Frequently Asked Questions

Find some answers here and don't hesitate to ask as anything!

What is PPO vs. HMO?

HMOs are sometimes more affordable, but you’ll usually get less coverage and more restrictions. PPOs are more flexible and provide greater coverage, but often have a higher price tag and probably require a higher deductible. Here’s a summary of some of the key comparison points.

Access to a network of doctors, hospitals, and other healthcare providers
Ability to visit the doctor you choose without a PCP to authorize treatment
Referral from a PCP not needed to see a specialist
Low or no deductible and generally lower premiums
Coverage for medical expenses outside the plan’s network Possibly

What is deductible vs. max out of pocket?

A deductible is an amount you have to pay out of your own pocket before your health plan’s benefits kick in. If, for instance, you buy a plan with a $500 deductible, you will pay for the first $500 of your medical expenses yourself. At that point, your plan will start paying some share of the expenses. When you visit a doctor, you might pay a flat $30 (this is your copay) and the plan will pay the rest of the bill. If you have outpatient surgery, the plan might pay 80 percent and you’ll pay the other 20 percent (this is called coinsurance).

Some plans provide some services “outside” the deductible. For instance, they might pick up part of the cost of a few primary care doctor visits a year even before you’ve spent to the limit of your deductible.

Out-of-pocket limit is the most you will ever have to pay out of your pocket for health care during the year – not including premiums, but definitely including the deductible AND the copays and coinsurance you will continue to pay after you hit the deductible. If you hit your OOP for the year, your insurance will pick up 100 percent of costs thereafter.

What's the difference between In Network Deductibles and Max outs Vs out of network?

Deductible first, then out-of-pocket max. What you pay goes toward your deductible first. Once you’ve met that amount for the year, further payments accumulate on top of that deductible amount until you meet your out-of-pocket max. For example, a $7K deductible for in-network coverage can go all the way up to $16K for out of network.

How long will it take to get my quote?

No more than 3 business days. If you have any questions regarding your submission, feel free to call us at (866) 297-3045

Is my information kept private?

 Yes. Before using our services, take a look at our privacy policy for more information.

What is a copay? (Medical or health-related expense)

A copay is the fixed portion of a medical or health-related expense that you are required to pay as outlined in your health insurance terms.

If your health insurance plan requires you to pay a copayment, this is your portion of the bill for services or items. Your health insurance company will have pre-determined copayment amounts for all medical services and goods. You will usually pay your copayment directly to the medical or service provider.

What Is Cobra Health Insurance?

COBRA, short for Consolidated Omnibus Budget Reconciliation Act, provides the opportunity for employees and their dependents to stay on their employer group insurance coverage after the loss of employment.

Being let go from your job can be overwhelming and unnerving. Not only do you now have a loss of income, but you also have a loss of health insurance or need to find health insurance elsewhere.

Congress understood this dilemma in 1986 and set forth the COBRA provisions. This new act amended the Employee Retirement Income Security Act, the Internal Revenue Code, and the Public Health Service Act in order to expand benefits for those who had lost insurance coverage through their employer.

Who Is Eligible for COBRA?

Employers with 20 or more employees are generally mandated to provide COBRA benefits and need to notify their employees of its availability. Qualifying events for employees for COBRA coverage include:

  • Voluntary or involuntary loss of a job as long as it was not for gross misconduct
  • Reduced hours on the job

Spouses are also covered in the event that they divorce or legally separate from the covered employee, the covered employee becomes eligible for Medicare, or the covered employee dies. If a dependent child loses their dependent status under the plan rules, they are also eligible for COBRA coverage.

What is Your Effective Date?

The effective date is the date at which your insurance policy begins, or becomes effective. Prior to this date, even if your application has been approved, you do not have access to your new health insurance coverage. This means your health care policy will not begin covering any portion of your medical expenses.

When Does Your Effective Date Start?

In general, the date that your policy becomes effective is after your first premium payment has been made. This date is determined by your health insurance company, so it can also be the date that you applied for a policy or the date that your application was accepted.

In some situations, if you’re going through your employer for health insurance, there may be a waiting period before your insurance policy becomes effective. This can be anywhere from 30 to 180 days, and it’s generally determined by the employer. Someone at your company, usually one of your Human Resources representatives will have the information available.

