What is the name of your health plan? Who’s your insurance carrier? If you had to look it up right now to check, you’re not alone; many people are not sure. If you don’t know the basics, you won’t be able to take full advantage of your benefits.

Health insurance is a tool—but only if you know how to use it. You don’t want to be like so many people out there who experience a health emergency and must deal with the stress of not understanding their health care coverage in a time of trauma.

Knowing your health plan matters

Surprise Bills

  • You may get a procedure for which you need pre-authorization, and did not know until you received an unexpected bill. This happens more often than you can imagine.
  • If you don’t know whether your provider is in-network or out-of-network, or how your plan covers care, you are more likely to pay out-of-pocket for services that should have been covered.

Miss Out on Preventive Services

  • Many plans offer 100% coverage for preventive services (such as mammograms, colonoscopies, and annual physicals), virtual visits, and wellness programs. But you can’t use benefits you don’t know you have.

You Can’t Advocate for Yourself Without the Basics

  • Here are just a few of the ways understanding your plan helps you:
    • Ask the right questions and go through the proper channels for care; reach out for help by calling your insurance provider
    • Spot billing errors
    • Take advantage of telehealth, HSA options, or mental health coverage (to name a few)

What You Need to Know – Today

At the very least, every health insurance subscriber should know:

  • Your carrier (the company providing your insurance, such as Anthem, Delta Dental, and VSP)
  • Your plan type (Health Maintenance Organization – HMO, Preferred Provider Organization – PPO, Exclusive Provider Organization – EPO, or Health Savings Account – HSA)
  • Whether your plan is individual, employer-sponsored, or part of an association

How to Find These Items Quickly

  • Check your insurance ID card – it typically lists the plan name and carrier
  • Log in to your carrier’s member portal (the website usually is on the ID card) – this is where you will find your plan documents, benefits, and provider network information
    • Download your carrier’s app and create an account so that you have access to your ID card at all times, as well as to your health and benefit information and plan summary (Summary of Benefits and Coverage – SBC)
  • Ask your HR or firm administrator if you’re part of an employer or association plan

Then, take a few minutes to review your SBC, as it outlines the services that are covered, excluded, and the pre-authorization requirements. It also helps you understand what your plan will cover and what you may need to pay out-of-pocket for. Knowing the basics gives you power as a healthcare consumer and enables you to become your own best advocate.

Please don’t wait for an emergency to try and understand your health plan; familiarizing yourself with it now is a smart way to save time, avoid stress, and ensure you get the most from your benefits.

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Created by CalCPA in 1959 as The Group Insurance Trust of the California Society of CPAs, CalCPA Health has remained steadfast in its mission to provide quality “boutique style” health care solutions—from medical, dental and vision to life and long-term disability—with unparalleled convenience and stability. It helps ensure that members can navigate the challenges of health care with confidence and peace of mind. CalCPA Health offers exclusive health and benefit plans to members, and there is a high level of trust knowing that these plans are operated by individuals who understand the unique needs of the profession – CalCPA members.

February marks Heart Health Awareness Month, a time dedicated to raising awareness about cardiovascular health and encouraging individuals to take proactive steps toward maintaining a healthy heart. Heart disease remains one of the leading causes of death globally, highlighting the importance of understanding how to care for our hearts. According to the Centers for Disease Control and Prevention (CDC), about 695,000 people died from heart disease in 2021 in the United States which is 1 in every 5 deaths. * This month we will look at some important aspects of heart health, risk factors for heart disease, and tips for maintaining a healthy heart. Read more

The Internal Revenue Service released the annual maximum 2024 contribution limits for HSAs under high deductible health plans (HDHPs). For 2024, we will see the largest jump in recent years for contribution limits – mainly due to continued high inflation. The annual limit on HSA contributions for an individual will be $4,150 (up from $3,850 in 2023) and $8,300 for family coverage (up from $7,750 in 2023).  HSA “catch-up” contribution for participants 55 and older, can contribute an extra $1,000 to their HSA, which is the current amount in place for 2023.

Effective January 1, 2024 – Contribution Limits for Health Savings Accounts

Tax Year Individual Coverage Limit Family Coverage Limit
2024 $4,150 $8,300
2023 $3,850 $7,750
2022 $3,650 $7,300
At age 55, members are allowed to contribute an additional $1,000 

What is a HSA? It is a tax-advantaged account, paired with a high-deductible health insurance plan (HDHP), that allows you to save pre-tax dollars for future qualified medical expenses. You can invest the funds in the HSA account tax-free and grow your savings. You own the account, it travels with you if you change jobs, change your health plan, or retire.

 

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The IRS has released the contribution limits for Health Savings Accounts (HSA) for 2023 and the numbers are significantly higher than in prior years, as you can see from the chart below. Knowing these numbers will help employers prepare for open enrollment and think about their contribution levels as well as help employees understand the benefits of contributing to their HSAs.

Tax Year Individual Coverage Limit Family Coverage Limit
2023 $3,850 $7,750
2022 $3,650 $7,300
2021 $3,600 $7,200
At age 55, members are allowed to contribute and additional $1,000 

What is a HSA? It is a tax-advantaged account, paired with a high-deductible health insurance plan (HDHP), that allows you to save pre-tax dollars for future qualified medical expenses. You can invest the funds in the HSA account tax-free and grow your savings. You own the account, it travels with you if you change jobs, change your health plan, or retire.

 

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The new California Law, SB 1375, was signed by Governor Brown on September 22, 2018 and will affect many small firm’s group health insurance. SB 1375 changes the Health Insurance Code to reclassify certain small employer groups as individuals. The affected firms will have to obtain individual health insurance in 2019, rather than the small employer group plans they currently have. Individual health insurance is typically more expensive with less provider network and benefit plan choices than small group plan offerings.

Fortunately, for CalCPA members and their firms, CalCPA Health received certain exemptions from SB 1375, which generally allows us to treat the affected firms as groups, and not as individuals. Commercial carriers (Blue Shield, UnitedHealthcare, Anthem, etc.,) must comply with the new regulations and reclassify these groups as individuals.

SB 1375 defines groups that consist entirely of owners/partners, and/or W-2 employees that are spouses of owner/partners, as not eligible for group health coverage. Even though these entities may be classified as employer/employees by other regulations, (e.g. Workers’ Comp, payroll tax, etc.,) SB 1375 specifically states they do not qualify for group health coverage and may only purchase individual plans.

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