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. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.
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What kinds of individual and family insurance plans are available?
Individual and family health insurance plans are usually described as either "indemnity" or "managed-care" plans. Put broadly, the major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.
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How can I insure just my child?
When getting quotes for your child(ren) only, enter the child's gender and birth date in the "Applicant" or first row. Additional children should be entered below in the "Child" rows, but not the "Spouse" row.
However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. You are free to apply for each child separately.
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When I buy an insurance plan, how do I make payments?
In most cases, when you complete your application you'll provide a credit card number or a check written to the health insurance company for the first premium payment. Typically, your credit card will not be charged nor will your check be cashed until you are approved for coverage. If you are not approved for coverage, or if you cancel your application, your card will not be charged and any check payment you made will be returned or refunded.
Once you've been approved for coverage, your ongoing premium payments are paid to your health insurance company typically on a monthly or quarterly basis. Insurance companies typically offer several payment options including monthly billings to be paid by check or credit card, automatic bank drafts or automated credit card charges. Please note that credit card billing of premiums is optional and you can obtain coverage without using that method of payment.
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If I apply for an insurance plan, am I obligated to buy?
No. You are under no obligation to buy a health insurance plan when using our site. After submitting your application you may cancel it at any time during the underwriting process. When you submit an application you will typically include your credit card number, bank account information, or a check for the initial premium payment. Most insurance companies will not charge your card, debit your account, or deposit your check until you are approved. If you are charged or your check is cashed and you are denied for coverage or cancel your application prior to approval, the insurance company will issue a refund to you.
A few insurance companies may charge an application fee. You will be notified in the application if the plan you chose requires an application fee. Please note that these fees are non-refundable.
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What is short-term health insurance?
Short-term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. If you think you'll need coverage for a longer period of time, you may want to look at a standard, longer-term health insurance option like our individual and family health insurance plans.
The application process for short-term health insurance is usually simpler than standard, longer-term health insurance. Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care.
Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise. If you wish to maintain your eligibility for HIPAA plans, you should not purchase a short-term plan. Please consult your benefits advisor to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.
Short-term health insurance plans typically do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA, which you should seriously consider if you have an existing medical condition.
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How will I know if I qualify for short-term health insurance coverage?
In most cases, as soon as you complete your application, we will be able to let you know if you do not qualify for short-term coverage.
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Do short-term health insurance plans include dental and vision benefits?
No. Short-term health insurance plans are designed to protect you in the event of an unexpected illness or injury and are not intended to cover dental and vision care. Short-term health insurance plans are for temporary coverage only and therefore do not include some of the benefits offered by standard, longer-term heath insurance plans.
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Should I pay monthly or make a single payment up front?
Most short-term health insurance plans give you the option of paying in monthly installments, or in a single up-front payment. Often, single payment plan costs may be lower than monthly plan costs.
We recommend you select "Monthly", if you:
• don't know exactly how long you will need coverage, or
• don't want to make a single up-front payment
We recommend you select "Single Up-front Payment", if you:
• know exactly how long you will need coverage for,
• want lower plan costs, and
• don't mind paying your whole premium up-front
If you select " Single Up-Front payment" you will need to specify the duration of your coverage (30-185 days). Also, if you select " Single Up-Front payment" payment, you will enjoy the convenience of not having to manually cancel your plan at the end of your coverage period, although typically you will not be able to get a refund once coverage starts. If you need short-term health insurance after your specified duration, you will need to re-apply for a new short-term plan. (Note: most short-term health plans will only allow you to re-apply once.)
Note: Some insurance companies only offer the "Single Up-Front payment" option, thus selecting this option may give you a greater selection of plans to choose from.
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What if I get a standard, longer-term insurance policy at a future date?
Once you receive written confirmation that the health insurance company you selected approved your application for a standard longer-term health insurance policy, you should contact the insurance company that issued your short-term health insurance plan and cancel the short-term policy.
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Will purchasing a short-term insurance plan make it harder for me to get coverage in the future for a pre-existing medical condition?
If you recently lost health insurance coverage through an employer, purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue, individual health insurance plans commonly referred to as HIPAA plans. Oftentimes, HIPAA plans are quite expensive but may be appropriate for those whose pre-existing conditions make it difficult to obtain health insurance in the private market. Therefore, if you wish to maintain your eligibility for HIPAA plans, you should not purchase a short-term health insurance plan. Please consult your benefits advisor to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.
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Why would I want coverage for a limited amount of time?
If you're between jobs, waiting for coverage from another health insurance plan to start, laid off, on strike, a recent college graduate or seasonal employee and know that you only need coverage for a specific period of time,
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What happens when I reach the end of my coverage period?
At the end of your coverage term, most health insurance companies will allow you to re-apply for another short-term plan. These plans do not typically constitute an automatic continuation of your first plan. Many short-term health insurance plans only allow you to re-apply once.
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What if I only need coverage for less than 30 days?
Most short-term health insurance plans have a minimum coverage period of 30 days. Even if you only need coverage for less than 30 days, you can either:
• Make a single payment upfront for 30 days of coverage, or
• Select the monthly payment option, and then cancel your coverage when you no longer need it. Please note that you will not be refunded for partial months of coverage.
