Frequently Asked Insurance Questions

Are all Insurance Plans the same?
How do I know which plan is right for me?
What is the difference between group coverage and individual coverage?
Can my insurance agent get me a rate of discount?
What conditions are typically declined with individual insurance coverage?
Can the insurance company cancel me if I have large claims?
Can I go to my doctor?
What do you do for me that another insurance agent will not?
How long does the application process take?
Who determines if my rate will go up and how?
How can I save money on my insurance?
Do you offer assistance or information on COBRA?

Are all Insurance Plans the same?

No. There are many different plans with each company, although some do have similarities. There are PPO plans (preferred provider Organization), HMO plans (Health Maintenance Organization), Open Access plans which are HMO plans with out of network benefits and more.

How do I know which insurance plan is right for me?

That is where Leady Benefits comes in. We will discuss and inquire and together we will determine which plan or plans will suit you and your budget.

Most individual plans are PPO based.

What is the difference between group coverage and individual coverage?

Group Coverage:
• Guaranteed Issued
• Maternity coverage is automatic
• Chiropractic coverage is automatic
• Mental/Nervous benefits are automatic
• Premiums are higher, most of the time, depending upon the coverage level

Individual Coverage:
• Not guaranteed issued/subject to underwriting and possibly being declined or rated up
• Maternity coverage is not automatic; some companies will allow a writer to be added on at an additional expense for a limited benefit
• Chiropractic coverage may or may not be a benefit
• Mental/Nervous may or may not be a benefit
• Premiums are most times lower

Can my insurance agent get me a rate of discount?

No. Beware if an insurance agent tells you they can get you a discount on rates. The insurance company must follow their rates and the increases for the State of Florida approval. Agents have no control over the premiums. With group coverage, there is generally a 15% swing on the rates and once underwriting is completed the rates can go up or down 15% depending on the overall health condition of the entire group.

With individual insurance coverage, once underwriting is completed the rates can go up depending upon the health of the individual and he/she is also subject to being declined depending on the severity of their health conditions.

What conditions are typically declined with individual insurance coverage?

Any heart conditions, insulin dependent diabetes, HIV/AIDS, any health condition that is not in good control, hypertension, high cholesterol, etc. Basically any condition that has potential to be or is catastrophic in nature and could cost the insurance company a lot of money over a long period of time. Or, if you or your spouse is pregnant, it is an automatic decline.

A pre-existing condition is one that a person or persons had 1 year prior to health insurance beginning. An insurance company will generally, "look back" for 6 months to 1 year and pre-existing exclusions will last for 1 year. Even though someone may have a pre-existing condition that is not covered, any other health condition that comes up will be covered.

Can the insurance company cancel me if I have large claims?

No. The insurance company cannot terminate your coverage because of health issues; however, they will increase your premium. You can be canceled for nonpayment of premium.

Can I go to my doctor?

The majority of health plans either individual or group are Network Based. That is one of the questions Leady Benefits asks when first discussing companies and quotes, is who your physicians are. If you have any particular physician(s) that you see, we check the networks and see which they are in, so that you can go to your preferred physician. In most cases we can find a network your physician belongs to.

What do you do for me that another insurance agent will not?

Leady Benefits provides full customer service to you starting form quoting, enrolling, underwriting until you are approved. Once approved, Leady Benefits will provide further customer service; billing issues, claim issues, etc. Your first call should always be to us when you have a coverage, etc. Leady Benefits will either know the answer right away or find out and get back to you.

How long does the application process take?

Individual:
That is a very broad question. Individual insurance can take from 24 hours up to 4 – 6 weeks. It depends on a number of factors. The insurance company, the type of coverage, health of the individual(s) applying, if medical records are requested, etc. If an individual is very healthy with no medical conditions or medication the underwriting will be generally very quick (I have seen individuals in less than a day). If an individual has medical conditions, the underwriting will take longer as in most cases, the insurance company will want to obtain medical records. That is usually the biggest hold up; getting the physicians to provide medical records in a timely manner.

Group:
With small group (under 20 lives), the case must be submitted at least 30 days prior to the requested effective date. Since it is guaranteed issue; no medical records are required but the employee application has medical questions that need to be answered by the employee. There is also paperwork that the employer has to submit to the insurance company as well.

Who determines if my rate will go up and how?

The underwriter at the insurance company looks at several things; medical records, age, height/weight, any prescription drugs, how long the person has been taking the medication and their condition is under good control.

They also look at the M.I.B. (Medical Information Bureau). That is like the “Credit Bureau” of your health. It may include who you saw for physicians, when and for what reason. That is why it is very important to disclose all information on your health insurance application.

Based on all those factors, your rate may go up or down (yes, I have seen rates go down). At that point, I will contact you and we will review the rates and you can accept the rate or we might switch to a different plan that could possible bring the rate down. It is always opened for discussion. But, basically, the rate they offer you is a “Take it or Leave it” option.

How can I save money on my insurance?

There are lots of ways that you can save money on your premiums: higher deductible, no RX coverage, mini-medical plans, there are ways, we just need to learn to be creative and get only the coverage you need. A generally healthy person would probably do ok with a high deductible plan. You can also save money on prescription medications by using Wal-mart, Target, Sweetbay and Kmart. Did you know that Publix has several antibiotics that are free of charge? You just can’t beat free! As a consumer you can also "shop" around for test that may need to be done. There may be a several hundred dollars savings on major test from one company to another. Basically, as a consumer we need to take more responsibility in healthcare. You wouldn’t buy a car without getting information about it would you? When you go grocery shopping don't you look for the sale items? Healthcare needs to be the same thing. Don't be afraid to talk to your doctor about what is necessary and what is not. A doctor is there to serve you not the other way around.

Do you offer assistance or information on COBRA?

COBRA is coverage that is offered to an employee who has lost their job who had insurance benefits with it. It can be purchased for 18 months up to 36 months depending upon the reason for termination. The premium for cobra is passed 100% on to the ex-employee and is either paid directly to the insurance company or to the ex-employer, depending upon how many employees are at the ex-employer. Leady Benefits typically recommends that the insured tries to move to a temporary policy or to an individual policy. The premium is much less money. COBRA is good if there is a pre-existing condition or pregnancy.