Dynamic Work/Life Solutions Blog

Zika Virus

Posted by Blog Tipster on Fri, Dec 30, 2016 @ 03:30 PM


Looking back on 2016, the Zika Virus was certainly a hot, yet troublesome, topic.  Unfortunately, Zika is still a concern and since there are so many questions surrounding the virus, eni’s BalanceCare Guides wanted to provide our members with a few important FAQs.

What is the Zika virus?

Zika is a mosquito borne illness. Its name is derived from the Zika Forest of Uganda where the virus was first isolated in 1947. 

How is it spread?

  • Mosquito bites
  • From a pregnant woman to her fetus
  • Sex
  • Blood transfusions
  • If the virus continues to spread, additional methods may be added to this list

What are the symptoms?

Many people who contract the Zika Virus won’t have any symptoms.  However, the most common symptoms include:

  • Fever
  • Rash
  • Joint pain
  • Conjunctivitis (red eyes)
  • Muscle pain
  • Headache

Symptoms can last for several days up to a week. Once a person is infected with Zika, they are likely to be protected from future infections.

Why is it dangerous?

If you contract the Zika Virus while pregnant, it can cause birth defects such as microcephaly, defects of the eye, hearing and impaired growth.

How can you prevent Zika?

Although there is no vaccine to prevent Zika, there are several things you can do to protect yourself from getting bitten by any type of mosquito:

  • Wear long sleeved shirts, long pants, hats, and socks.
  • Treat clothing and gear with permethrin or buy pre-treated items. Permethrin is a medication and chemical used as an insecticide. Permethrin is a cream or spray which can be purchased over the counter at your local drug or department store.
  • Use insect repellent with one of the following ingredients:
    • DEET
    • Picaridin
    • IR3535
    • Oil of lemon eucalyptus
    • Para-menthane-diol

These are safe for pregnant and breastfeeding women when used as directed.

*DO NOT use insect repellents on babies younger than 2 months old*

*DO NOT use oil of lemon eucalyptus or para-menthane-diol on children younger than 3 years old*

While at home:

  • Stay in air conditioned places.
  • Use screens in windows and doors to keep mosquitoes outside.
  • Use mosquito netting to cover babies under 2 months old in carriers, strollers, and cribs.
  • Sleep under a mosquito bed net if sleeping outdoors.
  • Prevent sexual transmission by using condoms or abstaining from sex.
  • Avoid places where mosquitoes are breeding, such as swamps.
  • Get rid of water containers to eliminate mosquitoes’ breeding sites.

How Zika is diagnosed

  • Diagnosis is based on person’s recent travel history, symptoms, and test results
  • Blood or urine test
  • Tests may be used to rule out other infections

If you have Zika

  • Get plenty of rest
  • Drink lots of fluids to prevent dehydration
  • Take fever and pain reducer
  • DO NOT take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
  • If you’re taking medicine for another condition, talk to your healthcare provider before taking additional medication


Before you travel, check the CDC travel advisory list which is frequently updated. If pregnant or thinking about becoming pregnant, check with your healthcare provider and follow their advice.

Since Zika infections in the United States are relatively new, the implications for the medical insurance community is still a bit of an unknown.  If our members do have any questions, please call BalanceCare and we can get answers for you.



Centers for Disease Control and Prevention


Tags: Health Insurance, Health Advocacy, Zika, Zika Virus


Posted by Blog Tipster on Wed, Feb 17, 2016 @ 03:51 PM


There are a wide variety of vaccines available to help prevent illness.  Some vaccines are required for children to enter school, but others are completely voluntary and it is up to the individual and their doctor to decide if the vaccine is right for them.  In this article, eni’s Health Advocates will review two common vaccines.

Pneumococcal Conjugate Vaccine (PCV13):

Pneumococcal disease is caused by bacteria and is spread from person to person with close contact. It can cause ear infections, and can lead to more serious illnesses such as pneumonia, bacteremia or meningitis.

Approximately 18,000 older adults die of pneumococcal disease each year in the United States alone.  Children under 2 years of age, adults 65 and older, people with certain medical conditions and smokers are at greater risk for pneumococcal  pneumonia.

