Q1.  Do you offer the best price?

A.  You pay the same monthly premium for the same plan.

Health insurance premiums are filed with and regulated by the Florida Department of Insurance.  Whether you buy from Florida Health Insurance Professionals, another agent, or directly from the health insurance company, you'll pay the same monthly premium for the same plan.  This means that you can feel confident you're getting the best price, the best advice, and the best possible plan to fit your needs when you buy from Florida Health Insurance Professionals.  And you will only be a phone call away from your agent when you need help, from 7 AM to 11 PM any day of the week.

Q2.  Will I pay an extra fee to use your services?

A.  No.

All the services offered by Florida Health Insurance Professionals are provided at no extra cost to you, the consumer.  If you purchase a health insurance plan through Florida Health Insurance Professionals, you'll pay the regular monthly premium directly to the health insurance company.  You'll pay nothing to Florida Health Insurance Professionals.  Our fees are paid by the insurance companies in the form of commissions.  You pay the same premium whether you purchased the plan from Florida Health Insurance Professionals, another insurance agent, or directly from the insurance company.

Q3.  Why should I buy from Florida Health Insurance Professionals?

A.  Because we pride ourselves in providing the best customer service, always being available, complete honesty, and have many years of experience.

To put it simple: We care.  We are NOT a telemarketing room pushing the most expensive plans on our clients. We shop to find the best plan at the best price.

Our agents are trained to help you shop and find a plan that works for you.  With other online companies you're left in the dark to find and research a plan on your own.  You wind up buying a plan because it was the cheapest and later find out it does not have the coverage you thought it did.  Insurance can be a confusing process.

We pride ourselves on customer service.  The process does not stop once you are approved with a plan.  If you EVER have any problems, questions, or just want to say hi, your agent is a phone call away.

Health insurance is the same price no matter where you purchase it.  Why not purchase it from someone who cares and will be there when you need it?

Be AWARE of telemarketers who call to sell plans.  They are NOT licensed insurance agents or they may be selling discount plans or mini-medical plans as real health insurance.   This is what an intelligent insurance shopper should do before making any purchases over the phone:

• Always ask for the agent's insurance license number and look it up online.
  1. A license is required to sell insurance.
  2. Florida is one of the few states that regulates discount plans, but sales people are not required to have a license to sell some discount plans.
• Make sure you can see the plan details on a website.
• If the agent tells you that this is guaranteed acceptance, this is a sign of discount, limited benefit, or mini-medical plans.  Major medical insurance must be underwritten before you are accepted.  This can take 1-10 business days depending on the carrier and longer if you have pre-existing medical conditions or if the carrier requires medical records.

Q4.  What is the Patient Protection and affordable Ace Act (“PPACA”)?

A.  This is is the new law, effective March 23,2010, that many people refer to as “Health Care Reform.”  Click here for Wikipedia’s entry that explains the new law, the legislative history, provides an explanation and listing of the effective dates for the most important changes, and other information.

Q5.  What are the “grandfather” rules under PPACA for individuals who had plans on March 23, 2010?

A.  Subscribers who had coverage on March 23, 2010 will be able to retain their plans and be exempt (hence “grandfathered”) from many of the requrements of PPACA.  All health plans subject to the new law--whether or not they are grandfathered plans--must provide certain benefits to their customers for plan years  (i.e. plan anniversary dates) starting after September 23, 2010 including (1) no lifetime limit on coverage; (2) no recisssions on coverage when people who get sick made an unintentional mistake on their applications; and (3) extension of parents’ coverage to young adults under 26 years old.  Click here  for the news release and information about regulations issued by the Department of Health and Human Services on “grandfathered” health plans.  The regulations are very complicated and each carrier is acting differently in response.  If you had a plan in effect on March 23 and are considering making changes in response to any renewal letter or if you are changing carriers, you should determine how you might be affected if you make these changes.

Q6.  What is individual or family health insurance?

A.  Affordable insurance for individuals and families.

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups.  If insurance through your employer is not an option for you or is too expensive, it is still important for you to obtain coverage.  You will find that individual insurance is very affordable.  With a knowledgeable licensed agent, it can also be quick and easy.

Q7.  What is the best insurance plan?

A.  The plan that best meets your specific needs.

Every person is different and has different needs.  The best way to determine which plan is the right one for you is to call Florida Health Insurance Professionals and work with them to determine which plan will work best for you.

Our friendly licensed agents will review: Your budget, how often you go to the doctor, do you take prescriptions, do you have any illnesses, do you want basic/catastrophic coverage or a complete plan with all the bells and whistles, do you need short term insurance or do you intend to keep your plan over the long haul, and what is your primary reason for purchasing insurance.  Your answers will help them work with you to find the right plan.

Q8.  Do I need an individual policy if I have an individual plan at work?

A.  Maybe.

Many factors must be considered, such as: Do I plan to remain at my current job? Do I feel secure in my current job? What current benefits does my employer provide, and do I feel they are sufficient? Are there certain benefits that are not provided, or limited in a way I feel leaves a gap to be filled in my coverages? Are there members of my family who are not adequately covered, or are ineligible for my group benefits?

