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Frequently Asked Questions By Topic

Individual and Family Health Insurance

Why will individual and family health insurance work for me?

Although most people would prefer to receive health insurance benefits from their employer, this service is not always available. Individual and family health insurance is easily accessible to people who do not have the advantage of group health insurance. is certain that you will find our broad selection of individual and family health insurance plans coupled with a variety of payment options for reasonable prices to be quite a winning combination.

What types of individual and family insurance plans does offer?

Indemnity and Managed-Care are the two main types of individual and family health insurance plans. Generally speaking, the most important differences between the two categories are the number of healthcare providers from which to choose, the amount of out-of-pocket expense, and the bill-paying process. Normally, indemnity plans offer more choices of healthcare providers than managed care plans, but it is important to note that indemnity plans will not begin to make payments on your claims until they have received a bill from the provider. This usually results in required payment at the time services are rendered and then subsequent reimbursement by the insurance company. Healthcare provider networks are the main structures utilized by managed-care plans. Insurance companies and healthcare providers within a network develop predetermined rates for specific services, and the providers agree to perform those services for managed-care plan patients as well as submit the claim to the insurance company. There are three main types of managed-care health insurance plans. These include Health Maintenance Organizations(HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. To summarize the two categories of plans, an indemnity plan offers a wider selection of healthcare providers and utilizes a reimbursement system; a managed care plan provides the options of lower out-of-pocket costs and very little paperwork along with a reduction in healthcare provider choices.

What is a Preferred Provider Organization (PPO) plan?

Although it is not required that you do so, when you use the insurance company's network of preferred doctors and hospitals, a PPO plan will have lower costs. If you choose an out-of-network provider, the cost will be much higher. In-network healthcare providers have predetermined rates, usually nominal, for the provision of each service to the health insurance plan's members. Consider the following example: Let's assume that the out-of-network coverage rate is sixty percent. This means that the insurance company will pay sixty percent of what that service would have cost had you gone to an in-network provider. If you received $500 worth of services from an out-of-network provider and those same services were available from an in-network provider for $250, the insurance company will only pay sixty percent of $250, which is $150, leaving you responsible for the remaining $350. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.

It is generally not required to pick a primary care physician which allows plan members to seek medical services from any doctor or specialist within the network. While one of the most popular qualities of PPO plans is the flexibility in choosing providers, it is essential to confirm that your preferred doctor or neighborhood hospital belongs to the network. Additionally, if you will be including children in your plan, preventive and well-child care benefits will be of special importance to you. An annual deductible typically must be met before the insurance company starts covering your medical bills. A co-payment may be required for certain services or it may be necessary for the plan member to cover a certain percentage, or coinsurance, of the total charges.

What is a Health Maintenance Organization (HMO)?

The biggest benefits of a standard HMO plan are the lower out-of-pocket healthcare expenses, the strong focus on preventative medicine, and nominal co pays that are independent of a deductible. However, more often than not, these features are paired with more limited options as far as freedom to choose specific physicians or hospitals. Unlike a PPO, the selection of a primary care physician (PCP), who will handle the majority of your healthcare needs, is required. With an HMO plan, your insurance claims are submitted for you by the provider. It is important to note that should you decide to receive services out-of-network, an HMO will most likely cover none of the cost. In addition, even in-network providers are not covered for services rendered without being referred by your PCP. In order for the insurance company to cover specialist visits, it is up to the discretion of the PCP to make a referral.

What is a Point of Service (POS) plan?

A POS plan is a cross between an HMO plan and a PPO plan. Similar to an HMO, it is required to select a primary care physician (PCP) whose services will usually be provided independently of a deductible. POS plans also share the HMOs concentration on preventive medicine. The highest percentage of coverage will almost always be for services rendered or referred by your PCP. As with PPOs, visits to out-of-network providers generally require payment of the deductible and less of the costs will be absorbed by the insurance company. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.

What is an Indemnity plan?

An Indemnity plan is one of the most flexible health insurance plans on the market. It allows you to freely choose any doctor or hospital you wish with no difference in the levels of coverage. Selection of a primary care physician is not required, nor is it necessary to get a referral to see a specialist. However, Indemnity plans are considerably more expensive than managed care plans because a deductible, usually ranging from $500 to $1500, must be met annually before the insurance company begins to absorb any of the cost. When the deductible is met, claims will be paid at a certain percentage of the usual, customary, and reasonable rate (UCR), which is determined by examining the standard costs of healthcare in your area. Additionally, since the insurance company does not have managed care agreements with providers, the responsibility for filing claims for reimbursement is left to you.

