• In general no. Most companies do not require you take a physical examination.

• Underwriting decisions are usually based on:

• • Medical records

• • Information in M.I.B.

• • Information you provide in the application

• • If there is any question as to your current medical condition the insurance company may do a phone interview with you.

• There are two ways: Online or Paper Applications.

• ONLINE: Some companies offer online applications. After you obtain the quote from our system, if that option is available you will select it and follow the instructions. You will establish an ID and password with the insurance company and fill out the forms electronically. Initial payment is always by debit/credit card. Most companies are in the process of making this a reality but for now the traditional paper application is still the standard.

• TRADITIONAL PAPER APP: You can obtain a paper application several ways. Contact the agent and have it mailed/faxed/email to you fill it out then sign and return...or Fill out an electronic form online then print the form, sign it and mail back...or Print the application from a .PDF file, fill out by hand and mail back.

• REMEMBER Do Not Cancel your current coverage until you have received written notification of your approval from the new Insurance Company.

• At E Hummel Insurance Group we are committed to protecting your privacy. WE WILL NOT SELL, TRADE or GIVE AWAY your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application. The privacy policy Pertains to the information that you provide to obtain insurance. The agent usually only has the information you provide on the application. The insurance company typically obtains additional information from independent sources such as MIB.

• If you have any questions about our privacy statement, our company policies and procedures or your experience with our site, you can contact us at privacy@erichummel.com

• • I have questions about completing my application?
    You can also call us toll free at (800) 452-9261 Monday through Thursday 9AM - 5PM MST and on Friday 9AM - 12PM MST.

• Feel free to call us after hours and leave a message, which will be immediately returned the next business day.

• A "claim" for benefits occurs when you or the provider of the medical care submits a bill or copy of the bill to the insurance company for consideration of payment. The claim can be:

• • Paid as submitted

• • Applied to the deductible

• • Adjusted down to a different amount then applied/paid

• • Denied

• • Reviewed with a request for additional information

• You should receive an EOB for the insurance company explaining how this was handled. When a serious medical problem occurs it is always wise to keep a log of what procedure was done and when. You will likely forget over time and become confused when multiple EOB's and bills roll in the door

• Gather all the information you have (EOB's, bills etc...) and fax them to us at (603) 843-1829. Call us the next day and we can discuss the problem and help with a solution.

• Call the doctors office and ask if a claim was filed with the insurance. If yes, give it 30 days then follow up with the insurance company to see how it was handled. If no, send the bill to the insurance company yourself or fax it to us and we will do it for you. Our fax number is (603) 843-1829. Be sure to include your name, company, and policy number when you send the fax. We are happy to help.

• This is sort of a combination HMO with a Classical Major Medical. If this really appeals to you stick with a PPO co-pay style insurance plan and you'll be happier.

• Basically in a POS you can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.

• PPO stands for Preferred Provider Organization. The organization is a list of providers (doctors, hospital, labs etc...). You are not a member of a PPO you are the insured. A PPO is not an HMO. The members of a PPO are the doctors and hospitals within the PPO network. When an insurance company combines a Classical Major Medical Plan with the PPO list they typically call this a PPO insurance plan. Under the co-pay style you can see doctors, go to labs, get x-ray imaging and prescriptions for a co-payment. Major medical problems are handled in the typical Classical Major Medical way but you must use the PPO list otherwise you will pay additional out of pocket expenses.

• The big advantage of a co-payment is the co-pay it is usually small ($10 - $50), the big disadvantage is the co-payment doesn't usually count toward your deductible. Because of this you could be "nickel and dimed" ("co-paid") to the poorhouse. Most plans have no maximum limit on co-pays. Picture a chronic neck injury after a car accident and you get my drift. Look for maximums and additional deductibles also.

• Remember PPO stands for Preferred Provider Organization. The organization is a list of providers (doctors, hospital, labs etc...). You are not a member of a PPO, you are the insured. A PPO is not an HMO. The members of a PPO are the doctors and hospitals within the PPO network. When an insurance company combines a Classical Major Medical Plan with the PPO list they typically call this a PPO insurance plan. Under the discount style you can see doctors, go to labs, get x-ray imaging and prescriptions for a discount. Major medical problems are handled in the typical Classical Major Medical way but you must use the PPO list otherwise you will pay additional out of pocket expenses.

