FAQ

What’s the difference between a PPO and an HMO?

A PPO is a Preferred Provider Organization. The term Provider refers to a health professional, like your doctor. With a PPO you can select any doctor or hospital that accepts your health coverage, and in most cases you do not need a referral to see a specialist.

An HMO is a Health Maintenance Organization. With an HMO you are required to utilize physicians and facilities that participate in the HMO you have selected. Kaiser Permanente is an example of an HMO, but other carriers also offer HMO plans. With an HMO you are required to obtain a referral from your primary care physician to see a specialist. Often times HMO plans have higher premiums, but lower costs for such services as labs and X-rays.

Which one is right for me?

That’s where we come in. We can help you determine which plan structure is right for you based on your needs and health coverage premium budget.

Isn’t Group coverage less expensive than Individual and Family coverage?

Not necessarily. With Group coverage or Employer sponsored coverage, your employer is paying all or a portion of the cost of your premium. Group coverage is not medically underwritten and is considered a Guaranteed Issue product.

What is needed for Group Coverage?

You need 2 employees, or owners to qualify for group coverage. For a two person group there are several other criteria that would need to be met: The organization must be a bona fide business, and significant income would need to be demonstrated. The way the business is structured, sole proprietor, partnership, corporation, etc. will determine what documents are needed for the application. Normally, the business would need to be in operation for at least 50% of the previous quarter.? This is not a complete list of requirements, but meant as a quick over-view.

What is COBRA?

COBRA is the Consolidated Omnibus Budget Reconciliation Act (COBRA). It gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

For more information please click here COBRA