Frequently Asked Questions
With so many health insurance options to consider, the more you know, the better decisions you'll make. We've made it easy by providing you with answers to the most frequently asked questions.
Health Insurance Basics
Q. What is a deductible?
A. A deductible is the amount you pay each calendar year before health insurance benefits are paid for covered medical expenses.
Q. When does my deductible start over?
A. Your deductible starts over each year on January 1st .
Q. What is coinsurance?
A. Coinsurance is the percentage of covered expense you are responsible for after you meet your deductible. For example, you can choose 20% coinsurance of $5,000 (which equals $1,000). That means you'll pay 20% and we pay 80% of the first $5,000 (which equals $4,000) of covered expenses. After that, we pay 100% of covered charges for the remainder of the year, up to the policy maximum.
Q. What is a copayment?
A. A copayment is a set amount that you pay for a specific service, such as $25 for an office visit. You are usually responsible for payment at the time of service.
Q. What is the Doctor Office Copayment (DOC) option?
A. Our DOC option lets you know up front exactly how much you'll pay for routine care. When you add the DOC option to your plan, your copayment is all you pay for an eligible network office visit — things like lab and x-ray, examinations, diagnosis, history of immunizations and allergy shots.
Q. What is individual out-of-pocket expense?
A. It's the maximum amount in covered charges you'll pay — per person, per calendar year. The amount is determined by adding your deductible and coinsurance together. For instance, if you have a $1,000 deductible and 20% coinsurance of the next $5,000, the most you'll pay is $2,000.
Q. What is family out-of-pocket expense?
A. Like individual out-of-pocket expense described above, it's the combined total of your deductible and coinsurance, but for your whole family — which is the maximum amount in covered charges you'll pay no matter how many members of your family collect insurance benefits.
Q. What is the difference between a network and non-network (or out-of-network) medical provider?
A. A network provider is a doctor or hospital who's made an arrangement with us to provide services at a discounted rate. Non-network providers haven't arranged to provide services at a discounted rate for our customers. Simply put, you'll typically pay less for services from a network provider than a non-network provider.
Q. What is a Preferred Provider Organization (PPO)?
A. A PPO is a large group of doctors and hospitals who've agreed to provide their services to our customers at a discounted rate. Buy a PPO plan to reduce your premium and out-of-pocket costs.
Q. What is an indemnity plan?
A. An indemnity plan, also called a traditional health insurance plan, gives you the freedom to choose any doctor or hospital for your care. And since an indemnity plan isn't associated with any network, you won't pay any penalty for choosing a particular doctor or hospital. Premiums for an indemnity plan are higher than PPO plans.
Plan Differences - Things to Consider
Q. Different plans have different lifetime benefit maximums. What does that mean?
A. The lifetime benefit maximum is the total amount a plan will pay out for as long as you own it. While it's rare for claims to exceed a $2 million maximum, it does happen. And if it happens to you, it's almost certain to bring serious financial hardship. You'll be glad to know we offer one of the nation's highest lifetime maximums — up to $8 million.
Q. Intensive Care Unit (ICU) costs are expensive. What type of plan covers these costs?
A. With Assurant Health, there's no specific limit on ICU for most plans. So you get the care you need, without the worries.
Q. What if I'm traveling and need care?
A. It's important to know whether a health plan provides coverage when you're abroad. With our worldwide coverage, services incurred outside the U.S. are covered the same as if they we're incurred in the U.S.
Q. Does ambulance coverage include air ambulance?
A. Not all insurance plans include air ambulance service. Read the exclusions section of a policy carefully, to make sure you won't be faced with an air ambulance bill, which can easily be $5,000. Our plans provide for medically necessary air or ground ambulance service to the nearest facility equipped to provide proper care.
Q. Some plans require referrals. What should I look for?
A. It's true that many plans require a referral before you can see a specialist. It's a way to control costs, but it can become burdensome. With Assurant Health, no referral is required. And you can still save money by using network providers.
