PPO = more flexibility to choose your doctors; heaven forbid someone gets cancer, they have the freedom to go see a specialist at UNR or Stanford and still be covered. You are not locked into a region or a primary care doctor, you can go see that specialists and still have coverage. The trade off is that you will help share the costs when you get sick or hurt in the form of a deductible or co-insurance.
HMO = less flexibility you choose a Primary Care Physician who has more control over referral and/or decisions regarding your care. You must remain within your medical group and within a geographic region. The trade off with this more structured approach is that there will be less out of pocket when sick or hurt. For example, for inpatient hospital, you may be looking at nothing out of pocket. Basically you pay a premium cost for limited benefits?
TIP – PPO is the way to go! HMO's have become more expensive so compare the annual premium difference with PPO options to make sure you are not paying too much.
Getting Approved When applying for coverage, the carrier will make their decision to approve/decline coverage and/or increase rates based on pre-existing conditions. The carriers are mainly looking for current or ongoing situations; they will also heavily weigh anything that is open-ended such as a doctor's request for a check up in the future which has not happened yet. Medications now weigh heavily on acceptance or rate-ups because of the associated cost. Please run your situation by us first to see what the probable outcome might be, sometime it is nothing, other instances we try a specific carrier who may not be as stringent toward your situation.
Once Approved Typically if you have not had coverage in the prior 63 days before your effective date, there is a 6 month waiting period for pre-existing conditions. This means they will not pay out for claims relating to pre-existing conditions until you have been on the plan for 6 months. If you have not lapsed coverage more than 62 days up to your new effective date, the carrier will take into account your prior coverage against a 6 month waiting period.
Please give us a call and we will find that information out for you. 1-888-268-4421
Typically PPO plans breakdown into four main categories: Office visit, Prescriptions, Urgent Care, and everything else (hospital, labs/x-rays, emergency room, surgery, specialist, etc…) Most plans offer some type of immediate coverage for office visits, prescriptions and things like that (sometimes there is a deductible associated with prescriptions). The everything else is subject to your main deductible, once you meet that deductible you then pay a percentage until you reach your out-of-pocket max. Then the rest is pretty much covered for the rest of the calendar year.
The deductible is the amount you will pay first before the plan kicks in. You will still be getting the benefit of the negotiated rate for whatever service you need, typically between (30% and 60% discount) for “In Network” services. Another word for deductible is co-insurance.
This usually has to do with catastrophic or major medical issues (unless you have a very low deductible). Max-out-of-pocket lets you know when your stop-loss is, stop-loss is the maximum amount you would have to pay in a calendar years time before 100% of all you medical services would be paid for by the insurer.
Your rates can change. Most companies have annual increases, sometimes its semi-annual; they can (rarely) go down too. Rates vary by geographic location and age, however once approved rates cannot change because you get sick or are going to the doctor allot.
Absolutely! You can have a single child or multiple children on one policy if they are under the age of 18.
You can contact us and we can help? We basically need the completed health insurance application and the first payment to the carriers for at least one months worth of premium (check or credit card payment made out to the insurance company) If more information or medical records are needed usually a direct request will be made to your doctor. You can expidite the process by faxing it directly to us at 1-888-448-7802.
Depends? If you are in great health and the carrier doesn’t want any further information could be a week or two weeks? If the carrier needs further information such as medical records, it can take an additional 1 or 2 weeks dependant on how long it takes for the doctor to respond.
Simple Answer: Yes! The first months premium must be submitted with the application, this can be done via check or credit card made out to the insurance carrier (ie. Blue Cross, UHC, Aetna etc.). If your application (minus application fee if there is one) for major medical is not approved the entire payment is refunded.
Usually no, however just recently one company Assurant does have an application fee to apply. Most of the other major medical carriers do not have a fee to apply.
A physical is not required! The completed application and the first months premium is all that’s required. I have seen it a couple times that an applicant over 55 years old that has not had a physical in few years may be asked to take one.
First call us 1-888-268-4421, we will help you get it going ASAP and handle or at least let you know what needs to be done and when.
Family/Individual Nevada Health Insurance is a month-to-month process, you can cancel at anytime.
There are a few options for paying the monthly premium. Paper billing: (some carriers charge a monthly or quarterly processing fee for a paper bill) Credit Card: no additional fee for automatic credit card billing. Checking Account Auto Deduction: A monthly deduction taken from your checking account (also no “processing fee” for this service).
Downgrading a plan is very easy, just call us and we will take care of that for you. Upgrading is possible especially if you are in good health. Switching carriers is something we do also however that involves the application process all over again and we will walk you through that process. Sometimes switching carriers just makes sense, if you no longer need maternity on your policy, why pay for it? Lets look at the the entire market to see what meets your needs and get the best value for you.
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If You Have Any Questions Or Comments Please Call Or Email Us At: 1-888-268-4421
Email: info@las-vegas-health-insurance-expert.com
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