Frequently Asked Questions
General Info |
Claims |
Prescription Drug
Benefits |
PPO's, HMO's, Providers & More
GENERAL INFO
What is individual and family health
insurance?
What kinds of individual and family insurance
plans are available?
What is a
co-payment?
What is a
deductible?
What is
coinsurance?
What is the difference between in-network and
out-of-network providers?
What's the best health insurance plan for me?
When can
my coverage start?
How
can I insure just my child?
Why should I shop with you rather than buying
an insurance plan elsewhere?
How do you protect my private information?
When I buy an insurance plan, how do I make
payments?
If I apply for an insurance plan, am I
obligated to buy?
Do you
offer the best prices?
How do I
apply?
Do I have
to take a physical?
Can I
cover child (children) only?
What is
individual and family health insurance?
Individual and
family health insurance is a type of health insurance coverage that
is made available to individuals and families, rather than to
employer groups or organizations. Given the option, most people
would prefer to have their employer provide group health insurance
coverage. But, if this is not an option for you, it is still
important for you to seek coverage. You may be pleasantly surprised
with the variety and affordability of the individual and family
health insurance options available.
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What kinds of individual and family insurance plans are available?
Individual and
family health insurance plans are usually described as either
"indemnity" or "managed-care" plans. Put broadly, the major
differences concern choice of healthcare providers, out-of-pocket
costs and how bills are paid. Typically, indemnity plans offer a
broader selection of healthcare providers than managed care plans.
Indemnity plans pay their share of the costs for covered services
only after they receive a bill (which means that you may have to pay
up front and then obtain reimbursement from your health insurance
company).
There are several different types of managed-care health insurance
plans. These include HMO, PPO, and POS plans. Managed-care plans
typically make use of healthcare provider networks. Healthcare
providers within a network agree to perform services for
managed-care plan patients at pre-negotiated rates and will usually
submit the claim to the insurance company for you. In general,
you'll have less paperwork and lower out-of-pocket costs with a
managed care health insurance plan and a broader choice of
healthcare providers with an indemnity plan.
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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. For
example, your health insurance plan may require a $15 co-payment for
an office visit or brand-name prescription drug, after which the
insurance company often pays the remainder of the charges.
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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. Not all health
insurance plans require a deductible. As a general rule (though
there are many exceptions), HMO plans typically do not require a
deductible, while most Indemnity and PPO plans do.
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What is coinsurance?
Coinsurance is the
term used by health insurance companies to refer to the amount that
you are required to pay for a medical claim, apart from any
co-payments or deductible. For example, if your health insurance
plan has a 20% coinsurance requirement (and does not have any
additional co-payment or deductible requirements), then a $100
medical bill would cost you $20, and the insurance company would pay
the remaining $80.
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What is the difference between in-network and out-of-network
providers?
An in-network
provider is one contracted with the health insurance company to
provide services to plan members for specific pre-negotiated rates.
An out-of-network provider is one not contracted with the health
insurance plan. Typically, if you visit a physician or other
provider within the network, the amount you will be responsible for
paying will be less than if you go to an out-of-network provider.
Though there are some exceptions, in many cases, the insurance
company will either pay less or not pay anything for services you
receive from out-of-network providers.
As a general rule, PPO, POS, and HMO plans make use of provider
networks. Indemnity plans typically do not.
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What's the
best health insurance plan for me?
Choosing between
different health insurance plans isn't always easy. There is no one
"best" plan for everyone. The best match for you and your family may
be different than the best match for someone else. In order to help
you answer this question, here are a few things to consider:
1) Are you going to need long-term coverage or just something for
the short-term?
If you're between jobs for 1-6 months, you may want to look into our
short-term coverage options. Alternatively, if you have no prospects
of receiving group health insurance coverage through an employer,
you may value the stability and increased benefits offered through
an individual and family health insurance plan which will provide
longer term coverage.
2) Are you looking for basic coverage or more comprehensive
coverage?
Some insurance plans offer basic coverage (i.e., primarily inpatient
hospitalization and outpatient surgery coverage) to cover you in
case of a major accident or illness. These insurance plans typically
have a lower monthly premium than plans with more comprehensive
coverage, and may be appropriate for people who intend to use their
insurance primarily in the event of a serious accident or illness.
