Frequently Asked Questions
What is a deductible and how does it work?
A deductible is the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.
What is coinsurance?
Coinsurance is a cost-sharing requirement where you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your plan deductible is met.
What are co-pays?
A co-payment or co-pay is a specific flat fee you pay for each medical service, such as $30 for an office visit, after which the insurance company often pays the remainder of the covered medical charges.
What's the difference between a Primary Care Physician (PCP) and a specialist?
A Primary Care Physician, or PCP, is the doctor you would go to on a regular basis, such as when you're simply not feeling well, have an ear ache, or the flu. A specialist is a doctor that your PCP might refer you to if the problem you have requires a doctor with more experience in a certain area.
What is "Out-of-Pocket-Maximum"?
An out-of-pocket expense includes the co-payment, coinsurance, and deductible. The maximum out-of-pocket would be the limit of all these expenses combined. When the term annual out-of-pocket maximum is used, that refers to the amount the insured could be liable to pay the whole year out of their pocket, excluding premiums. Usually, your maximum out-of-pocket is usually not more than a couple of thousand dollars higher than your chosen deductible.
What is a network?
A network is a list of doctors, hospitals, and other providers that have contracted, or agreed, with an insurance company to do business with the insurance company. The provider's fees have been pre-negotiated, which means that the doctor or hospital has agreed to accept a lower fee for services rendered.
What is a pre-existing condition?
A pre-existing condition is any health condition you have or have had prior to applying for a health insurance policy.
Can I get health insurance if I'm currently pregnant?
Unfortunately, no. You certainly may obtain insurance prior to becoming pregnant and if you have other children, they may be insured through us at any time. Check if you quailfy for Medicaid benefits for pregnant women.
What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act. It is a health care law covering many topics. The main item of interest being that anyone belonging to a group health insurance plan must be allowed to purchase individual health insurance, regardless of current health status, within a period of time after the loss of group coverage.
What is Term Insurance?
Term insurance provides protection for a specific period of time. It pays a benefit only if you die during the term. Some term insurance policies can be renewed when you reach the end of a specific period. The premium rates increase at each renewal date. Many policies require that evidence of insurability be furnished at renewal for you to qualify for the lowest available rates.
Do I have to take a medical exam?
Medical exam requirements will vary depending on the company. In some cases you will need to take a brief paramedic exam which includes blood and urine samples. This service is free and can be done in your home or office, at your convenience, and usually takes less than 30 minutes.
Do life insurance companies really check to see if I'm a smoker?
Because smoking is a health hazard, life insurance companies may charge you a higher premium if you smoke. Worse yet, smoking may even prevent you from obtaining life insurance coverage at all. How does an insurance company find out if you smoke and how much? In most cases, they start by simply asking you. Almost every application for life insurance contains questions about health issues, including smoking. Your responses to any smoking-related questions will play a part in a company's decision about whether to sell you life insurance and at what price.