What is considered a “qualifying event”?

Qualifying events include, but are not limited to, the following: Marriage Birth, adoption or placement for adoption of a child Obtaining legal guardianship of a child Loss of eligibility for other health coverage for you or your dependent if: The other coverage was in effect when you were first eligible to enroll for this coverage […]

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I had a wellness exam conducted by my doctor and received my explanation of benefits showing it was applied to my deductible. Is that right?

Maybe, but most often the answer is no. First, it depends on the type of plan that is offered by your employer. If wellness should be paid at 100%, then what likely happened is the bill wasn’t properly coded when sent to your insurance company. When that happens, call Vista’s claim concierge unit. We can […]

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If my spouse and I are both offered a healthcare FSA and a daycare FSA plan through our employers, how much can we elect?

Both you and your spouse can each have healthcare FSAs at your respective employers up to the maximum of $2,500. Also, each FSA at each employer is considered family, so it doesn’t matter if the husband’s FSA is paying for the wife’s out-of-pocket expenses or visa versa. For a daycare FSA, the IRS limits the […]

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I cover my children on my plan and my spouse also covers the children through his employer’s plan. How does this work and which insurance plan should pay for medical expenses first?

Determining the order of coordination of benefits requires “the birthday rule.” Because both parents are insuring the children, the parent’s birthday that falls first in the year would be primary. For example, if your birthday is July 5th and your spouse’s birthday is March 15th, your spouse’s plan would be primary for the children.

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