Frequently Asked Questions
General
Benefits - General
Benefits - Coverage on Demand™ Plans
Benefits - HSA Plans
Special Situations
Network Providers
Pharmacy
Payment Options
Why Us
Current Policyholders
Contact Us
GENERAL
Q: What is a deductible?
A: A deductible is a specific dollar amount that your health insurance company requires that you pay out each year before your health insurance plan begins to make payments for claims. Your monthly premium payments do not count toward your deductible. All of our health plans except for one (Tempo) have a deductible.
Q: When does my deductible start over?
A: With all our health plans, you have a full 12 months to accumulate medical costs against your plan’s deductible. Your deductible starts over on the anniversary of your policy’s effective date.
Q: What is coinsurance?
A: Coinsurance is the amount that you are obliged to pay for covered medical services after you've satisfied the deductible required by your health insurance plan. Coinsurance is typically expressed as a percentage of the allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you will be required to cover the remaining 20% as coinsurance. The coinsurance percentages vary by plan and whether a network or non-network provider is used.
Q: What are out-of-pocket costs?
A: These are healthcare expenses that you must pay for out of your own pocket, including deductibles, copayments and coinsurance. Premiums are not included in out-of-pocket costs.
Q: What is lifetime maximum?
A: This is the maximum dollar amount that a health insurance company agrees to pay on behalf of you for covered services during the course of your lifetime.
Q: What is a premium?
A: A premium is the amount you must pay a health insurance company in exchange for health insurance coverage. In the case of Coverage on Demand™ plans, your premium gives you the initial coverage level, plus guaranteed access to additional levels of coverage. Generally the premium is expressed as a monthly cost.
Q: What is the effective date?
A: This means the date your insurance coverage begins.
Q: What is a PPO (Preferred Provider Organization)?
A: A PPO is a large group of doctors and hospitals who've agreed to provide their services to our customers at a discounted rate. A PPO plan typically reduces your out-of-pocket costs, to the extent you use doctors and hospitals in the PPO network.
Q: What is the difference between an in-network versus an out-of-network provider?
A: An in-network provider is a PPO doctor or hospital contracted by the network to provide services to you for specific pre-negotiated rates. An out-of-network provider is one not contracted by the network. Typically, if you visit a physician or other PPO 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.
Q: What is a health savings account?
A: A health savings account is a tax advantaged savings account to be used in conjunction with HiFi™ 2500 and HiFi™ 5000, our qualified high-deductible HSA health insurance plans, to pay for qualifying medical expenses. Contributions may be made to the account on a tax-free basis. Funds remain in the account from year to year and may be invested at the discretion of the individual owning the account. Interest or investment returns accrue tax-free. Penalties may apply when funds are withdrawn to pay for anything other than qualifying medical expenses.
Q: What is an HSA plan?
A: An HSA plan is a qualified high-deductible health plan eligible to be used in conjunction with a health savings account. We offer two: HiFi 2500 and HiFi 5000.
Q: What sort of medical expenses can I pay for out of a health savings account without any penalties or taxes?
A: The list is large. All the expenses you would expect like doctor fees, hospital services, and prescription drugs are considered qualified medical expenses. But even things like over the counter medications, chiropractor fees, and laser eye surgery are considered to be qualified medical expenses that can be paid from your health savings account. For a complete list of qualified and non-qualified expenses, go to www.irs.gov.
Q: What are the tax advantages of health savings accounts?
A: Here are the four main advantages:
- Tax-deductible: You’re not paying tax on the money you put into the account. (within legal limits)
- Tax-free: As long as you pay qualified medical expenses with the dollars, they are never taxed.
- Tax-deferred: The interest you earn on this account will also be tax-free if you use it to pay for qualified medical expenses.
- No penalty over age 65: Withdrawals for any non-medical purpose after age 65 are taxed as ordinary income with no penalty.
Q: Is health savings account money mine to keep?
