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- Can I buy health insurance for less if I deal directly with an insurance company?
No. Health insurance rates for the same plan will be the same whether you use an independent health insurance agent or deal directly with the insurance company offering the plan.
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- Must I pay a fee to an independent health insurance agent?
No. An independent health insurance agent/agency is paid a commission by the health insurance company for educating and directing the consumer to the best health plan for their particular needs. No additional fees are added to your health insurance cost for this service, rates are set by the carriers.
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- I have previous group health insurance coverage. Does this mean the health insurance company must accept my application and apply no pre-existing condition limitations?
No. In Florida it does not matter that you have previous group health insurance coverage. A health insurance company can still deny your application for individual or family coverage.
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- What are my options if I my application for coverage is denied?
It depends on the specific health condition(s) at issue. If you are denied coverage by one company for medical underwriting reasons you can apply to another health insurance company. Different insurance companies use different underwriting guidelines. You may obtain coverage with another provider who may have more lenient guidelines for the same pre-existing condition(s). Please complete a simple pre-screen application on our website so we can locate a carrier for you
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- What are the different plans types and features I should consider when applying for health insurance?
Fully Comprehensive Plans- These plans usually have a choice of deductibles once they are met the insurer will cover the first dollar of all medical expenses.
Co-Pay Insurance Plans- A insurance plan that will pay just a fixed amount of the cost of prescriptions drugs and Doctor Office visits.
Coinsurance Plans/ Major Medical Insurance- a higher deductible of your choice ranging from $1000-$5000 that requires you to pay for all medical expenses until the deductible is met then pay 20% of all treatment and the insurer pay 80%.
Health Savings Accounts (HSA's)- This plan is like a self managed insurance that offers low premiums combined with high deductibles, the insurer pays 100% of expenses after the deductible is met . The insurer sets up a tax sheltered savings account for you where the money can grow tax deferred to use for covering your deductible. The account comes with a debit card to use for office visits and prescriptions
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- Can my health insurance be terminated for any reason?
Florida provides strong consumer protection. In general, once you have been approved for coverage, the insurance company can terminate your coverage for only the following reasons: (1) failure to make premium payment within the payment grace period, (2) material omission or misrepresentation on your health insurance application, or (3) the insurance company becomes insolvent or bankrupt.
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- How long does a company have to pay a medical claim?
Once proof of loss has been submitted and received by the carrier, the company has 45 days to pay or deny the claim unless additional information is requested. If additional information is requested, the company has up to 120 days to pay or deny the claim.
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- What is short-term health insurance?
Short-term health insurance is designed to fill temporary gaps in your "permanent" health insurance coverage. Insurance carriers are getting creative in trying to create plans to help consumers obtain coverage for specific situations such as when leaving an employer offering choices other than COBRA. These policies are relatively inexpensive and can go into effect very quickly. Many short term plans can be applied for from 1-12 months. You can purchase short-term health insurance coverage in one-month increments or in a single payment for one to twelve months of coverage. Short-term plans may exclude coverage for pre-existing conditions. Some applicants who would be denied by insurance companies providing "long-term" or "permanent" health coverage may be able to obtain short-term health insurance.
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- Under a new health insurance plan, can I keep my doctor?
You should review a health insurance plan's physician network before applying to the plan. Each insurance provider has different network restrictions. PPO plans, for example, may allow you to visit any doctor but will offer better benefits and lower premiums if you use a provider within their network. HMOs might not provide benefits outside of their doctors network except in emergency situations where a network doctor is not available.
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- How do PPO plans and HMO plans differ?
The primary difference is that HMOs limit your non-emergency health care coverage to a limited network of physicians and hospitals. A PPO plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service to their policyholders. Generally, the preferred service provider agreed to accept an insurance company's usual and customary payment.
For many individuals and families in Florida, PPO rates will be lower than HMO rates. In addition, HMO plans are rarely an option for persons not participating in employer-sponsored programs. The large majority of our individual and family health insurance clients enroll in PPO plans due to the lower premiums and quality coverage.
