Frequently Asked Questions

Click on the tabs below to view expandable questions and answers about Disability, Life, Health, and Cancer Insurance products.

Who may apply?

All employees or members, actively employed in the full-time duties (20 hours a week) of their occupation, may apply!

This is the period of time (calendar days) you must wait before your benefits kick in.  The day your doctor takes you off of work is day 1.

Based on the salary chart in the brochure, you may apply for that amount or any amount below it.

Benefits are paid directly to you. All benefits you receive are yours to use as you please. Pay hospital, doctor or other miscellaneous medical expenses.  Pay at-home expenses or continuing monthly bills.  The choice is yours!

No tax is payable on your monthly benefits as long as you, not your employer, pay the entire premium.  If you use the premium under a pre-taxed section 125 plan, your benefits are taxable. Please consult your tax advisor.

No! After 6 months of total disability (and after your elimination period), your premium is waived for as long as you’re disabled and benefits are payable.

Maximum benefits are available, subject to a new elimination period, for the same recurring disability after Insureds return to work for at least 180 consecutive days.

Renew your coverage until retirement – provided you pay your premiums, remain a member, are gainfully employed and the group policy remains in force. This policy is renewable at the option of the company.

The disability plan pays for the disability portion of the leave only – for pregnancy leave, usually 6-8 weeks.  If you make the choice to stay off longer under FMLA (i.e. care for a newborn), that time is not considered a disability so no benefits would be payable.   The FMLA is unpaid, job-protected leave.  For more details on FMLA, please visit  http://www.dol.gov/agencies/whd/fmla/

Benefits are not payable for any injury, sickness or condition caused by or due to: war or acts of war declared or undeclared; military service of any country or international organization; pregnancy or childbirth (unless applying for maternity coverage); abortion, except to save the life of the mother; illegal blood alcohol content; being under the influence of any narcotic, barbiturate or hallucinatory drug, unless administered under advice of a physician and taken in the prescribed dosage; suicide or any attempt at suicide while sane or insane; travel or flight in any kind of aircraft while participating in aviation training, or as a pilot, officer or other member of the crew; injury or sickness arising out of and in the course of any occupation for wage or profit.

Why do I need Life Insurance?

Life insurance is an essential part of financial planning. One reason most people buy life insurance is to replace income that would be lost with the death of a wage earner. The cash benefit provided by life insurance also can help ensure that your dependents are not left with debt when you die. Life insurance proceeds could mean your dependents will not have to sell assets to pay outstanding bills or taxes. An important feature of life insurance is that no income tax is payable on proceeds paid to beneficiaries*.

*This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice.

Before buying life insurance, you should assemble personal financial information and review your family’s needs. There are a number of factors to consider when determining how much protection you should have. These include:

  • any immediate needs at the time of death, such as final illness expenses, burial costs and estate taxes;
  • funds for a readjustment period, to finance a move or to provide time for family members to find a job
  • ongoing financial needs, such as monthly bills and expenses, day-care costs, college tuition or retirement.

Buying life insurance is not like any other purchase you will make. When you pay your premiums, you’re buying the future financial security of your family that only life insurance can provide. Among its many uses, life insurance helps ensure that, when you die, your dependents will have the financial resources needed to protect their home and the income needed to run a household.

Choosing a life insurance product is an important decision, but it often can be complicated. As with any other major purchase, it is important that you understand your needs and the options available to you.

The main types of life insurance available are term and permanent. Term insurance provides protection for a specified period of time. Permanent insurance provides lifelong protection. To learn more about term and permanent insurance click HERE.

If you miss a premium payment, you typically have a 30- or 31-day grace period during which you can pay the premium. After that, the policy will lapse. You may be able to reinstate with evidence of insurability depending on your policy’s provisions. If your policy has sufficient cash value, the company can, with your authorization, draw from a permanent policy’s cash surrender value to keep that policy in force. This does not apply to term insurance because there is no cash value to draw from. In some flexible premium policies, premiums may be reduced or skipped as long as sufficient cash values remain in the policy. However, this will result in lower cash values.

