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If you need clarification on any issue, please call us.
Can I buy health insurance
for less from the insurance company?
No! Insurance premiums are
standardized and the cost will be the same whether the plan is purchased
directly from the insurance company or through an insurance broker.
Commissions are built-in both quotes.
However, there are specific advantages to
using a good insurance broker. A professional agent can provide you with
a wide variety of front-end and post-sale services, which will save you
an enormous amount of time and money. Helping you select a plan and then
being available to answer questions on processing claims, adding and
deleting employees and keeping abreast of the ever-changing insurance
regulations can be a real tangible benefit to your company.
Can an
insurance broker negotiate a lower premium for me?
No! Again, Insurance quotes and subsequent premiums will be the
same through all insurance brokers.
Should I
get quotes from multiple insurance brokers?
Not necessarily! If you fill out multiple insurance census forms
through multiple brokers they will all be submitted to the same
insurance companies for quoting, which will always come back with the
same price. It would be better and less confusing to pick an insurance
broker that you are comfortable with and provides you with valuable
Services after the Sale.
If I have questions while
completing an application, how can I reach you?
Our staff is available
to assist you Monday through Friday from 8:00 AM to 5:00 PM Mountain
Standard Time (MST) or you can contact us through or website
Contact Form.
How can I be sure
that my data is kept secure and private?
We
are committed to protecting your privacy. Insurance Matters will NOT
SELL, TRADE or GIVE AWAY your personal information to anyone, except
those specifically involved in the referral or processing of your health
insurance quote or application. Additionally, we use industry leading
technologies to ensure the SECURITY of the information under our
control.
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.
Here's a list of key
questions to consider in selecting the plan that best meets your needs:
How much will it cost
me on a monthly basis?
Are there deductibles
I must pay before the insurance begins to help cover my costs? After I
have met the deductible, what part of my costs are paid by the plan?
What doctors,
hospitals, and other medical providers are part of the plan? Are there
enough of the kinds of doctors I want to see?
Where will I go for
care? Are these places near where I work or live?
If I use doctors
outside a plan's network, how much more will I pay to get care?
Are there any limits
to how much I must pay in case of major illness? What about limits and
deductibles for certain types of care such as surgery or maternity?
What types of health plans are
available to me?
The two major types of Health insurance plans are Indemnity (fee-for-service) or
Managed Care. Some of the major differences are based on choice of
providers, out-of-pocket costs for covered services, and how bills are paid.
Indemnity Plans usually offer more choices in
selecting 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. However, you will have a broader choice of health care providers if you select an
indemnity-type plan.
Besides
indemnity plans described above, there are three basic types of managed care plans: PPOs,
HMOs, and POS plans.
What is a PPO?
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 obtain care from a medical
provider outside of the PPO network, you will pay more for the
service. For example, a PPO might pay 90 percent of the cost for a
visit with an in-network doctor but only 70 percent of the cost for a
visit to a non-network doctor.
You will typically pay
a copayment for each visit/service. These copayments are typically
higher than an HMO copayment but not always.
You will usually be
responsible for paying an annual deductible.
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.
What is an HMO?
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 obtain care without your
primary care physician's referral or obtain care from a non-network
member, you may be responsible for paying the entire bill. (with
exceptions for emergency care)
With some HMOs, you
pay nothing when you visit in-network doctors. With other HMOs there
may be a small copayment for the visit or service.
With most HMOs you
will not be responsible for paying a deductible.
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.
What is a POS?
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.
What is a health Savings Account (HSA)?
HSA is a Health Savings Account that works like an IRA except
that the money is used to pay health care costs. Participants must be
enrolled in a qualified high deductible health plan. Then, a
tax-deductible savings account may be opened to cover current and future
medical expenses. The money deposited, as well as the earnings, is
tax-deferred. This money can then be withdrawn to cover qualified
medical expenses tax-free. Unused balances roll over from year to year.
What is an Indemnity
Plan?
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 pre-certify 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.
What is a
provider?
A provider is a
hospital, healthcare facility, physician or other medical professional
that provides healthcare services.
