Health Insurance FAQs

Frequently Asked Questions

What type of plan is right for me and my family?
Every family has different needs, and health concerns, and family health insurance plans should take that into consideration when shopping for coverage. Newtek Insurance Agency will help you break down the plan, explain the coverages ensure you have proper coverage for your personal health concerns. Not all plans are created equal and we will work with you to make sure that your family has the plans and coverage that they need at a price they can afford.

Will my plan change on January 1, 2014?

If your plan is purchased with an effective date prior to 1/1/2014, then carriers will honor a 12 month policy term. You will not see a change in plan structure, pricing, or coverage, until your renewal in 2014.

If you have a plan that currently has a rider for a certain condition(s), or excludes certain coverages that you are looking for specifically, policy holders will have the option to purchase another policy post 1/1/2014 that will include coverage for the pre-existing conditions that they were not able to obtain coverage for previously.

How will Obamacare affect my plan options?
Healthcare Reform will provide more comprehensive coverage for more individuals upon the full implementation on 1/1/2014. Healthcare plans will be required to offer “minimum essential health benefits” which will require that certain standards / coverages are being offered.

Individuals will also no longer be able to denied individual coverage, nor be subject to pre-existing conditions. The removal of pre-existing conditions exclusions means that everyone will be able to obtain coverage regardless of health history.

Carriers have also removed lifetime maximum coverage limits from policies for individuals and small groups. By removing these annual maximum coverage limits, individuals no longer need to worry about exhausting their coverage if they are diagnosed with an expensive illness/injury.

How much can I expect my pricing to drop after January 1, 2014?

It is expected that with the increased coverages that are now being provided to individuals that the cost of offering this coverage to individuals is expected to increase substantially. Some industry estimates indicate that individual health insurance pricing is expected to increase as much as 116%. These increases are not guaranteed for every individual, and reflect premium increases, do not account for out of pocket costs that individuals may incur.

Is there one carrier better than another?

We will work with you to help confirm which carrier is right for you. There is not one carrier that is a best for every individual, and we will work with you to confirm which carrier will provide you and your family with the best network, coverage, deductible credits and cost.

What is the process to obtain coverage?

In order to look at proposals and options for you and your family, all we will need is a short conversation to review your plan objectives, cost/savings and structure. After reviewing this information with you, we will work on plan options to personally review with you.

What should I look for in an individual health insurance plan?

You should take an honest look at how you tend to use the healthcare system historically, and reflect on family history/previous health history to confirm what you truly need in a health care plan. We will walk you through the process and help you determine what you need in a health plan and line that up with different cost options. You do not want to pay for coverage that is not necessary, coverage that you don’t use, or waste your hard earned money on in ineffective health plan.

Are all plans created equal?

Different carriers have different plans, networks, pricing, and some provide ancillary services and deductible credits. We will work with you and your family to confirm which pricing will be the best value and provide the best coverage for you as the insured.

What other services are included / available with my individual health insurance?

We have the ability to integrate individual dental, vision, accident, disability, term life, universal life, and home and auto coverages under one roof. We will work with you to manage your family’s risk and ensure that you and your family are protected.

What is a private exchange?

A private exchange is a marketplace that is set up by a private company in conjunction with health insurance carriers, in order to provide multiple coverage and pricing options to small business owners who are looking to offer benefits to their employees. Many markets have private exchanges, and small business owners are exploring these exchanges as new and different ways to offer comparable and competitive benefits to their employees.

Private exchanges have been in the marketplace for about 15 years, and many small businesses approach them in an effort to expand the number and quality of options to their staff, while limiting the administrative expense. This allows a smaller employer to offer a more complex benefit package than they may traditionally be able to offer based on the size of the company. A private exchange may work with a number of carriers in the private market. After setting up an account as the plan administrator with the private exchange, the small business owner can select a number of carriers and plan designs to offer to their employees regardless as to which carrier the plan is underwritten by. The employer can set up a defined contribution for each employee, and allow them to buy whatever insurance plans they are interested in participating in, and they would cover the difference through a payroll deduction.

The employer will then receive one statement at the end of every billing cycle, and contact the exchange for any customer service issues. This allows the business owner to save on the administration of handling multiple bills with different carriers, and possibly running into carrier enrollment issues because of participation. The state and federal exchanges that were set up were intended to mimic these private exchanges. However instead of being set up by a private company, they were set up and are regulated by federal and state governments.

While many employers like the flexibility of the exchange option, some prefer a more measured and streamlined approach to offering benefits. Being that the exchanges need to contract out with the carriers individually, there are some instances where a carrier plan has been cancelled and employees have had to move their coverage mid-term to another comparable option. Other business owners find that from a management perspective they would rather offer more limited and streamlined plan options, in order to cut down on explaining such different benefits to all of their employees. Some business owners also like the idea of providing consistency amongst the benefit plan.

What is a HSA account?

It is a medical savings account, similar to an IRA. You have to be enrolled in a high-deductible plan to be eligible for a health savings account. That means your insurance has a minimum deductible of $1,250 as an individual or $2,500 for a family. If that’s the case, you’ll be able to opt into a health savings plan.
The plan lets you designate a certain amount of your paycheck to be funneled into the account pretax. The funds can then be used for any qualifying medical expense, from surgery to prescriptions. An individual can contribute up to $3,300 a year, while a family can give a maximum of $6,550. The funds also roll over year-to-year, so you never lose the money

Even if you don’t usually have high medical expenses throughout the year that you think you’ll need HSA funds for, the account can be used strictly as a way to build up savings and reduce your taxable income.

What is a FSA account?

A flexible spending account offers the same savings and pretax benefits as an HSA, but to someone in a higher cost health plan – one with a higher premium and lower deductible. It essentially works the same as an HSA, but you can’t contribute as much money to it – a maximum of $2,500 a year – and the funds don’t roll over if you don’t use them. They get absorbed back into your employer’s fund.

Important Note

There’s a 20% penalty for using HSA or FSA funds for non-qualified expenses.