Individual & Family
What is individual and family health insurance?
When possible, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.
What kinds of individual and family insurance plans are available?
Typically, indemnity plans offer a broader selection of health care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically use health care provider networks. Health care providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you.
In general, you'll have less paperwork and lower out-of-pocket costs with a managed-care health insurance plan, and you'll have a broader choice of health care providers with an indemnity plan.
How does a PPO plan work?
You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a copayment for certain services or be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.
How does an HMO plan work?
With an HMO, you'll likely have coverage for a broader range of preventive health care services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your copayments could be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage at all for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
How does a POS plan work?
Typically, however, you will receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you'll likely have to pay up-front and submit a claim to the insurance company yourself.
Please note this information may vary by insurance company.
How does an indemnity plan work?
Under an indemnity plan, you can see whichever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.
However, this kind of freedom can cost you. You'll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the "usual, customary, and reasonable (UCR) rate" for the service. The UCR rate is the amount that health care providers in your area typically charge for any given service.
An indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.
How does an HSA work?
An HSA is a tax-favored savings account that may be used in conjunction with an HSA-compatible high deductible health insurance plan to pay for qualifying medical expenses.
Choosing an HSA-compatible health insurance plan may help you save money. Typically, the monthly premium on an HSA-compatible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
Contributions to an HSA may be made pre-tax, up to certain annual limits.
Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.
What is a copayment?
For example, your health insurance plan may require a $15 copayment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
What is a deductible?
Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most indemnity and PPO plans do.
What is coinsurance?
For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional copayment or deductible requirements), then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.
What is the difference between in-network and out-of-network providers?
Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.
As a general rule, PPO, POS, and HMO plans make use of provider networks. Indemnity plans typically do not.
When does my coverage start?
Under the Affordable Care Act (ACA), you normally need to apply for your individual or family health coverage during the Open Enrollment Period (OEP). OEP is a period of time in which you can enroll for health insurance without experiencing a life event that qualifies you for a Special Enrollment Period (see below for more information). For health coverage starting in 2015, the OEP is Nov 15, 2014 through Feb 15, 2015.
The specific date your 2015 coverage starts depends on when you submit your application. In general, if you apply between the 1st and 15th of the month, your start date is the 1st of the next month. If you apply after the 15th of the month, your start date is usually the 1st of the month after the next. Your exact start date depends on your particular insurance company and the plan you choose. To speed up the process, it’s a good idea to e-sign your application.
Do be aware that after 2015 OEP ends (Feb 15, 2015), you can sign up for 2015 health coverage during a Special Enrollment Period (SEP), if you qualify. You qualify for an SEP if you experience certain life events, such as marriage, birth or adoption of a child, or a change in employment.
How can I insure just my child?
However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. You may apply for each child separately.
Why should I shop with you rather than buying an insurance plan elsewhere?
Broad selection. Because we are a health insurance agency and not a health insurance company, we can offer plans from multiple insurance companies in your area. We offer a broad selection of health insurance companies and plans, letting you find the plan that best fits your needs. In fact, eHealthInsurance is the leading online source of health insurance for individuals, families, and small businesses.
Best prices. Health insurance premiums are filed with and regulated by your state's Department of Insurance. Whether you buy from eHealthInsurance, your local agent, or directly from the health insurance company, you'll pay the same monthly premium for the same plan.
Fast processing. eHealthInsurance offers a fast way to apply for health insurance because many of the plans offered on our website can be submitted and signed electronically, eliminating the need to manually print and mail applications. This reduces average processing time significantly.
Excellent customer care. The licensed health insurance agents and knowledgeable representatives that staff our customer care center will help you make the most of your money with professional, unbiased advice.
How do you protect my private information?
When I buy an insurance plan, how do I make payments?
Once you've been approved for coverage, your ongoing premium payments are paid to your health insurance company typically on a monthly or quarterly basis. Insurance companies typically offer several payment options including monthly billings to be paid by check, credit card, automatic bank drafts, or automated credit card charges. Please note that credit card billing of premiums is optional, and you can obtain coverage without using that method of payment.
If I apply for an insurance plan, am I obligated to buy?
A few insurance companies may charge an application fee. You will be notified in the application if the plan you chose requires an application fee. Please note that these fees are non-refundable.
Do you offer the best prices?
Whether you buy from eHealthInsurance, your local agent, or directly from the health insurance company, you'll pay the same monthly premium for the same plan. This means that you can enjoy the advantages and convenience of shopping and purchasing your health insurance plan through eHealthInsurance and rest assured that you're getting the best available price.
Can I contact someone if I need help?
Call us: Our licensed insurance agents and knowledgeable representatives are ready to help you. Just call 877-731-9560, Monday - Friday, 5AM - 9PM PT, and Saturday - Sunday, 7AM - 4PM PT.
- Please note that insurance plan benefits and rates can be discussed only by phone with one of our licensed health insurance agents.
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