Legacy Health Benefits

How does Individual Health Insurance work?

As part of the application process, the insurance company will request that you fill out a health statement for each member of the family that you intend to insure. Based on that information the company will make one of the following decisions:

1. Accept all or certain family members,
2. Accept certain family members with limitations,
3. Increase the price by changing the rate from “preferred” to “standard”,
4. Exclude certain preexisting conditions or
5. Decline the application.

Depending on the insurer, 70-80 percent of applications are accepted without being uprated or having exclusions.

What if I have a question and want to speak with a representative?

Please call 866.543.0534 and we will be happy to answer any question you may have. We also offer the Free Quote Consult which you can fill out 24/7 and we will respond within 24 hours.

Why is individual or family health insurance often cheaper than insurance at employers?

Individual health insurance products typically cost one third to one half of group insurance. This price difference is mostly due to medical underwriting, whereby insurance companies can deny or limit coverage based on an applicant’s health status. In addition, individual and family health insurance policies often have high deductibles, limited maternity and limited prescription drug coverage. As you shop for health individual or family health insurance please pay particular attention to these items.

Can children over 18 be insured on a family health insurance policy?

Family Health Insurance companies will typically insure children of the policyholder through age 23 if they are enrolled as full time students. Otherwise they are required to obtain their own insurance when reaching age 18.

What is an exclusion or preexisting condition?

An insurance underwriter may accept an application but exclude coverage for “preexisting conditions.” For example, you may have had recent knee surgery and the insurance carrier will accept your application excluding all claims related to your injured knee. Such exclusions may last for a specific period of time or the life of the policy.

What is COBRA?

COBRA is 1985 federal legislation that requires employers with more than 20 employees to allow employees that leave the company to continue their insurance in the company plan for 18 to 36 months. The employee is required to reimburse the employer for the cost of the insurance plus up to a 2 percent administrative fee.

Recently there is new legislation that has been passed for COBRA and state continuation benefits. If you have A group under 20, give us a call for more information.

How does age, gender and tobacco use affect the price of health insurance?

The older you are the higher the cost of the policy. Gender has less impact except if there is maternity coverage. And finally tobacco use may increase the cost of the policy up to 35% for certain insurers.

How do I know if I am getting the best price?

Health insurers are required to file their health plan prices in each state that they do business. Insurers then must sell each benefit plan at the filed price. You will not find a health policy on our website at a better price. Guaranteed.

When will I get an increase?

Each carrier has different rules. Some increase prices on January 1 of each year, regardless of when you sign up. Others increase prices on the policy anniversary. And some will also increase prices on the policyholder’s birthday. To determine a particular insurance carrier’s policy, please call us.

How long does it take to apply? When will my effective date be?

For most carriers we sell at Legacy Health Benefits you can apply online or print out the application, complete it and mail it in. Once a completed application is received by the insurance carrier, it typically takes two weeks to be accepted.

Some carriers only have effective dates on the first of the month. Others will start coverage during the month. If your requested start date cannot be accommodated by the insurer, you will be alerted online to the available start dates for that insurer.

Why should I use Legacy Health Benefits?

You cannot get better prices than at Legacy Health Benefits. Guaranteed by law! We are experts in individual health insurance and understand the complexities of the business. That expertise can help you save money buy purchasing the best policy for your situation.

How do I know which carrier is right for me?

There are many elements to consider when choosing an insurance carrier, including price, physician network and benefit design. Some carriers have lower prices initially but raise them quickly. Depending on the length of time you expect to hold the policy will help determine if it is right for you.

Some carriers have smaller networks and than others. Some and certain carriers require referrals to see physician specialists. We can help you sort through these items to choose the best insurance carrier for you.

How do I choose the right plan?

You need to determine what benefits are important to you. Below we have listed some of the more important points to consider.

1. The hospitals and physicians that are in the network of the plan you choose.
2. Doctor visit co-pay.
3. Prescription benefit and copay.
4. Annual deductible.
5. Co-Insurance.
6. Out of pocket annual maximum.
7. Lifetime Maximum Coverage
8. Premium
9. Health Savings Account Qualified Plans (tax advantage plans)

We will assist you through the entire process of choosing a plan and give you a clear chart of options to help guide you to your decision. Accurate, concise information and a real-time representative with years of experience in the insurance business supports you every step of the way.

