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Frequently Asked Questions
Individual & Family Insurance
- Basics
- What is a deductible?
- A deductible is the amount you pay each calendar year before health insurance benefits are paid for covered medical expenses.
- When does my deductible start over?
- Your deductible starts over each year on January 1st.
- What is coinsurance?
- 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.
- What is a copayment?
- 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.
- What is the Doctor Office Copayment (DOC) option?
- 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.
- What is individual out-of-pocket expense
- 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.
- What is family out-of-pocket expense?
- 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.
- What is the difference between a network and a non-network (or out-of-network) medical provider?
- 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.
- What is a Preferred Provider Organization (PPO)?
- 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.
- What is an indemnity plan?
- 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
- Different plans have different lifetime benefit maximums. What does that mean?
- 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.
- Intensive Care Unit (ICU) costs are expensive. What type of plan covers these costs?
- With Assurant Health, there's no specific limit on ICU for most plans. So you get the care you need, without the worries.
- What if I'm traveling and need care?
- 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 were incurred in the U.S.
- Does ambulance coverage include air ambulance?
- 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.
- Some plans require referrals. What should I look for?
- 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.
- 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.
Do plans cover dental care, eyeglasses, contact lenses or hearing aids?
- 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
- How can I help reduce the costs of my insurance coverage?
- 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.
- What is the difference in plans with higher or lower premiums?
- 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)
- What is a Health Savings Account (HSA)?
- 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
What are the advantages of an HSA?
- 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
- Sometimes I need prescription drugs. What kind of coverage is important?
- 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
- What prescription drug coverage options are available?
- 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
How do I use my prescription drug card?
- 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.
If my doctor prescribes a brand-name drug for me, will it be covered?
- 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
- Which plans include child preventive care?
- Most plans cover baby and child wellness exams, as well as immunizations.
- How long can my dependent children remain on my policy?
- 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
- What should I consider when looking at health plan and the company that offers it?
- 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.
Why should I use Assurant Health?
Short Term Medical Insurance
- Basics
- What is Short Term medical insurance?
- Short Term Medical is temporary health insurance designed to protect you from an unexpected illness or injury when you are between permanent health plans.
- What is the definition of pre-existing condition?
- A pre-existing condition is an illness or injury for which the covered person received medical treatment or advice from a physician within the 5 year* period immediately preceding the covered person's effective date; or that produced signs or symptoms within the 5 year* period immediately preceding the covered person's effective date.
* May vary by state.
- How long of a time period may I purchase Short Term medical coverage?
- When does my coverage begin?
- If you are submitting your application by:
Internet-The earliest your coverage can begin is the day following transmission, if all other eligibility criteria have been met. For example, if you submit your application online on March 16th, the earliest your coverage can begin is at 12:01 a.m. on March 17th.
All transmissions take place and are recorded based on the time and date in the Central Time Zone. For example, if you submit your application on-line at or after 10:00 p.m. on March 15th from a location in the Pacific Time Zone, the time of the transmission will be at or after 12:00 a.m. Central Time. The transmission date of your application will be March 16th,and your effective date will be March 17.
- Can I change my deductable?
- No. Deductible changes cannot be made after your plan is issued.
- What is the Lifetime Maximum Benefit?
- Lifetime Maximum Benefit is the total benefit that can be paid out over the lifetime of the policy.
Pre-authorization
- Does this plan require pre-authorization?
- Yes. Short Term Medical requires authorization prior to receiving certain services. The identification card you receive with your policy provides a toll-free number for easy access to this service. The authorization process must be followed in its entirety to receive maximum benefits. The policy explains the authorization process in detail.
Authorization is required in advance of:
- All hospital or skilled nursing facility admissions
- Outpatient or day surgeries
- Rehabilitation programs
- Home health care
- Physical medicine/Chiropractic care
- Transplants
The number to call for pre-authorization is 1-800-800-2412. The Short Term Medical identification card, which is attached to a copy of the insurance contract, also lists the pre-authorization phone number.
Payment information
Benefits
Are prescription drugs covered?
- Yes. A prescription drug is one that is prescribed by a physician and payment is subject to deductible and coinsurance amounts for an illness or injury that occurs while a policy is in force
Does the Short Term Medical plan cover routine dental and optical expenses?
- No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover non-injury related dental and optical care.
Will a routine checkup be covered?
- No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include most of the benefits a permanent heath plans offer.
Extending Short Term coverage
- Time Insurance Company's Short Term Medical plan is not renewable.
However, if your temporary need continues beyond your policy period, you may apply for a new plan under the following circumstances:
- There has been no significant change in your health.
Any previous or current health condition or symptom will be considered a pre-existing medical condition that will not be covered under a new plan. There is no continuous coverage between plans -- therefore your new plan will not provide benefits for any condition or symptom which began during a previous plan. In addition, no benefits are available for any period in which you are not covered by a Time Insurance Company Short Term Medical plan.
To obtain an additional plan, you must complete a new enrollment form. If the enrollment form is approved, a new plan will be issued.
* Varies by state.
Federal reform legislation
- Are Short Term Medical plans affected by the Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?
- No. Under HIPAA, short term limited duration policies are generally exempt from this legislation. This means that when issuing a Short Term Medical policy, insurance carriers do not have to: guarantee renewability, guarantee issue or waive the pre-existing condition limitation for federally eligible individuals.*
- Is a Short Term Medical plan considered "creditable coverage" under HIPAA?
