Question 1

What types of insurance plans do you offer?

Accepted Answer

We offer comprehensive health insurance plans for individuals, families, and businesses, including medical, dental, vision, life insurance, and supplemental coverage. Our plans range from basic essential coverage to premium comprehensive plans with extensive benefits.

Question 2

How do I choose the right insurance plan for me?

Accepted Answer

Consider your healthcare needs, budget, preferred doctors and hospitals, prescription medications, and family situation. Our licensed agents can help you compare plans and find the best fit. You can also use our online comparison tools or request a free personalized quote.

Question 3

When can I enroll in a health insurance plan?

Accepted Answer

You can enroll during the annual Open Enrollment Period (November 1 - January 15), or during a Special Enrollment Period if you experience a qualifying life event such as marriage, birth of a child, or loss of other coverage. Some plans may offer year-round enrollment.

Question 4

Are pre-existing conditions covered?

Accepted Answer

Yes, all our ACA-compliant health insurance plans cover pre-existing conditions with no waiting periods or exclusions. You cannot be denied coverage or charged higher premiums based on your health status or medical history.

Question 5

What is the difference between HMO, PPO, and EPO plans?

Accepted Answer

HMO plans require you to choose a primary care physician and get referrals for specialists, offering lower costs but less flexibility. PPO plans allow you to see any doctor without referrals but cost more. EPO plans fall in between, offering no referrals but requiring in-network providers except for emergencies.

Question 6

What documents do I need to apply for individual insurance?

Accepted Answer

You'll need a government-issued ID, Social Security number, proof of income (pay stubs or tax returns), and basic information about your current health status. The application process typically takes 10-15 minutes online.

Question 7

Can I keep my current doctor with an individual plan?

Accepted Answer

It depends on the plan type and network. PPO plans offer the most flexibility to see any doctor, while HMO plans require you to choose doctors within the network. We can help you verify if your preferred doctors are in-network before you enroll.

Question 8

How much does individual health insurance cost?

Accepted Answer

Individual health insurance costs vary based on age, location, plan type, and coverage level. Our plans start at $129/month for essential coverage. You may qualify for tax credits or subsidies that reduce your monthly premium, depending on your income.

Question 9

What happens if I lose my job and employer coverage?

Accepted Answer

Losing employer coverage qualifies you for a Special Enrollment Period to enroll in an individual plan. You typically have 60 days from the loss of coverage to enroll. Your individual plan provides the same protection and is portable, meaning it stays with you regardless of employment changes.

Question 10

Are prescription medications covered under individual plans?

Accepted Answer

Yes, all our individual plans include prescription drug coverage. The specific medications and copay amounts vary by plan tier. Essential plans cover generic drugs, while Preferred and Premium plans cover both generic and brand-name prescriptions with lower copays.

Question 11

What is the maximum number of family members I can cover?

Accepted Answer

Our Family Starter plan covers up to 4 members, Family Plus covers up to 6 members, and Family Elite covers unlimited family members. Family members typically include spouses, domestic partners, and dependent children up to age 26.

Question 12

Is maternity and newborn care included in all family plans?

Accepted Answer

Yes, all our family plans include comprehensive maternity care, including prenatal visits, delivery, and postnatal care. Newborn care is automatically covered from birth under your family plan at no additional cost.

Question 13

Can my college student be covered under our family plan?

Accepted Answer

Absolutely! Dependent children are covered until age 26, even if they're away at college. Our Family Plus and Elite plans include extended college health coverage, and Elite even offers worldwide coverage for students studying abroad.

Question 14

Do you offer pediatric dental and orthodontics coverage?

Accepted Answer

Yes! Family Starter includes basic pediatric dental, while Family Plus and Elite include full dental and orthodontics coverage. This covers braces, retainers, and other orthodontic treatments for children and teens.

Question 15

What happens if we have another child during the year?

Accepted Answer

Having a baby qualifies as a Special Enrollment Period. Your newborn is automatically covered from birth for the first 30 days. You can then officially add them to your policy within 60 days of birth without waiting for Open Enrollment.

Question 16

What is the minimum number of employees required for group coverage?

Accepted Answer

Most states require a minimum of 2 employees to qualify for group health insurance. Our Small Business plan is designed specifically for businesses with 2-10 employees, making it easy for even the smallest companies to offer comprehensive benefits.

Question 17

How does the pricing per employee work?

Accepted Answer

Pricing is based on the number of enrolled employees, their ages, location, and plan selections. The rates shown are per employee per month. Larger groups typically receive better rates due to economies of scale. We'll provide a detailed quote customized to your specific workforce.

