Learn About Health Insurance through our FAQ

What is the difference between individual and family health insurance?

Individual and family health insurance is a type of health insurance coverage that is available to an individual (one person) or a family (more than one person within the family). This is different than a group health insurance policy which provides health insurance coverage to owners and their employees of a business or organization. If offered, most people would prefer to have their employer provide group health insurance coverage. The truth is, not all employers offer it. If health insurance benefits are not offered, then an individual or family plan is another option. There are many affordable individual and family plans available to fit any budget. Keep in mind, the more you can afford, the richer the benefit.

What kind of individual and family plans are available?

Individual and family health insurance plans are either "indemnity" or "managed-care" plans. The major differences include choice of healthcare providers, out-of-pocket costs and how bills are paid. 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 use provider networks. These providers within a network agree to perform services for patients at pre-negotiated rates and most of the time will submit the claim to the insurance company for you. This means that you will have less paperwork and lower out-of-pocket costs.

How does a PPO plan work?

With 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 you at a discounted rate. You will not be required to choose a primary care physician (like you would with an HMO plan) but you should be proactive in only seeing providers within the network to avoid extra out of pocket expense.

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 provider will ultimately cost you extra out of pocket expenses. We cannot stress enough the importance of staying within the network to minimize your medical premium dollars spent.

How does an HMO plan work?

An HMO (Health Maintenance Organization) plan provides rich benefits. They offer lower out-of-pocket healthcare expenses. They offer less flexibility in the choice of providers than other health insurance plans. You will be required to choose a primary care physician (PCP) when you apply for an HMO plan. You will be required to visit your PCP if and when you need medical attention. If you need to see a specialist, you will need to be referred by your PCP. You may have no coverage provided for services rendered by non-network providers or for services rendered without a proper referral from your PCP.

How does an HSA work?

Legislation establishing Health Savings Accounts (or "HSAs") took effect on January 1, 2004. HSAs and HSA-compatible health insurance plans are becoming more and more popular. Here are the basics:

An HSA is a savings account that may be used in conjunction with an HSA-compatible high deductible health insurance plan (HDHP) to pay for qualifying medical expenses that are established by the federal government. Not all high deductible health plans are HSA compatible.

Choosing an HSA-compatible health insurance plan may help you save money. The monthly premium on an HSA-compatible high deductible plan is less expensive than the monthly premium on a lower-deductible health insurance plan.

Contributions to an HSA may be made at any time subject to certain annual limits established by the federal government.

Funds in the HSA may be used at your discretion for non medically qualified expenses but you will be subject to a penalty. Record keeping is essential. Unused funds remain in the HSA account and accrue interest year-to-year and are tax-free.

 

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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 calendar 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 commonly do not require a deductible, while most Indemnity and PPO plans do.

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. This is your share of costs.

What is coinsurance?

Coinsurance is a term used by health insurance companies to refer to the amount that you are required to pay for a medical claim. These can be separate from any co-payments or deductible. Coinsurance is your share of costs generally after the plans annual deductible.

What is the difference between in-network and out-of-network providers?

An in-network provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is not contracted with the health insurance company. If you visit a 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. Staying within the network is most cost effective for you.

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What's the best health insurance plan for me?

Choosing between different health insurance plans isn't always easy. There are many options available. There is no one "best" plan for everyone. The best plan for you and your family may be different than the best plan 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 have a lower monthly premium than plans with more comprehensive coverage. They may be appropriate for people who intend to use their insurance 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?

Generally, the higher the monthly premium you pay, the richer the benefits in terms of lower doctors visit 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 be a good option.

4) How important to you is easy access to specialists?

Some health insurance plans require that you coordinate your care through a primary care physician (PCP). They require you to obtain a referral before seeing a specialist. 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?

Most insurance plans use provider networks. These are contracted providers that offer services at pre-negotiated rates. Each insurance company and plan may have a different provider network. Be sure to check to see if your doctor is a part of that plan's network before you apply. Also keep in mind that networks utilized by health insurance plans can change. There s 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 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 generally 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 review the out-of-pocket maximums for the health insurance plans you're considering. Depending upon the plan, the out-of-pocket maximum may or may not include your annual deductible.

When can my coverage start?

You can request that your Individual and Family health insurance plan start anytime between 1 and 75 days in the future. It is ultimately the decision of the underwriter. Insurance company application processing times may vary. It is always best to allow for plenty of time for the underwriting process and the need for medical record information (if necessary). Applications applied for online tend to be processed more quickly than paper applications.

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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 by notifying us in writing of your request to cancel. When you submit an application you will be required to submit at a minimum the first months premium using either your credit card, bank account debit 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.

Do you offer the best prices?

Health insurance premiums are filed with and regulated by the Department of Insurance. Whether you buy from CaliforniaHealthInsuranceNow.com, your local agent, or directly from the health insurance company, you will pay the same monthly premium for the same plan. There are no broker fees. This means that you can enjoy the advantages and convenience of shopping and purchasing your health insurance plan through CaliforniaHealthInsuranceNow.com and rest assured that you're getting the best available price.

Can I contact someone if I need help?

Yes. We believe in providing you with top-quality customer service. Our health care specicialists are available and are ready to assist you.

Call Us

Our knowledgeable specialists are available Monday - Friday by calling 800-560-2443.

Email Us

You can also email us 7 days a week by emailing us from our "Contact Us" page. One of our knowledgeable health care specialists will reply to your email or call you if you also provide your telephone number.

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