A: Unused money in your health savings account isn’t forfeited at the end of the year; it continues to grow, tax-deferred year after year. The money can be easily withdrawn at any time with no penalty or taxes to pay for qualified medical expenses. But if you decide to pay for your next vacation with your health savings account funds, you will pay a 10% penalty and you will pay taxes on the funds you withdraw. Consult a tax advisor for more information.
BENEFITS - General
Q: What medical costs are covered?
A: All of our plans cover what you might expect such as hospital room and board, physician’s fees for surgery, sickness, and follow up visits, lab tests, x-rays, etc. They also cover prescription drugs, dental and vision exams. Plus, all of our plans cover what you might not expect, such as preventive care, so that you can stay healthy. Read your policy for details.
Q: What is preventive care coverage and do you offer it?
A: With the intent to help keep you healthy, preventive care coverage pays for expenses associated with routine physical exams and related lab tests or x-rays, age appropriate screenings and immunizations. The great news is that we pay up to $400 each year for preventive care, which is not subject to any deductibles in-network, but is subject to coinsurance and plan limits.
Q: What costs are covered with hospitalization?
A: Typically, hospitalization services include services related to staying at a hospital for either scheduled procedures, accidents or medical emergencies. Hospitalization services typically do not include hospital stays for giving birth to a child. Read your policy for details.
Q: What about medical emergencies? Am I covered when I go to an ER (emergency room)?
A: Yes. All of our plans cover you for medical emergencies, subject to deductibles, coinsurance and plan limits, on a 24/7 basis anywhere in the U.S. See your policy for details on when emergency care is covered.
Q: But what if I have a bad cold over the weekend and can’t see my regular doctor right away. Can I go to an extended-hour urgent care center and be covered?
A: Yes. You can save yourself some money by noting what urgent care centers in your area are in the network. Click here for a current list of network centers. Of course, you can also go to a non-network urgent care center, but you’ll pay more.
Q: Some plans require referrals. Do you require that I get a referral to see a specialist, like a dermatologist?
A: It's true that some plans require a referral before you can see a specialist. With us, no referral is required. And you can save money by using network providers.
Q: Do you cover dental and eye exams?
A: After you pay your annual deductible, if any, we will pay up to $250 each policy year for routine dental care like cleanings, exams, and fillings, and will also pay for the cost of one eye vision exam each policy year.
Q: How are claims handled?
A: There are virtually no claim forms to fill out. Just show your current ID card to your network provider. They will process the claim through the network, and apply all applicable discounts.
Your doctor or hospital will be paid according to your plan benefits, subject to any deductibles or coinsurance. You will receive an Explanation of Benefits, showing what was paid or applied to your deductible, and your share of the cost.
Q: Can I be cancelled because I file a lot of unanticipated claims?
A: No. As long as you answer all the medical questions on the application honestly, eligible expenses will be covered. Our health plans are guaranteed renewable after the first year as long as you pay your premiums on time and have given us honest answers to the medical questions on the application.
BENEFITS - Coverage on Demand™ Plans
Q: What is Coverage on Demand?
A: Unlike traditional health insurance plans, Tempo™, Rhythm™ and Groove™ plans permit you to get additional insurance coverage, at 100% for medical costs in-network, all the way up to $5 million, even after you’ve found out you need it. No other company offers this unique and valuable benefit. Our health plans are really precedent setting!
You can purchase up to three levels of additional coverage as you need them, even after the fact. The coverage levels must be activated in order (Level 2, then Level 3, then Level 4). Your request for additional coverage must be received by us within 60-days of the end date of the applicable policy year. Coverage resets at the initial level each plan year.
Q: What is the maximum amount of claims paid under Level 1 for Coverage on Demand plans – Tempo, Rhythm and Groove?
