When you visit an out-of-network dental provider, you may need to pay for expenses that exceed the allowable charges.
This is also known as the “member responsibility” portion of your bill. It’s the amount you pay each calendar year before the coinsurance applies.
The amount you spend for covered medical expenses (including the deductible and prescription drugs) within a plan year is capped at this amount. After you reach the out-of-pocket maximum, the Plan reimburses 100% of eligible covered charges for the rest of that year.
This is the percentage of covered charges the Plan pays after you meet the annual deductible.
An HSA is a tax-advantaged account funded by a contribution from Givaudan and pre-tax contributions from you. Your HSA balance can be used to pay for eligible medical, prescription drug, dental and vision expenses now or in the future – even in retirement.
“Precertification” is designed to help you avoid unnecessary or prolonged hospital stays, along with related costs. Qualified health care professionals will carefully review your condition and the recommended treatment to ensure you get the most appropriate and cost-effective care.
The precertification phone number is on your Medical ID card. You must call to precertify any out-of-network hospitalization. If you don’t call to precertify your stay prior to the date of admission, you’ll be responsible for paying 50% of expenses that otherwise would have been covered by the Plan, up to a maximum penalty of $500. Once you’re hospitalized, any hospitalization beyond the number of days originally precertified must also be precertified by the insurance company.
Annual screenings that are determined to be appropriate, per your primary care provider’s recommendation, and within the guidelines of the American Medical Association for a patient’s age and gender are considered to be preventive care. Most in-network services within this category are covered at 100% by the medical plan. The purpose of these evaluations is to obtain vital health markers that present a picture of a patient’s overall well-being in an effort to avoid chronic or critical health conditions.
The Open Enrollment period is the only time you are permitted to make changes to your coverage unless you experience a qualifying life event (QLE) that changes your status, such as birth or adoption of a child, marriage, legal separation, divorce, or a change in your spouse’s employment status.
If you experience a QLE, visit the Givaudan benefits portal and find out what changes you may make. Changes must be made within 31 days of the event. If you miss the 31-day deadline, you’ll have to wait until the next Open Enrollment period to make a change in your coverage.
Adding a newborn? Don’t wait for your child’s birth certificate to be issued to notify us. Make the change online within the 31-day period and send the Benefits Department a copy of your baby’s footprints or ID card from the hospital. Then send in the baby’s birth certificate and update the Social Security number as soon as you receive them.
“R&C” refers to the typical or expected charges for a dental service within a specific geographic area. Insurance companies use this standard to determine how much they will reimburse for out-of-network services, ensuring that costs are not significantly higher than what is generally charged by other providers in a certain location.
See a board-certified doctor anytime using your computer, tablet or mobile phone through the UnitedHealthcare telemedicine network.
