Call Today! 262-675-9399

Providing Quality Health & Life Insurance for Wisconsin & Michigan Residents.

What are Covered Expenses?

What is a Deductible?

What is Co-Insurance?

What is a Co-Pay (co-payment)?

What is an HMO?

What is a PPO?

What is the difference between "in network" and "out of network"?

How do I pay?

Can I buy health insurance cheaper if I go directly to the health insurance company?

What are Covered Expenses?

These are expenses that your insurance plan covers. For example: Your plan states that it covers out-patient surgery. This is a covered expense and will apply to your deductible. Your plan says that it doesn't cover chiropractic visits and you go to a chiropractor. This is not a covered expense and will not be applied to your deductible. You will pay for these expenses out of your pocket.

What is a Deductible?

A deductible is a set dollar amount of annual medical expenses that you must pay before you plan starts to cover medical costs. For example: If you have a $1000 deductible and go to the hospital and your bill is $10,000. You pay the first $1000.00 and your insurance pays $9,000. Only covered expenses apply to your deductible.

What is Co-Insurance?

This is a percentage that you pay after you meet your deductible. For example: You have a $1000.00 deductible and an 80% - 20% co-insurance plan. Your hospital bill is $10,000.

$10,000.00 - $1000.00 deductible = $9,000.00

Now your co-insurance starts.

$9,000.00 x 80% = $7,200.00

This means out of a $10,000 bill your insurance pays $7,200.00 and you pay $1000.00 deductible plus $1,800.00 co-insurance for a total of $2,800.00.

Most plans have a maximum out of pocket cap so your portion of the co-insurance has a limit. This is called a "Stop Loss". We recommend to never buy a plan without a stop loss!

What is a Co-Pay (co-payment)?

A Co-Pay is a fixed dollar amount that you pay for each visit/service. For example with some plans you may pay $20-$30 per doctors visit or prescription.

What is an HMO?

A Health Maintenance Organization is a company that offers comprehensive prepaid health care services to its subscribing members. HMO's not only finance the health care services, but also organize and deliver the health services. HMO's are known for stressing preventive care with the idea of reducing the amount of hospital admissions. The biggest drawback with HMO's is that they usually have smaller networks of doctors and hospitals and sometimes will not pay for services obtained outside of the network.

What is a PPO?

A Preferred Provider Organization is a collection of doctors, hospitals and clinics that offer their services at pre-arranged prices. PPO providers are normally in private practices. They have agreed to offer their services to members at discounted prices. In exchange, because the group refers its members to the PPO, the providers broaden their patient base. These networks are generally larger than HMO's (sometimes nationwide) and give the patient a wider range of doctors, specialists, and hospitals to choose from.

What is the difference between "in network" and "out of network"?

An in-network provider is within the approved network of providers for a particular health plan. Out of network providers are not on the list. Generally speaking, your out-of-pocket expenses will be lower if you stay in-network because the providers have agreed to set prices for services. In some cases the insurance company will not pay for services received outside of your network. There are some exceptions to this however (emergencies).

How do I pay?

Most companies require your first month premium with the signed application. This can be paid with a credit card or check. If you are not approved for coverage with that company, you will be refunded your money. If you are accepted, most companies prefer to automatically withdraw your premium monthly from a checking or savings account. This helps them reduce costs. Most companies will not bill on a monthly basis. However they will bill for quarterly, semi-annual and annual payments.

Can I buy health insurance cheaper if I go directly to the health insurance company?

No. Insurance companies charge the same premium whether the plan is bought direct, through a broker, or on-line through Little Village Insurance. The advantage to you as a consumer when buying through Little Village Insurance is that we will continually shop your coverage with various companies each year to help you keep your premium down. An insurance company sales or customer service representative will not tell you to go to a competitor in order to reduce your premium or get better coverage.