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Frequently Asked Questions

Individual Health Insurance Plans

1. What is a deductible?

A deductible is the amount you must meet before your insurance company will begin paying claims. This excludes any part of your policy that is not subject to the deductible or has a co pay.

2. What is a co pay?

A co pay is a pre determined amount you pay, for instance doctor office visits, emergency room visits, and for prescription drugs. These are not subject to the deductible. These are called first dollar benefits.

3. What are preexisting conditions?

Preexisting conditions include anything that has been treated or diagnosed prior to the effective date of your new policy. These conditions, or anything caused or related will not be covered in the preexisting waiting period.

4. Are there preexisting conditions?

Some individual health insurance plans cover preexisting conditions when prior coverage was in place. Those plans will credit you with prior coverage as long as there was no lapse in coverage of more than 63 days. Each plan in Georgia is different so it is best to ask your health insurance broker specialist.

5. How long can my child be a dependent on my plan?

Most plans allow a dependent to remain on your health insurance plan as long as they are a full time (12 credit hours a semester) student until they are 25 years old. You are required to submit a student school schedule for proof every year after they turn eighteen. However, since coverage for young people is very affordable, it may be more cost effective for you to consider an individual plan after the dependent is eighteen.

6. What happens if I get a divorce?

When your divorce is finalized, and you notify your insurance carrier, the company will terminate the policy you and your ex-spouse shared. At that time, you will be issued your own individual policy (separate from your ex souse) with the same provisions as your prior policy. There is “no loss, no gain”, from divorce with medical coverage in Georgia.

7. What happens if I have a baby?

If you have maternity coverage, your baby will be covered automatically for the first thirty days after birth. It is your responsibility to add the baby for coverage within this first thirty day period to have guaranteed coverage.

8. Does the federal Cobra law apply to individual coverage?

No, it only applies to group coverage.

9. Under current laws in Georgia, are individual health plans issued on the guaranteed basis?

No, all applications go through each insurance company’s underwriting process.

10. Is my insurance a yearly contract?

Your health insurance policy is only a month to month contract; you can cancel it at any time.

11. What does in network/ out of network mean?

Health insurance “Networks” refer to all the doctors within your insurance company’s approved list of doctors. Your co pays are only taken by “In Network” doctors. You will have greater out of pocket expenses with "out of network" doctors.

12. What is the best network in Southwest Georgia?

Blue Cross Blue Shield has the most comprehensive individual medical network in Southwest Georgia.

13. Is there dental/vision coverage included in my plans?

Most individual health plans don’t include dental/vision. Blue Cross Blue Shield’s Tonik health insurance plan is the exception and includes dental and vision coverage. In general, "stand alone" individual dental plans are not a good value.

14. Does the health care reform affect me now?

No, most of the changes will take place in the year 2013.







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