Health Insurance FAQ's

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A. Individual and family health insurance is specifically designed for individual use as opposed to group coverage. By purchasing your own health insurance in Michigan you can save money and be personally responsible for your health care dollars. In addition to this sense of personal responsibility, your health insurance now will continue whether you are employed or not. You will be pleasantly surprised with the variety of affordable health insurance plans for you and your family.

A. Individual health insurance 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 (Health Maintenance Organizations) which you need to be part of group for, PPO(Preferred Provider Organizations), and POS (point of service)plans. Managed-care plans use healthcare provider networks which 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. As a result, you'll have lower out-of-pocket costs with a managed-care health insurance plan.

A. As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged through their pricing of services to use the insurance company's network of preferred doctors and hospitals. 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. Our team of advisors can help you research your preferred Doctors to see if they are included in the network. 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 most likely 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.

A. HMO (Health Management Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospitals than other health insurance plans. As a member of an HMO, you'll be required to choose a primary care physician (PCP) which you must see prior to being referred to a specialist.

With an HMO, you'll likely have coverage for a broader range of preventative healthcare services some even offer discounts to health clubs. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. HMO's typically offer no coverage whatsoever for services rendered by non-network providers or for services rendered without proper referral from your primary care physician (PCP).

A. 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.

A. HSAs and HSA-eligible Michigan health insurance plans are a great way for people to control their health care dollars. 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 at a qualified financial institution of your choice. Unused funds remain in the account and accrue interest year-to-year, tax-free.
• Not all high-deductible plans are eligible for use in conjunction with an HSA.

A. A "co-payment" or "co-pay" is a specific charge that your Michigan health insurance plan may require that you pay for a specific medical service or supply. We like to call this the "office visit fee". If the insurance plan requires a $15 co-payment for an office visit then the insurance company pays the remainder of the charges.

A. 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. Most Indemnity and PPO plans require you to meet the annual deductible prior to making payments.

A. Coinsurance is the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. If there is a 20% coinsurance requirement, then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80 until you meet the total annual out of pocket requirement.

A. An in-network provider is one contracted with the Michigan health insurance company to provide services to plan members for specific pre-negotiated rates. 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, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

A. Choosing between health insurance plans isn't easy. My Insurance Expert provides licensed advisors to help you sort through the myriad of options in order to meet your specific budget and health insurance needs. We will help find the best match for you and your family, and provide you with a Michigan health insurance quote. 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 are between jobs for 1-6 months, you may want to look into our short-term coverage options. You should also consider taking over your health insurance needs on a long term basis so that your insurance remains with you and not your employer.

2. Are you looking for basic coverage or more comprehensive coverage? Some Michigan health insurance plans offer basic coverage 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 Michigan health insurance plans typically have a higher monthly premium.

3. How important is the cost of the monthly premium to you? The higher the annual deductible amount is the lower the monthly premium. If you anticipate infrequent 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. If you prefer easier access to specialists, you should consider a plan that provides that flexibility.

5. Do you have a specific doctor or hospital that you would like to visit for healthcare? If you would like to continue seeing a specific Doctor please check with the appropriate carrier to confirm that the Doctor is included in their network. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. 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 serious illness of injury? Health insurance plans typically place limits on how much a member is required to pay out per year. 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.

A. You can request that your health insurance plan start anytime between 1 and 90 days in the future. The insurance companies may need some time to process your application, so keep in mind that the actual start date of your coverage may vary depending on the underwriting process and the availability of your medical records.

A. When getting quotes for your child(ren) only, enter the child's gender and birth date in the "Applicant" or first row. Many Michigan health insurance companies require one policy per child. So if you have more than one child, try entering one child to see a larger selection of plans and prices. You can apply for each child separately.

A. We offer you the best of all worlds; a comparison shopping experience, expert advise, and our service is totally free.

• Broad Selection. Because we are a Michigan health insurance agency and not a health insurance company, we can offer plans from multiple insurance companies in your area and find the best plan that fits your budget and insurance needs.
• Best Prices. Health insurance premiums are regulated by the States Department of Insurance so we offer the best Michigan health insurance plans at the best rates.
• Expert Advice. My Insurance Expert offers the assistance of licensed advisors that can help you define your health insurance needs and match it to your budget.

A. My Insurance Expert.com will not share your personal information with anyone outside of our organization except as required to secure you insurance coverage. We will not sell or share your personal information with any third party and we will maintain the highest professional standards of confidentiality and integrity.

A. 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 months 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.

A. No. You are under no obligation to buy a health insurance plan. 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. You will be notified in the application process if the plan you choose requires an application fee. Please note that these fees are non-refundable.