Q. Do all health plans offer the same benefits?
Not all health plans offer the same benefits. When you're shopping for health insurance, look for plans that offer a range of options. Within your budget, look for plans that cover the essentials and meet your individual needs. Take a look at some benefits that we offer you that you may not be able to get elsewhere:
- Lifetime maximum benefit options up to $8 million
- Worldwide coverage, 24 hours-a-day
- Air ambulance
- Wellness benefits — so you can keep healthy
- Discounts on drugs with the Prescription Drug Card
- Optional benefits, like the Dental/Vision Card and Maternity
- Plans with a $20, $25, $30 or $40 Doctor Office Copay (DOC) optional benefit
The amount of benefits provided depends upon the plan selected and the premium will vary with the amount of benefits.
Q. Do plans cover dental care, eyeglasses, contact lenses or hearing aids?
A. Generally, health insurance plans for individuals and families do not cover dental care (unless it's caused by an accident), eyeglasses, contact lenses or hearing aids . Assurant Health offers a Dental-Vision Discount Card that can help you cut the costs for those services, especially since your entire family can take advantage of the savings. When you present your card to a participating dental or eyewear provider, you receive:
- Discounts of 10% to 50% on dental care expenses such as orthodontics (braces), dentures, cosmetic dentistry, crowns, extractions, fillings, oral surgery, periodontics and most other services.
- Discounts of up to 50% on eyeglasses, contact lenses (excluding disposable), and other retail eyewear items. You can also receive discounts on eye examinations and surgical procedures including Lasik where available.
Note: Savings vary by provider, location and actual service. The Dental-Vision Discount Card is not a health insurance policy. The plan provides discounts at certain health care providers of medical services. The plan does not make payment directly to the providers of medical services.
Cost Options
Q. How can I help reduce the costs of my insurance coverage?
A. The easiest way to reduce your costs is to buy a plan with a higher deductible. With a higher deductible, you share more of the cost of your care. But, if you don't have a need for care, the good news is you're not spending money for benefits you won't use.
In addition to choosing the right plan design, a Health Savings Account ( HSA ) is a terrific way to offset costs. This special type of account offers tax benefits on money put aside for future medical expenses. You enjoy tax-deductible contributions, tax-deferred interest and tax-advantaged withdrawals for qualified medical expenses.
Note: Assurant Health and its affiliates are not engaged in rendering tax, investment or legal advice. Federal and state tax regulations are subject to change. If tax, investment or legal advice is required, seek the services of a licensed professional.
Q. What is the difference in plans with higher or lower premiums?
A. It's really about choice and trade-offs.
- Typically, you'd choose a higher premium plan if you want your health insurance plan to pay mainly for routine needs, like a doctor visit or a prescription. It feels affordable to pay only a $25 copay at the time of visit, but you'll pay more for the convenience of knowing what you'll spend every time you visit the doctor or need a prescription.
- You'd choose a lower premium plan if you want your health insurance to protect you against a serious illness or injury. You'll pay more out of your pocket for the costs associated with everyday health care needs — but you'll pay less overall in premium.
Health Savings Accounts (HSAs)
Q. What is a Health Savings Account (HSA)?
A. A Health Savings Account (HSA) is an account that works like an Individual Retirement Account (IRA), except the money saved is earmarked for future health care costs.
- Anyone who buys a qualified high deductible health plan (one that meets the requirements the government has determined), with at least a $1,000 single or $2,000 family deductible, qualifies for an HSA.
- The money you deposit into your Health Savings Account, as well as the earnings, is tax-deferred. You can withdraw money at any time to pay for qualified medical expenses, without being penalized.
- You can even roll over unused balances from year to year.
Note: Assurant Health and its affiliates are not engaged in rendering tax, investment or legal advice. Federal and state tax regulations are subject to change. If tax, investment or legal advice is required, seek the services of a licensed professional.
Q. What are the advantages of an HSA?
A. There are so many advantages to opening a Health Savings Account. And, you'll feel good knowing that Assurant Health has the experience of being the first to offer an HSA. With this great product, you can:
- Gain greater control over your health care dollars. You can withdraw your funds for qualified medical expenses as you need them. Your withdrawals are tax-free and penalty-free when you use them for qualified medical expenses.
