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We work with prospective clients all across the country who need to purchase health insurance. Oftentimes, the client wishes to know why they should use a health insurance agent to complete the transaction. In other words, why shouldn’t they just buy direct from the company?  There are several reasons to use an independent agent including price, knowledge, availability, healthcare reform and service.

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Understanding Health Insurance Costs And Tax Credits

It is important to note that health insurance premiums are controlled by law.  No agency, agent, or company has the power to undercut their competition. In essence, you are buying direct no matter what channel you use.

Consumers often will tell us that they are shopping for the best health insurance rates.  While rates for similar plans will vary between competing health insurance carriers, the exact same plan with the exact same company will be identical in price from all sellers – including the carrier itself.  An agent, however, will know which providers are more affordable depending on the client’s needs.

Certain carriers are more affordable in different niches; whether it be family coverage, individual plans, short term polices, maternity, etc.  An experienced agent can quickly help shoppers narrow down their choices.  Speaking hypothetically, if you are working with a representative from the Anthem home office, do you think they would tell you that you can purchase similar coverage with Golden Rule for less? And when premiums increase year over year, the agent will be available to help the consumer lower their rates by either selecting a new plan or a new carrier.

Healthcare Reform & Health Insurance Plan Knowledge

This may be the single most important area that consumers need help with. Understanding health insurance jargon and plan differences can be quite difficult – especially with all of the changes brought on by healthcare reform. It is the agent’s job to explain the advantages and disadvantages of all available plans. Insurance coverage can be very comprehensive or only catastrophic in nature. If the consumer purchases a poorly understood plan, there can be negative consequences in the future.

Consumers may not understand any shortcomings without speaking to an experienced agent.  The insured needs to know how the plan works, when the insurance will pay, how coinsurance works, what the waiting period is for preexisting conditions or maternity, prescription drug coverage limitations, doctor’s office copay options, and the tax advantages of a health savings account.  This knowledge is paramount when selecting appropriate coverage.

Medical Insurance Underwriting Experiences

Underwriting practices can and will vary dramatically between competing health carriers.  If the potential insured has certain preexisting conditions, some health insurance providers will not underwrite the insured under any circumstances. The consumer might be wasting valuable time by making an application.

To further the point, some companies will only underwrite to an accept/decline decision while others might accept the new insured but not cover a preexisting condition.  Companies that use the accept/decline standard can raise the overall monthly rates for the insured depending on his/her build and or health history.

However, companies that  issue polices with exclusionary riders can be a good choice for someone who has been declined elsewhere.  The length of the exclusionary rider can be short in duration or indefinite. At the very least, the insured will have coverage for any unknown future health concerns.

Knowledgeable agents will know where consumers will have a better chance of being underwritten for coverage. The difficulty of underwriting only reinforces the notion that it is extremely important for consumers to purchase health insurance while they are in good overall health. There are very few advantages in waiting.

Editor’s note: There are no longer waiting periods for maternity or medical underwriting practices due to healthcare reform.

Independence and Availability With an Agent

When consumers buy direct, they may be inadvertently limiting their options. Independent agents will be licensed with several competitive companies. Not all plans are offered in all states and some benefits like dental, vision, and maternity might not be available where the consumer resides.

Network availability can also be tricky. While most carriers offer coverage in most states, there can be significant limitations to the doctors and hospitals that are in the plan’s network. And some carriers offer several networks to choose from when the policy is purchased.  An agent can help you select a reliable carrier in your area and most importantly one with a strong network.  Staying in network for coverage can save the insured thousands of dollars should a significant claim arise.

Personal Service From Your Health Insurance Agent

This may be the most overlooked yet most important reason to retain a good agent. Undoubtedly, questions will arise for the consumer. Of course, there will be several inquiries before the plan has been purchased, but what about service while the insurance is in force?

When the consumer buys direct from the carrier, they will be  hard pressed to find an agent who will help them service their policy.   After all, we are not volunteers. And most people do not enjoy long hold times when calling the carrier directly.

However, when insurance is purchased through a  agent, they can be your resource for questions and answers. As an agent working in this business for over eleven years, I can attest to the fact that policyholders have many questions about changes to or explanations with their in force coverage. While it may seem trivial now, the agent can be a valuable liaison in the future – so it is counter intuitive to subtract him from the equation.

Purchasing health insurance through an independent agent is oftentimes the best means to an end. It does not cost a penny more and the agent’s knowledge and experience will  result in much less work for the prospective insured. In reality, there is very little reason not to use an agent.

Hyers and Associates, Inc. is a leading independent agency offering direct to consumer medical and health insurance plans across the country.

Category: Health Insurance

National General (Allstate) offers several different insurance options in both the individual and group markets. They are well-known for their popular short-term plans, but also offer dental policies, fixed benefit, cancer stroke, & heart attack plans, hospital indemnity as well as self-insured small group coverage.

