Health Insurance Frequently Asked Questions by
Selected Benefits of Houston
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What is a deductible? A deductible is a dollar amount that a person must satisfy before reimbursement by a Houston health insurance policy for medical expenses will begin. Generally, the higher the deductible, the less expensive the health insurance policy.
What is coinsurance? Coinsurance requires you to pay a certain percentage of the covered medical expenses as outlined in your Houston health insurance policy booklet. The actual percentage is usually expressed as "80-20" or "75-25", but we also offer plans that have 100% coinsurance (these are normally Texas Health Savings Accounts). After you have satisfied your deductible as stated in your Texas health insurance policy, you will pay 20% of the covered medical expenses and the Texas health insurance carrier will pay 80% of the covered medical expenses. When your total medical expenses reach a certain dollar amount as stated in your health insurance policy (this is called your coinsurance limit), the insurance company generally pays 100% of the covered medical expenses thereafter, up to the lifetime maximum of your Texas health insurance policy.
What is an HMO? An HMO (health maintenance organization) is an organization that provides complete medical care to an enrolled group of people at a predetermined cost. Members pay a fixed monthly rate directly to the HMO and receive healthcare services whenever they like.
When will my policy begin? All Texas health insurance policies are subject to underwriting prior to approval. This process can take anywhere from the same day up to 14 days in most cases. Most Texas health insurance policies are approved within 3-5 days. Make sure not to cancel any existing health insurance policy until your new policy is issued an effective date.
What is a waiver? A waiver is used when a certain area of the body or particular medical condition is not covered due to previous medical history. Some waivers can be temporary and some can be permanent.
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