Pneumococcal meningitis is most common among adults and can cause deafness and brain damage.

The PCV13 vaccine protects against 13 types of pneumococcal bacteria. For children, the vaccine is given at 2, 4, 6, and 12-15 months of age. Older children and adults with certain health conditions are encouraged to get the vaccine as well.

People who have ever had an allergic reaction to earlier versions of this vaccine (PCV7), or DTaP, or any of its components should not get the PCV13 vaccine.

If you’re scheduled for the vaccine and aren’t feeling well on that day, you and your provider may want to reschedule it for when you’re feeling better.

For children, reactions range from mild fever to drowsiness.  Adults may experience site pain, redness and swelling. Any serious reactions should be reported to your provider.

Shingles Vaccine:

Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. After the virus becomes active again, it can only cause shingles, not chickenpox.

You can't catch shingles from someone else who has shingles. However, there is a small chance that a person with a shingles rash can spread the virus to another person who hasn't had chickenpox and who hasn't gotten the chickenpox vaccine.

Shingles may start as unusual pain or tingling in one location on one side of the body. This area may be sensitive to touch.  A red rash then leads to fluid-filled blisters that wrap around either the left or right side of the torso. It can also appear around one eye or one side of the face or neck.

The shingles vaccine is almost 70% effective for those 50-59 years of age and 51% effective for those 60-69 years of age.  The current shingles vaccine offers protection for about 8 years.  A new vaccine which may be effective longer is currently being tested.

As always, check with your provider to see if he recommends either vaccine.

Some vaccines have age requirements and some insurance companies won’t pay for certain vaccines without a prescription.  BalanceCare is available to assist our members with determining if your insurance will pay for these vaccines and help you navigate the complexities of your healthcare.



US Department of Health and Human Services, Centers for Disease Control and Prevention


AARP Bulletin, November 2015


Tags: Health Insurance, Health Care, Health Advocacy, vaccines

2016 Changes to Minimum Essential Coverage

Posted by Blog Tipster on Wed, Dec 09, 2015 @ 04:33 PM


eni’s Health Advocates explain the 2016 changes to Minimum Essential Coverage under the Affordable Care Act:

Small companies are considered those with less than 100 employees (this was formerly 50 employees).

Pediatric coverage is provided to the enrollee until the end of the month in which they turn 19, which aligns with current industry practice.

Drug formularies must be published by insurance companies in a readable format so third parties can create resources that aggregate information on different plans. These formularies must be up-to-date, accurate and have a complete list of all covered drugs including any tiering structure and any restrictions on the manner in which the drug can be obtained. They also must be in a manner that is easily accessible to plan enrollees, prospective enrollees, the state, the Marketplace, HHS, OPM, and the general public.

Insurers must have a process so the enrollee can request and obtain medications not on the formulary.  Decisions must be made within 72 hours of the request. There are detailed procedures for the standard review process and a requirement that insurers have a process in place so an enrollee can request an independent review if the health plan denies an internal request made on a standard or expedited basis.   Cost sharing for such medications must count towards the annual limitation on cost sharing for health plans subject to the EHB requirement.

Most medications need to be available through network retail pharmacies instead of only through mail order. Mail order discounts can still be applied.

Most or all medications for specific conditions cannot be placed on a higher tier level.

Insurers cannot restrict services based on age when services are appropriate for all ages.

Insurers must provide telephonic interpreter services for 15 languages and critical documents must be available in languages spoken by at least 10% of the state’s population.

Provider directories must be up-to-date, accurate, complete, and include which providers are accepting new patients. These must be accessible to plan enrollees, prospective enrollees, the state, Marketplace, HHS, and OPM.

Directories must be easily accessible on a public website through a clearly identifiable link or tab without having to register or create an account or enter a policy number.  Insurers must update directory information at least monthly.

Habilitative services have increased to include health services and devices that help a person keep, learn , or improve skills and functioning for daily living.  These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities.

