Frequently Asked Questions – FAQ
Q: Can I save money by going directly through the insurance company?
A: No. Rates for insurance are filed through the Colorado Division of Insurance. The rates filed with the division of insurance are the only rates that can be charged – whether you buy your policy from the insurance company or a broker.
Q: But, I’ve talked to somebody at the insurance company and the quotes they gave were different than the quotes I received on your quote engine?
A: The quote engines aren’t always 100% accurate, they may be slightly higher or lower than the actual price you’ll end up paying. To get the actual price, contact us to go over your options. We use the same software each of the health insurance companies use in order to verify your quotes – all with one call.
Q: What are the benefits of using a broker?
A: Working with large health insurance companies can be difficult, but a knowledgeable broker can make the experience of getting your own health insurance policy much more tolerable. Insurance Shoppers helps you choose the right plan to fit your tolerance for risk and budget by working with you to compare all of the available options. We understand the application and underwriting process of each company in Colorado, and we know how to streamline the underwriting process for quicker decisions. Finally, we’re able to act as your advocate for any customer service, billing, or claims issues that may arise. Since the price is the same whether you go directly through the company or through a broker, you’re paying for a broker whether you have one or not. You might as well have someone on your side if you ever have the need.
Q: What if I have a pre-existing condition?
A: Starting, in 2014, there won’t be any underwriting. Until then… all health insurance companies in Colorado have different underwriting standards and each health condition is unique in it’s own way. So although you may have heard that your condition may prevent you from getting coverage or if you’ve been declined before, we’re experts in finding the best options for pre-existing conditions.
If you’ve been declined, we’ve written a good article on your options here.
Q: How does Insurance Shoppers get paid?
A: Like any agent or broker, we’re paid a commission by the insurance company each month you have coverage, so we have a vested interest in keeping you as a happy client as long as possible. All you end up paying is the same premium you’d have to pay even if you went directly through the health insurance company. And we end up getting paid a commission if you decide to purchase a policy we recommend to you. The insurance company benefits a lot from this because they don’t have to dedicate resources to have somebody at their company do all of the things we do for you (like explain your options and how the plans work, figure out your best underwriting options, help you through the application and underwriting, and being your advocate if you have any problems with billing or claims after you have the policy)
Q: Where is the Insurance Shoppers office?
A: In April 2008 we gave up a “real office” because 99% of our clients preferred doing business by phone and email instead of meeting face to face. When we did meet with clients, it was in their office or home. So now we still have an office just like before, but it is just a separate place out back of our house in Wellington, Colorado. Now we don’t have the overhead of a lease on office space, we work much more efficiently, and we’re happier. Our office is 99% paper free, all of our energy is wind energy from the Excel Energy “Wind Source” program, and we aren’t wasting gas driving anywhere.
In July of 2009, we moved up to Wellington, just north of Fort Collins. Wellington is a much more bike friendly place with room for a garden.
Q: How long of a contract am I going to be stuck in?
A: All of the health insurance policies are month to month. Even if you have quarterly or annual billing, you are able to cancel and receive a refund of any months you’ve paid for but won’t use.
Q: How is individual/family health insurance changing in 2014?
Q: I’m filling out the health insurance application and they want payment information, but I don’t even know if they accepted my application yet? How does this work?
A:All of the health insurance carriers get payment information on the application because they don’t want to dedicate resources underwriting bogus applications from people that really don’t want coverage. If you end up not wanting the coverage and they may have already charged you, you’ll get a refund. You have a “10 day free look period” – which allows you 10 days after you receive the policy in the mail to turn down the policy and get the refund. That is why credit card is the best form of payment for the first month – they would just reverse the charge instead of having to issue a refund.
Q: What is an HSA?
A: Health Savings Accounts combine a high deductible health plan with a tax deferred savings account. The idea is to self insure the smaller things and have them count toward your deductible. This will give you a large premium savings which you can put into your own health savings account. This money can grow tax deferred until you retire, or you can use it to pay for the smaller healthcare expenses you incur before your deductible. You can learn more from our HSA page and also by reading the HSA FAQ’s.
Q: I can’t understand all of the insurance terms used when I get instant quotes!
A: Most people we talk to everyday get confused with all of the insurance terms like copay, coinsurance, PPO, and out-of-pocket maximum. That’s why we’ve created this easy to understand glossary of health insurance terms.
Q: Both my husband & I are self-employeed. As owners, we have both have opted-out of the workers compensation program. That said, if either of us is injured while at working, will the individual health insurance plan I choose take care of our medical needs?