A: Tempo – $1,000; Rhythm – $2,500; Groove – $5,000. These amounts represent the maximum amount WE PAY under Level 1 for eligible expenses after your deductible and coinsurance. The amounts listed are the maximum payout amounts by us for Level 1. Eligible charges in excess of those amounts are your responsibility unless you pay an activation fee to increase your level of benefit. Prescription drugs are paid at 60% under all three Coverage on Demand plans, and all include $400 in preventive care with no deductible, plus dental and vision care. Your Coverage on Demand plan resets to the initial coverage level on each anniversary date, which runs twelve months from the effective date of your policy.
Q: How much coverage can I get with my Coverage on Demand plan?
A: Below are the maximum paid charges for additional coverage by plan. As long as you stay “in network,” coverage under Levels 2, 3 and 4 are paid at 100%.
| Tempo | Rhythm | Groove | |
| Coverage Level 2 | $7,500 | $10,000 | $15,000 |
| Coverage Level 3 | $15,000 | $20,000 | $25,000 |
| Coverage Level 4 | $5,000,000 | $5,000,000 | $5,000,000 |
Q: What is an Activation Premium?
A: This is a non-refundable charge that you must pay in order to activate additional coverage levels under your Coverage on Demand plan. Coverage resets to the initial level each plan year.
Q: What do the Activation Premiums cost for additional coverage under Coverage on Demand plans?
A: Activation Premiums vary by your plan and age. To see what your Activation Premiums would be, go to this page.
Q: Can I activate more than one coverage level at a time with a Coverage on Demand plan?
A: Yes, but you need to activate them in order. For example, if you need Level 4 coverage, you must buy the Level 2 and Level 3 coverage levels as well.
Q: What is the accident benefit?
A: If you are injured in an accident, the Coverage on Demand plans waive the deductible for claims related to the accidental injuries within 30 days of the event. We want to cushion the financial blow of any accident or injury.
BENEFITS - HSA Plans
Q: What is an HSA plan?
A: An HSA plan is a qualified high-deductible health plan eligible to be used in conjunction with a health savings account. We offer two: HiFi 2500 and HiFi 5000.
Q: What is a health savings account?
A: A health savings account is a tax-advantaged savings account to be used in conjunction with our qualified high-deductible HSA plans to pay for qualifying medical expenses. Contributions may be made to the account on a tax-free basis. Funds remain in the account from year to year and may be invested at the discretion of the individual owning the account. Interest or investment returns accrue tax-free. Penalties may apply when funds are withdrawn to pay for anything other than qualifying medical expenses prior to age 65. You may want to consult a tax advisor to determine if HSA plans are right for you.
Q: What sort of medical expenses can I pay for out of a health savings account without any penalties or taxes?
A: The list is large. All the expenses you would expect, like doctor fees, hospital services, and prescription drugs are considered qualified medical expenses. But even things like over-the-counter medications, chiropractor fees, and laser eye surgery are considered to be qualified medical expenses that can be paid from your health savings account. For a complete list of qualified and non-qualified expenses, go to www.irs.gov. Bear in mind that all health savings account withdrawals for a non-qualified medical expense will be subject to a 10% penalty if done prior to age 65 and you will be subject to taxes as well. Consult a tax advisor for details.
Q: Is health savings account money mine to keep?
A: Unused money in your health savings account isn’t forfeited at the end of the year; it continues to grow, tax-deferred, year after year. The money can be easily withdrawn at any time with no penalty or taxes to pay for qualified medical expenses. But if you are not yet 65 and decide to pay for your next vacation with your health savings account funds, you will pay a 10% penalty as well as taxes on the funds you withdraw. Consult a tax advisor for details.
Q: Do you provide health savings account fund administration with your HSA plans - HiFi 2500 and HiFi 5000?
A: We have partnered with American Chartered Bank for health savings account fund administration. This bank specializes in administering health savings accounts. Whether you open a health savings account at American Chartered Bank or not is entirely up to you. For more information about American Chartered Bank, go to www.americanchartered.com.
