Frequently asked questions

A copay is simply an entry fee to see a provider.  The copay does not go towards a deductible, however your copays will stop when you reach your out-of-pocket maximum.

A deductible is the amount you must pay full price for services out of pocket before you start to receive most benefits from the insurance company.   A lower deductible is traditionally more desirable.

⁃ PPO - Preferred Provider Organization - nationwide benefits and the largest network of them all. Most people prefer a PPO because you will not need a referral to see a specialist.

⁃ HMO - Health Maintenance Organization - Limited to your zip code or county, an HMO is a more limited network.  Once you leave the network, you will be paying out-of-network pricing and will have a separate out-of-network deductible

⁃ EPO - Exclusive Provider Organization - This is a small network with a pre-selected list of hospitals and providers that you are able to use your insurance benefits with 

⁃ POS - Point of Service - The smallest network.  Generally they have lower costs, but with fewer choices.  They do not offer great flexibility or convenience

Insurance premiums are based on demographic risk.  Age, sex, and location are the main determining factors.  As we get older, our bodies have added stress and we tend to have more health issues which make us more expensive to insure.

Insurance companies have their own ‘grace periods’.  Anywhere from 24 hours to 30 days is a grace period that you have to make your premium payment before the policy lapses.  This way you will still have benefits throughout the grace periods and are able to use your insurance.  Once a policy lapses due to non-payment, you must reapply for coverage.

Waiting periods vary from company to company.  Some benefits on a plan have a waiting period.  For instance, you may not be able to receive benefits on a yearly wellness physical for 30 days after the insurance plan goes into effect.