Other insurance plans, in addition to offering coverage in case of a
major accident or illness, offer more comprehensive coverage which
MAY include benefits such as: preventative care, physician services,
prescription drug benefits and routine office visits. These
insurance plans typically have a higher monthly premium than plans
that only offer basic coverage, and may be appropriate for people
who intend to use their insurance on a regular basis.
3) Would you rather pay for your services before you use them or
when you use them?
Typically, the higher the monthly premium that you pay, the less you
will pay per doctor's visit in co-payments and deductibles. If you
choose a health insurance plan with a low monthly premium, you're
likely to have a higher co-payment or deductible. If you don't
anticipate making frequent use of your health insurance coverage, a
higher-deductible plan with a lower monthly premium may suit you
best.
4) How important to you is easy access to specialists?
Health insurance plans that require you to coordinate your care
through a primary care physician typically require that you obtain a
referral before seeing a specialist. Thus, if you prefer easier
access to specialists, you may wish to consider a different type of
plan.
5) Do you have a specific doctor or hospital that you would like to
visit for healthcare?
Some insurance plans utilize provider networks. Pay special
attention to the network of doctors or facilities that each health
insurance plan utilizes. You'll want to make sure that your favorite
doctor or hospital is included on the list for the health insurance
plan you choose. Also note that networks utilized by health
insurance plans can change, so there is no guarantee that your
doctor will always be contracted with your chosen health insurance
plan.
6) What is the most you could pay out in case of a serious illness
or injury?
Health insurance plans typically place limits on how much a member
is required to pay out per year for his or her healthcare. This
limit is often referred to as an out-of-pocket maximum. Once you've
contributed this maximum amount toward your healthcare, the health
insurance company typically covers all other costs for the remainder
of the benefit year. If you're concerned about what may happen to
you in case of a serious illness or injury, you may wish to pay
special attention to the out-of-pocket maximums for the health
insurance plans you're considering.
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When can my coverage start?
You can request
that your Individual and Family health insurance plan start anytime
between 1 and 90 days in the future. However, the insurance
companies will typically need some time to process your application
so keep in mind that the actual date for the start of your coverage
may vary depending on the underwriting process and the availability
of your medical records. (Underwriters will receive your application
much faster if you "eSign" your application.)
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How can I insure just my
child?
When getting quotes
for your child(ren) only, enter the child's gender and birth date in
the "Applicant" or first row. Additional children should be entered
below in the "Child" rows, but not the "Spouse" row.
However, many health insurance companies require one policy per
child. So if you have more than one child, try entering just one
child to see a larger selection of plans and prices. You are free to
apply for each child separately.
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Why should I shop with you rather than buying an insurance plan
elsewhere?
By combining the
localized knowledge of a neighborhood agent with the broad
experience and comprehensive understanding of a national health
insurance agency, we are able to offer our customers:
Broad Selection.
Because we are a health insurance agency and not a health
insurance company, we can offer plans from multiple insurance
companies in your area. We offer a broad selection of health
insurance companies and plans, which allows you find the plan that
best fits your needs. In fact, QuotesLine is the number one source
for individual and family health insurance plans nationwide,
online or offline.
Best Prices.
Health
insurance premiums are filed with and regulated by your state's
Department of Insurance. Whether you buy from QuotesLine, your
local agent, or directly from the health insurance company, you'll
pay the same monthly premium for the same plan.
Fast Processing. QuotesLine offers the fastest way to apply for health insurance
because many of the plans offered on our website can be submitted
and signed electronically, eliminating the need to manually print
and mail applications. This reduces average processing time
significantly.
Excellent Customer
Care. We believe that you'll enjoy the best customer experience
available in the health insurance industry. The licensed health
insurance agents and knowledgeable representatives that staff our
customer care center will help you make the most of your money
with professional, unbiased advice.
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How do you
protect my private information?
Shopping with
QuotesLine is safe. As your health insurance agent, we're committed
to protecting your privacy and the information you provide to us.