- Under HIPAA, Short Term Medical coverage is generally considered creditable coverage to help satisfy any pre-existing condition period.* Previous creditable coverage includes:
- A group health plan
- Health insurance coverage
- Part A or Part B of title XVIII of the Social Security Act (Medicare)
- Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928 (Medicaid)
- Chapter 55 of title 10, United States Code (Champus)
- A medical care program of the Indian Health Service or of a tribal organization
- A state health benefits risk pool
- A health plan offered under chapter 89 of title 5, United States code (Federal Employee Health Benefit Plan)
- A public health plan (as defined in regulations)
- A health benefit plan under section 5(e) of the Peace Corps Act
*State reform legislation may vary, consult your state for specific rights and requirements.
Health Access Plans
- Basics
- What makes Health Access Plans limited-benefit plans?
- Health Access limited-benefit plans are an affordable option for everyday health care needs. They are not major medical health plans and are not replacements for them. Health Access Plans have calendar year maximums. Certain dollar limits are in place for:
- Brand and generic prescriptions
- Emergency room services
- Inpatient and outpatient hospital services
- Surgical services
- Ground and air ambulance
Please note Health Access Plan A does not cover some of the services listed above. Limited-benefit plans are an affordable solution to going without coverage. They provide access to services people value most, like doctors’ office visits and prescriptions. Limited-benefit plans also deliver benefits for preventive care and immunizations. They also provide savings through discounts for services by in-network providers
Who is eligible for the Health Access Plans?
- The eligibility rules include anyone through age 63.
How much do Health Access Plans cost?
- Plan premiums start as low as $40 per month. You can get quick pricing information from the comprehensive plan brochure or the rate sheet. In certain states, a Health Advocates Alliance membership (includes 24-hour Nurse Line access) is required and is only $4 per month.
What is the difference in offerings between the three Health Access Plans?
- Health Access Plan A is not subject to medical underwriting and is issued without pre-existing condition limitations. It provides limited benefits for services such as doctors’ office visits, wellness care, and outpatient diagnostic services (subject to per office visit and calendar year limits). Health Access Plans B and C require limited medical underwriting questions for eligibility and provide limited coverage for physician services, plus hospitalization, outpatient medical services, ambulance, and emergency room subject to calendar year limits. See the plan brochure for details on plan benefits and limitations.
Are there pre-existing limitations?
- Health Access Plan A is not subject to any pre-existing limitations. For Health Access Plans B and C, no benefits are paid for charges incurred due to a pre-existing condition until an insured has been continuously insured under the plan for 12 months. State variations apply. See brochure or contract for pre-existing definition.
Can Health Access Plans be set up for dependents only?
- Yes. Health Access Plans are often an affordable alternative to adding dependents to major medical plans. They are also a solution for dependents who are not covered by employer plans.
Do policyholders receive network discounts?
Can a Health Access Plan be paired with an existing health plan?
- A Health Access Plan cannot be paired with an Assurant Health Individual Medical, Small Group or Short Term Medical plan at this time, but can be a perfect supplement to other carriers’ health plans. Adding Health Access Plan A to a high-deductible health plan is a good way to provide first dollar benefits. Note: Health Access Plans should not be sold with HSA-qualified plans.
Please note Health Access Plan A does not cover some of the services listed above. Limited-benefit plans are a viable, affordable solution to the rising cost of health care. They provide affordable access to services people value most, like doctor office visits and prescriptions. Limited-benefit plans also deliver benefits that help keep people healthy, like preventive care and immunizations, which may reduce the need for health care down the road.
For specific costs and further details of the coverage, including exclusions, reductions, limitations, and the items under which coverage may be continued in force, contact your agent.
Worksite Availability and Billing
- Why would an employer want to offer employees access to Health Access Plans?
- Health Access Plans are an affordable alternative when the costs of small group health insurance are out of reach. They are a way for small employers to offer employees access to coverage without having to fund it and a way to attract and retain good employees. Note: In AL and WI, individual medical coverage cannot be marketed through the workplace of an employer with 2-50 full-time employees.
- What if an employee who has a Health Access Plan leaves his or her employer?
- Health Access Plans provide individual coverage and are portable — meaning the individual can take the plan with him or her. Since the employer is not paying the premiums, an employee doesn’t have to lose coverage.
- How can payments be made for Health Access Plans?
- A convenient payment method is to set up payroll deduction (List Bill). The entire premium is deducted from each employee’s paycheck and the employer remits one consolidated check to Assurant Health. There are no fees for this service. The other methods of payment are monthly Electronic Funds Transfer (EFT) from an individual’s checking account, credit card (first payment only in most states), and direct billing (paper mailed bill).
- Can an employer contribute money toward the individual plan for employees?
- No. The employer cannot contribute to the monthly premium in any way.
- Can employers purchase a Section 125 plan with individual medical insurance to pay part of the employees’ premiums?
- Employee premiums cannot be paid through a Section 125 or a Health Reimbursement Arrangement (HRA) plan without the plan being subject to small group reform laws, which require all employees be issued coverage. Therefore, this approach is not allowed when purchasing individual medical plans, including Health Access Plans.
- If payroll deduction is selected, when is the bill generated?
- The bill is mailed to the account holder (typically the employer) approximately 24 days before the billing due date.
- How does the account holder remit payment to Assurant Health?
- The account holder should remit one check, along with the coupon attached to the bill, to the P.O. Box address indicated on the coupon.
- What options for payment are available to an individual who leaves the company and wants to continue his/her individual coverage?
- An individual can choose EFT or direct billing. If the employer notifies Assurant Health to remove an employee from a payroll deduction (List Bill) account, this individual is automatically placed on quarterly direct billing.
- Can the employer payroll deduct the premiums for dependent insurance?
- Can independent contractors pay premiums through payroll deduction?
- Yes. However, in DE, ID, MD, NC, and OR, the employer must have more than 50 full-time employees in order to payroll deduct for independent contractors who receive a 1099.
- Can premiums be deducted on a pre-tax basis for employees?
- No. Deductions for premiums must be on a post-tax basis.
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