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| Frequently Ask Questions |
Why Do I Need Health Insurance?
Today, health care costs are high, and getting higher. Who will pay your
bills if you have a serious
accident or a major illness? You buy health insurance for the same reason
you buy other kinds of
insurance, to protect yourself financially. With health insurance, you protect
yourself and your family in
case you need medical care that could be very expensive. You can't predict
what your medical bills
will be. In a good year, your costs may be low. But if you become ill, your
bills could be very high. If
you have health insurance, many of your costs are covered How do I pick
a health plan?
If your employer gives you a choice of plans or you need to purchase your
own coverage, it is crucial that you understand your health insurance
choices and pick the insurance that is best for you and your family.
Here are some questions you should ask yourself when choosing a health
insurance plan:
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How affordable is the cost of care?
- What is the monthly premium I will have to pay?
- Should I try to insure most of my medical expenses or just the large
ones?
- What deductibles will I have to pay out-of-pocket before insurance
starts to reimburse me?
- After I’ve met my deductible, what percentage of my medical
expenses are reimbursed?
- How much less am I reimbursed if I use doctors outside the insurance
company’s network?
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Does the insurance plan cover the services
I am likely to use?
- Are the doctors, hospitals, laboratories and other medical providers
that I use in the insurance company’s network?
- If I want to use a doctor outside the network, will the plan permit
it?
- How easily can I change primary-care physicians if I want to?
- Do I need to get permission before I see a medical specialist?
- What are the procedures for getting care and being reimbursed in
an emergency situation, both at home or out of town?
- If I have a preexisting medical condition, will the plan cover it?
- If I have a chronic condition such as asthma, cancer, AIDS or alcoholism,
how will the plan treat it?
- Are the prescription medicines that I use covered by the plan?
- Does the plan reimburse alternative medical therapies such as acupuncture
or chiropractic treatment?
- Does the plan cover the costs of delivering a baby?
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What is the best health plan for me?
Choosing between health plans is not as easy as it once was. Although
there is no one "best" plan, there are some plans that will
be better than others for you and your family's health needs. Plans differ
in how much you have to pay and how easy it is to get the services you
need. Although no plan will pay for all the costs associated with your
medical care, some plans will cover more than others.
With any health plan you will pay a basic premium, usually monthly, to
buy the health insurance coverage. In addition, there are often other
payments you must make. These payments will vary by plan but essentially
are deductibles and co-payment.
In the "Things to Consider" section of the site, there are some
excellent guides about choosing and comparing health plans.
Here's a list of key questions to consider in selecting the plan that
best meets your needs:
- How much will it cost me on a monthly basis?
- Are there deductibles I must pay before the insurance begins to help
cover my costs? After I have met the deductible, what part of my costs
are paid by the plan?
- What doctors, hospitals, and other medical providers are part of
the plan? Are there enough of the kinds of doctors I want to see?
- Where will I go for care? Are these places near where I work or live?
- If I use doctors outside a plan's network, how much more will I pay
to get care?
- Are there any limits to how much I must pay in case of major illness?
What about limits and deductibles for certain types of care such as
surgery or maternity?
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| How do I compare plans?
You can compare benefits and prices of different plans side by side using
the "COMPARE BENEFITS" feature. On "Step 2: Compare Plan
Benefits and Prices From Leading Companies", check the box of each
plan you want to compare. Then click "COMPARE BENEFITS". Where
are the other health plans I am familiar with?
Not all health plans sell health insurance directly to individuals and
families. Many, like Aetna and Cigna, provide insurance predominately
through employers.
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What is a PPO?
A PPO is a Preferred Provider Organization. As a member of a PPO, you
can use the doctors and hospitals within the PPO network or go outside
of the network for care. You do not need a referral to see a specialist.
- If you obtain care from a medical provider outside of the PPO network,
you will pay more for the service. For example, a PPO might pay 90 percent
of the cost for a visit with an in-network doctor but only 70 percent
of the cost for a visit to a non-network doctor.
- You will typically pay a copayment for each visit/service. These
copayments are typically higher than an HMO copayment but not always.
