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The Hunsicker Building
177 North Main Street
Souderton, Pa 18964
1-877-939-HISI
(215) 721-2220
hisi@gethisi.com
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Questions
Frequently asked questions about health benefits
CONSUMER HEALTH BENEFITS GUIDE
 WHAT KIND OF PRODUCTS DO YOU OFFER?
n Individual and Family Health Insurance.
Singles and families should take a look at our individual and family health insurance plans. If you do not get your health insurance coverage through an employer, an individual and family health insurance plan is your standard, private market option.
n Small Business Health Insurance.
We offer group health insurance plans for small businesses and organizations (2-50 employees).
n Large Group Business Health Insurance.
We can customize group health insurance plans for large businesses and organizations (50-5000+ employees) to help you contain health benefit costs.
n Medical Expense Reimbursement Plans.
The employer offers one deductible to the employees and contracts with the carrier for a higher deductible. The difference between these 2 deductibles is the figure which the employer reimburses up to this amount directly to the employee.
n Pharmacy Carve-Out.
We offer pharmacy carve-out as a viable alternative to reduce overall group health costs. We are your pharmacy carve-out specialists in the industry. We can offer this option for groups from 5-5000+ employees.
n Short-Term Health Insurance.
If you are in need of temporary coverage, you willl want to take a look at our short-term health insurance plans. Obtaining short-term coverage is quick and easy and though it is not a long-term solution, short-term coverage can protect you while you are between jobs or after you graduate from college.
n Student Health Insurance.
Full-time college students and their parents will want to explore our student health plan options for valuable protection and savings.
n Dental Insurance.
We provide dental insurance options priced to fit most budgets.
n Dental Discount Cards.
As an alternative to standard dental coverage, we offer Dental Discount Cards. Though not an insurance plan, these cards can provide you with deep discounts from local dentists on many dental procedures.
n Life Insurance
We either are represented or have access to over 200 life insurance carriers for individuals or business groups.
n Disability Insurance
We have excellent plans for short-term or long-term disability. If you own a business you need to take a look at your options.
n Health Savings Accounts.
We provide Health Savings Accounts (HSAs) and HSA-eligible health insurance plans. Our website is a good source for HSA information.
n Mini-Med Products.
Mini-Med Plans Reduce Physician and Hospital Costs. A Discount Medical Plan provides access to PPO (Preferred Provider Organization) physician and hospital networks at reduced rates. It is not an insurance plan and no claims are submitted. Your bill will be discounted (repriced) and you are responsible for full payment of the adjusted bill.
n Medicare Advantage Plans.
Under Medicare Advantage, a Medicare beneficiary may choose to remain in the traditional Medicare program or their current managed care plan, or to receive Medicare covered services through any of the appropriate health insurance plans. The Medicare Advantage program is designed to provide access to a wider array of private health plan choices than under the M+C program and to increase the number of areas in which private health care options are available to Medicare beneficiaries.
WHAT KIND OF SERVICES DO YOU PROVIDE?
n Health Insurance Solutions is a licensed health insurance agency for individuals, families and businesses purchasing health insurance. We have insured thousands of customers nationwide. We offer a broad selection of health insurance plans from many of the nation's leading health insurance companies, and deliver customer experience that is exceptional. Our knowledgeable representatives and licensed health insurance agents that staff our office will assure you that health insurance can be attainable and affordable. After providing your zip code and some basic information about yourself, your family, or your business, our staff will prepare free quotes, compare plans side by side, and apply for coverage. Whenever you have a question or need personal assistance, you can contact one of our licensed health insurance agents for the answers and unbiased advice you need to make intelligent decisions with your insurance dollars.
Once you have submitted your application for coverage, your account manager will work with the health insurance company selected to expedite the approval process. Even after you purchase a health insurance plan, we will answer any questions and concerns, to serve as your advocate with the health insurance company, and to help you with all your future health insurance needs. You have found your health insurance solution at Health Insurance Solutions Inc.
Refer to our SERVICES section for specific details about our service options.
WHAT ARE MY COSTS FOR USING YOUR COMPANY'S BENEFIT SERVICES?
n Our health services offered are provided at no extra cost to you, the consumer. If you buy a health insurance plan through HISI you pay the regular monthly premium to the health insurance company you chose, but you pay nothing to us. Our fees are paid by the insurance companies in the form of commissions, which are built into the premium amount.
