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FAQs About Health Insurance

How do I contact my insurance carrier?

Log into your Zenefits account and click on the Medical, Dental, or Vision Insurance card. This will take you to the Overview page. On the right side of the page, you'll find a link that says Member Services & Claims Info. 


Clicking the link will show you: 

  • the URL to your carrier's website where you can create a profile
  • the Member Services number so you can give your carrier a call
  • the address where you can send any claims information
  • the number to ask about any claims questions

If you are experiencing difficulty on the carrier's website, please note that the best people to contact would be the carrier directly. Zenefits cannot advise on how an insurance carrier's website functions.

What is considered proof of insurance?

In cases where proof of coverage is required, an active member ID card can typically suffice as proof. In the event that a physical member ID card is not available (the carrier does not provide physical cards or the employee has not received the ID cards yet) a statement of coverage can suffice as proof of insurance coverage.

A Statement of Coverage is an official document from the carrier stating an employee is active in the group policy. Please reach out directly to your carrier to obtain a Statement of Coverage.

What is preventive care?

Under the Affordable Care Act, services considered to be "preventive care" are 100% covered with an in-network doctor for these services. Refer to the plan's Summary of Benefits and Coverage for any additional details around this benefit.

Some examples of preventive care include:

  • Blood pressure and cholesterol screenings.
  • Many immunization vaccines, including flu and tetanus.
  • FSA-approved contraception.

There are different services covered for adults, women, and children. For a comprehensive list of preventive health services, please refer to the U.S. Department of Health & Human Services website here.

What is a certificate of creditable coverage COCC?

A certificate of Creditable Coverage (COCC) is a document provided by your previous insurance carrier that proves that your insurance has ended. This includes the name of the member to whom it applies as well as the coverage effective date and cancelation date.

See this page for an example of a COCC.

If you need a COCC for proof of loss of coverage, contact your insurance carrier directly. In most instances, the insurance carrier will fax or email the COCC to you.

Zenefits does not provide COCCs and cannot request one on an employee's behalf. 

What is an out-of-pocket maximum?

An insurance plan's Out-of-Pocket (OOP) maximum is how much someone will have to spend on healthcare before the insurance carrier will cover 100% of their medical expenses.

For example, if an employee selects a plan with a $5,000 OOP max and spends $5,000 out of pocket by mid-year, any medical costs that are incurred for the rest of the plan year will be 100% covered by their insurance company.

The OOP maximum does not carry over from plan year to plan year -- it resets with the plan year, much like deductibles.

Employees can view their plan's OOP maximum from the Medical Overview page under the Benefits Summary section.

The amount applied to the OOP maximum may vary depending on whether medical expenses were incurred inside or outside of the plan's network.

What is the difference between a PPO and HMO plan?

An HMO plan requires you to designate a Primary Care Physician (PCP) and are not available to out-of-state employees, or employees who live outside of the carrier's established network area.

Alternatively, a PPO plan offers nationwide coverage and enrollees can see any doctor any time with a PPO plan; a referral from a Primary Care Physician (PCP) is not necessary.

Why is dental coverage available under my medical benefits?

Some carriers provide pediatric dental coverage through their medical coverage. This coverage is only available for children under the age of 18 who are enrolled in the medical plan.

Can you help me choose a plan?

If you need assistance selecting a health insurance plan, please contact your insurance carrier or insurance broker for further assistance. Your broker's contact information can be found on the lower right side of your Zenefits dashboard upon logging in to your account, under Benefits Contacts.

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