National General Enrollment

  • Guaranteed Issue Short Term Coverage
  • Nationwide Aetna Network
  • Cancer, Stroke & Heart Attack
  • Add-On Dental Coverage
  • Zero Underwriting Options

Short Term Health Insurance Options

The Affordable Care Act has made it difficult for some to find coverage that meets their needs and budget.  Many consumers have turned to short-term coverage to fill gaps and cover the unexpected.  National General aims to meet the needs of those who have been priced out of ACA coverage by offering two different short term health insurance plans. One is medically underwritten and the other can be purchased on a guaranteed issue basis.

Both cover a wide range of medical needs and can be tailored to meet most budgets. The medically underwritten plan is best for those in good health while the guaranteed issue plan works well for those who are content to cover unexpected healthcare needs, but not ongoing conditions.

In many states, plans can be purchased that last 12 months. (Some states only allow for 6-month plans.) Strategies can provide coverage for a full year without worries of future insurability. While short-term plans are not ACA-compliant, they tend to be much less expensive and can provide peace of mind for the insured – especially when purchased in blocks.

Group Coverage That Avoids Penalties

There are two main penalties associated with the Affordable Care Act (aka Obamacare). The first is the A penalty for failure to provide coverage to a group of 50 or more full-time employees. The second is the B penalty which is enforced when employees purchase subsidized coverage on the Federal Marketplace.

The A penalty is often referred to as the sledgehammer and is much more costly. The B penalty is lower and does not hurt as much. In order to avoid the B penalty, groups only need to offer Minimum Essential Coverage. These plans can be found for under $50 a month per employee in many instances. A few insurance companies specialize in these plans to help employers stay compliant.

If you wish to offer more comprehensive group health insurance, then a self-funded plan with National General (0r others) can be a good choice. These fully underwritten plans tend to cost less and work well in groups that trend younger and healthier. Several of our clients have saved thousand of dollars a month using this technique while not sacrificing their benefits.

Dental, Critical Illness, Cancer, Heart Attack, & Stroke

National General offers several ways to fill in your coverage gaps. Whether you are under 65 and on a traditional health plan – or over 65 and on a Medicare supplement or Advantage plan, there are several options to cover unknown accidents and illnesses.

Fixed indemnity and critical illness plans are growing in popularity as more and more insurance plans increase deductibles and cover less. These types of insurance cover the first dollar costs associated with accidents, illness, cancer, stroke, heart attack and more.

Most pay a fixed amount (you choose the amount at purchase) should one of these events be encountered. This coverage can go a long way in keeping your assets stable in times of need.

Aetna & Cigna Health Insurance Network Options

National General (now Allstate) uses Aetna & Cigna network of doctors and hospitals.  If your medical providers accept Aetna, then they should also accept National General Health.  This is a very large, stable network and encompasses many areas across the county.

In summary, National General is a carrier offering both catastrophic and comprehensive plans to the public.  Those who desire affordable coverage with robust network options should consider their offerings. Working with us, consumers can enroll in a suitable plan for themselves, their family, or their small business.  Contact us today to learn more!

Category: Health Insurance, Illinois Insurance, Missouri Insurance Products

As a life and health insurance agent with fifteen years of experience, I am still unsettled by the number of inquiries I get from prospective clients who I cannot help.

Pregnant mothers looking for maternity insurance, consumers who need dental insurance because of a root canal, family members trying to purchase long term care insurance for someone entering a convalescent facility – the list goes on.  Simply put, you must plan ahead and purchase insurance before these types of event occur.

Problems with Losing Group Health Insurance Coverage

A major issue facing many Americans is what to do when they lose employer sponsored coverage.  Senior employees may wish to retire, but are not yet eligible for Medicare.

Additionally, the recent economic downturn has led to many layoffs and forced many employees off of company health plans.  COBRA is an option for some, but unfortunately it is only temporary in nature and can be very expensive.

Guaranteed Health Insurance Plans

In order to address this problem, United Healthcare (United HealthOne) has created a very innovative product for those who wish to plan ahead.  It is called UnitedHealth Continuity and is designed to protect against voluntary or involuntary health insurance loss.  Consumers can purchase insurance and by paying a small percentage of the premium can keep their coverage dormant until it is needed.

How Does It Work?

View UHC Quotes Here »

Like all insurance products, this policy needs to be purchased while the prospective member is healthy enough to be medically underwritten.  In this way, the medical coverage is a hedge against the unanticipated poor health coupled with the loss of employer coverage.

The consumer can purchase a traditional health insurance plan of their liking and add the continuity rider to the policy.  If  they are already insured through their place of employment, then the policy can be deactivated until it is needed.

The insured only pays a fraction of the premium to keep the policy in force, but inactive.  (If the insured needs individual or family coverage now, then the policy would be in force and could be deactivated later if group coverage became available.)

