FREQUENTLY ASKED QUESTIONS
Why should I use a broker?
Looking for health insurance can be a confusing process. A broker will help you identify and understand the options that best suit your needs, preferences, and budget. We know the industry and the market and can guide you through the process of picking a plan and applying for coverage. We’ll help you compare prices with a variety of insurance carriers and work through underwriting issues. A good broker can also serve as your liaison with the insurance company after you buy coverage. Lastly, our service is free for you.
Do I pay more to use a broker?
No. The health insurance industry is unique in that the prices are fixed, meaning your policy will cost the same regardless of how or from whom you buy it. Nobody (including us) has any special deals or prices. We are paid a commission by the insurance companies, but because the prices are unaffected by this, our service comes at no extra charge to you. So you get all of the advantages of using a health insurance broker at no extra charge.
No. Brokers like us are paid by the insurance companies. We make a commission off our clients’ premiums – so we have a stake in you being happy with your coverage!
No! And don’t let anyone mislead you! Our industry is unique in that the prices are fixed, meaning your plan will cost you the same no matter how or from who you buy it. The only way to adjust the price is by adjusting the various plan options.
A discount health plan and/or a limited benefit plan is an alternative to major medical insurance, typically for those who cannot get individual major medical health insurance coverage or just can't afford it. Unfortunately, many unlicensed agents try to lead consumers to believe that it is major medical insurance! Don’t be misled! There are many viable limited benefit plans and discount plans on the market, but we only recommend these if individual health insurance is not an option. Contact AC Forrest to learn more or get quotes.
The insurance providers we deal with are major national carriers who typically have networks in place (or agreements with other companies) so that you should have no trouble obtaining healthcare when you travel. If there are particular places you frequent, let us know and we’ll make sure you’ll be covered there. (If you travel internationally, talk to us about overseas options).
Most of the providers we deal with are major national carriers who typically have networks in place nationwide. So you would likely have continuity of coverage, though your premium could change based on the cost of healthcare in your new area.
Once you choose a health insurance plan you’ll fill out a detailed application that will primarily involve your health history and related issues. That application will then go to the insurance company’s underwriting department for review. Often, an underwriter will call you for a brief follow-up interview to clarify or get more information related to issues raised on your application. Occasionally the underwriter will order a copy of medical records from your doctor or an applicant will be asked to provide additional information or will be asked to take a paramedical exam (usually a little blood work at the insurance company’s expense). The underwriting process is usually fairly quick and straightforward. When it is complete, you will either be approved, denied, or you will receive a counter-offer. The counter-offer could be a different premium amount based on particular circumstances or issues; or it may include exclusions or limitations related to certain pre-existing conditions. If you choose to accept the counter-offer, you will pay the first month premium and your coverage will be effective on the date specified in your application.
Your health insurance premium will be locked in for a specific amount of time – usually for one year. When your coverage is up for renewal, your premium may change. In fact, to be honest, your premium will almost certainly go up a bit each year, if only because the cost of healthcare goes up an average of 15% each year. Of course, should your renewal be too high, we are happy to once again help you examine other health insurance plans, options, and providers.
Tobacco use will not automatically disqualify you from getting health insurance, but you will likely pay more than you otherwise would (though there is at least one exception in South Carolina).
Individual health insurance plans do not automatically include maternity coverage. There are some that offer it as an option, though there may be a waiting period before maternity coverage kicks in. Let us know if you’d like maternity coverage as part of your individual health insurance plan. Maternity is a standard benefit in group health plans.
There may be other options for you. While there are certain circumstances and conditions that will result in an automatic decline with any health insurance carrier, the underwriting guidelines are not the same in every case. Here again is a benefit of using an independent health insurance broker – we have some familiarity with the underwriting practices at different companies, and we often pre-screen clients before going through a full application to get an idea of what the outcome might be. Talk to us about the specifics of your case and we’ll do our best to help you find coverage. If individual health insurance is not an option, there are limited benefit plans (link to our page on that) or discounts plans (link) that could benefit you.
Absolutely! It happens every day. We are blessed with secure technology that expedites the process for everyone involved.
No. As long as you pay your health insurance premium, you’ll have coverage. But if you stop paying your premium, your coverage will end. There is no obligation on your part to maintain coverage (this is not like the contract you sign with a cell phone company) and no penalty if you drop it.