What is an HSA?

A Health Savings Account, or HSA combines high deductible health insurance with a tax-favored savings account. Money in the savings account helps pay the deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep. There is no “use it or lose it” restriction with an HSA.

Who is eligible for an HSA?

Anyone who is not entitled to Medicare can accumulate tax-favored savings for healthcare needs. You must have a qualified high deductible plan to receive the benefits. Such a plan must have a minimum deductible for $1,050 for a single or $2,100 for a family. Learn more about HSA (Health Savings Accounts).

How does the prescription drug benefit work?

The prescription drug benefit for individual and family plans varies greatly. Some plans limit the annual benefit and others have a deductible. Please closely review the drug benefit before selecting a health plan.

How do you protect my privacy?

As your health insurance agent, we're committed to protecting your privacy and the information you provide to us. Legacy Health Benefits will not sell trade or give away your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application. We use industry leading technologies to ensure the security of all the information under our control.

We encourage you to read our Privacy Policy online. If you have any questions about our privacy policy or how your personal information is protected at Legacy Health Benefits, contact us by email at privacy@legacyhealthbenefits.com.

Will using your service cost me anything?

All the services offered by Legacy Health Benefits are provided at no extra cost to you, the consumer. If you buy a health insurance plan through Legacy Health Benefits, you'll pay the regular monthly premium to the health insurance company you chose, but you'll pay nothing to us. Our fees are paid by the insurance companies in the form of commissions, which are built into the premium amount.

Why should I shop with you rather than buying an insurance plan elsewhere?

By combining the localized knowledge of a neighborhood agent with the broad experience and comprehensive understanding of a national health insurance agency, we are able to offer our customers:

Broad Selection: Because we are a health insurance agency and not a health insurance company, we can offer plans from multiple insurance companies in your area. We offer a broad selection of health insurance companies and plans, which allows you find the plan that best fits your needs.

Best Prices: Health insurance rates are filed with and regulated by your state's Department of Insurance. Whether you buy from us, your local agent, or directly from the health insurance company, you'll pay the same monthly premium for the same plan.

Excellent Customer Care: You don't just get to talk to an inexperienced sales rep in a call center. You get the expertise and customer care of a knowledgeable, licensed health insurance agent who can define your situation to find you the health insurance that is right for your health and financial situations. Because we specialize in supporting Ohio individuals and small groups, we can accurately process your application and quickly review your health insurance choices with all the major carriers.

How can I view quotes?

Once we have received your medically accurate application, we will put together a report with all the carrier quotes. We will email this quote to you and then review it with you either over the phone or through email. The quality of our customer care is very important to us and we want you to have all the information to make the right choice.

What is an HMO?

HMO's are managed care plans that provide care for enrollees by contracting with specific health care providers to provide specified benefits. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary.

HMO plans often do not include deductibles, but copays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member to forego some choice and flexibility with regard to selecting physicians and hospitals.

Additionally, HMOs do not cover non-emergent services received from providers outside the network. HMOs do not require members to submit claims to the insurance carrier.

What is Coinsurance?

The amount that you may be required to pay for covered medical services after you have satisfied any plan deductible. Coinsurance is typically expressed as a percentage of the allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance. Please note that definitions vary across insurance companies.

What is a PPO (Preferred Provider Organization)?

If a member of a PPO, you will seek treatment from an approved network of providers, or you can see healthcare providers outside the network. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Normally you can see any doctor or specialist within the network at your own discretion, and will not be required to select a PCP. Usually you will pay small copay and satisfy a deductible before benefits are paid. If you go outside the PPO network for healthcare services, your share of the bill will be higher.

What are “short-term policies” and are they a good option?

Short term health insurance is a catastrophic health policy intended to last anywhere from one to twelve months. It requires a very short underwriting questionnaire so it’s much easier to obtain that regular insurance; however, pre-existing conditions in the last five years are not covered. We would only recommend these plans for one to two months time frame. Often a major medical plan can be obtained for not much more money.


