Frequently Asked Questions

Q. What is individual and family health insurance?
A. Individual and family health insurance is specifically designed forindividual use as opposed to group coverage. By purchasing your ownhealth insurance in Texas you can save money and be personallyresponsible for your health care dollars. In addition to this sense ofpersonal responsibility, your health insurance now will continuewhether you are employed or not. You will be pleasantly surprised withthe variety of affordable health insurance plans for you and yourfamily.


Q. What kinds of individual and family insurance plans are available?
A. Individual health insurance and family health insurance plans areusually described as either "indemnity" or "managed-care" plans. Putbroadly, the major differences concern choice of healthcare providers,out-of-pocket costs and how bills are paid. Typically, indemnity plansoffer a broader selection of healthcare providers than managed-careplans. Indemnity plans pay their share of the costs for coveredservices only after they receive a bill (which means that you may haveto pay up front and then obtain reimbursement from your healthinsurance company).

There are several different types of managed-care health insuranceplans. These include HMO (Health Maintenance Organizations) which youneed to be part of group for, PPO(Preferred Provider Organizations),and POS (point of service)plans. Managed-care plans use healthcareprovider networks which agree to perform services for managed-care planpatients at pre-negotiated rates and will usually submit the claim tothe insurance company for you. As a result, you'll have lowerout-of-pocket costs with a managed-care health insurance plan.


Q. How does a PPO plan work?
A. As a member of a PPO (Preferred Provider Organization) plan, you'llbe encouraged through their pricing of services to use the insurancecompany's network of preferred doctors and hospitals. With a PPO plan,services rendered by an out-of-network physician are typically coveredat a lower percentage than services rendered by a network physician.Our team of advisors can help you research your preferred Doctors tosee if they are included in the network. You typically won't berequired to pick a primary care physician but will be able to seedoctors and specialists within the network at your own discretion.

You will most likely have an annual deductible to pay before theinsurance company starts covering your medical bills. You may also havea co-payment for certain services or be required to cover a certainpercentage of the total charges for your medical bills.


Q. How does an HMO plan work?
A. HMO (Health Management Organizations) plans typically enable membersto have lower out-of-pocket healthcare expenses but also offer lessflexibility in the choice of physicians or hospitals than other healthinsurance plans. As a member of an HMO, you'll be required to choose aprimary care physician (PCP) which you must see prior to being referredto a specialist.

With an HMO, you'll likely have coverage for a broader range ofpreventative healthcare services some even offer discounts to healthclubs. You may not be required to pay a deductible before coveragestarts and your co-payments will likely be minimal. HMO's typicallyoffer no coverage whatsoever for services rendered by non-networkproviders or for services rendered without proper referral from yourprimary care physician (PCP).


Q. How does the Indemnity plan work?
A. A traditional Indemnity plan offers a great deal of freedom inchoosing which doctors and hospitals to use, but will probably involvehigher out-of-pocket costs and more paperwork.

Under an Indemnity plan, you may see whatever doctors or specialistsyou like, with no referrals required. Though you may choose to get themajority of your basic care from a single doctor, your insurancecompany will not require you to choose a primary care physician.

However, this kind of freedom will cost you. You'll likely be requiredto pay an annual deductible before the insurance company begins to payon your claims. Once your deductible has been met, the insurancecompany will typically pay your claims at a set percentage of the"usual, customary and reasonable (UCR) rate" for the service. The UCRrate is the amount that healthcare providers in your area typicallycharge for any given service.

An Indemnity plan may also require that you pay up front for servicesand then submit a claim to the insurance company for reimbursement.


Q. How does an HSA work?
A. HSAs and HSA-eligible Texas health insurance plans are a great wayfor people to control their health care dollars. Here are the basics:


Q. What is a co-payment?
A. A "co-payment" or "co-pay" is a specific charge that your Texashealth insurance plan may require that you pay for a specific medicalservice or supply. We like to call this the "office visit fee". If theinsurance plan requires a $15 co-payment for an office visit then theinsurance company pays the remainder of the charges.


Q. What is a deductible?
A. A "deductible" is a specific dollar amount that your healthinsurance company may require that you pay out-of-pocket each yearbefore your health insurance plan begins to make payments for claims.Most Indemnity and PPO plans require you to meet the annual deductibleprior to making payments.


Q. What is coinsurance?
A. Coinsurance is the amount that you are required to pay for a medicalclaim, apart from any co-payments or deductible. If there is a 20%coinsurance requirement, then a $100 medical bill would cost you $20,and the insurance company would pay the remaining $80 until you meetthe total annual out of pocket requirement.


Q. What is the difference between in-network and out-of-network providers?
A. An in-network provider is one contracted with the Texas healthinsurance company to provide services to plan members for specificpre-negotiated rates. If you visit a physician or other provider withinthe network, the amount you will be responsible for paying will be lessthan if you go to an out-of-network provider. Though there are someexceptions, the insurance company will either pay less or not payanything for services you receive from out-of-network providers.


