The New Fully Insured HRA “Two Card” Health Insurance Program Works. And. High Deductible Major Medical Plan. The employer purchases 2 insurance policies that work together to provide employees great medical health insurance benefits.
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“Two Card”Health Insurance Program Works
Major Medical Plan
The major medical insurance program has a large deductible. That’s the amount you are responsible for before major medical begins paying benefits.
Whenever you use medical services, which apply to the deductible or co-insurance, you Present BOTH Cards. There is a toll free 800 number on each card for medical providers to call to answer any billing questions
The Premium Saver Insured HRA Plan covers the same expenses as the major medical plan except for the professional fee in a doctor’s office or medical clinic or outpatient prescription drugs. If you have a copay requirement on your major medical plan, you’ll still have to pay those at the time of service.
The employee portion will be the Premium Saver deductible and coinsurance that the Employer elects.
In the mail, you will receive what’s called an “explanation of benefits” or “EOB” from your Major Medical plan AND the Administrator of the Premium Saver plan.
Most medical providers will send a copy of your bill and your EOB to the administrator for you. The administrator will process both documents to determine the amount of deductible or coinsurance you may owe.
The EOB from the administrator informs you the deductible or coinsurance amount you may owe. It should match your final bill from your medical provider. You pay that amount to your medical provider as your deductible or coinsurance responsibility.
THIS POLICY PROVIDES SUPPLEMENTAL COVERAGE.Policy Form SLIC-GAP-P(0405)
The policy contains exclusions and limitations.
For a complete description of the terms and conditions, please contact your insurance agent.