What is a deductible? Back to Top |Homepage
A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims.

What is a co-payment? Back to Top |Homepage
A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

What is the difference between
in-network and out-of-network providers? Back to Top |Homepage
An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

What is individual & family health insurance? Back to Top |Homepage
Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.

How does an HSA work? Back to Top |Homepage
Legislation establishing Health Savings Accounts (or "HSAs") took effect on January 1, 2004. HSAs and HSA-eligible health insurance plans are becoming more and more popular. Here are the basics:

• An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.
  
  
• Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
  
  
• Contributions to an HSA may be made pre-tax, up to certain annual limits.
  
  
• Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.
  
  

How can I insure just my child? Back to Top |Homepage
When getting quotes for your child(ren) only, enter the child's gender and birth date in the "Applicant" or first row. Additional children should be entered below in the "Child" rows, but not the "Spouse" row. However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. You are free to apply for each child separately.

When can my insurance covereage start? Back to Top |Homepage
You can request that your Individual and Family health insurance plan start anytime between 1 and 90 days in the future. However, the insurance companies will typically need some time to process your application so keep in mind that the actual date for the start of your coverage may vary depending on the underwriting process and the availability of your medical records. (Underwriters will receive your application much faster if you "eSign" your application.)

How does a PPO plan work? Back to Top |Homepage
As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.
You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.

What does Pre-existing condition mean? Back to Top |Homepage

Pre-existing means a condition for which medical advice, diagnosis, care of treatment was recommended or received within the 6 (six) months immediately prior to the effective date of your policy.

If you have creditable coverage your period of creditable coverage will be credited toward satisfaction o the pre-existing condition exclusion period, as long as there was not a break of 63 days or more between the date the certification of creditable coverage was issued and your enrollment in this plan. Certain periods, including any plan sponsor-imposed waiting period, will be ignored in determining if there has been a 63-day or more break in coverage. If there has been a break in coverage of 63 days or more, you will receive no credit for any previous creditable coverage you may have had and you will be subject to the full 12-month or 18-month pre-existing condition exclusion period, as applicable.

The pre-existing condition exclusion does not apply to you if you are a child and EITHER:

• You enrolled in the plan during a special enrollment period because, at the time of enrollment, you were a newborn or child under age 18 who was newly adopted or placed for adoption. OR
• You meet all of the following requirements:
• You previously were covered under a plan providing creditable coverage.
• At no time after enrolling in that prior plan did you have 63-day break in health care coverage.
• You were eligible to enroll in the prior plan as a newborn or a child under age 18 who was newly adopted or placed for adoption.
• You enrolled in the prior plan within 31 days of your birth, adoption or placement for adoption.

If you are unable to obtain individual health insurance due to pre-existing conditions we can also assist you with a Montana Comprehensive Health Association (MCHA) application, which offers policies to individuals that are eligible Montana residents who are considered uninsurable due to medical conditions. The MCHA also has the coverage available to persons who are leaving group coverage and unable to get Individual coverage. The MCHA provides coverage of “last resort” and is not intended to duplicate coverage from any other source, public or private. The MCHA plans are administered by Blue Cross Blue Shield of Montana and currently provide coverage for about 3,600 Montanans.

Why do I need to fill out a Health Statement for individual coverage if they already have everything on file from my previous group application? Back to Top |Homepage
Because they can see the claim(s) that you have filed, but they do not know how the claim(s) turned out.

What happens when you go from group coverage to individual coverage?
Back to Top |Homepage
Pre-existing is not a factor; however you could end up with riders, ratings or a decline in coverage.