Frequently Asked Questions

A Qualifying Life Event (QLE) is a specific life change that allows you to make changes to your health insurance and other benefits outside of the annual Open Enrollment period. These changes are permitted because the event significantly impacts your coverage needs. Common QLEs include:

• Marriage, divorce, or legal separation

• Birth or adoption of a child

• Death of a dependent

• Loss or gain of other coverage (e.g., through a spouse's job)

• A significant change in employment status (e.g., starting or leaving a job, changing from full-time to part-time, or retiring)

• A change in residence that affects your coverage area (e.g., moving to a different state)
  

When a QLE occurs, you have a limited window of 30 days from the date of the event to make adjustments to your benefits. This could include enrolling in, changing, or canceling coverage. It's essential to act quickly and provide any necessary documentation to avoid missing this opportunity. For more information or to report a QLE, contact your Lacher Healthcare Advocate.

1. What screenings or preventive tests do I need based on my age, gender, and medical history? This helps ensure you’re up to date on essential health checks like blood pressure, cholesterol, and cancer screenings.
   

2. Are my current medications still appropriate and necessary for my condition? This question allows your doctor to review your prescriptions and consider whether any adjustments or alternatives are needed.
   

3. How can I improve my overall health and wellness? This opens the door for discussions about diet, exercise, mental health, and lifestyle changes that could benefit your well-being.
   

4. What vaccines or boosters do I need at this point in my life? Your doctor can ensure you’re up to date on important vaccines like the flu shot, COVID-19 boosters, or others based on your age and health status.
   

5. Are there any health risks I should be aware of, given my family medical history? This can prompt a conversation about any genetic or hereditary conditions you might be more prone to, so you can take preventive steps. BONUS QUESTION:
   

6. Will my preventive care checkup be covered by insurance? It's essential to know if your annual preventive care visit is fully covered to avoid unexpected costs.

You can make changes to your benefit elections during your healthcare and benefits open enrollment OR if you have a qualifying life event (QLE).

A QLE is a change in your situation, like a marriage, divorce, or having a baby, for example, which allows you to make changes to your health insurance. Take a look a this document for more information.

You have 30 days to submit your changes online through our benefits enrollment system.

Here's an overview of qualifying life events from Healthcare.gov.

If you have a QLE, contact your Lacher Benefits Advocate.

You can make plan changes and enroll dependents during open enrollment, or if you have a qualifying life event, by visiting the Enroll Now page.

First, make sure you compare the bill you received with the EOB from the insurance. If you need to locate an EOB you can find one by logging into your account at www.meritain.com. If the bill does not match the EOB, please contact your Lacher Benefits Advocate for further assistance.

While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health. When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed. However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.

Here’s how to be sure your preventive care visit is free for you:

1. Mention prevention upfront – When scheduling your appointment, confirm that you are scheduling a preventive care visit.

2. Know what to discuss with your doctor during the visit – During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.

3. Ask your doctor - If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.

For more information about preventive care, contact your Lacher Benefits Advocate.

Take a look at this flyer to learn about your choices when it comes to where you should receive care.

High level overview:

Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:

• Plan 1: $35 copay

• Plan 2: $40 copay

• Plan 3: After you pay your deductible, insurance pays 100%

Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:

• Plan 1: $500copay

• Plan 2: $500 copay

• Plan 3: After you pay your deductible, insurance pays 100%

Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. Cost to you:

• Plan 1: $75copay

• Plan 2: $75copay

• Plan 3: After you pay your deductible, insurance pays 100%

Telemedicine through Teladoc - Consider using Teladoc for non-life threatening conditions, and when you need 24/7 care. Cost to you:

• Plan 1: $49

• Plan 2: $49

• Plan 3: $49