FAQs

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As we have discussed before, your insurance won’t cover everything involved in your healthcare. I like to compare it to caring for your car. You may have a warranty that will cover major repairs. The daily costs such as gas, oil changes, tires, etc. are your responsibility.  Health insurance will cover emergencies and major occurrences.  The daily costs of some prescriptions or over-the-counter medicines, knee compression sleeves, allergy medications, etc. are most likely your responsibility.

To help you with the daily costs, the InsuranceExperts.team has put together this Healthcare Savings Guide to give you resources and information to make your healthcare journey easier.

Your best resource is always your InsuranceExperts.team member. They are a phone call away!

 360 Benefit Solutions offers several plans that are very affordable, provide robust benefits and provide PPO provider networks as well as Affordable Care Act plans.

Typically, you would be paying 104% of what you paid during your employment. This is the 50% your employer paid, the 50% you paid and a 2-4% administrative fee.

Great question!

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Supplement insurance plans help to pay for healthcare costs that are not covered by a person’s regular health insurance plan. These costs include copayments, coinsurance and deductibles. There are supplemental health insurance plans for accidents and specific conditions, such as cancer, critical illness, heart attacks and strokes or kidney failure.

• Doctors may not take all types of health insurance, and some don’t accept any insurance at all.
• Doctors may stop taking insurance if they believe the health insurance company isn’t offering enough compensation.
• If a doctor stops taking your health insurance, you have a few avenues, including asking if the doctor will take a reduced fee or provide flexible payment terms.

In some cases, cash prices are less than the negotiated insurance rates.  However, if you pay cash, it will not go toward your deductible. If you are close to meeting your deductible, it may be wiser to have these services go through your insurance.

An EOB (Explanation of Benefits) is the statement you receive from the insurance company after your claim has been processed. It will state what the insurance pays and what your financial responsibly will be for the medical event.

A PPO is a Preferred Provider Organization and includes a large number of doctors and hospitals that accept the insurance plan. You don’t need a referral to see a specialist within a PPO. A HMO (Health Maintenance Organization) is a much smaller network and requires a referral from a primary physician to a specialist.

The max out of pocket limit is the maximum dollar amount you would pay before achieving 100% of your maximum benefit.

A co-pay is a set dollar amount you pay for a medical service, i.e., $50 co-pay for a doctor visit. The deductible doesn’t apply to the co-pay. Any services outside of the doctor visit would go toward your deductible.

The deductible is the dollar amount you must spend before you receive any health insurance benefit for medically necessary treatment.

Coinsurance is the amount you would pay after you meet your deductible, i.e., 80/20 coinsurance means that after your deductible insurance pays 80% of your medical bills and you pay 20% for any medically necessary service.

No. Private plans do not have open enrollment periods; you or your family can secure coverage at any time of the year.

Open Enrollment refers to the time in which one can enroll in an Affordable Care Act Plan (ACA) or for certain Medicare plans know as Annual Election Period (AEP). Typical open enrollment for ACA plans is November 1^st – December 15^th.  AEP is October 15^th – December 7^th. There are Special enrollment periods for the ACA and Medicare if individuals meet specific qualifications.