When we administer Pharmacy Carve-Out Accounts, our administrative fees are a fraction of what is charged by the insurance carriers and other TPA's. Contact our Pharmacy Department for options and specific details.
DO YOU OFFER THE BEST PRICES?
n Health insurance premiums are filed with and regulated by each state Department of Insurance. Whether you buy from Health Insurance Solutions, your local agent, or directly from the health insurance company, you pay the same monthly premium for the same plan. You can enjoy all the advantages of purchasing your health insurance plan through HISI and be assured that you are getting the absolute best price for the insurance that fits your budget. We will shop the marketplace, service your account and explain and advise as your own personal insurance advocate. It is all about showing options and we will help simplify the process for you.
When it comes to group accounts there are many creative options available to reduce overall benefit costs. We can "Carve-Out" pharmacy and administer the account ourselves to substantially reduce the total benefit cost over "bundled" plans. We also have creative alternatives using high deductibles with employer-assisted funding. We will shop the market every year for potential cost savings prior to your renewal and spread sheet your options.
WHAT KINDS OF INDIVIDUAL AND FAMILY INSURANCE PLANS ARE AVAILABLE?
n There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers.
WHAT IS AN HRA ACCOUNT?
n Health Reimbursement Arrangement (HRA) is an instrument offered in conjunction with a high-deductible health plan, and is funded by the employer for each participating employee. It pays for eligible health care expenses typically covered under the medical plan.
Unused funds can be carried over to the next year to cover future health care expenses, an incentive to employees to use their personal HRA wisely. If funds are exhausted, the employee is responsible for satisfying the remaining deductible before the plan begins to pay. If the employee changes jobs, the money stays with the employer.
HRAs are among the most flexible insurance products on the market. These federally approved accounts may be tied to high deductible insurance plans, or they may be offered on their own. HRAs allow funds to be placed in a special account to reimburse employees for out-of-pocket medical expenses that they may incur. HRAs are similar to Flexible Spending Accounts (FSA); however, while an FSA is an add-on to your already existing medical coverage, an HRA is your medical coverage.
HOW DO HRA'S WORK?
n As most commonly constructed, HRAs are linked with high-deductible health plans that include preventive care not charged against the deductible and access to information tools that help consumers make informed decisions. Members can use the fund to pay qualified medical expenses or roll over unused funds at year end for future use. Most HRA members who use up the fund then have to meet a deductible for medical expenses before major medical coverage kicks in. With the opportunity to determine how and when their health care dollars are used, HRA members have an incentive to become informed and value seeking health care consumers.
WHAT IS AN HSA ACCOUNT?
n Health Savings Accounts (HSAs) were created by the Medicare Modernization Act signed in December 2003. HSAs allow individuals to save money to pay for current and future medical expenses on a tax-free basis.
By law, HSAs must be coupled with high-deductible health plans (HDHPs). Individuals can withdraw HSA funds tax-free to pay qualified medical expenses (e.g. doctor’s visits, hospital care, dental care, prescription drugs, etc), as defined by the IRS. After the deductible is paid for, HDHP coverage starts, with limited out of pocket expenses also specified by the IRS. Unused deductible amounts remain available in the HSA account, accumulating interest, tax-free.
The IRS has allowed certain kinds of preventive care (e.g. routine prenatal and well-child care, immunizations, annual physicals, smoking cessation programs, obesity weight loss programs, etc) to be offered by HDHPs with little or no deductible. As of March 2005, 1,031,000 people were covered by HSA/HDHP products. Forrester research forecasts that there will be more than 6 million HSA holders in 2008.
Proponents of HSAs believe that they are an important reform that will help reduce the growth of health care costs and increase the efficiency of the health care system. According to proponents, HSAs encourage saving for future health care expenses, allow the patient to receive needed care without a gate keeper to determine what benefits are allowed and make consumers more responsible for their own health care choices through the required High-Deductible Health Plan.
