BASIC INSURANCE Q&A’S
Health insurance is a list of medical benefits that an insurance company agrees to cover when you meet certain requirements. You pay a premium each week for this coverage; it is automatically deducted from your paycheck with The Ōnin Group. When you use the insurance, we will pay part or all of the costs based on your specific insurance contract, called a policy.
Health insurance helps to protect you from the high costs of medical procedures. In the past, US citizens were required to have basic coverage either through their employer, a private insurer or the government. If you did not have health insurance, you would be fined each year. In 2019, that has changed in most states around the country, and you will no longer be penalized. This means you won’t have to pay extra money for not having insurance. Insurance policies include some basic preventative benefits to help keep you healthy, and cover other conditions as well. The amount of coverage you have depends on the policy you pick.
A premium is the amount of money that is deducted from your paycheck each week to pay for your insurance plan. It is the fee you pay for the service, like your cable bill or Netflix. Basically, money is taken out of your check and we pay it to the insurance company for you.
A copay is what you pay when you go to the doctor’s office. The amount of this copay will vary based on the type of plan you choose. You will pay this each time you visit the doctor.
Coinsurance is the percentage of the bill you will have to pay when you go to the doctor. You will pay part and your insurance company will pay the rest. You will pay the coinsurance amount at the time of service or you will pay it when you receive it in the mail as a bill.
A deductible is the total amount you will have to pay for medical services before your insurance starts to help you pay for your medical expenses. Your deductible is based on the type of plan you choose. It is important that you pick a plan that has a deductible you can afford. Our Teammate/Medical MEC Plan is a no deductible plan, so the insurance company will immediately begin to help pay for your services.
A no deductible plan means you do not have to pay any money toward your medical bills before your insurance begins to help you pay.
- Deductible Plan: Jane’s deductible insurance plan requires her to spend $2,000 on medical services before insurance will help her pay.
- No Deductible Plan: Joe’s no deductible plan immediately helps him pay to visit a specialist even though Joe has not spent any money (except his premium) for health insurance so far this year.
Our Teammate/Medical MEC Plan can be used in the PHCS network. The Bronze Plan is used in the CIGNA network. To find the doctors and hospitals available in your area, call the Advocate line at 833-751-1096.
- If you choose the Teammate/Medical MEC Plan, it is best to add up the copays for each service you expect to use. You will only pay your copay costs instead of a high deductible amount first. This means your insurance will automatically begin helping to pay for your covered expenses. This is great, because many plans require you to pay thousands of dollars before insurance will help you pay for your medical expenses. If you only plan to work with Ōnin for a limited amount of time, this insurance plan is a great option, because you can immediately receive financial help from the insurance company for your medical expenses. That said, for the remaining estimation, you do not have a maximum out-of-pocket amount with this plan, so there is no limit to the amount of money you can spend on healthcare.
- If you choose the Bronze Plan, multiply the cost of your premiums by 52 weeks, then add your out-of-pocket maximum. This is the highest total amount you would have to pay in a year for your health insurance. That will cover your premiums, copays, coinsurance and deductibles. You may not reach your maximum in the year, but that is the MOST you would have to pay. However, often people do not meet their deductible amount or maximum out-of-pocket within a year, which is important to remember when selecting plan. If you need more information about this plan’s costs, call the Advocate line 833-751-1096.
Yes, you have the ability to opt-out of the insurance. You must do this yourself; Ōnin’s staff cannot do this for you.
You will need to call the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup to opt-out of or choose a different insurance plan. If you do not opt-out or choose a different plan, you will be automatically enrolled in the Teammate/Medical MEC individual plan.
For the Teammate/Medical MEC Plan, you do not have to pay any deductible. This is helpful for you because it means your insurance will automatically begin to help you pay for your healthcare bills that are covered by the plan. If think you may only work with Ōnin for a short period of time, this is a great option because you can immediately receive amazing prices on health services – including $5 prescriptions, free online or telephone unlimited visits with a doctor through our teledoctor program, and two $5 in-person visits with your doctor.
For the Bronze Plan, you must meet a deductible ($3,000 for a single person plan or $9,000 for a family plan) before insurance begins to help you pay your medical bills. This is a lot of money to spend before insurance begins to pay for your services, especially if you think you may only work with Ōnin for a short period of time, which is why we custom-built the Teammate/Medical MEC Plan.
Deductibles works like this: When you go to the doctor, you will be charged for the service you received in addition to your copay. Although some preventative services are free, most of the time you will get a bill for your visit. Once you’ve met your deductible, meaning you’ve spent the deductible amount ($3,000 for a single person and $9,000 for a family plan in the Bronze Plan) on your medical costs, the insurance company starts to pay part of the bills. You will still pay your copay, plus your part of the bill, which is called coinsurance.
Your maximum out-of-pocket refers to the total amount of money you have to pay for services covered by your insurance plan in a year. There are a few exceptions though. The maximum out-of-pocket does not include your premiums, balance-billed charges, healthcare costs not covered by the plan, or penalties for not pre-authorizing your service.
For instance, if your maximum out-of-pocket is $6,500 for a single person plan or $13,200 for a family plan, like in the Bronze Plan, you won’t have to pay for any more money on in-network services for the rest of the year, but you will still have your premiums deducted from your paycheck.
We offer plans for you, you and your spouse, you and your children, or you and your family (spouse and children). Who is covered by your policy will depend on the type of plan you pick. If you choose an individual plan, you will be the only person covered by the insurance and additional benefits, like the Vision Plan, MYidealDOCTOR and the Employee Assistance Plan. However, if you choose other coverage, this can include your legal spouse, and children for which you are legally responsible who are under the age of 26, who live with you or who attend school.
