Health Insurance

Families experience a health scare at least once in their lives where they question if they have the proper healthcare coverage. Healthcare can be very expensive whether going to a primary doctor or having to be admitted to a hospital for critical care. It is important that you cover yourself and your family with the proper health insurance to pay for your healthcare expenses.

Why should you have health insurance? 

  • It is never known when you’ll need medical help. Without health insurance, medical expenses can quickly grow to thousands of dollars. 
  • To stay healthy, you need preventative checkups and testing.  
  • Under the Affordable Care Act, you may have to pay a penalty if you do not have health care coverage. 

Important definitions when getting a health insurance policy:

  • Individual Health Insurance Policy – A health plan for people that aren’t connected to job-based coverage and are regulated under state law.
  • Group Health Insurance Policy – A health plan offered by an employer or employee organization that provides health coverage to employees and their families.
  • Office Visit Co-Payment - A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.
  • Referral - When a plan requires a referral for you to see a specialist, you must first see your primary care doctor and they will electronically put in a request to give you authorization to see that specific specialist.
  • Deductibles - An amount you must pay before your insurance carrier begins to pay/cover a specific benefit. Many plans have deductibles both in-network and/or out-of-network.
  • Network of Participating Physicians - Doctors who are contracted with the health insurance carrier for that specific plan. When you are enrolled on a plan with in-network benefits only, the health insurance carrier will NOT pay a claim for a doctor who does not participate in your plan. It is recommended that you verify they participate with the carrier or by calling the doctor's office directly.
  • RX Coverage - Coverage for prescribed medications. Many plans include 50% coverage. Tiered RX plans may be available for Generic/Name Brand/Non-Formulary Drugs (i.e. $10/25/50). The prescription plans are now built into the medical plan and cannot be changed.
  • Guaranteed Issue - In New Jersey, no one can be declined to enroll in a health insurance plan due to a pre-existing condition, age, claims history, or other risk factors.
  • For more insurance term definitions please click here or click here.

Here at NorthEast Insurance Services, Kathi Podolla and Laura Mount are here to help you with any questions and concerns you may have. Please call us at (732) 972-1771 ext. 1111 for more information.