Resource Documents for Employers:


The Averta Video Gallery


Understanding The Summary of Benefits Document

July, 2022

Averta Insurance Solutions

Reviewing The Basics in Healthcare Definitions

July, 2022

Averta Insurance Solutions

Completing A Cal-Choice Employee Application

July, 2022

Averta Insurance Solutions


Anthem: Finding a Doctor is Easier Than You Think!

November, 2017

Anthem Blue Cross Blue Shield

Anthem: Urgent Care vs. ER & Associated Costs

April, 2017

Anthem Blue Cross Blue Shield

Anthem: Virtual ID Card - Digital Insurance Card

June, 2020

Anthem Blue Cross Blue Shield


Cigna: Hospital Indemnity Insurance

December, 2020

Cigna

Cigna: Accidental Injury Insurance

June, 2020

Cigna

Cigna: Critical Illness Insurance

June, 2020

Cigna


Health Net CA: Affordable Plans for You and Your Employees

November, 2020

Health Net CA

Colonial Life: What if You Could Expect the Unexpected?

January, 2020

Colonial Life

Health Net CA: Member Over-the-Counter (OTC) Benefit

June, 2020

Health Net CA


MetLife: Jeremy & Morton, Disability Insurance

November, 2020

MetLife

MetLife: Mia & Martin, Accident Insurance

November, 2020

MetLife

MetLife: Health Savings & Spending Accounts

October, 2020

MetLife

Colonial Life: What Are Voluntary Benefits?

March 29, 2017

Colonial Life

Blue Shield of CA: Get the Most from Your Healthcare Plan

February, 2019

Blue Shield of CA

Guardian Dental Insurance: A Reason to Smile

February, 2020

Guardian Dental Insurance


Humana: How to Use the Find a Doctor Tool

October, 2020

Humana

Kaiser Permanente: Experience the Kaiser Permanente Difference

September, 2019

Kaiser Permanente

UnitedHealth Care: Taking Great Care

September, 2020

UnitedHealth Care


California Choice: Multiple Options: One Program

December, 2018

California Choice

Anthem: How to Get Business Health Insurance

March, 2017

Anthem Blue Cross Blue Shield

Health Net: Stay Covered During Your Employer’s Open Enrollment - California

November, 2020

Health Net


Cigna Dental: Our whole-person health approach to dental care.

October, 2020

Cigna Dental

Colonial Life: Critical Illness Insurance

June, 2013

Colonial Life

Colonial Life: Accident Insurance

March, 2013

Colonial Life


Colonial Life: Life Insurance

June, 2013

Colonial Life

Colonial Life: Disability Insurance

February, 2013

Colonial Life

Colonial Life: Hospital Indemnity Insurance

April, 2013

Colonial Life


Glossary of Terms, FAQs, and Useful Links

Click on an option below to expand and view each section of content.

Glossary of Health Insurance Terms

Actuary - A mathematician in the insurance field. Responsible for calculating premiums, developing plans and defining underwriting risk.

Agent - A licensed individual who represents several insurance companies and sells their products.

Benefit - Reimbursement for covered medical expenses as specified by the plan.

Brand-name drug - A Prescription drug which is marketed with a specific brand name by the company that manufactures it. May cost insured individuals a higher co-pay than generic drugs on some health plans. (see "generic.")

Broker - A licensed insurance professional who obtains multiple quotes and plan information in the interest of his client.

Captive - A captive insurer is generally defined as an insurance company that is wholly owned and controlled by its insureds; its primary purpose is to insure the risks of its owners, and its insureds benefit from the captive insurer's underwriting profits. Captive insurance is utilized by insureds that choose to:

  • • Put their own capital at risk by creating their own insurance company
  • • Working outside of the commercial insurance marketplace, to achieve their risk financing objectives

Carrier - Insurance company or HMO insuring the health plan.

Certificate Booklet - The plan agreement. A printed description of the benefits and coverage provisions intended to explain the contractual arrangement between the carrier and the insured group or individual. May also be referred to as a policy booklet.

