Answers to common questions about insurance.   

Why do we need health Insurance?

You are much more likely to seek treatment for a medical condition if you have health insurance. Also it has been proven that if you have insurance, you will be more interested in taking preventive measures (like scheduling an annual physical) to stay healthy and fit.

However...

the main reason to have health insurance is to protect yourself and your family against financial ruin in the case of a catastrophic illness or injury. The majority of bankruptcies filed in the United States are due to people being unable to pay huge medical bills.

What are the different types of plans available? 

Indemnity

Indemnity plans provide coverage for a wide range of health care services. Many plans have special hospital and physician programs that provide hospital discounts and a “no-balance-billing” arrangement with certain physicians. These plans do not offer a co-pay option for use before your deductible is met.

1. Fee-For-Service Plans

• Old fashioned insurance, popular before co-pays for office visits existed
• Total choice of doctors = highest prices
• No referral required
• Available in both Individual and Group Plans

Managed Care

2. PPO Plan-Preferred Provider Organization: The preferred provider organizations that Georgia Health Insurance represents offer extensive networks of physicians and hospitals providing care at negotiated rates. A PPO plan also provides coverage for out-of-network services however there are financial incentives to use network physicians.

• More doctors, more hospitals = more choice = higher prices
• No referral required
• Available in both Individual and Group Plans

3. HMO Plan-Health Maintenance Organization: A health maintenance organization will require a primary care physician to coordinate your care. As a rule you must receive services from a participating provider in order to have coverage (except in extreme cases).

• Less doctors, less hospitals = less choice = lower prices
• Referral required
• Available in both Individual and Group Plans

4. POS Plan-Point of Service: A point-of-service plan offers more flexibility than an HMO by allowing some reimbursement for covered services from a provider that is not in the plan. But once again, there are financial incentives to make use of the network physicians.

• The best of both PPO and HMO combined = mid-range prices
• Referral usually required, but not always-depending on the plan you buy
• Available only in Group Plans

Under Managed Care falls the Newest type of Plans:

5. HSA Qualified Plans: HSA-qualified high deductible health plans are major medical plans designed to work with the tax-advantaged Health Savings Accounts (HSA). These plans must meet certain requirements established by the U.S. Treasury Department in order to qualify to work in conjunction with an HSA. Providing consumers with flexibility and choice, along with financial incentives, these plans offer a way for you to become a savvy health care consumer.  

• Available in PPO, POS and HMO plans
• Referral depends on if you buy PPO, POS, or HMO
• Available in both Individual and Group Plans

What if my company does not offer health insurance?

There are individual plans available to you and your family. You will have to answer medical questions and the plans are not guaranteed issue for individuals.

For additional, detailed information, please refer to the Georgia Insurance Commissioner’s website at:

http://www.gainsurance.org/INSURANCE/HealthFAQ.aspx

What if I am between jobs and need health insurance?

We offer a short term medical plan that is designed for individuals who find themselves between jobs, waiting for approval of their permanent Blue Cross application they have submitted or for their employer-sponsored coverage to go into effect. Or perhaps you are a temporary, part-time or seasonal employee without medical insurance (although in this situation you are often better served by a permanent plan which you only pay for 30 days at a time also). Coverage can be purchased 30 days at a time, up to 180 days. Blue Cross offers three deductible options, along with an 80 percent coinsurance rate. This makes Short Term Medical an affordable and valuable health care choice.

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