Bob Ryals
Health Insurance Agent
Holly Conley
Health Insurance Agent
Chris Whimire
Health Insurance Agent
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Bob Ryals Health Insurance Agent |
Holly Conley Health Insurance Agent |
Chris Whimire Health Insurance Agent |
With over 15 years experience as top producing Georgia Individual
Health Insurance Agents Bob, Holly and Chris take the time to
answer the most common and important questions that should be
asked when looking at all of the individual health insurance options
available.
Q: When looking for health
insurance, where should I begin? What is important to know?
A: There are several factors to decide on when selecting
the best coverage for your needs. What is your budgeted amount?
Do you need maternity (pregnancy) coverage? What deductible is
best for you and your family? Does anyone have pre-existing conditions
or does anyone take expensive medications?
Q: Do I have to pay the deductible
before I can see a doctor?
A: If you enroll in an individual health insurance
policy that has a copay option for office visits, you should only
have to pay the copay when seeing a physician for visits for medical
problems. Depending on the policy, you may still have to pay for
office visits for pre-existing conditions. Charges for procedures
that are performed that are considered "in-office surgeries"
(ex. mole removals) will not be covered under the copay and will
apply to the deductible, if not already met. Also, read your benefits
for "Preventive Care" (well visits and physicals). You
may or may not have to meet the deductible before those benefits
are paid out and there may also be a limit on the amount covered.
Several companies are now requiring a waiting period before they
will cover preventive care.
Q: If I go into the hospital and have
to pay the deductible, do I have to pay anything else?
A: It depends on your policy. If the benefits for the insurance
policy that you are looking at tell you that the coinsurance amount
is 100%, then deductibles and copays are all that you will pay.
But unfortunately, most individual health insurance policies have
coinsurance amounts of 80% or less. In this case, the most important
part to look at in order to decide on the policy is the "maximum
out of pocket" or "coinsurance maximum". For example,
if you have an insurance policy with $2500 deductible that covers
at 70% after the deductible, and the maximum out of pocket is
$2000 plus the deductible, then you would be out of pocket $4500
(excluding copays, which are accrued and do not apply to deductibles
or maximums). The same is true for a $2500 deductible plan that
covers at 80% after the deductible and the maximum out of pocket
is $2000 plus the deductible.
Q: What is a "Pre-existing Condition"
and will it be covered?
A: A pre-existing condition is defined as any condition
or symptom (either diagnosed or not) that exists or begins before
insurance coverage goes into effect that a prudent person would
have sought medical attention for. Fox example, if you have a
knot the size of a golf ball on your face, whether or not you
have seen a doctor, it will be considered pre-existing because
a prudent person would have gone to a doctor. This is an exaggerated
example, but it helps you to understand. Individual Insurance
functions similar to an Auto insurance policy - you can't get
the auto policy to cover the accident that you've already had,
you have to have the coverage in place before the
accident.
Depending on the condition and medications, the individual health insurance underwriter will give one or more of the following answers: 1.) Accept you for coverage and cover the condition and medications,: 2.) Accept you for coverage and charge an additional premium for the added risk: 3.) Accept you for coverage but not cover the pre-existing condition or medication or; 4.) Decline you for coverage. Be sure to ask your agent what the best policy is for your needs.
Q: What if I just don't disclose
my pre-existing condition on the application?
A: Not disclosing a known pre-existing condition on
an application will cause the insurance company to retro-actively
cancel you and your family members coverage. They will refund
your premium paid, but they will also request (and recieve) payment
back from every provider that they paid a claim to. Additionally,
the insurance company can prosecute you for Insurance Fraud, which
doesn't look good on anyone's resume...
Q: Does it cost more to use an individual
health insurance agent instead of enrolling directly through the
health insurance company?
A: No, using an agent should never cost you any additional
money. Likewise, all insurance agents should be giving you the
same rate quotes if they have the same information. Some reasons
for getting different rates for the same plan would be if an agent
is familiar with the underwriting guidelines and knows to add
additional premium amount to the quote they give due to existing
health risks. Their quote may be higher than the agent who doesn't
ask any questions and just wants to quote you the lowest rate.
Eventually, you will end up with the same rate no matter who you
use, because when the application is turned in, the underwriter
at the insurance company will make the decision based only on
their underwriting guidelines. But, it helps to tell the agent
everything so that you have less chance or a big, bad surprise
after you submit your application. Sometimes the agent has no
way of knowing how an underwriter will interpret the application
that you submit and you're still surprised.
Q. What are the advantages of using
an experience individual health insurance agent?
A: Since most individual health insurance agents sell individual
plans from several different insurance companies, they should
have access to pricing, benefits, and know the underwriting guidelines
for the different companies. Likewise, an experienced agent will
know which companies have easier underwritng for specific conditions
and which companies are the most stable with their rate increases
(yes, all companies raise individual health policy rates every
year, but not every company raises rates at the same level). Also,
in the event of problems with billing, claims payment errors or
questions, a reputable and experienced agent should be able to
help you. However, not all agents help with questions after the
policy is issued, so be sure to ask. To clarify, Insurance
Now is happy to help with all of those issues - remember,
we strive to help you in the same manner that we would help our
own family members.
 9 Dunwoody Pk., Suite 136 Atlanta, GA 30338 |
(770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. Email: holly@insurance-now.com |
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