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- Q: What is Insurance?
A: Insurance is a contract that allows parties to share risk. Basically,
a person pays their Premiums in exchange for the Insurance Company's
commitment to pay a predetermined amount of money for any or all problems
(Claims).
- Q: What is a Deductible?
A: It is a predetermined amount of money that a person commits to pay
before the Insurance Company is responsible for any benefit payments.
This is done so that people will make sure that any problem that an
insured might have really needs medical assistance. It is a way for
Insurance Companies to keep premium costs down.
- Q: What is a "Doctor's Office Visit Copay"?
A: Generally, this is an amount of money that an insured patient would
pay to their doctor for that particular visit. In most cases, any costs
incurred in that visit are covered 100% after the copay. Often, any
lab tests (MRIs, Blood work ups, etc.) are not included in that visit
cost and are subject to Deductibles and Coinsurance.
- Q: Do I have to pay my deductible before "Office Visits" are covered
by copays?
A: The simple answer is no. However, there may be companies that do
have that clause in their contracts. It wouldn't be against the law
to have that clause, but we rarely see this situation.
- Q: What is Coinsurance?
A: Coinsurance is the portion of medical costs that are shared by both
the Insured (the patient) and the Insurer. For example, if you have
an 80% to $5,000 coinsurance;
~ The Insurer is responsible for
80% of the next $5,000 in covered medical expenses.
~ The Insured is responsible for
20% of that same $5,000 in covered medical expenses.
* In the above mentioned policy with $1,000 deductible and 80% coinsurance
to $5,000: If a covered event occurred that had a total cost of $10,000,
the insured would be responsible for the first $1,000 (deductible).
Of the next $5,000 in covered expenses, the insured would pay another
$1,000 (coinsurance). After deductibles and coinsurance are satisfied,
Insurance Companies pay 100% of all other covered expenses. For this
example the Insured would pay $2,000 and the Insurer would pay $8,000.
- Q: Are copayments credited against my annual deductible requirements?
A: No, for the most part, insurance policies with "Office Visit Copays"
handle office visits and hospital stays differently. Hospital stays
are generally covered under the "Major Medical" portion of the policy
and tend to be subject to deductibles and coinsurance.
- Q: What is the difference between "Group" and "Individual" coverage?
A: A simple explanation is that group policies can include two families
or more and require an employer to pay a minimum of 50% or the single
person premium to qualify. Individual policies cover only one family
or individual.
- Q: Can I be charged more for a policy than a nonsmoker would because
I smoke?
A: No. Insurance companies can only choose to accept or reject your
application based on smoking or any physical impairment.
- Q: Can I be singled out for cancellation of a policy because of
health problems?
A: No. You can, however, use up your benefits by having covered expenses
in excess of your lifetime maximums.
- Q: Does it cost me more to deal with an agent than it would if
I dealt directly with an Insurance Company?
A: No. In dealing with an agent, you are dealing with the Insurance
Company. Agents are appointed (approved) by insurance companies and
are required to fairly and accurately represent them. There are no extra
fees to be paid to us for our services. The benefit of dealing with
an agent who represents several companies is that you get an even analysis
of each company's products and options.
- Q: What is Group Insurance?
A: Generally, Group Insurance is defined as a policy that an employer
makes application for with an Insurance Company. The employer is generally
required to pay some portion of the employees' premium and the employee
must work some minimum number of hours per week. The employer can pay
a greater portion of the premium, but is not required to do so. In some
states, Group Insurance is "Guaranteed Issue". which means that the
Insurance Company cannot turn down any applicant.
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