Insurers will no longer be able to define habilitative services themselves.  They cannot impose limits on services and devices that are less favorable than those they impose on rehabilitative services. As of January 1, 2017, insurers will be prohibited from imposing combined limits on both habilitative and rehabilitative services but must treat them separately.

 eni’s Health Advocates are available to help our members navigate the complexities of the healthcare system.


Final HHS Notice of Benefit and Payment Parameters for 2016

Tags: Health Care, Affordable Care Act, Health Advocacy, Minimum Essential Coverage

Dental Insurance FAQs

Posted by Blog Tipster on Wed, Oct 07, 2015 @ 04:40 PM

eni’s BalanceCare Guides answer many questions regarding dental coverage, usually after dental care is received. Many times, callers have received a large dental bill for services they thought would be covered.

When accessing your dental benefit, it helps to be aware of the following:

Like medical policies, you may have a choice of a DMO policy (dental HMO) or PPO policy. DMO policies have a limited network of dentists whereas PPOs have a broader network of dentists to choose from. PPO plans may also give you an option of using out-of-network dentists.  Out-of-network dentists are paid at a lower percentage and aren’t contracted to accept what the insurance company pays.  This means you will probably be billed for the difference between the dentist’s billed amount and what the insurance company pays.

Deductibles are applied to basic and major services but not routine services.

Most policies cover 2 annual checkups, cleanings, and x-rays at 100%.  Periodontal cleanings are included in the annual number of checkups and aren’t considered separately.  If you change insurance companies, checkups still need to be spaced out by a minimum of 6 months.

Insurance companies categorize services as routine, basic, and major.  Your policy will indicate what services are covered under each category.   

Most dental policies have an annual maximum of $1,000.00 or $1,500.00. You are responsible for paying for any costs above that amount.

Waiting periods are the time required before benefits can be paid.  It’s usually 1 year from your policy effective date.  The waiting period resets every time you change insurance companies. This prevents insurance companies from paying for some basic and major services even if your dentist tells you it’s an emergency.

A note about the missing tooth clause.  Benefits are not payable to replace a tooth that was extracted prior to having dental coverage under your present policy.

If you are having major work done on your teeth, it’s always good practice to have the dentist get a pre-treatment estimate from your dental carrier.  A pre-treatment estimate from your dental carrier is different from the estimate your dentist gives you. The estimate from your insurance carrier lets you know in advance what’s covered and the amount you’ll be responsible for.

If pediatric dental coverage is imbedded with the plan, this usually covers fluoride treatments and orthodontia (only if it’s medically necessary) as well as cleanings, x-rays, and fillings.  Pediatric coverage is for dependents 19 years of age or under. 

eni’s BalanceCare  Guides are available to answer our member’s dental questions!

Tags: Health Advocacy

Choosing Between Insurance Plans

Posted by Melissa Mayfield on Wed, Jun 17, 2015 @ 11:16 AM


With healthcare being so expensive, it’s important that you choose the right type of plan for your medical needs. 

HMO - Health Maintenance Organizations

This type of plan gives member access to certain doctors and hospitals within network. Providers agree to lower their rates for plan members and also meet quality standards. Care is only covered if you see providers within that network.  Other restrictions include allowing a certain number of visits, tests or treatments.

HMO Features:

  • Required to select a primary care physician (PCP) who determines the treatment you need
  • PCP referral is needed to see a specialist or to have medical tests performed
  • No coverage for out of network providers, meaning the member is responsible for the entire cost out of network
  • Premiums are generally lower and some plans have no or low deductibles

PPO – Preferred Provider Organizations

This type of plan offers flexibility when choosing a doctor or hospital.  Members can see non-network doctors but reimbursement is at a lower rate.

PPO Features:

  • No referral is needed
  • Premiums are higher and there is a deductible

PPO plans give you flexibility. You don’t need to select a primary care physician. You can go to any health care professional you want without a referral - inside or outside of your network.  Staying inside your network means smaller co-pays and full coverage. If you choose to go outside your network, you will have higher out-of-pocket costs and not all services may be covered.