Provisions or riders that provide additional benefits can often be added to a policy. One such rider is a waiver of premium for disability. With this rider, if you become totally disabled for a specified period of time, you do not have to pay premiums for the duration of the disability.

  • “Accidental Death Benefit”, provides for an additional benefit in case of death as a result of an accident.
  • “Accelerated Benefits”, also known as “living benefits.” This rider allows you, under certain circumstances, to receive the proceeds of your life insurance policy before you die. Such circumstances include terminal or catastrophic illness, the need for long-term care or confinement to a nursing home.
  • “Child rider”, provides insurance for all your children, usually from $1,000 to $20,000 of death benefit.

If you decide to purchase the policy, find out when the insurance becomes effective. This could be different from the date the company issues the policy.

It allows policyholders to receive all or part of the policy’s proceeds prior to death under certain circumstances, including the need for long-term care and confinement to a nursing home. Because payments may affect tax status and Medicare eligibility, and will be deducted from the overall benefits paid later to beneficiaries, policyholders should thoroughly investigate options in advance.*

*This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice.

Medical tests can provide accurate and current information about an applicant’s health, thus enabling insurers to charge premiums that reflect the level of risk an applicant represents. Because some health conditions are easily managed through proper medication, therapy or lifestyle changes, medical information sometimes makes it possible for insurers to cover applicants who might not otherwise be insurable. More serious or incurable conditions present an enormous risk that an insurer simply cannot assume.

  • Always name a “contingent,” or secondary, beneficiary, just in case you outlive your first beneficiary.
  • Select a specific beneficiary, rather than having the proceeds of your life insurance paid to your estate. One of the great advantages of life insurance is that it can be paid to your family immediately. If it is payable to your estate, however, it will have to go through probate with the rest of your assets.
  • Be very clear in wording beneficiary designations. Naming specific children may exclude those born later. If your child dies before you, do you want the proceeds to go to that child’s children? Changing the beneficiary designation is easy, but you have to remember to do it.

Think twice before you do, because in many situations it may not be to your advantage. Before dropping any in-force policy, make sure your “new” policy is paid for and in effect and first consider:

  • If your health status has changed over the years, you may no longer be insurable at preferred or standard rates.
  • Even if both policies pay “dividends,” it may be years before the new policy’s dividends equal those of your present one.
  • If you replace one cash-value policy with another, the cash value of the new policy may be relatively small for several years and may never be as large as that of the original one. There may also be a period wherein a surrender charge is applicable on the first policy.
  • You should ask for a detailed listing of cost breakdowns of both policies, including premiums, cash surrender value and death benefits. Compare these as well as the features offered by both policies.
  • If you decide to surrender or reduce the value of the policy you now own and replace it with other insurance, be sure your new policy is in force before you cancel the old one.

The answer almost always is yes. You may want to consider these options:

  • Disability income insurance – especially important for self-supporting singles without sizable assets, this can replace a good part of the income you would lose if you were unable to work because of accident or illness. If you don’t have long-term disability coverage at work, it would be wise to consider an individual policy designed to replace at least 60 percent of your income.
  • Health insurance – if you don’t have on-the-job coverage, an individual policy is your first line of defense against ever-escalating medical and hospital costs. You can keep premium costs down by electing a large deductible, thereby “self-insuring” as much as you can afford.
  • Life insurance – even if you have no dependents now, you may later. If you buy now when you are younger and healthier, you can “lock in” coverage, including guaranteed insurability.

Why buy insurance just for cancer?

More than 1.8 million new cancer cases are expected to be diagnosed in 2020. The estimate does not include carcinoma or basal cell and squamous cell skin cancers. The Agency for Healthcare Research and Quality estimates that cancer-related direct medical costs in the US in 2015 were $80.2 billion, with 52% of those costs resulting from hospital outpatient or office-based provider visits and 38% from inpatient hospital stays.*  This may be more than your health insurance will cover. An affordable cancer plan helps with the extraordinary high cost of cancer treatment.

* Source: American Cancer Society Facts & Figures 2020 – www.cancer.org

Yes, as long as you’ve been cancer-free for the last ten years.

Yes. We pay in addition to any other insurance you may have… including the Kaiser Plan, Blue Cross, Blue Shield and Medicare.Whenever cancer strikes you, or any insured family member, all of the benefits of your Cancer protection Plan will be available for you (and paid directly to you) in this time of great need.

