FAQ

The Staff At Health Quest Insurance take pride in doing the research and recommending products and offering services customized to your needs. We offer a one-stop shopping service. Our goal is to keep it simple. We don’t look at ourselves as brokers or agents looking for a quick sell. We establish long term relationships and we are prepared for all of your long term health, life, dental and vision needs.

A Health Maintenance Organization (HMO) provides complete medical services from a closed network of providers. Generally, coverage is not provided and benefits are not paid if you get care outside of the network without prior approval from your primary care physician (PCP) and your medical group. HMO plans use PCPs as gatekeepers to manage your care.

A primary care physician (PCP) is a doctor you choose to manage all your health care. Your PCP provides preventive and routine care and refers you to specialists and hospitals when you need them. A PCP can be an internist, a family or general practitioner, or a pediatrician for a child You choose your PCP from the network of doctors in your health plan.

Preferred Provider Organization. A health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network providers at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is often a deductible for out-of-network expenses and a higher co-payment. A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO.

WTH?

The amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on a yearly deductible.

Co-payment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some HMOs require a $10 “co-payment” for each office visit, regardless of the type or level of services provided during the visit. Co-payments are not usually specified by percentages.

Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called “co-payment.” Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.

The maximum amount of money you will pay in a year for deductibles and coinsurance plus regular premiums. After you reach the annual out-of-pocket maximum (also called a “stop loss”) the insurance company should pay for all additional qualified medical expenses.

Federal legislation that lets you, if you work for an insured employer group of 20 or more employees, continue to purchase health insurance for up to 18 months if you lose your job or your coverage is otherwise terminated. For more information, visit the Department of Labor.

HIPAA – Health Insurance Portability and Accountability Act of 1996. It is designed to protect health insurance coverage for workers and their families when they change or lose their jobs. Specifically, individuals who exhaust their COBRA coverage can obtain affordable individual health insurance plans because of HIPAA. HIPAA also safeguards the medical records of people from unauthorized disclosure.

Temporary coverage for an individual for a short period of time, usually from 30 days to six months.

Medicare, , is available to people who meet certain age and disability criteria. Eligible people include:
those who are age 65 years and older some younger individuals who have disabilities
those who have end-stage renal disease (permanent kidney failure). Click here for more information.

Term Life Insurance is a form of life insurance that covers an individual for certain period of time. This low cost insurance is only valid during that specified period of time and has no cash surrender of loan value.

Whole Life Insurance is a life insurance policy that remains in force for the insureds whole life and requires (in most cases), premiums to be paid every year into the policy. Permanent life policies offer death benefits and a “savings account” (also called cash value”). The longer you live the more premiums you pay therefore the more money you can get out of the policy by either cashing in the policy or by borrowing against.