Frequently Asked Questions

• If I have a question, how can I reach you?
  • You can call us at (619) 543-8000 during normal business hours. Feel free to call us after hours and leave a message, which will be immediately returned the next business day. You can also contact us through the website.
• What is the best health plan for me?
  • Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and co-payments.
• What is a PPO?
  • A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist. If you obtain care from a medical provider outside of the PPO network, you will pay more for the service. You will typically pay a copayment for each visit/service. You will usually be responsible for paying an annual deductible. If you join a PPO, you should find you have more flexibility than with an HMO, but your total out of pocket costs for care are likely to be somewhat higher.
• What is an HMO?
  • An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO's network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network. If you obtain care without your primary care physician's referral or obtain care from a non-network member, you may be responsible for paying the entire bill. (with exceptions for emergency care) With most HMOs there will be a small copayment for the visit or service. With most HMOs you will not be responsible for paying a deductible. If you join an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO.
• What is an HSA?
  • An HSA is a Health Savings Account. It is a tax-advantaged personal savings account used in conjunction with specific high deductible health policies. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and copayments.
• Where can I find a list of the contracted PPO or HMO doctors for these health insurers?
  • Each carrier has a provider network on their website. You can find a Provider List on this site.
• What is the difference between an in-network and an out-of-network medical provider?
  • An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you visit a doctor within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network doctor. In many cases, the insurance company will not pay anything for services you receive from outside their network.
• Can I buy health insurance for less if I buy directly from the insurance company?
  • No. Insurance companies charge the same premium whether the plan is purchased directly from the company or through a broker. We obviously advise you to use an independent broker, who helps you navigate the health industry at –in effect—no charge to you.
• What are my options for making my first payment?
  • You can usually make your initial payment by credit card or check. The payment must be made out in the name of the insurance company. However, some insurance companies may require a check for the initial payment. Normally, your credit card will not be charged nor will your check be deposited until you have been approved. If you are not approved for coverage by the insurance company, your money will be refunded by the insurance company. Any financial information submitted over the web is kept private and secure. Once accepted as a plan member, all bills will be sent from the health insurance company and you will pay them via the choices offered by that company.
• What is an office visit Co-Payment?
  • An office visit copayment is a fixed dollar amount or a percentage that you pay for each doctor visit. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your copayment is 10% and the doctor visit was $300 you would pay 10% which, in this case, would be $30.
• What happens if some of the employees on a group census reside outside the service area of a plan?
  • We will quote the quote rates for the plan options that are avaialble (usually the PPO options). Plans that are not available are noted specifically in the employee rate breakdown and rates are not quoted. Premium totals for these groups make note of how many employees were omitted from the total to avoid inaccurate comparison with plans that include more employees in their service areas.
• Why is the RAF for some carriers different from what I requested?
  • Some carriers establish a minimum RAF based on group size, and some have a "locked" RAF based on group size. The RAF for each carrier is adjusted automatically in compliance with these rules.