In most cases, as soon as you complete your application, we will be able to let you know if you do not qualify for short-term coverage.
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Do healthcare services need to be preauthorized?
Yes. The insurance company uses an authorization service which ensures you receive the most appropriate and cost effective care available. Trained staff work with you and your physicians to review the course of treatment and advise you of your eligibility for benefits. The identification card you receive with your policy provides a toll-free number for easy access to this service.
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How does a Health Savings Account work?
A Health Savings Account is a savings account designed to help consumers save and pay for their healthcare expenses on a tax-advantaged basis. Funds can be deposited by consumers into the account on a tax-free basis and may be withdrawn without tax consequences to pay for qualified medical expenses. Employers may also deposit money into an employee's Health Savings Account on a tax-free basis. Funds in the account may be invested and earnings will not be taxed, and unused money will roll over from year to year.
Health Savings Accounts may only be used in conjunction with HSA-compatible health insurance plans. These health plans typically have lower monthly premiums and higher deductibles than other types of health insurance plans. Funds from the Health Savings Account may be used to pay for qualified healthcare expenses accruing toward the deductible. Once the deductible is met, coverage under the HSA-compatible health plan pays for covered expenses (subject to co-payments) for the remainder of the year.
Health Savings Accounts, used in combination with HSA-compatible health insurance plans, give consumers control over how their healthcare dollars are spent, and provide a valuable means of saving and investing for healthcare needs and for retirement.
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Why should I consider getting an HSA?
You may save money in the short and long term by:
• Deducting 100% of your HSA contributions from your taxable income
• Having the money in your HSA accrue interest and/or gains on a tax-free basis
• Paying no penalties or taxes when you use your HSA to pay for qualified medical expenses
• Having a high-deductible HSA-compatible health insurance plan, which typically has a lower premium than a plan with a lower deductible
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What insurance plans are HSA-compatible?
In order to have a Health Savings Account, you must get an HSA-compatible health insurance plan. This type of insurance plan is often referred to as a High Deductible Health Plan, and typically has lower premiums than plans with lower deductibles.
A health insurance plan must meet the following criteria to be considered HSA-compatible:
• The health insurance plan must have an annual deductible of at least $1,150 for individuals and at least $2,300 for families.
• The sum of the annual deductible and the other annual out-of-pocket expenses required to be paid under the plan (other than premiums) does not exceed $5,800 for individuals and $11,600 for families.
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How much can I contribute to my HSA?
Maximum yearly contributions (and associated tax deduction) are determined as follows:
For individuals, it is $3,000, and for families it is $5,950.
You do not have to contribute the maximum each year, although some HSAs require a small minimum monthly contribution.
Note: If you are between the ages of 55 and 65, you can make an additional annual "catch up" contribution (of up to $1,000 in 2009.)
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Can I roll over funds from other accounts into my HSA?
You can make a one-time distribution from an IRA to fund your HSA, provided it doesn't exceed HSA contribution limits. Employees have the opportunity for a one-time, tax-free transfer of funds from their flexible spending account (FSA) or health reimbursement arrangement (HSA) to their HSA.
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Is my money safe?
Funds in an HSA are held in a trust and are administered by a bank, insurance company, or other approved Trustee. This institution is often referred to as your HSA Administrator.
Funds in your HSA are invested at your discretion. Typically an HSA will allow you to choose from one or more of the following investment options:
• Interest-bearing account
• CDs
• Money market funds
• Mutual Funds
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How do I use the funds in my HSA?
Using funds in your Health Savings Account is easy:
• Typically an HSA will provide you with a checkbook or debit card. When you pay for a qualified medical expenses, use the debit card or check to make the payment.
• You do not need to get approval from the HSA administrator when you use funds in your account.
• You do not need to submit receipts to the HSA administrator, although you should save them just as you keep receipts for other items that are deducted from your taxes.
NOTE: You must establish the HSA before you incur medical expenses otherwise the expenses will not qualify.
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What are my investment options?
Depending on which institution is the HSA Administrator for your Health Savings Account, you will be able to choose from one or more of the following investment options:
• Interest-bearing account
• CDs
• Money market funds
• Mutual funds
Because the range of your investment options is determined by the HSA Administrator you select, you should evaluate your options before setting up you account. Our site makes it easy to do this by presenting you with a link which allows you to view all your HSA Administrator options for each health insurance plan you are considering. Simply click the "HSA Options" link (illustrated below).
Once you find an insurance plan that meets your needs and has suitable HSA Administrator options, simply click the "APPLY" button to start the online health insurance application process. After completing the health insurance application, you will be able to select your HSA Administrator.
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How do the tax savings work?
HSAs make it easy to save on your taxes:
• At the end of each year, you will be sent a statement showing the amount you contributed to your HSA that year. You can deduct this amount provided it is less than or equal to the maximum allowable contribution.
• Much like an IRA, HSA deductions are "above-the-line" and thus can be taken even if you do not itemize.