QuotesLine 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. We use industry-leading technologies to ensure the
security of all the information under our control.
We encourage you to read through our Privacy Policy online. If you
have any questions about our privacy policy or how your personal
information is protected at QuotesLine, contact us by email at
privacy@quotesline.com.
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When
I buy an insurance plan, how do I make payments?
In most cases, when
you complete your application you'll provide a credit card number or
a check written to the health insurance company for the first
premium payment. Typically, your credit card will not be charged nor
will your check be cashed until you are approved for coverage. If
you are not approved for coverage, or if you cancel your
application, your card will not be charged and any check payment you
made will be returned or refunded.
Once you've been approved for coverage, your ongoing premium
payments are paid to your health insurance company typically on a
monthly or quarterly basis. Insurance companies typically offer
several payment options including monthly billings to be paid by
check or credit card, automatic bank drafts or automated credit card
charges. Please note that credit card billing of premiums is
optional and you can obtain coverage without using that method of
payment.
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If
I apply for an insurance plan, am I obligated to buy?
No. You are under
no obligation to buy a health insurance plan when using our site.
After submitting your application you may cancel it at any time
during the underwriting process. When you submit an application you
will typically include your credit card number, bank account
information, or a check for the initial premium payment. Most
insurance companies will not charge your card, debit your account,
or deposit your check until you are approved. If you are charged or
your check is cashed and you are denied for coverage or cancel your
application prior to approval, the insurance company will issue a
refund to you.
A few insurance companies may charge an application fee, typically
$25 or less. You will be notified in the application if the plan you
chose requires an application fee. Please note that these fees are
non-refundable.
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Do you offer the best prices?
Health insurance
premiums are filed with and regulated by your state's Department of
Insurance. Whether you buy from our health insurance
provider, your local agent, or directly from the health
insurance company, you'll pay the same monthly premium for the same
plan. This means that you can enjoy the advantages and convenience
of shopping and purchasing your health insurance plan through
QuotesLine and rest assured that you're getting the best available
price.
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How do I apply?
● Fill out Application Request Form
● Customer Support will call and
verify the information you have provided to us and discuss
coverage options you have selected.
● We will send your application 1st
Class mail/Sign and return.
● Your application will be forwarded
to the company you selected for underwriting approval and can take
as little as 2 weeks.
● Your policy is delivered to you via U.S.
Mail.
Do Not Cancel
your current coverage until you have received written notification
of your approval from the Insurance Company
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Do I have to take
a physical?
NO. Most companies do not require you take a physical examination. If
there is any question as to a current medical condition a potential
insured may have, medical records may be requested from your doctor.
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Can I cover
child(ren) only?
YES.
With most health insurance plans you can purchase health insurance
for child(ren) only.
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CLAIMS
What is a claim?
Where to call with claim questions.
What
to do if a doctor bills you directly.
What is
an Explanation of Benefits (EOB)?
What is a claim?
When current customers visit a doctor or
hospital, the provider may submit a bill to the insurance company.
Companies usually refer to this bill as a "claim" for benefits.
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Where to
call with claim questions.
Whenever customers have questions about
claims, they should call their insurance company directly.
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What to do if a
doctor bills you directly.
Most insurance companies file claims
electronically. If you receive a bill it's wise to call your
insurance company first. They may have already paid the bill in
question or they may request you send the bill to them for review.
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What is an
Explanation of Benefits (EOB)?
An EOB explains what benefits were
available according to a customer's Contract. The insurance company
will usually send an EOB after reviewing the claims they received
from a provider or hospital.
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PRESCRIPTION DRUG BENEFITS
What is a
brand-name prescription drug?
What is a generic drug?
Why
choose generic drugs?
What
are the differences between brand-name and generic drugs?
What is a three-tier drug benefit or formulary/preferred drug list?
Does a formulary/preferred
drug list limit choices?
What is a brand-name
prescription drug?
Prescription drug manufacturers patent
new drugs when they’re discovered and are called brand-name drugs
and can be very expensive. After the patent runs out, a generic
equivalent can be manufactured.
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What is a generic
drug?
