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Did You Know!

Choosing HMO vs. PPO
Weighing an HMO vs. a PPO can be tricky. You may not have an option if your company provides your health insurance. Some corporations only offer one plan, in which case your decision has been made for you.

HMOs tend to be cheaper and are easier to budget for since you will have a set monthly payment and predetermined co-pays. If you don’t go to the doctor or get prescriptions often, you may not pay much for coverage. The downside of choosing HMO vs. PPO is the lack of freedom in choosing your care provider.

A PPO could be right for you if you need that extra freedom of seeing whomever you wish or if you go to a lot of specialists. Rather than waiting around for your PCP’s referral, you can make your own appointment with anyone you want. Many health insurance consumers see HMOs and PPOs as the difference between timeand money: PPOs save you time, HMOs save you money. Your personal situation can help you decide.

Coinsurance and Health Coverage Coinsurance pertaining to health insurance is the amount of money you will have to pay after your deductible has been met. For example, if your deductible has already been met and your coinsurance level is 25%, you will be responsible for $25 of a $100 charge for any medical expenses covered by your insurance policy. In this particular scenario, the health insurance policy might be referred to as an 75/25 policy.

COBRA/State Continuation
Know your rights and responsibilities.
COBRA law applies to groups of 20 or
more. State Continuation law applies
to groups of 19 and less.

Full Coverage for Everyone!
If you've been declined or are at risk
of being declined coverage there
are still options. Ask us about the
Illinois Comprehensive Health
Insurance Plan (CHIP).

Understanding Benefits

What is the difference between group plan eligibility waiting periods and pre-existing
conditions waiting periods?

The Eligibility Waiting Period is determined by the employer group.  For example,
all new employees may be eligible for group coverage on the first of the month
following a waiting period determined by the employer, typically between one and
six months.

Pre-existing conditions waiting periods are governed by the Health Insurance Portability
and Accountability Act (HIPAA).  Group plan pre-existing condition waits can not exceed
12 months (18 months if a late enrollee).  The pre-existing condition wait is waived if the
employee has had twelve months of coverage with no more than 63 days gap.  If the employee had six months of prior coverage, he may have six months pre-existing conditions wait.

For more information, read the pre-existing conditions and the Health Insurance
Portability and Accountability Act