Q1. Who do I contact if I have further questions?

Our personalized benefits specialists are ready to help you! Call 315-437-9346

Q2. Can I switch to a different primary care physician?

Yes. You may switch to another primary care physician for any reason with any insurance plan. HMO’s are the only plans that require you to notify the insurance company when selecting your PCP or making a PCP switch.

Q3. Can I choose my own primary care physician?

You may choose your Primary Care Physician(PCP). However, it is important to choose a PCP that is in the provider network of your health insurance plan.

Q4. Is maternity / pregnancy covered?

Yes, all plans in New York State cover maternity and pregnancy. The fee is based upon the rates of your chosen plan. Delivery is covered under hospitalization and your contribution rates vary according to your chosen plan.

Is the baby covered when born?

If you enroll your baby within 30 days from the date of birth, then yes, the baby’s birth is covered. Your contribution costs vary according to your chosen plan and according to any special care that may be needed at birth.

Q5. What is the difference between a copayment plan and coinsurance?

Deductible and coinsurance usually go toward the annual out of pocket maximum. Once a subscriber has accumulated the annual out of pocket maximum amount, they will not be required to pay anymore deductible or coinsurance for the remainder of the calendar year. Some plans have an out of pocket maximum for the “plan” year; this could be different from the calendar year. The expenses the subscriber will have (for the remainder of the calendar year/or plan year) are monthly premiums & copays.

Q6. What is an annual out of pocket maxiumum?

Deductible and coinsurance usually go toward the annual out of pocket maximum. Once a subscriber has accumulated the annual out of pocket maximum amount, they will not be required to pay anymore deductible or coinsurance for the remainder of the calendar year. Some plans have an out of pocket maximum for the “plan” year; this could be different from the calendar year. The expenses the subscriber will have (for the remainder of the calendar year/or plan year) are monthly premiums & copays.

Q7. What type of physician is considered a primary care physician(PCP)?

-General Practice
-Family Practice
-Internal Medicine
-Pediatrician

Some insurance companies will accept an OB/GYN as a PCP

Q8. How do HSA's work for groups?

An HSA is a “Health Savings Account.” Groups that enroll in a high deductible plan with an HSA have the option of opening up an HSA account at the financial institution of their choice. An HSA enables employees and/or employers to set aside money for medically related expenses. There are tax advantages for both employees and employers when putting money into an HSA. If an employee leaves the business, the money in the Health Savings Account remains with the employee. For more information, please contact us.

Q9. What is the cost for a physical exam?

A physical would be the cost of a “preventative physical exam.” Additional costs may apply for any lab or imaging work.

Copyright 2016 by The Exchange Agency