Frequently Asked Questions

And the answer is...

Every life decision involves trade-offs. When it comes to health insurance, are you better off paying out of pocket for occasional medical care, or should you pay a regular amount that guarantees more and better coverage than you could afford yourself? The answer is somewhere between. If you rarely visit the doctor and have disposable income, you might be best off with a high deductible health insurance policy. Since the policy does not cover routine care, the premiums are small, leaving you more cash on hand to pay for minor medical care out of pocket. However, if you happen to be hit with a serious illness or injury, the bulk of your treatment will be covered by the insurance.

And the answer is...

Many families with young children find that a health care insurance plan that emphasizes wellness is better than a plan that protects only against major illness and injury. That's because young children need ongoing care, even when they are healthy. As a result, many families opt to be insured by a health maintenance organization (HMO) that covers well baby and well child visits, immunizations, and physicals with relatively small co-payments. The HMOs are able to control their costs by requiring members of their plans to receive all care through a network of preferred providers. The care is managed by a "primary care" doctor, who provides most of the care and authorizes lab work, tests, and additional care from specialists.

And the answer is...

By California state law, health insurance providers must charge everyone the same rate for a specific health insurance plan. As a result, the rates you pay for a plan are exactly the same, whether you buy directly from the insurance provider or through an independent agent. However, an independent agent can shop around to find a plan that meets your medical requirements at a lower cost. With our depth of experience, Stokely Health Insurance normally can you find an equal or better plan for less.

And the answer is...

Yes. The 63-day rule will remain in effect until the new healthcare reform law is completely phased in at the beginning of 2014. The 63-day rule was established in 1996 by the Health Insurance Portability and Accountability Act (HIPPA). It defined the number of days a person has to sign up for a new health insurance plan before he or she is no longer deemed to have "continuous coverage." The rule is important, because people without continuous coverage can be subject to delays or even denial of coverage. However, if you sign up for new health insurance coverage within the 63-day window, you will be deemed to have continuous coverage. If you have a preexisting condition, the period of your continuous coverage will be applied to any waiting period you might have for a preexisting condition. For example, if you have a condition that results in a waiting period of 18 months, you will have to wait 18 months minus the amount of time you had continuous coverage. If you had coverage for 18 months or more, you will have no waiting period. If you recently lost your health care insurance coverage, contact Stokely Health Insurance immediately, and we will help you obtain a new policy within the 63 days.

And the answer is...

• Re-read your health insurance policy to refresh your understanding of what types of tests, treatments, and medications the plan covers and what portion you are responsible for paying.
• Find out what procedure the health care insurance company has for handling claims that are denied, then follow the procedure.
• Retain all correspondence, records, and other documents pertaining to the denied claim.
• If your employer provides your health insurance, speak with your human resources department for guidance. If you purchased individual health care insurance, speak with your independent health insurance agent.

And the answer is...

Under current law, the answer depends on the number of people on the payroll of your employer. If the company as 19 employees or fewer, it can terminate your health insurance coverage when you turn 65. If the company as 20 or more employees, it must offer you the same group plan it offers everyone else in the company until you turn 69. Even if you are insured through an employer, you should sign up Medicare Part A when you turn 65. Medicare Part A does not require you to pay premiums, and it may cover some conditions your employer's health insurance plan does not.