A: Any individual/family health insurance plan will cover you 24/7 – on or off the job.
Q: All of the health insurance options I see are too expensive. What about this company: http://www.cinergyhealthplans.com? They have the same low rates for everybody, cover pre-existing conditions, and don’t require us to meet deductibles.
A: Plans like this are called “discount plans.” Insurance is there for catastrophic protection, these plans only provide a VERY small payout in some rare cases and sometimes a discounted rate for the services on top of that. Basically, you’ll be better off with nothing.
They are confusing for the consumer though, because they make a serious attempt at marketing themselves as insurance. And they’re hard for the division of insurance to regulate, because they’re not insurance. Here is the warning the Colorado Division of Insurance gives about discount plans: http://www.healthinsurancecolorado.net/discount-health-plans.pdf
Read through this page to see how they call the coverage “insurance” in the big print, but explain how it isn’t insurance in the regular size and small print: http://www.cinergyhealthplans.com/preferred_plan.asp
To help, here is an excerpt from the small print: “It is NOT Major Medical Insurance and is not meant to replace catastrophic health insurance or major medical coverage. [...] These programs provide discounts at certain health care providers for medical services and do not make payments directly to the providers of medical services. The member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with Patriot Health Florida, Inc., located at 160 Eileen Way, Syosset, New York 11791. Members may cancel within 30 days and discounts may vary.“.
Call 25 doctors and hospitals in your area and see how many of them are contracted with “Patriot Health Florida, Inc.” It will likely be zero. Even if all of them were contracted with that company, that’s not what you want. You’re still only getting a smalldiscount on services instead of coverage and you’ll go bankrupt if something happens.
Q: On the application for individual health insurance, it says “We will not pay for services related to a pre-existing condition for 12 consecutive months after the member’s original membership effective date.” But they put an “exclusion” on my asthma, and said they won’t ever pay for any expenses related to asthma. Is that legal?
A: Individual health insurance companies in Colorado will give credit for prior credible coverage that was in effect within 90 days of the effective date of the new policy. This credit waives the pre-existing coverage period, up to 12 months. This means that if there was prior coverage, no claims will be denied as a pre-existing condition, as long as it is not one that the insurance company has applied a benefit exclusion to. If there is no prior credible coverage, in addition to any conditions that were imposed a benefit exclusion, coverage will not be provided for up to one year for certain conditions that were treated within the 12 months prior to the effective date of the new health insurance policy.
A benefit exclusion from 3 years to lifetime can be put on the policy for any condition that the member has received treatment for in the period of time the health insurance company asks about on the application (usually 10 years). The length of the benefit exclusion is at the discretion of the health insurance company. These are conditions that may reoccur and/or have the possibility of the need for further treatment or follow up. When this/these conditions are listed in the health statement portion of the application, they may be imposed the benefit exclusion. If there was prior coverage, those conditions that have the benefit exclusion are the only ones that would be denied for claims payment. If there is not prior coverage, then the health insurance company can review to see if the condition is a new onset, or one that the member had been treated for in the previous 12 months. If there was treatment for a condition, the health insurance company may deny those claims, for up to 1 year, in addition to any benefit exclusions. After the one year period, then claims for the pre-existing conditions will be paid, while those that have a benefit exclusion will not.
Q: I have had continuous coverage for years, even on a group plan. I am also a self-employed group of one. The health insurance company should not even have the right to decline me on the basis of any health condition, or impose any pre-existing conditions. Why do I even have to go through the medical history when I have continuous credible coverage?
A: There are two types of health insurance coverage: underwritten individual and family plans and guarantee issue group plans.
Underwritten coverage is much less expensive because of the lower cost structure of not having to cover pre-existing conditions and it also has fewer mandates.
Guarantee issue coverage is more expensive (you’ll see the actual cost if you’ve ever had COBRA), but worth the extra cost if you have a serious pre-existing condition. In Colorado, there are two ways to get guarantee issue coverage: through an employer or through CoverColorado. Employer sponsored health insurance is required to be guarantee issue so there won’t be any incentive to discriminate hiring based on health. You can even get a group of one guarantee issue plan if you have your own business, but you’ll want to compare group of one coverage to CoverColorado. The reason is that they both have an extremely low number of healthy people in the pools to subsidize those with health conditions, but CoverColorado is subsidized with taxpayer money. If you have health conditions that require the insurance company to cover you on a business group of one plan, you’ll likely only qualify for the “basic” or “standard” plans instead of the wide range of plan options they offer.
