With Health Maintenance Organization (HMO) plans, you:

• Receive most covered services right No charge or for a fixed amount
• Choose a Personal Physician from HMO Network who provides, refers and coordinates your medical care; and
• Receive all medical services from providers in your Personal Physician' s medical Group or IPA.
• With some insurance carriers, you can refer yourself to many types of specialist in your Medical Group or IPA.

Preferred Provider Organization (PPO) plans allow you to:

• Choose your own providers - each time you seek medical care;
• Access discounted charges through your plan's participating provider network;
• Choose a plan with or without a Plan Deductible;
• Receive some benefits even before you meet any plan deductible; and
• Pay a percentage of charges for most covered services after you meet the plan deductible.

• What's important to you in a plan? Not having a deductible? A wide choice of coverage? Freedom of choice?
• How often do you go to the doctor? If you go at least four times a year, consider a plan with a fixed Office Visit co-payments.
• Do you have children? You can cover them with low or no deductible YouthCare plans and cover yourself separately.
• Are you looking for "catastrophic coverage" and your lowest rates?
• Are you self-employed? Preferred Savings "High deductible" plans will protect you against major health expenses, and can help the self-employed to qualify for a Medical Savings Account.
• Where do you live? Do you wish to keep your current doctor? Some areas of California are not covered by HMO. Check list of participating providers before choosing a plan.

How soon can I be covered? If approved, your coverage could begin from one to four weeks after the carrier receives your application. Some applications could take longer to approve when medical records are needed to review the application.

Do all plans have exclusion for pre-existing medical conditions? HMO plans have no waiting period or exclusion for a preexisting condition. The PPO plans, however, have a six months preexisting clause. Benefits will not be provided for that condition in the first six months of coverage. This exclusion may be waived if you have prior creditable coverage".

How do family deductibles work? A family deductible counts the expenses of all covered family members taken together and is just twice an individual deductible amount, no matter how many people in your family are covered.

If I have questions while completing an application, whom can I call? You may call us anytime during business hours. We have knowledgeable and responsive staff to help you go complete your application.

What is a co-payment? A copayment is a fixed dollar amount that you pay every time you visit a physician. It could also be in terms of percentage. Some plans may have a $20, $30 or even $40 copayment per visit. Most HMOs and PPO's have copayments. Most deductible PPO programs allow members to have a copay on doctor's visits without having to meet their deductible. These copayments do not go towards the satisfaction of your deductible.

What are my options for making my first payment? Most plans require either the first month's or two month's premium with your application. You have the option to pay by credit card or by check. If your application is not approved, your money will be refunded to you. Once accepted, all bills will be sent to you by the insurance company and you may pay them according to the choices offered by the carrier.

Will I be spending more out of pocket with a PPO than with an HMO? If you join a PPO, you will experience more flexibility and have more choices than with an HMO, but your total out of pocket costs are likely to be higher. It is a trade off.

Can I buy health insurance for less if I go directly to the insurance company? No. Insurance companies charge the same premium whether you purchase it directly from the company, or through a broker.

Do you offer health insurance for business? Yes! We specialize in health insurance for small businesses and individuals. If you have a business, visit our small business section for the different plans offered.