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Resources

Frequently Asked Questions

Have questions? We've got answers. If you can't find what you're looking for, feel free to contact us.

The most common plans are PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations), EPOs (Exclusive Provider Organizations), and POS (Point of Service) plans. Each type offers different levels of flexibility in choosing doctors and hospitals.

It depends on whether your doctor is in the new plan's network. PPO plans typically offer more flexibility with out-of-network providers, while HMOs often require you to use in-network doctors. Always check the plan's provider directory before enrolling.

A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. For example, if you have a $2,000 deductible, you pay the first $2,000 of covered services yourself.

Yes, under the Affordable Care Act (ACA), health insurance companies can't refuse to cover you or charge you more just because you have a "pre-existing condition" — that is, a health problem you had before the date that new health coverage starts.

A co-pay is a fixed amount you pay for a covered health care service, usually when you receive the service. Coinsurance is your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.

Generally, you must wait until the next open enrollment period. However, you may qualify for a Special Enrollment Period if you experience certain life events like getting married, having a baby, or losing other health coverage.

This is the absolute most you'll pay for covered services in a policy year. After you spend this amount on deductibles, co-pays, and coinsurance, your health plan pays 100% of the costs of covered benefits.

If you visit an in-network provider, they will usually file the claim for you. For out-of-network care, you may need to pay upfront and submit a claim form to your insurance company for reimbursement. Check your plan's website for specific forms and instructions.