Family and Individual Insurance FAQ’s

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FAQs about Family and Individual
Arizona Health Insurance
Whether you are new to health insurance coverage or not, many questions typically arise when shopping for plans. If you live in Arizona, individual health insurance plans differ greatly. To help you find an affordable individual health insurance plan that fits your particular circumstances, Higgins Companies has compiled a list of frequently asked questions about individual insurance coverage.

Who needs this type of coverage?

 
An individual insurance policy is an ideal, affordable type of medical insurance for those who are: self-employed, business owners looking for an alternative to costly small group health insurance plans, recent college graduates, those in need of an alternative to COBRA, and many other reasons. You will see that this coverage provides many special and unique coverage features while maintaining a very competitive premium structure.
Who is eligible for this coverage?
All individual and family health plans are available to you, your family, through the age of 64 years old, and dependent children through the age of 29, whether a full-time student or not. Blue Cross Blue Shield of Arizona does not require proof of citizenship. Child-only coverage is also available.
What are the coverage limits under this plan?
All PPO type plans have a maximum of $5,000,000 for each insured. Please refer to the Exclusions and Limitations section for all limitations. The Blue Select HMO plans do not have a dollar limit.
How do I apply for this coverage?

You must reside in the state of Arizona for at least six months of each year to qualify for individual/family health insurance coverage. Next, look up the rates that apply to you based on your gender and county in which you reside. Then, complete the application, e-sign it, and click submit, it’s that easy. There is no $20.00 application fee when applying online through this website.
When does my coverage begin?
The insurance can be effective within a few days of applying, or longer if medical records are requested by Blue Cross Blue Shield of Arizona.
What if an applicant for an Individual/family plan is currently taking medication for high blood pressure AND high cholesterol?
The applicant will be accepted so long as the blood pressure is 130/90 or below, and the total cholesterol is 200 or below. Multiple medications for controlling cholesterol levels is also acceptable. Applicants must still meet the height/weight requirements.
How long does it take to obtain a health insurance policy?
It depends on the health status of the applicant, the insurance company to which the applicant applies, and whether medical records are requested. Some health insurance companies may approve the application of a healthy young adult within a few days. If medical records are requested by the insurance company, processing an application can take several weeks or more. Physicians’ offices and hospitals need time to gather the requested records and this takes 1-3 weeks in most cases. You should consult your independent agent to get a realistic expectation. If you need insurance coverage that starts right away, you should consider short-term health insurance coverage, which can begin as soon as the next day.
Is a physical exam required to obtain insurance coverage?
Blue Cross® Blue Shield® of Arizona does not require physical exams to be considered for individual/family plans.
What is the difference between an HMO and a PPO plan?
The primary difference is that HMOs limit your non-emergency health care coverage to a limited network of physicians and hospitals. PPO plans insure covered services delivered by any licensed physician or hospital, but under a PPO, you will receive improved benefits if you use physicians and hospitals participating in the PPO preferred network.
PPO networks are normally much larger than HMO networks, though HMOs provide higher benefit levels. For most individuals and families in Arizona, PPO rates will be lower than HMO rates. In addition, HMO plans are rarely an option for persons not participating in employer-sponsored programs. The large majority of our individual and family insurance clients enroll in PPO plans.
Will my weight affect my premium rates?
Yes. All Arizona health insurers use height and weight tables to make risk determinations. People above or below the height/weight ratios will be refused coverage. These height/weight standards vary from health insurer to health insurer. Please call Mike Higgins at 602.405.8769 to see if you qualify.