Question 18

Can employees choose different plan levels?

Accepted Answer

Yes! We offer flexible plan designs that allow employees to choose the coverage level that best fits their needs and budget. This helps control costs while still providing comprehensive options for your team.

Question 19

What compliance support do you provide?

Accepted Answer

We provide full ACA and ERISA compliance support, including help with required forms (5500, 1094-C, 1095-C), COBRA administration, and keeping you updated on changing regulations. Our Mid-Size Business and Enterprise plans include dedicated compliance assistance.

Question 20

Do you offer benefits administration platforms?

Accepted Answer

Yes, all our business plans include access to our online benefits administration platform. This includes online enrollment, employee self-service portals, payroll integration, claims tracking, and reporting tools. Enterprise plans receive our full-featured platform with advanced analytics.

Question 21

What is the ACA Health Insurance Marketplace?

Accepted Answer

The ACA (Affordable Care Act) Marketplace is a platform where individuals, families, and small businesses can shop for and purchase health insurance plans. All plans meet minimum essential coverage standards and offer protections for pre-existing conditions.

Question 22

Can I qualify for financial assistance or subsidies?

Accepted Answer

You may qualify for premium tax credits or cost-sharing reductions based on your household income and size. Most people with household income between 100% and 400% of the federal poverty level qualify for some assistance. Our advisors can help you determine your eligibility.

Question 23

What's the difference between bronze, silver, gold, and platinum plans?

Accepted Answer

Metal tiers indicate how costs are split between you and the insurance company. Bronze plans have lowest premiums but highest out-of-pocket costs (60/40 split), while Platinum plans have highest premiums but lowest out-of-pocket costs (90/10 split). Silver and Gold plans fall in between.

Question 24

When can I enroll in Marketplace insurance?

Accepted Answer

You can enroll during the annual Open Enrollment Period (typically November 1 - January 15) or during a Special Enrollment Period if you experience qualifying life events like marriage, birth of a child, loss of coverage, or relocation.

Question 25

How do I compare plans in the Marketplace?

Accepted Answer

Compare plans based on monthly premium, deductible, out-of-pocket maximum, provider network, prescription drug coverage, and specific benefits you need. Use our filtering tools to narrow your options, and consider both your current health needs and potential future needs.

Question 26

What is virtual care and how does it work?

Accepted Answer

Virtual care (also called telemedicine) allows you to consult with healthcare providers remotely via video, phone, or messaging. You can connect with doctors, therapists, and specialists from the comfort of your home for non-emergency medical issues, prescriptions, and follow-up care.

Question 27

What types of conditions can be treated through virtual care?

Accepted Answer

Virtual care can treat common conditions like cold and flu, allergies, sinus infections, skin conditions, UTIs, minor injuries, mental health concerns, and chronic disease management. For emergencies or conditions requiring physical examination, you'll be directed to in-person care.

Question 28

Is virtual care available 24/7?

Accepted Answer

Yes! Our virtual care service provides 24/7 access to board-certified physicians and healthcare providers. Whether it's early morning, late night, or on weekends, you can connect with a doctor whenever you need care.

Question 29

How much does a virtual care visit cost?

Accepted Answer

Virtual care visits are typically much more affordable than traditional in-person visits. Most plans include virtual care at no additional cost or with a low copay ($0-$25). Check your specific plan details for exact pricing.

Question 30

Can virtual doctors prescribe medications?

Accepted Answer

Yes, virtual care providers can prescribe medications when medically appropriate and send prescriptions directly to your preferred pharmacy. However, they cannot prescribe controlled substances or certain other medications that require in-person evaluation.

Question 31

What dental services are covered?

Accepted Answer

Our dental plans cover preventive care (cleanings, exams, X-rays), basic procedures (fillings, extractions), and major procedures (crowns, root canals, bridges). Premium plans also include orthodontics. Preventive care is typically covered at 100% with no deductible.

Question 32

How often can I get dental cleanings?

Accepted Answer

Most plans cover two routine dental cleanings per year at 100%. Some premium plans offer additional cleanings if recommended by your dentist for specific oral health conditions.

Question 33

What does vision coverage include?

Accepted Answer

Vision coverage includes annual eye exams, prescription eyeglasses or contact lenses, and lens enhancements. Many plans also offer discounts on LASIK and other vision correction procedures. You can typically get new lenses every 12 months and frames every 24 months.

Question 34

Can I choose my own dentist or eye doctor?

