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248 Columbia Turnpike Florham Park, NJ 07932 Office: 973.845.6444 / Cell : 917.538.3905

248 Columbia Turnpike Florham Park, NJ 07932 Office: 973.845.6444 / Cell : 917.538.3905 Fax: 973.845.6466 www.sjpha.com sl@sjpha.com. Understanding Your Plan Types of Insurance.

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248 Columbia Turnpike Florham Park, NJ 07932 Office: 973.845.6444 / Cell : 917.538.3905

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  1. 248 Columbia Turnpike Florham Park, NJ 07932 Office: 973.845.6444 / Cell: 917.538.3905 Fax: 973.845.6466 www.sjpha.com sl@sjpha.com

  2. Understanding Your PlanTypes of Insurance 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  3. Understanding Your PlanTypes of Insurance 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  4. Is the plan fully-funded or self-funded?Fully Funded or Fully Insured Plan • Employer and Employee or stand-alone Individual pay monthly premiums to the insurer. • The insurer then pays for any medical treatment covered under the policy. • Regulated by state in which the plan is written. In NJ the governing agency is the Department of Banking and Insurance (DOBI) and in NY the governing agency is the Department of Financial Services (DFS). • Less flexibility to change or update what is and is not a covered benefit. • Plans tend to be for small employers and individuals. 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  5. Is the plan fully-funded or self-funded?Self Funded or Self Insured Plan • Employer and Employee pay monthly premiums to insurer. • Employer covers the cost of any claims for medical treatment. • Most self-funded plans are administered by a third-party administrator or insurance company that administers and processes claims for a fee. • Most self-funded plans buy protection called stop-loss and pay a premium so that if a predetermined threshold is crossed the insurer rather than employer assumes the risk. • Regulated by the Federal Employee Retirement Income Security Act (ERISA). • More flexibility to change or update what is and is not a covered benefit. • Plans tend to be for large corporations. 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  6. What are the plan exclusions and limitations? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  7. What are the plan exclusions and limitations? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  8. What are the plan exclusions and limitations? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  9. What are the deductibles & coinsurance amounts? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  10. What are the deductibles & coinsurance amounts? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  11. How does the plan reimburse?

  12. What does a proper invoice look like for out of network providers & how does this affect reimbursement?Refer to the HICF 1500 FORM

  13. Example 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  14. How are claims processed? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  15. How to file an appeal if specific services/treatments/procedures are denied? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  16. How to file an appeal if specific services/treatments/procedures are denied? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  17. How to file an appeal if specific services/treatments/procedures are denied? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  18. How to file an appeal if specific services/treatments/procedures are denied? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  19. How to file an appeal if specific services/treatments/procedures are denied? 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  20. NJ Autism Mandate 248 Columbia Turnpike - Florham Park, NJ 07932 - Office: 973.845.6444 / Cell: 917.538.3905 - Fax: 973.845.6466 www.sjpha.com / sl@sjpha.com

  21. 248 Columbia Turnpike Florham Park, NJ 07932 Office: 973.845.6444 / Cell: 917.538.3905 Fax: 973.845.6466 www.sjpha.com sl@sjpha.com

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