Frequently Asked Questions

A: Is a fully underwritten plan that is applied for by individuals and families who do not have access to coverage through and employer. It can also be used for a more cost effective alternative to employer coverage for the employee's dependents.

Q: What types of individual and family insurance plans are available?

A: Most individual and family plans come in two different varieties, Preferred Provider Organization(PPO) or Health Maintenance Organization (HMO). Within these broad categories there are some sub-catagories such as HSA Compatible PPO plans, or Exclusive Provider Organizations (EPO) plans.

Q: How does a PPO plan work?

A: As a member of a PPO plan, you'll be encouraged to use an insurance companies (carrier) network of preferred contracted doctors and hospitals. These providers have been contracted to provide service to the insurance plans members at a discounted rate. In most instances no prior approval is required to see a specialist or for services from a Primary Care Physician or Gatekeeper. a member may also use providers outside the network, but this woudl increase the member's our-of-pocket expense greatly.

Q: How does an HMO plan work?

A: Typically, an HMO plan enables members to have a lower out-of-pocket expense for healthcare and it accomplishes by having a Primary Care Physician (PCP) manage the health of the member. The member chooses one doctor as their PCP and if the member requires a specialist or non-emergency hospital stay they must acquire a referral from the PCP. If the referral is not obtained prior to services being rendered, the member is responsible for the full cost of care.

Q: What is a POS plan?

A: A POS (Point of Service) plan combines an HMO and a PPO into one plan, which gives the patient more freedom on how to render services. Of course this flexibility comes at a cost of higher premiums.

What is an HSA (Health Savings Account)?

A: If a member has a high deductible HSA Compatible plan, they can open a tax-favored savings account that may be used in conjunction with their health plan to pay for qualified medical, dental and vision expenses. Depending on the financial institution, the money in the account can be invested and/or gain interest tax free. Also, the money is the account holders and will rollover year after year. The IRS sets the rules on how much can be placed into this account every year. Currently the money deposited can help reduce the individual's income and therefore reduce their federal taxes only. California has no HSA rules or deductions.