Frequently Asked Questions
From ColoradoHealthInsuranceWiki
[edit] 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.
[edit] 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.
[edit] 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 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.
[edit] Q: What if I have a pre-existing condition?
A: 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.
[edit] 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)
[edit] 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.
[edit] 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.
[edit] 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.
[edit] 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.
[edit] Q: Filing a claim?
A: See how to file a claim.
[edit] 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.
[edit] Q: Are the rates I'm being quoted "teaser" rates?
A: ALL companies have a rate increase EVERY YEAR, anybody who says differently is lying. Anthem Blue Cross Blue Shield, Humana, and Kaiser have the most stable rates in Colorado. Also, the way those 3 companies manage their rates is desirable;
Those 3 companies just come up with a new rate grid every year. Anthem Blue Cross Blue Shield and Kaiser change their rates for all customers on 1/1, no matter when they signed up (Those that had an effective date between 7/1 and 12/31 have a 6 month rate guarantee with Anthem Blue Cross). This grid is the same one that everybody looks at - 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, Humana, or Kaiser 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 3 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.
[edit] 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.
[edit] 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.
[edit] 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
[edit] Q: I've heard that short-term policies are not creditable insurance coverage. Is this true?
A: All of the short term health insurance companies we work with will provide a certificate of creditable coverage to insureds upon request.
[edit] 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.
[edit] Have questions about HSAs?
See the HSA Frequently Asked Questions (HSA faq) page.