**If you have a choice between these two types of plans, consider your medical needs, availability of in-network providers in your area, and your income. If you’re looking at an HMO, take a close look at the network to determine if the choice of doctors and medical facilities are enough to meet your needs. A PPO gives you more freedom, including the potential to be covered for medical bills outside the network, but your costs may be higher.

Open Access and POS (Point of Service)

These plans have characteristics of both HMO and PPO policies. These plans have fixed co-pays for many services and you may be required to choose a primary care physician and get referrals to see a specialist.

EPO – Exclusive Provider Organizations

EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. You won't need to choose a primary care physician and you don't need referrals to see a specialist. However, you will have a limited network of doctors and hospitals to choose from.  EPO plans don't cover care you get care outside your network unless it's an emergency.

If you prefer to have your care coordinated through a single doctor, an HMO plan might be right for you. If you want greater flexibility or if you see a lot of specialists, a PPO plan might be what you’re looking for. Finally, if you are interested in saving money by using a smaller network of doctors and hospitals, an EPO plan might be a good fit.

High Deductible Health Plan (HDHP)

This type of plan offers higher deductibles than traditional insurance plans. High deductible health plans (HDHPs) can be combined with a health savings account or a health reimbursement arrangement to allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.

HDHP Features:

  • Lower premiums, but members are responsible for most healthcare costs until the deductible is met
  • Can be PPO, HMO or POS plans
  • Usually do not cover prescription drugs until deductible has been met
  • After deductible is met, co-pays and co-insurance will still apply for visits and services

If you have a HDHP, you’re eligible for a Health Savings Account which enables you to pay for eligible health expenses, including expenses before the deductible has been met, with tax free dollars. This helps members take control of their healthcare expenses and save for the future.

Individuals may contribute pre-tax earnings to their Health Savings Account, sometimes through payroll deductions.  Employers may also contribute to this account. Contribution limits may apply.  Any unused amounts can be rolled over to the member’s new employer or to the following year.

Health Reimbursement Accounts also offset high deductibles. This fund is contributed to only by the employer and can’t be used if the employee changes jobs.

BalanceCare, eni’s Health Advocacy service is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits.


Medical mutual.com
Blue Cross/Blue Shield.com

Tags: Health Care, Health Advocacy, Benefit Fair, health insurance plans

Insurance Data Breaches and Identity Theft

Posted by Melissa Mayfield on Wed, Apr 08, 2015 @ 04:29 PM

describe the image

Data breaches have been in the news quite a lot lately. Two of these breaches have involved insurance companies; Premera and Anthem Blue Cross Blue Shield. This is frightening since you don’t have any control over your information once it leaves your hands.

However, there are ways to protect yourself and steps you can take if a data breech occurs.  eni’s BalanceCare Guides offer tips on what  you can do if your insurance (or credit) information is jeopardized


While it can be tough to protect yourself against a data breach, you should safeguard your Social Security number and medical insurance card and ask medical providers how they use your personal information.

You should treat medical bills, prescription drug labels and insurance statements as you would any other sensitive information -- and shred them.

The best way to find out if you've had your medical identity stolen is to read your Explanation of Benefits (EOB) statement from your insurance company, which will accompany each claim.  If the claim is unfamiliar and you are a BalanceCare Member, call your BalanceCare Guide or insurance company immediately.  BalanceCare can investigate the claim for you.


Guard against fraud by monitoring all medical billing statements and returning any calls from medical billing offices.

Check the accuracy of your medical records for things like your blood type, medical conditions and procedures.  You can request to have your medical records corrected if you find false information.

Sign up for online accounts with your insurance company, prescription drug provider and medical providers, even if you don't intend to use them. That will prevent someone else from signing up under your name.


Consider purchasing protection services.  Identity theft protection services do the work for you by monitoring your personal information to detect and/or prevent identity theft. Many services monitor several different types of information for fraudulent activity, including your credit reports, public records, and black market websites where stolen information is bought and sold. Identity thieves can strike in numerous ways, so the more protection you have, the better.  Some services offer free trials so you can try them before you purchase them.