Accepted Answer

Yes! PPO plans allow you to visit any licensed dentist or eye doctor, though you'll save more using in-network providers. HMO plans require you to choose from our network of providers. We have extensive networks with thousands of providers nationwide.

Question 35

Is orthodontic coverage included?

Accepted Answer

Orthodontic coverage varies by plan. Our Premium dental plans include comprehensive orthodontic coverage for both children and adults, covering braces, retainers, and Invisalign. There's typically a lifetime maximum benefit of $1,500-$3,000 for orthodontic work.

Question 36

What’s the Real Difference between Dental Insurance and Dental Discount Plans?

Accepted Answer

Dental insurance helps pay part of your dental bills (often with premiums, deductibles, annual maximums, and waiting periods) , while a dental discount plan doesn’t pay anything for you but gives you access to pre‑negotiated lower fees at participating dentists, with no deductibles, claims, or annual limits. Read more about the differences between dental insurance and discount plans in our blog post: Dental Insurance vs. Dental Discount Plans: What’s the Real Difference?

Question 37

What's the difference between term and whole life insurance?

Accepted Answer

Term life insurance provides coverage for a specific period (10, 20, or 30 years) at lower premiums. Whole life insurance provides lifetime coverage with a cash value component that grows over time, but has higher premiums. Term is ideal for temporary needs, while whole life offers permanent protection.

Question 38

How much life insurance coverage do I need?

Accepted Answer

A common rule of thumb is 10-12 times your annual income. Consider your debts, mortgage, children's education costs, and income replacement needs. Our coverage calculator and licensed agents can help you determine the right amount for your specific situation.

Question 39

Do I need a medical exam to get life insurance?

Accepted Answer

It depends on the coverage amount and type of policy. Many policies up to $250,000 are available with simplified underwriting (no medical exam required). Larger amounts typically require a medical exam, which we arrange at no cost to you at a convenient location.

Question 40

Can I convert my term life insurance to whole life?

Accepted Answer

Yes! Most of our term life insurance policies include a conversion option that allows you to convert to whole life insurance without a medical exam, typically within the first 10-20 years of your policy. This provides flexibility as your needs change.

Question 41

When do life insurance benefits pay out?

Accepted Answer

Life insurance benefits are paid to your designated beneficiaries upon your death, after the claim is processed and approved. Most claims are processed within 30-60 days. Beneficiaries can typically choose between a lump sum payment or structured payments over time.

Question 42

What is short-term disability insurance?

Accepted Answer

Short-term disability (STD) insurance provides income replacement if you're unable to work due to a covered illness or injury. It typically covers 40-70% of your salary for a period of 3-6 months, helping you pay bills while you recover.

Question 43

What conditions are covered by short-term disability?

Accepted Answer

STD covers non-work-related illnesses, injuries, surgery recovery, pregnancy and childbirth, and complications from medical procedures. Common claims include accidents, back injuries, pregnancy complications, surgery recovery, and serious illnesses requiring extended time off work.

Question 44

How long is the waiting period before benefits begin?

Accepted Answer

The elimination period (waiting period) is typically 7-14 days from the date of disability. This means benefits start after you've been disabled for that period. Some plans offer options for shorter elimination periods with slightly higher premiums.

Question 45

How much does short-term disability insurance cost?

Accepted Answer

The cost of short-term disability insurance varies based on your occupation, age, location, and the level of coverage you select. Generally, it costs between 1-3% of your annual salary. Some employers offer group plans at a reduced rate.

Question 46

Can I get short-term disability if I'm self-employed?

Accepted Answer

Yes! Self-employed individuals can purchase individual short-term disability insurance. While it may cost slightly more than group coverage through an employer, it provides crucial income protection if you can't work due to illness or injury.

Question 47

What is critical illness insurance?

Accepted Answer

Critical illness insurance provides a lump-sum cash payment if you're diagnosed with a covered serious illness such as cancer, heart attack, stroke, or organ transplant. You can use the money for any purpose - medical bills, living expenses, or treatment not covered by health insurance.

Question 48

What illnesses are covered under critical illness insurance?

Accepted Answer

Covered conditions typically include cancer (excluding skin cancer), heart attack, stroke, kidney failure, major organ transplant, coronary artery bypass surgery, paralysis, and ALS. Some plans also cover additional conditions like blindness, deafness, coma, and severe burns.

Question 49

How does critical illness insurance differ from health insurance?

