October 17, 2017

Individual Health Plans
Miscellaneous - 1We offer both comprehensive and major medical insurance individuals and families. Vision benefits are included with select medical plans. Dental insurance is available as a separate policy and can be purchase without medical coverage.

When choosing a medical or dental plan, there are primarily three things to consider: 1) providers, 2) benefits, and 3) rates. Provider networks basically define the three different types of plans available: Health Maintenance Organization (HMO), point-of-service (POS), and Preferred Provider Organization (PPO). If you currently have a doctor you are comfortable with, we want to find a plan that includes your doctor in their network.
Providers
An HMO plan provides services through a designated network of doctors, hospitals, labs, and other providers. To receive benefits, you must first see your chosen Primary Care Provider (PCP). The choice of doctors is most restrictive with an HMO plan. If you do not use one of the network's doctors, clinics, or hospitals, you will usually be responsible for the cost of services.

A POS plan is a type of managed care plan where you also must choose a PCP. The POS network is generally larger than the HMO network. To receive the highest level of benefits, most care must be received by your PCP or a specialist referred by your PCP. However, if you do not use a network provider, you will still be covered under the plan, but at a lower precentage.

A PPO plan includes the largest network of doctors, hospitals, labs, and other providers. To receive the highest level of benefits, most care must be received by a PPO provider. The plan allows you self-refer to any PPO physician or specialist. Care received from a non-PPO provider is usually covered at a lower percentage. However, less than 10% of doctors in the State are non-PPO providers
Benefits
Most major medical plans cover only catastrophic medical expenses. In comparison, most comprehensive plans provide additional benefits for preventive care, maternity, and prescription drugs. Some plans also cover hearing exams, vision exams, vision hardware, and occupational injuries. Comprehensive plans usually have a lower annual deductible, and a lower annual out-of-pocket maximum (coinsurance maximum). Although every plan is different, all individual plans exclude coverage for mental health and chemical dependency.
Rates
Individual plan rates are based on the type of plan (benefits), your age, and your use of tobacco products. Each age-bracket has a published rate for smokers and non-smokers. In order to qualify for these rates, you must pass a health test. The test is in the form of a Standard Health Questionnaire. If your score is too high, the insurance company will notify you that your application has been rejected and they will be refer you to the Washington State Health Insurance Pool (WSHIP). Plans offered through WSHIP include Rx benefits but do not cover routine maintenance services. Rates are between 110% and 150% higher than the market average.

At Pacific NW Insurance Brokerage, we compare all plans available to find the plan that best fits your budget and protection needs. We will clearly explain the plan's benefits, exclusions, and limitations to make sure it is the right one for you. Throughout the life of the policy, your agent will be available to provide any service you may need regarding your policy.
Contact us today for more information about Individual Health Insurance or fill out our online quote form.

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