Understanding Health Insurance

Our expert team will help you decide on the best plan for your lifestyle or workstyle.  Before you request a quote, take a minute to review some of the most often requested health insurance plans.  The questions you have about coverage will help us research companies and policies that will best meet your needs.

HMOs

The HMO is a collection of subscribers who receive services from doctors, hospitals and clinics that are members of that particular “Health Maintenance Organization.”  If your current doctor is not a member of that HMO, you will need to find a doctors that is participating.

• You choose a primary care physician (PCP) from a list of participating doctors. He or she is your personal doctor, who you see for routine medical care like annual exams and health issues. If you need to see a specialist, be hospitalized, or have lab or X-ray work, your doctor will refer you to a provider or facility. Your doctor must give authorization for those services to be covered by your HMO.
• You may have to pay some portion of the cost (called a co-payment) for each office or hospital visit, such as $15 per doctor visit, regardless of what the services cost.
• You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).
• You do not have to fill out claim forms, which makes this a relatively simple system.

PPOs

You have more choices and access to servcies in a PPO. Referrals are not required for specialists. The PPO is also a network of providers, but you are allowed to see a professional outside the network. In those cases, your portion of the costs will be higher.

• You will have choices to make about your insurance options within the PPO system when you enroll. Your choices will apply to you and any dependents you enroll in the plan, and can usually only be changed once a year during “open enrollment” periods.
• You’ll receive a list of participating medical professionals, which you can use to find health care. Or you may continue to see anyone you already use.
• You may have to pay a portion of the cost for each office or hospital visit, regardless of how much the visit costs. Your portion is the “co-payment.”
• You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).

Major Medical – Traditional Indemnity

You may experience the greatest freedom in this plan, but with that freedom comes a higher share of the costs on your party. You are allowed to see any licensed health care professional for anything the policy covers. You can choose the level of your deductible, which in turn applies to any dependents that are enrolled in the plan.

• The deductibles you choose apply to each person enrolled in the plan (so if you and a spouse enroll and select a $250 deductible, you each must pay $250 in medical expenses before your plan starts paying further costs each year). But companies typically set a maximum of two or three deductibles per family.
• Costs that exceed your deductible are covered by a coinsurance plan, so you and the insurance company share the cost for services covered by the policy. For example, with an 80/20 provision, the insurance company pays 80% and you pay 20%.
• After you meet your deductibles, coinsurance maximums apply that protect you from escalating bills.
• You may have to pay extra for some services (emergency room, mental health and chemical dependency services, for example).

Ready to get started?

Choose one of the buttons below.  If you would like to request a quote for individual health insurance, the best place to start is by filling out the online application through Blue Cross and Blue Shield of North Carolina.  If you are a business or an individual with more needs than just individual health insurance, choose the “Request a Quote” button to tell us how we can help!

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