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Frequently Asked Questions
How long does it take to get approved for a health insurance plan?
This varies from company to company. For folks who are generally very healthy with little medical history it can be as little as 2 to 5 days. However if the insurance company orders medical records it can take longer - maybe 3 to 4 weeks. Usually it's not necessary for health insurance companies to order medical records with the application but they do from time to time.
Can I get "dropped" by an insurance company?
None of the companies we recommend or work with can single you out for cancellation or drop you. As long as you keep paying your premiums you can keep the plan as long as you want. You can also choose to terminate the coverage on your terms whenever you choose to.
Do I pay extra to use a broker or agent?
No. The cost of a health plan is exactly the same to the penny whether you use a broker, apply on line or go through the insurance company directly. The cost is the same each way. Given this is the case why wouldn't you use a broker? You get impartial advice from an expert in the industry who can help guide you through the potential minefields and pitfalls.
What is an HSA plan? Is it normal health insurance?
Yes. The HSA stands for Health Savings Account. The insurance operates like regular major medical health insurance. Typically the plan has a higher deductible and then it usually pays at 100% after the deductible or in some cases at 80%.
The Health Savings Account is a feature through which you can write off most medical expenses you incurred against your taxes. In 2010 the maximum deduction is $3,050 for an individual and $6,150 for a family.
What is a PPO or Network?
This is the same thing. To help keep medical costs and health insurance premiums lower most companies now offer a PPO network where if you choose to receive care within the network you get better benefits as those providers have contracted with the insurance company to provide services at a lower cost.
If you have a PPO plan or a network plan you always want to make sure that (in order to get the best benefits) you stay in-network wherever possible.
It does also mean however that you will still be covered for doctors and hospitals out-of-network.
I've heard about PPO discounts if I stay in-network, what is this?
Basically all medical providers have a list price for any medical service. Insurance companies with their buying power rarely pay the full list price and negotiate lower costs for their members from providers. This is how a PPO network works.
A PPO provider would provide services at a lower cost to someone with health insurance because of the negotiated discounts. Depending on the services received this could be anywhere from a 20 - 60 percent discount.
So it's always in your best interest to stay within the PPO network wherever possible to receive these discounts.
What is a deductible?
A deductible is the amount that you pay before the health insurance kicks in. Major medical coverage starts after the deductible however, depending on the plan, preventative care, doctor visits and prescription coverage, may be covered before the deductible.
What is co-insurance?
Co-insurance is the percentage of coverage offered by the insurance company - usually after the deductible. Traditional plans have 80% co-insurance or are known as 80/20 plans. This means that once you reach the deductible the company pays 80% and the insured pays 20%.
All good plans will have a cap or a limit on the co-insurance that you will pay.
Again depending on the company or plan this can range anywhere from $2,000 to $10,000.
What is the maximum out of pocket?
That is the most that you would be liable to pay e.g. the deductible plus your co-insurance. If your plan is a 100% plan then it would be only the deductible. Some plans also have one deductible per person; others have one for the entire family.
You want to know the benefits of the specific plan you're looking at.
If there is no co-pay on my plan, can I still go to the doctor?
Yes. For a plan without co-pays you can still go to the doctor as often as you wish. It generally means you'll pay more for each visit so it's always good to weigh the extra cost per visit versus the monthly savings on the health insurance premiums.
What happens if I have a pre-existing condition?
Each health insurance company looks at each pre-existing condition differently. Therefore some companies would be a better fit for someone with high blood pressure than others. It may also be a different company that might be a better fit for someone suffering from asthma. For free advice you should speak with a broker as they can help you determine which company would be the best fit for your particular situation.
I've already been declined coverage, what options do I have?
This really depends on when you were declined, the reason and which state you're in. Again you should definitely contact a broker. We'll be glad to go through your specific options.
You may be able to get coverage with another company and most states also have options for those who have been declined coverage from more than one company.
What is short-term health insurance? Is this right for me?
Short Term Health Insurance is regular major medical coverage and is really designed for people in transition. For example, they have a waiting period before their group insurance starts; they may only be a year away from Medicare and just need insurance for one year.
Short Term insurance lasts for up to 12 months and is much lower cost than permanent traditional health insurance because at the end of 12 months the plan expires.
You can apply for multiple short term plans however the danger to be aware of is that short term plans don't cover pre-existing conditions.
If you have any pre-existing condition that you'd like to be covered it may not be the best option for you. If you have any questions give us a call and we'll be glad to guide you through your specifics.
Does applying mean I have to take the plan?
No. Submitting your application doesn't commit you to taking health insurance.
It enables your application to be processed by the underwriters and for the health insurance company to come back with an offer - either the standard offer or a modified offer depending on your specific situation.
You always have a 10 day free look period by law once you receive the documents on your health insurance to decide whether you want to keep the plan or not. If you cancel within this free look period then you'll get a full refund of any premiums you've already paid.
Why do I have to pay now if I don't know if I'm going to be accepted?
All major health insurance companies require your payment information on the health insurance application.
Some companies take it out when you apply however more common is for the payment to be processed once you are approved and your policy is in force.
Each company differs a little with their processes.
Can I cancel at any time?
Yes you can. You are not locked in for any time period and most companies pro-rate by the day. If you do cancel during the middle of the month most companies will refund the premium for the days you have not used.
One or two companies will terminate the coverage at the end of the month when you notify them you want to cancel.
Will my rates go up in the future?
Unfortunately the answer is probably yes. They've been going up consistently over the last 30 years and it doesn't look like that will change any time soon.
Two major things that cause rates to go up:
1) Each year we get older and the risk of claims is higher the more we age.
2) Medical costs are increasing at about 12% a year on average and have done so since 1970. As medical costs increase, so do claims and therefore premiums. As independent brokers, if any of our clients' premiums go up dramatically we can shop other carriers and other companies to help them maintain the most competitive coverage.
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