FAQ/Q&A

If you have a specific question and don’t see it listed, let us know.

  1. What is the difference between HMO, PPO and POS coverage?
  2. What is individual and family health insurance?
  3. Can I purchase an individual health care policy?
  4. What is open enrollment?
  5. How do I add a dependent to my insurance plan?
  6. How long does it take to get health insurance coverage?
  7. Will my college-bound child still be covered under my insurance plan?
  8. Why do I need health insurance?
  9. How can I afford the high cost of health insurance?
  10. With so many options, how do I decide the best coverage for my needs?
  11. Why do I need health insurance coverage right now while I’m healthy?
  12. What is an HSA and how does it work?
  13. What is the best health insurance plan?
  14. What is the difference between in-network and out-of-network providers?
  15. What is a co-payment?
  16. What is a deductible?
  17. What is coinsurance?
  18. What things should I consider when choosing a health insurance plan?
  19. What do most health insurance plans cover?

1. What is the difference between HMO, PPO and POS coverage?

HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses. As a HMO member, you choose a primary care physician (PCP) at the time of enrollment. The PCP will handle most of your healthcare needs. The member must receive a referral from their PCP in order to see a specialist.

HMO plans offer a broader range of preventive coverage than most other plans. You may not be required to pay a deductible before your coverage begins and your co-payments will likely be minimal. If members use healthcare services by non-network providers without a referral from their PCP, services will not be covered.

PPO (Preferred Provider Organizations) carriers use a larger network of providers. These healthcare providers offer services to members at a discounted rate. Members typically are not required to pick a primary care physician but will be able to see doctors and specialists within the network at their own discretion.

An annual deductible usually must be met before the insurance company starts covering medical expenses. A member may also have a co-insurance for certain services (ex: doctor visit) and/or may be responsible to cover a certain percentage of their own medical expenses.

If members use out-of-network service providers, they would have coverage but at a lower percentage than if they used an in-network provider.

POS (Point of Service) coverage combines features of an Exclusive HMO and an Indemnity PPO. These plans typically provide for a primary care physician, but gives you access to a broader range of doctors, as in a PPO plan. If you stay within in-network providers, a flat co-payment applies; however, out-of-network services carry high deductibles and higher out-of-pocket expenses.

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2. What is individual and family health insurance?

Individual and family health insurance is medical insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Most people prefer to have their employer provide group health insurance coverage. However, if this is not a option, it is till important for you to seek coverage. You will be surprised with the variety and affordability of the individual and family health insurance options available.

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3. Can I purchase an individual health care policy?

Yes. Several insurance carriers will issue individuals health insurance for you and/or your family. Individual policies include PPO plans found in group policies. Other health plan options for individuals include Point of Service (POS) and Fee-for-service (FFS). Certain high-deductible plans can also be used in conjunction with a separate Health Savings Account (HSA). HSA’s enable you to pay for qualified medical costs with pre-tax dollars.

Note: You may not qualify for an individual plan if you are currently ill. However, you may be able to obtain health coverage through a state sponsored program for high-risk individuals. These programs usually cost more than an individual insurance plan, but they may be the only option for some individuals.

Please contact our office at (586) 314-3400 for a quote. We can help you determine the best health insurance plan that’s right for you.

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4. What is open enrollment?

In a group health insurance plan, open enrollment is a 30-day time period when an employee and/or dependents can enroll in the group health plan.

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5. How do I add a dependent to my insurance plan?

Dependents can be added or deleted from your group health plan during the open enrollment period. However, if certain qualifying events occur, you can add or delete dependents outside of the open enrollment period. Qualifying events include (but are not limited to): birth, child loses coverage from other parent, adoption, marriage, death, or divorce. Contact our office for the necessary forms for a qualifying event.

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6. How long does it take to get health insurance coverage?

With some insurance carriers, individual coverage can be applied for and issued within a few days. Group insurance carriers typically require 30 days to issue coverage.

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7. Will my college-bound child still be covered under my insurance plan?

Typically, insurance carriers will allow a child to remain on their parent’s health insurance policy until age 23 or 25. However, each insurance carrier differs.

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8. Why do I need health insurance?

Health insurance protects you again the unpredictable. Even if you’re healthy now and live a healthy lifestyle, you could be faced with an unexpected injury or illness.

Health insurance helps protect you financially. Medical care costs add up quickly and can set up for a staggering financial loss. Health coverage can limit out-of-pocket costs, protect your assets and even safeguard your future earnings. It also offers coverage for preventive care as well as the cost of a possible catastrophic illness or injury.

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9. How can I afford the high cost of health insurance?

Health insurance coverage is more affordable than you think, and you can’t afford to be without it! One emergency room visit could cost you thousands of dollars for only basic care. Your costs will be significantly lower if you have health care coverage.

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10. With so many options, how do I decide the best coverage for my needs?

Online decision tools are a tremendous help and have greatly simplified the process of purchasing health insurance coverage.

For further assistance with online decision tools or to get a quote, please contact our office at (586) 314-3400.

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11. Why do I need health insurance coverage right now while I’m healthy?

           

Health coverage is like any other insurance—you pay premiums to protect yourself from unexpected accidents or illness. By paying premiums, you protect yourself from the possibility of larger bills later. If you wait until you become ill or injured, you may not qualify for a plan. Or, you may be faced with significantly higher premiums for high-risk, pre-existing conditions.

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12. What is an HSA and how does it work?

An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for certain medical expenses.

Typically, the monthly premium on an HSA-eligible 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 an HSA account may be invested at your discretion. Unused funds remain in the account and accrue tax-free, annual interest.

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13. What is the best health insurance plan?

Choosing the best health insurance plan isn’t always easy. The best match for you and your family may be different from the best match for someone else. When choosing which health insurance plan fits you best, consider the following:

To better match your answers to a health insurance plan, give us a call at (586) 314-3400.

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14. What is the difference between in-network and out-of-network providers?

In-network providers contract with a health insurance company to provide services to plan members for specific pre-negotiated rates. If you visit a physician or other provider within the network, the amount you pay will be less than if you go to an out-of-network provider.

Out-of-network providers do not contract with an insurance company, therefore members will pay more if they go to an out-of-network provider. Although there are some exceptions, the insurance company will either pay less or nothing at all for services you receive from out-of-network providers.

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15. What is a co-payment or co-pay?

A co-pay is a specific charge that you are required to pay for a specific medical service or supply. Your health insurance plan may require a $15 co-pay for an office visit or brand-name prescription drug. The remaining charges are paid by the insurance company.

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16. What is a deductible?

A “deductible” is a specific amount that your health insurance company requires you to pay for out-of-pocket expenses each year before your health insurance coverage begins to make payments for claims. Not all health insurance plans require a deductible. Typically, HMO plans do not require a deductible, while most Indemnity and PPO plans do. The amount of your chosen deductible can have an effect on your health insurance premiums.

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17. What is coinsurance?

Coinsurance refers to the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional co-payment or deductible requirements), then a $200 medical bill would cost you $40, and the insurance company would pay the remaining $160. Coinsurance percentages can also effect the insurance premiums charged to the plan member.

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18. What things should I consider when choosing a health insurance plan?

When considering what health insurance plan best fits your lifestyle and needs, ask yourself the following questions:

If you need help in finding the answers to these questions, feel free to give us a call at (586) 314-3400.

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19. What do most health insurance plans cover?

Most health insurance plans cover the following expense:

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Still have a question?

If you have a specific question and don’t see it listed, let us know by calling our office at (586) 314-3400 or contact our staff with our short contact form.