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Frequently Asked Insurance Questions

Here are the most common insurance questions Professional Benefits Team Inc receives.

Our insurance brokers are always available to answer any questions and address any concerns you may have. Call us at (559) 275-7706 for any further inquiries.

Q 1. What is health insurance?

Health insurance is an insurance product that provides cover for medical and surgical expenses of an insured person, in case of a medical emergency. However, you are required to pay a premium to avail health insurance policy.

Q 2. Why should I buy health insurance?

You should purchase health insurance so that you don’t lose your lifelong savings while paying for medical bills in a critical situation.

Q 3. How will health insurance pay for my emergency medical expenses?

Your health insurance plan will pay your hospital bills towards medical expenses incurred due to an illness or injury. Your benefits remain the same whether you go in or out of network within your PPO plan – that is the law.

Q 4. Will I be allowed to cover my family under my health insurance?

Yes! You can gain coverage for self, spouse, children, and others if your plan allows.

Q 7. What are the common coverage benefits under my health insurance?

Health insurance benefits differ from policy to policy. However, basic health insurance benefits include cover for an inpatient hospitalization, pre & post hospitalization, daycare procedures, emergency ambulance expenses, organ donor expenses, domiciliary hospitalization, OPD expenses, and more.

Q 8. What are the benefits of buying a critical illness insurance policy?

Critical illness policies provide coverage for life-threatening illnesses such as Cancer, Stroke, Heart Attack, Kidney Failure, and others. If buying a critical illness plan, you can expect wide cover for critical illnesses (number of illnesses covered depends on plan), lump-sum amount payment on diagnosis, tax benefits, and more.

Q 5. Will I be allowed to buy more than one health insurance plan?

Yes, you are free to buy another plan based on your specific medical needs.

Q 6. Can I pay my group health insurance premium in installments?

In general, the health insurance premium is paid on a monthly basis. But, you can pay your premium in installments (monthly, quarterly or half-yearly basis) as well, if approved by the insurance carrier.

Q 9. Will I be eligible for tax benefits if I buy health insurance?

Yes! Buying health insurance will earn you the eligibility to claim tax benefits under Section 80D of the Income Tax Act, 1961.

Q 10. What if I already have a health insurance policy, but I just want to increase my sum insured?

If you already have an insurance policy but want to extend your cover, you can do so at the time of policy renewal.

Q 11. I have been recently diagnosed with a medical condition. Will I be allowed health insurance?

If you have already been diagnosed with a medical condition, it is considered a pre-existing condition. Due to recent legislation health plans can no longer exclude pre-existing conditions or impose a coverage waiting period. You’re Covered!

Q 12. What are the things I should consider before buying my health insurance policy?

Before making a health insurance policy purchase, it is advisable for you to consider your medical needs, the type of plan you want to invest in, features of the plan, sum insured options, network hospital list, exclusions, premium, and customer reviews.

Q 15. Does my health insurance policy cover me for COVID-19 treatments?

Yes. As per the regulatory requirements, every health insurance policy will cover you for expenses related to treatment required due to positive diagnosis of COVID-19. The level of coverage may vary based upon the plan design and coverage requirements you purchase.

Q 16. What are some common exclusions under health insurance plans?

Common exclusions under health insurance plans include cosmetic surgeries, dental treatments, therapies such as naturopathy, magnetic therapy, acupressure, and other alternative treatments.

Q 13. Will my health insurance coverage begin from day one?

Your policy will start on the agreed upon effective date. For employer provided group health insurance you may have to wait for a period of up to 90 days (waiting period) before your policy starts covering you. Please contact your employer for your specific waiting period to determine your coverage effective date. If you have a health insurance policy for accident coverage, there will be no waiting period.

Q 14. What is the maximum number of claims allowed in a year?

There is no limit to the number of claims that can be made during a policy term.

Q17. What if I haven’t had health insurance before?

If you haven’t had health insurance before or if it’s been a while, you can learn about using your coverage and improving your health with our "From Coverage to Care: A Roadmap to Better Care and a Healthier You"

Q18. Can I get health coverage outside Open Enrollment?

Outside Open Enrollment, you can only get health insurance 2 ways:

Due to a Qualifying Event - Loss of Coverage or job, Divorce, Marriage, Birth of a Child, Death of a Dependent

Due to a move outside your county that resulted in a change to the access you have to provider networks

Q19. Can I buy health insurance if I don't have health insurance?