FAQs - Your Questions Answered
How does Individual Health Insurance work? As part of the application process, the insurance company will request that you fill out a health statement for each member of the family that you intend to insure. Based on that information the company will make one of the following decisions: 1. Accept all or certain family members, 2. Accept certain family members with limitations, 3. Increase the price by changing the rate from “preferred” to “standard”, 4. Exclude certain preexisting conditions or 5. Decline the application. Depending on the insurer, 70-80 percent of applications are accepted without being uprated or having exclusions. What if I have a question and want to speak with a representative? Please call 866.543.0534 and we will be happy to answer any question you may have. We also offer the Free Quote Consult which you can fill out 24/7 and we will respond within 24 hours. Why is individual or family health insurance often cheaper than insurance at employers? Individual health insurance products typically cost one third to one half of group insurance. This price difference is mostly due to medical underwriting, whereby insurance companies can deny or limit coverage based on an applicant’s health status. In addition, individual and family health insurance policies often have high deductibles, limited maternity and limited prescription drug coverage. As you shop for health individual or family health insurance please pay particular attention to these items. Can children over 18 be insured on a family health insurance policy? Family Health Insurance companies will typically insure children of the policyholder through age 23 if they are enrolled as full time students. Otherwise they are required to obtain their own insurance when reaching age 18. What is an exclusion or preexisting condition? An insurance underwriter may accept an application but exclude coverage for “preexisting conditions.” For example, you may have had recent knee surgery and the insurance carrier will accept your application excluding all claims related to your injured knee. Such exclusions may last for a specific period of time or the life of the policy. What is COBRA? COBRA is 1985 federal legislation that requires employers with more than 20 employees to allow employees that leave the company to continue their insurance in the company plan for 18 to 36 months. The employee is required to reimburse the employer for the cost of the insurance plus up to a 2 percent administrative fee. Recently there is new legislation that has been passed for COBRA and state continuation benefits. If you have A group under 20, give us a call for more information. How does age, gender and tobacco use affect the price of health insurance? The older you are the higher the cost of the policy. Gender has less impact except if there is maternity coverage. And finally tobacco use may increase the cost of the policy up to 35% for certain insurers. How do I know if I am getting the best price? Health insurers are required to file their health plan prices in each state that they do business. Insurers then must sell each benefit plan at the filed price. You will not find a health policy on our website at a better price. Guaranteed. When will I get an increase? Each carrier has different rules. Some increase prices on January 1 of each year, regardless of when you sign up. Others increase prices on the policy anniversary. And some will also increase prices on the policyholder’s birthday. To determine a particular insurance carrier’s policy, please call us. How long does it take to apply? When will my effective date be? For most carriers we sell at Legacy Health Benefits you can apply online or print out the application, complete it and mail it in. Once a completed application is received by the insurance carrier, it typically takes two weeks to be accepted. Some carriers only have effective dates on the first of the month. Others will start coverage during the month. If your requested start date cannot be accommodated by the insurer, you will be alerted online to the available start dates for that insurer. Why should I use Legacy Health Benefits? You cannot get better prices than at Legacy Health Benefits. Guaranteed by law! We are experts in individual health insurance and understand the complexities of the business. That expertise can help you save money buy purchasing the best policy for your situation. How do I know which carrier is right for me? There are many elements to consider when choosing an insurance carrier, including price, physician network and benefit design. Some carriers have lower prices initially but raise them quickly. Depending on the length of time you expect to hold the policy will help determine if it is right for you. Some carriers have smaller networks and than others. Some and certain carriers require referrals to see physician specialists. We can help you sort through these items to choose the best insurance carrier for you. How do I choose the right plan? You need to determine what benefits are important to you. Below we have listed some of the more important points to consider. 1. The hospitals and physicians that are in the network of the plan you choose. 2. Doctor visit co-pay. 3. Prescription benefit and copay. 4. Annual deductible. 5. Co-Insurance. 6. Out of pocket annual maximum. 