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If you are a small group between 1-50 employees, you are not required to put a plan in place. However, the plan options available for groups are substantially more comprehensive than those available on the individual and family market.
Not all doctors contract with all plans, it's best to use these provider links and to double check with your doctor before scheduling any visits.
Nothing. A broker's services are always free to the consumer. We are paid by the insurance vendors, and it is a large part of our job to service your account and help resolve any issues that may arise.
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.
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.
This is the maximum amount you could be required to pay out for claims incurred during any calendar year, provided that you are only using in-network services. The maximum is considerably higher if you use non-network services, so try to stay in the network.
In some plans, these providers are not covered at all. In other plans, they are covered to a much lower level. It is highly recommended not to go out of network if at all possible. If you must see an out of network provider for an emergency issue, this would be paid as an in-network expense.
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.
