FAQ

  • Frequently Asked Questions
  • How Do You Compare Health Plans?

    When shopping for health insurance it is easiest if you keep 3 main features in mind when comparing benefits:

    1. What do I pay for an Office Visit?
    2. What do I pay if I end up in the Hospital?
    3. What do I pay for Prescription Drugs?

    When you compare these 3 benefits for each of the plans you are considering, the differences are much easier to understand. For example, take the Anthem Blue Cross Silver level PPO plan. The co-pay for an office visit is $__. The annual deductible if you land in a hospital is $____ and the co-pay for prescription drugs is $__ and $__.

  • How are Individual and Family Plans different from Group Plans?

    Group plans are offered by large and small businesses and organizations to their employees.

    Individual plans can be purchased by anyone under age 65. If members of your immediate family need coverage, you can add them to your individual plan.

    Group plans, large and small are guarantee issue. That means any employee who is eligible to be on the plan will be accepted, regardless of their health status.  Currently individual health plans require medical underwriting or approval based on health, in order to qualify.  Starting on Jan. 1st, 2014, under Health Care Reform, Individual plans will also be guarantee-issue.

    Currently individual health plans are significantly less expensive than group plans.  With the introduction of health care reform and the guarantee-issue mandate in Jan. 1, 2014, individual plans rates will likely rise to the level of group plan rates.

    
    
  • How come I paid so much less for my Employer Group Plan?

    Most employers subsidize or contribute a percentage of the cost of their employees (and families) insurance.  Usually, anywhere from 50% to 100% of the cost of the employee’s premium, and from 0% to 100% of the cost of the dependents’ premium.  You likely paid little or none of the cost for yourself and a small percentage of the cost for your family members. The full cost of this insurance is apparent only when you leave an employer, when the cost is passed down to you if you continue your coverage under COBRA. With COBRA coverage, you pay the entire cost of your health plan plus an administrative fee of 2% for Federal Cobra or 10% for CalCobra.

  • Who should buy Individual and Family Health Insurance Plans?
    • Anyone from  0 to 64 years old.
    • If you are currently uninsured.
    • If you are paying too much for your current plan.
    • If you are self employed.
    • If you own a small business.
    • If your employer does not offer group health insurance.
    • If your employer offers to pay for an individual plan on your behalf.
    • If you don’t like the choice of plan offered by your employer.
    • If you are on COBRA or CalCobra.
    • If you are on an out-of-state health plan.
    • If you are on a health discount program, which is not true health insurance.
    • If you have been laid off or in between jobs.
    • If you are forced to seek individual coverage due to a divorce.
    • If your employer plan costs too much to include your spouse and children.
    • If your employer plan does not offer you the providers you need.
    • If you missed your employer’s open enrollment period for coverage.
    • If you got dropped from your parents plan due to age 26.
    • If you retire before age 65 and need to bridge coverage to age 65.
    • If you just started your own business.
    • If you just immigrated to the U.S.
    • If you plan to travel to other states or countries for part of the year.
    • If you are uninsured and don’t want to rely on county or state hospitals and clinics.
    • If you are a physician with your own practice.
    • If you are on a work visa in the U.S.
    • If you are visiting the U.S. for an extended period of time.
    • If you are a foreign student.
    • If your College or University does not offer any medical care outside of an on-campus clinic, or offer plans that are too expensive or lacking in benefits.

     

  • How do I know which plan is best for me?

    The easiest way is to seek advice from one of the experienced no-fee agents. An agent can help you make an educated decision about which insurance plan you should enroll in. To choose the right plan, you have to take many factors into consideration. Some of the factors that you and your agent will need to consider are:

     

    1. What is your current insurance cost?
    2. When did your last insurance end?
    3. How much can you afford?
    4. What routine medical services do you use?
    5. What ongoing medical treatments do you receive?
    6. What ongoing medications do you take?
    7. Do you have an option for COBRA, HIPAA, retirement plan, veterans plan, Medi-Cal, Medicare or Medicaid?
    8. Do you need maternity coverage?
    9. Are you looking for a job that offers health insurance?
    10. Does your spouse’s employer offer coverage?
    11. What is the cost of this coverage for just the employee? What is the cost with the spouse? What is the cost with the children?
    12. Are you a domestic partner?
    13. Are you planning to move out of state?
    14. Do you own a small business?
    15. Are you planning to start a new business?
    16. Are you self-employed?
    17. Are your doctors in the PPO or HMO network?
    18. Are you losing coverage because of a divorce?
    19. Are you currently uninsured?
    20. Are you interested in a tax shelter, in the form of a Health Savings Account?

