Frequently Asked Questions (FAQ)
Life & Health
- Do Life & Health companies really check out if I am a smoker? How?
Yes! Because smoking is a health hazard, life insurance companies charge a higher premium if you smoke. Worse yet, a smoking-related illness may even prevent you from obtaining life insurance coverage at all. Most life insurance applications will ask "Have you used a tobacco product in the last twelve months?" You'll need to answer about cigarettes, cigars or even chewing tobacco. Most importantly, you must state how often you use each tobacco product. Even if you only have a cigarette once a month, most insurers still consider you a smoker. If you do smoke, the best approach is to be truthful. Don't lie about your smoking habit just because you're afraid the insurance company will charge you more for insurance. Because a life insurance policy is a legal contract, lying on your application is fraud (not to mention unethical behavior) that could invalidate your policy. Keep in mind that the application you fill out is not the only source of data a life insurance company can use to evaluate your risk potential. Most companies will require you to submit to a physical exam, including lab tests, the results of which may indicate that you smoke.
- What is a life insurance medical exam and how should I prepare for it?
A typical medical exam may include a basic physical, blood work, and urine tests. Some insurance companies also require EKGs and/or treadmill EKGs (stress tests), especially for large life insurance policies. You'll also have to provide information on your medical history, including the names of doctors you've seen, dates you saw them, and any treatment recommended. A nurse or doctor (often an independent contractor) who is paid by the insurance company will normally conduct the exam. There are a number of simple steps you can take to make sure you get the best possible results at your medical exam:
- Get a good night's sleep the night before the exam
- Fast for eight hours before the exam if possible to ensure the most accurate results
- Don't smoke for at least one hour before the exam
- Avoid caffeine for at least one hour before the exam
- Avoid alcohol for at least eight hours before the exam
- Don't engage in strenuous exercise for 24 hours before the exam
- Limit your consumption of salt and cholesterol for 24 hours before the exam
- Cancel the exam if you get sick-"even a minor infection can distort the results
- What is a Drug Formulary?
A drug formulary is a list of prescription drugs (both generic and brand name) that are preferred by your health plan. Your health plan may only pay for medications that are on this "preferred" list, unless your healthcare provider talks with your health plan and gets prior approval.
Copayments - You will need to pay a share of the cost of the prescription, a fee known as copayment. Your copayment amount will depend on what "tier" your drug is in on your health plan's formulary:
- Tier 1 drugs have the lowest copayment and usually include generic medications.
- Tier 2 drugs have a lower copayment and usually include preferred brand-name medications.
- Tier 3 drugs have the highest copayment and usually include non-preferred brand-name medications.
Talk to Your Provider - If you need a prescription, talk to your healthcare provider about prescribing a generic drug or a preferred brand-name drug if it is appropriate for your heath condition. If your provider prescribes a medication that is not on the formulary and your health plan does not approve its use, you will have to pay the full cost.
Know Your Health Plan's Formulary -Health plans have different formularies and it is important for you to understand your plan's formulary. When you enrolled in your health plan, you should have received a booklet that describes the formulary and lists all of the approved medications along with an explanation of the tier copayments. Each year your plan should send you an update that includes any changes made in the formulary such as new drugs added to the formulary and drugs that are no longer covered. Most plans also provide access to formularies online.
- What is the UP Blue Rider?
UP Blue is a rider that can be added onto certain group health plans sold through Blue Cross Blue Shield of Michigan. Health services obtained outside of Michigan would be considered out-of-network, unless an approved referral is obtained prior to the service. Providers can fill out a referral form and submit it for review. If approved, the claims will still be applied to out-of-network cost sharing, the insured can then call Blue Cross and ask to have the claims reprocessed at the in-network levels.
What if I have a dependent child living out of state and I am required by court order to provide health insurance? UP Blue subscribers with dependent children must contact the UP Regional Center for the waiver of Out-of-network cost sharing after the services have been processed. To initiate the waiver, the subscriber and/or member must provide to the UP Regional Center the following:
- Court Order information
- Explanation of Benefits
- Any other pertinent information pertaining to the out-of-state services
- I have a qualified health insurance plan, why should I open an H.S.A. account?
Whether you fully fund your H.S.A. account right away or just deposit money as you need it, it is important to have your account open prior to incurring claims. If your account is not open on the date of service, you can not use money from your H.S.A account to pay for the services. By not using your H.S.A. account to pay for your medical expenses, you are missing out on the available tax saving benefits.
- How can I find out if a doctor participates with my health plan?
- Check the provider search on your Insurance Company's website
- Call the phone number on the back of your Insurance Card
- Call your doctor and ask their billing department
- Are flood and earthquake covered under my homeowner's policy?
NO. Flood is a separate policy and earthquake is not an automatic coverage. Some companies provide earthquake coverage but it needs to be requested.
- Why do I need so much coverage on my home? I paid half that amount when I bought it.
A standard homeowner's policy covers your home for replacement. The dwelling coverage is calculated on how much it would cost to rebuild if a total loss were to occur. Most of the time market value policies are more expensive and do not offer the same coverage.
- When do I pay a deductible on my homeowner's insurance?
Every covered loss requires a deductible be paid before the insurance company will pay. You choose the deductible amount. Usually, the higher deductible chosen the lower the premium.
- Why is there a deductible for deer, hail and lightning? Aren't these acts of God.
These are all considered comprehensive or other than collision losses. You have to choose to add this coverage and choose the deductible. The lower the deductible the higher the premium.
- Can I delete the Personal Injury Protection?
NO. Personal Injury Protection or PIP is mandated by law in MI. Every policy has this coverage. You have the option of Excess Medical if you carry other medical insurance that would cover you in an accident or Excess Wage if you are retired.
- What is Personal Injury Protection?
This covers you and any household members in the event of an injury in, on or getting out of a vehicle. It also pays, up to a maximum amount, lost wages for up to 3 years. Coverage includes, medical expenses, lost wages, replacement services, survivors payment, and funeral expenses.
- What is MCCA?
Michigan Catastrophic Claims Association. The state of MI offers unlimited personal injury benefits. The MCCA reimburses auto insurers who are catastrophically injured in auto accidents. Every vehicle in the state of Michigan is charged a fee to fund the program.
- What types of collision are available?
There are 3 types of collision:
- Broad- you choose a deductible and pay only if at- fault in the accident.
- Regular or Basic- you choose a deductible and pay in any collision loss.
- Limited- only collision coverage if another party is at fault. You choose a deductible option.
- Does my auto insurance cover a rental car?
Every company offers different coverage. Please check with your agent to find out what your policy offers.
- What does PLPD cover?
Personal Liability and Property Damage. This is the necessary coverage every driver must carry in the state of MI. There is no physical damage coverage when you choose PLPD or liability only.
Mazzali Agency is committed to providing our customers/prospects With tools and information on group and individual health insurance.
You may be asking yourself what health care reform is all about. The following links will provide you with the health care reform basics.
Open enrollment was Nov. 15, 2014 thru Feb 15, 2015. If you did not purchase Health Insurance during the open enrollment period, the penalties for 2015 are $325 per adult and $337.50 per child (up to $675 per family) or 2.5% of the family income, whichever is greater. Don't go a single day without health care - call us today.
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