Health insurance provides financial protection for medical expenses. With traditional health

insurance, the insured person pays a monthly fee in exchange for healthcare coverage

according to the plan terms.

Health insurance matters because without it, a sick or injured person will have to pay out of

pocket for medical coverage. Medical care can cost up to hundreds of thousands of dollars

without health insurance. With health insurance, someone needing medical care can get the

care they need and potentially get coverage for all or some of the costs, depending on the

plan terms.

At AZ Health Insurance Brokers, we consult with our clients to find out who needs coverage

(individual, spouse, children, etc.) and what kind of coverage works for the individual or

family. We then present a variety of options from our partner insurers to find the most cost-

effective plan that provides the exact coverage needed.

In addition to individual health insurance and family health insurance plans, we help

businesses select group insurance plans for their employees.

To understand your best health insurance plan choice, it’s best to talk with a health

insurance professional who can help you compare plans and options. Consider the

frequency of medical care you require, if you have any current medical issues, if you have

upcoming procedures or surgeries, and/or if you anticipate any future healthcare needs may

arise, like pregnancy.

If you’re relatively healthy and you’re looking for preventive care, your ideal plan will be

different compared to someone with a preexisting condition who requires more frequent

medical care and prescriptions. That’s why talking with a health insurance professional can

be helpful, so you understand all relevant options.

In health insurance terms, HSA stands for health savings account. Business owners may offer

their employees an HSA, which workers can contribute to tax-free to cover future

healthcare costs. HSA balances roll over every year. HSA plans must be paired with high-

deductible health plans, which results in members paying lower monthly premiums toward

healthcare costs.

An HRA in health insurance terms refers to a health reimbursement arrangement. With an

HRA, the employer provides tax-free healthcare reimbursement to employees. HRA types

include a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) and an

Individual Coverage Health Reimbursement Arrangement (ICHRA).

FSA stands for flexible spending account. Employers may offer employees an FSA, where

workers can put money into the account, pre-tax, to use toward healthcare expenses, as

well as dependent care expenses.

Healthcare coverage may vary depending on the plan terms, but typically, health insurance

covers primary care doctor visits, specialty care doctor visits and emergency health services,

such as hospital stays.

It may also provide coverage for various surgeries and procedures, mental health and

substance use disorder services, pediatric services, pregnancy and newborn care,

prescription drugs, laboratory services and rehabilitative services and devices.

HMO stands for health maintenance organization. HMO plans typically require that the

insured uses medical providers who are in-network with the plan. Primary care physicians

provide referrals for specialists.

PPO stands for preferred provider organization. PPO plans typically cover out-of-network

care, so the insured can choose their own providers and specialists.

EPO stands for exclusive provider organization. EPO plans only cover in-network care, but

the insured can typically see any specialist in the plan’s network, without the need for a

referral from a primary care doctor.

POS stands for point of service. POS plans typically require the insured to select a primary

care physician and get referrals for specialists. Out-of-network services are covered with

referrals but may result in higher out-of-pocket costs.

The Affordable Care Act (ACA) offers a federal health insurance marketplace to American

citizens, which includes providing subsidies to qualifying low-income households. ACA plans

are an alternative to private healthcare insurance plans and may be more expensive or

more affordable, depending on the insured’s income and medical care needs.

Open enrollment is an annual time period in which people can sign up for new health

insurance, cancel their current health insurance plan or make adjustments to their current

health insurance plan. For employees who get health insurance through work, the employer

sets the open enrollment period. Otherwise, the open enrollment period is determined by

the insurer or marketplace.

Yes, you may be able to purchase health insurance outside of the open enrollment period.

Certain qualifying events, such as job loss or marriage, may trigger a special enrollment

period. Talk with the AZ Health Insurance Brokers for options.

A health insurance deductible is how much the insured pays out of pocket for covered

healthcare services before an insurance plan starts to pay for healthcare costs. A high

deductible typically results in lower monthly premium costs. A low deductible typically

results in higher monthly premium costs.

Group health insurance is an insurance plan offered through a business, also known as

insurance you get through work, or business health insurance. The business owner

purchases an employer-sponsored healthcare plan, which provides healthcare coverage for

employees and their dependents.

With individual health insurance, the individual chooses their own plan and purchases it

through an insurance broker, through the insurance provider or through an insurance

marketplace.

Since group health insurance is offered through an employer, an individual’s eligibility will

depend on if their employer offers health insurance coverage or not.

To offer group health insurance, employers must have at least one qualified full-time or full-

time equivalent employee, other than a spouse or the business owner, who is on the payroll

and whose payroll taxes are paid by the employer. The business must also be considered a

legal business entity, per state regulations.