• If you are self-employed, in addition to deducting your HSA contributions, you may be able to deduct 100% of your health insurance premiums, provided that:
• You are not eligible to participate in a subsidized health plan offered by an employer or your spouse's employer.
• The deduction does NOT exceed the amount of net income from your business.
Note: Check with your accountant or tax advisor for the specific federal and state tax benefits that apply to you.
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Are there fees associated with HSAs?
Depending on which institution is the HSA Administrator for your Health Savings Account, you may be subject to different fees, including: initial setup fee, monthly maintenance fee, and check fees.
Because the type and amount of the fees differs between HSA Administrators, you should evaluate your options before setting up your account. Our site makes it easy to do this by presenting you with a link which allows you to view all your HSA Administrator options for each health insurance plan you are considering.
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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.
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How does an HMO plan work?
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.
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How does a POS plan work?
A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan's network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.
Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you'll likely have to pay up-front and submit a claim to the insurance company yourself.
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How does an Indemnity plan work?
A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.
Under an Indemnity plan, you may see whatever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.
However, this kind of freedom will cost you. You'll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the "usual, customary and reasonable (UCR) rate" for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service.
An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.
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What is a co-payment?
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.
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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.
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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.
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What is the difference between in-network and out-of-network providers?
An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network 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.
As a general rule, PPO, POS, and HMO plans make use of provider networks. Indemnity plans typically do not.
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How does dental insurance work?
Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.
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What kinds of dental insurance plans are available?
Like health insurance plans, dental insurance plans are usually categorized as either Indemnity or managed-care plans (Dental PPO plans fit in this latter category). Put broadly, the major differences concern choice of dental care providers, out-of-pocket costs and how bills are paid. Typically, Indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).
Managed-care plans typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a broader choice of dentists with an Indemnity plan.
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What is the best dental insurance plan for me?
Although there is no one "best" dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you'll have to pay monthly for your coverage and how much you'll have to pay when dental services are rendered. Some plans will require that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance company begins payment. Other plans may limit coverage to a specific dollar-amount maximum per year.
When reviewing your dental insurance options, here are a few questions to ask yourself:
• How much will it cost me on a monthly basis?
• Will I be required to meet a deductible? Once the deductible is met, how much will the dental insurance provider pay for my services?
• What dentists participate in the plan's network? Are these dentists that my family and I would like to see?
• If I used a dentist outside the plan's network, how much will I have to pay?
• Are there waiting periods for certain procedures?
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What is a Dental PPO plan?
Dental PPO (Preferred Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates. When you use a network provider, you will typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance company will pay the remaining percentage (e.g. 80%).
As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.
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What is a Dental Indemnity plan?
A Dental Indemnity plan is commonly known as a fee-for-service or traditional plan. If you select an Indemnity plan you'll likely have the freedom to visit any dentist you wish. You typically will not be required to obtain referrals; however, some plans may require you to obtain preauthorization for certain procedures. Most Dental Indemnity plans require you to pay a deductible. After you have paid your deductible, Indemnity policies typically pay a percentage of "usual, customary and reasonable (UCR) rates" for covered services. For instance, the insurance company may pay 80% and you may be required to cover the remaining 20% of the UCR.
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What is the difference between and in-network and an out-of-network dentist?
An in-network dentist is one contracted with the dental insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network dentist is not contracted with the insurance company. Typically, if you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from non-network dentists.
As a general rule, Dental PPO (and other managed care) plans utilize provider networks. Dental Indemnity plans typically do not utilize a network of providers.
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What is a Dental Network plan?
A network of dentists that have agreed to provide dental services to a health insurance plan's members at discounted costs. While the health plan's members are free to use any dental care provider, the cost to use network providers is less than using non-network providers.
Please note, however, that definitions of certain terms may vary across insurance companies.
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What are Discount Cards?
Discount Cards provide you with a great way to save money on your dental, vision, and/or chiropractic needs. Depending on your Discount Card company, you can enjoy discounts of up to 60% with a national network of leading service providers.
Getting your Discount card is easy. Simply fill out an application and you will receive your card in the mail soon after.
When it's time to use your card, simply locate a service provider in the network, present your card to the provider at the time of service and get instant discounts.
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Is a Discount Card an insurance plan?
No. Discount Cards are not health insurance policies. They are strictly discount programs that give you and your family preferred rates from selected health care providers. However, Discount Cards may provide you with a valuable, inexpensive alternative or supplement to a standard health insurance plan
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How soon can I start receiving discounted rates?
Your membership will become active as soon as you receive your discount card in the mail. Depending on the company, this may be one to two weeks after completion of the application.
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How often may I use my Discount Card?
As often as you like. There are no restrictions on how frequently you use your card.
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Are the discounted rates the same at all network providers?
No. Discount Card preferred rates will vary depending on the provider, type of healthcare service, and your geographic area.
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What if a network provider won't accept my card?
Ask the provider to call the provider service number listed on your Discount Card. We recommend that you confirm your provider's acceptance of the Discount Card at the time you make your appointment.
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