Frequently Asked Questions

Individual and Family Medical Insurance


Why buy medical insurance?


Individuals and families buy medical insurance to insure themselves against the risk of financial ruin as a result of someone getting sick or injured. Several different types of plans exist which offset the risks in different ways. Three of the most common are Traditional Major Medical, PPO and HMO plans.


I'm in a hurry.
How fast can I get medical insurance?


Once we have your completed application and your check, a decision can usually be obtained within 3 to 4 weeks.

Remember, never cancel any existing insurance policy that this new coverage is intended to replace until after you have received your new policy and found it to be satisfactory.


Must I be a U.S. resident to buy
medical insurance ?


Yes. Most all insurance companies require U.S. citizenship or a permanent Green Card or Visa.


Why do you need to know my occupation?


Many insurance companies base their rates on your actual occupation. Generally, if your occupation is more hazardous than that of a non-hazardous nature, coverage becomes more difficult and expensive to obtain.


Why do you need my zip code and
county information?


Many insurance companies rates are based on postal zip codes and/or county of residence information. In order to deliver an accurate quotation of rates, this information is required.


What is the difference between:  
Traditional Major Medical, HMO, and PPO plans?


A Traditional Major Medical plan is one in which your insurance company will  reimburse you for covered medical expenses after certain conditions are met. One of these conditions is that you will have to pay a deductible. Deductibles can range from $50 to $5,000.  As a general rule, the higher the deductible, the lower the premium cost.  A second condition is a Traditional Major Medical plan typically requires you to pay a portion of the cost above the deductible, this is often referred to as co-insurance. Typically, the co-insurance amount is expressed as a percentage of the claim amount above the deductible. A common  co-insurance percentage is 80/20, where the insurance company pays 80% and you pay 20%. You will find plans with deductibles from $50 to $5,000 and co-insurance percentages from 50/50 to 100/0. You will be able to choose or keep your own doctor without reference to the approved list provided by the insurance carrier thats common with other types of plans. If you want to make your own choices and decisions about the quality of your health care, then this type of plan will appeal to you. However you will pay alittle more for this privilege.


An HMO (Health Maintenance Organization) is a managed care program.  Most HMO's require each family member to select a Primary Care Physician from an approved list provided by the HMO.  This Primary Care Physician will then direct all of your medical treatment including referring you to a specialist.  This specialist is usually a member of the HMO you are insured with.  Failure to see your selected Primary Care Physician first (unless in an emergency situation) can result in sharply reduced benefits or no benefit at all.  As a general rule, HMO's provide comprehensive medical care; such as routine office visits, physical exams, well-baby care and immunizations.  HMO's also feature low office visit co-payments and usually do not require the filing of claim forms. However with this type of plan you will be giving up much of your choice and they will be making the decisions about your health care. The overall out of pocket cost should be less however.


A PPO plan (Preferred Provider Organization) combines elements of a Major Medical plan with an HMO.  There is a list of Preferred Providers of doctors and hospitals you can choose from, but you are free to choose an out-of-network doctor or hospital.  However, if you choose an out-of-network provider, you will probably have to pay an increased percentage of the cost. A typical plan may provide that in-network provider services are provided with an 80/20 co-insurance percentage, while out-of-network provider services would be provided with a 60/40 co-insurance percentage. You usually will have to pay a deductible and a co-insurance payment with a PPO plan. But like the HMO, many plans also feature low office visit co-payments without having to pay the deductible. This type of plan is proving to very popular as the best of both worlds. You retain much more choice and the cost overall is very reasonable.


How do I know which plan is right for me?


There are a number of factors to consider before choosing a health plan; many depend on your location, specific family situation and personal preference.  Questions you should ask before deciding include:
Do you have a personal/family doctor you want to continue using?
How far would you need to travel for medical care covered by your plan and how important is this?
Does a low premium/ high deductible plan fit your needs, or would an HMO or PPO plan serve your needs better?
What type of plan do you prefer - HMO, PPO, traditional major medical?
What is the maximum you would have to pay, including premiums, deductibles, and co-insurance payments?
What is the maximum benefit the insurance company will pay?


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