• The big disadvantage of a discount style is the discount payment is usually higher than the smaller ($10 - $50) co-pay, the big advantage however is the discount payment does usually count toward your deductible. Because of this you avoid being "nickel and dimed" ("co-paid") to the poorhouse. Most of these plans have a maximum out of pocket limit.

• A computer generated document describing how the insurance company handled a claim.† The EOB usually includes details about the service, provider, the date of the service, amount allowed, amount paid, cost sharing details, member liability, denial reasons, and appeal rights.
  Keep all of these you receive. They will be invaluable if you receive any bill from providers that you may question.

• Click on the link for 4 definitions from a web search. Keep in mind an HMO is more "organization" than "insurance" and should be though of as such. Pay close attention to the emphasized statements.

• • 1. Health Maintenance Organization. A plan that provides health care from specific doctors and hospitals that contract with the plan. Usually there are no deductibles to be met, no claim forms to be completed by the enrollee, and a geographically-restricted service area.

• • 2. Health care delivery system that typically uses contracted primary care physicians to coordinate all health care for enrolled members. HMOs require you to select a primary care physician (PCP). The PCP coordinates your care and refers you to specialists and hospitals. Covered services are usually paid in full after you pay any required co-pay. No claim forms are required

• • 3. Health Maintenance Organization A health care payment and delivery system involving networks of doctors and healthcare institutions. It offers consumers a comprehensive range of benefits at one annual fee (often with co- payments or deductibles that vary from service to service) but they can see only providers in the network. Physicians and other health professionals often are on salary or contract with the HMO to provide services. Patients are assigned to a primary care doctor or nurse as a "gatekeeper" who decides what health services are needed and when.

• • 4. Health Maintenance Organization is a health plan that receives a discount from hospitals, physicians, and other providers based upon the volume of patients each provides. The HMO's members receive comprehensive preventative, hospital, and medical care from specific medical providers who have agreed upon pre-set rates. Members select a Primary Care Physician or medical group from the HMO's list of affiliated doctors and generally have no deductibles or claim forms. Members make a small co-payment, usually between $3 and $20. Some HMO's have capitated contracts with providers and some pay providers on a single discounted fee-for-service basis.

• • An HMO generally cannot be sued if you are dissatisfied with the care you are receiving but you can complain and arbitrate through a grievance procedure.

• Sometimes called fee-for-service plans or sometimes called indemnity plans (these are old names and should not be used). Classical Major Medical Insurance concerns itself mostly with illnesses and injuries and is pretty light on the preventative side of health care (some preventative coverage is in most plans ... an example might be mammograms or prostate cancer checks).

• This type of insurance covers most traditional medical care charges and begins to pay when the deductible is met. Claims costs are kept under control by applying the usual and customary fee standard to a charge. These plans have no network of providers that you must use, however many such plans have networks attached that you can use, if you prefer, for a discount.

• There are two basic types.

• • 1. Major Medical Insurance Types See

• • • "What is Classical Major Medical Insurance?"

• • • "What is a PPO co-pay insurance plan?"

• • • "What is a PPO discount insurance plan?"

• • • "What is a POS insurance plan?"

• • 2. HMO (Health Maintenance Organization) Types:

• • • See "What is an HMO?"

• Selecting a health insurance plan does not have to be difficult. Although there are no "best" plans, there are some plans that will be better than others for your insurance needs. No plan will pay for all the costs associated with your medical care, some plans cover more than others. Plans differ basically in the following areas (helping you balance these areas to fit your needs is the job of an agent):

• • Premiums - what you pay each month to have the insurance coverage.
    You can pay monthly or quarterly (every 3 months) some plans still offer annual and semi-annual premiums. Rates that you pay are based partially on where you live, but benefits are usually based on where you get your care. This is good and benefits you by allowing you to go where you feel you receive the best care and not worry so much about how this will affect your rates. Premiums go up based on the claims experienced by the insurance company as a whole and not your claims individually. A grace period of 30 days to pay your premium is standard in most health insurance contracts. Check your policy to be sure. Most of the time monthly payments are done by auto-drafting your checking or savings account.

• • Deductible - what you pay for a serious medical problem before the insurance begins to pay. Deductibles can range all over...as little as $50.00 to $25,000.00 with the standard ranging between $500 to 2,500. Most deductibles are per person per calendar year, but some policies are per incident (not so good) so be careful to check. All other things being equal... generally the higher the deductible the lower the premium.

