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General
Questions Regarding Insurance |
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Health insurance is a means of sharing the expense of health care with
an insurance company. Insurance companies typically offer many different
insurance plans to suit the many different needs of people of various ages and
degrees of health.
There are typically five characteristics of a plan that will tell you what
you have to pay for and what the insurance company will cover. These
characteristics are:
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Deductible
- amount of money before the plan will cover your expenses
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Coinsurance
- % you are required to pay, aside from any co-payments or the deductible
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Out-of-pocket limit - max amount the plan will pay per year
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Lifetime maximum - max amount the plan will pay in your lifetime
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Co-payment - a flat fee you owe for a
medical service
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Individual or family health insurance is basically the same as group
insurance that some employers or organizations provide, but for one person
and/or that person’s family. |
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Individual and family insurance plans typically fit into four
categories: PPOs,
HMOs, POSs and
HSAs. They are described in detail below. |
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Like most plans, members of PPO (Preferred Provider Organization)
plans are encouraged to use the insurance company’s contracted network of
Primary Care Physicians (PCPs), pharmacies and hospitals.
You are not required to choose a Primary Care Physician as you would with an
HMO plan, which equals more flexibility for you.
If you decide to seek treatment with a Primary Care Physician outside of the
insurance company’s recommended network, you may be covered but at a greater
cost to you. |
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Like most plans, members of HMO (Health Maintenance Organizations)
plans are encouraged to use the insurance company’s contracted network of
Primary Care Physicians (PCPs), pharmacies and hospitals. Unlike a PPO plan,
you are required to choose a Primary Care Physician.
If you seek treatment outside of your network without a referral from your
Primary Care Physician, you will typically be responsible for the full cost of
the treatment. |
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On an HMO, you are restricted to
one doctor called your Primary Care Physician, and you need a pre-authorization
before you can go see a specialist. On a PPO,
you have the freedom to go to any doctor within the network at any time. |
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POS (Point Of Service) plans have some features of
PPO plans and some features of HMO
plans. You are able to go to an HMO doctor or a PPO doctor and out-of-network
doctor. This offers 3 levels of coverage – HMO/PPO/Out-of-Network coverage. |
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HSA (Health Saving Account) plans are similar to IRA’s (Individual
Retirement account) where your funds accrue interest for the funds that remain
in the account.
There are tax advantages depending on how much you contribute in one year
(Maximum contribution per year is $2650–this may have changed). You can use
these funds in the account for specific health related expenses. |
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These plans have no contracted network of doctors and you are able to see
any doctor you choose and receive benefits by being subject to your deductible
first. 80/20 coverage is standard. |
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This is temporary coverage available for a minimum of 30 days up
to 365 days (12 months). It is available for anyone who is in between
jobs, waiting for permanent coverage to become effective, or if you’ve just
graduated college. |
How
does short-term health
insurance differ from
individual & family
health insurance?
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Short term insurance provides
emergency service coverage and does not cover preventative care. Doctor office
visits, RX drugs, hospitalization, and ER visits are covered. |
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The best plan is one that fits your health needs as well as your
budget. |
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A deductible is the amount of your money you must spend before a plan
begins to cover your eligible expenses. |
| What
is a co-payment?
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A co-payment (or co-pay) is a flat fee you owe for a medical service. |
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| What
is the difference between
in-network and out-of-network
providers?
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An in-network provider is a company or service who has a contract
with the health insurance company, while an out-of-network provider does not.
This means most treatments with in-network providers are covered (partially or
fully), while most treatments with out-of-network providers are typically not
covered at all. |
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No. You may cancel an application at any time during the underwriting
process and you typically will not be charged until you are approved. However,
some companies do charge an application fee, which is approximately $15 to $30. |
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General
Questions Regarding
This Website |
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When
using this website, when
you are required to enter
the ages and sexes of
all applicants simply
leave the applicant and
spouse boxes empty and
enter the age and sex
of your child in the
1st child slot. |
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After
you have chosen a plan,
you will need to complete
an application for coverage
which typically is accomplished
by filling out multiple
forms. Some insurance
companies allow you to
fill out these forms
online, which can speed
up the process significantly.
Once approved, your coverage
will typically start within
1 to 90 days, but
varies depending upon the
time it takes for an insurance
company to process your
application and access
your medical records if
necessary.
We highly recommend acquiring
short-term insurance if
your coverage does not
start immediately. Just
give us a call! |
| When
I buy an insurance plan,
how do I make payments?
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Many
insurance companies offer
automatic payment options
usually via a credit
card or checking account.
Most payments are made
on a monthly basis, but
some companies offer
semi-monthly, quarterly
or semi-annual payments
as well. |
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You
will not be offered coverage
through private insurance.
This is considered a “pre-existing” condition.
You can get coverage
through a government
sponsored program or
through an employer,
if that’s an option. |
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There
are select HMO and PPO plans
that cover this benefit.
On an HMO plan, your prenatal
care would be covered with
a co-payment. For hospitalization/
delivery, there is a co-payment
per day while you are hospitalized.
On a PPO plan, you would
be subject to your deductible
for prenatal/postnatal
hospitalization/delivery. |
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There
are, or could be, waiting
periods for a pre-existing
health condition if you
have had no break or
gap in health coverage.
It would be applied to
the plan you are signing
up for. Depending on
the health condition,
you may or may not be
eligible for coverage.
If you are on any
medication, the Underwriter
takes into consideration
the cost of the medication
as well as the frequency
the medication is taken,
as well as the condition
it is prescribed for. |
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Short-term
health plans offer
immediate coverage. The
effective date is often
the following day,
depending on when the
application is received. |
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We
are fully committed to
maintaining the privacy
of your personal information.
You can rest assured
that we do not share
any personal information with
anyone, with the exception
of those who will be
processing your application.
We employ the latest technology
and techniques to keep
your data safe. For more
details please visit our privacy
policy. |
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As
an insurance brokerage
and authorized agent
for over 100 health carriers,
we have the knowledge
and experience to find
a product that fits your
needs while saving you
money.
The advantage of shopping
with us is that we represent
multiple health companies,
and do not charge
a broker fee, so we are
able to provide them with
multiple quotes vs. a quote
with just one carrier. |
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We
do not charge
a broker fee and we emphasize
personalized service.
We help the client shop
around for a plan that
best fits their needs as
well as their budget. They
will get the same agent’s
assistance each time they
call in, rather than getting
a different agent each
time. |
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We
represent multiple health
carriers in multiple
states, so we are able
to help the client shop
around rather than contacting
each carrier individually
to get a quote. |
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You
can either send our agents
or sales representatives
an emailed response,
or you can call in to
speak with a live representative
Monday through Friday
from
8:00 A.M.
to
5:30 P.M.
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