Q: Do your plan meet the Affordable Care Act (ACA) requirements?

 

A: Yes!  Both our Advantage Care and Super Preferred plans meet the Affordable Care Act requirement for minimal essential coverage (also known as qualifying health coverage).  All individuals and/or companies will receive a 1095 at the end of the year with the number of months paid they had coverage for.  All eligible plans cover everything on healthcare.gov/preventive-care-benefits with $0 out of pocket.

 

Q: Can I really use any doctor?

 

A: Any doctor, nurse, clinic, or hospital that delivers care for any covered service on your plan you can use.  If the healthcare provider is a subscriber of certain networks in many cases the insured will be receive in network discounted pricing.  Regardless of the provider you choose, our reimbursement system is set up to guarantee that no member will be
responsible for a balance bill due to the discount taken for charges above the UCR reference pricing (Usual and
Customary and Reasonable charges), subject to the terms outlines in the certificate of insurance. This insurance plan
reimburses medical providers based on:
• 125% of UCR for physician claims
• 150% of UCR for medical facilities

 

Q: Why are your plans so affordable?  

 

A:  Traditional medical plans are required to accept anyone no matter what health they are in.  Think how expensive your car insurance would be if you could crash your car and then get insurance the next day and it was paid for completely?  Instead we reward people who are healthy at the time they enroll.  Less risk to us means you get exceptional coverage at an unbeatable price.

 

Q: How is this different than my major medical plan I get from my employer or marketplace?

A:  Traditional major medical plans have to accept everyone regardless of health, we do not.  Our plans are generally reserved for healthy individuals and families.  We do a 5 year look back for major illnesses like cancer and heart problems, COPD, AIDS/HIV, diabetes, over weight etc.  As well as any pre-planned upcoming surgeries or on going tests.  In simple terms if there is a medical expense you already know about, you can't buy insurance with us and expect it to be covered.  That said, if you are in good health and after the plan is in force and you have a covered medical event then you can expect the same or better care just like any other medical plan you have had in the past.  Other ways we help give you a much better plan for your money is we do not pay for comedic surgeries such as sex changes, Botox, lap bands etc.

 

Q: Do you only have health insurance?

 

A: Not even close! We use our outstanding relationships with hundreds companies to find the best plan options for you, which include deductible/gap plans, catastrophic cash fund, mortgage insurance, dental, vision, critical illness, auto, home, even pet insurance.

 

Q: What is the difference between a co pay and a deductible and co insurance?

 

A:  A co-pay is for things like an urgent care sick visit (most of our plans it is $30 out of your pocket) is all you pay for admission.  A deductible is the amount you will need to pay on your own, once you meet that number the co-insurance kicks in meaning that on a 80/20 plan you are only responsible for every 20 cents on the dollar.  Once your co-insurance max is met then the insurance pays the rest.

 

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