• Slider Image

EMPLOYEE Frequently Asked Questions

Please use the links below to aid you in your search for answers to your small business insurance and wellness questions.

When can I make changes to my current benefit elections?
You can make changes to your current benefit elections during your annual open enrollment period or when you experience a qualified life event.
I recently lost my insurance card ... who do I contact?
If John J Boyd is your benefits agency, you can contact your enrollment specialist for help with a replacement card. If you are unsure who you Enrollment Specialist is, you can contact your dedicated Account Manager or you can call our help desk at 586-314-3400. We will work directly with the carrier to make sure that you have everything that you need.

If you are not a client of John J Boyd, you can contact your human resources department or you can contact your insurance carrier directly.

What is Evidence of Insurability (EOI) and why do I need it?
Evidence of Insurability (EOI) is an application process to provide an insurance company with information on your health status in order to get certain types of insurance coverage. EOI is required when electing more life insurance than the guaranteed issue amount of coverage. If you elect coverage that requires an EOI, the coverage is not valid until the EOI process is completed and the carrier has approved it.
What is RX drug step therapy?
Step therapy is used by insurance carriers to help control the rising costs of prescription drugs. With step therapy, you will be required to try a medication or dosage before stepping up to a drug that costs more.
What is the difference between a generic, formulary and specialty drug?
A generic drug is identically equivalent to the brand name drug in form, safety, strength, quality and intended use. Although identical, generic drugs are substantially cheaper than their brand name counterparts.

 A formulary drug is a drug that is listed on a preferred drug list from your insurance carrier. They are drugs that insurance carriers believe to be well suited to treat specific conditions, while keeping costs more manageable for both the carrier and the insured individual.

 A specialty drug is a high-cost medication used to treat a chronic or complex health condition. These drugs require special handling, administration or monitoring and generally need prior authorization to order them.

What is the difference between an in-network and out-of-network physician?
An in-network physician is part of your insurance companies network and is contracted by your carrier to provide lower costs for services. If you have a PPO insurance plan, you are allowed to see providers that are out-of-network, however, you are subject to higher costs and generally you will pay a larger percentage of the total cost of care. If you have an HMO or EPO plan, you will generally pay all costs associated with providers that are outside of your network.
How do I find an in-network physician?
The best way to find an in-network physician is to go to your insurance carrier website. Each insurance carrier has a listing of physicians affiliated with their networks.
What is a Health Reimbursement Arrangement (HRA)?
A Health Reimbursement Arrangement (HRA) is also referred to as a Health Reimbursement Account. With an HRA, your employer sets aside money for you to use on qualified medical expenses. Your employer will decide which qualified medical expenses are eligible for coverage, however, HRA’s generally cover deductibles, coinsurance, and copays (PPO only). An HRA cannot be used to pay your monthly insurance premium.
What is a Flexible Spending Account (FSA)?
A Flexible Spending Account (FSA) is an account that is set up for individuals to set aside pre-tax money to be used for eligible health care expenses. Many FSAs provide debit cards for you to use, rather than having to seek reimbursement after the fact. The limit on FSA contributions for 2017 is $2,600, up $50 from 2016. If you leave your company, the FSA account only remains available to you if you elect COBRA and the contributions are continued. If you do not elect COBRA, the FSA funds are not available after you leave the company, unlike an HSA.
What is a Health Savings Account (HSA)?
Health Savings Accounts are savings accounts for individuals with High Deductible Health Plans (HDHP). These savings accounts allow you to pay for qualified out-of-pocket expenses with pre-tax dollars. Unlike a Flexible Spending Account (FSA), the funds in an HSA belong to you, not to your employer, and remain with you even if you change jobs. Funds in an HSA can grow, tax deferred and after age 65, you can withdraw HSA funds and they are only taxed as ordinary income.
I don't understand all of the benefits terminology. Where can I go for help?
At John J Boyd, we understand that benefits terminology can be complicated and confusing. That’s why we created a benefit glossary that highlights some of the most common benefits terms and what they mean. CLICK HERE for our glossary of benefit terms. We take pride in creating communication materials that are easy-to-understand with real-world, relatable examples. If you still have questions, please reach out to your dedicated Account Manager for further guidance.
How do I login to my SmartBenefits account
If you are logging into your account for the first time, your username will be your first initial + the first 6 letters of your last name + the last 4 digits of your social security number. Your password is your date of birth, formatted as follows:  YYYYMMDD (Example: 19760325).