Health Coverage Without Medical Underwriting

Once the loss of group coverage occurs, the insured provides proof and their previously selected plan with United Healthcare is now active. Medical underwriting is not required as the consumer was already underwritten when the plan was purchased.  In this way, there are no gaps in coverage and the insured does not have to worry about changes in their health status.

In summary, by purchasing a health plan with a continuity rider now, early retirement and/or loss of group coverage will no longer cause problems.  Employees are not tethered to their jobs because of health insurance issues so long as they purchased a plan in anticipation of loss of coverage.  By simply planning ahead, consumers can worry less about early retirement and loss of group benefits.

Category: Health Insurance

Anthem Blue Cross and Blue Shield offers several comprehensive health insurance plans in the individual, family and group marketplaces. We work direct with Anthem to provide those quotes to our clients – both on and off of the federal exchange.

While Anthem may be more well known for their employer sponsored plans, medical coverage for individuals and families is also prominent in Ohio.  Recently, Anthem has introduced a new portfolio of plans for individuals and families offering a wide array of coverage choices.

Blue Cross & Blue Shield Health Insurance Plan Choices

OH Anthem QuotesOH Anthem BCBS Quotes »

  • Short Term Insurance
  • Popular Maternity Plans
  • Great Preventive Care
  • HSA and Dental Insurance
  • Copay and Coinsurance Options

Offerings from Anthem are extensive in all markets. They offer comprehensive coverage through their Bronze, Silver & Gold plans as well as their HSA plans.

By law, preventive care is included in all plans and is not subject to the deductible.  Insureds can visit their regular physician and/or OBGYN yearly without significant out of pocket.

Ohio Anthem Maternity Insurance Coverage

By law, all plans include maternity coverage with no waiting periods.  Plans must be purchased during open enrollment or if you are experiencing a qualifying life event.  There are no special deductible for maternity coverage any longer.

All coverages offer an unlimited lifetime maximum of benefits as mandated by law.  Prescription drug coverage is available as a first dollar benefit as well as a benefit that would begin after the deductible has been reached – such as with an HSA plan.  Additionally, dental and life insurance riders can be added to any plan.  Groups can add life insurance, vision, and accidental death and dismemberment riders.

Anthem’s Competitive Niche

Anthem is competitive across the board – especially for those who desire comprehensive coverage.  Small groups will also find premiums to be competitive.  The network is vast and nationwide.  Frequent out of state travelers can benefit from such a large network.  The preventive care benefit follows the recommendations of the American Medical Association and is thus quite good.

Unlike some insurers, underwriting is offered on either an accept or decline basis.  There are several premium bands for consumers depending on their health status, but coverage for preexisting conditions will not be excluded from the policy for any longer than twelve months.

In summary, Anthem is a well known insurer offering medical insurance in all markets.  They are competitively priced with a large nationwide network of doctors and hospitals.  Preventive care benefits are robust and maternity coverage is very reasonably priced when added to an HSA qualified policy.

Contact us for assistance today!

Category: Health Insurance

Health Insurance With MaternityOur insurance agency receives several inquiries regarding health insurance including maternity coverage.

Our clients want their coverage to begin immediately.  And they need to know which insurance company offers plans with no waiting period for pregnancy.

The good News: All Affordable Care Act Plans Must Now Offer Maternity Coverage.

Even if you’re pregnant, ACA plans must accept you. There is a catch, however. They do not have to accept you outside of the Open Enrollment window. Open Enrollment begins on November 1st and runs through January 15th.

If you’re outside of Open Enrollment, you will need a Qualify Life Event to enroll in a new plan. These event usually revolve around loss of other creditable coverage.

Maybe you lost coverage from work or perhaps you moved and could your insurance plan would not cover you in your new resident State. Another example would be losing your parent’s insurance at age 26.

In those cases, a new ACA Marketplace plan must accept you no questions asked. They cannot ask any health related questions nor ask if you’re pregnant. You will usually be covered at the beginning of the next month.

Maternity Insurance – No Waiting Periods

There’s more good new here too. Many plans before the advent of the Affordable Care Act has waiting periods before maternity coverage began. Sometimes it was six months, other times it could be an entire year.

That is no longer the case. ACA-type plans will begin coverage right away. There are no waiting periods whatsoever.

This is not the case with short term health insurance plans, however. They do not cover pregnancies and, in fact, can turn you down for coverage if you’re already pregnant.

You most likely do not want to purchase a short term health plan if you’re pregnant or want a plan offer maternity benefits. ACA and group (employer-based) plans are best for immediate and full coverage for pregnancies.

Contact Us Today For Personal Assistance

If you are unsure of your options when it comes to maternity insurance, please contact us. A lot has changed with the implementation of the Affordable Care Act.

We can help you understand the rules, regulations and timelines so that you can enroll in the health insurance coverage that best suits your needs and future.