You can change health insurance plans, but it is much easier to raise your deductible than it is to lower it. If you want to lower your deductible, you will likely have to go back through the underwriting process. If you cannot decide between two deductibles, we suggest you apply for the lower deductible, because it is no problem at all to raise it.
INSURANCE GLOSSARY
Claim
Quite simply, when you incur a health expense that is covered by your health insurance policy, your medical provider submits a “claim” to the insurance company. It’s basically their request for payment. When the insurance company pays the claim, you’ll receive a form called an “explanation of benefits.”
In most traditional plans, once you reach your annual deductible, you enter into coinsurance, where the company will pay some percentage of subsequent claims and the client pays the rest (usually an 80/20 or 70/30 split). There is typically a cap on what the client will pay, called your “out-of-pocket maximum.” Once you reach that cap, the insurance company will pay all claims.
Some health insurance plans allow you to visit the doctor and pay a predetermined fee for services, which is called a copay. The insurance company then pays the remainder of the cost of the visit. A copay typically covers expenses that take place in that office on that day. Some plans limit the number of copays a client may use in one year.
Your deductible is basically the portion of your health expenses that you will be responsible for each year before the health insurance company begins paying benefits. As a general rule, the higher your deductible, the lower your monthly premium.
The date your plan takes effect.
Sometimes, after reviewing an application, an insurance company will offer coverage with certain limitations – they may exclude certain pre-existing conditions from coverage, meaning that they would not pay claims related to that condition. Often you can apply to have an exclusion reconsidered after 1-3 years.
An employer may choose to set up a group insurance policy for employees. As the name suggests, there must be at least two people on a company’s payroll in order to set up a group plan. There are typically participation requirements (a certain percentage of eligible, full-time employees must participate in the plan for it to remain in force). A group health insurance plan is a great way to attract and retain great employees, and can provide some tax advantages as well (talk to your tax professional).
Health Savings Accounts are a rather new option that function much the same as an IRA, the retirement account many people are more familiar with. You are eligible to open an HSA when you are covered by a high deductible health insurance plan that meets federally mandated requirements. These plans generally provide good major medical protection with a higher deductible and lower premiums. You can establish your health savings account at the bank of your choosing and deposit pre-tax money to fund health-related expenses. The money you place in the account is not taxable income. (For this reason, the IRS sets annual limits on maximum contributions.) The idea is that you take the money you save on monthly premiums and put some of it into this account to fund medical expenses – so you’re saving (with interest) and controlling your health dollars rather than sending them on to the insurance company whether you need it or not. Again, this money is yours and rolls over year to year (not a use it or lose it situation). The tradeoff is that you are typically responsible for your healthcare costs up to the deductible amount. You will, of course, benefit from provider discounts when you stay in network.
There is a cap on the benefits your coverage will pay over the life of the plan, but it is usually at least $1 million, and often much more.
In most traditional plans, once you reach your annual deductible, you enter into coinsurance, where the company will pay some percentage of subsequent claims and the client pays the rest (usually an 80/20 or 70/30 split). There is typically a cap on what the client will pay, called your “out-of-pocket maximum.” Once you reach that cap, the insurance company will pay all claims.
Any condition that you has been diagnosed or for which a reasonable person would have sought medical advice or treatment.
Routine healthcare examinations such as physicals, vaccinations, mammograms, and annual OBGYN exams.
An estimate of what a particular health insurance plan will cost, usually generated by a client’s date of birth and zip code (though it may also consider other factors such as height/weight and tobacco use). A quote is a “ballpark” estimate that is particularly useful in comparing how plans and providers stack up. The actual premium you would pay would be determined by your application and the specifics of your case. Quotes are particularly useful in comparing plans against one another.
A change or addition that may be included in your policy, often involving an exclusion.
A basic insurance policy that will bridge the gap when you have recently lost group coverage and anticipate getting on a group health insurance plan fairly soon. These plans are designed for those who are between jobs and for recent graduates who no longer qualify as dependents on their parents’ plan.
Life insurance that is in force for a defined period of time (most commonly for 10, 20, or 30 years). After the policy period is over, the policy ends (though it can usually be converted to a more expensive permanent policy at that point). Term life insurance is not an investment product, and is significantly less expensive than whole or universal life insurance.
The process whereby the health insurance company reviews an application and gathers information before making a final decision on an applicant. Often, a member of an underwriting team will call an applicant to gather more information or ask follow-up questions related to information in the application. The task of an underwriter is essentially to assess the risk of insuring each applicant.
