Here are a couple of definitions that we get asked about most often:

Coinsurance -

• A form of medical cost sharing in a health insurance plan that requires an
  insured person to pay a stated percentage of medical expenses after the deductible
  amount, if any, was paid.
• Once any deductible amount and coinsurance are paid, the insurer is responsible
  for the rest of the reimbursement for covered benefits up to allowed charges: the
  individual could also be responsible for any charges in excess of what the insurer
  determines to be “usual, customary and reasonable”.
• Coinsurance rates may differ if services are received from an approved provider
  (i.e., a provider with whom the insurer has a contract or an agreement specifying
  payment levels and other contract requirements) or if received by providers not
  on the approved list.
• In addition to overall coinsurance rates, rates may also differ for different types
  of services.

Co-payment -

A form of medical cost sharing in a health insurance plan that requires an
insured person to pay a fixed dollar amount when a medical service is received. The
insurer is responsible for the rest of the reimbursement.

• There may be separate co-payments for different services.
• Some plans require that a deductible first be met for some specific services
  before a co-payment applies.

Deductible -

A fixed dollar amount during the benefit period – usually a year – that an
insured person pays before the insurer starts to make payments for covered medical
services. Plans may have both per individual and family deductibles.

• Some plans may have separate deductibles for specific services. For example, a
  plan may have a hospitalization deductible per admission.
• Deductibles may differ if services are received from an approved provider or if
  received from providers not on the approved list.

Health maintenance organization (HMO) -

A health care system that assumes both
the financial risks associated with providing comprehensive medical services
(insurance and service risk) and the responsibility for health care delivery in a
particular geographic area to HMO members, usually in return for a fixed, prepaid
fee. Financial risk may be shared with the providers participating in the HMO.

Maximum out-of-pocket expense -

The maximum dollar amount a group member is
required to pay out of pocket during a year. Until this maximum is met, the plan and
group member shares in the cost of covered expenses. After the maximum is reached, the
insurance carrier pays all covered expenses, often up to a lifetime maximum.

Point-of-service (POS) plan -

 A POS plan is an “HMO/PPO” hybrid; sometimes
referred to as an “open-ended” HMO when offered by an HMO. POS plans resemble
HMOs for in-network services. Services received outside of the network are usually
reimbursed in a manner similar to conventional indemnity plans (e.g., provider
reimbursement based on a fee schedule or usual, customary and reasonable charges).

Preferred provider organization (PPO) plan -

An indemnity plan where coverage
is provided to participants through a network of selected health care providers (such
as hospitals and physicians). The enrollees may go outside the network, but would
incur larger costs in the form of higher deductibles, higher coinsurance rates, or non-discounted
charges from the providers.
For additional definitions please see http://www.bls.gov/ncs/ebs/sp/healthterms.pdf . 

Contact Crosby and Crosby to help with your health insurance needs.

If you have any questions or would like Crosby & Crosby’s help in finding you or your family health coverage please call us at 661-327-5531, complete a quote online, email our health department at benefits@crosbyandcrosby.com, or stop by our office at 111 H Street. 

Crosby and Crosby Insurance Services offers health insurance plans through great carriers like, Anthem/Blue Cross, Blue Shield, Aetna and Kaiser. We have been helping families in Bakersfield and throughout Kern County since 1963!

 Depending on your need we can find a plan that fits both your coverage needs and your budget. 
 At Crosby & Crosby Insurance we work directly with Anthem Blue Cross, Blue Shield, Aetna and Kaiser to provide you with a perfect fit.  Many of our plans now cover preventive care at no additional charge to you—that’s right, the deductible and/or co-pay may be waived for routine preventive care depending on the plan you choose.  Plans are also available that cover up to 4 doctor visits per year with a small co-pay, no deductible applies. 

Not interested in doctor visits or preventive care?  We also have plans available with high deductibles and low monthly premiums for you.  These plans are better suited for those that are more concerned with a major illness or accident being covered than a routine doctor visit. 
 Let us take the confusion out of health insurance for you.  Start by getting an online quote , call us today at 661-327-5531, email our health insurance department at benefits@crosbyandcrosby.com, or stop by our office at 111 H Street.

Question: Are all insurance policies the same?

The answer is loudly a big shouting “NO”!!! On the basic level of the actual policy contract and how it is written companies use a similar form. The key word is similar. How does your policy wording cover things like- water backup, valuable items like your jewelry and firearms and your liability? Especially with so-called “tiered” policies the policy contract can vary drastically even within the same company.

It pays to speak with a knowledgeable agent like Crosby and Crosby to discuss specific contracts and policy coverages.

Some policies are the Motel 6 of the insurance world and some are the Ritz. Spending a $100 per night at a Motel 6 is probably a rip-off but probably is a great  deal at the Ritz. The same goes with insurance. Make sure you are getting a great deal at the Ritz and not paying for bargain basement coverage. And never forget to watch for bedbugs!

What is the best health insurance company in Bakersfield?

Health insurance is one that we have seen a ton of changes within the last few years and the markets can change literally overnight. Depending on your individual situation and the coverages that you are looking for the company may be different.

We offer coverage from Anthem, Blue Shield, Aetna and now Kaiser. These 4 companies can give us a great snapshot of the best company for your needs.

To get a health quote you can complete the online form, email our health agent Jennifer Crosby at jenni@crosbyandcrosby.com  or give us a call 661-327-5531.

Are my ATV’s covered under my homeowners insurance while they are in my garage?

This is a very common question and usually gets lumped in with dirt bikes, off-road vehicles,  personal watercraft, and power boats. Your homeowners policy very specifically excludes  coverage for, “Motor Vehicles or all other motorized land conveyances”.

If you vehicle is not subject to motor vehicle registration and is used for service at your residence or for the assistance of the handicapped it may be covered.

If you have a ATV or off-road vehicle such as a dirt bike or dune buggy please speak to us about coverage.

Coverage is very affordable and you do not have coverage on your homeowners policy even while in your garage.

That wraps up this ”Question and Answer”. Make sure to send us your questions! 

When asked if possible jail time was appropriate for failing to purchase mandatory Health Insurance President Obama said, ” What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don’t, you’re subject to some penalty…”

What is so fundamentally wrong with this statement is that auto insurance is not mandatory. You have two options besides traditional auto insurance…

1. In California you may post a $35,000 cash deposit with the DMV, a DMV Self-insurance certificate or a $35,000 surety bond. CA DMV
2. Don’t drive.

What options will there be to opt out of a plan either from the government or endoresed by the government?