Frequently Asked Questions About Health Insurance

Frequently Asked Questions- General Insurance Information

HMO means "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.  Though there are many variations, HMO plans typically enable members to have lower out-of-pocket healthcare expenses. However, keep in mind that you'll likely have no coverage for services rendered by out-of-network providers or for services rendered without a proper referral from your PCP.

Frequently Asked Questions- Individual Coverage

QLE stands for qualifying life event.  A SEP is a special enrollment period.  Basically, a QLE or SEP is a change to your current living circumstances, or your way of life, such as: getting married, having a baby, or losing health coverage through other means.  Those events could make you eligible for a SEP/QLE, allowing you to enroll in health insurance, outside the yearly Open Enrollment Period.

Frequently Asked Questions- Medicare

Medicare is a federal health insurance entitlement program that pays for a variety of health care expenses. It’s administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services (HHS). Medicare beneficiaries are typically senior citizens aged 65 and older. Adults with certain approved medical conditions (such as Lou Gehrig’s disease) or qualifying permanent disabilities may also be eligible for Medicare benefits.  Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. Even if you didn’t work long enough to be entitled to Medicare benefits, you may still be eligible to enroll, but you might have to pay more.

Frequently Asked Questions- Group/Employer Benefits

A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.  Most private sector health plans are covered by the Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans, including providing access to plan information.