Resources: Health Insurance FAQ

Knowledge Database around Employee Benefits

Get answers to frequently asked questions about health insurances.

It depends. If you have no health problems, don’t do hazardous work or play. You may not. Can you withstand paying several thousand dollars to a hospital, if you were in a car wreck. If you have a spouse or children, it becomes more important.

A PPO usually costs more because they have more providers inside their network, more doctors, more specialists, and more hospitals. An HMO has a smaller network – less doctors, less specialists, and less hospitals to choose from. HMOs also have a Primary Care Provider that must approve or refer you to a specialist. Usually you have to designate a Primary Care Provider (PCP) when you sign up for an HMO.

Telehealth is linking the participant to a qualified medical provider via smart device or computer. This is one of the newest forms of modern medicine. Some plans offer this features for no cost, others have a cost and other don’t offer this benefit. Check your plan for exact details.

When a participant has 100% coinsurance, the insurance carrier pays 100% of the cost for provided, covered services. This is an extremely valuable part of health insurance.

Some plans have the family deductible and the out of pocket maximum as a multiple of the individual deductible and out of pocket maximum, some do not. Check your plan for exact details on your plan.

These are plans that offer a cost saving arrangement for participants. Usually they offer a pool of funds to participants based on level of participation and length of participation. They are NOT insurance plans. Usually Share Plans will have limits on coverage available per health incident as well as limits on pre-existing conditions. Share Plans are usually not backed by an insurance carrier.

  1. Try to avoid the Emergency Room (ER). The ER whether inside a hospital or a free standing facility in shopping center, can charge thousands more than an Urgent Care Center or Telemedicine call. Rule of thumb: Go to the ER immediately for heart attack, stroke, or heavy bleeding you can’t stop. Broken bones, earaches, rashes, sprained ankle, UTI, etc. can usually be treated faster and cheaper at Urgent Care or via telemedicine.
  2. Consider a Health Savings Account. Choose a plan that says HDHP HSA in the name. Premiums are usually less, but your deductible may be higher. You may be able to bank the difference in an account that you can use for everyday medical expenses. You save on taxes, and you don’t lose the balance that you don’t use that year.
  3. Try to exercise more. You don’t have to work out at a gym every day to lose weight. You should adopt a healthy lifestyle that includes daily or regular exercise. Just walk with a partner and hold each other accountable. Certain health plans may even pay you to be on a wellness program.
Insurance companies are regulated by the state and must have reserve money to pay all claims. The state of Texas guarantees that a claim of $300,000 or less will be paid. Other states may have different laws.
  1. Ask your doctor for samples. Before your doctor prescribes you a new medicine, ask if they have samples or a discount card for the prescription. Usually they do have some type of sample or discount available.
  2.  Generics may be less expensive without your insurance plan. Many pharmacies offer a list of generic medications at a flat rate of $4 or $5. That flat rate may be less expensive than using your medical plan, if so, use that instead. You don’t have to use your medical plan if it doesn’t make sense.
  3. Use mail-order if your plan has it available. In most cases, mail-order will save you up to a month copay at the pharmacy and it is delivered to your door, usually at no cost. It is more economical and more convenient.