Category: Health Care Reform, Health Insurance

Aetna is a leading carrier in the group health insurance marketplace, but more recently expanded into the individual and family markets. They offer a wide array of plans including traditional coverage, first dollar PPO plans, high deductible health savings accounts and hospital care only policies. Dental insurance can be added to any individual or family plan.

Click on the Aetna Logo Below To View Quotes

Aetna Health Insurance Benefit Options

AetnaView Aetna Quotes Here »

  • Preventive Care Options
  • Health Savings Accounts
  • Nationwide Networks
  • Add-On Dental Coverage
  • Gold, Silver & Bronze Plans

All plans offer preventive care benefits that are not subject to the deductible. The copay for preventive care will vary depending on the plan selected. Coverage includes annual OBGYN exams, well child care, and physical exams every two years.

All policies offer prescription drug coverage with a small pharmacy specific deductible.  Generic, preferred, non-preferred, and oral contraceptives are included. Additionally a dental insurance rider can be added to all polices. By law, all plans cover maternity related expenses.

Out of Pocket Expenses

The lifetime maximum is five million dollars per insured. The out of pocket maximum will vary depending on the plan selected.  The insured will be responsible for the deductible and co-insurance with traditional plans, only the co-insurance with first dollar PPO plans, or a set deductible for a health savings account qualified plan.

Competitive Niche

Typically, Aetna coverage is competitive for singles in most age groups as well as some families.  Single females will find their plans to be priced very competitively. The network is extensive and covers a large portion of the nation. If the insured moves, he or she will most likely be able to take their policy with them to the new service area.

In summary, consumer have many choices when it comes to purchasing health insurance.  Aetna offers competitive plans with attractive first dollar benefits and an extensive nationwide network of doctors and hospitals.

Category: Health Insurance

The final presidential debate of 2008 highlighted the stark differences between the two candidates health care plans. In a nutshell, Senator McCain favors tax cuts, choice and portability while Senator Obama is looking for an increase in corporate and government responsibility. Either way, it may be years before any significant legislation is passed to reform health care in the United States.  Our government is running enormous yearly deficits and will continue to do so – especially considering the most recent $700 billion bailout for Wall Street.

Obama’s plan will have significant costs if a centralized federal pool is created and McCain’s plan for government tax credits will essentially mean less tax revenue for the treasury. It is difficult to determine where these additional funds might materialize during such difficult economic times.

Are you Waiting to Buy Coverage?

The point of the story is if you are waiting to purchase a health insurance plan for you, your family, or your small business, then it could be a long wait.  Health care reform is more than a couple of years away and at that time, it is nearly impossible to guess what shape it may take. Consider that the current President Bush could not pass Medicare reform until his second term. These are “hot button” issues and our elected officials are reluctant to pass legislation that may affect their time in office.

It is cliche, but there is no time like the present to enroll in a health insurance plan.  You may need care before Congress and the President have done anything to increase access to affordable health coverage.

There is no doubt that health insurance provides significant peace of mind to individuals, families, and groups who elect coverage.  Premiums can be tailored to fit almost any budget. After all, insurance is for the unknown. Consumers who wait may severely limit their options.  Purchase a health insurance plan today and rest easy.  Reform is most likely years away.

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Category: Health Insurance

Finding a suitable health insurance plan can be difficult for many consumers. However, obtaining reliable medical insurance with adequate prescription coverage requires even more due diligence. The problem lies in the fact that consumers taking several prescriptions are likely to have preexisting conditions or poor health. Poor health and/or several preexisting conditions may cause the insurance company to decline the application.

Editor’s Note: No longer can applicants be denied health insurance due to preexisting conditions.

Assuming the potential insured is in moderately good health, he or she will have several health plans with rx coverage to choose from. Those under age 65 and in the individual and family market can choose from traditional plans and health savings accounts. And those above age 65 or on disability can choose from several prescription Part D insurance plans.

Prescriptions Coverage Tiers

Many plans cover generic drugs ($15 co-pay is most common) without the insured first reaching a predetermined deductible. Preferred name brand drugs and non-preferred name brand drugs usually have close to $25 and $50 co-pays respectively. However, in order to be eligible for the co-pay amount with name brand drugs, a predetermined deductible (not the policy deductible) will need to be met first. This amount is usually between $100 and $250 depending on the insurance carrier.

More recently, health carriers have also introduced a 4th tier. This tier usually includes the more expensive drugs or newer drugs that have just been approved. The insured will be responsible for a percentage of the cost of Tier 4 medications, usually 25%.

It should also be noted that many health insurance companies have a calendar year maximum in prescription benefit payouts. It is not uncommon for drug benefits to cease if the insured reaches $5000 in prescription benefits in a given year. However, some plans will allow, at an additional cost, a buy-up provision that has no maximum in yearly RX benefits.