Monitor existing accounts. Watch out for someone using your information to trick a call center into letting them take over or transfer money out of your existing accounts. Criminals will try to get through the security questions using information like what was stolen in this breach, including the last 4 digits of your social and street address.  Watch for any unauthorized activity or transfers on your current financial accounts, including 401k and brokerage accounts.


When a data breach occurs, most companies offer free credit monitoring and identity protection services to all affected customers. These services will keep an eye on your reports for known indicators of identity theft and send you alerts, look for changes of address, and alert you when someone else tries to use your identity.

Don't wait for the company to complete its investigation.  Sign up for service on your own, now, to thwart any immediate attempts.


A fraud alert cautions lenders and other to take special care to ensure your identity before issuing new credit. It won't necessarily stop a fraudster but it will raise a red flag to take extra steps, including potentially contacting you directly.

Contact each of the three major credit bureaus--Experian, Transunion and Equifax--and ask that a fraud alert be placed on your file. That will stay on your report for 90 days.

A more extreme measure is a credit freeze, which will stop any kind of credit being extended at all. Don't take this step without thinking it through. Besides stopping crooks, it also means that you yourself won't be able to get any kind of credit card, including in-store credit card, or get a loan, without notifying the bureaus first.


It only takes two pieces of information for a crook to snag your tax refund by filing your taxes early and claiming it for themselves and the information stolen can contain both.  File as early as you can to avoid any problems.

No one knows when or where or if the stolen identities will be used so affected consumers will simply have to stay mindful... forever. "Your Social Security number is not going to change.  One tip to avoid fallout from bad guys using the stolen personal information is to never use personally identifiable information as answers to your "secret questions".  Make up your own questions and answers, or use answers that are fictitious but memorable to you to prevent criminals from guessing their way into your online accounts.

Federal law requires each of the three nationwide consumer credit reporting companies—Equifax, Experian and TransUnion—to give you a free credit report every 12 months if you ask for it. Use that as another monitoring weapon over time.

Set a reminder on your calendar to visit AnnualCreditReport.com and request your free credit reports. Take the time to study them. Even if you don’t find evidence of fraudulent activity, you might find incorrect or outdated information that is adversely impacting your credit score.

Young children and the elderly are especially vulnerable to identity theft. Children in particular don't actively use credit or apply for loans, so they're less likely to discover fraudulent activity. A five-year-old child today will not likely realize their credit has been destroyed by fraudulent activity until it comes time for them to use it to apply for student loans in about 13 years.

The Experian site contains a lot of helpful explanations and information about how to manage and protect a minor’s credit history. The challenge is that there is nothing to monitor until or unless the child has a credit history, and according to Experian there are reasons that you would not want to preemptively establish and freeze a credit history in your child’s name.  However, you can certainly check to make sure no credit history has been created using your child’s Social Security number.

Remain vigilant & stay protected!



NBC News

USA Today


Tags: Fraud, Health Care, Health Advocacy, Insurance, Data Breeches

The Affordable Care Act - What You Need To Know

Posted by Melissa Mayfield on Wed, Jan 28, 2015 @ 04:51 PM

doctor stethoscope resized 600

The Affordable Care Act (ACA) requires that everyone has insurance coverage.  eni’s health advocates discusses the parameters surrounding the ACA. To avoid future tax penalties everyone must have insurance that qualifies as minimum essential coverage (MEC). Tax penalties can affect both employer and employee.

The following types of plans qualify for this coverage:

  • Any Marketplace plan

  • Any individual plan you already have

  • Any employer plan with or without “grandfathered” plan status

  • COBRA 

  • Medicare

  • Medicaid

  • Children’s Health Insurance Program (CHIP)

  • Tricare

  • Veteran’s health care programs [including Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA) and Spina Bifida Health Care Benefits Program]

  • Peace Corp Volunteer plans

  • Self-funded health coverage offered to students by universities for plan or policy years that began on/or after December 31, 2014

 Types of plans that DON’T qualify as coverage:

  • Coverage for vision or dental care only

  • Worker’s Compensation

  • Coverage only for a specific disease or condition

  • Plans that offer only discounts on medical services

 MEC offered through the marketplace must cover the following at minimum:

  • Outpatient care – the kind you get without being admitted to the hospital

  • Trips to the emergency room

  • Treatment in the hospital for inpatient care

  • Care before and after your baby is born

  • Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

  • Prescription drugs

  • Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.