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 healthcare system. Also known as a primary care provider,
personal care physician, or personal care provider.
What is an office visit
co-payment?
An office visit
co-payment 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.
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What is a deductible?
A deductible is the amount of
annual medical expenses that a health plan member must pay before
the plan will begin to cover expenses. For example, if your plan has
a $500 deductible, you will pay the first $500 of your medical
expenses before your health plan begins paying the expenses. Only
expenses for covered services apply towards the deductible. For
example, if you paid $100 for a visit to a chiropractor but the plan
does not consider chiropractic care a covered expense, then the $100
will not apply toward your annual deductible.
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 exceptions 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.
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.
What is the ERISA Act of 1974 –
US Department of Labor?
The Employee Retirement Income Security
Act of 1974 (ERISA)
is a federal law that sets minimum standards for most voluntarily
established pension and health plans in private industry to provide
protection for individuals in these plans.
ERISA
requires plans to provide participants with plan information including
important information about plan features and funding and provides
fiduciary responsibilities for those who manage and control plan assets.
It requires plans to establish a grievance and appeals process for
participants to get benefits from their plans. It also gives
participants the right to sue for benefits and breaches of fiduciary
duty.
There have been a number
of amendments to ERISA, expanding the protections available to health
benefit plan participants and beneficiaries. One important amendment, the
Consolidated Omnibus Budget Reconciliation Act (COBRA), provides some
workers and their families with the right to continue their health coverage
for a limited time after certain events, such as the loss of a job. Another
amendment to ERISA is the Health Insurance Portability and Accountability
Act. HIPAA provides important new protections for working Americans and
their families who have preexisting medical conditions or might otherwise
suffer discrimination in health coverage based on factors that relate to an
individual's health.
Other important amendments include the Newborns' and Mothers' Health
Protection Act, the Mental Health Parity Act, and the Women's Health and
Cancer Rights Act
What is Cobra & HIPPA US Department of Labor?
The
Consolidated Omnibus Budget Reconciliation Act (COBRA)
gives workers and their families who lose their health benefits the
right to choose to continue group health benefits provided by their
group health plan for limited periods of time under certain
circumstances such as voluntary or involuntary job loss, reduction in
the hours worked, transition between jobs, death, divorce, and other
life events. Qualified individuals may be required to pay the entire
premium for coverage up to 102% of the cost to the plan.
COBRA
generally requires that group health plans, sponsored by employers with
20 or more employees in the prior year offer employees and their
families the opportunity for a temporary extension of health coverage
(called continuation coverage) in certain instances where coverage under
the plan would otherwise end.
COBRA
outlines how employees
and family members may elect continuation coverage. It also requires
employers and plans to provide notice.
The Health Insurance Portability and
Accountability Act (HIPAA)
provides rights and
protections for participants and beneficiaries in-group health plans. HIPAA
includes protections for coverage under group health plans that limit
exclusions for preexisting conditions; prohibit discrimination against
employees and dependents based on their health status; and allow a special
opportunity to enroll in a new plan to individuals in certain circumstances.
HIPAA may also give you a right to purchase individual coverage if you have
no group health plan coverage available, and have exhausted COBRA or other
continuation coverage.
Some of the information
listed herein has been extracted from:
Choosing and Using a Health Plan
Agency for Health Research and Quality
http://www.ahcpr.gov/consumer/hlthpln1.htm
Property and Casualty Coverage
We can provide a specialist in Commercial Insurance to assist you with your
general liability, property, workers compensation, auto, umbrella, bonding,
and professional liability insurance needs.
Please Note
Information on this Web site is only intended as general summary
information that is made available to the public. It is not intended to
provide specific medical advice or to take the place of either the
written law or regulations. Furthermore,
Insurance Matters' FAQs should not be construed as investment advice. Please
consult one of our Agents for specific information and always consult a CPA
and an Attorney before you purchase Insurance.
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Steve Lohrig, CLU, ChFC
President / Broker
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Suite 210
2918 Austin Bluffs Parkway
Colorado Springs, CO 80918 |
719 955-0606 Tel
719 955-0609 Fax
slohrig@insurancematters.org
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