Whether you are looking for a plan for yourself, your spouse, or your entire family, we can guide you to the best plan for your situation. We currently offer plans in California and Arizona. To get started, simply click on the Quote button below. You can get a quote, and even apply online. It’s instant and it’s free!
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Selecting the right health insurance plan can be an intimidating process for many of our clients. While we encourage you to contact us regarding your specific needs, we have prepared this short buyer’s guide to help answer some common questions up front.
HMO - A Health Maintenance Organization plan requires the insured to select a single doctor/medical group. This doctor is designated as the member’s “primary care physician” or PCP, and all care is accessed through this gatekeeper. An HMO tends to offer more cost certainty than a PPO by virtue of lower or no deductibles and lower copays when accessing care, but is more restrictive than a PPO as far as doctors that can be seen, in most instances care must be accessed through the designated PCP.
PPO - A Preferred Provider Organization is less restrictive than an HMO in that the insured can self refer to any licensed physician. These plans have deductibles that the insured must satisfy before the plan will pay and typically has specified copays for doctors visits. The richest coverage is obtained when the insured utilizes physicians within the carrier’s network but most plans also include limited out of network benefits once the deductible has been satisfied.
HSA - A Health Savings Account is a special type of PPO plan. Members of an HSA have access to the same doctor network as the PPO plan, but they also have the right to open a separate Health Savings Account at a participating bank or financial institution. Members can fund the HSA up to the allowable amounts for each calendar year (for 2011, this amount is $3,050 for individuals and $6,150 for families). The HSA is funded on a pre-tax basis and allows you to withdraw from the account to pay for eligible health care expenses with tax advantaged dollars. The major drawback to an HSA is that prescription drugs are not accessed through a copay until the deductible is satisfied.
Who can be covered under the same plan?
You can apply for a plan that covers any one of the following combinations of family members:
Can you explain the following pertinent plan features?
Premium - This is the monthly amount an insured pays to a carrier in exchange for the carrier providing the specified insurance coverage.
Deductible - This represents the dollar amount an insured must pay for covered expenses during a calendar year before the insurance plan will assume responsibility for any payments.
Annual Out-of-Pocket Maximum - This is the maximum amount an insured will pay out of pocket in a given calendar year so long as the insured receives all treatments from an in network provider.
In-Network vs. Out-of-Network - At the carrier level, PPO contracts are negotiated with certain physicians who form that carrier’s PPO network. PPOs make arrangements for discounted fees within that network of health care providers which gives their policyholders an incentive to stay within that network. The PPO policy will also include a provision that provides some reimbursement when an insured decides to self refer to a doctor outside of that PPO network. In this situation, the insured will typically pay the entire bill up front then submit a claim for reimbursement. The amount of reimbursement is specified in each individual plan and is often subject to a deductible and the difference between what the out of network doctor charges and the carrier’s contracted fee schedule. In certain situations, out of network visits may not be covered at all. The best way to keep your out of pocket costs down is to only see network providers.
Brand Name Drug - A prescription drug which is marketed with a specific brand name by the company that manufactures it. It is typically more expensive for an insured to purchase than a generic drug and may be subject to a separate brand name drug deductible before the insured can fill such a prescription with a copay. Many carriers have both formulary and non-formulary brand name drugs, with different copayment amounts (after any applicable deductible) for each.
Generic Drug - The chemical equivalent to a brand name drug; these drugs typically become available once a drug manufacturer’s patent on a brand name drug expires. These drugs usually cost less and the savings is typically passed on to the insured in the form of a lower copay.