Q: What is the major difference between group and individual health insurance?
A: The major difference between group and individual health insurance involves evidence of insurability. To purchase individual health insurance, a person or family must generally answer a health questionnaire, and go through the company's underwriting. An insurer may decline coverage on the basis of the applicant's personal habits, health, medical history, age, income or any other factors that bear on risk acceptance. Or the insurer may issue a policy with limitations on coverage. The majority of group health insurance plans issue coverage without medical examination or other evidence of individual insurability because the insurer knows that it can cover enough individuals to balance those in poor health against those in good health. The risk of an insurer failing to achieve this balance is diminished as the size of the group increases, or as the insurer underwrites additional group policies and increases the total number of individuals covered. This is known as the "law of large numbers."

Q: What is an HSA?

HSA's (Health Savings Accounts) provide you with an alternative method to help pay for health care expenses and plan for retirement, providing you with more control over your health care dollars. They were mandated by Congress. They are now very popular in California. They give you a terrific tax-break; an HSA is similar to an IRA but better. You get an "above the line" tax deduction, just like an IRA.

80% of purchasers have families with children.
70% of purchasers are over age 40.
45% of purchasers are from households with four or more people.

HSA's are tax-deductible, interest-bearing accounts that permit unused funds to roll over from year to year, even if you change employment.  Health care savings account's must be combined with a qualified HDHP. (High Deductible Healthcare Plan)  Contributions to your savings account may be made by employers, employees, or individuals.  You may contribute up to $2,850 for a single-person policy and $5,650 for a family policy in 2007.  Once the deductible is met, the remaining health expenses are paid according to the plan's benefits.  If you have a 100% co-insurance plan, all remaining expenses will be paid by the carrier.  If you have an 80/20 co-insurance plan, 80% of the remaining expenses will be paid by the carrier.  Any individual with a HDHP (High Deductible Healthcare Plan) may contribute to an HSA.  Individuals over age 65 who are not eligible for Medicare may also contribute to an HSA.  Individuals between the ages of 55 and 65 and those over 65 who are not eligible for Medicare may make additional "catch-up" contributions. Distributions from your HSA are tax-free if they are used to pay for qualified medical expenses.  Distributions for any other purpose are taxable and subject to an additional 10% penalty.  Distributions may be made for qualified expenses, even those not covered by your health care plan - for example, dental expenses and chiropractic care. Once you are 65 years old, the money may be used to pay for health expenses and certain insurance premiums such as Medicare Parts A and B, Medicare HMO, and your share of your retiree medical insurance. See HSA Insider for more info.

Q: What are the advantages of group health insurance over individual health insurance?
A: For an employer that intends to provide health insurance protection to its employees, the group approach ensures that all employees, regardless of health, can be covered. Those with known health problems, who might otherwise be unable to obtain individual insurance, can be covered automatically upon employment without evidence of insurability. Some employers may also impose a waiting period prior to their enrollment in the plan, most employees can receive coverage as soon as they are eligible. The waiting period is set by the employer, and it usually ranges anywhere from 30 to 180 days. Group health insurance plans are also typically more flexible and tend to provide more liberal benefits than individual health insurance coverage.

Q: What is an HMO?
A: A Health Maintenance Organization (HMO) is an organization that provides managed comprehensive health care to a voluntarily enrolled population at a predetermined price. Members pay fixed, periodic fees directly to the HMO, and in return receive health care services as often as needed.

Q: What is a PPO?
A: A Preferred Provider Organization (PPO) is an association that contracts with a group of doctors, dentists, hospitals or other health care service providers to provide care at prearranged rates or discounts.

Q: What is a deductible?
A: A deductible is a specific dollar amount that an individual must pay (or "satisfy") before reimbursement for expenses begins. The higher the deductible the lower the premium on a health insurance policy.

