Frequently Asked Questions

Frequently Asked Questions

The Basics

How does a PPO plan work?

As a member of a PPO (Preferred Provider Organization) plan, you’ll be encouraged through their pricing of services to use the insurance company’s network of preferred doctors and hospitals. 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. Our team of advisors can help you research your preferred Doctors to see if they are included in the network. 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 most likely 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.

How does an HMO plan work?

HMO (Health Management Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospitals than other health insurance plans. As a member of an HMO, you’ll be required to choose a primary care physician (PCP) which you must see prior to being referred to a specialist.

With an HMO, you’ll likely have coverage for a broader range of preventative healthcare services some even offer discounts to health clubs. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. HMO’ typically offer no coverage whatsoever for services rendered by non-network providers or for services rendered without proper referral from your primary care physician (PCP).

How does an HSA work?

HSAs and HSA-eligible health insurance plans are a great way for people to control their health care dollars. Here are the basics:

  • An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.
  • Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
  • Contributions to an HSA may be made pre-tax, up to certain annual limits.
  • Funds in the HSA may be invested at your discretion at a qualified financial institution of your choice. Unused funds remain in the account and accrue interest year-to-year, tax-free.
  • Not all high-deductible plans are eligible for use in conjunction with an HSA.

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. We like to call this the “office visit fee”. If the insurance plan requires a $15 co-payment for an office visit then the insurance company pays the remainder of the charges.

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. Most Indemnity and PPO plans require you to meet the annual deductible prior to making payments.

What is coinsurance?

Coinsurance is the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. If there is a 20% coinsurance requirement, then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80 until you meet the total annual out of pocket requirement.

 

 

 

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