Frequently Asked Questions on Health Insurance

Answer: There are basically two types of health insurance available to the individual, HMO's (health maintenance organizations) and PPO's (preferred provider organizations). Both have their advantages and disadvantages, and a prospective client should consider what is important to him or her before choosing either plan.

An HMO requires that you use the doctors and hospitals in their network. There are no benefits if you see a non-provider. Additionally you must choose a primary care provider or PCP (also known as a personal care physician, personal care provider, or a gatekeeper). This is a physician or other medical professional that serves as a member's first contact with an insurance plan's healthcare system. If you need to see a specialist, your PCP must refer you. There is no deductible with an HMO. Every service (office visits, wellness benefits, x-rays and lab work, emergency visits, surgeries, hospitalizations, etc.) using a contracted provider is a co-pay. You will always know what something is going to cost.

If you are traveling outside of the Southern Nevada provider area, an HMO provides only "life or limb" emergency benefits. If you see a doctor in California for a cold, you're going to pay for everything.

A PPO allows you to see any doctor or facility in their network without obtaining a referral. PPO networks are much larger that HMO networks. Additionally, out-of-network benefits allow you to see providers not in the network, but at a higher cost to you. This is important if you frequently travel outside of the provider area. The major advantage of a PPO is doctor-selection flexibility.

Routine doctor visit consultations and prescription drugs come under a co-pay With most PPO plans, services provided outside of the doctor's office (x-rays, lab work, surgeries, hospitalizations, etc.), are first paid by a deductible followed by a co-insurance percentage. As PPO plans vary, deductibles and coinsurance vary as well. Just like auto insurance, however, the lower your deductible, the higher your monthly premiums.

Answer: This is a type of insurance plan combining features of an HMO and a PPO. You decide whether to go to an HMO network provider and pay a co-pay or go to a PPO provider and pay a deductible and a coinsurance percentage. POS plans sometimes offer maternity benefits.

Answer: A provider is a hospital, health care facility, physician or other medical professional that provides health care services.

Answer: An office visit co-payment (or co-pay) is a fixed dollar amount that you pay for each doctor visit consultation. Most insurance plans require a co-pay of $10 to $40.

Answer: A deductible is a dollar amount that you must pay before the insurance begins to pay your yearly medical expenses. For example, if you plan has a $500 deductible, you must pay the first $500 of your medical expenses before your insurance starts paying anything. Deductibles are most common to PPO plans and usually apply to those services other than regular doctor's office consultations. This usually includes lab work, x-rays, surgeries, emergency room visits or hospitalizations. Office visit consultations are usually covered by a co-payment.

Answer: A preexisting condition is a sickness, symptom or bodily injury for which a person received a diagnosis, medical advice, consultation or treatment before the insurance policy's effective date or for which a person had symptoms before the effective date.

Most insurance companies will not cover preexisting conditions for a period of 12 to 24 months after the policy effective date. As preexisting conditions and insurance companies differ, you should advise us of any health conditions so that we may make appropriate recommendations.

Answer: We offer HMO, PPO and POs plans with maternity coverage. However, these plans usually have a waiting period before benefits begin. Prices may vary significantly between the plans, so it is important that you specifically mention maternity coverage when you request a quote.

Answer: You can compare benefits and prices of the leading health insurance plans in Southern Nevada by either completing the online individual health form or by calling us at 702.258.1995 and we can review all your options. We're open between 7am and 9pm, 7 days a week.

We will then fax, e-mail or mail you a free spreadsheet comparison quote. This two-page summary shows the co-pays, prescription prices, deductibles and premium prices of the leading HMO's and PPO's in Southern Nevada. In most cases, we can then mail or deliver an application to you within 24 hours.

Answer: If you have any questions about the plans, deductible options, preexisting conditions, doctor availability, or monthly costs, please call us at 702.258.1995 and we can review all your options. We're open between 7 am and 9 pm, 7 days a week.

Answer: Not all health insurance companies sell plans directly to individuals and families. Many, like Aetna, Cigna or Principal, provide insurance only for employers or companies.

Answer: No. Insurance companies must charge the same premium whether the plan is purchased directly from the company or though us.