What is a copayment?

A copayment or "copay" 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 $30 copayment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

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 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 is an out-of-pocket maximum?

An out-of-pocket maximum is the most a member will be required to pay out-of-pocket in a calendar year, often including coinsurance and deductibles. Usually first dollar benefits like copayments do not apply toward meeting the out-of-pocket maximum. Please note that definitions may vary by insurance carriers.

How does a PPO plan work?

As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or 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 are typically covered at a lower percentage than services rendered by a network physician.

How does an HSA work?

A Health Savings Account or “HSA” is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.

Not all high-deductible plans are eligible for use in conjunction with an HSA.

What's the best health insurance plan for me?

A copayment or "copay" 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 $30 copayment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

• Are you going to need long-term coverage or just something for the short-term?
  If you're between jobs for 1-6 months, you may want to look into our short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.


• Are you looking for basic coverage or more comprehensive coverage?
  Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness.
  
  Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.


• Would you rather pay for your services before you use them or when you use them?
  Typically, the higher the monthly premium that you pay, the less you will pay per doctor's visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you're likely to have a higher co-payment or deductible. If you don't anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.


• How important to you is easy access to specialists?
  Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.


• Do you have a specific doctor or hospital that you would like to visit for healthcare?
  Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. You'll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.


• What is the most you could pay out in case of a serious illness or injury?
  Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you've contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you're concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you're considering.

Do you offer the best prices?

Health insurance premiums are filed with and regulated by your state's Department of Insurance. Whether you buy from us, another brokerage firm or directly from the health insurance company, you'll pay the same monthly premium for the same plan. This means that you can enjoy the advantages and convenience of shopping and purchasing your health insurance plan through Insurance Pros and rest assured that you're getting the best available price.

Can I contact someone if I need help?

Yes. We believe in providing you with top-quality customer service. Our customer care center is staffed with licensed health insurance agents and knowledgeable representatives, ready to assist you.

Our licensed insurance agents and knowledgeable representatives are ready to help you. Just call 913-944-4465 Mon - Fri, 8AM-5PM

Click here to send us an email. One of our knowledgeable specialists will reply to you soon.

What is a Pre-existing Condition?

A pre-existing condition is a health problem that existed or was treated before the effective date of your health insurance coverage. Most health insurance contracts have a pre-existing condition clause that describes conditions under which the health insurance company will cover medical expenses related to a pre-existing condition.