HOW DO HSA'S WORK?
n HSA plans have three components: a portable savings account, high-deductible medical coverage that typically includes 100 percent payment for covered preventive care not charged against the deductible, and access to informational tools that help consumers make informed decisions. HSA plans encourage members to become more involved in their own health care decisions and give them the tools and resources necessary for being responsible and efficient health care consumers. And, HSA plans are uniquely positioned to help consumers be better prepared for medical expenses later in life, regardless of where or whether they work.
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HOW DOES A PPO PLAN WORK?
n As a member of a PPO, or "Preferred Provider Organization," plan, you are encouraged to use the insurance company's network of participating doctors and hospitals. These providers have been contracted to provide services to the plan's members at a discounted rate. You won't be required to pick a primary care physician and you 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 begins paying your claims. Once the deductible is met, you will be required to make a co-payment for most doctors' office visits. Some plans may also require that you cover a percentage of the total charges.
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. Seeing an out-of-network provider can become costly. For example, if you visit an out-of-network provider for services totaling $500, the PPO plan may cover the charge at only 60% of the amount that a network provider would charge for the same service. If a network doctor would accept $250 as payment in full, this means that the insurance company would pay only $150 and the remaining $350 would come out of your pocket. Additionally, if you see a provider outside of the plan's network, you may have to pay the charges up front and then submit your own claim for reimbursement.
PPO plans offer flexibility in choosing your providers, however, make sure that you familiarize yourself with the plan's provider network before choosing a PPO plan. You may wish to make sure that your favorite doctor or local hospital belongs to the network. If you have children who need to make regular visits to the doctor, be sure that you're aware of the plan's benefits for preventive and well-child care.
HOW DOES AN HMO PLAN WORK?
n As a member of an HMO ("Health Maintenance Organizations"), you will be required to choose a primary care physician (PCP). Your PCP will take care of most of your health care needs. Before you can see a specialist, you must obtain a referral from your PCP.
With an HMO you will likely have coverage for a broader range of preventive healthcare services than through any other type of health insurance plan. Additionally, you probably will not have a deductible to pay before services are covered. You also won't have to worry about much if any of the paperwork involved in submitting claims.
However, keep in mind that you will likely have no coverage whatsoever for services rendered by non-network providers or services rendered without a proper referral from your PCP.
HOW DOES A POS PLAN WORK?
n A POS, or "Point of Service" plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan's network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.
Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely only receive partial coverage. If services are rendered outside of the network, you will likely have to pay up-front and submit a claim to the insurance company yourself.
WHAT IS A MINI-MED PRODUCT AND HOW DO THEY WORK?
n A Mini-Med is a limited benefit indemnity health insurance plan which can be issued with very few restrictions through age 64. Medical bills are submitted to the insurer for reimbursement up to the limits of the policy. The Mini-Med policy can be used with any medical provider and is not limited to any specific PPO network. It is commonly used in conjunction with a high deductible major medical policy to help "fill the gap" in coverage. Mini-Med Plans are considered supplemental coverage and are not meant to replace major medical policies.
Most Mini-Med policies include reimbursement for in-patient hospital procedures, surgical benefits, doctor visits, emergency treatment, and life and accident insurance benefits. All allow you to choose your desired level of coverage. Mini-Med plans do not use deductibles or co-pays. Some policies have 6-12 month wait periods for pre-existing conditions, while others have no restrictions or waiting periods at all for pre-existing conditions. Many require that you be employed or self-employed to qualify
Mini-Med plans usually include access to doctor and hospital providers at wholesale (discount) pricing through PPO Networks. To receive discounts (repricing) you must use a provider within the designated network. To receive maximum benefits from a Mini-Med Insurance Policy, always try to use a PPO network provider. The discounted bill can then be submitted to the insurance company for reimbursement. If you do not use a network provider you can still submit the bill for reimbursement, but you will not receive a discount on the bill. Most Mini-Med plans also include access to additional health discounts including dental, vision, and prescriptions.
WHAT IS A "MEDICARE ADVANTAGE" PLAN AND HOW DOES IT WORK?
n With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, "Medicare+Choice" plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as "Medicare Advantage" (MA) plans.
Traditional or 'fee-for-service' Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships.In exchange for these extra benefits, enrollees may be limited on the providers they can receive services from without paying extra. Typically, the plans have a 'network' of providers that you can use. Going outside that network may require permission or extra fees. .
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