- You will usually be responsible for paying an annual deductible.
If you join a PPO, you should find you have more flexibility than with
an HMO, but your total out of pocket costs are likely to be somewhat
higher.
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What is an HMO?
An HMO is a Health Maintenance Organization. As a member of an HMO, you
select a primary care physician from a list of doctors in that HMO's network.
Your primary care physician will be the first medical provider you call
or see for a medical condition. He or she will make any needed referrals
to a medical specialist. Typically, these specialists will be part of
the HMO network.
- If you obtain care without your primary care physician's referral
or obtain care from a non-network member, you may be responsible for
paying the entire bill. (with exceptions for emergency care)
- With some HMOs, you pay nothing when you visit in-network doctors.
With other HMOs there may be a small copayment for the visit or service.
- With most HMOs you will not be responsible for paying a deductible.
If you join an HMO, you should find that you have few out-of-pocket
expenses for medical care -- as long as you use doctors or hospitals
that are part of the HMO.
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| What is an MSA?
An MSA is a Medical Savings Account. It is a tax-advantaged personal savings
account used in conjunction with a high deductible health policy. Individuals
can contribute money to this account on a pre-tax basis to set aside money
for qualified medical care and expenses, including annual deductibles and
copayments.
What is a POS?
POS is a Point-of-Service Plan A type of managed care plan combining features
of health maintenance organizations (HMOs) and preferred provider organizations
(PPOs). You can decide whether to go to a network provider and pay a flat
dollar or to an out-of-network provider and pay a deductible and/or a coinsurance
charge.
What is an Indemnity Plan?
An indemnity plan is commonly known as a fee for service or traditional
plan. If you select an Indemnity plan you have the freedom to visit any
medical provider. You do not need referrals or authorizations; however,
some plans may require you to precertify for certain procedures.Most indemnity
plans require you to pay a deductible. After you have paid your deductible,
indemnity policies typically pay a percentage of "usual and customary"
charges for covered services; often the insurance company pays 80% and you
pay 20%. Most plans have an annual out of pocket maximum and once you've
reached this they will pay 100% of all "usual and customary" charges
for covered services.
Many health insurance companies have moved away from indemnity plans and
are instead offering managed care plans such as HMOs and PPOs. You may have
few or no indemnity plan choices in your area.
Q: Why should I purchase health insurance for my children when I can
take them to a hospital Emergency Room if they get sick?
A: Regular check-ups and healthy habits contribute to overall good health.
With insurance, you can provide routine and preventive care that can help
your child stay healthy and avoid more serious and costly health problems
that could occur later. In addition to covering medical, dental and vision
care, the Family Health Insurance Program also provides mental health
services (counseling), including dealing with teen issues.
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Q: What Health Insurance programs/options do Family Health Insurance
make available?
A: This program serves the children of parents in our community who earn
minimal incomes, are unemployed, or don't have medical insurance for a
number of reasons (including immigration status). Parents, legal guardians,
step-parents, foster parents or caretaker relatives may apply for insurance
for a child, but only the parents' income will be considered to determine
eligibility.
Children, age 18, and under may apply for their own insurance if they
meet the income requirements. Minors who do not live with parents, legal
guardians, step-parents, foster parents or caretakers may be eligible
for the program for themselves or their children if they meet all other
requirements.
Children, age 18, and under may apply for their own insurance if they
meet the income requirements. Minors who do not live with parents, legal
guardians, step-parents, foster parents or caretakers may be eligible
for the program for themselves or their children if they meet all other
requirements.
Newborns and children under one year old may qualify if their family meets
the income requirements.
The eligibility guidelines for any of the health insurance programs that
Family Health Insurance works with includes a review of all the following
criteria:
- Age
- Family size
- Income
- Immigration status
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| What is a provider?
A provider is a hospital, healthcare facility, physician or other medical
professional that provides healthcare services.
What is a Primary Care Physician (PCP)?
A physician or other medical professional who serves as a group member's
first contact with a plan's healthcare system. Also known as a primary care
provider, personal care physician, or personal care provider.
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