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FAQ's - Individual & Family Health

What is Individual and Family Health Insurance?

This is health insurance made available to an individual, their spouse, and dependents not through an employer or organization. If employer group health insurance is not an option for you, individual coverage will provide you with peace of mind in the event an accident or illness strike. With the ever increasing cost of group insurance, some families find it advantageous to move their dependents from an employer group plan to an individual plan.

Should I consider a PPO plan?

A Preferred Provider Organization (PPO) is a network of doctors, hospitals, and other providers who have contracted with an insurance company to provide services to the insurer’s members at a discounted rate. You are encouraged to use network providers to lower both your costs and the insurance company’s costs.

As a PPO member, you are allowed to see providers who are not in the PPO network, but you will have higher out-of-pocket costs. The out-of-network penalties can leave you with significant uncovered expense, so you should use a PPO network provider whenever possible. Before selecting a health insurance plan, be sure to check the network if you have a favorite doctor or hospital you want to use.

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I have a Pre-Existing Condition – Will It Be Covered?

In the individual marketplace, an insurance company has a number of ways that they can issue a policy to you – they can issue at the rate quoted, they may choose to “rate-up” the original rate based on your medical conditions, they can issue with a rider for specific conditions, or they can decline to issue coverage. It is important to know that all carriers have different underwriting standards and may not view a medical condition in the same way. This is one reason you want to work with an experienced agent who can advise you which carrier is most likely to provide an underwriting decision favorable to you.

Each of the individual health insurance carriers also apply pre-existing condition limitations a bit differently. So if you have a pre-exitsting condition, before you choose a carrier be sure to ask how they will cover your condition compared to other carriers.

One of the provisions of healthcare reform is that insurance carriers cannot apply pre-existing condition limitations on children under age 19. There is no restriction, however, on how much they can rate up for such conditions.

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What Happens If I Change My Mind After Applying For Coverage?

You are under no obligation to purchase the insurance coverage. If you change your mind at any point in the process, just let us know and we’ll advise the insurance company. If the insurance company has charged your credit card or debited your account, they will issue you a refund. Some insurance companies charge an application fee for certain coverages. This fee will be clearly stated on the application. Application fees are not refundable.

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When Will My Coverage Start?

Each carrier has slightly different rules for when coverage can begin, although it is generally from the date of underwriting approval to up to two weeks after that. There is also some time required to do the underwriting and processing of your application. Doing an online application will speed up the process. If you need coverage immediately, you can choose a short-term policy while your long-term policy is being underwritten. Short-term medical policies can start the day following submission of the application as long as you qualify for coverage.

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Can My Insurance Company Terminate My Policy?

The insurance carrier can terminate only in limited circumstances – if you fail to pay your premium within the grace period, if you intentionally misrepresent your health history on your application, or if the insurance company withdraws from the individual health insurance marketplace in your state.

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Won’t I Save Money By Buying Directly From The Insurance Company?

No. Regardless of whether you purchase from us, another agent, or directly with the insurance company, the rate you are charged will be the same. Health insurance premiums are file with and regulated by the state Department of Insurance. Take advantage of our knowledgeable, licensed representatives who will work hard for you and rest assured you’re still getting the best rate available.

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