Claim - A formal request made by an insured person for the benefits provided by a policy.

COBRA (Consolidated Omnibus Budget Reconciliation Act) - Federal legislation that requires group health plans to provide health plan members the opportunity to purchase continued coverage in the event their insurance is terminated. Applies only to employer groups with 20 or more employees. Learn more about COBRA at the Department of Labor's website. - Please note this may take a few minutes to appear.

Co-insurance - The percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member's co-insurance is 20%.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan's stop loss amount. (see "stop loss.")

Co-pay/co-payment - The amount an insured individual must pay toward the cost of a particular benefit. For example, a plan might require a $10 co-pay for each doctor's office visit.

Credit for prior coverage - Any pre-existing condition waiting period met under an employer's prior (qualifying) coverage will be credited to the current plan, if any interruption of coverage between the new and prior plans meets state guidelines.

Deductible - The dollar amount an insured individual must pay for covered expenses during a calendar year before the plan begins paying co-insurance benefits.

Dependents - Usually the spouse and unmarried children (adopted, step or natural) of an employee.

Effective date - The date requested by an employer for insurance coverage to begin.

Exclusions - Expenses which are not covered under an insurance plan. These are listed in the Certificate Booklet/Policy.

Explanation of Benefits (EOB) - A carrier's written response to a claim for benefits. Sometimes accompanied by a benefits check.

Generic drug - The chemical equivalent to a "brand name drug." These drugs cost less, and the savings is passed onto health plan members in the form of a lower co-pay.

Group insurance - An insurance contract made with an employer or other entity that covers individuals in the group.

Health Maintenance Organization (HMO) - An alternative to commercial insurance that stresses preventive care, early diagnosis and treatment on an outpatient basis. HMOs are licensed by the state to provide care for enrollees by contracting with specific health care providers to provide specified benefits. Many HMOs require enrollees to see a particular primary care physician (PCP) who will refer them to a specialist if deemed necessary.

HIPAA - Health Insurance Portability and Accountability Act of 1996, P.L. 104-91. This law relates to underwriting, pre-existing limitations, guaranteed renewal, COBRA and certification requirements in the event someone terminates from the plan. The new law, commonly known as the "Kennedy-Kassebaum Bill," establishes new requirements for self-funded, fully-insured group plans (including church plans) and Individual Health policies. The purpose of the law is to:

  • • Improve portability and continuity of health insurance coverage in the group and individual markets
  • • To combat waste, fraud and abuse in health insurance and health care delivery
  • • To promote the use of medical savings accounts
  • • To improve access to long-term care services and coverage
  • • To simplify the administration of health insurance
  • • To promote the use of medical savings accounts
  • • Learn more about HIPAA at the Department of Labor's website

Pre-certification - an insurance company requirement that an insured obtain pre-approval before being admitted to a hospital or receiving certain kinds of treatment.

ID card/identification card - Card given to insured individuals which advises medical providers that a patient is covered by a particular health insurance plan.

Indemnity insurance plans - Traditional insurance plans (not HMOs or PPOs) which permit insured individuals to choose their doctors and hospitals. Insured individuals do not have to choose doctors or hospitals from a specific list of providers. Also called "fee-for-service" plans.

In-network - Describes a provider or health care facility which is part of a health plan's network. When applicable, insured individuals usually pay less when using an in-network provider.

Lifetime maximum benefit - The maximum amount a health plan will pay in benefits to an insured individual.

Limitations - A restriction on the amount of benefits paid out for a particular covered expense.

Long-term disability (LTD) - Insurance which pays employees a percentage of monthly earnings in the event of disability.

Managed care - The coordination of health care services in the attempt to produce high quality health care for the lowest possible cost. Examples are the use of primary care physicians as gatekeepers in HMO plans and pre-certification of care.

Multiple Employer Trust (MET) - an arrangement created to obtain health and other benefits for participating employer groups. Small employers can pool their contributions to receive the advantages of large group underwriting.

