Frequently
Asked Questions
If you have a question, we hope that the following
questions and answers will help.
Choosing between health plans is not as easy as
it once was. Although there is no one "best" plan,
there are some plans that will be better than others
for you and your family's health needs. Plans differ
in how much you have to pay and how easy it is to
get the services you need. Although no plan will
pay for all the costs associated with your medical
care, some plans will cover more than others.
With any health plan you will pay a basic premium,
usually monthly, to buy the health insurance coverage.
In addition, there are often other payments you
must make. These payments will vary by plan but
essentially are deductibles
and copayments .
In the "Things to Consider" section of the site,
there are some excellent guides about choosing and
comparing health plans.
Here's a list of key questions to consider in selecting
the plan that best meets your needs:
- How
much will it cost me on a monthly basis?
-
Are there deductibles I must pay before the insurance
begins to help cover my costs? After I have met
the deductible, what part of my costs are paid
by the plan?
-
What doctors, hospitals, and other medical providers
are part of the plan? Are there enough of the
kinds of doctors I want to see?
-
Where will I go for care? Are these places near
where I work or live?
-
If I use doctors outside a plan's network, how
much more will I pay to get care?
-
Are there any limits to how much I must pay in
case of major illness? What about limits and deductibles
for certain types of care such as surgery or maternity?
resource:
Agency for Health
Care Policy and Research and Health Insurance Association
of America.
You can compare benefits and prices of different
plans side by side using the "COMPARE BENEFITS"
feature. On "Step 2: Compare Plan Benefits and Prices
From Leading Companies", check the box of each plan
you want to compare. Then click "COMPARE BENEFITS".
You can also call us at 702-380-8232
Feel free to call us after hours and leave a message,
which will be immediately returned the next business
day.
Back
to top of FAQ
Health insurance plans usually are described as
either indemnity (fee-for-service) or managed care.
Indemnity and managed care plans differ in their
basic approach. Put broadly, the major differences
concern choice of providers, out-of-pocket costs
for covered services, and how bills are paid. Usually,
indemnity plans offer more choice of doctors (including
specialists, such as cardiologists and surgeons),
hospitals, and other health care providers than
managed care plans.
Indemnity
plans pay their share of the costs of a service
only after they receive a bill. Managed care plans
have agreements with certain doctors, hospitals,
and health care providers to give a range of services
to plan members at reduced cost. In general, you
will have less paperwork and lower out-of-pocket
costs if you select a managed care-type plan and
a broader choice of health care providers if you
select an indemnity-type plan.
Besides indemnity plans, there are three basic types
of managed care plans: PPOs, HMOs, and POS plans.
A PPO is a Preferred Provider Organization. As a
member of a PPO, you can use the doctors and hospitals
within the PPO network or go outside of the network
for care. You do not need a referral to see a specialist.
-
If you obtain care from a medical provider outside
of the PPO network, you will pay more for the
service. For example, a PPO might pay 90 percent
of the cost for a visit with an in-network doctor
but only 70 percent of the cost for a visit to
a non-network doctor.
-
You will typically pay a copayment for each visit/service.
These copayments are typically higher than an HMO
copayment but not always.
-
You will usually be responsible for paying an annual
deductible.
If you join a PPO, you should find you have more flexibility
than with an HMO, but your total out of pocket costs
are likely to be somewhat higher.
An HMO is a Health Maintenance Organization. As
a member of an HMO, you select a primary care
physician from a list of doctors in that HMO's
network. Your primary care physician will be the
first medical provider you call or see for a medical
condition. He or she will make any needed referrals
to a medical specialist. Typically, these specialists
will be part of the HMO network.
If you join an HMO, you should find that you have
few out-of-pocket expenses for medical care -- as
long as you use doctors or hospitals that are part
of the HMO.
POS is a Point-of-Service Plan A type of managed
care plan combining features of health maintenance
organizations (HMOs) and preferred provider organizations
(PPOs). You can decide whether to go to a network
provider and pay a flat dollar or to an out-of-network
provider and pay a deductible and/or a coinsurance
charge.
An indemnity plan is commonly known as a fee for
service or traditional plan. If you select an Indemnity
plan you have the freedom to visit any medical provider.
You do not need referrals or authorizations; however,
some plans may require you to precertify for certain
procedures.Most indemnity plans require you to pay
a deductible. After you have paid your deductible,
indemnity policies typically pay a percentage of
"usual and customary" charges for covered services;
often the insurance company pays 80% and you pay
20%. Most plans have an annual out of pocket maximum
and once you've reached this they will pay 100%
of all "usual and customary" charges for covered
services.
Many health insurance companies have moved away
from indemnity plans and are instead offering managed
care plans such as HMOs and PPOs. You may have few
or no indemnity plan choices in your area.
Back
to top of FAQs
A provider is a hospital, health care facility,
physician or other medical professional that provides
health care services.
A physician or other medical professional who serves
as a group member's first contact with a plan's
health care system. Also known as a primary care
provider, personal care physician, or personal care
provider.
An office visit copayment is a fixed dollar amount
or a percentage that you pay for each doctor visit.
For example, with some plans you may pay a fixed
amount such as $5 or $10 per visit. Other plans
will charge you a percentage of the total fee for
the visit. So if your copayment is 10% and the doctor
visit was $200, you would pay 10% which, in this
case, would be $20.
A
deductible is the amount of annual medical expenses
that a health plan member must pay before the plan
will begin to cover expenses. For example, if your
plan has a $500 deductible, you will pay the first
$500 of your medical expenses before your health plan
begins paying the expenses. Only expenses for covered
services apply towards the deductible. For example,
if you paid $100 for a visit to a chiropractor but
the plan does not consider chiropractic care a covered
expense, then the $100 will not apply toward your
annual deductible.
An in-network medical provider is within the approved
network of providers for a particular health plan.
Out-of-network providers are not on the list. If
you visit a doctor within the network, the amount
you will be responsible for paying will be less
than if you go to an out-of-network doctor. In many
cases, the insurance company will not pay anything
for services your receive from outside their network;
however, there are exception to this.
As a general rule, HMOs tend to have smaller provider
networks than PPOs. In HMO and PPO plans, referrals
to specialists will be to doctors within the network.
Indemnity plans typically do not have networks;
you go to whatever doctor you want.
You can usually make your initial payment by credit
card or check. The payment must be made out in the
name of the insurance company. However, some insurance
companies may require a check for the initial payment.
Normally, your credit card will not be charged nor
will your check be deposited until you have been
approved. If you are not approved for coverage by
the insurance company, your money will be refunded
by the insurance company. Any financial information
submitted over the web is kept private and secure.
Once accepted as a plan member, all bills will be
sent from the health insurance company and you will
pay them via the choices offered by that company
No. Insurance companies charge the same premium
whether the plan is purchased directly from the
company, or through a broker
Back
to top of FAQs
For the plans presented here we can provide the
lowest price available anywhere.
Not all health plans sell health insurance directly
to individuals and families. Many, like Aetna and
Cigna, provide insurance predominately through employers.
Please call us at 702-380-8232
for any assistance you may need and speak to our
friendly and enthusiastic customer service representatives:
M
- F 9am - 5pm PT
Feel free to call us after hours and leave a message,
which will be immediately returned the next business
day.
Back
to top of FAQs
Life and Health Insurance Services
Steven M Weinstock, Licensed
Broker
Office: 702-380-8232
Toll Free: 800-799-4224
info@mynewinsurance.com
© 2004 Life and Health Insurance
Services. All rights reserved.
|
Home 
Office