7. Lifetime Maximum Coverage 8. Premium 9. Health Savings Account Qualified Plans (tax advantage plans) We will assist you through the entire process of choosing a plan and give you a clear chart of options to help guide you to your decision. Accurate, concise information and a real-time representative with years of experience in the insurance business supports you every step of the way. What is an HSA? A Health Savings Account, or HSA combines high deductible health insurance with a tax-favored savings account. Money in the savings account helps pay the deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep. There is no “use it or lose it” restriction with an HSA. Who is eligible for an HSA? Anyone who is not entitled to Medicare can accumulate tax-favored savings for healthcare needs. You must have a qualified high deductible plan to receive the benefits. Such a plan must have a minimum deductible for $1,050 for a single or $2,100 for a family. Learn more about HSA (Health Savings Accounts). How does the prescription drug benefit work? The prescription drug benefit for individual and family plans varies greatly. Some plans limit the annual benefit and others have a deductible. Please closely review the drug benefit before selecting a health plan. How do you protect my privacy? As your health insurance agent, we're committed to protecting your privacy and the information you provide to us. Legacy Health Benefits will not sell trade or give away your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application. We use industry leading technologies to ensure the security of all the information under our control. We encourage you to read our Privacy Policy online. If you have any questions about our privacy policy or how your personal information is protected at Legacy Health Benefits, contact us by email at privacy@legacyhealthbenefits.com. Will using your service cost me anything? All the services offered by Legacy Health Benefits are provided at no extra cost to you, the consumer. If you buy a health insurance plan through Legacy Health Benefits, you'll pay the regular monthly premium to the health insurance company you chose, but you'll pay nothing to us. Our fees are paid by the insurance companies in the form of commissions, which are built into the premium amount. Why should I shop with you rather than buying an insurance plan elsewhere? By combining the localized knowledge of a neighborhood agent with the broad experience and comprehensive understanding of a national health insurance agency, we are able to offer our customers: Broad Selection: Because we are a health insurance agency and not a health insurance company, we can offer plans from multiple insurance companies in your area. We offer a broad selection of health insurance companies and plans, which allows you find the plan that best fits your needs. Best Prices: Health insurance rates are filed with and regulated by your state's Department of Insurance. Whether you buy from us, your local agent, or directly from the health insurance company, you'll pay the same monthly premium for the same plan. Excellent Customer Care: You don't just get to talk to an inexperienced sales rep in a call center. You get the expertise and customer care of a knowledgeable, licensed health insurance agent who can define your situation to find you the health insurance that is right for your health and financial situations. Because we specialize in supporting Ohio individuals and small groups, we can accurately process your application and quickly review your health insurance choices with all the major carriers. How can I view quotes? Once we have received your medically accurate application, we will put together a report with all the carrier quotes. We will email this quote to you and then review it with you either over the phone or through email. The quality of our customer care is very important to us and we want you to have all the information to make the right choice. What is an HMO? HMO's are managed care plans that provide care for enrollees by contracting with specific health care providers to provide specified benefits. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary. HMO plans often do not include deductibles, but copays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member to forego some choice and flexibility with regard to selecting physicians and hospitals. Additionally, HMOs do not cover non-emergent services received from providers outside the network. HMOs do not require members to submit claims to the insurance carrier. What is Coinsurance? The amount that you may be required to pay for covered medical services after you have satisfied any plan deductible. Coinsurance is typically expressed as a percentage of the allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance. Please note that definitions vary across insurance companies. What is a PPO (Preferred Provider Organization)? If a member of a PPO, you will seek treatment from an approved network of providers, or you can see healthcare providers outside the network. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Normally you can see any doctor or specialist within the network at your own discretion, and will not be required to select a PCP. Usually you will pay small copay and satisfy a deductible before benefits are paid. If you go outside the PPO network for healthcare services, your share of the bill will be higher. What are “short-term policies” and are they a good option? Short term health insurance is a catastrophic health policy intended to last anywhere from one to twelve months. It requires a very short underwriting questionnaire so it’s much easier to obtain that regular insurance; however, pre-existing conditions in the last five years are not covered. We would only recommend these plans for one to two months time frame. Often a major medical plan can be obtained for not much more money.