Frequently Asked Insurance Questions

Q: How do I know what plans I'm eligible for?
A: Eligibility is most easily determined through two questions. First, do you currently live in New York? Second, does untaxed income reported on Schedule C tax documents account for the majority of your income? If the answer to these questions is "yes," you are likely to be eligible for these plans.

Q: How do I know which is the best health insurance plan for me?
A: Selecting the right health insurance plan for your specific situation requires some careful consideration. We will guide you through a very simple process that will take into account your basic needs. You will need to determine which insurance carrier has your doctors participating within their network. You will also want to consider how you will be using the plan - i.e. whether or not you see doctors regularly for a chronic condition or annually for routine check ups. When you have this framework in mind, the staff at Total Capital Planning will be able to help guide you towards the selection of a plan that is right for you.

Q: What are the differences between the different plans?
A: All the plans offered have differences in price, benefits, and doctor networks. If you have any questions regarding the differences between specific plans, please call TCP at 212 879 0122 so that they can answer your specific questions.

Q: How much will this insurance cost me a month?
A: The cost of the insurance depends on the plan selected and your dependant status, but the price of the plans can range from the mid-$200s to the high $600s for a single person.

Q: What is IRBA?
A: IRBA is the Independent Retail Business Association. This is the small business association through which several of the plans are offered through.

Q: What if I don't live in the state of New York?
A: If you do not live in the state of New York, then you are not eligible for any of the plans currently offered through this area - refer to http://www.mediabistro.com/insurance/national.asp for more information on national options.

Q: If I sign up for one plan, how hard is it to switch?
A: You will be able to change carriers at any time by filling out the necessary applications for the new carrier. However, you will not be able to change plans within a carrier until the renewal period for that carrier. So for example, while a person could change their coverage from HIP to Atlantis at any time, they would not be allowed to change from their HIP plan with a specific benefit to a different plan within HIP until the open enrollment period.

Q: Are prescription drugs covered?
A: Most of the plans offered do cover prescriptions, although some have yearly maximum limits for coverage. If you have questions regarding prescription coverage, please feel free to call TCP at 212 879 0122.

Q: Are pre-existing conditions covered?
A: If an individual can demonstrate that for the last twelve months they have had prior coverage through an insurance carrier with no lapse in coverage greater than 63 days, they can not be denied coverage for pre-existing conditions. If they can not meet these criteria, pre-existing conditions will not be covered.

Q: Are children, spouses, and domestic partners covered?
A: Any spouses and children can be covered by the plans as long as the plan-holder enrolls them on the plan and pays the corresponding rate to have them covered. Not all the carriers offer benefits for domestic partners, but some do.

Q: Can I choose any doctor?
A: On one of the HMO or EPO plans offered - You can see any doctor who participates within the network of your insurance carrier for a nominal co-payment. If your doctor does not participate within your doctor network then you will not be reimbursed.
On one of the POS or PPO plans offered - You can see any doctor who participates within the network of your insurance carrier for a nominal co-payment OR if your doctor does not accept your insurance plan then you will be reimbursed subject to the Out of Network deductible and coinsurance.

Q: Do I need to get a referral from my doctor in order to see a specialist?
A: While some plans do require a referral from your primary care physician to see a specialist, several others do not require this.

Q: Who are National Administrators (NAI) ?
A: They are the company that handles the billing for the plans offered through IRBA. This is the company that does the billing and to whom all checks for the MVP, HIP and GHI plans are paid to.

Q: Will these plans cover me for doctor visits overseas?
A: None of these health insurance plans will cover an individual for routine care such as checkups outside of the US. However, all carriers will cover emergency care anywhere in the world. Any follow up care would need to be provided within the US.

Q: I've recently become a freelancer; my most recently filed taxes won't reflect Schedule C untaxed income. Am I ineligible?
A: No. Individuals who have just become freelancers would still be eligible for the plans - the requirements for a recent freelancer will vary between carriers, but in most cases will subsist of a letter from an attorney or accountant or copy of a bank statement. If you believe that you will fall into the category of a recent fulltime freelancer it is probably best to speak with someone at TCP at 212 879 0122 to discuss your eligibility.

Q: Am I under a contract to the insurance company for any length of time?
A: No. You will be able to terminate your coverage as of the 1st of any month as long as you provide written notification before the 1st of the month to the appropriate representatives.

Not sure if you qualify? Want an application mailed or faxed to you? Contact Jason Silverman or Bryan Kelly at or (212) 879-0122.