FAQ

With so many health care plan options to consider, the more you know, the better decisions you'll make. We've made it easy by providing you with answers to the most frequently asked questions.

Health Care Plan Basics

Q. What is a deductible?
A. A deductible is the amount you pay each calendar year before health health care plan benefits are paid for covered medical expenses.

Q. When does my deductible start over?
A. Your deductible starts over each year on January 1st .

Q. What is coinsurance?
A. Coinsurance is the percentage of covered expense you are responsible for after you meet your deductible. For example, you can choose 20% coinsurance of $5,000 (which equals $1,000). That means you'll pay 20% and we pay 80% of the first $5,000 (which equals $4,000) of covered expenses. After that, we pay 100% of covered charges for the remainder of the year, up to the policy maximum.

Q. What is a copayment?
A. A copayment is a set amount that you pay for a specific service, such as $25 for an office visit. You are usually responsible for payment at the time of service.

Q. What is individual out-of-pocket expense?
A. It's the maximum amount in covered charges you'll pay — per person, per calendar year. The amount is determined by adding your deductible and coinsurance together. For instance, if you have a $1,000 deductible and 20% coinsurance of the next $5,000, the most you'll pay is $2,000.

Q. What is family out-of-pocket expense?
A. Like individual out-of-pocket expense described above, it's the combined total of your deductible and coinsurance, but for your whole family — which is the maximum amount in covered charges you'll pay no matter how many members of your family collect insurance benefits.

Q. What is the difference between a network and non-network (or out-of-network) medical provider?
A. A network provider is a doctor or hospital who's made an arrangement with us to provide services at a discounted rate. Non-network providers haven't arranged to provide services at a discounted rate for our customers. Simply put, you'll typically pay less for services from a network provider than a non-network provider.

Q. What is a Preferred Provider Organization (PPO)?
A. A PPO is a large group of doctors and hospitals who've agreed to provide their services to our customers at a discounted rate. Buy a PPO plan to reduce your premium and out-of-pocket costs.

Q. What is an indemnity plan?
A. An indemnity plan, also called a traditional health insurance plan, gives you the freedom to choose any doctor or hospital for your care. And since an indemnity plan isn't associated with any network, you won't pay any penalty for choosing a particular doctor or hospital. Premiums for an indemnity plan are higher than PPO plans.

Plan Differences - Things to Consider

Q. Different plans have different lifetime benefit maximums. What does that mean?
A. The lifetime benefit maximum is the total amount a plan will pay out for as long as you own it. While it's rare for claims to exceed a $2 million maximum, it does happen. And if it happens to you, it's almost certain to bring serious financial hardship. You'll be glad to know we offer one of the nation's highest lifetime maximums.

Q. What if I'm traveling and need care?
A. It's important to know whether a health plan provides coverage when you're abroad. With our worldwide coverage, services incurred outside the U.S. are covered the same as if they we're incurred in the U.S.

Q. Some plans require referrals. What should I look for?
A. It's true that many plans require a referral before you can see a specialist. It's a way to control costs, but it can become burdensome. With Premier Health Care, no referral is required. And you can still save money by using network providers.

Q. Do all health plans offer the same benefits?
Not all health plans offer the same benefits. When you're shopping for health care plans, look for plans that offer a range of options. Within your budget, look for plans that cover the essentials and meet your individual needs. Take a look at some benefits that we offer you that you may not be able to get elsewhere:

Worldwide coverage, 24 hours-a-day
Wellness benefits — so you can keep healthy
Discounts on drugs with the Prescription Drug Card
Optional benefits, like the Dental/Vision Card

The amount of benefits provided depends upon the plan selected and the premium will vary with the amount of benefits.

Q. Do plans cover dental care, eyeglasses, contact lenses or hearing aids?
A. Generally, health care plans for individuals and families do not cover dental care (unless it's caused by an accident), eyeglasses, contact lenses or hearing aids .Premier Health Care offers a Dental-Vision Discount Card that can help you cut the costs for those services, especially since your entire family can take advantage of the savings. When you present your card to a participating dental or eyewear provider, you receive:

Discounts of 10% to 50% on dental care expenses such as orthodontics (braces), dentures, cosmetic dentistry, crowns, extractions, fillings, oral surgery, periodontics and most other services.
Discounts of up to 50% on eyeglasses, contact lenses (excluding disposable), and other retail eyewear items. You can also receive discounts on eye examinations and surgical procedures including Lasik where available.

Note: Savings vary by provider, location and actual service. The Dental-Vision Discount Card is not a health insurance policy. The plan provides discounts at certain health care providers of medical services. The plan does not make payment directly to the providers of medical services.

Cost Options

Q. What is the difference in plans with higher or lower premiums?
A. It's really about choice and trade-offs.

Typically, you'd choose a higher premium plan if you want your health care plan to pay mainly for routine needs, like a doctor visit or a prescription. It feels affordable to pay only a $25 copay at the time of visit, but you'll pay more for the convenience of knowing what you'll spend every time you visit the doctor or need a prescription.
You'd choose a lower premium plan if you want your health care plan to protect you against a serious illness or injury. You'll pay more out of your pocket for the costs associated with everyday health care needs — but you'll pay less overall in premium.

Prescription Drugs

Q. Sometimes I need prescription drugs. What kind of coverage is important?
A. Prescription drugs are expensive. And costs seem to be going up every day. Look for a plan that doesn't limit prescriptions. Premier Health Care markets many plans without prescription-specific drug dollar limits.

Q. How do I use my prescription drug card?
A. Each time you fill a prescription, present your card at a participating pharmacy. You'll find information on participating pharmacies on the back of your card. If you have a plan with a prescription copay, once you satisfy your annual deductible, you'll pay the copayment specified on your drug card. After applying any discounts, deductibles, or copayments, the pharmacy will submit your claim electronically.

Q. If my doctor prescribes a brand-name drug for me, will it be covered?
A. Yes, a brand-name drug will be covered. However, if a comparable generic drug is available, our plans are designed to encourage generics. If you choose the brand-name drug when generic is available, an additional charge may be applied.

Children

Q. Which plans include child preventive care?
A. Most plans cover baby and child wellness exams, as well as immunizations.

Q. How long can my dependent children remain on my policy?
A. The age at which dependent children cease to be covered varies, depending on the kind of plan you have, the state where your policy was issued and where you live. Disabled children may remain on a policy indefinitely. Call us for details.

Choosing Your Health Care Plan

Q: What should I consider when looking at health plan and the company that offers it?
A: It's about more than just the premium. When comparing health plans, assess the standard benefits that each company has to offer.

Think about if there are limits on important things, like prescription drugs and hospitalization.
Look at the available lifetime benefit maximum and how the company pays for ambulance service, which can be very expensive.
Beyond what a plan offers, you'll want to look at a company's experience and focus — since it takes a long time to become an expert at health care plans.
You'll also want to look at the company's strength and stability, so you can rest assured that a company is financially stable and will be there when you need it.

Q: Why should I choose Premier Health?
A: When you choose Premier Health for your health care needs, you are backed by an organization with experience, expertise and commitment.