Insurance FAQs2019-07-10T19:57:17-05:00

Here are some common frequently asked questions in our insurance FAQs that we often answer.  We would be happy to discuss any of these in more detail with you:

FAQ’s for Business Insurance:

A: No, but if you have more than 50 FTE (Full Time Equivalent Employees), you will be subject to fines for not offering coverage.
A:  Yes, you will have to pay a percentage of the premium, typically 50% of the single rate.  The cost to the employee for single coverage cannot be more than 9.5% of the employee’s single wages.
A:  AUI can help you find ways to lower your costs in addition to the tradition methods of changing plans and switching carriers.  We offer some alternative benefits that other agents do not where medical underwriting can lower costs.  In addition, we are experts in small group self-funding.
A:  Adding voluntary (or supplemental) benefits is a great way to do this!  Click here to learn more.

FAQ’s for Individuals and Families:

A:  Most individuals must have health insurance or be subject to a fine from the Federal Government.  The fine for 2016 is either:  2.5% of your yearly household income or $695 per person ($347.50 per child under 18) with the maximum penalty per family using this method is $2,085.  The fine is whichever of these amounts is greater.
A:  The Affordable Care Act (ACA) also known as Obamacare made it a legal requirement for most Americans.  And having health insurance will allow you cover the cost of medical care when you need it.
A:  No.  You can choose an individual insurance plan outside of the Federally Facilitated Marketplace in a private exchange.  This plan, however, will not qualify for a subsidy.
A: Yes, but there’s a catch.  If your employer offers affordable coverage, you would not be able to obtain a subsidy to help pay for your coverage.

FAQ’s for Individuals and Families:

The date of treatment by a physician or medical facility.
The portion of a covered claim the subscriber (or insured) is responsible to pay.
Stands for Explanation Of Benefits which is an insurance carrier form explaining how your claim has been paid to the provider.
(FFM) Commonly known as is the website where individuals can purchase insurance plans that qualify for a subsidy. Individuals do not have to qualify for subsidies to purchase plans on
A Health Maintenance Organization is an organization of physicians that provides comprehensive health care, in which you select a Primary Care Physician to manage all your health care needs. Not going through your PCP can lead to a reduction in benefit levels on reimbursement or coverage.
The combination of the deductible and insured’s share of co-insurance based on the allowed amount per calendar year.
Insurance products offered by insurance carriers that do not qualify for a subsidy.These plans may have different networks and coverages available from their FFM counterparts.
A Preferred Provider Organization is a network of providers such as physicians and hospitals, which have contracted with a carrier to accept an agreed level of payment, provided to persons insured by that carrier.
A Point Of Service is a network of providers accessed through a Primary Care Physician (PCP). The subscriber is generally required to go to or through their PCP to receive maximum reimbursement levels allowed.
Stands for Usual, Customary and Reasonable which is the amount determined to be usual, customary and reasonable. This is the amount computed for reimbursement after deductible and co-insurance.
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