Individual Health Insurance

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Individual plans cover one person or all the members of a family under one plan. Family policies generally pay benefits for your spouse and children up to age 25. However, your insurance company cannot terminate coverage for dependent children who lack other means of support due to mental or physical handicaps.

• Your Cobra coverage has expired without a conversion option.
• Your prior carrier went out of business or left the area and cancelled your coverage.

Please call our office if you think you  might qualify for guarantee issue.

Much of the health insurance sold in Florida as ýindividual coverageý actually involves association-based group plans marketed to individuals. In such cases, the association will require membership as a prerequisite for coverage. In addition, you will receive a ýcertificate of coverageý instead of a policy in your name.

Do you need Traditional or Managed care?

With traditional health insurance, you- the policy holder- selects a health care provider, such as a doctor or hospital. You normally pay for services when rendered and then submit the bill to the insurance company for reimbursement of the portion they agreed to pay under the policy terms. Frequently, the provider will submit the bill directly to the insurer and await payment.

The managed-care system combines the delivery and financing of health care services. This limits your choice of doctors and hospitals. In return for this limited choice, however, you usually pay less for medical care (i.e. doctor visits, prescriptions, surgery and other covered benefits) than you would with traditional health insurance. The managed-care network controls health care services.

Types of Managed care:

HMOs (or Health Maintenance Organizations)

Like those with traditional health insurance, HMO members pay a fixed premium in advance for a wide range of health care services. They must use the the HMO's network of providers, which includes the doctors, pharmacies, and hospitals under contract with that particular HMO. The HMO does provide any benefits for out of network providers, except for emergency situations.

PPOs ( or Preffered Provider Organizations)

A PPO offers another kind of provider network to meet the health care needs of members. A traditional insurance carrier provides the health benefits. An insurer contracts with a group of health care providers to control the cost of providing benefits to members. These providers charge lower-than-usual fees because they require prompt payment and serve a greater number of patients. Members choose who will provide their health services, but pay less  with a prefered provider than with a non-prefered provider.