Health Savings Accounts and Prescription Drug Insurance

Typically, health insurance plans coupled with a health savings account will offer no prescription drug coverage until the policy deductible has been met. This is unlike the traditional plans described above in that traditional plans have prescription specific deductibles unrelated to the overall policy deductible. HSA plans will only provide drug coverage when the policy deductible has been met. Health savings account plans are advantageous for health consumers who are not worried about immediate drug coverage and who also want to keep their premiums low.

Group Health Insurance and RX Coverage

When selecting a group  health insurance plan for their employees, the administrator will usually have three or more prescription options to couple with their group policy. A simple way to describe plan offerings in the group market is high, medium, and low. Companies wanting to offer the best drug coverage will select a “high” coverage plan for their employees. Of course, the better the plan, the more expensive it will be for the group. Agents specializing in group health insurance will be able to provide information and descriptions of the options available from various insurance carriers.

Part D Drug Coverage

Part D plans are the result of recent legislation from the federal government separating prescription coverage from Medicare and Medicare supplement insurance. There are several insurance carriers offering plans to consumers on Medicare and/or Medicare disability. Most companies offer three plans to choose from and each plan will have a different deductible and/or co-pay for generic and brand name drugs. Usually, consumers can use online software to determine which plan is best for them based on their prescription needs. In fact, www.medicare.gov allows consumers to compare plans with almost all carriers offering Part D coverage.

In summary, when consumers are most concerned with prescription drug coverage, it is best to compare several plans with a knowledgeable agent. Health polices can differ greatly in the amount of benefits provided, when the benefits begin, and when the insured has reached the maximum in benefits. Learning limitations on benefits and purchasing an appropriate plan can eliminate potential problems in the future.

Contact us today for a health insurance quote including prescription drug coverage.

Category: Health Insurance

Health Insurance Terms ExplainedWhen speaking with our prospective clients, oftentimes there is confusion as to the meaning of certain insurance terms.

Consumers want to understand health insurance terminology. They also want to learn how it affects not only the cost of their health insurance policy, but also their out of pocket exposure.

Listed below are explanations of common terms associated with most individual and family health insurance coverage.

Health Insurance Deductibles Explained

The deductible is the amount the insured must pay before the insurance company provides most benefits. Deductibles can range from a very small amount, such as $250, to much larger amounts, like $10,000 or $20,000. Insurance providers keep a running total of all claims in a calendar year until the deductible has been satisfied.

The insured is not responsible for paying the deductible until there is a claim. The insured only needs to pay the premiums. If there is not claim against the policy in a given year, the insured does not also have to pay the deductible amount.

It’s important to note that some benefits are not subject to the deductible like preventive care for instance. In other words, the insured has access to preventive care at a $0 cost and the deductible will not come into play.

Traditional Family Deductibles

Family plans will usually double the deductible amount from an individual plan. If the individual deductible is $2500, then the family deductible is $5000. A family must reach the increased amount before the insurance pays toward any claims.

For example, if a family selects a $5000 deductible, then the policy would not pay benefits until the family had collectively reached $10,000 in covered out of pocket expenses.

Family Embedded Deductibles

Family policies with an embedded deductible will require that at least two family members meet the deductible in a calendar year before the entire family has satisfied the policy requirements.

For example: If a family selects a $3000 deductible, the policy would pay benefits to the individual who reaches $3000 in out of pocket expenses. An additional family member would also have to reach the $3000 amount in the same year to obtain benefits from the policy. Once two family members have reached the deductible, the entire family would be eligible for immediate benefits from the policy.

It is difficult to say whether a traditional or embedded deductible is more advantageous to the insured. Depending on the situation, one plan might be better for one family and another plan will be more favorable to another. It really depends on what the family is most comfortable with in the long run.

Health Insurance Coinsurance Explained

Coinsurance is the percentage of the bill the insured is responsible for after the deductible has been reached. The most common percentage is 80/20 and it usually applies to the next $10,000 of the health related bill. The insurance provider would be responsible for 80% of the bill and the insured would be responsible for 20% of the medical bill up to $10,000. Then the coinsurance cost-sharing ends and the policy pays 100% of the covered bill.

For example: An insured with a $500 deductible and an 80/20 to $10,000 plan has medical bills totaling $7,000. The insured would be responsible for the first $500 (the deductible amount) and 20% of the next $6,500 of the medical bill or $1300. The insured would be responsible for a total of $1,800 and the health insurance provider would pay the remainder.

[$500 (deductible amount) + $1300 (coinsurance) = $1800]

After the coinsurance has reached its maximum, the insurance company is responsible for the remainder of the bill at 100%. It is important to note, that coinsurance amounts will cover wide ranges with different carriers. If the insured opts to be responsible for a larger coinsurance percentage, generally the policy will cost less. Additionally, some policies will offer a zero percent coinsurance option such as plans coupled with health savings accounts.

Maximum Out of Pocket Expenses

This is the maximum amount the insured is responsible for in a calendar year. Insurance companies arrive at this number by adding the deductible to the insured’s coinsurance percentage.

