Why do I need insurance?
A. You need disability insurance
to protect your most important asset
YOU and YOUR LOVED ONES!
You need medical coverage for the peace of mind for yourself and
loved ones. No one wants to be responsible to pay expenses for 10
years or longer after an illness or injury and no one wants to leave
incurred charges to a family member to pay.
Q. How do I determine how much coverage
A. It will be based on need and
Q. Why do I need an
A. An agent can provide personalized
customer service, competitive quotes and alternatives, in addition
to being a liaison between you and the insurance carrier.
Q. What is the difference
between an agency and a brokerage house?
A. An agent/agency is directly
involved with the client whereas a broker/brokerage house mostly
works directly with many agents and carriers. An agent provides
more personalized service to the client. A broker/brokerage house
provides service to the agent.
Q. Can you find the
most competitive companies in the market?
A. Yes, we are independent agents
and we represent over 40 different insurance carriers with a wide
variety of products and plans.
Q. Why do my premiums
increase, even if I do not have a lot of claims?
A. Premium increases are necessary
because the amount of money received to the carrier should be more
than the carrier pays out in expenses. Increases are usually based
on the following things, trend (the anticipated rise in the cost
of health care), demographics (county and state), age brackets (usually
go in 5 year increments) and claims loss ratio (dollars received
versus dollars paid in claims).
Q. How can I lower
A. You can lower your premiums
by going with higher deductibles, coinsurances, and co-pays. The
more risk (financial responsibility) you take the lower your premiums
Q. What is a co-pay?
A. A co-pay is a set dollar amount
indicated in your policy that you pay for a specific service and
does not accumulate toward your deductible. For example, an office
co-pay of $15 you would pay exactly $15 and the insurance carrier
would pay the remainder of the bill for that office visit.
Q. What is a deductible?
A. A deductible is a preset annual
dollar amount that you pay each year before the plan begins to pay.
For example, a $500 deductible you would pay the first $500 of covered
expenses each year before the carrier would begin to pay any of
Q. What is coinsurance?
A. Coinsurance is the preset annual
portion of the bill that you and the carrier share up to a predetermined
limit. For example, a 90% coinsurance to $5,000 means that the carrier
would pay 90% and you would pay 10% of covered expenses up to $5,000
or the carrier would pay $4,500 and you would pay $500.
Q. What is a pre-existing
A. A pre-existing condition is
any illness or injury that is present prior to a policy taking effect.
Q. What is the difference
between COBRA and State Continuation?
A. COBRA (Consolidated Omnibus
Budget Reconciliation Act) is regulated by federal and state laws
and applies to businesses with 20 or more employees. State Continuation
is regulated by state laws and applies to businesses with less than
20 employees. COBRA and State Continuation provides the right to
continue health and/or dental benefits (dental can only be continued
under COBRA) for employees and their dependents that otherwise would
be lost due to qualifying events as indicated by law. Under COBRA
a person has 60 days from the date of the notice informing them
of their right to continue coverage to decide and notify the business
of their election, under State Continuation a person has 30 days
from the date of the notice informing them of their right to continue
coverage to decide and notify the business of their election.
In both cases the insured is responsible to pay the full amount
of the premium to the business in a timely manner to keep coverage
Q. What can I
do if I disagree with the insurance carrier's decision about a claim?
A. You have the right to appeal
a claim a maximum of three times. Each time you file an appeal it
goes to a higher level of decision makers. You should refer to your
certificate/policy for each carrier's procedure for filing appeals/grievances
or you should contact your agent with any questions on filing an
Q. Do I have the right
to file a complaint against the carrier? If so who do I send the
A. Yes, you do have the right
to file a complaint. You should refer to your certificate/policy
for each carrier's grievance procedures. If your complaint is not
handle to your satisfaction you have the right to file a complaint
with the Office of the Commissioner of Insurance who will in turn
follow up on your complaint by contacting the carrier and requesting
various information so that a determination can be made if the carrier
violated any state statues and/or laws.