Health Insurance Plans

MAJOR MEDICAL PLANS (Affordable Care Act): aka Obamacare

  • I sell individual, family, and group Health Insurance.
  • Will cover all pre-existing conditions from day 1 start date.
  • Covers Maternity and suicide
  • 2 Health questions: Do you use tobacco and are you pregnant?
  • 95% of plans are HMO.
  • Must get a referral from your Primary Care Provider to see a specialist.
  • Will not cover medical services out of network except for true emergency.
  • Deductible and Maximum out of Pocket apply to all plans.
  • A single must earn at least $12,750 in 2021 to qualify for a APTC (tax credit/subsidy)
  • No limit on how much Insurance will cover yearly or lifetime.

Group Insurance

  • Two or more unrelated people working 32 hours or more for same business entity.
  • Family members can be included in the insurance plans, health insurance not a must.
  • HMO and PPO available, as well as self-funded plans
  • Owner must pay at least 50% of premium for company to get tax benefits.
  • Can include extra benefits such as Legal Shield, ID Shield, Dental, Vision, Pet Insurance, Roadside Assistance

SHORT TERM MEDICAL: may be perfect for those in transition:

  • Recent graduate or student no longer eligible under parents’ health insurance plan
  • Between jobs or out of work
  • Waiting for other coverage plan to begin
  • Retired early and needing to bridge to Medicare eligibility
  • Can’t afford your Cobra or Major Medical plan
  • Good for 1 month up to 3 years, can cancel plan anytime
  • Must answer no to all health questions
  • You choose deductible, maximum out of pocket, co-insurance and maximum coverage up to $1 million.
  • Limited preventative care benefits
  • Teledoc available sometime extra fee or copay applied

FIXED INDEMNITY PLANS:

  • About 40-50% less expensive than Obamacare with no or little Advance Payment Tax Credit
  • Pays you a fixed amount or schedule for medical services.
  • Deductibles only apply to hospitalization for more than 24 hours.
  • PPO networks such as Aetna, Cigna, First Health, PHCS, and Multiplan Ltd. Plans good nationwide, cost less to stay in network.
  • 12 Month waiting period on pre-existing conditions.
  • Never covers Maternity.
  • Good up to age 65
  • Small annual increases possible based on age
  • Preventive care covered after 60 days.
  • Can be rated up, must answer all health questions and names of medication.
  • Limit of $1-$2 Million per year, $5 Million per person per lifetime
  • Teledoc usually included free of charge.

Global / Travel Health Insurance Plans

  • Will cover you when traveling outside of the USA.
  • Covers foreign person visiting the USA, student, relative, temporary worker
  • Available to Ex-pats living or working abroad.
  • Foreign students coming to the USA or Canada to study
  • Study Abroad
  • Does not cover pre-existing health conditions.
  • Will cover transportation to closest qualified hospital or repatriation to home country.
  • Cover limited loss of luggage during travel.
  • Covers trip interruption due to illness while on trip.
  • You choose deductible, maximum coverage, and length of coverage. Policy is renewable.