You will start paying your premium (the amount of money taken out of your paycheck each week) the first pay period after you have reached your 30 days of working with Ōnin. At this point, you can begin using your insurance policy and you will receive an insurance card in the mail. If you do not sign up for the insurance plan of your choice or opt-out, you will be automatically enrolled in the Teammate/Medical MEC individual plan.
There are three ways to change your coverage once you have signed up for insurance with Ōnin:
- Open Enrollment – every year around November, we allow our Teammates who have worked 30 days, or more, to change their health insurance coverage. You will be notified through the Teammates App, mail and with signs in our offices. Be sure you make changes during this time.
- A Life Changing Event – there are a few specific situations that happen in life where the government allows us to make changes to your insurance policy outside of open enrollment. These events include: marriage, birth or adoption of a child, death, divorce, gaining/losing coverage through a spouse’s employment or turning 26-years-old. If you experience one of these events call the Enrollment Assistance line at 833-236-7463.
- Ending Employment with Ōnin – if you are out of an assignment for more than 13 weeks, your insurance coverage will be cancelled. We will be able to start a new policy for you on your first pay period 30 days after you begin working with Ōnin again.
Previously, under the Affordable Care Act, all US citizens were required to have qualifying healthcare coverage. If you did not have coverage, you could be penalized with fines. Our insurance plans are designed to meet these requirements. In 2019, the federal individual penalty will no longer be fined when you file taxes in 2020. In other words, in 2019, you will not be required by federal the government to have health insurance. Some states may still have their own penalties, so check what your state requires.
The prescription coverage will vary based on the type of medicine you take and the plan you choose. Under the Teammate/Medical MEC Plan, generic prescriptions are $5.00. Under the Bronze Plan, generic prescriptions are $15.00. All prices are based on a 30-day prescription. For specific questions about other medications, please call the Advocate line at 833-751-1096.
- If you sign up for benefits for the first time with Ōnin: Your effective date is the pay period following 30 days after you started working for Ōnin.
- If you had medical benefits with Ōnin through the end of 2018: Your new medical plan starts at the beginning of the year, in January 2019.
Once you have insurance through Ōnin, we are unable to cancel your policy unless you have a qualifying life event (like marriage or birth of a new child), your assignment is ended for 13 weeks or you stop working with Ōnin. If you quit working at Ōnin, you are fired from Ōnin or you are hired permanently by a company, your insurance policy will be cancelled.
No. As an Ōnin Teammate, you are required to enroll in a medical insurance plan to enroll in a dental insurance plan with us.
No. In order to get Ōnin vision insurance, you must be signed up for Ōnin’s Teammate/Medical MEC Plan or Ōnin’s Bronze Plan.
You must be employed with Ōnin for 30 days from your start date. When you have reached the pay period following 30 days of hire, you will receive an insurance card in the mail five to seven business days later. If you do not receive this card, call the Advocate line (833-751-1096) for help.
The Teammate/Medical MEC was custom-built for our Teammates’ needs. The plan offers more comprehensive coverage for our Teammates and their families. It provides copays starting at $5.00, plus there is no deductible with this plan, meaning your insurance will immediately help you pay for your doctor’s visits. It also includes our teledoctor service, EAP benefits and the Vision Plan at no extra cost. If you think your medical costs will be less than $6,500 for yourself or $13,200 for your family, this plan may be a good option.
The Bronze Plan has a high deductible. In other words, you will have to pay $3,000 with an individual plan or $9,000 with a family plan before your insurance starts to help pay your medical bills. It offers basic coverage and preventative health screenings. It includes our teledoctor service, EAP benefits and Vision Plan at no extra cost. This plan provides a maximum-out-of-pocket of $6,500 for the individual plan and $13,200 for the family plan. If you expect your medical expenses to cost more than these amounts during your time at Ōnin, this plan may be a good option.
Enrolling your spouse or dependents into your insurance is a personal decision. We have custom-built our plans to be affordable and usable for our Teammates and their families. However, we encourage you to compare Ōnin’s insurance benefits with your husband or wife’s plan to see which offer is best for you and your family. If your spouse has a health insurance plan which works better for your needs, you can choose that plan and call the Enrollment Assistance line at 833-236-7463 to opt-out of automatic enrollment for the Teammate/Medical MEC Plan.
We have representatives available to help you with all of your questions. Call the Enrollment Assistance line at 833-236-7463 if you are not currently enrolled in Ōnin benefits and have questions. If you are currently enrolled in an Ōnin benefits plan, call the the Advocate line at 833-751-1096. It is important to us that you understand how to use your insurance and make it work best for you.
It can be frustrating and scary when medical bills are coming in and not paid as you thought they would be. There can be many reasons for this, from coding errors to non-qualified services. Please call the Advocate line at 833-751-1096 and a representative will help you with your concerns.
You must call us at the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup before you have worked with Ōnin for 30 days from your start date to let us know you do not want the health insurance. If you do not call this number or visit the site, you will be enrolled in the Teammate/Medical MEC single plan and will not be able to cancel or change it until open enrollment in November of next year unless you have a major life event.
If you want the Teammate/Medical MEC Plan for a single person, you don’t have to take any action. You will automatically be enrolled after 30 days. If you want to add other family members, add dental insurance, pick the Bronze Plan, or opt-out of the plan, you will need to call us the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup to make those changes before 30 days after you are hired. Unfortunately, the branch cannot do this for you, so you must call the Enrollment Assistance line or visit the website to make your selection.