If you don’t already have health insurance or if you’re interested in switching to a new health insurance plan, you may want to buy a plan on your own through the ACA’s Health Insurance Marketplace. Individuals who need coverage and small employers with fewer than 50 full-time employees can purchase coverage through the Marketplace.

Q20. I’m self-employed. Is it better for me to buy health insurance through a broker, or through the exchange?

You can have the best of both worlds – a broker can help you in the health insurance buying process by giving you personalized help and recommendations. A broker can help you understand terminology, compare available plans, make policy recommendations and complete the enrollment process. They are licensed by the state in addition to being certified by the exchange.

It does not cost you anything to use a broker, and our brokers are certified by the exchange and able to help you compare ACA-compliant off-exchange plans with the options available through the exchange. If your income is too high for subsidies, a broker who can help you shop on and off-exchange will be an excellent resource.

After you purchase a plan, the broker will continue to be your go-to resource when you have questions about your policy, network, or claims – and in almost all cases, there’s never a charge for these services.

Q 23. Is the rate given to me accurate?

Our team makes sure to provide you with the most accurate rate possible so that you know what to expect. If anything, the estimate we give you is higher than the actual price as we rather underpromise and overdeliver.

Q 24. My current insurance company has significantly increased my rate. How can I get a lower rate?

If your current insurance company has increased your rate, you can be sure to find lower rates with Professional Benefits Team Inc. Our insurance brokers are here to find you the most competitive prices on the market today, and we’ll fit you with an insurance package that suits both your needs and your budget.

Q21. Is there still a penalty for being uninsured?

The federal individual mandate penalty was eliminated at the end of 2018, however there is a penalty in New Jersey, DC, Massachusetts, California, and Rhode Island.

Contact us for more information about whether your business is exempt from the penalty in California. (559) 275-7706

Q22. Can I buy health insurance that’s compatible with a health savings account (HSA) through the health insurance exchange in my state?

If you enroll in a high-deductible health plan (HDHP), you’ll be eligible to fund an HSA. And in almost every county in the country, HDHPs are available through the exchange.

Q25. Is there a fee for getting an insurance quote?

With us, there isn’t.

Book a no-obligation consultation with our team, and you’ll receive free insurance quotes from different carriers so that you can easily compare and contrast. We work with you to find the right insurance quote, no strings attached.

Q26. What is a lapse in insurance?

A lapse occurs when you stop paying for or cancel your insurance. We recommend avoiding an insurance lapse as this can result in costly consequences.

When you choose Professional Benefits Team Inc, we make sure you’re making your payments on time and let you know about all the risks involved.

Q27. What is a deductible?

When you incur health care services your health care provider will typically submit a insurance claim on your behalf. A deductible is an amount that is typically applied each calendar year to any major services you had prior to the health plan paying their portion. You’re responsible for the deductible. The deductible amount varies based upon the plan you've purchased.

As your dedicated insurance brokers, we do our best to introduce you to carriers with the lowest deductibles so that you limit the amount you have to pay out of pocket. This way, not only will we shop the most competitive rates, but also varying levels of deductibles, which allows you to determine what amount meets your needs and your budget.

Q29. When should I review my insurance protection?

At Professional Benefits Team Inc, we believe it’s a good idea to review your insurance protection at least once a year. Still, if you have gone through a significant life change, it’s best to check in with us as soon as possible.

Get in touch with us now at (559) 275-7706 to schedule an appointment.

Q28. How do Out-of-Pocket limits and deductibles impact my premium?

Your premium is how much you pay your insurance company regularly to keep your coverage in place. Depending on the insurance type and specific policies, you can pay your premium monthly, quarterly, biannually, or annually. Deductibles are common factors that affect your premium rates.

An out-of-pocket limit is the maximum amount you will have to pay each calendar year for covered services when making a claim—usually, the lower your out-of-pocket limit, the higher your premium. Our insurance agents can guide you in the right direction when it comes to pinpointing the perfect coverage limit for your needs. And they’ll stay on budget, too!

An insurance deductible is the amount of money you have to pay out of pocket for covered services each calendar year. Generally, you may be able to save money on premiums by selecting policies with higher deductibles. Consult with our insurance professionals to see what’s in your best interest.

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