Frequently Asked Questions

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Lifetime Financial Growth Benefits provides health insurance coverage in 50 states across the United States.

Copays are a fixed dollar amount paid for specific services, such as office visits or prescription medications.

• Misconception: Copays always apply toward meeting the deductible.
• Reality: Some copays count toward the out‑of‑pocket maximum but may not count toward the deductible, depending on the plan.

A deductible is the amount of money you or your dependents must pay toward a health claim before your organization’s health plan makes any payments for health care services rendered. For example, a plan participant with a $100 deductible would be required to pay the first $100, in total, of any claims during a plan year.

• Misconception: Many people think a deductible is the amount they pay at every appointment, or they’re unsure when it applies.
• Reality: The deductible is a yearly threshold. Once it’s met, covered services are typically shared through coinsurance or copays rather than paid entirely out of pocket.

On top of your deductible, coinsurance is a provision in your health plan that shows what percentage of a medical bill you pay and the percentage a health plan pays.

• Misconception: Insurance pays everything once the deductible is met.
• Reality: After meeting the deductible, costs are usually split. For example, with 20% coinsurance, the individual pays 20% of the allowed amount, and the plan pays 80%.

An OOPM is the maximum amount (deductible and coinsurance) that you will have to pay for covered expenses under a plan. Once the OOPM is reached the plan will cover eligible expenses at 100 percent.

• Misconception: There’s no limit to how much medical care might cost in a year.
• Reality: Once the out‑of‑pocket maximum is reached, the plan generally covers 100% of covered services for the rest of the year.
   

An EOB is a description your insurance carrier sends to you explaining the health care benefits that you received and the services for which your health care provider has requested payment. 

A PPO is a group of hospitals and physicians that contract on a fee-for-service basis with insurance companies to provide comprehensive medical service. If you have a PPO, your out-of-pocket costs may be lower than in a non-PPO plan. 

An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with a specified network. Premiums are paid monthly, and a small copay is due for each office visit and hospital stay. HMOs require that you select a primary care physician who is responsible for managing and coordinating all of your health care.  

HMO plans typically offer lower out-of-pocket costs, but require you to choose a primary care physician and get referrals for specialists. PPO plans offer more flexibility in choosing healthcare providers, but may have higher out-of-pocket costs.

Lifetime Financial Growth Benefits offers a range of health insurance plans such as HMO, PPO, EPO, POS plans, and level-funded and self-funded plans. They also have their own captive insurance plan.

An HDHP is a type of insurance plan that offers a low premium offset by a high deductible. Because of the low cost of the plan, the insurer will not cover most medical expenses until the deductible is met. As an exception, preventive care services are typically covered before the deductible is met. HDHPs are often designed to be compatible with health savings accounts (HSAs), which are tax-advantaged accounts that can be used to pay for qualified out-of-pocket medical expenses before the HDHP’s deductible is met. 

Receiving a bill doesn’t always mean something is wrong. Sometimes your provider sends a bill before your claim is fully processed. Other times, parts of your visit may be subject to a copay, deductible or coinsurance. It can also happen if the provider didn’t send the correct  information to the insurance company, or if the service isn’t fully covered under your plan. Many billing surprises come from coding, timing or benefit rules.

Preventive care is usually covered at 100%, but only when the visit is strictly preventive. If your provider adds services, such as additional labs, tests or treatment to treat a condition, the visit may be billed differently. While it is normal and often correct, there are other reasons you could still be charged. Charges can also happen if the provider or lab wasn’t in network or if the appointment wasn’t coded correctly. It’s best practice to check for errors or mistakes when you are charged. 

Even with an in-network provider, claims can be denied for several reasons. Some services need preauthorization, referrals or specific documentation. Your provider might be in network, but the lab, imaging center or facility they used may not be. Sometimes a claim is denied  simply because information was missing or the service isn’t covered under your specific plan.

Dependent coverage may end for several reasons, such as missing documentation, incomplete enrollment during open enrollment, timing requirements related to life events like marriage or birth, or dependents aging out under the plan. In some cases, dependents must be verified annually. While coverage lapses often relate to an administrative step that needs follow up, it’s important to note that under Affordable Care Act compliant plans, federal mandates do not require coverage beyond age 26 and allow coverage to end midyear, which can also explain why coverage ends unexpectedly. Some employer-sponsored plans cover individuals through the end of the month they turn 26; others, like Marketplace plans, continue coverage through the end of the year. In certain states, some plans are required to offer coverage to qualified dependents to a later age, such as 29 or 30, so age limit requirements vary.

Managing your employee benefits can involve several different contacts. Knowing who to reach out to can save time and frustration. Start with the option that best fits your situation: 

• Your insurance company—Contact your medical or prescription insurance carrier for questions about claims, coverage details, billing issues, prior authorizations or denied services. 

• Your voluntary benefits provider—Benefits like dental, vision, life or disability insurance are often offered through separate companies. Each provider has its own customer service team to help with coverage questions, claims, or payment issues related to those benefits. 

• Your HR or benefits team—Reach out to your HR or benefits team for help with enrollment, eligibility changes, required documentation or general guidance on how your benefits work. 

• Your health care provider—Your doctor’s office or health care provider is the best resource for questions about treatment plans, appointment scheduling, referrals or medical advice specific to your care.