Several companies can manufacture
generic drugs, which must contain the same active ingredients in the
same amounts as the brand-name drugs. This process helps ensure the
brand-name and generic drugs compare to each other.
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Why choose
generic drugs?
Generic drugs can cost much less than
brand-name drugs and help lower health-care expenses. Generic drugs
may also help lower out-of-pocket expenses.
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What are the
differences between brand-name and generic drugs?
The main difference between generic and
brand-name is the cost. The Food and Drug Administration (FDA) must
deem generic drugs to be equally effective to brand-name drugs. The
same FDA quality and safety requirements must be followed for
generic and brand-name drugs.
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What is a
three-tier drug benefit or formulary/preferred drug list?
A formulary/preferred drug list
identifies drugs a physician may wish to consider when deciding
which drug to prescribe. Tiered drug plans can help save money when
customers use less expensive drugs. A formulary/preferred drug list:
● Promotes appropriate and
cost-effective therapy.
● Provides physicians with
information about other available drug therapies.
● Gives information that may help in
discussing medications with physicians and pharmacists
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Does a
formulary/preferred drug list limit drug choices?
Doctors prescribe the drugs that are
right for individual situations. Having a plan with a
formulary/preferred drug list does not limit the selection of drugs,
but it allows customers to have lower out-of-pocket expenses when
they use drugs from the formulary/preferred drug list.
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PPO's, HMO's, PROVIDERS AND
MORE
Whats the difference between
traditional plans and plans using a PPO?
What is a PPO?
How does a
PPO plan work?
Why choose plans using PPOs?
How can you tell if a plan
uses a PPO?
How to find PPO doctors and
hospitals.
How does
an HMO plan work?
How does a
POS plan work?
How
does an Indemnity plan work?
How does an
HSA work?
What are different
types of doctors?
What’s the difference
between traditional plans and plans using a PPO?
Traditional or indemnity plans tend to be more
expensive because they give the same level of benefits no matter
what provider is choosen (customers don’t have to use specific
network doctors or hospitals).
Plans
using a PPO (preferred provider organization) allow customers to
choose any qualified doctor. And customers may have less
out-of-pocket expense when using PPO doctors or hospitals in the
network.
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What is a PPO?
A PPO is a network of credentialed doctors,
clinics, hospitals, and other health-care facilities that are
contracted to provide medical services at negotiated fees.
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Why choose plans using PPOs?
PPO Benefit plan designs usually cost less than
traditional or indemnity plans while providing coverage for eligible
expences no matter what qualified doctor you select. PPO Benefit
Plans allow customers to help control costs and reduce out-of-pocket
expenses when choosing PPO network doctors.
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How does a PPO plan work?
As a member of a
PPO (Preferred Provider Organization) plan, you'll be encouraged to
use the insurance company's network of preferred doctors and
hospitals. These healthcare providers have been contracted to
provide services to the health insurance plan's members at a
discounted rate. 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 probably 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.
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.
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How can you tell if a
plan uses a PPO?
Customers can check the Contract to determine if
their plan uses a PPO. Choosing providers from that PPO network may
mean less out-of-pocket expense.
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How to find PPO
doctors and hospitals.
Customers have several options for finding
doctors and other providers that are contracted with the network
their plan uses. The most accurate and up-to-date way is to ask
their doctor or other health-care providers before their appointment
and on the date of service to determine if the provider is part of
the PPO network.
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How does an HMO plan work?
Though there are
many variations, HMO (Health Maintenance Organizations) plans
typically enable members to have lower out-of-pocket healthcare
expenses but also offer less flexibility in the choice of physicians
or hospital than other health insurance plans. As a member of an
HMO, you'll be required to choose a primary care physician (PCP).
Your PCP will take care of most of your healthcare needs. Before you
can see a specialist, you'll need to obtain a referral from your
PCP.
With an HMO you'll likely have coverage for a broader range of
preventive healthcare services than you would through another type
of plan. You may not be required to pay a deductible before coverage
starts and your co-payments will likely be minimal. With an HMO
plan, you typically won't have to submit any of your own claims to
the insurance company. However, keep in mind that you'll likely have
no coverage whatsoever for services rendered by non-network
providers or for services rendered without a proper referral from
your PCP.
