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What is my health insurance effective date?
Your effective date is when you benefit coverage begins. That date is determined upon the approval of your application. Typically, the effective date is the 1st of the month following application approval, although it can sometimes be the 15th of the month for individual coverage and can be any day of the month for short-term coverage.
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How will my monthly health insurance premium be collected and paid?
Your monthly premium payments will sent to you by monthly statement and you can mail in your payment each month, or, in the case of individual coverage you may choose automatic deduction from your checking account once a month or automatic payment by designated credit card.
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What if I want to end my health coverage or add more people to my coverage?
Health insurance is written on a "month-to-month" basis, so a person can begin or end coverage at any time. Just send us an email or call us (see Contact Us section above) and we will take care of the process for you.
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What is a deductible?
This is the set amount you pay each year before the insurance provider pays any benefits. For example, if the policy you select has a $500 deductible, you would need to pay the first $500 of covered services before the insurance provider will begin to pay any benefits. (Your office visit coverage is usually a separate benefit so the deductible does not apply.)
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What is a copayment?
This is a fixed dollar amount charged to you for certain health care services. You pay the copayment to the physician or other health care provider at the time services are rendered. For example, many policies have a copayment feature such as a $20 copayment for simple office visits to your physician. There may also be a copayment for your drug benefit.
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What is coinsurance?
This means the percentage of an allowable charge that the covered person must pay for a covered service.
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What is the out-of-pocket maximum?
This is the most you would have to pay in coinsurance and deductibles each year for covered health care services. Once you reach this amount, all other care covered under the policy will be paid for by the insurance provider. Copayments do not count toward your out-of-pocket maximum but services with coinsurance do apply.
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What does it mean if there is a pre-existing conditions clause? This means that any conditions—physical or mental—for which you were treated in a certain number of months prior to enrolling in the insurance provider's coverage will not be covered until the policy has been in force for 12 consecutive months, provided that the condition(s) is otherwise covered under the policy. This includes conditions for which medical advice, diagnosis, care or treatment was recommended or received.
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What happens if I become eligible for health coverage through an employer?
You have the option of enrolling in your employer's group health plan, or you may choose to keep your own individual coverage which will stay with you even if you change jobs or move.
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Who is eligible for individual health coverage?
Everyone who is under the age of 64 1/2 years is eligible.
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Are children eligible?
Yes. A separate application may be necessary for each child you want covered. A parent or guardian must sign applications for all children under 18 years of age.
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What is the difference between in-network benefits and out-of-network benefits?
In-network benefits apply when you receive care from physicians or facilities that are part of the insurance provider's PPO network. When you choose services from in-network providers, you enjoy a higher level of benefits and lower out-of-pocket costs.
Out-of-network benefits apply when you receive care from physicians or facilities that are not part of the insurance provider's network. When you choose services from out-of-network providers, you are still covered for those services, but you must pay a higher share of the cost. That means your out-of-pocket costs are higher.
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What if I need treatment when I'm out of town?
Every insurance provider has its own policy for out-of-town care and rules may vary even according to which plan you have selected from a particular provider. Contact us to find out what the exact rules are for your particular policy.
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