What should I look for in a health insurance plan?

What is a PPO?

What are eligible expenses?

What is a deductible?

What is coinsurance?

What is a doctor's office visit co-pay?

What is the difference between an in-network provider and an out-of-network provider?

Who should I buy health insurance from?

What should I look for in a health insurance plan?

Choosing between health insurance plans is not an easy task. There is no one "perfect" plan, but, there are plans that will serve you and your families needs better than others. Plans differ in how much you will have to pay (premiums), benefit amounts and how many providers are available in your area. Although no plan will pay for all costs associated with your or your family member's medical care and treatment, some plans will cover more than others will.

Your health insurance plan will charge you a premium, usually monthly, to pay for the cost of the health insurance plan. You will normally have a deductible, coinsurance and co-payments. Each health insurance plan you review will typically have these additional payments before coverage is afforded by the insurance carrier.

The following is a list of questions to consider when reviewing health insurance plans to best meet you and your families' needs:

• What is the insurance carrier rated?
• What is the insurance carrier's history of claims payment and customer service?
• What are the deductible choices?
• What are the coinsurance choices?
• Does the plan have a doctor's office visit co-pay?
• What hospitals, doctors and other medical providers are "in-network"?
• What is the penalty for using out-of-network providers?
• What is the lifetime maximum for benefits?
• What are the exclusions and limitations of the health insurance plan?

What is a PPO?

A PPO is a Preferred Provider Organization. If you use a provider (hospital, doctor or other medical provider) that is a member of the PPO you normally will pay a lower deductible and/or coinsurance amount. The insurance carrier can do this because the carrier and PPO have a written agreement to provide the carrier a discount for services provided to the carrier's customers. The insurance carrier passes on the savings to the customer in the form of lower deductibles and/or coinsurance.

What are eligible expenses?

Eligible expenses are medical expenses incurred by an Insured Member for covered services listed in the health insurance plan that are ordered or prescribed by a Physician for the treatment of a covered Accident or Sickness and are Medically Necessary. In most health insurance plans, the amount of expenses in excess of the Usual and Customary Charges, as determined by the insurance carrier, in the geographic area where the expenses are incurred are not considered Eligible Expenses.

What is a deductible?

A deductible is the amount of eligible expenses incurred during a Calendar year that an Insured Member must pay before any benefits are payable. In some health insurance plans, eligible expenses incurred after September 30th, which have not been paid because the deductible has not been met, may be used to help satisfy the deductible for the next calendar year.

What is coinsurance?

Coinsurance is the percentage applied to eligible expenses after subtracting the deductible. In many health insurance plans the coinsurance an Insured Member is responsible for is capped after a certain dollar amount of eligible expenses have been incurred.

What is a doctor's office visit co-pay?

A doctor's office visit co-pay is the fixed amount payable by an Insured Member on a per visit/service basis.

What is the difference between an in-network provider and an out-of-network provider?

An in-network medical provider is a provider that is a member of a PPO that is approved by your insurance carrier. An out-of-network provider is not a member of a PPO that is approved by your insurance carrier. The amount you will be responsible for paying will be less if you use an in-network provider than an out-of-network provider.

Who should I buy health insurance from?

The individual health insurance industry is the most volatile of insurance markets. There are always companies entering and exiting the market. Rate increases are a fact of life, and with many companies they can be dramatic. There are enormous differences in product offerings and initial premiums from company to company. For these reasons it is important for you to buy your health insurance from a Health Insurance Specialist. The Health Insurance Specialist is an agent that is immersed in the individual health insurance market full time. This agent devotes all of his resources to health insurance. This agent is on top of the different carriers in the market, benefits options, premiums and company performance. You will serve yourself and your family well if you purchase your health insurance from a Health Insurance Specialist.