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A: HMO’s (Health Maintenance Organizations)are typically the highest level of managed care. They have specified doctors and hospitals. Typically each member has a Primary Care Physician (PCP) which helps to guide their care. HMO’s typically have the most health coverage for the least premium. They typically have fixed co-pays for specified services. (i.e. $15 / office visit, $100/ hospital admission)

PPO’s are doctor / hospital networks that have agreed to accept certain charges for specified care. PPO networks are sometimes large and may be nation wide. Different health plans may use the same PPO network. PPO health coverage typically allows the patient to choose any doctor in the network without a referral. PPO health coverage typically has a deductible, with percentage cost sharing on major medical bills. Many PPO’s will also cover care from doctors outside the network, but at a greater expense to the patient. A typical PPO will have a $20 office visit, $500 deductible and the 80% coverage in Network. 60% coverage out of network for major medical items.

INDEMNITY plans allow you to go to any Doctor or hospital. They have the most freedom but are typically are the most expensive and generally cover only "Usual and Customary Rates" which may be less that the actual charges. Indemnity plans have shrunk in popularity with the growth of HMO’s and PPO’s but they can be an excellent option for rural area’s with limited doctor networks.

Q: What the difference between a Business health insurance and Individual / Family health insurance.

A: You need to have a company in order to qualify for business health insurance. Self employed people will qualify if they have been in business for a year and have reportable IRS income. A new law requires one person companies to apply within 31 days of their birthday in order to be Gauranteed issue. Business groups of 2 to 50 are typically ALWAYS gauranteed issue. Spouses and children of employees may also be covered.
Anyone can apply for Individual / Family health insurance. It is generally medically underwritten, which means they don’t have to accept you if you have medical problems. If you have exhausted your COBRA coverage you may qualify for guaranteed issue individual insurance but at a higher premium.

Q: What happens if I don’t qualify for business insurance and get turned down for individual/family insurance.

A: Give us a call, but check out CUHIP, the Colorado Uninsurable Health Insurance Plan. They have a website www.CUHIP.com. They will accept people who have been turned down. Their rates are typically higher and they do have some waiting periods for pre-existing conditions.

Q: Do all plans cover maternity and preventative healthcare.

A: No, Most Individual plans don’t cover maternity and many individual PPO’s do not cover preventative checkups. (State law requires that well child care and certain mammograms be covered on all plans .) Business plans typically cover Maternity and HMO’s typically cover preventative care as well as some PPO’s.

Q: What about pre-existing conditions?

A: Typically business HMO’s have no pre-existing conditions, business PPO’s will waive the 6 month exclusion if you have had prior continuous coverage.

Q: What do your services cost and can I get a lower premium by going direct.

A: We are Brokers for all of the major health Carriers in Colorado. Our services are FREE to you and you can’t get a lower premium. We can help you get your best match for coverage, premium and Doctors because we know the advantages and limitations of the various plans. We are also experts in Partially self funded plans for companies with 20 or more employees. These plans may offer substantial savings for healthy business groups.

Q: I still have other questions.

A: Give Jim, Michelle, Tina or Tom a call at Co-Health.com and we will do our best to help. 303-782-0123 email=Mail@C0-Health.com