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FAQ

Why buy Health Insurance?

Commonly used Health Insurance terminology?

Underwriting and markup?

Maternity Coverage?

Vision plans?

Pre-existing conditions?

HSA Eligible Plans?

Temporary Insurance?

Small Business Group Insurance?

 

Why buy Health Insurance?
Whether you are trying to purchase health insurance for the first time, moving from group insurance to individual insurance because of expiration of Cobra or change of employment or are ready to change plans; We Will Help.

Health insurance should not be the last insurance you purchase, your health is your most important investment and must be insured. An accident or illness can ruin you financially and destroy your peace of mind.
Our website provides you with all available health insurance plans offered by the top insurance carriers. On the quotes page you will find all the rates for each available plan. Go through the Benefits by clicking the Details link to confirm the coverage.

  • The plans with the maximum coverage and the lowest deductible will be the most expensive. If the cost is too high then;
  • Look for a higher deductible for the same maximum coverage plan to compare the cost. If this is also out of budget then;
  • Look for a plan such as Blue Cross Blue Shield of Texas Saver plans or Humana’s Monogram plan; these plans will protect you against any unforeseen illnesses and accidents because you will be covered after your maximum out of pocket cost is met. If you only want coverage for hospitals then;
  • Look for plans such as Blue Cross Blue Shield of Texas Hospital Foundation plans; again this will protect you after you have met your out of pocket requirement.

Even though the Saver and the Hospital plans may require you to pay out of pocket till you meet your deductible before the insurance company will pay for any expenses; You and your assets are protected after your deductible and coinsurance maximum has been satisfied. This will give you peace of mind because you know that you are only at risk for the agreed upon amount. You may feel that in case of an illness, you will not be able to come up with the cash to satisfy your deductible; think of the alternative; you can always make payment plans with the hospitals and doctors to pay the maximum (for example $5,000.00) out of pocket maximum; but how will you pay the total hospital and doctor bills if you are uninsured.

Some people argue that why should I pay the premium every month for a plan with a deductible that I will never meet in a year? Think about this argument; Now when you pay your car insurance monthly and pay for all your repairs out of pocket, are you upset at the end of the year that your premiums were wasted because you did not have an accident?

Think of your Health as your most important asset; get the coverage that you can afford today to limit your risk; there is no contract, you can move to another carrier and cancel this coverage at any time; or you can upgrade your plan as your budget allows.

Get yourself insured; whether you get coverage through us or somewhere else.
Call us for assistance at any step; when reviewing the quotes, comparing the rates, comparing plans, applying online or right now before you start your quote; we are here to guide you in selecting the plan that best meets your needs and your budget.

The rates you see on our website are the insurance company’s published rates, there is no additional amount added to these rates. You apply directly with the company of your choice. We follow up and keep you informed of the progress and assist you with the process as needed.


Commonly used Health Insurance terminology
We will use the following example to define the health insurance terms.

Premium: Premium is the insurance payment amount; the premium quoted is the monthly cost for coverage. You will normally pay the premium via automatic bank draft or be billed monthly for it. Choosing the automatic draft is the best option because this option prevents any chance of insurance coverage lapse due to late payments. In case of coverage lapse, you may request reinstatement, but if it has been more than 30 days, you will have to reapply and pay the new rates.

Co-payment: Co-payment or as it is called Co-pay’ is the set amount that the insurance company requires you to pay for services such as Doctor visit, prescription or emergency room visit. The co-pay amount varies by insurance companies or for the same company by insurance plans. A co-pay example is Blue Cross Blue Shield of Texas-Select Choice individual plans charges $25 for unlimited dr visits. Therefore, you will pay $25 for each Dr consultation and Blue Cross Blue Shield of Texas will pay the remainder of the Dr’s consultation bill.

Deductible: This is the set amount that you select and agree to pay out-of-pocket before the insurance company starts to pay any part of certain medical charges. Each plan has a deductible amount; for example if you choose BCBSTX Select Choice 1500 deductible then you are agreeing to pay $1500 out-of-pocket in a calendar year before BCBSTX starts to pay their portion of the 80% co-insurance for laboratory or hospital charges. All plans have set deductibles and depending on the plan, you may have to satisfy the deductible before the insurance company pays for anything or the deductible may apply to certain medical charges and others may be covered with co-pay such as the Dr’s consultation fee under the Select Choice plans.