Network - a group of doctors, hospitals and other providers contracted to provide services to insured individuals for less than their usual fees. Provider networks can cover large geographic markets and/or a wide range of health care services. If a health plan uses a preferred provider network, insured individuals typically pay less for using a network provider.

Out-of-network - describes a provider or health care facility which is not part of a health plan's network. Insured individuals usually pay more when using an out-of-network provider, if the plan uses a network.

Out-of-pocket maximum - the total of an insured individual's co-insurance payments and co-payments.

Plan administration - overseeing the details and routine activities of installing and running a health plan, such as answering questions, enrolling new individuals for coverage, billing and collecting premiums, etc.

Point-of-service (POS) - health plan which allows the enrollee to choose HMO, PPO or indemnity coverage at the point of service (time the services are received).

Pre-certification - Pre-admission review and approval of appropriateness and medical necessity of hospitalization or other medical treatment.

Pre-existing condition - an illness, injury or condition for which the insured individual received medical advice, treatment, services or supplies; had diagnostic tests done or recommended; had medicines prescribed or recommended; or had symptoms of typically within 12 months (time periods may vary depending on state laws) prior to the effective date of insurance coverage.

Preferred Provider Organization (PPO) - A network or panel of physicians and hospitals that agrees to discount its normal fees in exchange for a high volume of patients. The insured individual can choose from among the physicians on the panel.

Premiums - payments to an insurance company providing coverage.

Provider - any person or entity providing health care services, including hospitals, physicians, home health agencies and nursing homes. Usually licensed by the state.

Referral - within many managed care plans, transfer to specialty physician or specialty care by a primary care physician.

Rider - a modification to a Certificate of Insurance policy regarding clauses and provisions of a policy. A rider usually adds or excludes coverage.

Risk - uncertainty of financial loss.

Short-term medical - temporary health coverage for an individual for a short period of time, usually from 30 days to six months.

Small employer group - groups with 1 - 99 employees. The definition of small employer group may vary between states.

State mandated benefits - state laws requiring that commercial health insurance plans include specific benefits.

Stop-loss - the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

Third Party Administrator (TPA) - An organization responsible for marketing and administering small group and individual health plans. This includes collecting premiums, paying claims, providing administrative services and promoting products.

Underwriter - entity that assumes responsibility for the risk, issues insurance policies and receives premiums.

Waiver of coverage - a section on the enrollment form which states that an employee was offered insurance coverage but opted to waive this coverage.

Workers' Compensation Insurance - insurance coverage for work-related illness and injury. All states require employers to carry this insurance.





This information is followed by a comprehensive list of Frequently Asked Questions to help guide you through any confusion you may have regarding insurance and how to go about getting the right coverage. If after reading this information you still have questions, please feel free to connect with us on the CONNECT page of our website.

Introduction

If you have ever been sick or injured, you know how important it is to have health coverage. But if you are confused about what kind is best for you, you're not alone.

What types of health coverage are available? If your employer offers you a choice of health plans, what should you know before making a decision? In addition to coverage for medical expenses, do you need some other kind of insurance? What if you are too ill to work? Or, if you are over 65,will Medicare pay for all your medical expenses?

These are questions that today's consumers are asking; and these questions aren't necessarily easy to answer.

Making Sense of Health Insurance

The term health insurance refers to a wide variety of insurance policies. These range from policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care. Even disability insurance which replaces lost income if you can't work because of illness or accident is considered health insurance, even though it's not specifically for medical expenses.

But when people talk about health insurance, they usually mean the kind of insurance offered by employers to employees, the kind that covers medical bills, surgery, and hospital expenses. You may have heard this kind of health insurance referred to as comprehensive or major medical policies, alluding to the broad protection they offer. But the fact is, neither of these terms is particularly helpful to the consumer.

Today, when people talk about broad health care coverage, instead of using the term "major medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you'll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.

While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.

The section below is designed to acquaint you with the basics of fee-for-service and managed care plans. But remember: The detailed differences between one plan and another can only be understood by careful reading of the materials provided by insurers, your employee benefits specialist, or your agent or broker.

