benefit is paid
if you die in an accident. If you lose a hand or a foot, 50% of the full
benefit is paid.
What is Holsum Bakery's Open Enrollment (Admin Plan Only)?
Holsum's Open Enrollment occurs once a year. During this time you have
the opportunity to enroll yourself or your dependents for benefits. You
can also change your coverage for yourself or your dependents.
If you decline to enroll in health benefits during Holsum's Open Enrollment,
you will have to wait until the next enrollment.
What is a pre-existing limitation?
Typically, a condition is considered pre-existing if you had incurred
expenses or received a diagnosis for an injury or sickness within six
months before your enrollment date - the date you first begin your waiting
period. The pre-existing condition provision usually does not apply to
newborn infants, adopted children or pregnancy-related care. Additionally,
the pre-existing condition does not apply if you have proof that you were
covered by group insurance no more than 63 days before you become eligible
for Holsum's benefits.
What if I get married or have a baby?
If you get married or have a baby, it is considered a qualified life event.
You may enroll your spouse, dependent or drop coverage within 30 days
of the event. To learn more about life events see the Qualified
Life Event section on this Web site.
What do I do if I changed my address or telephone number?
If you recently moved, complete the Change of Address
form and submit it to the Associate Services Department. You may also
call the Associate's Services Department.