     

  • Why use Lee Insurance?
    • We offer one-stop shopping for plans within the Covered California exchange as well as a wider variety of plans outside of the exchange.
    • Lowest prices available for all the plans because, by law, rates have to be the same wherever you get your plan from.
    • Free consultations.
    • Help you to submit and monitor the progress of your Enrollment applications.
    • Advise you and help you apply for subsidies should you be eligible.
    • Review your plan annually.
    • Provide ongoing customer service.
    • Assist you with claims disputes.
    • Recommend alternative plans.
    • We alert you to avoid cancellation.
    • Advise you on the most economical plans.
    • Help you to change plans.
    • Help you to beat rate increases by changing plans.
    • Help you to appeal rate-ups so you have the best chance of getting preferred rates.
    • Keep in touch with you via newsletters, birthday cards, greeting cards and calendars.
    • Help you to upgrade.
    • Provide you with other products such as life, disability and long-term care insurance.
    • Give you reliable advice.
    • Experienced insurance professionals with many years of experience.
    • More knowledgeable and personable than 800 call center operators.
    • Local family-owned business with over 23 years of experience -- not a faraway website with an 800 number.

     

  • How do I know I can trust Lee Insurance?
     

    ·         Lee Insurance is a family owned insurance agency that has been in business for over 23 years. In 1996 the Lee Insurance website was the first on the internet to offer instant insurance quotes. Over the years Lee Insurance has assisted tens of thousands of satisfied customers in saving millions of dollars a year on their health care costs.

    • Clients of our Licensed Agents are protected by Errors & Omissions and Liability Insurance.
    • Every Licensed agent has over 52 hours of initial classroom education, on top of dozens of hours of annual continuing education requirements.  In addition, dozens of hours of education are required to offer special plans from the Covered California Exchange, the SHOP Small Business Exchange, Medicare Advantage and Prescription Drug plans.

    ·         A+ rating with zero complaints as verified and reviewed by the Better Business Bureau.

    ·         5 Star ratings on Yelp and many other online review services.

    ·         Lee Insurance has 3 physical retail locations in Northern California to serve its clients.

    ·         Numerous testimonials from satisfied clients.

    ·         Our agents are Certified Insurance Agents (CIA).  Beware of using Navigators or Assistors also know as Certified Enrollment Specialists (CES), who are not licensed, not bonded, with no experience, no liability or Errors & Omissions policy to protect their clients.

     

  • How can my business qualify for guarantee-issue group plans?

    If your business has 2 or more full-time employees (including the owners), you may qualify for a guarantee-issue small group plan. (Guarantee issue means that all employees and their dependents are accepted into the plan regardless of pre-existing health conditions). Consult with one of Lee Insurance’s experienced agents for rates and advice that’s specific to your situation.

  • Which doctors and hospitals are in the provider network?

    In most cases, PPO and HMO networks for individual plans closely overlap those of employer group plans. With PPO Plans you can expect most private doctors and hospitals to be in-network. Carriers like Anthem Blue Cross, Blue Shield and Health Net include over 50,000 physicians (over 80% of the physicians in California) with no referrals or authorizations necessary.  The networks for HMO Plans are more limited. You may use only your chosen primary care physician and the hospitals who belong to the same medical group or IPA (‘Individual Practice Association’) that your Primary Care Physician belongs to. With HMO’s you also need to get a referral from your Primary Care Physician to see any specialists or to have any work done that your Primary Care Physician cannot do in their office. You may search for a provider network using our Doctor Finder.

  • Are there any waiting periods for coverage?

    It depends on your situation. If you have had continuous coverage for over 6 months with no gaps, any waiting periods will likely be waived. If you are accepted into an HMO plan, there is no wait regardless of gaps in coverage. If the gap in coverage is over 63 days you may be subject to a waiting period for any pre existing conditions. Consult with one of Lee Insurance Services’ experienced agents for advice that is specific to your situation.

  • How do I know I’m getting the best rates?

    You get the same rates and the same plans whether you use Lee Insurance Services, get them directly from the insurance carrier, from the Covered California Exchange, from a Navigator or Assistor or CES, or through another insurance agent. Health insurance rates are controlled by state regulators. These rates are filed with the State of California, the State Exchange and are the same whomever you buy the insurance through.

  • What is guarantee-issue health insurance?

    Guaranteed-issue insurance refers to plans that cannot turn you do for enrollment. Examples of guarantee issue plans are employers group plans, COBRA, HIPAA, Conversion plans, government sponsored programs like CA MRMIP, Healthy Families, AIM, MediCal, Medicaid, etc. Consult with one of Lee Insurance Services’ experienced agents to determine what you may qualify for.  On Jan. 1st 2014, under Health Care Reform, all individual and family health plans will be guarantee-issue.

