A method of paying medical providers through a pre-paid, flat monthly fee for each covered person. The payment is independent of the number of services received or the costs incurred by a provider in furnishing those services.
The Consolidated Omnibus Budget Reconciliation Act 1985, commonly known as COBRA, requires group health plans with 20 or more employees to offer continued health coverage for you and your dependents for 18 months after you leave your job. Longer durations of continuance are available under certain circumstances. If you opt to continue coverage, you must pay the entire premium, plus a two percent administration charge.
The amount you are required to pay for medical care in fee-for-service plan or preferred provider organization (PPO) after you have met your deductible. The coinsurance rate is usually expressed as a percentage of billed charges. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.
A cost sharing arrangement in which a person pays a specific charge for a specific medical service -- say $10 for an office visit or $5 for a prescription.
The amount of money you must pay upfront each year to cover your medical care expenses before your insurance policy starts paying.
Specific conditions or circumstances for which the policy will not provide benefits.
A payment system for health care where the provider is paid for each service rendered.
Prepaid health plans in which you pay a monthly premium and the HMO covers your doctor's visits, hospital stays, emergency care, surgery, preventive care, checkups, lab tests, X-rays, and therapy. You must choose a primary care physician who coordinates all of your care and makes referrals to any specialists you might need. In an HMO, you must use the doctors, hospitals and clinics that participate in your plan's network.
An HSA works like an IRA, except that money is used to pay health care costs. Participants enroll in a relatively inexpensive high deductible insurance plan. Then, a tax-deductible savings account may be opened to cover current and future medical expenses. The money deposited, as well as the earnings, is tax-deferred. The money can then be withdrawn to cover qualified medical expenses tax-free. Unused balances roll over from year to year.
A cap on the benefits paid under a policy. Many policies have a lifetime limit of $1 million, which means that the insurer agrees to cover up to $1 million in covered services over the life of the policy.
An organized way to manage costs, use, and quality of the health care system. The major types of managed care plans are health maintenance organizations (HMOs), point-of-service (POS) plans and preferred provider organizations (PPO).
A joint federal-state health insurance program that is run by the states and covers certain low-income people (especially children and pregnant women), and disabled people.
The federally sponsored health insurance program of hospital and medical insurance primarily for people age 65 and over.
The most money you will be required to pay in a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which individuals decide whether to go to a network provider and pay a flat dollar copayment (say $10 for a doctor's visit), or to an out-of-network provider and pay a deductible and/or coinsurance charge.
The ability for an individual to transfer from one health insurer to another health insurer with regard to pre-existing conditions or other risk factors.
A cost containment feature of many group medical policies whereby the insured must contact the insurer prior to a hospitalization or surgery and receive authorization for the service.
A health problem that existed before the date your insurance became effective. Many insurance plans will not cover preexisting conditions. Some will cover them only after a waiting period.
A network of health care providers with which a health insurer has negotiated contracts for its insured population to receive health services at discounted costs. Health care decisions generally remain with the patient as he she selects providers and determines his or her own need for services. Patients have financial incentives to select providers within the PPO network.
The amount you or your employer pays in exchange for insurance coverage.
Under a health maintenance organization (HMO) or point-of-service (POS) plan, usually your first contact for health care. This is often a family physician, internist, or pediatrician. A primary care physician monitors your health, treats most health problems, and refers you to specialists if necessary.
Any person (doctor or nurse) or institution (hospital, clinic, or laboratory) that provides medical care.
Any payer of health care services other than you. This can be an insurance company, an HMO, a PPO, or the federal government.
The amount a health plan will recognize for payment for a particular medical procedure. It is typically based on what is considered "reasonable" for that procedure in your service area.
A cost control mechanism by which the appropriateness, necessity, and quality of health care services are monitored by both insurers and employers.
Info Before Buying
The “4 C’s” of Health Insurance
Many experts recommend that you evaluate health insurance plans along four areas of concern.
Company: Is it a reputable company with a good rating that has been in business for a long time?
Cost: Is the plan affordable to start with and can it be expected to remain affordable in the future?
Coverage: Do you understand how the plan works and are you comfortable with the plan benefits?
Continuity: Once you are accepted by the company can they guarantee that the policy will stay in force as long as you continue to pay the premiums?
The Current State of Health Insurance
The ACA (Obamacare) is imploding under it’s own weight and it eventually will be repealed or replaced.
A major blow to the law is the elimination of the tax penalty starting in 2019.
There is currently strong demand for more affordable alternatives that can be purchased all year long.
We offer the biggest selection of health plans for people looking for alternatives to Obamacare.
What options are available to you?
Defined Benefit Plans
Guaranteed renewable health insurance plans that pay “defined” benefits for specific medical services.
Our best plan features:
Plan Highlights Include:
$5 Million Lifetime Maximum
Use any Doctor or Hospital you choose
TelaDoc and ScriptSave Rx Card included
Up to $6,750 per day for inpatient charges
3 times the Medicare schedule for surgery
$100 for doctor’s visits / $125 for an annual check-up!
Reduce or Eliminate out-of-pocket expense with:
PPO Network Provider
Claims Remediation Service
An organization that facilitates the sharing of health care costs among its members who have common religious or ethical beliefs
Healthcare plans for individuals and families
Comprehensive plans with no underwriting
Provides an exemption from ACA tax penalty
Pays level commissions for the life of the plan
Full portfolio of individual and group plans
Available in most states nationwide
STM Bridge Plans
Major Medical Plans With a Termination Date
Offers comprehensive major-medical type coverage for a limited duration
We currently have plans that offer up to 12 months of continuous coverage
This type of plan gives clients an option to “bridge” themselves to the next Open Enrollment Period