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Frequently Asked Questions

Below you’ll find a list of frequently asked questions related to using your Assurant Health plan. You can also view the full list of frequently asked

questions to see other questions and answers related to health care reform, plans for individuals and families and plans for small businesses.

MEMBERS Understanding Your Plan

Q: How do I know which Individual major medical plan I have?

Grandfathered plans: Plans effective on or before the passage of the Affordable Care Act laws on March 23, 2010. Grandfathered plans are exempt from many changes required under the Affordable Care Act and customers can retain their grandfathered status if their plan has not had significant changes.

Non-grandfathered plans: Plans issued after March 23, 2010. Plans with non-grandfathered status must conform to all applicable reform requirements as of the first plan year after January 1, 2014. This also includes plans sold prior to the passage of health care reform laws if certain changes were made to the plan.

Extended plans: Plans issued in states that are allowing non-grandfathered plans to continue for a designated extended period of time. Extended plans may also be referred to as Grandmothered plans.

Metallic plans: Major medical plans with effective dates of January 1, 2014 or later. Metallic refers to the series of plan types that meet the essential health benefit requirements as defined by the Affordable Care Act. Bronze, silver, gold and platinum refers to the progressively increasing range of coverage levels and corresponding pricing structure.

Q: What is now covered by my major medical plan?

Major medical plans effective on or after January 1, 2014 provide coverage for essential health benefits. Essential health benefits include the following categories of benefits, which are not subject to annual dollar limitations:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and disorders
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care

The specific benefits considered in these categories may vary by state.

Q: What preventive services are fully covered under my plan?

Major medical plans that are compliant with the Affordable Care Act may cover the following in-network preventive services, depending on your age.

  • Blood pressure, diabetes and cholesterol tests
  • Many cancer screenings, including mammograms and colonoscopies
  • Counseling on topics such as contraception, breastfeeding, quitting smoking, losing weight, eating healthy, treating depression and reducing alcohol use
  • Annual eye exams and dental checkups and cleanings for children under age 19
  • Routine vaccinations against diseases such as measles, polio or meningitis
  • Certain female contraceptives
  • Counseling, screening and vaccines to ensure healthy pregnancies
  • Flu and pneumonia shots
  • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
  • Depression screening for adults

Note: Short term medical plans do not pay for preventive services.

Q: When does my calendar year deductible start over?

The calendar year begins January 1 and ends December 31, each year.

Q: What is the name of my network?

This information is printed on your health insurance ID card, along with a telephone number for you to contact if you need more assistance.

Note: If you purchased an Assurant Health plan through the Marketplace, your network is named Aetna Signature Administrators PPO.

Q: Which physicians and hospitals are members of my network?

Visit the Assurant Health network page to learn more about the network associated with your Assurant Health plan. You can find the network listed on your ID card. You may also contact your provider’s office and ask if the physician is a member of the network. Always verify whether your provider is a member of the network in order to maximize your health insurance benefits.

Q: What does out of network mean?

This refers to doctors, hospitals, pharmacies, and other providers who do not belong to a health plan s network, and therefore do not include network discounts.

Q: What is preauthorization?

Sometimes called prior authorization or prior approval, this is a decision by your insurance company or plan that a health care service, treatment, prescription drug or durable medical equipment is medically necessary. Your health insurance or plan may require preauthorization for certain medical services before you receive them, except in an emergency. However, preauthorization isn t a promise that your health insurance or plan will cover the cost.

Your health insurance ID card shows the preauthorization telephone number, and a full listing of the services that require preauthorization can be found in your health insurance policy. Please follow the preauthorization procedure in order to maximize your benefits.

Q: What is a predetermination?

A predetermination of benefits is a written request for verification of benefits. We review these requests based on policy provisions, and send an explanation of your potential health insurance benefits. You may request a predetermination before your medical procedure, although a predetermination of benefits is generally not necessary.

Q: What is a specialty pharmaceutical?

These are types of prescription drugs that may:

  • Be used to treat rare or certain chronic diseases
  • Have a highly targeted, cellular mechanism of action
  • Require injection or other parenteral or unique method of administration
  • Require special administration and monitoring
  • Be regularly supplied by designated specialty pharmacy providers

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Q: Does my surgery/hospital stay need preauthorization?

In most cases, preauthorization is a requirement for specific services listed in your health insurance policy. Please review your health insurance policy for details.





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