- Broaden your range of health care services. While you can use funds from your HSA to pay for covered expenses that apply toward your deductible, you can also use those dollars to pay for qualified medical expenses that your plan doesn't cover — things like contact lenses, dental services, non-prescription drugs, acupuncture and even long term care premiums.
- Gain tax advantages. Contributions and earnings are tax-free. Distributions are also tax-free, if used for qualified medical expenses.
- Invest your money. We offer seven different fund families.
- Supplement your income when you retire. At age 65, your accumulated funds can be withdrawn for medical expenses not covered by Medicare. Funds used for non-qualified expenses may be subject to penalties and income tax.
- Do all your administration online. If you use HSA Tools to administer your Health Savings Account, you get access to a number of online features to help you manage your money. You can pay providers online, check your balance, and benefit from a wealth of health and prescription information. And, Assurant Health is the only organization that offers you an integrated health plan and HSA administration all on one site — so you don't have to go back and forth between screens to make sense of things. You'll also have access to seven different fund families.
Note: Assurant Health and its affiliates are not engaged in rendering tax, investment or legal advice. Federal and state tax regulations are subject to change. If tax, investment or legal advice is required, seek the services of a licensed professional.
Account custodian is UMB Bank
Prescription Drugs
Q. Sometimes I need prescription drugs. What kind of coverage is important?
A. Prescription drugs are expensive. And costs seem to be going up every day. Look for a plan that doesn't limit prescriptions. Assurant Health markets many plans without prescription-specific drug dollar limits.
Q. What prescription drug coverage options are available?
A. Your options will vary by state and the plan you choose, but you'll typically have a choice of deductibles and copayments. For instance:
- $0, $250 or $500 deductibles
- $10 copay on generic prescriptions
- $25 copay on brand prescriptions, plus 20% coinsurance
Q. How do I use my prescription drug card?
A. Each time you fill a prescription, present your card at a participating pharmacy. You'll find information on participating pharmacies on the back of your card. If you have a plan with a prescription copay, once you satisfy your annual deductible, you'll pay the copayment specified on your drug card. After applying any discounts, deductibles, or copayments, the pharmacy will submit your claim electronically.
Q. If my doctor prescribes a brand-name drug for me, will it be covered?
A. Yes, a brand-name drug will be covered. However, if a comparable generic drug is available, our plans are designed to encourage generics. If you choose the brand-name drug when generic is available, an additional charge may be applied.
Children
Q. Which plans include child preventive care?
A. Most plans cover baby and child wellness exams, as well as immunizations.
Q. How long can my dependent children remain on my policy?
A. The age at which dependent children cease to be covered varies, depending on the kind of plan you have, the state where your policy was issued and where you live. Disabled children may remain on a policy indefinitely. Call us for details.
Choosing Your Insurance Company
Q: What should I consider when looking at health plan and the company that offers it?
A: It's about more than just the premium. When comparing health plans, assess the standard benefits that each company has to offer.
- Think about if there are limits on important things, like prescription drugs and hospitalization.
- Look at the available lifetime benefit maximum and how the company pays for ambulance service, which can be very expensive.
- Beyond what a plan offers, you'll want to look at a company's experience and focus — since it takes a long time to become an expert at health insurance.
- You'll also want to look at the company's strength and stability, so you can rest assured that a company is financially stable and will be there when you need it.
Q: Why should I choose Assurant Health?
A: When you choose Assurant Health for your health insurance needs, you are backed by an organization with experience, expertise and commitment.
You are choosing a unique and innovative health insurance organization that caters to individuals who choose to live life on their own terms. And you're choosing an organization with more than 110 years' experience — who was also the first to introduce the Health Savings Account (HSA).
Health insurance is most important when you need to use it. You'll feel good knowing that Assurant Health is the brand name for products underwritten and issued by Time Insurance Company, rated Excellent (A-) by A.M. Best, the leading insurance analyst, based on financial stability and ongoing ability to meet policyholder obligations.
A.M. Best ratings and analysis, June 2005.