Examples of How an Effective Date Works
Let’s say that you’ve applied for an insurance policy and the provider has accepted your application. The insurance provider, in this example, doesn’t consider your policy effective until you’ve made your first premium payment.

If you decide to go to the doctor before you’ve made you first premium payment, you may be expecting to have your doctor’s visit covered. However, since the policy isn’t effective (again, because you haven’t made your first payment), your visit won’t be covered under your new health insurance plan, and you can be left footing 100% of the bill for the medical services you received. This is why it is so important to be aware of when your effective date is.

What Is Employee Contribution?

If you have a health insurance plan through your employer, it’s likely that you have to pay for at least a portion of your premiums. Your employee contribution is the portion of the premium that you have to pay to a health insurance provider for your coverage, but contributions are normally taken out automatically by your employer.

If you’re making a contribution as an employee to a health care plan, it usually means that you’re getting a discount on a plan. However, if your contribution is a large percentage of your premiums, you may be better off finding a plan that’s not offered by your employer. Many organizations have healthcare plans that are offered by only one provider. Unless the plan offered is stellar or the employer is making a significant contribution, you may be able to find a cheaper health insurance plan or one that better suits you and your family’s needs.

How Does Employee Contribution Work?

In the majority of cases, contributions from employees are taken out of the employee’s paycheck after their taxes have been deducted. Deductions are generally automatic, but they may be spread out in different ways depending on the health insurance plan, the employer’s preference, or employee’s preferences.

For instance, a contribution may be taken out of the first paycheck of every month, which means the employee will pay a lump sum every month for their contribution. Alternatively, contributions from employees may be split up so a percentage is taken out of each paycheck, which means they will pay less money more often.

Your Employer contribution, on the other hand, is the dollar amount your employer pays towards your policy. This is usually a significant percentage of an employee’s premiums, and most companies that do make payments to employee insurance costs contribute more than 50% of the employee’s premiums. However, while many employers contribute to the premiums for an employee’s health insurance, not all employers cover the premiums for family members or dependents.

What Is Your Health Insurance Grace Period?

What happens if you choose the perfect policy, but am unable to keep up with the monthly maintenance fees or what is called your insurance premium due to a financial hardship? Health insurance companies actually have your back by offering an additional layer of protection to you and your family through what is known as a health insurance grace period. A grace period can be described as the period of time after you have missed payment for your insurance premium in which you, the policyholder, can make a payment before the policy lapses or cancels.

How Long Does A Grace Period Usually Last?
This 24 hour to 30 day time period is decided by each health provider, with the length of the time period varying due to the company’s individual rules and regulations regarding policy procedures and state laws. The length of the health insurance grace period can also vary depending upon the type of policy the holder has agreed to.

What Is the Individual Mandate?

In health insurance, the individual mandate, or shared responsibility payments refer to the penalty or fee charged to people who can afford to buy health insurance but choose not to buy it.

When the Affordable Care Act was created, the individual mandate was devised to help ensure that everyone who could afford health insurance would participate in health insurance pools. Individuals who are able to purchase health insurance but fail to do so will be penalized with a fee for any month that they, their spouse, or their children don’t have a policy that provides minimum essential coverage.

Paying the Penalty

People are not required to pay the government a fee in the way that they might a parking ticket. Instead, the fee is paid when someone files their federal tax return. It is added to someone’s tax obligation, and it may reduce the amount of their tax refund if they have one.

The fee amount is either 2.5% of a person’s annual income, but not more than the cost of the average Bronze plan through the Health Insurance Marketplace, or a per-person charge of $695 per adult and $347.50 per child under 18 years old. You end up paying whichever amount is higher.

There are two different ways the individual mandate fee is calculated:

  • You pay a penalty equal to 2.5% of your annual household income, but not more than the cost of the average Bronze plan sold through the Health Insurance Marketplace. As of 2016, the average Bronze plan cost approximately $2,243.
  • You pay a per-person charge of $695 per adult and $347.50 per child under 18 years old. The per person charge is capped at $2,085 for the entire family.

Why Is There an Individual Mandate?

The individual mandate was created due to a concern that if only unhealthy individuals participated in the Health Insurance Marketplace, it would cause problems. One of the biggest potential problems that could arise from a large pool of unhealthy participants is that it would drive up the cost of premiums and make health insurance less affordable.

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