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Frequently
Asked Questions
Q.
Why shop for insurance with a
Broker/Brokerage Firm?
A. An Insurance Broker is a trained insurance expert,
independent of any insurance company, who represents the interests of
the consumer in searching for the most affordable and suitable insurance
coverage available. Five reasons to shop for insurance with a
Broker/Brokerage Firm include:
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Our services are 100% FREE.
The insurance companies pay us directly.
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Since we represent mutiple companies we
can offer more options which helps in making the best
decision. Having options is always a plus.
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We shop the market for you. This
saves time and money.
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We only represent top rated companies.
The Health Companies we represent are all regulated by Florida law.
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We take the time to educate our clients,
and simplify the buying process.
Q.
If I pay the insurance company for the first months
premium can I use the insurance right away?
A. No. you can use the insurance once the company has accepted you
and issued the policy.
Q.
Can I get a better rate from another insurance agency, or agent?
A. No. The insurance rates are set by the insurance companies and only
them.
Q.
Will
using your service cost me anything?
A. All
the services offered by American Insurance Plus are provided
at no extra cost to you, the consumer. If you buy a health
insurance plan through us, you'll pay the regular monthly
premium to the health insurance company you chose only, and
pay nothing to us. The insurance companies compensate us in
the form of commissions, which are built into the premium
amount.
Q.
What is Co-insurance ?
A. The amount you must pay for medical care in a point-of
service plan (POS) or preferred provider organization (PPO)
after you have reached your deductible. It is often a
percentage of bills charged.
Q.
What is a Co-payment ?
A. A charge you pay for medical services. Your health
care plan covers the remaining medical charges. As an
example, you may pay $25.00 for an office visit or a
prescription. *THIS HAS NOTHING TO DO WITH THE
DEDUCTIBLE*
Q.
What is a Deductible ?
A. The amount of money you must pay each year for
coverage to your medical care expenses, before your
insurance policy begins to pay.
Q.
What is an HMO (Health Maintenance Organization) ?
A. Prepaid health plans for which a premium is due each
month. The HMO covers your cost of care to see a doctor
within their working network at pre-negotiated rates.
You are required to choose a primary care physician who
takes care of you and makes referrals to any specialists
you may need. If you, as an HMO member, do not use the
doctors, hospitals and clinics that do not participate
in your planýs network, you may be required to pay the
cost of those medical services.
Q.
What is a Lifetime Maximum ?
A. The maximum percentage of benefits available to a
member during their lifetime, in which, all benefits
served are subject to this limit unless stated as
unlimited. * WE RECOMMEND PLANS WITH $5 MILLION
COVERAGE.
Q.
What is an Out-Of-Pocket Maximum ?
A. The most amount of money you will pay in a calendar
year for deductibles and coinsurance. Ex.
Your plan may have a $1500 deductible, 80/20
coinsurance, and Out of Pocket Maximum of $3000.00. This
simply means that after you have met your deducible
of $1500 the insurance company will pay 80% and you will
Pay 20% until $3,000. After you have spent a total of
$3,000 the insurance company will pay the rest of the
bill. Another Example: With the same plan
mentioned above if you are hospitalized and the bill is
$250,000, you will only be responsible for $3,000 and
the balance of 247,000 will be paid by the insurance
company.
How Insurance
Works
The below example is for illustrational purposes only.
Hospital Bill for Heart
Surgery
Surgery $50,000
Room & Board $25,000
Doctors Fees: $25,000
Total $100,000 |
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Insurance Plan
Deductible $1,000
Coinsurance 20% *
Maximum Out of
Pocket Expense $3,000
Total Cost To Member $3,000 |
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Following a
typical hospital stay for heart surgery, an individual could expect
to pay up to $100,000 in medical expenses as shown in the example
above. With some of the select plans that we offer, a member
would be responsible for the first $1,000, then the next 20% of the
bill until $3,000 is met. After the member has reached $3,000, the
insurance company will pay the remaining $97,000.
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Member Savings
$97,000
(with financial protection) |
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Members
Responsibility
$3,000
(for heart surgery) |
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* Not all insurance plans feature deductible
and coinsurance.
* In Network benefits
Q.
What is a Point-Of-Service (POS) Plan ?
A. A certain managed care plan combing features of
health maintenance organizations (HMOs) and preferred
provider organizations (PPOs). You may choose whether to
go to a network provider and pay a flat dollar amount or
to an out-of-network provider and pay a deductible and/or
coinsurance charge.
Q.
What is a Pre-existing Condition ?
A. A health problem that existed or was treated before
your insurance became in effect. Most health insurances
have a pre-existing condition plan that describes under
what conditions they will cover medical expenses that
relate to a pre-existing condition.
Q.
What is a PPO (Preferred Provider Organization) ?
A. A network of health care providers that offers
medical services to health plan members at a discounted
cost. PPO members usually make their own decisions about
their health care instead of going through a primary
care physician like an HMO member. The costs to use
physicians within the PPO network are less than using a
non-network provider.
Q.
What is a Premium ?
A. The amount you must pay in exchange for health
insurance coverage. (your monthly bill)
Q.
What is a Primary Care Physician ?
A. Under a health maintenance organization (HMO) or
point-of-service (POS) plan, a primary care physician is
often the first contact for health care. It is usually a
family physician, internist, or pediatrician. A primary
care physician makes referrals to specialists if
necessary.
Q.
What is a Provider ?
A. Any person (doctor or nurse) or institution
(hospital, clinic, or laboratory) which is certified,
that provides medical care.
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