Frequently Asked Questions
If you have a question,
we hope that the following questions and answers will help.
Q) What is the best health plan for me?
Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.
With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and copayments .
In the "Things to Consider" section of the site, there are some excellent guides about choosing and comparing health plans.
Here's a list of key questions to consider in selecting the plan that best meets your needs:
resource: Agency for Health Care Policy and Research and Health Insurance Association of America.
Q) How do I compare health plans?
You can compare benefits and prices of different plans side by side using the "COMPARE BENEFITS" feature. On "Step 2: Compare Plan Benefits and Prices From Leading Companies", check the box of each plan you want to compare. Then click "COMPARE BENEFITS".
Q) If I have questions while completing an application, how can I reach you?
You can also call us
at 702-568-9320
Feel free to call us after hours and leave a
message, which will be immediately returned the next business day.
Q) What types of health plans are available to me?
Health insurance plans usually are described as either indemnity (fee-for-service) or managed care. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans.
Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of health care providers if you select an indemnity-type plan.
Besides indemnity plans, there are three basic types of managed care plans: PPOs, HMOs, and POS plans.
A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.
If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs are likely to be somewhat higher.
An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.
If you join an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO.
POS is a Point-of-Service Plan A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
An indemnity plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any medical provider. You do not need referrals or authorizations; however, some plans may require you to precertify for certain procedures.Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services.
Many health insurance companies have moved away from indemnity plans and are instead offering managed care plans such as HMOs and PPOs. You may have few or no indemnity plan choices in your area.
A provider is a hospital, health care facility, physician or other medical professional that provides health care services.
Q) What is a Primary Care Physician (PCP)?
A physician or other medical professional who serves as a group member's first contact with a plan's health care system. Also known as a primary care provider, personal care physician, or personal care provider.
Q) What is an office visit copayment?
An office visit copayment is a fixed dollar amount or a percentage that you pay for each doctor visit. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your copayment is 10% and the doctor visit was $200, you would pay 10% which, in this case, would be $20.
Q) What is the difference between an in-network and an out-of-network medical provider?
An in-network medical
provider is within the approved network of providers for a particular health
plan. Out-of-network providers are not on the list. If you visit a doctor
within the network, the amount you will be responsible for paying will be
less than if you go to an out-of-network doctor. In many cases, the insurance
company will not pay anything for services your receive from outside their
network; however, there are exception to this.
As a general rule, HMOs tend to have smaller provider networks than PPOs.
In HMO and PPO plans, referrals to specialists will be to doctors within the
network. Indemnity plans typically do not have networks; you go to whatever
doctor you want.
Q) What are my options for making my first payment?
You can usually make your initial payment by credit card or check. The payment must be made out in the name of the insurance company. However, some insurance companies may require a check for the initial payment. Normally, your credit card will not be charged nor will your check be deposited until you have been approved. If you are not approved for coverage by the insurance company, your money will be refunded by the insurance company. Any financial information submitted over the web is kept private and secure. Once accepted as a plan member, all bills will be sent from the health insurance company and you will pay them via the choices offered by that company
Q) Can I buy health insurance for less if I buy directly from the insurance company?
No. Insurance companies charge the same premium whether the plan is purchased directly from the company, or through a broker
Q) What do you mean by best price?
For the plans presented here we can provide the lowest price available anywhere.
Q) Where are the other health plans I am familiar with?
Not all health plans sell health insurance directly to individuals and families. Many, like Aetna and Cigna, provide insurance predominately through employers.
Q) If I have questions completing an application, whom can I call?
Please call us at 702-568-9320
for any assistance you may need and speak to our friendly and enthusiastic customer
service representatives:
Feel free to call us after hours and leave a
message, which will be immediately returned the next business day.