23 Questions to Ask Your Insurance Agent or Broker

When seeking guidance from an insurance agent or broker, it's crucial to ask the right questions and understand the context to ensure you make informed decisions about your insurance coverage. Here are some important questions you should consider asking your insurance broker:

1. What Kind of Agent are You, and What Company or Companies Do You Represent?

 Some agents are “captive”, meaning they are only licensed to sell products from a single company. Other agents are independent, which means they can represent a variety of companies. An independent agent usually has more flexibility in helping you find coverage to suit your needs.

2. What is This Plan’s Deductible and Does This Amount Apply to Each Individual on the Policy or My Family as a Whole? 

Most plans have a per person/per year deductible, which means each person in your family has his and her own deductible that has to be met before coverage kicks in. Some plans offer a “worst case scenario” deductible, which applies if your family is in a serious accident together or everyone gets sick at the same time. In these cases, the deductible only applies to one or two people before coverage takes over for the entire family.

3. What is This Plan’s Patient Responsibility and Stop Loss? 

Patient responsibility, or coinsurance, is the percentage of the cost of services that the policyholder is responsible for paying. A stop-loss number sets the maximum dollar amount that an insured’s coinsurance percentage can be applied to. It basically works to set a limit on a patient’s out-of-pocket expenses for a calendar year. Once this stop-loss number has been reached, the insurance company will pay 100 percent of the cost of services for the remainder of that year.

4. What is This Plan’s Yearly Maximum Out-of-Pocket Expense? 

This will include things like co-payments, deductibles, coinsurance percentages, and other fees.

5. What is the Lifetime Maximum Benefit, and Does This Plan Have a Per-Illness Maximum?

 Most plans have either a $2 or $5 million lifetime maximum, which is the ultimate amount the insurance company will pay if you or someone in your family becomes seriously ill. Per-illness caps are restrictions placed on how much an insurance company will pay for individual illnesses or serious injuries. Some plans require patients to stay within these limits in order to qualify for the lifetime maximum benefit.

6. Is This a Scheduled Health Insurance Plan?

 Some health insurances stipulate a scheduled structure—fixed costs for procedures—even if those procedures cost more than the policy allows. Patients are responsible for paying any remaining balance out of pocket.

7. Are Yearly Doctor Visits Limited? 

Most quality plans let you visit your doctor as many times as you want, but some plans restrict how often you can see a physician in a single year.

8. Does the Plan Offer Prescription Drug Coverage and Are There Any Other Fees Associated With the Plan? 

Hidden fees can add up quickly and may become seriously burdensome if you or one of your dependents requires long term care, regular prescription drugs, a lengthy hospital stay, or emergency room care.

9. What Types of Coverage Do I Need?

Begin by discussing your specific needs and circumstances to determine the types of insurance coverage required, such as auto, home, health, or life insurance.

10. What Are the Policy Options Available?

Inquire about the different policy options within each insurance category. Understanding the choices helps you tailor coverage to your needs and budget.

11. What Is the Coverage Limit and Deductible?

Know the maximum amount the insurance will pay (coverage limit) and how much you'll need to pay out of pocket before the insurance kicks in (deductible).

12. What Are the Premium Costs?

Understand the premium costs associated with the policies you're considering. Ask about payment frequency options, such as monthly, quarterly, or annually.

13. Are There Any Discounts or Bundling Options?

Inquire about potential discounts for bundling multiple insurance policies with the same provider or other discounts you may be eligible for.

14. What Is the Claims Process?

Familiarize yourself with the steps involved in filing a claim and how long it typically takes for a claim to be processed.

15. Is the Coverage Comprehensive?

Ensure you understand the scope of coverage. Ask about any exclusions or limitations that may apply to your policy.

16. What Are the Policy Terms and Conditions?

Read and discuss the policy terms and conditions, including cancellation policies and any penalties for early termination.

17. How Does the Insurance Broker Get Compensated?

Be transparent about how the broker earns their commission, whether it's through a fee or a percentage of your premium.

18. Can I Make Policy Changes Easily?

Ask about the flexibility of making changes to your policy and how to contact both carrier and broker if your circumstances change. You can contact us at (800) 596-1715 (TTY 711).

19. What Is the Company's Reputation and Financial Stability?

Inquire about the insurance company's reputation, customer service track record, and financial stability. You want a provider that can fulfill its obligations.

20. How Are Customer Reviews and Ratings?

Look for customer reviews and ratings of both the insurance broker and the insurance companies they represent to gauge customer satisfaction.

21. Do I Need Any Additional Riders or Endorsements?

Discuss whether additional riders or endorsements are necessary to customize your policy further.

22. What Happens if I Miss a Payment?

Understand the consequences of missing premium payments and any grace periods provided.

23. How Does the Insurance Handle Renewals and Rate Increases?

Ask about the renewal process and how rate increases are determined to avoid unexpected surprises.

By asking these questions and having open communication with your insurance broker, you can make more informed choices when selecting insurance coverage that best suits your needs and budget.