Network: A group of doctors, hospitals and other health care providers contracted to provide services to insurance companies customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.
Explanation of Benefits: The insurance company’s written explanation to a claim, showing what they paid and what the client must pay. Sometimes accompanied by a benefits check.
COBRA: Federal legislation that lets you, if you work for an insured employer group of 20 or more employees, continue to purchase health insurance for up to 18 months if you lose your job or your coverage is otherwise terminated. For more information, visit the Department of Labor.
Waiting Period
This is the time one would have to wait until certain health insurance coverages are available.
Lifetime Maximum
This is the most amount of money the health insurance policy will pay for the entire life. Pay attention to individual lifetime maximums and family lifetime maximums as they can be different.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.
Health insurance companies use historical data and analysis to help predict the medical expenses for any given group of individuals (usually a company’s employees). The premiums they charge are based on the amount of claims they’ve paid in the past and what they expect future claims to cost. When insurers pay out more in claims than they receive in premiums and when future services are predicted to cost more, premiums go up. (more…)
A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period.
Under the law, most of which goes into effect on July 1, 1997, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered. without additional waiting periods. even if you have a chronic illness.If you have a pre-existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months.
To find out how this new law affects you, check with either your employer benefits office or your health plan.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.
HEALTH CARE COVERAGE DESIGNED FOR YOU AND YOUR FAMILY.
Whether you are looking for traditional PPO or a high-deductible health plan, Blue Advantage and Blue Options HSA plans offer choices to meet your needs and your budget. Both plans offer protection against covered services that can be expensive. And with either plan, you’re covered up to a least $5 million for covered expenses over your lifetime.
Getting prescription medications is simple. The following is a brief overview of a standard pharmacy benefits plan.
. Visit a participating pharmacy with your prescription and your BCBSNC ID card.
. A copayment or coinsurance amount is required for a prescription, unless the copayment or coinsurance is waived. Copayments are the amounts paid for each prescription. Copayments or coinsurance are determined by the tier classification for a medication.
. Claims are filed electronically. No paperwork is required.
During many conversations with prospective and current senior clients, I am often asked a question about the differences between a Medicare Supplement Policy and Medicare Advantage. To answer that question, you first need to understand what Medicare is and how it works. Generally speaking, Medicare is health insurance for people age 65 or older or under age 65 with certain disabilities. It can also be elected by an individual at any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). It helps cover some of the medical services and supplies during inpatient and outpatient hospital procedures, doctor’s visits, and other health care settings. Original Medicare has two parts: Medicare Part A Hospital Insurance and Medicare Part B Medical Insurance.
Medicare Part A is normally a premium-free benefit if you or your spouse paid Medicare taxes while employed. If you paid this tax, you are automatically enrolled in Medicare Part A. It helps cover inpatient hosptial care, inpatient stays in skilled nursing facilities, hospice services, and home health care services. Medicare Part B helps cover medical services such as doctor’s visits, preventive care, outpatient surgeries, and other medical services. Unlike Medicare Part A, there is a monthly premium for Medicare Part B, which happens to be $96.40 for 2009. A Medicare Supplement policy, also referred to as a “Medigap” policy, is private health insurance that can be purchased by eligible individuals on Original Medicare (Part A and B) to help cover some of the gaps that the Original Medicare plan does not cover, such as coinsurance and deductibles. Without a supplement, costs for the portions that Medicare does not pay can be in the thousands of dollars! Both Original Medicare and the supplement policy will pay their share of the Medicare-approved amount for covered services, thus cutting the insured member’s out-of-pocket costs. Supplement policies are sold by private health insurance companies, like Blue Cross Blue Shield North Carolina. To purchase a supplement policy, an individual must be enrolled in Medicare Part A and Medicare Part B. A Medicare Advantage Plan is another way to get Medicare benefits. It is also known as Medicare Part C. These are plans approved by Medicare, but administrated by private health insurance companies, like Blue Cross Blue Shield North Carolina. Unlike a supplement policy, an individual does not purchase a Medicare Advantage Plan to supplement their Original Medicare. In contrast, the individual enrolls in a Medicare Advantage Plan which takes the place of their Original Medicare Plan. Benefits under these plans are often “richer” than Original Medicare as well. They usually include prescription drug benefits built right into the plan. Some plans are premium-free depending on their benefits, but individuals can also purchase extra benefits as well. Regardless if they are premium-free, an individual will always continue to pay their Medicare Part B premium. Plans include, but are not limited to, Medicare PPO’s, HMO’s, and Private Fee-for-Service Plans (PFFS). So, in summary, a supplement plan does just what the name implies – it “supplements” what the Original Medicare Plan does not cover. A Medicare Advantage Plan takes the place of Original Medicare, often with richer coverage. For more information on these policies, please call toll free at 877-359-9250 or CLICK HERE.
Our agency is an internet based company that provides health insurance to North Carolina residents through Blue Cross Blue Shield of North Carolina. We take tremendous pride in providing the best customer service in the industry. Most of our clients tell us we made what they thought would be a difficult process very easy to understand and accomplish. What do you do when you have a question about your application or coverage? The first thing you do is pick up your phone and call your agent or broker. Having the ability to handle your coverage from home and not drive across town to an office is very appealing for most people. With our hectic lifestyles and high gas prices, dealing with an internet based company for your North Carolina Health Insurance is definitely the best way to go for many people.
In 2000 our agency decided to shift our business model to an Online Internet Based Company. We have worked throughout these years training and experimenting with every aspect of an Online Company. As you may realize, the standard business model of a 9-5 platform quickly diminished as the need for a more fluctuating schedule became apparent. Our agency prides itself on helping individuals with their insurance needs, once they get off work or have time to focus on these issues on weekends.
The first step is for you to call our office and speak with one of our authorized agents to begin the process. It is our goal to explain all the plans offered through Blue Cross Blue Shield of North Carolina and answer ANY questions you may have. Once you decide on a plan, we simply email you the quote with the on line application for you to complete. Once the application is submitted, we keep you informed throughout the process until approval by BCBSNC. Its as easy as 1- 2 – 3!!!
If you would like to apply for North Carolina health insurance through Blue Cross Blue Shield of NC, simply click here and complete the form and we will be happy to email your quote and the on-line application.
For more information on North Carolina health insurance, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional authorized agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health, call all our office for details.
888-765-5400