FAQ

What are your choices?

There are many different types of health insurance. Each has pros and cons. There is no one “best” plan. The plan that’s right for a single person may not be best for a family with small children. And a plan that works for one family may not be right for another.

For example, if your family includes just two adults, it may be less expensive for each of you to have individual coverage than for just one of you to have a family plan. If you have children, or if you might have children soon, you need a family plan. Because your situation may change, review your health insurance regularly to make sure you have the protection you need.

Choosing a health insurance plan is like making any other major purchase: You choose the plan that meets both your needs and your budget. For most people, this means deciding which plan is worth the cost. For example, plans that allow you the most choices in doctors and hospitals also tend to cost more than plans that limit choices. Plans that help to manage the care you receive usually cost you less, but you give up some freedom of choice.

Cost isn’t the only thing to consider when buying health insurance. You also need to consider what benefits are covered. You need to compare plans carefully for both cost and coverage.

What Is A Deductible?

The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.  For example, if there is a $500 deductible, the insured patient must pay for the first $500 of healthcare expenses before the insurance company will begin paying claims.  The higher the deductible, the lower the cost of your health insurance plan.

What Is Co-Insurance?

The co-insurance clause requires you to pay a percentage (or a fixed amount) of your covered medical expenses. The percentage is usually expressed as “80/20” co-insurance. This means after you have paid the deductible amount (if any) as stated in your policy, you will pay 20% of the medical bills and the insurance company will pay the remaining 80% of the covered medical expenses. When your total expenses reach a certain dollar amount stated in your policy, the insurance company pays 100% of the covered expenses up to the maximum benefit of your policy. Most major medical plans have a maximum amount of 5 million dollars of coverage

Please note that all companies “80/20” plans are not created equal.  One plan may have an out of pocket, yearly, maximum of $4,000 on a $1,000 deductible and another may have a maximum of $1,500.

When Does My Coverage Begin?

All Texas Health Insurance plans are subject to underwriting approval. Do not cancel any current Texas Health Insurance policies until issued an effective date.

What Is A Rider/Waiver?

A term used when a particular area of the insured is not covered due to previous history. Some are temporary and some are permanent.

What Is an Exclusion?

This states the types of injuries or illnesses that are not covered. All policies have exclusions. The most common types of exclusions are pre-existing conditions, self-inflicted injuries, and injuries incurred while committing a criminal act. Injuries resulting from some specific activities may also be excluded.

What Are “Out-Of-Pocket” Costs?

An insured’s “out-of-pocket” costs under major medical expense plans include the deductible, cost-sharing amounts arising from the operation of the coinsurance clause, and medical expenditures that are deemed by the plan to be in excess of “reasonable and customary” charges. Only charges that are “reasonable and customary” for a specific type of service, in a particular location or geographic area, are eligible for reimbursement under medical expense plans. The definition of “reasonable and customary” may vary somewhat from one medical expense plan to another.

What Is a Co-Payment?

Under a co-payment or co-pay provision, the insured usually is required to pay a set or fixed dollar amount for Dr.’s visits (i.e, $25, $30) or Prescription (i.e., $10, $30 and $50) each time a particular medical service is used. Co-pay provisions are frequently found in medical plans offered by (PPO’s and HMOs) where a nominal co-payment is applied to each office visit and to each prescription  that is filled.

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AO Insurance is committed to helping you save money on medical, dental, and life insurance. if you’re ready to compare individual and family plans online, get your free quotes now. If you’d like to talk about your options, please contact us.

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Industry Experts

Using an agent to help find the best health insurance plan for you, your family or business is not only smart but free. Health insurance can be confusing so let us put our years of experience to work for you. Explore your plan options online or give us a call and let us walk you though the entire process.