Groups & Businesses

Is there a deductible for the plans you offer, and what is a deductible, anyway?

It varies depending on the plan. Similar to your insurance, a deductible is the amount you pay in full up front before the insurance company steps in and pays the lion's share of the costs. However, there are some services that you pay for on a strict copayment structure that you do not need to meet the deductible for. These include almost all basic medical visits.

What is a copay?

The amount you typically pay for office visits, laboratory tests, X-rays and prescriptions. After you pay the copay for these services, the insurance company typically pays the remainder. There are different copays and limits for out of network care, so try to stay in network whenever possible.

What happens if I don't have control over who treats me in an emergency situation? For example, an ambulance, anesthesiologist or an assisting surgeon in an emergency room?

These claims will often be declined or considered as out of network. Please use our services to help you attempt to get reimbursement on an in-network basis. We have a good track record with helping sort out claims problems, although we cannot guarantee this will always work out.

Why do I need to buy insurance, anyway?

There is a requirement under the Affordable Care Act, frequently referred to as Obamacare, that all legal residents of the USA have coverage compliant with the new plan requirements. There are tax penalties for deciding not to purchase insurance. For members with coverage starting in 2015, this is 2.0% of your overall income, or $295, whichever is larger. For coverage beginning in 2016, the penalty will be 2.5% of your overall income or $695, whichever is larger.