Individual & Family: Health, Dental & Vision in Encinitas, California

Individual & Family Quote Forms

Looking for coverage? Click any of the following links to submit a quote for quick, accurate and affordable rates.

Health insurance is complicated, but Schulte Insurance Agency can help you. Whether you’re shopping for an insurance plan for the first time or trying to stretch your health care dollars, our team can help you navigate how health insurance works, what plans cover and the benefits of individual coverage and group coverage. In the end, we’ll make sure you get the most appropriate coverage. 

Health Insurance Information

There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.

1. Fee-for-Service
   These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
    
2. Managed Care
   More than half of all Americans have some kind of managed-care plan¹. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan. Our agency offers a variety of PPO, HMO, and EPO plans to choose from.

Dental Insurance Information

There are many forms of insurance. Some, like car insurance, only provide a benefit to the few people who have a costly accident. Some, like life insurance, typically don't provide a benefit for many years. Some, like medical or health insurance, provide immediate benefits, but can be very costly. Dental insurance is rather unique. First, its low cost makes it highly affordable for individuals and families. Second, because dental insurance encourages and generally pays for regular check-ups, many people who purchase protection start to benefit immediately. Finally, the price of maintaining a healthy mouth can cost hundreds ... even thousands of dollars. Should you ever need costly care, from filings and crowns to periodontics and orthodontics, your dental insurance will be there to provide benefits when needed. So, if you buy dental insurance, you will probably use it. And, like millions of Americans who have protection, you'll probably be glad you did.

Vision Insurance Information

Vision insurance refers to a contract between a consumer and an insurance organization which provides vision care in return for a premium. In exchange for their premium payments, consumers usually receive eye examinations (given by doctors and clinics contracted with the insurance organization) and corrective eyewear. Exactly how much of the fees are covered varies according to the specifics of the plan.

Even if you have perfect vision, proper preventative eye care is an essential practice towards ensuring the health of your vision in the years to come . The most important step is receiving routine examinations from a qualified eye care professional. Individuals between the ages of 20 to 40 are recommended an exam every 5 years or so, provided no visual changes or injury has occurred. Individuals over the age of 40 should have an exam every 2 years or so.

Plan features and benefits will vary depending on the provider, but features typically discounted include:

• Eye examinations
• Surgical procedures - including Lasik procedures where available.
• Frames
• Lenses
• Contact Lenses
• Non-prescription sunglasses

Group Health Insurance: 


What Is Group Health Insurance? 
Group coverage is health insurance provided by an employer or by an association, such as a union, to its members. Typically, group health insurance plans offer the same benefits to all members of the group and their dependents. 

Since the definition of a group or employee can vary by state, call us at 760-436-5015 to find out any other insurance requirements in California. When helping clients manage a group insurance plan, Schulte Insurance Agency can provide resources and guidance along to way to employees. 

Pros of Group Health Insurance 
Group health insurance is fairly common, so most people are familiar with its structure. Enrolling in a group health insurance plan takes away most of your own guess work with networks, deductibles and premiums. Additionally, advantages of group health insurance include: 



• Choice of employer-provided health insurance plans

• Premium deduction directly from apaycheck

• Premium sharing costs due to a larger risk pool

• Tax advantages for both employees and employers




Individual Health Insurance 



What Is Individual Health Insurance? 
Individual coverage is health insurance you buy on your own. Since there are hundreds of options to pick from, Schulte Insurance Agency can help you navigate available individual plans to find which one provides the best coverage for you and your health care needs. 

Pros of Individual Health Insurance 
With health care reform, there are new advantages to buying individual health insurance plans. Now, people can feel empowered to take control of their health care decisions. Advantages of individual health insurance include: 



• Customizable plan options and coverage

• Choice of network and medical providers

• Coverage continues after job loss or change

• Coverage extends to dependents


Can I Be Denied Health Insurance if I Have a Pre-Existing Condition? 
The Affordable Care Act (ACA), made it illegal for Americans to be denied coverage or charged higher rates for pre-existing conditions. Also, if your health changes and you develop a chronic medical condition while enrolled in a heath plan, your rates cannot increase. The only exception to this is if you were enrolled in a health plan that started before 2010, when the ACA was passed.  

Contact us today for more information!