Q: Are there any fees associated in setting up my health savings account with American Chartered Bank?
A: No. There are no set up fees or monthly fees. They will also give you a free Visa check card to pay your medical bills along with free online banking and bill payment. You can set up your health savings account easily by filling out an American Chartered Bank application.
Q: What interest rates can I earn on my health savings account funds?
A: Competitive interest rates are offered by American Chartered Bank. Interest rates are subject to change. Go to www.americanchartered.com for the latest rate information.
SPECIAL SITUATIONS
Q: I live outside of Texas and would like to apply. Can I do so?
A: Right now, our plans are available only to Texas residents, which also includes full-time students at Texas schools and colleges who consider Texas to be their primary residence.
Q: I live in Texas now, but will be moving out of state in the near future. Is my policy still good after I move out of Texas?
A: Yes, your policy is still good if you leave Texas.
Q: Do I have to be a U.S. citizen to apply?
A: No, but you must have your primary residence in Texas.
Q: Do you have any special health plans for students?
A: Our individual health insurance is designed for young, healthy adults. Although we don’t have a plan specially designated for students, you’ll find our plans are very competitive on premium rates.
Q: I’m a college student whose home residence is in Texas, but I attend school in another state. Is my policy good where I attend school?
A: Yes.
Q: I’m an out-of-state college student attending school in Texas and would like to apply. Can I do so?
A: Yes, as long as you consider Texas to be your primary residence.
Q: What if I'm traveling and need care?
A: It's important to know whether a health insurance plan provides coverage when traveling to another state. With our plans, you are covered anywhere you travel in the U.S. To help you save money by staying “in-network,” there is a toll-free phone number to call (on your ID card) to help you find a doctor or hospital in the network when traveling outside of Texas. Alternately, you can look here. There are nearly 450,000 network providers nationally, along with 4,000 medical care facilities. When traveling outside the U.S., you will not have coverage under your plan except for medical emergencies.
Q: What happens if I have a baby?
A: None of our plans covers maternity costs, except for certain medical complications of pregnancy. But here’s a suggestion. If you call the hospital in advance, you can usually get an idea of the cost for a normal delivery, and you might even negotiate a better rate.
Q: I'm married and want to add my spouse to my health insurance plan. Can I do so?
A: We only offer coverage to individuals, not families, in order to keep our premium rates affordable. Your spouse must apply and buy a separate policy by completing a separate application. The same holds true for any dependent children you would like to cover.
Q: What is a pre-existing condition, and will I be insured if I have one?
A:A pre-existing condition, under our policies, is an illness or injury for which you received medical advice, diagnosis, treatment or services from a physician within one year prior to your policy’s effective date; or that produced signs or symptoms one year prior to your policy’s effective date. Claims related to pre-existing conditions are denied for up to two years after your policy effective date.
When you fill out our application, please indicate, when prompted, what pre-existing conditions you have. It is important for you to be completely honest with us in disclosing all your pre-existing conditions. If we discover later that you omitted a pre-existing condition, we could cancel your policy, probably right when you need it the most.
Once you have completed your application, we will evaluate the pre-existing condition(s) you disclosed. Since our plans are designed for young and healthy people, we may not offer you a plan because of pre-existing conditions. Everyone who applies is evaluated on an individual basis.
If you do have a pre-existing condition, we may choose to offer you plans that exclude coverage for that particular condition. This is because our products are designed to cover the risk of future medical conditions and accidents.
Q: What conditions and services are explicitly excluded by our plans?
A: Your policy will list them all under the General Exclusions section. Some of the common exclusions are medical expenses due to suicide, committing a felony, or while a member of the military. Other common exclusions include hearing aids, vitamins, supplements, maternity costs, treatment of acne, treatments for a mental illness or emotional conditions, and treatments for sleep disorders. Consult your policy for details.