For example: An individual who purchases a health plans with $500 deductible and 80/20 coinsurance to $10,000 will have a maximum out of pocket expense of $2500.
[$500 (deductible amount) + $2000 (or 20% of $10,000 coinsurance) = $2500]

Another example: A family who selected a $1000 traditional deductible and 80/20 coinsurance to $15,000 will have a maximum out of pocket of $5000.
[$1000 x 2 plus ($2000 family deductible amount) + $3000 (or 20% of $15,000) = $5000]

Lifetime Policy Maximum

The maximum amount the health insurance company will payout in the insured’s lifetime is referred to as the lifetime maximum. The amount varies based on the type of policy you choose, but insurance providers will cover a wide expanse here as well.

Typically, coverage mounts will range from one to two million with most short term health insurance plans. Should the insured reach their lifetime maximum, then the remainder of the expenses will not be covered by the insurance company.

Editor’s Note: All Affordable Care Act policies sold today do not have a lifetime maximum. They can theoretically pay-out tens of millions of dollars to the insured.

Doctor’s Office Copay Amounts

This amount is the insured’s responsibility for a routine visit to the doctor. Co-pays usually range from $25-$50 for a visit depending on the policy provisions. It is an optional feature on most health insurance plans and will increase the overall cost of the coverage.

Most clients request this feature as they do not want to pay the entire amount for an office visit. An office co-pay falls under a broad category of policy provisions referred to as first dollar benefits. In many cases, the copay amount for your primary doctor is less than for a specialist.

First Dollar Benefits

These are the benefits that are usually not subject to the deductible and/or coinsurance amounts. Preventive care, doctor’s office visits, child wellness visits, immunizations, OBGYN appointments, prescriptions and other policy specific provisions fall into this category. Certainly, the more first dollar benefits a policy contains, the better off the insured will be as he/she will have less in out of pocket expenses.

In summary, consumers in search of health insurance quotes and coverage have several options available to them. Deductibles, coinsurance, and first dollar benefits are three of the most important factors that determine the cost of the insurance as well as the strength of the benefits provided by the carrier.

Category: Health Insurance

Employer based health insurance provides coverage for tens of millions of Americans. Unfortunately, many employees will be without coverage if they lose their job, quit, retire or if their company goes out of business. In most cases, an employee can elect COBRA upon losing employment. The Consolidated Omnibus Budget Reconciliation Act will provide 18 months of additional coverage so long as the group consisted of 20 or more employees.

Size of the Employer Group Dictates Cobra Options

In Ohio, if the group is under 20 employees COBRA allows for up to six months of coverage. This law is sometimes referred to as”Baby COBRA.” There are certain rules regarding who is eligible to elect COBRA and what the cost will be, but in all cases COBRA is temporary insurance for the insured. In addition, the expense to the former employee can be significant. Ultimately, the cost will be determined by the premiums for the former plan plus a 2% administrative fee. Former employees are often surprised to discover how much it will cost to elect their company insurance through COBRA.

Once their COBRA benefits have run out, individuals and families will need to search the individual health market. If you are in good health, usually there are few problems obtaining an individual or family policy. However, if the former insured is in poor health – finding a comprehensive policy can be very difficult. (Editor’s note: Due to healthcare reform, those in poor health cannot be turned down for health insurance during a qualifying event.)

Buying Health Insurance Both On and Off The Federal Exchange

There are providers who will insure high risk individuals, but typically the benefits to the insured are far less than their employer sponsored plan. When possible, an individual in poor health may only be able to find adequate coverage in another employer sponsored plan. The state of Ohio does offer an HMO plan providing open enrollment with select companies. The coverage offered will vary by county and the enrollment window will differ from company to company. However, you can expect these plans to be very expensive.

Thus, it is advisable to explore your options as soon as you lose your employer sponsored coverage. COBRA can be helpful, but because it is not permanent, new coverage will usually be needed at some point. One potentially difficult scenario can be easily avoided by shopping for insurance early.

Electing COBRA while in good health and waiting to apply for permanent coverage until the allotted 18 months expires is a risky proposition. What if your health changed for the worse during that period of time? You may have difficulty finding coverage in the individual market. However, you would have been insurable had you applied for a plan immediately after becoming unemployed. In many cases, the permanent individual coverage would be less expensive as well.

Contact Us for Group and Individual Health Insurance Quotes

In summary it is always advisable to obtain permanent health insurance coverage while you are in good health. Once accepted, you can keep this coverage for as long as you need it. If you rejoin a group plan later, you may elect to drop the coverage or maintain it if you feel that you have a superior plan.

Contact us for health insurance quotes both on and off the exchange today!

Category: Health Insurance

Many families are in search of affordable health insurance that will provide maternity or pregnancy benefits. Health carriers offer such plans, but they vary in the amount of coverage provided. Most insurers provide no benefits for at least three to nine months and at least one insurance company will not cover a pregnancy for 18 months.