  • What if I have a pre-existing health condition?

    Many individuals and families with pre-existing conditions may still qualify for individual health plans, sometimes with slight ‘rate-ups.’ If your pre-existing condition causes you to be declined there are many other guarantee issue alternatives such as COBRA, HIPAA, small group plans, government sponsored programs like CA MRMIP, Healthy Families, AIM, MediCal, and Medicaid. Our knowledgeable agents are most experienced at helping consumers with borderline pre-existing conditions to:

    1. Obtain approval on individual/family plans
    2. Help them obtain alternative coverage if they are declined.

     

    Consult with one of Lee Insurance’s experienced agents for advice that’s specific to your situation.

    On Jan. 1st 2014, under Health Care Reform, all individual and family health plans will be guarantee-issue.

  • How long does it take to get coverage?

    Anywhere from 5 minutes to 5 weeks, depending on your situation. If you have no pre-existing condition, you may apply online now and be approved in as little as 5 minutes. If your medical records need to be checked it could take up to 5 weeks depending how long it takes your physician to get those records to the underwriters. Consult with one of Lee Insurance’s experienced agents for specific advice about your situation.

  • Can I change my mind after I apply?

    YES! You may change your mind even after you are approved and receive a full refund for any premiums paid. Department of Insurance regulations provide for a 10-day ‘Free Look Period’ from the time that you receive a copy of the detailed evidence of coverage or service agreement.

  • Does Lee Insurance provide ongoing services after purchase?

    Yes, definitely! Lee Insurance will keep in touch with you by mail and email. We will continue to monitor your account to alert you to potential problems such as pending cancellation or rate increases and any changes in the marketplace that may warrant a change in plans.

  • Can I insure just my children?

    Yes. Children, even newborns, may be enrolled in their own health insurance plans. Moreover, rates are usually significantly lower than for adults.

  • Do individual health plans have adequate coverage for catastrophic illnesses?

    Under Health Care Reform, all health plans have unlimited lifetime coverage.

  • What if I moved to another state?

    If you purchased your plan in California you may keep it as long as you live in California for at least 6 months out of the year. If you have plans to move out of state in the future there is at least one carrier with plans that you may keep indefinitely, even after you move out of the state. Most college students who go to school in another state may keep their in-state health plans.

  • How do high deductible plans save me money?

    High deductible plans have lower premiums but you have to satisfy the higher deductible if you end up in the hospital. However, most high deductible plans exempt ‘office visits’ from the deductible, meaning you get coverage for routine trips to the doctor. You’re only required to pay a small co-pay for doctor visits. Under Health Care Reform, all plans, including high deductible plans, offer Preventive Services including checkup, pap smear, mammogram, prostate exam, colonoscopies with no copay or deductible.

  • How do I beat rising health care costs?

    Buy an HSA (Health Savings Account) compatible plan and open a tax-free HSA account.  All health plans regardless of the deductible have out of pocket maximums that protect you from high out of pocket costs in the event of a catastrophic illness.

  • With High Deductible Plans, how am I protected against out of control or catastrophic medical costs?

    All plans have annual out of pocket maximums that protect you against extraordinary costs. Even though these out of pocket maximums may seem high, they are much lower than the cost of paying for serious medical care by yourself.

    When using in-network providers, all expenses are billed at ‘Negotiated’ or ‘Discounted’ Rates that are in most cases one half, one third or even one tenth the cost of posted hospital charges.

    Under Health Care Reform, all health plans have unlimited lifetime coverage.

  • Why does California have some of the lowest individual health insurance rates in the country?

    California regulates health insurance to protect consumers, but does not restrict competition and free market forces.

    California has a large number of insurance carriers each offering a wide selection of PPO and HMO type plans to consumers, small business and large corporations, in a free market environment.

    Consumers in California can often find individual/family health plans that cost half as much as those found in states like New York, New Jersey and Massachusetts where state regulations have driven the cost of individual health plans to unaffordable levels.

    California has a much larger number of physicians and hospitals than most other states. Also, a very high percentage of doctors and hospitals participate in PPO and HMO Networks.

    Under Health Care Reform, starting on Jan. 1st 2014, the low price advantage, relative to other states, that individual health plans have enjoyed in California, may disappear

  • How can I get started?

    To get a free look at your health insurance options, get a free online quote now. All it takes is answering a few simple questions. You’ll be able to compare rates and benefits in less than 60 seconds.

    When you get an online quote, one of our experienced agents will follow up with you by phone or email. We’ll answer your questions, and help you choose the best plan for your situation.  We will also help you to figure out if qualify for a subsidy to help pay for the premium.

    Need a quote for group health insurance? Get it here.

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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445