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How does a POS plan work?
A POS (Point of
Service) plan combines some of the features offered by HMO and PPO
plans. As with an HMO, members of a POS plan are required to choose
a primary care physician (PCP) from the plan's network of providers.
Services rendered by your PCP are typically not subject to a
deductible. Also, like HMOs, POS plans typically offer coverage for
preventive care visits.
Typically, however, you will only receive a higher level of coverage
for services rendered or referred by your PCP. Services rendered by
a non-network provider may be subject to a deductible and will
likely be covered at a lower level. If services are rendered outside
of the network, you'll likely have to pay up-front and submit a
claim to the insurance company yourself.
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How does an Indemnity plan
work?
A traditional
Indemnity plan offers a great deal of freedom in choosing which
doctors and hospitals to use, but will probably involve higher
out-of-pocket costs and more paperwork.
Under an Indemnity plan, you may see whatever doctors or specialists
you like, with no referrals required. Though you may choose to get
the majority of your basic care from a single doctor, your insurance
company will not require you to choose a primary care physician.
However, this kind of freedom will cost you. You'll likely be
required to pay an annual deductible before the insurance company
begins to pay on your claims. Once your deductible has been met, the
insurance company will typically pay your claims at a set percentage
of the "usual, customary and reasonable (UCR) rate" for the service.
The UCR rate is the amount that healthcare providers in your area
typically charge for any given service.
An Indemnity plan may also require that you pay up front for
services and then submit a claim to the insurance company for
reimbursement.
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How does an HSA work?
Legislation
establishing Health Savings Accounts (or "HSAs") took effect on
January 1, 2004. HSAs and HSA-eligible health insurance plans are
becoming more and more popular. 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. Unused funds remain in the account
and accrue interest year-to-year, tax-free.
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What are different
types of doctors?
There are many different types of doctors or
specialists to choose from. A primary doctor can understand your
health needs and help refer you to other doctors when necessary.
(Note: Primary doctors are not required for AMS-marketed plans.)
Some types of primary doctors:
● Family practice: treat all family members
(child or adult); may include maternity care
● Internal medicine: diagnose and treat
nonsurgical disease in adults
● General practice: provide service that’s
not limited to a specialty
● Pediatrics: specialize in caring for and
treating diseases in infants, children, and adolescents
Specialists for women:
● OB/GYN: physician specializing in
obstetrics and gynecology for women
● Certified nurse midwife: advanced practice
nurses specializing in women’s health-care needs throughout life
(prenatal, labor and delivery, and postpartum care for "normal"
pregnancies)
● Nurse practitioners: advanced practice
nurses prepared in programs specific to women’s health-care
including common gynecological problems, routine screenings, and
family planning
Other areas of specialty:
● Anesthesiology: anesthesia, either general
or spinal block for surgeries and some forms of pain control
● Cardiology: heart disorders
● Dermatology: skin disorders
● Endocrinology: hormonal and metabolic
disorders
● Gastroenterology: digestive system
disorders
● General surgery: common surgeries involving
any part of the body
● Immunology: disorders of the immune system
and allergies
● Infectious disease: infections affecting
the tissues of any body system
● Nephrology: kidney disorders
● Neurology: nervous system disorders
● Oncology: cancer and some other malignant
(growing worse - resisting treatment) diseases
● Ophthalmology: eye disorders and surgery
with services provided by an ophthalmologist (MD) or optometrist
● Orthopedics: bone/connective tissue
disorders
● Otorhinolaryngology: ear, nose, throat
disorders
● Physical and rehabilitative medicine:
coordinate return to optimal functioning in individuals with
musculoskeletal and neurological disorders (i.e., low back injury,
spinal cord injuries, and stroke)
● Psychiatry: emotional or mental disorders
● Pulmonary (lung): respiratory tract
disorders
● Radiology: evaluation of X-rays and related
procedures (such as ultrasound, CT scan, and MRI)
● Urology: male reproductive tract and both
male and female urinary tract disorders
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