Q: I recently left a job where I was covered by a group health plan, and I have a Certificate of Creditable Coverage from that plan. Will you cover my pre-existing conditions and waive the two year exclusion period?
A: Yes, if all of the following are true:
- You were continuously covered by a Group Health Plan with at least 18 months of Creditable Coverage.
- The effective date of your new plan is not more than 63 days from when your Group Health Plan expired, excluding any waiting periods.
There may be other circumstances which qualify you for a waiver or reduction in the preexisting condition period. Consult your policy for details.
NETWORK PROVIDERS
Q: How do I find a doctor in the network?
A: To find a participating doctor or hospital, go to www.phcs.com. The network of participating doctors and hospitals used with our plans is one of the largest networks of healthcare providers in Texas. If you prefer to make a phone call to find a network doctor, simply call the network at (866) 680-7427.
Q: Can I see a doctor who’s not in the network?
A: Yes. But you’ll probably wind up paying more, because all of our plans have higher coinsurance for services provided by non-network providers.
Q: How do I find a dentist or an eye exam professional who accepts my health insurance plan?
A: Our network of participating doctors and hospitals does not include dentists or eye exam professionals. Simply pay your dentist and/or eye exam professional and submit the paper claim to us at the address on the back of your ID card. We will reimburse you for all eligible charges.
PHARMACY
Q: What is a prescription drug?
A: It is a drug that may be obtained only with a doctor's prescription and which has been approved by the Food and Drug Administration.
Q: Are all prescriptions covered?
A: Most prescriptions are covered, but there are some that are not. Consult your policy for details.
Q: If my doctor prescribes a brand-name drug for me, will it be covered?
A: Yes, most qualified brand-name drugs will be covered. However, if a comparable generic drug is available, it will save you money. Always ask your doctor if generic options are available.
Q: Are oral contraceptives covered?
A: Yes.
Q: How much do you pay for prescriptions?
A: Our Coverage on Demand plans - Tempo, Rhythm, and Groove – all pay 60% of the cost of both brand name and generic drugs at all participating pharmacies, with no deductible. HiFi 2500 and HiFi 5000 pay 80% and 100%, respectively, of the cost after you’ve satisfied your deductible.
Q: What is a participating pharmacy and why should I go to one?
A: To pay the lowest possible costs for your prescription you should have it filled at a participating pharmacy. We have partnered with Caremark to offer you a large network of participating pharmacies. At a participating pharmacy, simply present your ID card when filling a prescription, and pay your deductible and coinsurance amount, if applicable, we will pay the rest. For a partial list of Caremark's participating pharmacies, go to our Caremark pharmacies list.
If you fill your prescription at a non-participating pharmacy, not only will your costs be higher, but you will also need to pay for the prescription in full and then submit a claim to us for reimbursement of our share of the cost.
Q: Do you have a mail order service, and can I have a prescription for more than a month’s supply filled?
A: Yes, we do have a mail service program. If you take a prescription regularly, your doctor can write a prescription for up to a 90-day supply. Read your policy for details.
PAYMENT OPTIONS
Q: How can I pay for my health insurance policy?
A: We have several convenient automatic payment options so that you don’t have to worry about missing a payment and run the risk of losing your insurance. Payments can be made monthly, quarterly, or annually. Payment options include:
- Automatic Payment - we can automatically deduct from your checking or savings account each month, quarter or anniversary date.
- Credit Card - we can charge your MasterCard, Visa, or American Express automatically each month, quarter, or anniversary date.
There are no extra fees or charges with any of our payment options.
Q: How long is my premium rate guaranteed?
A: Your premium rate is guaranteed for the first year of your policy, which runs twelve months from the effective date of your policy, not January to December.
WHY US
Q: Why should I choose Precedent/REMIX?
A: We have a unique and innovative line of products specifically designed for young and healthy individuals who are seeking affordable, flexible and broad health insurance coverage.
