Health Insurance

Since the implementation of the Affordable Care act the rules governing health insurance have been significantly changed. The  Affordable Care mandates 10 minimum Essential Benefits. You can qualify for the government to subsidize a portion of your health care payments. Those subsidies have a cost sharing aspect that reduce co-payments and coinsurance. Edward Financial  Group specializes in on and off market place plans including Short Term medical, hospital indemnity, dental and vision. The array of different plans that are offered should be determined in consultation with a professional. Give us a call to review your specific situation today!

ACA (Affordable Care Act) 10 Essential Benefits

• Ambulatory Patient Services this is things such as regular doctor visits, out patient services and Home health services.
• Emergency Services such as accidents sudden illness that if left untreated will result in death or disability. These instances cannot be penalized for going outside your network and you don't need pre-authorization.
• Inpatient Care (Hospitalization) this covers any charges from a hospital stay from labs to prescription drugs as well as any doctors nurses or specialists during the stay.
• Maturity which is care a women receives during child birth
• Mental health services and addiction treatment this include any outpatient or inpatient care including any psychotherapy, counseling or behavioral treatment( Plans can be limited to 20 days)

ACA (Affordable Care Act) 10 Essential Benefits (Cont'd)

• Prescription drugs Coverage for each of the federally mandated categories there has to be a drug available. The companies can place limits on this benefit. If a drug is more expensive the plan may only cover a less expensive alternative. If there is a generic available the plan may only cover the generic. Very expensive drugs may require a doctors approval and  may be required to try a cheaper alternative before it will be approved.
• Laboratory Services which are test provided by the doctor to diagnose or treat and injury or ailment. Some of these test are provided free of charge like breast and prostate exams.
• Preventative services are covered with no co payments or deductibles. Chronic management
• Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.