Accepted Answer

Health insurance pays for medical treatments and services, while critical illness insurance provides a cash benefit directly to you upon diagnosis. You can use critical illness funds for anything - deductibles, experimental treatments, travel for treatment, lost income, or household expenses.

Question 50

How much critical illness coverage do I need?

Accepted Answer

Consider your health insurance deductible and out-of-pocket maximum, potential lost income during treatment, and additional expenses like travel or home care. Many people choose coverage between $10,000-$50,000. Our advisors can help you determine the right amount.

Question 51

Can I purchase critical illness insurance if I have pre-existing conditions?

Accepted Answer

Coverage availability depends on the specific condition and when it was diagnosed. Some pre-existing conditions may result in exclusions or waiting periods. It's best to apply early when you're healthy, as acceptance becomes more difficult after a serious diagnosis.

Question 52

What is hospital indemnity insurance?

Accepted Answer

Hospital indemnity insurance (also called hospital insurance) pays you cash benefits when you're hospitalized. Unlike health insurance that pays the hospital, this pays you directly to help cover expenses like deductibles, copays, lost wages, childcare, or any other costs during hospitalization.

Question 53

How much does hospital insurance pay per day?

Accepted Answer

Daily benefits typically range from $100-$500 per day of hospitalization, depending on your plan selection. Some plans also include initial admission benefits ($500-$2,000) plus daily benefits. You choose your benefit amounts when enrolling.

Question 54

Does hospital insurance cover outpatient procedures?

Accepted Answer

Many hospital indemnity plans now include benefits for outpatient surgery, emergency room visits, ambulance services, and diagnostic testing. Coverage varies by plan, so check your specific policy details for outpatient benefits.

Question 55

Is there a waiting period before hospital insurance takes effect?

Accepted Answer

Most hospital indemnity plans have no waiting period for accidents and a short waiting period (0-30 days) for illness. Some plans may have longer waiting periods for specific conditions or pre-existing conditions.

Question 56

Can I use hospital insurance with my regular health insurance?

Accepted Answer

Yes! Hospital indemnity insurance works alongside your regular health insurance. Your health insurance pays the medical bills, while hospital insurance pays you cash benefits to help with out-of-pocket costs. It's supplemental coverage that adds an extra layer of financial protection.

Question 57

What are supplemental insurance products?

Accepted Answer

Supplemental insurance products provide additional financial protection beyond your primary health insurance. They include critical illness, hospital indemnity, accident insurance, cancer insurance, and disability coverage. These plans pay cash benefits directly to you to help cover out-of-pocket expenses.

Question 58

Why do I need supplemental insurance if I have health insurance?

Accepted Answer

Even with good health insurance, you can face significant out-of-pocket costs from deductibles, copays, and coinsurance. Supplemental insurance provides cash benefits to help cover these expenses, plus indirect costs like lost wages, childcare, or household help during illness or injury.

Question 59

Can I bundle multiple supplemental insurance products?

Accepted Answer

Yes! We offer bundle discounts when you purchase multiple supplemental products together. Common bundles include critical illness + hospital insurance, or short-term disability + critical illness. Bundling typically saves 10-20% compared to purchasing products separately.

Question 60

How do supplemental insurance claims work?

Accepted Answer

Claims are typically simple and fast. You submit proof of the covered event (diagnosis, hospital admission, etc.) along with a claim form. Once approved, benefits are paid directly to you, usually within 5-10 business days. You can use the money however you choose.

Question 61

Are supplemental insurance premiums tax-deductible?

Accepted Answer

It depends on the product and your situation. Premiums for accident and health insurance may be tax-deductible if you're self-employed or itemize medical expenses exceeding 7.5% of adjusted gross income. Disability insurance premiums are generally not deductible, but benefits may be tax-free. Consult a tax advisor for your specific situation.

Question 62

How do I enroll in a plan?

Accepted Answer

You can enroll online through our website, by phone with one of our licensed agents, or by submitting a paper application. Online enrollment takes about 10-15 minutes. You'll need personal information, Social Security number, and payment information.

Question 63

What payment methods do you accept?

Accepted Answer

We accept automatic bank draft (ACH), credit/debit cards, and for some plans, payroll deduction if offered by your employer. Automatic payments ensure you never miss a payment and may qualify for a small discount.

Question 64

When does my coverage start?

Accepted Answer

Coverage typically begins on the first day of the month following your enrollment and first payment. If you enroll before the 15th and pay immediately, some plans offer coverage starting the 1st of the current month. Special enrollment periods may have different effective dates.

Frequently Asked Questions