Q. What is the best health plan for me?
A. Choosing between health insurance plans isn't easy. AssurantHealthprovides licensed advisors to help you sort through the myriad ofoptions in order to meet your specific budget and health insuranceneeds. We will help find the best match for you and your family, andprovide you with a Texas health insurance quote. Here are a few thingsto consider:
1. Are you going to need long-term coverage or just something for theshort-term? If you are between jobs for 1-6 months, you may want tolook into our short-term coverage options. You should also considertaking over your health insurance needs on a long term basis so thatyour insurance remains with you and not your employer.

2. Are you looking for basic coverage or more comprehensive coverage?Some Texas health insurance plans offer basic coverage in case of amajor accident or illness. These insurance plans typically have a lowermonthly premium than plans with more comprehensive coverage, and may beappropriate for people who intend to use their insurance primarily inthe event of a serious accident or illness.

Other insurance plans, in addition to offering coverage in case of amajor accident or illness, offer more comprehensive coverage which mayinclude benefits such as: preventative care, physician services,prescription drug benefits, and routine office visits. These Texashealth insurance plans typically have a higher monthly premium.

3. How important is the cost of the monthly premium to you? The higherthe annual deductible amount is the lower the monthly premium. If youanticipate infrequent use of your health insurance coverage, ahigher-deductible plan with a lower monthly premium may suit you best.

4. How important to you is easy access to specialists? Health insuranceplans that require you to coordinate your care through a primary carephysician typically require that you obtain a referral before seeing aspecialist. If you prefer easier access to specialists, you shouldconsider a plan that provides that flexibility.

5. Do you have a specific doctor or hospital that you would like tovisit for healthcare? If you would like to continue seeing a specificDoctor please check with the appropriate carrier to confirm that theDoctor is included in their network. Pay special attention to thenetwork of doctors or facilities that each health insurance planutilizes. Also note that networks utilized by health insurance planscan change, so there is no guarantee that your doctor will always becontracted with your chosen health insurance plan.

6. What is the most you could pay out in case of serious illness ofinjury? Health insurance plans typically place limits on how much amember is required to pay out per year. This limit is often referred toas an out-of-pocket maximum. Once you've contributed this maximumamount toward your healthcare, the health insurance company typicallycovers all other costs for the remainder of the benefit year.


Q. When can my coverage start?
A. You can request that your health insurance plan start anytimebetween 1 and 90 days in the future. The insurance companies may needsome time to process your application, so keep in mind that the actualstart date of your coverage may vary depending on the underwritingprocess and the availability of your medical records.


Q. How can I insure just my child?
A. When getting quotes for your child(ren) only, enter the child'sgender and birth date in the "Applicant" or first row. Many Texashealth insurance companies require one policy per child. So if you havemore than one child, try entering one child to see a larger selectionof plans and prices. You can apply for each child separately.


Q. Why should I shop with you rather than buying an insurance plan elsewhere?
A. We offer you the best of all worlds; a comparison shopping experience, expert advise, and our service is totally free.


Q. How do you protect my private information?
A. My Insurance Expert.com will not share your personal informationwith anyone outside of our organization except as required to secureyou insurance coverage. We will not sell or share your personalinformation with any third party and we will maintain the highestprofessional standards of confidentiality and integrity.


Q. When I buy an insurance plan, how do I make payments?
A. In most cases, when you complete your application you'll provide acredit card number or a check written to the health insurance companyfor the first months premium payment. Typically, your credit card willnot be charged nor will your check be cashed until you are approved forcoverage. If you are not approved for coverage, or if you cancel yourapplication, your card will not be charged and any check payment youmade will be returned or refunded.

Once you've been approved for coverage, your ongoing premium paymentsare paid to your health insurance company typically on a monthly orquarterly basis. Insurance companies typically offer several paymentoptions including monthly billings to be paid by check or credit card,automatic bank drafts or automated credit card charges.


Q. If I apply for an insurance plan, am I obligated to buy?
A. No. You are under no obligation to buy a health insurance plan. Whenyou submit an application, you will typically include your credit cardnumber, bank account information, or a check for the initial premiumpayment. Most insurance companies will not charge your card, debit youraccount, or deposit your check until you are approved. If you arecharged or your check is cashed and you are denied for coverage orcancel your application prior to approval, the insurance company willissue a refund to you.

A few insurance companies may charge an application fee. You will benotified in the application process if the plan you choose requires anapplication fee. Please note that these fees are non-refundable.


Q. Why is my COBRA so expensive compared to Assurant Health health insurance plans?
A. Your COBRA is the cost of the health insurance plan plus an administrative fee you pay to your former employer.


Q. Is COBRA coverage better than an individual health insurance plan?
A. This depends on your health insurance needs. You could be paying forextra coverage that you don't need nor would never utilize. Also, theCOBRA coverage needs to be analyzed to see if an individual plan canprovide all of the same coverage for less money.


Q. How long does COBRA coverage last?
A. Typically COBRA will be available for 18 months after employment ends.