Share responsibilities and costs with higher deductibles and co-pays
Manage your health benefits with a three-way partnership
A high-deductible base plan saves your employer money
Your employer will make additional direct payments to your health care provider
Make better informed choices by being aware of the real costs of healthcare
Benemax will manage your employer’s payments and keep everyone informed
Your Independent Member Advocate
Pay any office visit co-payment due
Present both your insurance card and your Benemax card
When picking up prescriptions at the pharmacy, present only your insurance card and make any required co-payments
No co-payments are required for hospital and emergency department visits, outpatient surgeries, diagnostic tests, x-rays and imaging services.
Your provider will bill your insurance carrier directly for services provided.
Insurance carrier will pay your provider the insurance portion of the charge.
Your insurance carrier will send you a statement of fees paid to your provider. No action is required on your part.
Your carrier will also send Benemax a statement outlining fees paid to your provider.
Benemax will review the claim, make any payments on your employer’s behalf and send you a statement outlining charges and payments made.
This statement will also notify you of any additional balance you may owe your provider.
Review for accuracy
Contact Benemax with any questions or concerns
Review for accuracy
Contact Benemax with any questions or concerns
Make payment to your doctor (if owed)
800-528-1530
Your Independent Member Advocate
800-528-1530 | service@benemax.com
mybenemax.com
For Help
For Claims
Phone: Email: Online:
800-528-1530 service@benemax.com mybenemax.com
Fax: Email: Online: Mail:
508-242-6198 or 508-359-3601 claims@benemax.com mybenemax.com [Claims link on Virtual Benefit Manager]
Benemax PO Box 950 Medfield, MA 02052 Attention: Claims
Your Plan
How it Works
During a Visit
When Your Carrier's Statement Arrives
When Your Benemax Statement Arrives
Getting Help
Glossary of Terms and Concepts
Co-Insurance
A method of cost-sharing in which the plan member is required to pay a defined percentage of their medical costs.
Co-insurance Corridor
The amount of charges of which a plan member is required to pay a percentage (i.e., “the co-insurance percentage”). For example, a plan might call for 20% co-insurance on a $5,000 co-insurance corridor. In that case, the member would be liable for up to $1,000 of co-insurance cost.
Consumer-Directed Health Plans
These plans are designed to stimulate pro-active consumerism by giving members incentives to consider value (cost & quality) when making health care decisions.
Copayment
A fixed dollar amount that is paid by plan members when they receive a specific covered service from a provider. The fee may vary depending on the type of service provided. For example, a plan may have different co-pays for office visits, Rx drugs, Emergency Room visits, MRI’s, Hospital Admissions, etc.
Deductible
An amount of charges that a plan member is required to pay 100% of each year.
Explanation of Benefits/Claims Summary
A written statement identifying claim payment information and patient responsibility amounts, issued by a claims payor to health plan members and providers.
Out-of-pocket Costs
Covered health care costs such as deductible, copayments, and co-insurance – but not premiums – that are not paid by the insurance carrier.
Out-of-pocket Maximum
A yearly cap on the amount individuals are required to pay out-of-pocket. The out-of-pocket maximum includes deductibles and co-insurance but not premiums and usually not co-payments.