Armbruster Executive & Employee Benefits offers introductory answers to frequently asked questions about insurance and the services of a broker. Select a subject heading below to view the questions and answers relating to your query. We have provided links throughout the document that will aid you further in your search.

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What is an insurance broker? An independent agent who represents the buyer, rather than the insurance company, and finds the buyer the best policy by comparison shopping.

What are the benefits of using a broker? We analyze and compare the plans so that you don’t have to. This allows you to focus on the competencies within your business. You don’t know what you don’t know. We are the experts, lean on us.

What does “pre-existing condition” mean? A condition (physical or mental) that existed before the individual's effective date of coverage under a plan.

What is a deductible? A pre-determined dollar amount that an insured must pay for covered plan services each plan or calendar year before benefits are paid.

What is a co-pay? The dollar amount that an insured person must pay for certain covered plan services.

What is the difference between an In-Network and Out-of-Network Provider? 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.

What is a network? An arrangement that provides the financing and delivery of care, wholly or in part, through a defined set of contracted providers.

What is a group employer plan? Any plan of, or contributed to by, an employer (including a self-funded plan) or employee organization to provide health care to the employer's employees, former employees or their families. Generally includes medical insurance, medical leave, health related tests and services, fitness and wellness programs. Dental and Vision plans are also included.

What is large group? An employer that employed an average of at least 51 employees on business days during the preceding calendar year.

What is small group? An employer that employed an average of at least two but not more than 50 employees on business days during the preceding calendar year and who employ at least two employees on the first day of the plan year, unless otherwise provided under state law.

What is Health Plan Year? Generally, a 12-month contract that is designated in the plan document and / or group contract. May or may not be on a calendar year basis.

What is Enrollment Period? A specific time period when an individual can enter a plan or a plan participant makes plan changes.

What is COBRA? COBRA is the Federal continuation of health coverage law. It applies to all group health plans (fully insured and self-insured) maintained by employers with 20 or more employees, excluding governmental plans and certain church plans.

What is an HSA? Established, effective January 1 2004, by the Medicare Presciption Drug Improvement and Modernization Act of 2003, an HSA is a tax-exempt trust or custodial account created for the purpose of paying qualified medical expenses.

What is a Late Entrant? A participant whose plan enrollment occurs other than during the initial plan enrollment period or open enrollment. Plan limitations and/or evidence of insurability requirements may apply.

What is a Lapse in Coverage? A period of time (days, weeks, months, or years) a person/property does not have current insurance coverage.