Individual and Family Health Insurance

Questions and Answers:

What is Individual and Family Health Insurance?

            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. Unlike employer sponsored health insurance, you must qualify for individual insurance. Over 50% of all individual bankruptcies are caused from medical claims!  You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.

What types of Individual and Family plans do I have to choose from?

            There are three major types of plans: indemnity, preferred provider organization (PPO) and health maintenance organization (HMO). Indemnity plans pay a share of your healthcare costs upon receipt of a bill from a health care provider. Sometimes you might have to pay your provider (doctor or hospital) immediately when they provide service, then wait for reimbursement from your insurance company. PPOs, on the other hand, use healthcare provider networks. Doctors and hospitals within this network agree to provide services to you, the patient, at pre-negotiated rates and submit their bill directly to your insurance company. HMOs require you to visit a designated primary care physician first before seeing other specialists within their network. HMOs and PPOs can be lighter on the paperwork, but indemnity plans usually give you greater choice in selecting doctors.

What is a PPO?

            As a member of a PPO (Preferred Provider Organization) plan, you are "preferred" to use the insurance company's network of preferred doctors and hospitals. These providers are contracted to provide services to the health insurance companyýs members at a discounted rate.

You will probably have an annual deductible to pay before the insurance company starts covering your major medical bills. You may also have a copay for certain services and also a copay for prescription drugs.

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

What is a HMO?

            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.

What is a deductible?

            A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.

What is a copay?

            A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

What is coinsurance?

            Coinsurance is the term used by health insurance companies to refer 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 $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.

What are the differences between participating and non-participating providers?

            A participating provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. A non-participating provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

How Do I know which company to choose?

            ShopYourPolicy.com only offers health plans through A rated companies.  They offer a 5 million dollar maximum and are all true major medical plans.

What is common in a "good" Individual Family Health plan?

             Most of the plans we offer consist of a copay on office visits, a copay on prescription drugs, preventative coverage for adults and children, and an emergency room copay.  All of our plans also consist of a 5 million maximum on major medical.  Maternity is also an optional benefit.

Applying for an Individual or Family Plan

If I apply for a plan how long will it take to get a decision?

            It usually takes around 17 days to get a decision from an insurance company depending on your medical condition. 

If I purchase a plan when will coverage start?

            With most companies you can choose your effect date.  Your effective date will always be after your signature date on your application.  Effective dates are generally the 1^st or the 15^th of the month.

How do I apply for an Individual or Family Policy?

            Most carriers offer online applications.  You can apply directly off of our website with Unicare.  ShopYourPolicy.com can also assist you with online application from most other companies.  You can also download applications from our website and mail them or fax them directly to us.

Will online applications help get my coverage started faster?

            Online applications significantly decrease the amount of time it takes for your policy to go through underwriting.  In some cases you are automatically approved and can have coverage start the next day!