Midwest Health

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Frequently Asked Questions

In this section you'll find answers to the most commonly asked health and life insurance questions.

Health Insurance

Life Insurance

Health Insurance FAQ

What is a deductible and how does it work?
A deductible is the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.

What is coinsurance?
Coinsurance is a cost-sharing requirement where you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your plan deductible is met.

What are co-pays?
A co-payment or co-pay is a specific flat fee you pay for each medical service, such as $30 for an office visit, after which the insurance company often pays the remainder of the covered medical charges

What’s the difference between a Primary Care Physician (PCP) and a specialist?
A Primary Care Physician, or PCP, is the doctor you would go to on a regular basis, such as when you’re simply not feeling well, or have an ear ache or the flu. A specialist is a doctor that your PCP might refer you to if the problem you have requires a doctor with more experience in a certain area.

What is “Out-of-Pocket-Maximum”?
This is the amount of money one would pay out of their own pocket towards your medical expenses in any given year. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, that is referring to how much the insured would have to pay for the whole year out of their pocket, excluding premiums. Usually, your maximum out-of-pocket is never more than a couple of thousand dollars over and above your chosen deductible.

What is a network?
A network is a list of doctors, hospitals and other providers that have contracted, or agreed, with an insurance company to do business with the insurance company. The provider’s fees have been pre-negotiated, which means that the insurance company will not necessarily pay the doctor or hospital what your actual medical bills are, but will pay a lower amount.

What is a pre-existing condition?
A pre-existing condition is any health condition you have or have had prior to applying for a health insurance policy.

Can I get health insurance if I’m currently pregnant?
Unfortunately No. You certainly may obtain insurance prior becoming pregnant and if you have other children, they may be insured through us at any time.

What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act, which is a law mandating that anyone belonging to a group health insurance plan must be allowed to purchase health insurance within an interval of time beginning when the previous coverage is lost regardless of current health status.

Life Insurance FAQ

What is Term Insurance?
Term insurance provides protection for a specific period of time. It pays a benefit only if you die during the term. Some term insurance policies can be renewed when you reach the end of a specific period, which can be from one to 30 years. The premium rates increase at each renewal date. Many policies require that evidence of insurability be furnished at renewal for you to qualify for the lowest available rates.

Why Should I Buy Life Insurance?
One of the biggest reasons to buy life insurance is to provide money in case of death. If you’re single and don’t want to leave money to anyone, you may not need life insurance. But as you take on more responsibilities and your family grows your need for life insurance increases. The proceeds from a life insurance policy can replace the income lost to your family upon your death. The life insurance death benefit can also pay off debts and expenses provide money to a charity or organization, and cover final and estate expenses.

How much life insurance do I need?

 If you are providing financial support for people who are depending on you, you probably need life insurance. To determine how much you need, deduct the total income that would be lost upon your death from the sum required for your families ongoing financial stability. Beyond that, it depends on your particular circumstances (e.g., whether you have considerable net worth or few backup resources) and whether you want insurance for other purposes, such as educational funds or your own retirement income. Although there is no substitute for a careful evaluation of the amount of coverage needed to meet your needs, one rule of thumb is to buy life insurance that is equal to five to seven times your annual gross income.

Do I have to take a medical exam?
Yes and No. Medical exam requirements will vary depending on the company. In some cases will need to take a brief paramedic exam which includes blood and urine sample. This service is free and can be done in your home or office, at your convenience, and usually takes less than 30 minutes.

Why might the underwriting process take a while?
If you have any medical history that an insurance company may see as questionable, they will send a request to your physician(s) for your records and this process can take a few weeks. The other reason why underwriting can take a while is that if you are applying for a large amount of coverage, most companies will request a copy of your driving record, send for a copy of your doctor records (whether there is any history or not) and also call you to complete a Personal History Interview.

Can I name someone other than a relative as the beneficiary of my life insurance policy?
Although it is typical for an individual to name his or her spouse, child, parent, or other relative as the life insurance beneficiary, non-relatives can also be named. For instance, you can designate your estate, trust, business partner, lender, or domestic partner as beneficiary of your life insurance policy.

Check the laws in your state for specific requirements, though. A few states specify that under certain circumstances an unrelated beneficiary have an insurable interest. An insurable interest exists when one party has a financial interest in another party’s life. The beneficiary of a life insurance policy must expect to suffer a financial loss if the insured dies.

I don’t smoke cigarettes, but I smoke cigars occasionally. Will I have to pay smokers rates for life insurance?
Because of the increased mortality risk associated with smoking, smokers almost always pay more for life insurance than their nonsmoking counterparts. Some life insurance companies distinguish between moderate smokers (20 or fewer cigarettes per day) and heavy smokers (more than 20 cigarettes per day) and offer somewhat lower rates for those who smoke less. Rising cigar popularity raised numerous questions about how to classify cigar smokers. Unfortunately, there is not yet an industry-wide consensus on this issue.

Insurance companies will typically reevaluate your rates if you quit smoking for at least a year.

What does insurable interest mean on a life insurance policy?
If you want to buy a life insurance policy on someone else’s life, you must have an interest in that person remaining alive, or expect emotional or financial loss from that person’s death. This is called an insurable interest.

When you buy insurance on your own life, you are assumed to have an insurable interest. If you are buying a policy on someone else’s life, an insurable interest can typically be established if you have a sufficiently strong relationship with that person based on blood, marriage, or monetary interest.

I am single. Do I need life insurance?
Single people often think they don’t need life insurance, and in many cases, they are right. However, there are many factors that determine your need for life insurance; marital status is just one.

What you need to consider is if you died tomorrow, would you leave enough to cover your funeral expenses? If not, who would be responsible for paying? For many families, even a relatively simple funeral can create a major financial burden. For this reason alone, you might consider purchasing a small life insurance policy, or even a simple burial policy. As an alternative, you could invest the premiums you would spend on such a policy, and make sure your family knows this investment is earmarked for your final expenses, should the need arise.

Do life insurance companies really check to see if I’m a smoker?
Because smoking is a health hazard, life insurance companies may charge you a higher premium if you smoke. Worse yet, smoking may even prevent you from obtaining life insurance coverage at all. How does an insurance company find out if you smoke and how much? In most cases, they start by simply asking you. Almost every application for life insurance contains questions about health issues, including smoking. Your responses to any smoking-related questions will play a part in a company’s decision about whether to sell you life insurance and at what price.