  • Lab tests

  • Preventive services including counseling, screenings, and vaccines to keep you healthy

  • Care for managing a chronic disease.

  • Pediatric services: This includes dental care and vision care for kids

Commercial insurance policies have different minimum standards than Marketplace policies.  However, they must cover Essential Health Benefits (EHB), which include:

  • Outpatient hospital care (doctor’s visits)

  • Prescription drugs

  • Emergency Care

  • Mental Health Services including substance use disorder services and behavioral health treatment

  • Hospitalization

  • Rehabilitative and Habilitative Services

  • Preventive and Wellness Services

  • Laboratory services

  • Pediatric Care including oral and vision care

  • Maternity and Newborn Care

When comparing out-of-pocket expenses, look at benefits being offered to ensure you are getting the best value for your premium expenses.

BalanceCare, Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.




Tags: medical plan, Health Insurance, Benefits, Affordable Care Act, Health Care Reform, Health Advocacy

Choosing the Right Health Insurance for You!

Posted by Melissa Mayfield on Wed, Nov 12, 2014 @ 04:36 PM

health guide woman and daughter in hospital resized 600

Purchasing health insurance has become increasingly more confusing with the multitude of choices available. Whether choosing plans offered by your employer or individual plans through the health marketplace under the Affordable Care Act, there are several factors to consider. eni’s BalanceCare Guides review these important factors and how their services are available to assist members.

Are you healthy? One annual routine physical/office visit is covered 100% under all policies due to the Affordable Care Act. Routine visits include pap smears, mammograms, and colonoscopies as long as there are no health issues. Keep this in mind when computing your healthcare costs.

Do you take a lot of medications? Check the co-pays for the medications you are currently taking. Are the costs applied to the deductible before the co-pays?  What “tier” are your medications? Insurance companies can change their formularies up to 2 times every year. Changes also occur when medications have a generic equivalent. BalanceCare Guides are available to assist with the drug formularies to determine the coverage. They can also determine if there is a cost savings for ordering through the mail.

Are your doctors covered under the plan? Doctors that are in-network save you money. Some insurance plans have limited coverage areas and your doctor may not accept that plan.  Once a plan is selected, BalanceCare Guides can furnish you a list of in-network providers.

Do you see a chiropractor or a mental health provider? Are your costs subject to the deductible or do you have a traditional co-pay? Are the number of visits limited? These factors should be taken into consideration when comparing plans.

Are you eligible for Medicare? Some group plans will penalize you if you don’t sign up for Medicare when you turn 65. BalanceCare can offer information to assist you with your decision to keep your group plan with or without Medicare. 

What are the premiums? Compare the approximate costs of your annual healthcare (prescriptions, office visits, etc) with the premium you’ll be paying. If you are healthy, you may want to choose a plan with a higher deductible and lower premium payment. If you take a lot of medication and frequently visit the doctor, a lower deductible and higher premiums payment may be more cost effective in the long run.

eni’s BalanceCare Guides are available to assist our members navigate the complexities of choosing health insurance!

Tags: Health Care Exchanges, Health Insurance, Affordable Care Act, Health Care Reform, Health Advocacy

Understanding HIPAA and Your Privacy

Posted by Cindy Mccall on Wed, Aug 20, 2014 @ 03:02 PM


health insurance file resized 600

Since HIPAA (Health Insurance Portability and Accountability Act) is misunderstood by many people, eni’s BalanceCare Guides have prepared and provided information on many of the guidelines and regulations associated with the act.  The most important thing to remember about HIPAA is that it is in place to protect your privacy.

Doctors, nurses and other healthcare professionals cannot discuss your medical condition or treatment to other people without your permission.  It is within your rights to authorize who may have access to your medical information and you can change who gets this information at any time. 