As with all things insurance related, you must plan ahead. Occasionally, people call our agency once they are pregnant and are disappointed to learn insurance cannot be purchased to cover the pregnant spouse. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.

When is My Pregnancy Covered?

Generally, policies will provide benefits for maternity after the insurance has been in force for at least three to nine months. If you were to purchase a plan, then shortly thereafter conceive a child, and the child was delivered before the policy had been in force for nine months, then your pregnancy would not be covered. Again, it is prudent to plan ahead and purchase a policy with a maternity rider some months before conception.

It might be helpful to look at this from the insurance provider’s point of view. Typically, when a couple desires and pays for a maternity plan, then they are likely to use it. The insurance company is relatively certain that a claim will come in the near future. Thus, they will build the cost into the premium for the insured (you) and mandate a waiting period. That being said, some companies are offering plans that are more attractive than others.

Popular HSA Maternity Plans with a Small  Deductible

One insurance company offers a Health Savings Account (or HSA) maternity plan with a $1,500 individual deductible. Once the deductible has been reached and the nine month waiting period has been satisfied, the plan would cover the balance of the pregnancy.

In this example, you could fund the HSA account with at least the $1,500 and write that off against your income. The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in. Currently, this HSA plan is one of the more popular policies available.

(Our apologies – as of 2011 this plan is no longer offered)

Three Month Waiting Period

Another popular plan has a three waiting period and its own maternity specific deductible. This coverage is typically more expensive as the maternity coverage beings earlier than most other plans.

(Our apologies, as of 2010 this plan is no longer offered)

The insured would have their own deductible, but both amounts might need to be covered under certain circumstance – like complications due to pregnancy. It is important to speak with a knowledgeable agent to understand the coverage.

At this point, clients often ask about prenatal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, prenatal care and delivery are all included as part of the pregnancy and usually subject to one, predetermined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.

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The bottom line with health insurance policies and especially ones that cover pregnancy is that you must to plan ahead. There are only a few options available, but you will get the most from your policy if you research and purchase it ahead of time.

Editors note: By law, all plans must now cover maternity related expenses subject to their deductible. There are no longer waiting periods for the insurance to being, but you can only purchase health insurance during open enrollment unless you are experiencing a qualifying life event.

Category: Health Insurance

There are several resources available if you are looking to purchase individual or family health insurance plans online. Most of the major carriers offer online health insurance quoting links that independent agents can post on their personal websites. These links will describe all of the plan offerings in great detail and then allow you to make application immediately using their software.

Newer technologies provide a single quoting engine where you can compare several plans from competing carriers.   What plans pop up will depend on who the agent is licensed with and what plans they choose to make available.   Quoting using individual links will usually allow you to do so anonymously while multiple carrier technologies can require you to provide personal contact information.

Do I Need a Health Insurance Agent?

What really matters here is to what extent you want to be contacted. You might unknowingly fill out forms you think will provide an immediate quote from several carriers. Unfortunately, those quotes may not appear.  In fact, that site simply might be a business that collects your information and then sells it to multiple agents.  At this point your phone will be ringing quite a bit and your e-mail inbox will be full with messages for the next few days.

The reality is that a few large companies have produced several optimized websites designed specifically to collect your information. These sites are not provided by insurance agents, but rather technology companies. And selling leads to agents can be a very profitable business model. Most agents do not have the resources or know how to compete with such technology. Thus, they buy the leads and do their best trying to separate themselves from competing agents.

Ultimately, it may be you the consumer who looses in these situations. Most consumers are very annoyed by the multitude of phone calls and with the number of emails received – so annoyed that they might not want to work with anyone right away.  Thus, they may not get the insurance help they needed.

Using an Independent Health Insurance Agency

The principals of Hyers and Associates have tried to make the process a little easier for you. We have provided online links where you can search through the major health insurance carriers; including Aetna, Anthem Blue Cross and Blue Shield, Assurant Life, Golden Rule, Humana, Medical Mutual of Ohio, United Health Care and others.

You can search anonymously and then when you are ready to talk with an agent, simply give us a call. We can then speak knowledgeably about the different plans, send out descriptive brochures and help find a plan that suits your needs. This is done at no additional cost.

Let me repeat – there is no surcharge or extra fees created by working through our agency or any other for that matter. If you want to work with only one independent agency, then you have come to the right place. We will be happy to assist you when you are ready.

Contact Us for quotes and/or information today.

Category: Health Insurance

In an attempt to make health insurance and health savings accounts more attractive to consumers and businesses, Congress has revised HSA legislation in 2007. The new laws make HSA’s for individuals, families and businesses more beneficial which may likely increase the popularity of these plans.

The intended result may be that more Americans purchase high deductible health insurance/HSA plans over traditional insurance. The affordability of these plans could decrease the number of uninsured consumers across America.