We will pay in addition to any other coverage up to $50 per the policy schedule for a mammogram and up to $30 per year for a Pap smear, even if there is NO diagnosis of cancer. If you have no other coverage, actual charges will be paid per the policy schedule.

What is individual and family health insurance?

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. In fact, by 2014, the Affordable Care Act will require all to have health insurance or face possible tax penalties.

Individual and family health insurance plans are usually described as either “indemnity” or “managed-care” plans. Put broadly, the major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).

There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

As a member of a PPO (Preferred Provider Organization) plan, you’ll be encouraged to use the insurance company’s network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan’s members at a discounted rate. You typically won’t be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.

With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.

Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you’ll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.

With an HMO you’ll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won’t have to submit any of your own claims to the insurance company. However, keep in mind that you’ll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.

A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan may be required to choose a primary care physician (PCP) from the plan’s network of providers. Services rendered by your PCP may or may not be subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.

Typically, however, you will receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you’ll likely have to pay up-front and submit a claim to the insurance company yourself.

Please note this information may vary by insurance company.

A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

Under an Indemnity plan, you may see whatever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.

However, this kind of freedom will cost you. You’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the “usual, customary and reasonable (UCR) rate” for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service.

An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

Legislation establishing Health Savings Accounts (or “HSAs”) took effect on January 1, 2004. HSAs and HSA-compatible health insurance plans are becoming more and more popular. Here are the basics:

  • An HSA is a tax-favored savings account that may be used in conjunction with an HSA-compatible high deductible health insurance plan to pay for qualifying medical expenses.
  • Choosing an HSA-compatible health insurance plan may help you save money. Typically, the monthly premium on an HSA-compatible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
  • Contributions to an HSA may be made pre-tax, up to certain annual limits.
  • Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.

Not all high-deductible plans are eligible for use in conjunction with an HSA.

A “co-payment” or “co-pay” is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

A “deductible” is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.

Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional co-payment or deductible requirements), then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

As a general rule, PPO, POS, and HMO plans make use of provider networks. Indemnity plans typically do not.

Choosing between different health insurance plans isn’t always easy. There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:

  1. Are you going to need long-term coverage or just something for the short-term?
    If you’re between jobs for 1-6 months, you may want to look into our short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.
  2. Are you looking for basic coverage or more comprehensive coverage?
    Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness.Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.The Patient Protection and Affordable Care Act (PPACA) requires that all plans must provide coverage for certain preventive benefits, immunizations, and screenings*, without cost sharing requirements for plan/policy years beginning on or after September 23, 2010. This rule does not apply to grandfathered plans.*As recommended by the US Preventive Services Task Force, the CDC, and the Health Resource and Services Administration (HRSA).
  3. Would you rather pay for your services before you use them or when you use them?
    Typically, the higher the monthly premium that you pay, the less you will pay per doctor’s visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.
  4. How important to you is easy access to specialists?
    Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.
  5. Do you have a specific doctor or hospital that you would like to visit for healthcare?
    Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. You’ll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.
  6. What is the most you could pay out in case of a serious illness or injury?
    Health insurance plans typically place limits on how much a member is required to pay out of pocket per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. In 2014, PPACA will limit out of pocket expenses for essential health benefits* for low income individuals. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.* Essential health benefits will be determined by the Secretary of Health and Human Services.

You can request that your Individual and Family health insurance plan start anytime between 1 and 90 days in the future. However, the insurance companies will typically need some time to process your application so keep in mind that the actual date for the start of your coverage may vary depending on the underwriting process and the availability of your medical records.

When getting quotes for your child(ren) only, enter the child’s gender and birth date in the “Applicant” or first row. Additional children should be entered below in the “Child” rows, but not the “Spouse” row.

However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. You are free to apply for each child separately.