Coinsurance: This is the amount that the health insurance companies require you to pay as your portion of the medical charges. For example with the 80/20 coinsurance requirement, after you have satisfied the deductible; if the hospital bill is a $1000, then you are responsible for 20% ($200) and the insurance companies pays the balance 80% or $800.

Out of pocket maximum: This is the maximum amount you will pay out of pocket for covered medical expenses per year. Using the above example; With a $3000 out of pocket maximum; you will be pay your 20% coinsurance till you have satisfied the first $3000 per year. The insurance company pays 100% after you have paid out your maximum out of pocket. Even with a $50,000 hospital bill, after the maximum out of pocket, the insurance company will pay 100% of the bill, the only limitation for covered medical expenses will be the Lifetime maximum.

Lifetime maximum: This is the total that the insurance company will pay over the individual’s lifetime. With the $5,000,000 (five million) lifetime maximum, the insurance company has agreed to pay a maximum of five million dollars over the customer’s lifetime.


Underwriting and markup
Even though most of the requirements and plan benefits are similar; Each insurance company has it’s own underwriting guidelines.
We as agents can guide you in selecting the insurance company that will best meet your needs or condition.
Certain insurance carriers such as Blue Cross Blue Shield of Texas will offer a preferred rate to nonsmokers in good health who meet the height/weight guidelines. They offer their standard rates to other applicants who do not have a medical condition that they do not accept.
Other insurance companies for example Aetna may approve an individual with certain medical condition with a markup (higher rate than their published rates).
An nsurance company may also approve an individual but add a rider (exclusion) to the policy declining to pay any claims associated with the stated condition or disease.


Maternity Coverage
Individual insurance plans normally do not include any coverage for maternity expenses. Any charges related to maternity are not paid under the individual plans. Golden Rule and Humana offer a maternity rider that you can purchase along with your medical plan to cover your maternity and delivery charges. For example Humana charges an average of $300 per month for maternity coverage and you must be covered at least 30 days before you become pregnant. After the baby’s delivery and your first post delivery ob/gyn visit you can drop this rider from your plan. You must check the deductibles, coinsurance and copays that relate to maternity coverage because these are separate from your regular medical coverage.


Vision plans
Vision plans are normally discount plans included with the health plan. Once you purchase a health plan for example; once you purchase a Humana health plan you can register with their discount plans and receive up to 45% discount on eye glasses/contacts etc and pay a discounted rate for vision checkups.


Pre-existing conditions
We can guide you in choosing the insurance company that will approve your application.
If you have a significant medical condition Call Us before applying and we can help you with your selection. There is no obligation to purchase but if you are seriously looking to protect your health and start investing in your own health; We can steer you towards the companies and plans that best suit you.

  • If you have current coverage and have a pre-existing condition then you can purchase a new plan and your condition will be covered by the new plan depending on how long you had coverage and the time lapse between coverage.


HSA Eligible Plans
  • HSA’ stands for Health Savings Account. An HSA-eligible high deductible health insurance plan may be used with the Health Savings Account to pay for qualified medical expenses. An HSA contribution may be made with pre-tax dollars which means that you may deduct the contribution from your gross salary. The HSA account grows tax deferred for retirement, but can be used for medical expenses without any penalty or tax on such withdrawals.
  • An HSA eligible health plan is a high deductible health plan and therefore is low cost.
  • You can use your HSA account to pay for eligible medical expenses such as copays, prescriptions, dental health, deductibles etc but may not be used generally to pay for health insurance premiums. Therefore a withdrawal to pay for premiums will not be tax or penalty free.
  • HSA-eligible health plans are high deductible plans mainly because there is a yearly cap on the maximum tax deferred contribution that you can make into your HSA account. Employers are also allowed to contribute towards the employees HSA account.
  • The lowest deductible allowed for an HSA eligible health plan is $1,100 for individuals and $2,200 for families.
  • There is also a maximum cap set for the HSA eligible health plan annual individual payment. The health plan deductible plus coinsurance out of pocket maximum cannot exceed $5,500 for individuals and $11,000 for families.
  • You can make an annual pre-tax contribution to your HSA up to the maximum allowed for individuals and families. (2007; $2,850 individual and $5,650 family maximum). Also individuals between age 55 and 65 for year 2007 can contribute and additional $800 into the HSA.
  • You are allowed a one time transfer from your IRA or flexible spending account or Flexible Health reimbursement account into your HSA.