In order to protect your privacy all billing and medical information must be stored on secure computer systems and medical information which identifies you cannot be shared unless necessary.

You have the right to see your own medical records but you may be charged a fee for copies.  You are required to be given a notice of how your information will be protected, used, or shared.  You also have the right to file a complaint with your insurance company, healthcare provider, or with the U.S. Government, if you feel your rights have been violated.

Your healthcare provider cannot share your medical information with your employer without your consent.  Nor can your information be shared for advertising or marketing purposes without your permission.

HIPAA does not protect information held by life insurance companies, employers, schools, or workers compensation carriers.  HIPAA also exempts state agencies, municipal offices and law enforcement agencies.

It is important to remember that if you are in the hospital or other healthcare facility and would like your clergyperson, rabbi, or spiritual advisor to know you are there, you must list them as a representative.

Due to HIPAA regulations, in order for eni’s BalanceCare Guides to assist you with benefit or claims questions, they may need you to sign an authorization form giving them permission to speak to insurance companies or provider’s offices on your behalf.  Also, parents calling on behalf of dependents 18 and older must get the dependent’s permission to discuss any medical related information.  Members must also obtain benefit administrators and/or spouse’s permission to speak on their behalf.  These regulations may delay the time frame in which you receive your requested information but it does protect your privacy.

HealthCare providers, insurance companies and healthcare advocates (i.e. BalanceCare Guides) are covered under HIPAA regulations.

BalanceCare, eni’s health advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits.  eni’s program is designed to:
  • Create more efficient utilization of employee benefits

  • Save HR professionals’ time by answering benefits questions

  • Boost employee productivity by acting as liaison or ombudsman with billing or authorization issues

  • Help companies give employees better coverage at a lower cost

  • Assist with FMLA, Worker’s Comp and disability issues and concerns

For more information contact eni today!

Source: http://www.ehow.com/about_6307239_hipaa-explained-simple-terms.html




Tags: HIPAA, Health Insurance, Health Advocacy

BalanceCare Health Advocacy Services

Posted by Melissa Mayfield on Thu, Jun 05, 2014 @ 01:00 PM

call center PA resized 600Requesting assistance with navigating your health insurance can be as simple as picking up the phone.  eni’s BalanceCare Guides are here to assist our valued health advocacy clients with many aspects of their health insurance questions.

Some examples of how BalanceCare can assist your employees include:

  • Do you need a list of in-network providers that participate in your plan, if so, call us!  Using in-network providers can significantly decrease out of pocket expenses.

  • Are you unsure as to why you have received a bill for the services you thought would be covered in full?  BalanceCare can research and investigate that claim with the insurance carrier to be sure it was processed correctly.

  • Haven’t received your ID cards but you have an appointment coming up?  We can either obtain the ID information for you or connect you with the carrier so they can provide that to you directly.  We can also request cards be sent to you and provide the carrier website for the printing of a temporary card.

  • Do you need information on whether or not a service is covered?  With the information that you supply us, we can research if a service or medication is included in your plan.

  • Are you confused about how deductibles and co-insurance work?  We can review and go over these areas of the plan with you.  These two specifics areas can be very different from plan to plan.

If assistance is needed with general questions on plans prior to enrolling, BalanceCare may be able to help with this as well.

For example, when choosing between multiple plans it is important to consider:

  • The overall health of family members.

  • The number of medications a family requires.  Compare the prescription costs for the plans.  Do pharmacy benefits go towards the deductible or is there a separate deductible for medications?  Is mail order available and less expensive for a 90 day supply?

  • Do the deductibles and co insurance fit with your budget for the out of pocket expenses they create?

BalanceCare, Health Advocacy is a comprehensive, time-saving benefit that assists your employees in maximizing their healthcare benefits. Our Health Advocacy Services will work with you to fully customize a health advocacy program that will drive the most change for your employees.  Contact eni today to learn more!

Tags: enrollment services, employee satisfaction, employee engagement, Health Insurance, Health Care, Health Advocacy