Group & Individual Benefits FAQs

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.

No. You are under no obligation to buy a health insurance plan when using our site. After submitting your application you may cancel it at any time during the underwriting process. When you submit an application you will typically include your credit card number, bank account information, or a check for the initial premium payment. Most insurance companies will not charge your card, debit your account, or deposit your check until you are approved. If you are charged or your check is cashed and you are denied for coverage or cancel your application prior to approval, the insurance company will issue a refund to you.

Absolutely not!

In a preferred provider organization, or PPO plan, insurance companies partner with healthcare organizations to provide discounted rates to patients. In a PPO, you can usually go to a different doctor, or “out of network,” for service, for an additional charge. In a health maintenance organization, or HMO plan, the insurance company also partners with healthcare organizations, but you have to choose a primary care physician. If you want to get treated out of network, the HMO plan will usually not cover this. Point of service, or POS plans, are a combination of PPO and HMO plans. In a POS plan, you also need to choose a primary care physician, but the plan will pay for part of your medical costs if your primary care physician refers you to another doctor who is out of network.

As a member of a PPO (Preferred Provider Organization) plan, you’ll be encouraged to use the insurance company’s network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan’s members at a discounted rate. You typically won’t be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.

With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.

Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you’ll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.

With an HMO you’ll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won’t have to submit any of your own claims to the insurance company. However, keep in mind that you’ll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.

A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan may be required to choose a primary care physician (PCP) from the plan’s network of providers. Services rendered by your PCP may or may not be subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.

Typically, however, you will receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you’ll likely have to pay up-front and submit a claim to the insurance company yourself.

Please note this information may vary by insurance company.

Legislation establishing Health Savings Accounts (or “HSAs”) took effect on January 1, 2004. HSAs and HSA-compatible health insurance plans are becoming more and more popular. Here are the basics:

• An HSA is a tax-favored savings account that may be used in conjunction with an HSA-compatible high deductible health insurance plan to pay for qualifying medical expenses.
  
• Choosing an HSA-compatible health insurance plan may help you save money. Typically, the monthly premium on an HSA-compatible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
  
• Contributions to an HSA may be made pre-tax, up to certain annual limits.
  
• Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.
  

*Not all high-deductible plans are eligible for use in conjunction with an HSA.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was enacted in 1986. COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children with temporary health insurance at group rates for a specified period of time. If you’re let go from your job due to corporate downsizing, for example, you can file for COBRA health insurance so you or your family doesn’t go uninsured.

The answer is more complicated than you might think. The cheapest policy may not provide you the best overall value.

The most obvious feature of any policy is the premium — the amount you pay (usually monthly) to an insurance company for a health insurance policy.

Just as important as the premium cost, however, is how much you have to pay when you get services. Examples include:

• How much you pay before insurance coverage begins (a deductible);
  
• What you pay for services after you pay the deductible;
  
• How much in total you will have to pay if you get sick (the out-of-pocket maximum).
  

Often, there is a direct trade off between how much you pay for health insurance and the extent of the covered benefits.

As you weigh this trade off, remember that buying the policy with the cheapest premium or with a very high out-of-pocket maximum may leave many services and treatments uncovered. This could leave you vulnerable to high medical bills.

In order to do this, it’s important to know what questions to ask the salesperson or agent prior to buying. According to experts, here are some questions that you should ask your potential provider:

• What is the cost of the monthly premium, deductible, co-payment amount and cap? How does changing one amount affect the others?
  
• What does the policy cover? What does it exclude? Are there limits on the number of days the insurance company will pay for services such as prescription drugs, maternity or out-patient services?
  
• Does coverage begin immediately or am I subject to a waiting period?
  
• Is there a lifetime maximum cap the insurer will pay? This is important to know if you or someone in your family has a chronic or expensive illness or medical condition.
  
• How do I obtain emergency care? Can I use urgent care facilities without pre-approval? Am I limited to using certain facilities in the plan?
  
• What else is covered? It’s important to find out if routine services, such as preventive care, immunizations and mammograms are covered under the policy.