• What does the HealthcareShopper.com charge for its services?
• What is an Indemnity Plan?
• What is a PPO Plan?
• What is an HMO Plan?
• What is an HSA Plan?
• How do I determine if my doctor or hospital belongs to one of the plan networks?
• Who qualifies as a dependent?
• Do these plans have waiting periods or exclusions for preexisting conditions?
• Can I be turned down?
• Can I be charged a higher premium, but accepted?
• What are the steps of the application process?

What does the HealthcareShopper.com charge for its services?

The HealthcareShopper.com performs as your broker. We are paid a commission by the insurance company whose plan you buy. The commission is built into the monthly premium you pay. You will pay the same premium whether you buy directly from the insurance company or through a broker.

What is a Indemnity Plan?

An indemnity plan is commonly known as a fee for service or traditional plan. A traditional plan allows you to use any doctor. Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of “usual and customary” charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you’ve reached this they will pay 100% of all “usual and customary” charges for covered services. You must submit a claim to the carrier for reimbursement of the covered amount.

What is a PPO Plan?

A Preferred Provider Organization (PPO) is a health insurance plan which features a network of participating providers with whom the insurance company has negotiated discounts for it’s members. When you select a PPO, you are free to use any doctor. If you select a nonparticipating provider (out-of-network), you will pay more. Most PPO plans have an annual deductible. You will pay for the first $250 to $5000 in services you receive each calendar year. After you have met your deductible, you will pay a percentage (coinsurance) – usually between 10% and 50% of the negotiated fee. Prescription drug coverage may be included or optional. In-network providers bill the carrier directly. You must submit a claim for out-of-network services

 

What is an HMO Plan?

A Health Maintenance Organization (HMO) offers comprehensive medical coverage through an exclusive network of providers. When you select an HMO, your medical care will be guided by a Primary Care Physician, who will refer you to a specialist when needed. In an HMO plan you must seek medical care within your provider network. Exceptions are made for emergencies. Generally HMO Plans offer the most comprehensive coverage for the premium dollar. Your out-of-pocket expenses usually are limited to a modest copayment for a doctor visit or prescription drugs. No claim forms are needed.

What is an HSA Plan?

An HSA works like an IRA, except that money is used to pay health care costs. Participants enroll in a relatively inexpensive high deductible insurance plan. Then, a tax-deductible savings account may be opened to cover current and future medical expenses. The money deposited, as well as the earnings, is tax-deferred. The money can then be withdrawn to cover qualified medical expenses tax-free. Unused balances roll over from year to year.

How do I determine if my doctor or hospital belongs to one of the plan networks?

Most PPO and HMO plans have online provider directories. Click on the Provider Directory link at the top of this page to begin your search.

Who qualifies as a dependent?

Dependents are eligible if they are a spouse or any unmarried child (adopted, stepchild or recognized natural child) under age 23 who maintains with the employee a regular parent/child relationship.

Can I be turned down?

Yes. Individual health insurance plans are not guaranteed issue. Your application includes a health history questionnaire which will be reviewed by the carrier’s underwriting department. It the company decides not to accept the risk you will be denied.

Can I be charged a higher premium, but accepted?

Yes. Some companies have a multi-tier pricing structure. Perceived risks can be rated-up by 20% or 50%.

Do these plans have waiting periods or exclusions for preexisting conditions?

Depending on the state in which you live and the carrier you select, there may be waiting periods of up to 24 months for preexisting conditions. You may also have specific conditions excluded from coverage.

What are the steps of the application process?

1. Apply online or download and print an application. You can also request to have an enrollment kit sent to you by clicking on the Request Info link at the top of this page.
2. Complete the application and health questionnaire. Return to us by fax to 877-396-8974 or mail to HealthcareShopper.com, 1891 S. Coast Hwy., Suite A, Laguna Beach CA 92651.