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- Hours: Mon. - Fri. from 10 a.m. to 6 p.m. (CST)
- Hours: Mon. – Fri. from 10 a.m. to 6 p.m. (CST)
If you’re our customer, call us to request this document. We will process it for you as soon as it becomes available in the system. Otherwise, you can create a Health Insurance Marketplace account and log into its website to download it.
You will use the information from your 1095-A to complete Form 8962 for the Premium Tax Credit Premium (PDF). This document proves the correlation between your annual income and the subsidy you received.
Usually no later than ten business days after you send the documents needed to verify the information on your application (i.e., income, citizenship, or immigration status), they will be processed, and you’ll get a notice explaining whether you need to take any further action.
Suppose you need a treatment that costs $6,000. Your plan benefits are as follows:
Deductible: $2,000
Coinsurance: 20%
Out-of-pocket maximum: $7,000
You would pay the entire deductible of $2,000. Then, you would pay your coinsurance, which is 20% of the remaining $4,000, or $800.
So, the treatment would cost you $2,800—your $2,000 deductible plus your $800 coinsurance payment.
If the sum of your deductible and your coinsurance amount were higher than your
out-of-pocket maximum, then you would only pay the out-of-pocket maximum.
Note: This is paid to the healthcare provider, not the insurance company.
This is the most you will pay for covered services in one year of your plan. After you spend this amount on deductibles, copayments, and coinsurance, your health insurance plan will pay 100% of the costs of covered benefits. For example, if your out-of-pocket maximum is $7,000 and your treatment costs $50,000, the most you will pay is $7,000. However, you must continue to pay your monthly premium, and this does not include expenses for services that your plan does not cover.
You have probably already noticed that accessing healthcare services in the United States is very expensive. Enrolling in a health plan lowers health expenses significantly. You’ll be able to visit a doctor or specialist, get laboratory tests, go to rehabilitative therapies, receive preventive medical care, buy medicine, and access hospitals and emergency services for free or at a low cost. Take advantage of the opportunity to care for your health and finances!
To be eligible, you must have an official identification that proves your legal status in the United States, your income must be within ACA’s allowable ranges, and you may not currently have another health insurance plan or be in custody.
You can apply for health insurance during the Special Enrollment Period. However, you will only be eligible if you have experienced a change in your life—such as a new job, a new immigration status, or a change in your family composition or place of residence, etc. You must apply for health insurance within 60 calendar days after the life change. Don’t get discouraged, contact Yes to Insurance to sign up!
You can apply for health insurance during the Open Enrollment Period from November 1 to December 15 of the current year in order for your insurance to be effective as of January 1 of the following year. Currently, the period has been extended until January 15 for plans that will become effective as of February 1. Either way, these dates could vary from state to state.
You can renew your existing health insurance plan for the following year. However, its costs and coverage may vary, not only due to changes in your life (place of residence, number of family members, annual income, etc.), but also because the health insurance company may make changes. If you’d like to keep your plan, check updates from your health insurance company or call us to find out about the new cost and coverage. Plan in advance so you aren’t caught off guard.
You can call our customer service line at 1-800-887-9414, and one of our advisors will complete the process for you from start to finish.You can also get a quote here and fill in your form and we will contact you as soon as possible.
We must provide this information to the Health Insurance Marketplace to confirm your eligibility. (Your identity and annual income can be verified with your social security number.) The Health Insurance Marketplace will request additional documents if this information is not provided.
Yes, as long as the coverage is specified in your Benefits Booklet and you have purchased the healthcare service or medication at a network health center, laboratory, or pharmacy. Call your health insurance company’s customer service line or log into your member account to make the claim.
No. The Yes to Insurance team will only contact you if needed to check that everything is going well with your health insurance or to remind you to send documents to the Health Insurance Marketplace if requested. If you suspect a call is not actually from a Yes to Insurance agent, you may hang up and dial our customer service number.
Call Yes to Insurance whenever you need to. Remember that we have trained healthcare agents to guide and support you and answer your questions. If you’re our customer, please inform us of changes in your place of residence, job, marital status, number of family members, income, and official identification as soon as possible. You may also report these changes to the Health Insurance Marketplace directly.
