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Frequently Asked Questions
GENERAL INFORMATION
CLAIMS
PRESCRIPTION DRUG BENEFITS
PROVIDERS AND PPO's
GENERAL INFORMATION
How do I apply?
Do I have to take a physical?
Can I cover child(ren) only?

Q. How do I apply?
A.
  1. Fill out Application Request Form
  2. Customer Support will call and verify the information you have provided to us and discuss coverage options you have selected.
  3. We will send your application 1st Class mail/Sign and return.
  4. Your application will be forwarded to the company you selected for underwriting approval and can take as little as 2 weeks.
  5. Your policy is delivered to you via U.S. Mail.

Do Not Cancel your current coverage until you have received written notification of your approval from the Insurance Company

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Q. Do I have to take a physical?
A. NO. Most companies do not require you take a physical examination. If there is any question as to a current medical condition a potential insured may have, medical records may be requested from your doctor.

Q. Can I cover child(ren) only?
A. YES. With most health insurance plans you can purchase health insurance for child(ren) only.
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CLAIMS
What is a claim?
Where to call with claim questions.
What to do if a doctor bills you directly.
What is an Explanation of Benefits (EOB)?

Q. What is a claim?
A. When current customers visit a doctor or hospital, the provider may submit a bill to the insurance company. Companies usually refer to this bill as a "claim" for benefits.

Q. Where to call with claim questions.
A. Whenever customers have questions about claims, they should call their insurance company directly.

Q. What to do if a doctor bills you directly.
A. Most insurance companies file claims electronically. If you recieve a bill it's wise to call your insurance company first. They may have already paid the bill in question or they may request you send the bill to them for review.
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Q. What is an Explanation of Benefits (EOB)?
A. An EOB explains what benefits were available according to a customer's Contract. The insurance company will usually send an EOB after reviewing the claims they received from a provider or hospital.
PRESCRIPTION DRUG BENEFITS
What is a brand-name prescription drug?
What is a generic drug?
Why choose generic drugs?
What are the differences between brand-name and generic drugs?
What is a three-tier drug benefit or formulary/preferred drug list?
Does a formulary/preferred drug list limit choices?

Q. What is a brand-name prescription drug?
A. Prescription drug manufacturers patent new drugs when they’re discovered and are called brand-name drugs and can be very expensive. After the patent runs out, a generic equivalent can be manufactured.
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Q. What is a generic drug?
A. Several companies can manufacture generic drugs, which must contain the same active ingredients in the same amounts as the brand-name drugs. This process helps ensure the brand-name and generic drugs compare to each other.

Q. Why choose generic drugs?
A. Generic drugs can cost much less than brand-name drugs and help lower health-care expenses. Generic drugs may also help lower out-of-pocket expenses.

Q. What are the differences between brand-name and generic drugs?
A. The main difference between generic and brand-name is the cost. The Food and Drug Administration (FDA) must deem generic drugs to be equally effective to brand-name drugs. The same FDA quality and safety requirements must be followed for generic and brand-name drugs.
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Q. What is a three-tier drug benefit or formulary/preferred drug list?
A. A formulary/preferred drug list identifies drugs a physician may wish to consider when deciding which drug to prescribe. Tiered drug plans can help save money when customers use less expensive drugs. A formulary/preferred drug list:
  • Promotes appropriate and cost-effective therapy.
  • Provides physicians with information about other available drug therapies.
  • Gives information that may help in discussing medications with physicians and pharmacists

Q. Does a formulary/preferred drug list limit drug choices?
A. Doctors prescribe the drugs that are right for individual situations. Having a plan with a formulary/preferred drug list does not limit the selection of drugs, but it allows customers to have lower out-of-pocket expenses when they use drugs from the formulary/preferred drug list.
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PROVIDERS AND PPO's
Whats the difference between traditional plans and plans using a PPO?
What is a PPO?
Why choose plans using PPOs?
How can you tell if a plan uses a PPO?
How to find PPO doctors and hospitals.
What are different types of doctors?

Q. What’s the difference between traditional plans and plans using a PPO?
A. Traditional or indemnity plans tend to be more expensive because they give the same level of benefits no matter what provider is choosen (customers don’t have to use specific network doctors or hospitals).

Plans using a PPO (preferred provider organization) allow customers to choose any qualified doctor. And customers may have less out-of-pocket expense when using PPO doctors or hospitals in the network.


Q. What is a PPO?
A. A PPO is a network of credentialed doctors, clinics, hospitals, and other health-care facilities that are contracted to provide medical services at negotiated fees.

Q. Why choose plans using PPOs?
A. PPO Benefit plan designs usually cost less than traditional or indemnity plans while providing coverage for eligible expences no matter what qualified doctor you select. PPO Benefit Plans allow customers to help control costs and reduce out-of-pocket expenses when choosing PPO network doctors.
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Q. How can you tell if a plan uses a PPO?
A. Customers can check the Contract to determine if their plan uses a PPO. Choosing providers from that PPO network may mean less out-of-pocket expense.

Q. How to find PPO doctors and hospitals.
A. Customers have several options for finding doctors and other providers that are contracted with the network their plan uses. The most accurate and up-to-date way is to ask their doctor or other health-care providers before their appointment and on the date of service to determine if the provider is part of the PPO network.

Q. What are different types of doctors?
A. There are many different types of doctors or specialists to choose from. A primary doctor can understand your health needs and help refer you to other doctors when necessary. (Note: Primary doctors are not required for AMS-marketed plans.)

Some types of primary doctors:

  • Family practice: treat all family members (child or adult); may include maternity care
  • Internal medicine: diagnose and treat nonsurgical disease in adults
  • General practice: provide service that’s not limited to a specialty
  • Pediatrics: specialize in caring for and treating diseases in infants, children, and adolescents

Specialists for women:

  • OB/GYN: physician specializing in obstetrics and gynecology for women
  • Certified nurse midwife: advanced practice nurses specializing in women’s health-care needs throughout life (prenatal, labor and delivery, and postpartum care for "normal" pregnancies)
  • Nurse practitioners: advanced practice nurses prepared in programs specific to women’s health-care including common gynecological problems, routine screenings, and family planning

Other areas of specialty:

  • Anesthesiology: anesthesia, either general or spinal block for surgeries and some forms of pain control
  • Cardiology: heart disorders
  • Dermatology: skin disorders
  • Endocrinology: hormonal and metabolic disorders
  • Gastroenterology: digestive system disorders
  • General surgery: common surgeries involving any part of the body
  • Immunology: disorders of the immune system and allergies
  • Infectious disease: infections affecting the tissues of any body system
  • Nephrology: kidney disorders
  • Neurology: nervous system disorders
  • Oncology: cancer and some other malignant (growing worse - resisting treatment) diseases
  • Ophthalmology: eye disorders and surgery with services provided by an ophthalmologist (MD) or optometrist
  • Orthopedics: bone/connective tissue disorders
  • Otorhinolaryngology: ear, nose, throat disorders
  • Physical and rehabilitative medicine: coordinate return to optimal functioning in individuals with musculoskeletal and neurological disorders (i.e., low back injury, spinal cord injuries, and stroke)
  • Psychiatry: emotional or mental disorders
  • Pulmonary (lung): respiratory tract disorders
  • Radiology: evaluation of X-rays and related procedures (such as ultrasound, CT scan, and MRI)
  • Urology: male reproductive tract and both male and female urinary tract disorders

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