Frequently Asked Questions

The Amherst Chamber of Commerce has created some Frequently Asked Questions to answer questions that may arise when thinking about health care coverage.  If you have any questions or want more information on Chamber health insurance, please feel free to call 716.632.6905, or email healthinsurance@amherst.org.

What is a Health Savings Account?

A Health Savings Account (HSA) is a type of personal savings account that helps people with qualified high-deductible health plans (HDHPs) save money for out-of-pocket medical expenses like doctor visits, dental and vision care, and prescriptions.  Individuals in an HSA-qualified health plan can open an HSA on their own or through an employer.

My wife and I do not have any children. Can we both enroll in a single policy and save money? Is there a 2 tier rate available?

There is a tier 4 rating.  Not only can couples obtain a cheaper rate, but so can single parents.

What does “2.5 copays per 90 day supply of prescription drugs” mean?

Mail Order is an option you can use to save money on prescription drugs.  When you buy a 90 day  supply of a maintenance medication, you are presented with a cost savings opportunity.  Instead of paying 3 full copays for the 90 day supply, you save half a copay on the purchase.

What is the difference between in-network and out-of-network benefits?

Health insurance plans have a network of providers with whom they negotiate prices for certain services.  If the doctor, hospital, or health care facility you visit is in your health insurance plan’s network, you’ll get your health care at lower prices.  (These providers may be called “in-network,” “preferred” or “participating.”)

If you go out of your plan’s network for services, it can become a lot more expensive.  Note that services received in WNY can be considered out-of-network if the provider does not participate with your insurance plan.

I am an independent contractor and cannot access employer group insurance. Can the Amherst Chamber help me?

Absolutely.  As an independent contractor you are considered a sole proprietor eligible for individual plan coverage.  Please contact one of the Amherst Chamber of Commerce brokers to discuss the many individual plan options available to you.

Do I need to wait until my renewal to change my plan?

For Chamber businesses utilizing the Individual Market medical plans (Sole Proprietors/Independent Contractors and Small Group business owners without other eligible employees participating) contracts are firm for the calendar year.  For Small Group businesses with two or more eligible employees participating, coverage options through another carrier can be reviewed at any time and your group can be moved if the rates and benefits fit your needs.

Should I wait until I receive my renewal to begin preparing for the next plan year?

No. Small Group businesses with employees can start looking at plans any time throughout the year and do not need to wait for their renewal period to make a decision.  We advise you not to rush your decision, and take time to weigh any changes to your benefits that might affect the premiums.

What is the difference between a health insurance premium and a deductible?

A premium is the monthly (or quarterly) cost to maintain your health coverage.
A deductible is the amount you pay for health care services before your health insurance begins to pay.

How do deductibles, copays and coinsurance work?

All are types of cost-sharing charges you may have for a covered item or service in your health insurance plan.

  • deductible is the amount you pay out-of-pocket before your health insurance provider starts to pay any expenses. Example: If a plan has a $1,000 deductible, you will generally pay the full cost for medical services until you have spent $1,000. 

Once your deductible is met, you share costs with your health plan by paying a copay or coinsurance.

  • A copay is a fixed dollar cost-share that you pay for a covered service, usually at the time service is rendered. Example: A health plan may require you to pay $10 for a prescription drug; the plan pays the rest of the drug cost. 
  • Coinsurance is a fixed percentage cost-share for a covered service. Example: A health plan may require you to pay 30% of the cost of lab tests; the plan pays the remaining 70% of the charge. 
Is there a limit on the total amount of cost-sharing charges I have to pay?

Yes.  There is a maximum out-of-pocket limit that applies to most health insurance plans.  This is the maximum amount that you have to pay for all cost-sharing charges (deductible + copayments + coinsurance) for yourself and/or your dependents.  Once this limit is reached, all covered health services are paid in full by the health plan for the rest of the year.

Should I choose a plan with a lower deductible or a lower monthly premium?

It depends on how you use your health insurance.

High deductible bronze level plans are for people who do not expect to need much health care and want to pay as low a premium as possible.

If you use your health care often, you may come out ahead if you pay a little more in premium each  month to get a plan with a lower deductible. With a lower deductible, your insurance starts sharing costs sooner and you may pay less out-of-pocket.  In this case, you may want to consider a silver, gold or platinum level plan.

Are all covered benefits subject to a deductible?

No. In most health plans, certain preventative care services are free if delivered by providers in your plan’s network.

Additionally, some health plans exempt other items or services from the deductible.  Example: A health plan may immediately cover prescription drugs at a copay even if the enrollee has not yet met the plan deductible.

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