Health Insurance

Frequently Asked Questions

If you have questions, we hope that the following questions
and answers here will be of help for you.

What is the best health plan for me? If I have questions while completing an application, how can I reach you? How can I be sure that my data is kept secure and private? What types of health plans are available to me? What is a PPO? What is an HMO? What is an MSA? What is a POS? What is an Indemnity Plan? What is provider? What is a Primary Care Physician (PCP)? What is an office visit co-payment? What is a deductible? What is the difference between and in-network and an out-of-network medical provider? What are my options for making my first payment? Can I buy health insurance for less if I go directly to the insurance company? What do you mean by "best price?" Where are the other health plans I am familiar with? If I have questions completing an application, whom can I call?

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Q) What is the best health plan for me?

Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.

With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and coinsurance.

In the "Senior Issues" section of this site, there are some excellent guides about choosing and comparing health plans.

Here's a list of key questions to consider in selecting the plan that best meets your needs:

How much will it cost me on a monthly basis? Are there deductibles I must pay before the insurance begins to help cover my costs? After I have met the deductible, what part of my costs are paid by the plan? What doctors, hospitals, and other medical providers are part of the plan? Are there enough of the kinds of doctors I want to see? Where will I go for care? Are these places near where I work or live? If I use doctors outside a plan's network, how much more will I pay to get care? Are there any limits to how much I must pay in case of major illness? What about limits and deductibles for certain types of care such as surgery or maternity?  The above content was used with permission from the Agency for Health Care Policy and Research and Health Insurance Association of America.

Q) If I have questions while completing an application, how can I reach you?

You can call our service representatives. Our staff is available to assist you Monday through Friday. Feel free to call us anytime, even after hours and leave a message, which will be immediately returned the next business day.

Q) How can I be sure that my data is kept secure and private?

We are committed to protecting your privacy. We will NOT SELL, TRADE or GIVE AWAY your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application. Additionally, we use industry leading technologies to ensure the SECURITY of the information under our control.

Q) What types of health plans are available to me?

Health insurance plans usually are described as either indemnity (fee-for-service) or managed care. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans.

Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of health care providers if you select an indemnity-type plan.

Besides indemnity plans, there are three basic types of managed care plans: PPO's, HMO's, and POS plans.

Q) What is a PPO?

A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.

If you obtain care from a medical provider outside of the PPO network, you will pay more for the service. For example, a PPO might pay 90 percent of the cost for a visit with an in-network doctor but only 70 percent of the cost for a visit to a non-network doctor. You will typically pay a copayment for each visit/service. These copayments are typically higher than an HMO copayment but not always. You will usually be responsible for paying an annual deductible. If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs are likely to be somewhat higher.

Q) What is an HMO?

An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.

If you obtain care without your primary care physician's referral or obtain care from a non-network member, you may be responsible for paying the entire bill. (with exceptions for emergency care) With some HMO's, you pay nothing when you visit in-network doctors. With other HMO's there may be a small copayment for the visit or service. With most HMO's you will not be responsible for paying a deductible. If you join an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO.

Q) What is an MSA?

An MSA is a Medical Savings Account. It is a tax-advantaged personal savings account used in conjunction with a high deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and copayments.

Q) What is a POS?

POS is a Point-of-Service Plan A type of managed care plan combining features of health maintenance organizations (HMO's) and preferred provider organizations (PPO's). You can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.

Q) What is an Indemnity Plan?

An indemnity plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any medical provider. You do not need referrals or authorizations; however, some plans may require you to pre-certify for certain procedures. Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services.

Q) What is a provider?

A provider is a hospital, healthcare facility, physician or other medical professional that provides healthcare services.

Q) What is a Primary Care Physician (PCP)?

A physician or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider.

Q) What is an office visit co-payment?

An office visit co-payment is a fixed dollar amount or a percentage that you pay for each doctor visit. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your copayment is 10% and the doctor visit was $200, you would pay 10% which, in this case, would be $20.

Q) What is a deductible?

A deductible is the amount of annual medical expenses that a health plan member must pay before the plan will begin to cover expenses. For example, if your plan has a $500 deductible, you will pay the first $500 of your medical expenses before your health plan begins paying the expenses. Only expenses for covered services apply towards the deductible. For example, if you paid $100 for a visit to a chiropractor but the plan does not consider chiropractic care a covered expense, then the $100 will not apply toward your annual deductible.

Q) What is the difference between an in-network and an out-of-network medical provider?

An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you visit a doctor within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network doctor. In many cases, the insurance company will not pay anything for services your receive from outside their network; however, there are exception to this.

As a general rule, HMO's tend to have smaller provider networks than PPO's. In HMO and PPO plans, referrals to specialists will be to doctors within the network. Indemnity plans typically do not have networks; you go to whatever doctor you want.

Q) What are my options for making my first payment?

You can usually make your initial payment by credit card or check. The payment must be made out in the name of the insurance company. However, some insurance companies may require a check for the initial payment. Normally, your credit card will not be charged nor will your check be deposited until you have been approved. If you are not approved for coverage by the insurance company, your money will be refunded by the insurance company. Any financial information submitted over the web is kept private and secure. Once accepted as a plan member, all bills will be sent from the health insurance company and you will pay them via the choices offered by that company

Q) Can I buy health insurance for less if I buy directly from the insurance company?

No. Insurance companies charge the same premium whether the plan is purchased directly from the company, through a broker, or online through us.

Q) What do you mean by best price?

For the plans presented here we can provide the lowest price available anywhere.

Q) Where are the other health plans I am familiar with?

Not all health plans sell health insurance directly to individuals and families. Many, like Aetna and Cigna, provide insurance predominately through employers.

Q) If I have questions completing an application, whom can I call?

Please call us for any assistance you may need and speak to our friendly and enthusiastic customer service representatives. Our staff is available to assist you Monday through Friday. Feel free to call us anytime, even after hours and leave a message, which will be immediately returned the next business day.

                                                      
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