What is a co-payment?

A co-payment or "co-pay" is a specific dollar amount that plan members are required to pay for a specific service. The most common examples of co-payments are for office visit or prescription drugs, after which the insurance company will absorb the remainder of the cost. Co-pays frequently range from $10 to $50, although all plans vary in their specific charges.

What is a deductible?

Although there are exceptions, most Indemnity and PPO plans have a required deductible that must be met while HMO plans usually do not. A deductible is a set dollar amount that plan members must pay annually before the health insurance company will begin absorb any medical costs.

What is coinsurance?

Coinsurance is the percentage of coverage provided by health insurance companies, after co-payments or deductibles have been met. For example, a 25% coinsurance rate means that you are responsible for paying 25% of any medical costs incurred. Specifically, $75 of a $100 medical bill would be covered by the insurance company, and your out-of-pocket cost would be $25. It is important to note that each insurance company has its own combination of co-payments, deductibles, and coinsurance.

How is a network used by insurance companies?

A network is a group of providers with whom the insurance company has negotiated specific rates for specific services for plan members. These providers are called in-network providers. Any provider who has not contracted with the health insurance company is considered out-of-network. Services rendered out-of-network will either be covered at a much lower percentage or, as frequently occurs with HMOs, not covered at all. By and large, provider networks are generally utilized by PPOs, POS plans and HMOs while Indemnity plans allow their policy holders to visit any provider at their discretion at the same level of coverage.

How do I start my coverage?

The best way to expedite the coverage begin date is to "eSign" your application, which allows underwriters to start working on it right away. Individual and family health insurance plan start dates can range from 1 to 90 days in the future. An important consideration is that your selected insurance company will need some time to process your application, and much of it depends upon the underwriting process and the availability of your medical records.

What if I only want to insure my children?

Many insurance companies will not insure more than one child on a single policy. Although does provide you the options of performing quote searches for one or multiple children, the broadest selection of plans will be shown if you search one child at a time. When getting quotes for your child only, enter the child's information in the "Applicant" or first row as you would your own. When searching for policies for multiple children, you will want to be sure that a childýs information is not entered in the "Spouse" row. You are, of course, free to apply for each child separately or together, whichever best suits your needs.

If I provide my personal information to, how do I know it is safe?

In addition to utilizing state-of-the-art privacy technologies, will sell, trade, or give away your information to anyone, for any reason, except the items directly relevant to the processing of your application with the insurance company. OurPrivacy Policy, which ensures the confidentiality of all of your information, is available for viewing at your convenience. If you would like us to answer any questions or address any concerns please contact us at 1-888-423-6437.

Do I make payments directly to the insurance company?

Upon completion of most health insurance applications, a credit card number or a check written to the health insurance company will be required for the first premium payment. Generally, the insurance company will not charge your credit card or cash your check until they have confirmed your approval for coverage. If you are not granted coverage, or if you cancel your application, your check will be returned to you or your card will be credited. Usually, health insurance premium payments are paid either quarterly or monthly directly to the insurance company. There are many different options for payment and billing such as automatic withdrawal or standard paper bills. It is important to not that coverage can be obtained without utilizing credit card billing.

Is there any obligation for me to buy an insurance plan once I have applied?

Absolutely not. Using is a safe, easy method of finding the best health insurance plan for your individualized needs. You may cancel your plan at any time, even during the underwriting process and up to ten days after you actually receive your policy. Although you will provide payment information while completing your application, most insurance companies won't charge your account until you are approved. Some insurance companies may charge a minimal application fee, usually $25 or less, but you will be notified during the application process if this is the case. Due to insurance company policy, these fees are generally non-refundable.

How do I know you are finding me the lowest premiums?

Each state's Department of Insurance has all health insurance rates on file. Regardless of whether you purchase a plan through a local insurance agent,, or directly from the insurance company, you will still pay the same monthly premium. Why not allow to do the work for you to ensure that you get the lowest price possible?

Who do I contact if I need help?

Your personal health insurance advisor is able to walk you through this process from beginning to end. At, we believe in providing you with stellar customer service to address all of your health insurance needs. Call Us Just call 888-423-6437 anytime to speak to a health insurance advisor. Simply get a quote and we will get back to you as soon as possible.

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