Q: Can there be more than one deductible on a family health insurance plan?
A: Yes! Most individual health insurance plans will have a separate deductible per year for each family member on the policy. However most companies will have a maximum of 3 deductibles you'd have to satisfy each year. For example, if you had a family of 4 with a $1,000 deductible, your maximum out of pocket each year would be $3,000 ($1,000 x 3) plus any co-insurance you would owe, if any on the policy.

Q: What is co-insurance?
A: Co-insurance is found in most individual health insurance plans. It sets forth the percentage of covered expenses that the individual and the health insurance company will pay. The most common co-insurance level is one in which the individual pays 20 percent of the expenses and the insurer pays 80 percent. In this scenario it's called an 80/20 plan or 80/20 co-insurance. Plans typically offered are usually one of the following: 100/0, 80/20, 70/30 or 50/50. The most expensive (highest monthly premium amount) of these co-insurance options would be the 100/0 plan, meaning you would co-insure 0, nothing after your deductible. The least expensive (lowest monthly premium amount) would be the 50/50 plan, which means you would be responsible for 50% of the total bill after your deductible has been met. Most health insurance plans should have a “stop loss” built in, meaning your total out of pocket cost will be capped.

Q: Are all prescription drugs covered individual health insurance plans?
A: Not always! Only prescription drugs that are for treatment of an illness or injury are covered. (subject to applicable deductibles and coinsurance.) Most individual health insurance plans will have a co-pay for prescription drug coverage, usually a separate co-pay for a generic prescription and a co-pay for a name brand prescription after a yearly deductible. Some plans may also put a maximum dollar amount (cap) on your prescription drug coverage for the year. You definitely want a plan that will give you unlimited prescription drug coverage in case the unthinkable happens. (Cancer, Critical Illness, Diseases) Also keep in mind that most individual health insurance plans do not cover contraceptive prescription drugs or nicotine chewing gum prescribed for smokers who are trying to quit.

Q: How long does it take to get health insurance?
A: If you are applying for an Individual Health Insurance Plan it is medically underwritten and is not guaranteed issue in California. The process can take as little as one week if you are extremely healthy, and much longer if you are unhealthy. It will generally take longer if the insurance carrier has to get medical records. The average time is normally anywhere from 2 to 6 weeks. If you apply for Group Health Insurance on groups of 2 to 50, coverage will likely begin on the 1st of the next month. Business groups of one offer the same coverage dates provided they apply on their birthday to 30 days after, or they are at their 1st year anniversary of their new business.

Q: When can we contact you or someone at the InsuranceSolutions123.com Agency?
A: Anytime. We prefer you call between 8 and 4 PM weekdays or before noon on Saturday, but if it is an emergency give us a call (all are forwarded to one of us) and we will get back to you ASAP.

Q: With all this expert service do you charge for a consultation?
A: No! Our services are provided to you free of charge! We stay in business by getting paid directly by the insurance carriers based on the products that you choose. And no, we do not require you to apply or do business through us to answer your questions. We focus on helping you, our client, rather than focusing on closing a sale just to get paid like many other agents and brokers. Customer service and customer satisfaction will always be our #1 priority regardless if you use us or not.

Q: Is your agency more affordable than your competitors?
A: It is the same cost to you if you use our expert service than it is going direct to the health insurance carrier. The advantage to using us is that we can give you the personal attention that most large health insurance carriers cannot. Whether you have a question about the application, or a question about a claim, we will be there to help and assist you. We can be your agent of record if you do not like the service or lack of service your current agent is providing you. All at no cost!

Q: Will you meet with us in person?
A: Absolutely! All you have to do is call or email us for a no cost, no pressure, no obligation appointment! Click here to request an appointment!

Q: What if I get declined after applying for an individual health insurance plan?
A: Don't worry! We will work with you and make calls to various health insurance carriers to see if we can get you coverage elsewhere. Our main focus at this point will be getting you covered.

Q: What's considered a Pre-existing condition?
A: A pre-existing condition is a condition that you are currently taking a medication for, or have taken a medication for over the past few years. A pre-existing condition is also something you are currently seeing a doctor for, or have seen a doctor for over the past few years.