• • Co-insurance - this provision kicks in after the deductible is met. An example is 80/20 to $5000? where 80? represents the percentage of the medical bill the insurance company pays 20? represents the percentage you pay to. 5000 represents at what point the co-insurance relationship stops and the insurance company pays the remainder. In this example a person would be responsible to pay 20% of $5000 or in other words $1000.

• Typical is 80% or 80/20 to $5,000, but could be enhanced (say 100% for example) or reduced (50% or 50/50) depending on what you decide. This is a very important area of your coverage and is the area most people skip. Don't make that mistake.

• • Co-payments - small ($10.00 to $50.00 or more) payments you make to the providers of medical care (doctors, labs, and so forth..) each time they give you care (office visit, test, etc..). You pay this money upfront at the time of the service.

• Usually has nothing to do with the deductible or the co-insurance. There are advantages and disadvantages to this system. The big advantage is of course you can get access to the medical providers with very little money in your pocket however there are several major drawbacks. First, these plans are usually more expensive than their cousin plans... the discount PPO. Secondly the co-pay is unlimited meaning it usually doesn't apply toward your deductible. In other words it is additional out of pocket to you. Best to think of co-pays as mini-deductibles per use. A good rule of thumb with any insurance is It is not a benefit to me when I pay money out of my pocket only when the insurance company pays money out of its pocket?. If you'll try to remember this rule you won't get so confused when the insurance company calls money you pay out of your pocket a benefit.

• Out of pocket maximums (individual and family) - The total of the deductible and the co-insurance amounts. Usually does not include the co-payment amounts. The out of pocket maximum is a great equalizer that can help you shop and compare policies easier. Using this method can help ferret-out? the best coverage. For example a policy with a deductible of say ... $250 might seem very appealing but could have an out of pocket maximum totaling $5200 per year and cost you $300/month in premiums but a policy with a $1500 deductible could have an out of pocket maximum totaling only $2500 and only cost you 200/month. You would save $100 per month in premiums and cut your out of pocket by by several thousand. Out of pocket is a great way to shop and compare. Family out of pocket maximum is the number of times you are responsible for meeting the deductible in your family per year. Usually x 2 per year but could be 3 or more. Be sure to check this or call us and we will help you compare... its simple and easy. Call (800) 452-9261 today.

• Depends on what you want. To answer that question correctly, you need to compare and choose what is best for your needs. Here are the areas to compare:

• • Premium: Group Insurance (employer sponsored health insurance) is usually more expensive and individual insurance. This by and large is do to state mandated coverage in group health but other factors (age, health of the group and so forth) could also be involved. Keep in mind that in group health your employer often pays all or a large part of your premium; as a result it may cost you less. But remember the old adage "you get what you pay for"... so read on. There are other important factors to consider before pulling the switch on either of these plans.

• • Guaranteed Issue: Group health is guarantee issue and individual health insurance is not. So if you have serious health problems this is no-brainer, go with the group. If you lacked prior coverage before starting group coverage you may not be immediately covered for your serious health problems (up to 1 year wait is typical) but it will kick in at some point. Check with your human recourses department.

• • Benefit Requirements: The state you live in often mandates certain types of coverage in group health insurance (maternity, newborn care, mental health expenses etc...). So group health insurance coverage is usually better but this can make it more expensive (see premiums above). Ask yourself do you want the extra benefits or do you even need them. Money doesn't grow on trees and if you want your insurance to pay certain expenses the money must come from somewhere.
    So why is it important to decide up front if having more benefits is best for you and your family? Seems like a no-brainer right? Well maybe not. Here is one idea to consider... you may not always work for your current employer, but your (or your dependents) might have a sudden unexpected health problem that may require or force you to keep the insurance when you leave. That means you will be paying the premiums yourself (see COBRA), the higher premiums with the mandates you may or may not want or even need. In other words you would be stuck paying higher premiums just when you are changing jobs and you have a health problem. Not the best situation to find yourself in. This can be avoided by having individual health insurance not group.

• • Renewability: A big word for an important idea. There are a lot of folks running around out there who had group insurance, got sick or injured, lost there coverage for one reason or another and now can't buy coverage. Group health insurance is not guaranteed-renewable and most individual health insurance is. Your employer can cancel the group; the insurance company can cancel the group. Remember COBRA will only protect you for a time (see COBRA) and HIPAA (see HIPAA) is extremely expensive.