Fee-For-Service

This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for "covered" medical expenses, the ones listed in your benefits summary.

When a service is covered under your policy, you can expect to be reimbursed for some, but generally not all, of the cost. How much you will receive depends on the provisions of the policy on coinsurance and deductibles. Here's how it works:

• The portion of the covered medical expenses you pay is called "coinsurance." Although there are variations, fee-for-service policies often reimburse doctor bills at 80 percent of the "reasonable and customary charge." (This is the prevailing cost of a medical service in a given geographic area.) You pay the other 20 percent your coinsurance. However, if a medical provider charges more than the reasonable and customary fee, you will have to pay the difference. For example, if the reasonable and customary fee for a medical service is $100, the insurer will pay $80. If your doctor charged $100, you will pay $20. But if the doctor charged $105, you will pay $25. Note that many fee-for-service plans pay hospital expenses in full; some reimburse at the 80/20 level as described above.

• Deductibles are the amount of the covered expenses you must pay each year before the insurer starts to reimburse you. These might range from$100 to $300 per year per individual, or $500 or more per family. Generally, the higher the deductible, the lower the premiums, which are the monthly, quarterly, or annual payments for the insurance.

• Policies typically have an out-of-pocket maximum. This means that once your expenses reach a certain amount in a given calendar year, the reasonable and customary fee for covered benefits will be paid in full by the insurer. (If your doctor bills you more than the reasonable and customary charge, you may still have to pay a portion of the bill.) Note that Medicare limits how much a physician may charge you above the usual amount.

• There also may be lifetime limits on benefits paid under the policy. Most experts recommend that you look for a policy whose lifetime limit is at least $1 million. Anything less may prove to be inadequate.

Managed Care

The three major types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.

Managed care plans generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for each service that you receive, your coverage is paid in advance. This is called prepaid care.

For example, you may decide to join a local HMO where you pay a monthly or quarterly premium. That premium is the same whether you use the plan's services or not. The plan may charge a copayment for certain services for example, $10 for an office visit, or $5 for every prescription. So, if you join this HMO, you may find that you have few out-of-pocket expenses for medical care as long as you use doctors or hospitals that participate in or are part of the HMO. Your share may be only the small copayments; generally, you will not have deductibles or coinsurance.

One of the interesting things about HMOs is that they deliver care directly to patients. Patients sometimes go to a medical facility to see the nurses and doctors or to a specific doctor's office. Another common model is a network of individual practitioners. In these individual practice associations (IPAs), you will get your care in a physician's office.

If you belong to an HMO, typically you must receive your medical care through the plan. Generally, you will select a primary care physician who coordinates your care. Primary care physicians may be family practice doctors, internists, pediatricians, or other types of doctors. The primary care physician is responsible for referring you to specialists when needed. While most of these specialists will be "participating providers" in the HMO, there are circumstances in which patients enrolled in an HMO may be referred to providers outside the HMO network and still receive coverage.

PPOs and POS plans are categorized as managed care plans. (Indeed, many people call POS plans "an HMO with a point-of-service option.") From the consumer's point of view, these plans combine features of fee-for-service and HMOs. They offer more flexibility than HMOs, but premiums are likely to be somewhat higher.

With a PPO or a POS plan, unlike most HMOs, you will get some reimbursement if you receive a covered service from a provider who is not in the plan. Of course, choosing a provider outside the plan's network will cost you more than choosing a provider in the network. These plans will act like fee-for-service plans and charge you coinsurance when you go outside the network.

What is the difference between a PPO and a POS plan? A POS plan has primary care physicians who coordinate patient care; and in most cases, PPO plans do not. But there are exceptions!

HMOs and PPOs have contracts with doctors, hospitals, and other providers. They have negotiated certain fees with these providers and, as long as you get your care from these providers, they should not ask you for additional payment. (Of course, if your plan requires a copayment at the time you receive care, you will have to pay that).

