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How much coverage do I
need? Think about your
past health care needs and medical expenses. For some, it is important to
have coverage only in the event of a serious illness or emergency. You
should also consider how much of your own money you would be prepared to
pay toward possible medical bills.
There are so many plans, how do I know
which one is right for me?
Many plans offer a broad choice of coverage you want. Some people are
prepared to use their own money for routine or small bills and may only
want catastrophic coverage. Others may want a medical plan to cover
routine doctor's visits and maternity benefits.
How do I know exactly what the plan covers?
We are happy to explain the types of
coverage available and you should be sure to read the plan descriptions by
company. Click on a logo below for their plan descriptions.
Are all health care
companies the same?
No. You should only consider a company with
an established commitment to delivering quality health care coverage. We
only work with the state's largest providers of individual health
coverage that have been caring for Californians for over 65 years.
| Why is Adobe
Acrobat Reader required to use this web site?
Alignment, pagination and font control
issues. Some features on this site are intended to create printed
proposals, with HTML there is no way to divide the output into set
pages. Also, the grid type formatting cooridinated with rotated fonts
used in several features cannot be done in standard HTML.
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Why is the RAF for some
carriers different from what I requested?
(related to group plans)
Some carriers establish a minimum RAF
based on group size, and some have a "locked" RAF based on group size.
The RAF for each carrier is adjusted automatically in compliance with
these rules.
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| What happens if some of
the employees on a group census reside outside the service area of a
plan. We will quote the
quote rates for the plan options that are available (usually the PPO
options). Plans that are not available are noted specifically in the
employee rate breakdown and rates are not quoted. Premium totals for
these groups make note of how many employees were omitted from the
total to avoid inaccurate comparison with plans that include more
employees in their service areas.
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| What is the best health
plan for me? Although
there is no one "best" plan, there are some plans that will be better
than others for you and your family's health needs. Plans differ in
how much you have to pay and how easy it is to get the services you
need. Although no plan will pay for all the costs associated with your
medical care, some plans will cover more than others. With any health
plan you will pay a basic premium, usually monthly, to buy the health
insurance coverage. In addition, there are often other payments you
must make. These payments will vary by plan but essentially are
deductibles and copayments.
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| What is a PPO?
A PPO is a Preferred Provider
Organization. As a member of a PPO, you can use the doctors and
hospitals within the PPO network or go outside of the network for
care. You do not need a referral to see a specialist. If you obtain
care from a medical provider outside of the PPO network, you will pay
more for the service. You will typically pay a copayment for each
visit/service. You will usually be responsible for paying an annual
deductible. If you join a PPO, you should find you have more
flexibility than with an HMO, but your total out of pocket costs are
likely to be somewhat higher.
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| What is an HMO?
An HMO is a Health Maintenance
Organization. As a member of an HMO, you select a primary care
physician from a list of doctors in that HMO's network. Your primary
care physician will be the first medical provider you call or see for
a medical condition. He or she will make any needed referrals to a
medical specialist. Typically, these specialists will be part of the
HMO network. If you obtain care without your primary care physician's
referral or obtain care from a non-network member, you may be
responsible for paying the entire bill. (with exceptions for emergency
care) With some HMOs, you pay nothing when you visit in-network
doctors. With other HMOs there may be a small copayment for the visit
or service. With most HMOs you will not be responsible for paying a
deductible. If you join an HMO, you should find that you have few
out-of-pocket expenses for medical care -- as long as you use doctors
or hospitals that are part of the HMO.
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| What is an MSA?
An MSA is a Medical Savings Account. It
is a tax-advantaged personal savings account used in conjunction with
a high deductible health policy. Individuals can contribute money to
this account on a pre-tax basis to set aside money for qualified
medical care and expenses, including annual deductibles and copayments.
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| What is an office visit
copayment? An office
visit copayment is a fixed dollar amount or a percentage that you pay
for each doctor visit. For example, with some plans you may pay a
fixed amount such as $5 or $10 per visit. Other plans will charge you
a percentage of the total fee for the visit. So if your copayment is
10% and the doctor visit was $300 you would pay 10% which, in this
case, would be $30.
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| What is the difference
between an in-network and an out-of-network medical provider?
An in-network medical provider is within
the approved network of providers for a particular health plan.
Out-of-network providers are not on the list. If you visit a doctor
within the network, the amount you will be responsible for paying will
be less than if you go to an out-of-network doctor. In many cases, the
insurance company will not pay anything for services you receive from
outside their network.
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| Can I buy health
insurance for less if I buy directly from the insurance company?
No. Insurance companies charge the same
premium whether the plan is purchased directly from the company or
through a broker. A portion of your monthly premium goes to the
broker as a commission for his services. You pay the same
premium, whether you have a broker or not. Therefore you are getting
the most from your premiums by having a broker represent you and
consult you on the best plans and that latest trends in health
insurance. We encourage you to ask your broker to review your
insurance on a quarterly or semi-annual basis, to be sure you are not
missing out on any new developments or products. In other words, let
him earn his money!
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| What are my options for
making my first payment?
You can usually make your initial
payment by credit card or check. The payment must be made out in the
name of the insurance company. However, some insurance companies may
require a check for the initial payment. Normally, your credit card
will not be charged nor will your check be deposited until you have
been approved. If you are not approved for coverage by the insurance
company, your money will be refunded by the insurance company. Any
financial information submitted over the web is kept private and
secure. Once accepted as a plan member, all bills will be sent from
the health insurance company and you will pay them via the choices
offered by that company.
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| If I have questions while
completing an application, how can I reach you?
You can call us at directly (949)
394-7676 during normal business hours. Feel free to call us after
hours and leave a message, which will be immediately returned the next
business day. You can also click
here to email us. |
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