An individual can not be covered by both group insurance and an individual policy offering either standard, long-term or short-term insurance. However, a person can be covered by both group insurance and either supplemental insurance, most limited benefit plans, or a no medical questions asked or guaranteed acceptance health plan.

Q9.  What is a PPO plan?

A.  Preferred Provider Organization.

As a member of a PPO (Preferred Provider Organization) plan, you will want to use the insurance company's networks of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate (this is called the "network discount").  You won't have to pick a primary care physician.  You'll be able to see a specialist without having to get a referral from a primary care doctor.

You'll be able to use doctors and hospitals outside the network as well, but there will be more out-of-pocket expenses on your part.

With an individual or family PPO there's an annual deductible you'll have to meet before medical bills are paid.  Most companies offer optional benefits or plans with physician co-pays and prescription co-pays.  Physician co-pays are NOT subject to deductibles.  Prescription co-pays will either have no deductibles and/or separate deductibles before the co-pay.

With many plans there's a percentage called co-insurance that you'll be responsible to pay after the deductible.  Make sure that the plan you are purchasing has a "stop loss" (a maximum out-of-pocket expense that you are responsible for).

Q10.  What is an HMO Plan?

A.  Health Maintenance Organization.

HMO (Health Maintenance Organization) plans typically enable members to have lower out-of-pocket healthcare expenses but also usually offer less flexibility in the choice of physicians or hospitals compared to a PPO.  As a member of an HMO, you'll be required to choose a primary care physician (PCP).  Your PCP will take care of most of your healthcare needs.  Before you can see a specialist, you'll need to obtain a referral from your PCP.

Some HMO's like CoventryOne HMO (formerly Vista) have introduced "open access plans" that permit members to choose any provider who accepts the plan without a referral; these plans typically cost 6-7% more than similar non-open access plans with the same features (all four CoventryOne HMO "Z" Plans come only in "open access" versions).

With CoventryOne HMO, the largest and in our opinion best individual/family HMO available in South Florida, deductibles (some plans have no deductibles) and co-insurance or daily hospital co-pays apply ONLY to the hospital.  Hospital emergency room visits cost only $100 ($500 in participating hospitals for the “Z” plans). You pay only the office visit co-pay for all covered services in a doctor's office or urgent care center outside of the hospital.

With CoventryOne HMO individual plans you are covered for emergencies (hospital and emergency room only) in or out of South Florida.  

Other HMO's have different benefits and provisions.

AvMed, CoventryOne HMO, Medica, Neighborhood, Preferred Healthcare, and Citrus are the best known HMO's in Florida, and (with the exception of Citrus) are available on an individual plan basis only in South Florida.  Neighborhood does not offer individual plans. AvMed offers both HMO (Easy plans) and POS plans (all other plans; see next question for explanation of POS plans)) on an individual basis ONLY in Miami-Dade and Broward counties.

Q11. What is POS or Point of Service?

Some HMO’s offer plan members the option to self direct care, as under a PPO plan, rather than get referrals from primary care physicians.  An HMO with this opt-out provision is known as a point-of-service (POS)  plan.  How the plan functions (i.e. like an HMO or like a PPO plan) depends on what the individual plan members decide to do at the point-of service, as well as on the particular plan design.

Typically, when medical care is needed, the individual plan member has three choices.  The plan member can choose to go through his or her primary care physician, in which case services will be covered per the policy’s regular HMO guidelines.

Alternatively, the plan member can access care through a PPO provider and the services will be covered under in-network PPO rules. Some carriers permit this only outside their service area while others allow this in- or outside their service area.

Finally, if the plan member chooses to obtain services from a provider outside of the HMO and PPO networks, the services will be reimbursed according to out-of-network rules.  Because people who belong to POS plans are responsible for deciding where to seek care, it is important that they understand the financial implications of these choices.

Except for the Easy plans which are HMO plans, AvMed offers individual/family POS plans in Miami-Dade and Broward Counties.  Subscribers are in-network if they use AvMed providers in any Avmed service area throughout Florida.  They also receive in-network benefits if they use providers in the Private Healthcare Systems (“PHCS”) network outside AvMed service areas anywhere in- or outside of Florida.

Otherwise, major carriers offer true POS plans only in group plans in Florida.

Q12.  What is an HSA?

A.  Health Savings Account.

Legislation establishing Health Savings Accounts (or HSA's) took effect on January 1, 2004. HSA-eligible health insurance plans that permit subscribers to establish voluntary and tax-deductible health savings accounts are becoming more and more popular.  These are sometimes referred to as "consumer-directed health plans." Here are the basics:

• A voluntary tax-deductible health savings account may be established and used in conjunction with an HSA-eligible health insurance plan to pay for qualifying medical, dental, and vision care expenses and/or long-term care insurance premiums.
• HSA plans have minimum and maximum deductibles established by the government.  These amounts are indexed so that they usually change annually.
• Choosing an HSA-eligible health insurance plan may help save you money. Typically, the monthly premium on an HSA eligible plan is less expensive (as much as 60%) than the monthly premium for a lower-deductible health insurance plan.
• HSA's are particularly popular with people over age 40 and/or with large families.  (Over 40% of buyers in both groups purchase HSA plans.) Most HSA-eligible plans have ONE deductible for the ENTIRE family.
• Contributions to health savings accounts are made on a pre-tax basis up to limits set by the government (these limits usually are increased annually).
• Unused funds in the health savings account remain in the account (they are not forfeited) and accrue year-to-year tax free.