By combining the localized knowledge of a neighborhood agent with the broad experience and comprehensive understanding of a leading online health insurance source, 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 premiums 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.
  • Fast Processing. We offer a fast way to apply for health insurance because many of the plans offered on our website can be submitted and signed electronically, eliminating the need to manually print and mail applications. This reduces average processing time significantly.
  • Excellent Customer Care. We believe that you’ll enjoy the best customer experience available in the health insurance industry. The licensed health insurance agents and knowledgeable representatives that staff our customer care center will help you make the most of your money with professional, unbiased advice.

In most cases, when you complete your application you’ll provide a credit card number or a check written to the health insurance company for the first premium payment. Typically, your credit card will not be charged nor will your check be cashed until you are approved for coverage. If you are not approved for coverage, or if you cancel your application, your card will not be charged and any check payment you made will be returned or refunded.

Once you’ve been approved for coverage, your ongoing premium payments are paid to your health insurance company typically on a monthly or quarterly basis. Insurance companies typically offer several payment options including monthly billings to be paid by check or credit card, automatic bank drafts or automated credit card charges. Please note that credit card billing of premiums is optional and you can obtain coverage without using that method of payment.

No. You are under no obligation to buy a health insurance plan when using our site. After submitting your application you may cancel it at any time during the underwriting process. When you submit an application you will typically include your credit card number, bank account information, or a check for the initial premium payment. Most insurance companies will not charge your card, debit your account, or deposit your check until you are approved. If you are charged or your check is cashed and you are denied for coverage or cancel your application prior to approval, the insurance company will issue a refund to you.

A few insurance companies may charge an application fee. You will be notified in the application if the plan you chose requires an application fee. Please note that these fees are non-refundable.

Health insurance premiums 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. This means that you can enjoy the advantages and convenience of shopping and purchasing your health insurance plan through Pacific Educators and rest assured that you’re getting the best available price.

Yes. We believe in providing you with top-quality customer service. Our customer care center is staffed with licensed health insurance agents and knowledgeable representatives, ready to assist you.

  • Call Us
    Our licensed insurance agents and knowledgeable representatives are ready to help you. Just call 800-722-3365 Mon – Fri, 8AM-5PM PST.
  • Email Us
    Click here to send us an email. One of our knowledgeable customer care representatives will reply to you soon. Please note that our licensed health insurance agents can discuss insurance plan benefits and rates only by phone.

When will the health care reform law take effect?

The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act (PPACA), and the subsequent reconciliation bill, are phased-in over 5 years. Most provisions will not take effect until January 1, 2014. However, there are some new protections that have already been implemented:

  • Lifetime limits are prohibited and annual limits are restricted
  • Enhanced appeal procedures are available to consumers
  • Children under 19 years of age cannot be denied coverage
  • Children up to age 26 may remain on a parent’s policy
  • Preventive services must be coverage and cannot have cost-sharing
  • New rate review transparency requirements are in place
  • Medical loss ratio standards limit insurers’ overhead
  • A standardized summary of benefits must be used by all insurers, allowing for easier comparison of plans

In addition, subsidized coverage for people with pre-existing conditions that cannot find coverage in the private market is now available in every state through January 1, 2014.

No. Health plans in effect as of March 23, 2010, are grandfathered under the law and will be considered “qualified coverage” that meets the mandate to have health insurance that begins January 2014 as long as the issuer continues to offer it without substantial changes.

The key goal of the health care reform law is to ensure that nobody can be denied coverage or be priced out of coverage due to a health problem. However, if you allow people to wait until they have a health problem to purchase insurance, then the market simply will not work. There would be few choices available to consumers, and those choices would be expensive for everyone. So, the law requires everyone to have minimum coverage, thus creating a pool of both sick and healthy individuals.

Every plan sold or renewed in the individual and small group market after January 1, 2014, must include all the benefits in a “benchmark” plan – a plan chosen for the state based on coverage currently available in the state – and will cover services in the following categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

All plans sold or renewed in 2014, must limit the out-of-pocket exposure of consumers to approximately $6,000 for individual and $12,000 for families. These limits will be indexed to average premium growth in future years. In addition, the deductible for plans in the small group market will be limited to $2,000 for individuals and $4,000 for families in 2014, also indexed to average premium growth in future years.