Always look carefully at the description of the plans you are considering for the conditions of payment. Check with your employer, your benefits manager, or your state department of insurance to find out about laws that may regulate who is responsible for payment.

Self-insured Plans

Your employer may have set up a financial arrangement that helps cover employees' health care expenses. Sometimes employers do this and have the "health plan" administered by an insurance company; but sometimes there is no outside administrator. With self-insured health plans, certain federal laws may apply. Thus, if you have problems with a plan that isn't state regulated, it's probably a good idea to talk to an attorney who specializes in health law.

Appropriate Care

HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning.

For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to amore cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.

Almost all fee-for-service plans apply managed care techniques to contain costs and guarantee appropriate care; and an increasing number of managed care plans contain fee-for-service elements. While the distinctions among plans are growing increasingly blurred, the number of options available to consumers increases every day.

Pre-existing Conditions

Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. Starting July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. Your prior health insurance coverage will be credited toward the preexisting condition exclusion period as long as you have maintained continuous coverage without a break of more than 62 days. Pregnancy is not considered a preexisting condition, and newborns and adopted children who are covered within 30 days are not subject to the 12-month waiting period.

If you have had group health coverage for two years, and you switch jobs and go to another plan, that new health plan cannot impose another preexisting condition exclusion period. If, for example, you have had prior coverage of only eight months, you may be subject to a four-month, preexisting condition exclusion period when you switch jobs. If you’ve never been covered by an employer's group plan, and you get a job that offers such coverage, you may be subject to a 12-month, preexisting condition waiting period.

Federal law also makes it easier for you to get individual insurance under certain situations, including if you have left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 62 days.

If you have not been covered under a group plan and have found it difficult to get insurance on your own, check with your state insurance department to see if your state has a risk pool. Similar to risk pools for automobile insurance, these can provide health insurance for people who cannot get it elsewhere.

What Is Not Covered?

While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense.

Very few plans cover eyeglasses and hearing aids because these are considered budgetable expenses. Very few cover elective cosmetic surgery, except to correct damage caused by a covered accidental injury. Some fee-for-service plans do not cover checkups. Procedures that are considered experimental may not be covered either. And some plans cover complications arising from pregnancy, but do not cover normal pregnancy or childbirth.

Health insurance policies frequently exclude coverage for preexisting conditions, but, as explained, federal law now limits exclusions based on such conditions.

You should also remember that insurers will not pay duplicate benefits. You and your spouse may each be covered under a health insurance plan at work but, under what is called a "coordination of benefits" provision, the total you can receive under both plans for a covered medical expense cannot exceed 100 percent of the allowable cost. Also note that if neither of your plans covers 100 percent of your expenses, you will only be covered for the percentage of coverage (for example, 80 percent) that your primary plan covers. This provision benefits everyone in the long run because it helps to keep costs down.

What Happens to My Insurance if I Lose My Job?

If you have had health coverage as an employee benefit and you leave your job, voluntarily or otherwise, one of your first concerns will be maintaining protection against the costs of health care. You can do this in one of several ways:

• First, you should know that under a federal law (the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly known as COBRA), group health plans sponsored by employers with 20 or more employees are required to offer continued coverage for you and your dependents for 18 months after you leave your job. (Under the same law, following an employee's death or divorce, the worker's family has the right to continue coverage for up to three years.) If you wish to continue your group coverage under this option, you must notify your employer within 60 days. You must also pay the entire premium, up to 102 percent of the cost of the coverage.

• If COBRA does not apply in your case perhaps because you work for an employer with fewer than 20 employees you may be able to convert your group policy to individual coverage. The advantage of that option is that you may not have to pass a medical exam, although an exclusion based on a preexisting condition may apply, depending on your medical history and your insurance history.

• If COBRA doesn't apply and converting your group coverage is not for you, then, if you are healthy, not yet eligible for Medicare, and expect to take another job, you might consider an interim or short-term policy. These policies provide medical insurance for people with a short-term need, such as those temporarily between jobs or those making the transition between college and a job. These policies, typically written for two to six months and renewable once, cover hospitalization, intensive care, and surgical and doctors' care provided in the hospital, as well as expenses for related services performed outside the hospital, such as X-rays or laboratory tests.