To make our health insurance plans affordable, we don’t believe you should buy any more coverage than you think you might need. But if something unexpected happens, we think you should lock in access to additional coverage. To that end, our Coverage on Demand plans -Tempo, Rhythm and Groove - have coverage levels built in for medical costs that a young, healthy person would typically need in the course of a year, without a high deductible. This keeps your monthly premiums affordable. For a healthy 25-year-old male in Dallas, TX, the premium is under $100 a month*.
But if you need more coverage than your initial level, our Coverage on Demand plans give you guaranteed access to additional levels of coverage - no questions asked - even after you need it. That’s right, even after you incur large medical expenses you never imagined you would face. All the way up to $5,000,000 on a lifetime basis.
Coverage on Demand is what truly sets us apart - the option to buy more insurance coverage after you get sick or injured, all the way up to $5,000,000. With these plans, you get the best of all worlds when it comes to health insurance: low monthly premiums with little or no deductible. No other health insurance plan offers this today. Of course, you’ll have to pay a lump sum Activation Premium to access additional levels of coverage. But if you’re faced with high medical bills, the Activation Premiums will look pretty attractive.
We also offer two HSA plans, HiFi 2500 and HiFi 5000, at very affordable rates with coverage up to $5,000,000. These plans allow you to build up a savings account to pay for future medical expenses, tax-free. You can get a tax deduction and the money grows inside the account tax-free. And the money in your health savings account is yours.
* Rates are illustrative only. Do not send money in response to this advertisement. You cannot obtain coverage until you complete an application. Benefit exclusions and limitations may apply. Preferred rate of under $100 per month is for a health 25-year-old male living in Dallas, TX for Tempo, Rhythm and Groove plans.
Q: What are the monthly premiums?
A: The rates for our plans vary by age, gender, health and lifestyle profile. To give you an idea of how affordable we are, a healthy 25-year-old male in Dallas, TX would pay less than $100 a month* with any of our Coverage on Demand plans, Tempo, Rhythm, or Groove.
* Rates are illustrative only. Do not send money in response to this advertisement. You cannot obtain coverage until you complete an application. Benefit exclusions and limitations may apply. Preferred rate of under $100 per month is for a health 25 year-old male living in Dallas, TX for Tempo, Rhythm and Groove plans.
CURRENT POLICYHOLDERS
Q: Where can I view my plan benefits, payment history and status of my claims?
A: You can use your myPrecedent personal page to:
- Review your health plan's benefits.
- Print a temporary ID card or order a replacement card.
- Find a network doctor or hospital.
- Find a dentist.
- Locate a participating pharmacy.
- Change your billing arrangements or contact information.
- Link to open or access your health savings account.
Q: How do I access my myPrecedent personal page?
A: Within about two days of your purchase completion, we’ll send you an e-mail with a link that takes you to your secure personal myPrecedent page.
Q: Who do I call if I have a question about a claim or need a replacement ID card?
A: You can reach our Customer Service Department at (800) 991-2642 extension 6300, Monday-Friday from 8 a.m. to 5 p.m. ET. Your can also visit your myPrecedent site, where there's a link to request a replacement ID card.
Q: What happens if there is a problem with my bank account or my credit card?
A: If we cannot process your payment, we will send you a notice via U.S. postal mail. We will try withdrawing from your bank account or charging your credit card again 15 days after the first attempt. If we are still unable to process your payment, we will send you a second notice via U.S. mail.
You can update your bank account or credit card information by simply logging onto your myPrecedent personal page. Here you can change your bank account information, switch to a different credit card, or update your credit card’s expiration date.
HOW TO CONTACT US
Questions about any of our plans? Give us a call at (800) 991-2642 extension 6300 Monday-Friday from 8 a.m. to 5 p.m. EST.
If you’re a current policyholder and wish to speak to a Customer Service Team member, call (800) 991-2642 extension 6300, Monday-Friday from 8 a.m. to 5 p.m. ET.