Your doctor must contact your health insurance company to request prior authorization if you need a specialized medical service. Wait up to three business days for a response, then you can follow up by calling your health insurance company’s customer service number. Once you have authorization, schedule an appointment for the healthcare service you need.
*Note: If your application was denied, please appeal it. The resolution letter will explain the steps to take. You may also discuss other alternatives with your doctor.
To find out which drugs are covered by your health insurance plan, see your Benefits Booklet, where you can also find out which pharmacies are in your plan’s network. Remember, you can save money by buying generic medications and by having your prescription refills mailed to you. If a drug is not covered by your plan, you can ask your doctor to request prior authorization. In general, specialty medications require prior authorization.
If you’re a Yes to Insurance customer, you can send us your documents via text message to the customer service number or email them to documents@yestoinsurance.com, and we will upload them to the Health Insurance Marketplace system. If you are not our customer, you can mail a copy of your documents directly to the Health Insurance Marketplace at Health Insurance Marketplace, Attn: Coverage Processing, 465 Industrial Blvd, London, KY 40750-0001.
If you’re our customer, call our customer service number to check the delivery status. Otherwise, wait up to 10 business days to receive a notice from the Health Insurance Marketplace.
You have up to 95 calendar days to send the documents required by the Health Insurance Marketplace. Failure to provide this documentation may result in the termination of your plan or removal of the subsidy.
You can see a network doctor or provider from the first day that your plan becomes effective. In order for your plan to be effective, you need to pay the monthly premium. If the plan has a monthly premium of $0, it will automatically take effect on the first day of the following month.
The monthly premium is paid directly to your health insurance company. Each health insurance company offers different payment methods: online, by phone, by mail, and in person. Also, many provide the option of scheduling automatic monthly payments or making a single payment that covers all the premiums for the total duration of your plan. If you choose monthly payments, double check your payment deadline, otherwise your health insurance plan could be interrupted unexpectedly. Your health insurance will only be effective once you have paid the monthly premium. For more information, visit the Make a Payment page.
You can immediately cancel your health insurance at any time. If you’re our customer, please call customer service and request the cancellation. You may also cancel it through the Health Insurance Marketplace.
HMO plans are usually less expensive than EPO or PPO plans. They also require the referral of a primary care physician or general practitioner to see a specialist. If you have an EPO or PPO plan, you can see a specialist without a referral, but it may involve unexpected expenses.
If you have an HMO plan, you may choose a primary care provider (PCP) upon enrollment. If you don’t, the system will assign one to you. This doctor will be responsible for coordinating all your medical services. The primary care doctor may be a family medicine specialist, a gynecologist, a pediatrician, or an internal medicine specialist. To change your GP, call your health insurance company’s customer service number.
Yes, as long as this doctor is part of the network covered by your plan; otherwise, you would have to pay the full cost of the doctor’s visit. This is why we suggest that you check with your current doctor’s office to find out which companies and plans it accepts before choosing a plan.
Yes, as long as you’re insured, your plan is already effective, and you go to a network provider. You can enjoy the benefits of your plan by providing your member number, which is in the welcome letter.
After you enroll in the health insurance plan, your membership card(s) and Benefits Booklet should be delivered to your home. If you have not received this documentation by your plan’s effective date, please find your member number in your welcome letter. With this number, you can create a member account and view the brochure online or request to receive one in the mail.
Log into your member account or call your insurance company’s customer service number. Yes to Insurance also provides the links for the websites of our associated companies in Providers and Drug Formularies.
In the event of an emergency, your plan has coverage throughout the entire country. For specific treatments or doctor’s visits, you should refer to the plan’s benefits description and evaluate the costs of out-of-network services.
Yes, but you must go to a network pharmacy and always show your membership card upon purchase.
Prior authorization is required for certain health services or supplies. To get this authorization, you must first have a medical review to determine if you are eligible. Certain healthcare services require prior authorization to ensure quality and avoid unnecessary spending on tests and self-medication. However, they may not need prior authorization if you are in an emergency room or hospitalized.
Here is a list of some of the health services that require prior authorization:
These services will not require prior authorization if you are in an emergency room or hospitalized.
Cardiologists
Pediatricians
Obstetricians and gynecologists
Dermatologists
Chiropractors