The federal government sets maximum annual contribution limits that individuals or families may not exceed in order to claim a tax deduction.  For 2010 and 2011 these are $3,050 for individuals and $6,150 for families.  In addition, individuals over 55 can make annual “catch-up” contributions of up to $1,000.  Only one catch-up contribution can be made with one HSA even if both spouses are in that plan and are over age 55.

The government also establishes criteria that must be met by the plan in order to qualify.  These include minimum and maximum deductibles and exclusion of maternity care except for complications of pregnancy from coverage.  Preventive care is the only benefit that can be provided prior to the deductible being met.  Some carriers include preventive care prior to the deductible and some do not.

Click here to learn more about HSA's.

Q13.  What is a co-pay or co-payment?

A.  The amount you pay for an office visit or prescription.

A co-pay is your portion of the charge for an office visit or a prescription before the insurance company pays anything.

Office visit co-pays have no deductible requirements.  

Prescription drug co-pays may or may not have deductible requirements before the co-pay is applicable.

Q14. What is a deductible?

A.  A portion of your charges before your insurance pays.

A deductible is your portion of the charges before the insurance company begins to pay.  As a general rule, the lower the deductible, the higher your monthly payment will be.  The higher your deductible is, the lower your monthly premium payment will be. Deductibles apply either on an annual (anniversary date) or calendar year basis depending on the insurance company.

All available individual and family PPO plans have deductibles.  CoventryOne HMO has three plans that have no deductible requirements.

Q15.  What is co-insurance?

A.  Co-insurance is what you are responsible for after the deductible.

Co-insurance is what you are responsible for after the deductible.  For example: the most common co-insurance is an 80/20 plan (0% coinsurance as well as 60/40, 70/30, 75/25, and 50/50% are offered by some carriers.).  With an 80/20 plan the insurance company will pay 80% of the covered medical expenses after the deductible and you will pay 20%.  If there is a charge of $100, then you will pay 20%.  Florida Health Insurance Professionals advises clients only to purchase plans that limit your out-of-pocket expenses.  Note that plans from some carriers DO NOT limit your out-of-pocket co-insurance maximums.

Q16.  What is a pre-certification requirement?

A.  Most carriers require “pre-certification” or notification for inpatient hospital care;  depending on the carrier, this requirement may apply to procedures like colonoscopies, complex diagnostic testing, dialysis and transplant services, and certain drugs and non-emergency transport services.  You should review your policy to determine the requirements of your specific carrier.  Most providers are aware of these requirements and handle the pre-certification and notification for you; however, it is YOUR responsibility to make sure this requirement is met.  If not, carriers can require you to pay more for services and in some cases deny coverage.

Q17.  What is a facility payment?

A.  A separate daily charge for use of hospital facilities.

Plans from some insurance companies require facility payments in addition to deductibles, co-pays and/or co-insurance.  These are separate daily charges for use of in- or out-patient hospital facilities.

Q18.  What is a no-medical-questions-asked health plan?

A.   A plan that makes coverage available to individuals otherwise not qualified for standard, long-term coverage.

These plans provide more limited coverage than standard, long-term insurance and are issued regardless of medical condition.  They are also called Guaranteed Acceptance Plans by some providers. Most of these plans provide health coverage as well as other benefits like discounts and accidental death benefits. Other insured and non-insured features are also included.

Click here (for no medical-questions asked health plans) and here (for guaranteed acceptance health care benefits) and to enroll in one of these plans.  In our opinion Secure Advantage 2000 offered by USA+ provides the highest level of benefits available on either of these sites. We feel the AWA NPX 4 plan (which can not be offered if you are disqualified because of your answers to three qualifying questions) from Homeland Health Care is also an excellent plan, whereas the other plans on these two sites offer lesser benefits but are also lower in cost.

Q19. What is the Health Insurance Portability and Accountability Act ("HIPAA")?

A.  A federal law that requires insurance companies to issue individual policies without medical requirements to those who meet the requirements.

In general, individuals must meet the following five requirements in order to qualify:

• Insured under "Creditable Coverage" for at least 18 months (with no more than a 63 day gap in coverage), the most recent being under an employer-sponsored, governmental or church plan;
• Not eligible for coverage under an employer-sponsored plan, Medicare, or Medicaid;
• No other health insurance coverage;
• Most recent coverage must not have been terminated for non-payment or fraud; and
• Elected and exhausted any applicable COBRA or state continuation coverage.

"Creditable coverage" means employer-sponsored coverage; health insurance coverage; Medicare; Medicaid; CHAMPUS; tribal organization programs; public health plans; or Peace Corps plans.

HIPAA also specifies requirements for protecting and guaranteeing confidentiality of personal health information.