FREQUENTLY ASKED QUESTIONS
Individual and Family Health Insurance
What is individual and family health insurance?
Individual and family health insurance is health coverage designed specifically for individuals and families rather than employer groups. Although having health insurance provided by an employer is sometimes preferable, it is not an option for everyone. Those that typically seek individual and family health insurance are usually self employed, determine that the cost is too great on their employer plan, or are not eligible under a specific group.
As with all insurances, a PPO (Preferred Provider Organization) plan will encourage you to use the insurance company's network of preferred doctors and hospitals. All in-network healthcare providers have been contracted to provide services to the health insurance plan's members at a negotiated rate. Usually members are not required to choose a primary care physician. Members will be able to see doctors and specialists within the network at their own discretion.
Typically and annual deductible will have to have been met before the coinsurance portion the plan comes into effect. Many times, co-payments are provided for certain types services including, primary care, specialists visits, and even emergency care on some plans. Depending on your plan, you may be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network physician or care provider are covered at a lower percentage and have higher maximum out-of-pocket.
There are many variations of HMOs (Health Maintenance Organizations). Recently companies have started designing them to function like PPOs with deductibles and coinsurance. However, the traditional HMO enables 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. HMO members are typically required to choose a primary care physician (PCP). Your PCP will take care of the majority of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.
An HMO affords the member a broader range of preventive healthcare services than you would through another type of plan. Members usually aren't required to pay a deductible before coverage starts. Keep in mind the copayments are much less than most deductibles. HMO plans usually eliminate the need to submit any of your own claims to the insurance company. However, the trade-off is that members have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
An HSA or Health Savings Account is a pre-tax tool used to pay for medical expenses. Any adult who is covered by a high-deductible health plan (and has no other first-dollar coverage) may establish an HSA. Tax-advantaged contributions can be made in three way:
the individual or family can make tax deductible contributions to the HSA even if they do not itemize deductions
the individuak's employer can make contributions that are not taxed to the employer or the emploee
employers sponsoring cafeteria plans can allow employees to contribute untaxed salary through salary deduction.
To encourage saving for health expenses after retirement, individuals age 55 and older are allowed to make additional catch-up contributions to their HSAs. Once an individual enrolls in Medicare they are no longer eligible to contribute to their HSA
Amounts contributed to an HSA belong to the account holder and are completely portable. Funds in the account can grow tax-free through investment earnings, just like an IRA. Funds distributed from the HSA are not taxed if they are used to pay for qualified medical expenses.
- US Department of the Treasury
Some insurance providers require a parent to be included on a policy with a minor. However, most companies will gladly write policies for children without the parent being insured. In these cases, the parental or legal guardian's consent is required. To obtain free pricing information, click here
Rates vary based on state, type of plan, the negotiated rate of the employer. However, in some cases it may be less expensive to place the rest of the family on a separate policy. Important factors such as pre-existing conditions, needs for maternity coverage, and mental or nervous needs should be considered. To obtain free pricing information, click here
The answer is that it depends upon the composition of your group. The difference between group and individual insurances is that group insurances are guaranteed issue. If you have medical conditions that prevent you from obtaining individual coverage, then the group is the way to go. A group is defined as two or more employees working fulltime and receiving at least minimum wage. So why would anyone opt for individual health insurance policy instead of group policy? The answer is that because group insurance policies are guaranteed issue, the prices tend to be more expensive. Group insurance costs are generated by all people healthy or not in your block of business. Individual policies tend to be less expensive because the companies have the right to rider, rate your premium, or decline you depending upon your medical condition. Therefore, the people in your block of business are generally healthier and generate fewer claims. This reduces the overall cost.
As a business owner trying to attract quality employees, it is often a toss up between group health insurance and individual health insurance. Contact us for a free, no obligation consultation from one of our benefits specialists or click here.
Group Health Insurance
Typically, an employer is required to cover 50% of the employee's monthly premium. The employee covers the remainder of his or her own premium. If the employee has dependents covered under the same plan, they are usually required to pay for the difference. However, some employers choose to cover a greater percentage of the employee's monthly premium and sometimes a portion of the premium costs for an employee's dependants. Minimum employer contribution levels may differ from state to state and from one insurance company to the next. For free quotes and consultation, click here. Which employees would be available if we put a group policy in place? Underwriting guidelines vary by insurance provider and from state to state. However, a rule of thumb is that all W2 employees working at least 25 hours or more are eligible. Employees do have the option to decline coverage. For free quotes and consultation, click here
Short Term Health Insurance
Short-term health insurance provides you with coverage for a definitive period of time. It is an ideal solution for students and those between jobs. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. Coverage for a longer period of time is usually covered with a standard health insurance policy. Feel free to browse our individual and family health insurance plans for more information.
When applying online, coverage can begin at midnight the day of the application. Your application must be approved for this to be applicable. Feel free to browse our individual and family health insurance plans for more information.
The minimum is typically 30 days and can extend up to 12 months. Feel free to browse our individual and family health insurance plans for more information.
Dental Plans
Group dental plans usually provide the highest level of benefits to the insured. However, some individual coverage will provide large discounts for major services including orthodontia. Most have a small deductible and limit their coverage per year. For more information feel free to browse our dental plans.
Basic services such as examinations, teeth cleanings, and x-rays are usually covered at 100%. Services for work done on gums and roots are typically discounted and do vary by plan. Feel free to browse our dental plans.
