FAQ
A: A fixed-dollar amount that a plan member must pay for eligible services before an insurer begins applying insurance benefits. Deductibles are part of certain health care plans and based on a member's specific benefit period.
A: The portion of an eligible medical bill a member must pay out of pocket before an insurer begins paying insurance benefits. Coinsurance amounts are usually a percentage of the total eligible medical bill, such as 20%. Coinsurance applies after the member meets a required deductible or copay amount. Coinsurance is part of certain health care plans. .
A: A copay is a fixed-dollar amount that a plan member pays to a participating network doctor, caregiver, or other medical provider or pharmacy each time health care services are received. A copay is paid before BCBSF pays the covered benefit amount. Copays are part of certain health care plans.
A: Typically defined as a condition / symptom for which medical diagnosis or treatment has been sought in the previous 24 months (sometimes 12) or a conditon / symptom that would otherwise cause a prudent person to seek medical attention. Preexisting conditions can be treated as standard issue, rated-up, excluded or cause an individual to be declined coverage.
A: Medical services that do not qualify for payment or reimbursement by your health plan and are not included in your health plan coverage. Any exclusion is listed in your Contract, Evidence of Coverage, Member Handbook, or Summary Plan Description.
A: Once an appropiate plan has been agreed upon, applications are completed and submitted electronically with the assisstance of your broker.
Q: How long is the application process?
A: Individual applications are underwritten seperately and many factors determine the time it can take for a policy to be issued. A history of coverage and/or good medical history aid to speed the process. "Clean" applications can be issued in as little as 24-48 hours with many carriers, while those requiring addtional steps can average 3-6 weeks. Small group (less than 50 eligible employees) in the state of Florida are guaranteed issue - effective dates are determined upon submission deadlines.
A: Occasionally an insurer will require a para-medical exam to be completed, however, many will work with your existing medical records and conduct tele-interviews in lieu of an exam.