• Another possibility is obtaining coverage through an association. Many trade and professional associations offer their members health coverage often HMOs as well as basic hospital-surgical policies and disability and long-term care insurance. If you are self-employed, you may find association membership an attractive route.

FAQs

Question: How do I purchase a policy?

First, an application is sent for your signature. At the same time a medical examiner contacts you to set a convenient time at your home or office to take blood and urine. On larger amounts or older ages, a resting EKG or blood pressure check may be required. It is important to give blood after a 12 hour fast so it is better to do the exam in the morning. Once the insurance company receives the exam results, the application, and any additional doctors records that the insurance company obtains at their expense, we receive an offer. Every expense in this process is paid for by the insurance company!

Question: How long does this process take?

If no doctors records are ordered, 3 to 4 weeks (Less if there is an urgency). If doctors records have to be obtained, 4-7 weeks since we are dependent on the promptness of the doctor.

Question: If I apply and don't get the rate I applied for, what happens?

The company many times will make another offer. If our office thinks we can get a better offer from another company, we will ship your file over there.

Question: Are these stable companies?

Every company our agency uses has a strong financial rating as determined by the various rating agencies such as A. M. Best, Standard and Poor's and Moody's Bond Ratings.

Question: Are these stable companies?

Every company our agency uses has a strong financial rating as determined by the various rating agencies such as A. M. Best, Standard and Poor's and Moody's Bond Ratings.

Question: What is "Preferred Plus", "Preferred", and "Standard"?

Insurance companies are learning more and more about identifying their risks. Since cancer and cardiovascular disease are the two leading causes of death where the risk can be lessened by the individual, companies zero in on these risks. Those that qualify for the super preferred would be less at risk, then the preferred, then the standard. These companies look at height and weight, blood pressure, cholesterol(good and bad), family history(relatives dying before 60 of CV disease or cancer), personal history of cancer and CV disease, and smoking history. A more specific guide is as follows:

Question: What if I don't fit into any of these categories?

If an individual has one or more of these risk factors, they may still qualify for preferred or standard. If even standard is out of the question, there are some highly rated companies that will still take the risk. Insurance companies fear the unknown. If they can identify what those risk factors are, there is a greater chance they will offer a policy. For example, someone just finds out he has a blood pressure problem and his doctor is trying different medications to bring it under control. Until the blood pressure is under control, this remains an unknown to the insurance company. Once under control it could be a preferred with some companies, standard to others.

Question: Do most companies treat pilots the same way?

No. If a pilot has enough hours to lower the risk to the insurance company, it is possible to get preferred. Two of our companies with the lowest rates will consider preferred.

Question: Do insurance companies treat all tobacco users the same?

Cigarette smokers that smoke less than a pack a day have a chance to get a non smoker rate with one company. Other companies treat pipe smokers, chewers, and cigar smokers as non smokers. Still another company gives almost all tobacco users a non smoker rate for the first 3-4 years! This same company gives a preferred rate if you use tobacco less than three to four times a year. They look at the amount of nicotine in your system.

Question: What if an instant quote is not right for me because of my special medical history?

Using the same diligence we use to find the lowest preferred rates for our customers, we will prepare a custom quote. Of course we need to know the medical condition, its duration, treatment and prognosis.

Question: Can I apply at my age?

Our agency works with individuals 18 to 85! A few companies provide policies to age 85 for term, second to die or Disclaimer insurance. Occasionally Disclaimer is available past 85.

Question: How are companies and rates selected by our agency?

A. M. Best is the industry's most recognized insurance rating organization. A.M. Best uses a letter grade to rate companies overall strength and solvency. Our agency uses only insurance companies that have at least an "A" rating with A. M. Best The top three ratings with A. M. Best are:

• A++ Superior
• A+ Superior
• A Excellent

The companies rated lower than this, generally speaking, don't have rates that are as competitive.