HSA setup:
You select an HSA eligible health plan offered by one of the health insurance carriers (the plans are defined as HSA plans); this is normally a high deductible low cost plan.
Select a bank or another trustee for your Health Savings Account. Check with them when opening the account to confirm any charges and/or fees that apply to an HSA.

  • Health Savings Account may be an interest bearing account, CD, Mutual Fund etc.
  • You withdraw from your Health Savings Account to pay for your eligible medical expenses (such as copays, deductibles, dental expenses) without being penalized or taxed. Withdrawals other than eligible medical expenses will be taxed and penalized similar to distributions from your qualified retirement plans.


Temporary Insurance
Temporary or Short-term insurance plans are normally for individuals who are between jobs or have just started a job and there is a waiting period for the group coverage to take effect.

  • Temporary insurance plans are normally for periods up to 6 months.
  • Application is simpler.
  • Coverage is normally for unforeseen illnesses or accidents.
  • Does not provide comprehensive coverage; cannot add dental, preventive care etc.
  • Pre-existing conditions normally not covered.
  • Do not purchase a short term plan if you have pre-existing conditions because you will not be eligible for guaranteed issue when you move to a standard individual plan.
  • Temporary plans are only a good option for healthy individuals needing coverage for a specific short term.


Small Business Group Insurance
Small Business group insurance is medical insurance plans purchased through the employer. The plans and coverage are more extensive than the ones offered directly to individuals.
To get a group quote from our website please click the Group Health link in the left WE OFFER’ column on the Home Page.

The Group Health Insurance page opens up. To Get a Quote:

  • Click the group health insurance quote form Link to send us your contact information and we will Call you to complete the census and answer your questions. OR
  • Complete the Census Form on this page and Click the Submit button to send us your census information. We will contact you with group proposals based on this information.

Group Insurance Benefits:

  • As a business you can deduct the group insurance premium expense.
  • You can attract and retain the best employees by offering group insurance; as it is well known that employees consider insurance coverage as one of the most important benefits after compensation.
  • Your employees can pay for their share of the premiums with pre-tax dollars.
  • You can also add supplemental coverage such as dental and term life to the group plan as well as add riders to the plan such as maternity, in-vitro fertilization and serious mental illness.
  • Can choose between PPO, HMO or HSA eligible plans.
  • Can purchase multiple plans within the group.
  • Get a 12 month rate guarantee.

Group Insurance Premiums

  • As with Individual plans, the group insurance premiums vary by Zip Codes (cost of medical care varies by area), the number and ages of employees, the employees’ medical conditions, the type of selected plans and the selected deductibles.
  • Insurance companies normally require the employer to contribute at least 50% of the employee premium with the employee being responsible for the remainder and also being responsible for premiums for his/her dependents. You can always contribute more than this requirement and you may also contribute towards the dependents’ insurance. Whatever percentage you select is the percentage of premiums that you will contribute for all covered employees.
  • The premiums you pay for qualified health coverage is 100% tax deductible on your business return.
  • The insurance companies normally guarantee the premiums for one year and in certain conditions depending on the usage and medical conditions may even reduce the rates upon renewal.
  • Premium initially quoted may be different from the one finally offered due to medical conditions or other reasons as deemed necessary by the underwriters. You can complete a medical questionnaire along with your census form (quote request form with company and employee information) to get a preliminary medical rate % with your initial quote.

Your company can apply for group coverage if

  • Your company employs 2 or more employees, including you if you are the owner, officer or partner.
  • Your company is a legitimate business entity.
  • You pay at least the minimum employer contribution towards the group insurance premium.
  • You offer the group coverage to all eligible full time employees.

Required Application Documents include but not limited to

  • Employer application that defines the entity and type of requested coverage, waiting period selected for start of coverage, details of any supplemental coverage being selected, medical questionnaire, details of any employees declining coverage, contract workers included in the plan, signatures.
  • Employee applications completed for all employees accepting coverage and applications with the declination and reason for declination completed for each employee declining coverage.
  • State payroll tax report.
  • For new businesses, submit DBA (Doing Business As) business license for sole proprietorships/partnerships, Articles of Incorporation for corporations and Articles of Organization for limited liability companies.
  • Signed final approved rate sheet received from the insurance company.
  • First month’s premium check on your business account