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- How long does it take to enroll in a health insurance plan?
It depends on the health status of the applicant and the health insurance company to which the applicant applies. Some health insurance companies may approve, within a few days, the application of a healthy young adult. However, for less healthy or older applicants, processing of an application can take several weeks or more. Each circumstance is different. You should consult your independent health insurance agent to get a realistic expectation.
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- Can my health insurance application be denied?
Yes. Whether an application is approved or denied depends on the applicant's health and the underwriting guidelines of the insurance company. Contact your independent health insurance agent to get a realistic assessment regarding your own circumstance.
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- Why should I use an independent health insurance agent?
An independent agent can more objectively recommend the best health insurance company for your situation. In addition, an independent agent will be familiar with insurance company bureaucracies, which can save you a lot of aggravation. Further, if your circumstances change, an independent health insurance agent can recommend a more appropriate health insurance plan for you.
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- How do health insurance companies define "pre-existing condition?"
Each health insurance company has its own specific wording. However, the following statement is in line with many insurance company provisions: Preexisting condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within a five year period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician or received from a physician within a five year period preceding the effective date of the coverage or the insured person
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- Do I have to take a physical exam in order to obtain health insurance coverage?
The health insurance companies represented by Trinity 1 Financial Group usually do not require physical exams. The exceptions usually involve applicants who have not consulted a physician in the last couple years.
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- What are the options for making my initial health insurance premium payment?
An initial good faith premium payment (usually one month of insurance premium) is required with your health insurance application. Checks, money orders, credit or debit cards are usually acceptable. Health insurance companies will not accept cash.
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- I have maternity and dependent coverage rider on my policy. Will everything be covered.
Florida law requires health insurance policies that provide for dependent coverage to cover newborn children for injury or sickness from the moment of birth. The nursery charges associated with delivery of the child are not required to be covered. The Doctors visit at the birth of the child would be covered under the Child Health Assurance Act.
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- Will a new health insurance policy cover my pre-existing condition?
Many individual and family health insurance policies limit coverage for pre-existing conditions during the first nine to twelve months of coverage - sometimes longer. However, the pre-existing condition exclusion period is waived to the extent that the applicant has "qualifying" prior group coverage. This is a government-mandated requirement, though the health insurance company can still deny the application of someone whose health does not meet the insurance company's underwriting requirements. However, the insurance company can still waive coverage of the condition altogether rather than outright decline coverage. In the absence of prior group coverage, some health insurance companies will waive their pre-existing condition exclusion for any health conditions listed on the application. Many HMO plans do not have pre-existing condition exclusions, though HMO coverage is rarely available to people not participating in employer-sponsored plans. In addition, when such HMO coverage is available, the rates tend to be quite high or the HMO can decline coverage all together. You should fully discuss your pre-existing conditions with your independent health insurance agent
before you submit a health insurance application
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- Can my weight make a difference in my health insurance rates?
Yes. All Florida health insurers use height/weight tables to make risk determinations. People with "non-standard" height/weight ratios may be charged higher rates or refused coverage. These height/weight standards vary from health insurer to health insurer.
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- For how long am I committed to keep any health insurance I purchase?
Health insurance is generally purchased in one month increments (short-term plans are an exception), so your commitment is typically month to month. As in most insurance policies If you stop making health insurance payments, the insurance company will simply terminate your coverage.
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- What ages are eligible to apply?
You must be under 64¾. After that you would qualify for Medicare or a Medicare advantage plan.
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- Are there meaningful differences in how insurance companies underwrite health insurance applications?
Yes. For example, one insurance company assigns "preferred" rates to a 5'10" male who weighs 227 lbs. Another insurance company would assess an additional 40% charge for this person. One insurance company charges an additional 40% for smokers. Another charges an additional 25%. One may not charge a rate increase at all. There are many guideline variables such as these. To get the best health insurance value for your own situation, you need the advice of a good health insurance agent
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