Nevada Benefits

FREQUENTLY ASKED QUESTIONS

What types of individual health insurance plans are available to me?

What is point-of-service (POS) plan?

What is a provider?

What is an office visit co-payment?

What is a deductible?

What is a pre-existing condition and how will this affect my health insurance application?

I want to have a baby. What plans offer maternity coverage?

How can I compare all my insurance plan options?

If I have any questions about my quotes or about completing an application, how can I reach you?

Why aren't you quoting other health plans that I'm familiar with?

Can I buy health insurance for less if I buy directly from the insurance company?

I need a dental filling or root canal done right now. Will your dental insurance cover this?

Question: What types of individual health insurance plans are available to me?

Answer: There are basically two types of health insurance available to the individual, HMO's (health maintenance organizations) and PPO's (preferred provider organizations). Both have their advantages and disadvantages, and a prospective client should consider what is important to him or her before choosing either plan.

An HMO requires that you use the doctors and hospitals in their network. There are no benefits if you see a non-provider. Additionally you must choose a primary care provider or PCP (also know as a personal care physician, personal care provider, or a gatekeeper). This is a physician or other medical professional that serves as a member's first contact with an insurance plan's healthcare system. If you need to see a specialist, your PCP must refer you. There is no deductible with an HMO. Every service (office visits, wellness benefits, x-rays and lab work, emergency visits, surgeries, hospitalizations, etc.) using a contracted provider is a co-pay. You will always know what something is going to cost.

If you are traveling outside of the Southern Nevada provider area, an HMO provides only "life or limb" emergency benefits. If you see a doctor in California for a cold, you're going to pay for everything.

A PPO allows you to see any doctor or facility in their network without obtaining a referral. PPO networks are much larger that HMO networks. Additionally, out-of-network benefits allow you to see providers not in the network, but at a higher cost to you. This is important if you frequently travel outside of the provider area. The major advantage of a PPO is doctor-selection flexibility.

Routine doctor visit consultations and prescription drugs come under a CO-pay With most PPO plans, services provided outside of the doctor's office (x-rays, lab work, surgeries, hospitalizations, etc.), are first paid by a deductible followed by a co-insurance percentage. As PPO plans vary, deductibles and coinsurance vary as well. Just like auto insurance, however, the lower your deductible, the higher your monthly premiums.

Question: What is point-of-service (POS) plan?

Answer: This is a type of insurance plan combining features of an HMO and a PPO. You decide whether to go to an HMO network provider and pay a CO-pay or go to a PPO provider and pay a deductible and a coinsurance percentage. POs plans sometimes offer maternity benefits.

Question: What is a provider?

Answer: A provider is a hospital, health care facility, physician or other medical professional that provides health care services.

Question: What is an office visit co-payment?

Answer: An office visit CO-payment, or CO-pay, is a fixed dollar amount that you pay for each doctor visit consultation. Most insurance plans require a CO-pay of $10 to $40.

Question: What is a deductible?

Answer: A deductible is a dollar amount that you must pay before the insurance begins to pay your yearly medical expenses. For example, if you plan has a $500 deductible, you must pay the first $500 of your medical expenses before your insurance starts paying anything. Deductibles are most common to PPO plans and usually apply to those services other than regular doctor's office consultations. This usually includes lab work, x-rays, surgeries, emergency room visits or hospitalizations. Office visit consultations are usually covered by a CO-payment

Question: What is a pre-existing condition and how will this affect my health insurance application?

Answer: A preexisting condition is a sickness, symptom or bodily injury for which a person received a diagnosis, medical advice, consultation or treatment before the insurance policy's effective date or for which a person had symptoms before the effective date.

Most insurance companies will not cover preexisting conditions for a period of 12 to 24 months after the policy effective date. As preexisting conditions and insurance companies differ, you should advise Nevada Benefits of any health conditions so that we may make appropriate recommendations.

Question: I want to have a baby. What plans offer maternity coverage?

Answer: Nevada Benefits offers HMO, PPO and POs plans with maternity coverage. However, these plans usually have a waiting period before benefits begin. Prices may vary significantly between the plans, so it is important that you specifically mention maternity coverage when you request a quote.

Question: How can I compare all my insurance plan options?

Answer: You can compare benefits and prices of the leading health insurance plans in Southern Nevada by either completing the online individual health form or by calling Nevada Benefits at 258.1995 and we can review all your options. We're open between 7am and 9pm, 7 days a week.

We will then fax, e-mail or mail you a free spreadsheet comparison quote. This two-page summary shows the co-pays, prescription prices, deductibles and premium prices of the leading HMO's and PPO's in Southern Nevada. In most cases, we can then mail or deliver an application to you within 24 hours.

Question: If I have any questions about my quotes or about completing an application, how can I reach you?

Answer: If you have any questions about the plans, deductible options, preexisting conditions, doctor availability, or monthly costs, please call us at 258.1995 and we can review all your options. We're open between 7 am and 9 pm, 7 days a week.

Question: Why aren't you quoting other health plans that I'm familiar with?

Answer: Not all health insurance companies sell plans directly to individuals and families. Many, like Aetna, Cigna, or Principal, provide insurance only for employers or companies.

Question: Can I buy health insurance for less if I buy directly from the insurance company?

Answer: No. Insurance companies must charge the same premium whether the plan is purchased directly from the company or though Nevada Benefits.

Question: I need a dental filling or root canal done right now. Will your dental insurance cover this?

Answer: Probably not immediately. Most dental insurance companies have waiting periods before they begin covering certain types of services like fillings, root canals, crowns, bridges or dentures. To expect the insurance company to pay for this work immediately is similar to attempting to obtain automobile insurance after you've had the accident.

If you need work done immediately, sometimes very affordable dental discount plans are available that can offer you substantial discounts at participating dentists for all services, including preexisting conditions, immediately.

Call Nevada Benefits at 258.1995 between 7am and 9pm, 7 days a week, if you have any questions about preexisting dental conditions.