Idaho Health Insurance FAQ’s

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Frequently Asked Questions

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  • Does my school require me to have insurance?

    • Yes, not only is it federal law for individuals to have medical insurance, but your school requires you to have an ACA approved plan to enroll in classes.
  • Can I purchase a short term insurance plan?

    • If you are a NEW student who does not have an insurance plan, your school will accept a short term medical plan until Jan. 1, 2016.
    • Between Nov.1 and Dec. 14, 2015, the Federal Open Enrollment opens and you will be able to enroll in an ACA approved Bronze, Silver, Gold or Platinum Idaho health insurance plan.
    • If you do have an ACA approved  plan by Jan. 1, 2016, you may not be able to register for classes during the next semester
    • If you are a returning student who previously had a SHIP plan your school will not accept a short term plan. You must purchase a plan during your special enrollment period (SEP)
  • Do I need to purchase a plan form Your Health Idaho?

    • Due to the fact that Idaho did not expand Medicaid many people who do not earn at least $11,670 will not be eligible for any cost savings.
    • Therefore you may want to look for additional plans available off exchange as there may be more choices at lower prices.
  • What if I have a pre-existing condition?

    • The good news is that nobody can be denied coverage due to a pre-existing health condition
    • However, you must be sure to enroll during either an SEP or the Federal Open Enrollment Period.
  • What is an HMO?

    • An HMO, or Health Maintenance Organization, is a type of managed care health plan where you must receive care from an in-network provider. If your health insurance is provided through an HMO, you have to select a Primary Care Physician (PCP), the doctor who provides your basic health care, in the HMO network in order to receive any health care. This PCP also coordinates the care you receive from other providers and gives referrals to specialists, surgeons or for lab tests. While an HMO may be more restrictive by requiring that you live or work in its service to be eligible for coverage, in exchange for this limited access to providers, premiums are typically lower in an HMO than in other types of plans. In an emergency, you do not have to seek care from a provider in your HMO network. If your doctor leaves your HMO plan, you must select another doctor from the plan.
  • What is a PPO?

    • A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost.
  • What is a Copay?

    • A fixed amount (for example, $15) you pay for a medical visit or for medication that is covered under your health plan, usually when you receive the service. This is considered part of your out-of-pocket costs, separate from premiums and deductibles..
  • What is a Deductible?

    • The amount you must pay for health care services before your health insurance company will start paying benefits. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your deductible for covered health care services that are subject to the deductible. The deductible may not apply to all services.What is Coinsurance?
    • A kind of cost-sharing in which the insurance company pays for a percentage of the cost of medical treatment, and the patient pays the rest. This is separate from deductibles and premiums. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
  • What is a Coinsurance Maximum?

    • The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This does not include your premium , balance-billed charges or health care your health insurance or plan doesn’t cover. Some health plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.Why is it so important to stay “In-Network”?
  • What is a Network?

    • The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services

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Awesome guide that simplifies the confusing health insurance jargon. Great #guide to help you decide what’s best for you & your #family. REPIN & LIKE to share with friends. #healthcare


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