Can an application for individual health insurance be turned down?
Yes. Whether an application is approved or denied depends on the applicant’s health. Contact your independent agent to get a realistic assessment regarding your own circumstances.
Can I use my current doctor with the new insurance plan? Blue Cross and Blue Shield of Arizona has the largest network, with 88% of all physicians having a contract with BCBSAZ, and most hospitals.
You should review an individual health insurance plan’s physician network before applying to the plan.
What is the definition of a “pre-existing condition”?
Each health insurance company has its own specific wording. However, the following statement is in line with most insurance company provisions: “A pre-existing condition is a medical condition that would cause a normally prudent person to seek treatment during the eleven months prior to the beginning of coverage.”
Can I purchase individual health insurance at a lower premium by dealing directly with an insurance company?
No. Health insurance rates are strictly regulated by the state. Individual health insurance will cost the same amount whether you use an independent agent or deal directly with an insurance company.
Why should I purchase an individual health insurance plan from an independent agent?
An independent health insurance agent is not an employee of an insurance company. He/she is a broker of insurance products i.e. an agent who is able to sell the products of an insurance company. Because he/she is not an employee of insurance company, an independent agent can more objectively recommend the best company for your situation. In addition, an independent agent will be familiar with insurance company bureaucracies, which can save you a lot of aggravation. Further, if your circumstances change, an independent agent can recommend a more appropriate health insurance plan for you.
Do I pay anything to the independent agent?
No. An independent agent is paid a commission by the health insurance company. No additional fees are added to your insurance cost.
What payment choices are there for the initial health insurance premium?
Blue Cross® Blue Shield® of Arizona does not require an initial payment of the premium when applying for individual or family health insurance. When applying online through this website the $20.00 application fee is waived.
Will the insurance company accept my previous group coverage and exempt me from pre-existing condition limitations?
No. In Arizona it does not matter that you have previous insurance coverage. An insurance company can still deny your application for coverage. However, if your application is declined, you may be eligible to participate in your state’s “safety net” plan established for persons who are unable to obtain health insurance coverage on the open market. The “safety net” in Arizona is known as a “portability” policy. Portability policies are very expensive. The upside is that there are no riders or waivers placed on existing medical conditions that the applicant may have.
Can I obtain individual health insurance while I’m pregnant?
Unfortunately, no insurance company underwriting individual or family health coverage will agree to insure you while you are pregnant. However, group health insurance plans will accept new enrollees who are pregnant. Therefore, if you are pregnant and have an opportunity to enroll in a group health insurance plan, take advantage. Otherwise, you may wish to look into your state’s comprehensive “safety net” plan such as AHCCCS.
What if my application is denied?
You can apply to another health insurance company. Different insurance companies use different underwriting guidelines. It is not at all unusual for a person to be rejected by one insurer, but accepted by another. It depends on the specific health conditions at issue. If you are unsure about your situation, consult an insurance agent.
If no insurance company will agree to insure you, you may qualify for enrollment in your state’s comprehensive “safety net” plan.
Can my coverage be terminated?
Arizona provides strong consumer protection. In general, the insurance company can terminate your coverage for only the following reasons: (1) failure to make the premium payment within the payment grace period, (2) material omission or misrepresentation on your application, or (3) the insurance company entirely withdraws from the individual health insurance business in your state.
How long am I required to keep a new plan?

Health insurance is generally purchased in one month increments (single-period short-term plans are an exception) so your commitment is typically one month at a time. However, some health insurers (not all) will provide a pro-rated premium refund if you terminate during a coverage month. One thing is for sure, if you stop making health insurance premium payments, the insurance company will terminate your coverage.

What is the difference between Blue Cross® Blue Shield® of Arizona and other health insurance carriers?
Technically speaking, Blue Cross® Blue Shield® of Arizona is a service organization. As a non-profit organization, more monies are available to increase benefits for its members than that of a for-profit insurance company. Blue Cross® of Arizona has great recognition and a lot of clout, but they still get plenty of competition from other health insurance companies.
As I get older, do my health insurance premiums increase?
Yes. As people get older they tend to use more health care services so “individual” health insurance companies charge higher rates to older persons and lower rates to younger persons. For example, the health insurance rate charged to a 50-year-old is typically more than twice the health insurance rate charged to a 25-year-old.
At Michael Higgins Insurance, our goal is to help consumers make informed decisions about their individual health insurance coverage. We encourage our visitors to use this information as part of a research process that involves many sources of information. Send any questions to Mike Higgins, info@higginscompanies.com.