Health Insurance FAQ — Common Questions Answered

Question 1

What is a Private PPO Plan?

Accepted Answer

A Private PPO (Preferred Provider Organization) plan lets you choose any doctor or specialist without a referral. You're not locked into a network, which gives you maximum flexibility and control over your healthcare decisions. These plans are purchased outside the federal Marketplace and often offer broader access than ACA plans.

Question 2

What is an ACA / Major Medical plan?

Accepted Answer

ACA plans (also called Marketplace or Major Medical plans) are comprehensive health insurance plans sold through the federal Health Insurance Marketplace. They cover essential health benefits including preventive care, emergency services, hospitalization, prescription drugs, and more. Depending on your income, you may qualify for subsidies that significantly reduce your monthly premium.

Question 3

What does Health and Life Insurance cover?

Accepted Answer

Health insurance covers medical expenses such as doctor visits, hospital stays, surgeries, and prescriptions. Life insurance provides a financial benefit to your beneficiaries in the event of your passing. Bundling both through one broker can simplify your coverage and sometimes reduce costs.

Question 4

What are supplemental plans like Accident, Critical Illness, and Cancer coverage?

Accepted Answer

Supplemental plans pay you directly when a covered event occurs — such as an accident, a cancer diagnosis, a heart attack, or a stroke. They work alongside your primary health insurance to cover out-of-pocket costs like deductibles, copays, lost income, and everyday living expenses during recovery.

Question 5

Do you offer Dental and Vision coverage?

Accepted Answer

Yes. We offer standalone dental and vision plans that can be added to any health insurance package. Dental plans typically cover preventive care (cleanings, X-rays), basic procedures (fillings), and major work (crowns, root canals). Vision plans cover eye exams, glasses, and contact lenses.

Question 6

How do I get a quote?

Accepted Answer

Getting a quote is easy and completely free. You can fill out our online quote request form, call us directly at (850) 629-6911, or send us an email. We'll review your information and reach out with personalized options — no obligation, no pressure.

Question 7

What information do I need to apply for coverage?

Accepted Answer

To get started, you'll typically need the names, dates of birth, and Social Security numbers of everyone to be covered, your household income (for ACA plans), your current address and zip code, and information about any current coverage you have. We'll walk you through the full process step by step.

Question 8

When can I enroll in a health insurance plan?

Accepted Answer

ACA Marketplace plans have an Open Enrollment Period each fall (typically November 1 – January 15). Outside of that window, you may qualify for a Special Enrollment Period due to life events such as losing coverage, getting married, having a baby, or moving. Private PPO plans and supplemental plans can often be purchased year-round.

Question 9

Are you licensed in my state?

Accepted Answer

We are licensed in most states. When you reach out for a quote, we'll confirm coverage availability in your specific state. If we're unable to assist you directly, we'll do our best to point you in the right direction.

Question 10

How do I file a claim?

Accepted Answer

Claims are filed directly with your insurance carrier, not through our office. Your insurance card and policy documents will include the carrier's claims phone number and website. We're happy to help you understand the process and can assist if you run into issues with your carrier.

Question 11

How long does it take for a claim to be processed?

Accepted Answer

Processing times vary by carrier and claim type. Simple claims (like a routine doctor visit) are often processed within 30 days. More complex claims involving hospitalization or surgery may take longer. Your carrier is required to notify you of their decision within a specific timeframe set by your state's regulations.

Question 12

What should I do if my claim is denied?

Accepted Answer

If your claim is denied, you have the right to appeal. Start by reviewing the denial letter carefully — it will explain the reason. You can then file an internal appeal with your insurance company. If that's unsuccessful, you may request an external review by an independent organization. We can help guide you through this process.

Question 13

What is the difference between a Marketplace plan and a Private plan?

Accepted Answer

Marketplace (ACA) plans are sold through the federal or state exchange and may qualify for income-based subsidies. Private plans are purchased outside the Marketplace and don't qualify for subsidies, but they often offer broader networks, more flexibility, and faster enrollment. The best choice depends on your income, health needs, and budget.

Question 14

What is a deductible, and how does it affect my plan?

Accepted Answer

A deductible is the amount you pay out of pocket for covered services before your insurance begins to pay. For example, if your deductible is $2,000, you pay the first $2,000 of covered medical costs each year. Plans with lower premiums often have higher deductibles, and vice versa. We'll help you find the right balance for your situation.

Question 15

What is the difference between a premium, deductible, and out-of-pocket maximum?

Accepted Answer

Your premium is the monthly amount you pay to keep your insurance active. Your deductible is what you pay before insurance kicks in. Your out-of-pocket maximum is the most you'll ever pay in a year — once you hit that limit, your insurance covers 100% of covered costs for the rest of the year. Understanding all three helps you compare plans accurately.

Question 16

Do I need a referral to see a specialist?

Accepted Answer

It depends on your plan type. HMO plans typically require a referral from your primary care physician before seeing a specialist. PPO plans — including Private PPO plans — do not require referrals, giving you direct access to specialists of your choice. We'll make sure you understand your plan's referral requirements before you enroll.

Frequently Asked Questions

Coverage Types

Getting Started

Claims

Plan Differences

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