Note: SmartBenefits Online accounts are only available if your employer has elected this service from John J Boyd. 

Where should I go for treatment?
Where you seek treatment can have a huge impact on the overall cost of your care.  For non-emergent situations, most plans offer several options including doctor’s offices, urgent care centers, and telemedicine.

Your Doctor’s Office: If you can wait to be seen during normal office hours, your doctor offers a trusted on-going relationship to manager your care. Many doctors now offer extended hours and can be reached by phone or email for after-hours questions.

Telemedicine: No appointments or waiting room, available when your doctor isn’t, care is delivered via smartphone, tablet or computer. Great for sore throat, cough, low-grade fever, earache, cold and flu, mild allergies, skin rash, eye irritation, sprains and strains and minor asthma.

Urgent Care Center: Evening and weekend walk-in hours with convenient locations. Urgent Care Centers generally have a higher co-pay but offer a convenient solution when your doctor’s office is not open.

Great for sore throat, cough, low-grade fever, earache, cold and flu, mild allergies, skin rash, eye irritation, sprains and strains and minor asthma.

Emergency Room: If you are experiencing a life-threatening situation, you should call 911 or go to the nearest emergency room. The emergency room is open 24/7 and is suitable for all emergency situations. Emergency room co-pays are higher than Urgent Care and Office Visit co-pays.

Make sure to check if your provider is in-network.

How do deductibles, copays and coinsurance work?
A deductible is the amount of money that you pay before your insurance begins to pay. If your plan has a $1,000 deductible, you will pay 100 percent for most services until you have reached $1,000. After you have met your deductible, you will begin to pay coinsurance and co-pays as determined by your plan design.

A co-pay is a fixed amount that you pay for a healthcare service.  The amount of the co-pay can vary by the type of service and for some services you may have both a co-pay and coinsurance. An example of a co-pay is a $30 office visit charge or $40 prescription co-pay.

Coinsurance is your share of the costs of a healthcare service. You begin to pay your coinsurance after you have met your plan’s deductible. It is generally a percentage of the allowed amount that your plan covers for a service.

How do I resolve a problem with a claim that I received?
If John J Boyd is your benefits agency, you can contact your dedicated Account Manager to help resolve your claim. They will work with you to get the needed information to dispute the claim on your behalf.  If you do not have your account manager’s contact information, call our helpline at 586-314-3400 for additional help. Your account manager will work directly with the carrier to provide claim resolution. If JJB is not your benefits agency, you will need to contact your carrier directly or work with your HR department for further assistance.
How do I resolve a problem with a claim that I received?
If John J Boyd is your benefits agency, you can contact your dedicated Account Manager to help resolve your claim. They will work with you to get the needed information to dispute the claim on your behalf.  If you do not have your account manager’s contact information, call our helpline at 586-314-3400 for additional help. Your account manager will work directly with the carrier to provide claim resolution. If JJB is not your benefits agency, you will need to contact your carrier directly or work with your HR department for further assistance.
What is the difference between HMO and PPO?
An HMO is a Health Maintenance Organization that covers services solely by providers within their specific network. A Primary Care Physician (PCP) is required, the PCP is responsible for coordinating all medical care and makes referrals to in-network specialty providers.

A PPO is a Preferred Provider Organization that has a network of providers but also allows use of medical providers outside of the plan’s network, typically with greater employee cost sharing. A PPO is generally more flexible than an HMO, as a Primary Care Physician (PCP) and referrals for specialty providers are not generally required.

I need help selecting a plan. What should I do?
Selecting the benefits that are right for you and your dependents is a very personal process as every individual has a unique set of needs. Your dedicated John J Boyd account manager can help guide you in the decision-making process and answer any questions that you may have. If you are unsure of who your account manager is, you can contact our helpline at 586-314-3400.
What is SmartBenefits Online?
SmartBenefits Online is an easy-to-use online platform for you to review your benefit information and enroll conveniently online.