• Each company is slightly different, and most allow 5lbs leeway.
• No tobacco usage last 2 years.
• Cholesterol 180-220 (A couple of our companies will go as high as 230 to 250)
• Blood Pressure 140/90 (untreated)
• Family history (No deaths before age 60, siblings or parents) (sometimes one allowed) of cancer or cardiovascular disease
• Aviation - No super preferred
• Avocation (hazardous) - No super preferred
• Driving - No more than 3 moving violations in last 2 years.
• Travel- No extensive travel to underdeveloped or politically unstable countries.

If one or more of these variables are out of the guidelines, it can move you from super preferred to preferred. Even if moved to preferred these are still very competitive rates and only 5% to 10% higher. Again, the preferred rates vary between companies so it is important to try to find which company will consider you preferred. That's where we can help! The requirements vary between companies but here are some general preferred guidelines:

• Height and weight is the same as super preferred but with more leeway sometimes up to 20-25 pounds.
• Cholesterol 250 to 280
• Blood pressure 150/90 (treated or untreated)
• Family history cannot have both parents or one parent and one sibling die before age 60 of cancer or cardiovascular disease.
• Aviation - Sometimes depending on situation
• Avocation - Sometimes depending on how hazardous
• Driving - Same as super preferred
• Travel - Similar to super preferred but not as strict

These are general guidelines and will vary more from company to company than the requirements for super preferred. If after seeing your quote, you would like to discuss this with our office by e-mail, phone or fax, our office will be glad to advise. Other factors that may or may not exclude someone from preferred are:

• Current or history of alcohol/drug abuse
• Rheumatoid arthritis
• Asthma (current treatment)
• Personal history of cancer or cardiovascular disease
• COPD
• Crohn's disease
• Current treatment for depression
• Diabetes (oral diabetics can get standard rates, others can get a slightly higher premium)
• Epilepsy
• Kidney/liver disease
• Mental illness





The following links are to help guide you in the right direction as to any medical and voluntary insurance benefits needs you may have.

•  Follow Averta Insurance on Twitter: @AvertaInsurance

•  Connect With Us on LinkedIn: Averta Insurance Solutions Inc

•  Visit the Averta Insurance Solutions Benefits Education YouTube Channel

•  Averta Insurance Solutions Technology Platform Login

•  Cal Choice - Find a Cal Choice Provider Using the Cal Choice Care Provider Search Tool

•  Anthem - Find an Anthem Provider Using the Anthem Care Provider Search Tool

•  Kaiser Permanente - Find a Kaiser Care Provider in Your Area Using the Kaiser Provider Search Tool

•  Blue Shield of CA - Find a Blue Shield of CA Provider Using the BSCA Care Provider Search Tool

•  Cigna - Find a Cigna Care Provider Using the Cigna Care Provider Search Tool

•  UnitedHealth Care - Find a UnitedHealth Care Care Provider Using the UnitedHealth Care Provider Search Tool

•  Humana - Find a Humana Care Provider Using the Humana Provider Search Tool

•  Health Net - Find a Health Net Care Provider Using the Health Net Provider Search Tool

•  Anthem - Coronavirus (COVID-19) Resource Center

•  COVID.gov - Get FREE at-home COVID-19 tests

•  Federal Paycheck Calculator Tool - Calculate your take-home pay per paycheck!

•  The California Department of Insurance

•  IRS - COBRA Questions and Answers: for Employees and Former Employees

•  IRS - Medical and Dental Expenses Taxation Overview

•  The ACA Times: Articles: IRS AFFORDABILITY SAFE HARBORS HELP AVOID ACA PENALTIES

•  Anthem®: Are Health Insurance Premiums Tax Deductible?

•  IRS: Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act

•  IRS: Affordable Care Act Tax Provisions for Employers

•  IRS: Affordable Care Act Minimum Value and Affordability

•  California Association of County Veterans Service Officers Inc: Find Your VSO

•  WebMD™

Check back in the future for additional links of reference.