1. Account Holders Can Contribute More Money

HSA contributions are no longer limited by the deductible of the health insurance policy. Individuals account owners can contribute up to $3,050 while families can deposit up to a maximum of $6,150 as of 2011.   Each year these  amounts will increase.

Additionally, deposits are no longer limited by the 1/12th systematic contribution rule. Account holders can deposit the maximum allowance in a lump sum no matter when their insurance plan was purchased.

2. Account Holders May Transfer Tax Deferred Funds From an IRA to a HSA

HSA  owners can now make a lump sum distribution from a qualified plan like an IRA (Individual Retirement Account). This would not be considered a taxable event by the Internal Revenue Service.

This way funds will be available immediately for qualified medical expenses.   Should the owner not have access to a qualified plan, then s/he can contribute ordinary post-tax, non-qualified funds and write the contributions off for that taxable calendar year.

3. Employer/Employee Account Holders May Fund with Lump Sum Deposit

Employers and employees may make one-time, lump sum contributions to a qualified account such as a FSA (Flexible Spending Account), HRA (Health Reimbursement Arrangement) or Health Savings Account.   As a result, qualifying group health insurance plans will be easier to manage.

This will be appealing to employers who are switching over from traditional plans as they will no longer need to make systematic contributions, but rather can do so one time per year. Again, funds will be available immediately for qualified medical expenses.

Request Quotes and Information

These are the main benefits of the new legislation. They should make Health Savings Accounts less complicated to setup and maintain for individuals, families and businesses.

Additionally, increased contribution limits and funding options will allow consumers to save more for qualified health expenses on a tax advantaged basis.

Contact Us for a free health insurance consultation today.

Category: Health Insurance, Health Savings Accounts

The Internet has changed many industries for the better. Consumers want accurate and timely information at the touch of a button.

The Internet  is playing a major role in the insurance industry and in the process making more information are real time quotes available with the click of a mouse.  Even better, consumers can enroll in coverage direct and online at no additional cost!

We embrace this change at Hyers and Associates. As independent insurance brokers, it suits us and our customer’s interests to allow several competitive plans to be compared quickly and accurately. We hope to earn your business and you might be happier with the speed and simplicity of the process.

Does It Cost More To Purchase Insurance Online?

The short answer is no. It does not cost the consumer a penny extra to purchase coverage online through us, direct through the carrier or anywhere else. Prices are controlled by law and these same laws prevent discounting.

The migration to the Internet is slow in some areas, but quick in others. Health insurance is the first prominent coverage that can be easily purchased online. Most carriers allow brokers like us to post direct links to out site so consumers can compare, quote and purchase an individual or family health insurance plan direct.

This is a benefit for those consumers who simply do not want to sit down with an agent who only has one or two companies to present. Depending on your needs, one company might be better than others. For instance, Aetna will not automatically increase your rates if you smoke, where as Anthem Blue Cross is one of the few to offer maternity coverage.

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We imagine that purchasing other insurance policies will eventually be as easy as obtaining health insurance coverage. Medicare Supplement plans might be next. These policies are a nice fit for Internet purchases as web savvy baby boomers turn 65.

Long term care and disability insurance could be right around the corner as well. It will ultimately depend on the demands of the consumer and the innovations of the insurance providers.

We are an independent agency and realize that in many cases you may need help purchasing medical coverage.

Contact Us to day for all of your insurance needs.

Category: Health Insurance

The most common question I am asked as an insurance broker is: “Who has the most affordable insurance plans?” My stock answer is: What benefits are you looking for? To which the customer might reply: “I want the best benefits I can purchase at the most affordable price.”

We live in a county where consumers want the best, but do not want to overpay unnecessarily for products or services. Fortunately, in the health insurance market there is ample competition among the insurers. With the recent introduction of health savings accounts, insurance premiums have decreased even more.

Health Insurance Benefits Determine Price

The benefits that you select, presumably the ones most important to you and your family, will determine the cost. Some consumers want a dental and vision plan, others want a maternity benefit and still others are looking for prescription drug coverage. With such a wide array of choices, it can be difficult to sift through the health insurance plans on your own.

In order to make this process easier, we have direct health insurance links on our site for consumers. Those looking to purchase health insurance in should find the process a little less intimidating. We will be happy to email you brochures from the various insurance providers and discuss a plan tailored to your needs and budget.

Our Health Insurance Providers

Not all plans are created equal, so if there is one benefit that it is very important to you, we can point you in the right direction. In addition, you can use our links to Aetna, Anthem Blue Cross Blue Shield, Assurant Life, Golden Rule, Humana, Medical Mutual and United Healthcare to research on your own.

The insurance industry is changing rapidly as the days of the door to door broker slowly fade away. The popularity tablets, laptops, and smart phones make it easier and quicker than ever for you and your family to obtain quality comprehensive health insurance coverage. Contact us today!

Category: Health Insurance, Health Savings Accounts

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