Q: Are the rates I’m being quoted “teaser” rates?
A: All reputable health insurance carriers have a rate increase every year. Anthem Blue Cross Blue Shield, Kaiser, Humana United Healthcare, and Cigna have the most stable rates in Colorado. Also, the way those carriers manage their rates is desirable;
All of those carriers except United Healthcare just come up with a new rate grid every year. This grid is the same that all rates are based upon – both people looking to get a plan and people who already have the plan. This is desirable because you know that you are paying the same rate for your plan as somebody your age is getting quoted who may be looking at signing up for the plan. If Anthem Blue Cross, Kaiser, Aetna, Humana, or Cigna want new clients, these rates need to always be competitive. If your rate is always competitive: 1) You don’t need to always be shopping around 2) If you get “stuck” on the plan (having something happen that would prevent you from qualifying for any other companies underwriting), you know that your rate won’t skyrocket out of control on you. Those companies are the only ones who do their rates like that.
All other companies in Colorado have new client rates and existing client rates. This means they have low rates that they quote, but after the first year they will be higher than the rates that somebody your age is getting quoted for the same plan. After a few years with one of these companies, you could go to our website and see the rates you are getting quoted by your current company and other companies are substantially lower than your current rate.
Q: After we get an application filed, will the selected insurance company send out a person to take a history, weight, blood pressure, samples, and such before they decide whether to accept us? I’ve seen that done for life insurance. Is it done for health insurance?
A: Life insurance and health insurance have a very different underwriting process. The health insurance company will gain what they need through the application and any further information they need will be obtained through ordering medical records from the doctors listed or through the Medical Information Bureau.
Q: What’s the difference between Insurance Shoppers and ehealthinsurance.com?
A: 1) ehealthinsurance is a CA based company doing business in all states. We are a Colorado based company doing business in Colorado. 2) We represent many more health insurance companies than ehealthinsurance. 3) ehealthinsurance has a highly turned over staff of people new to the insurance industry that were (probably) telemarketing fraud protection for VISA last week staffed to “help” you. We have been doing business with and building relationships with all of the health insurance companies in Colorado since 2002. This affords us the knowledge of the Colorado health insurance industry that you need to get your questions answered quickly and correctly. And the insider leverage to get your billing and claims problems figured out promptly. I’ve even had people from ehealthinsurance call me with questions about Colorado health insurance law at least twice after finding us on the internet. 4) ehealthinsurance can’t sell you a policy any cheaper than we can. 5) ehealthinsurance can’t meet with you if you need personal assistance.
Q: It’s been about 8 months since I signed up for the short term insurance and I may need to sign up again. I used 4 months of short term insurance so does that mean I would be able to use up to 8 months?
A: Colorado law says that you can have a policy for up to 6 months and renew it once for up to 6 months. Then, you must wait at least 6 consecutive months before you can get another short term policy (for up to 6 months – followed by another 6 month policy if you like).
So in your case, you would be able to get another 6 months of short term coverage right now. But once that expires, you’ll have to wait 6 months to get another short term policy of any kind with any carrier for any length of time.
The reason is because you need to have that full 6 month consecutive gap between back-to-back policies. If you were to wait another 2 months from now, you could have up to 12 months of short term coverage. But if you sign up now, you’ll have to complete your 6 month lay-off after this 6 month policy runs out.
Get short term health insurance quotes
Q: We have contacted several health providers in the Vail valley, and they all tell us the same thing. They do not accept Aetna directly, but they bill “Cofinity”; could you clarify this for us.
A: Confity is owned by Aetna. Its the old Sloans Lake provider that merged together w. Aetna network. – so it is the same thing.
Q: I received my insurance cards but did not receive my wife’s or daughters. Do they get cards also?
A: Because you are the primary insured on the policy, the cards will typically only have your name on all of the cards for the family. Providers will still see which spouse and dependents are covered on the policy.
Q: What is your favorite ice cream flavor?
A: Hmmm…. good question – that’s a tough one. I’ll probably be changing this answer or adding to it every so often. But I tend to like ice cream with cookie dough in it – or chunks of reeses peanut butter cups. I think Ben and Jerry’s makes a flavor with both of those plus other stuff in it. I also like coffee flavored ice cream…
Have questions about HSAs?
See the HSA Frequently Asked Questions (HSA faq) page.
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