Also, all plans must design their cost-sharing (deductibles, copays, coinsurance) to fit into specific levels of coverage. The levels of coverage are defined as follows:

  • Bronze Level – The plan must cover 60% of expected costs for the average individual
  • Silver Level – The plan must cover 70% of expected costs for the average individual
  • Gold Level – The plan must cover 80% of expected costs for the average individual
  • Platinum Level – The plan must cover 90% of expected costs for the average individual

The exchange will group coverage by these “metal” levels, allowing consumers to easily compare comparable options.

Yes, though they may not charge older individuals a premium that is more than 300% of the premium charged a younger individual. Currently, rates can vary based on age as much as 700% in some cases. In addition, insurers may not vary rates based on health, claims, genetic information, or any other health-related factors. Insurers may only vary rates in a state by age (within limits), tobacco use, geography, and the number of family members covered.

The health reform law requires that insurers and employers that provide dependent coverage to children make that coverage available to adult children of enrollees up to their 26th birthday. This requirement became effective for “plan years” beginning September 23, 2010, so parents will be able to enroll a child in group coverage during the next open enrollment period. Children can be added to an individual policy when it is renewed.

Of course, adding an adult child to the plan will likely increase your premiums. If the child is 19 or older, the insurer may exclude coverage of pre-existing conditions for a period of time, as allowed by existing state and federal law, until the prohibition on preexisting condition exclusions takes effect in 2014.

The law and subsequent regulations prohibit insurers from denying coverage for children based on health status or excluding coverage of their pre-existing conditions if otherwise covered under the policy. This protection became effective after September 23, 2010. A child can be added to an existing policy under the enrollment rules of the policy. If you are seeking a child-only policy, you will need to inquire whether child-only coverage is available in your state. If you are covered under a group plan, you may add your child to your policy at the next open enrollment period.

Subsidized coverage is now available in every state to individuals with pre-existing conditions who have been uninsured for at least six months through the Preexisting Condition Insurance Program. This program, either run by the federal government or the state, provides coverage that immediately covers preexisting conditions at premiums that are capped at the average cost of private coverage in your state’s individual market.

Beginning January 1, 2014, insurers will be prohibited from discriminating against individuals with pre-existing conditions in offering or pricing health insurance policies. In addition, for those with qualifying incomes, subsidies will be available to reduce premiums and cost-sharing for plans purchased through the Exchange.

Low- and moderate-income individuals and families whose employers do not subsidize health insurance coverage will be eligible for subsidies that enable them to purchase coverage through the Exchange in their state. The amount of these subsidies, which will reduce premiums and out-of-pocket costs for deductibles, copayments and coinsurance, will depend upon the size of your family and your household income.

Exchanges are the central mechanisms created by the health reform bill to help individuals and small businesses purchase health insurance coverage. On October 1, 2013, an Exchange in every state will begin enrolling individuals and small businesses into qualified health plans. The Exchange, operated by the federal government or by the state, will provide information to consumers about their coverage options and what assistance is available to them. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid, and the Children’s Health Insurance Program (CHIP). The federal law does not require anyone to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. You will be able to purchase this coverage right on the Exchange’s website or through your agent if he or she is approved to sell Exchange plans. If you would rather buy other health insurance through an insurance agent or broker, you will be free to do so.

If your insurance company “rescinds,” or retroactively cancels, your health insurance coverage, it is now required to provide advance notice of its intention to do so, and may only do so if you committed fraud or made an intentional misrepresentation of an important fact. If your insurer notifies you that it wants to rescind your policy, and you have not done either of these things, request more information from the company. If you are not satisfied with their explanation, immediately contact your state Department of Insurance to file a complaint.

Yes, nothing in the legislation would infringe upon the ability of an individual to contribute to a Health Savings Account (HSA), or discourage an individual from doing so. The minimum level of coverage required to meet the individual mandate was specifically designed to allow for the purchase of a qualified high deductible health plan that would complement the HSA.

Unfortunately, the grim fact is that health care spending is likely to continue rising faster than general inflation well into the future, resulting in higher premiums. While some individuals and families with health problems may see their premiums decrease significantly under the new rating rules, for most Americans premiums will continue to increase from year to year. However, the new regulations are designed to prevent unreasonable and unexpected spikes in premiums and, over time, to slow the growth in health care spending.