How To Save Dollars On Your Health Insurance

Posted on May 21, 2011

Health insurance is the insurance that keeps an individual from the risk of incurring healthcare expenses. It is inevitable as you never know that when you will fell sick or have an injury. At the same time, health insurance is expensive too; not every American is able to buy health insurance. Moreover, the cost of health insurance is getting higher, day by day that it has become very hard to bear the cost of health insurance for many Americans. Even the employers, who have been providing health insurance to their employees for years, are asking them to pay more for health insurance.  However, federal government is trying to make it accessible to the common people by implementing Patient Protection and Affordable Act that has been signed into law on 23rd march, 2010.

Apart from government’s help, there are ways that you can adopt to lower the cost of health insurance or keep the cost from going up.

  • Buying health insurance from private health insurance companies is one of the most significant of them. For many individuals, purchasing health insurance from a private health insurance company is the only option for having health coverage. However, buying health insurance from a private health insurance company can be a money-saving option for even those having health insurance from their employers. An American employee pays his employer approximately $778 for individual health insurance plan, while he pays about $3514 for buying an employer-sponsored family health insurance plan. Some are paying even more. In such a scenario, shopping for a private health insurance plan would be a better option. Shopping online is the best choice for buying private health insurance. There are several websites that offer health insurance quotes provided by various private insurers at free of charge. You just need to fill up a simple questionnaire in order to get the best health insurance quotes as per your need and budget. The health insurance quotes, however, vary from state to state. Such websites are undoubtedly good source of finding information about private as well as public health insurance options along with their costs.
  • You can increase out-of-pocket expense to save on your health insurance. Most of the health insurance companies provide the customers with the option to select any health insurance policy with lower monthly premiums. If you agree to bear more out-of-pocket expenses through yearly deductible or co-payments for the medical services and also for prescription drugs, you can surely opt for it. It would be simply perfect for you, if you are a healthy person and not addicted to smoking and alcohol.
  • Change your lifestyle and food habits in order to stay fit and healthy. This is advisable for you as well as your family. Instead of consuming frozen or preserved food, start consuming plenty of fresh fruits and vegetables along with fishes, milk (if non-allergic) and fibrous food. Strictly avoid alcohol and cigarettes. If you stay healthy, you have least chance to fell sick and so the need of health insurance.

 


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Some Important Terms Related To Health Insurance

Posted on May 19, 2011

We all know about health insurance as well as different health plans. Most of us along with our family get health coverage through a health insurance plan. While we apply for a health plan, we often hear some words or terms that are not clearly known to us. However, we must have clear idea about these health insurance terms, so that the health insurance companies can’t deprive us and we get the best and the highest value for our money. These terms are generally mentioned in the member contract form or the booklet named ‘Evidence of Coverage’.

  • Medical benefits – medical benefits are the medical services for which the insurance company would pay either partially or in full.
  • Premium – a premium is the amount the policyholder or his employer has to pay to the health insurance company for buying health coverage or medical benefits from it.
  • Co-payment – this is the amount that the policyholder should pay from his pocket, prior to the health insurance company pays for any particular medical service. A co-payment should be paid every time a specific service is received.
  • Co-insurance – this is the term used to describe the shared amount between the insured person and the insurer. This amount is normally described in percentage. For example, the insured person may have to pay 20% of the total covered costs, while the insurance company will bear 80% of the total costs.
  • Capitation – this is the amount paid by the insurance company to the medical service providers every month for agreeing and providing services to all members of the insurance company.
  • Coverage – this is what the insurance company will pay or won’t pay for.
  • Coverage limit – some insurance plans only pay for medical services up to a particular dollar amount; they don’t pay anything beyond that amount. The insured person has to bear any amount that exceeds the coverage limit.

  • Out-of-pocket maximum limit – to some extent, this is similar to the coverage limit, but in this instance, the insured individual’s payment obligation ends up after he reaches the out-of-pocket maximum limit. The insurance company pays the additional covered charges.
  • Deductible - this is the amount should be paid by the person seeking for insurance coverage, before the insurance company starts paying its share. The amount or deductible is normally fixed for most of the health insurance plans and has to be paid by the insured person, every year.
  • Pre-existing condition – pre-existing condition is the medical condition that existed or was treated prior to an individual applies for a particular health insurance plan or enroll in a new plan. However, the definition varies from company to company as well as plan to plan.  Some insurance plans completely deny covering any pre-existing condition, while others implement a waiting period.
  • Exclusions – these are the services not covered by the health insurance plan. The insured person has to pay for such non-covered medical services.
  • In-network healthcare providers – in-network providers are the healthcare providers chosen by the health insurance company. The insurance company provides discounted co-payment, co-insurance along with other benefits, to the plan member to visit a healthcare provider within the network.

 

 

 

 

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Major Health Insurance Plans

Posted on May 12, 2011

Today, you can’t ignore the need of having health coverage for yourself as well as your family. You never know when you will fall sick or have a sudden injury. With ever increasing medical expenses, having health insurance has become simply inevitable for everyone. Different types of health insurance plans provided by various insurance providers are available in market to choose from. The choice, however, completely depends on a person’s individual need and budget.

Basically two types of major health insurance plans are available in US; Fee-for-service plan and Managed care plan. Some people prefer a fee-for-service plan; while others prefer a managed care plan.

  • Fee-for-service plans (FFS) – these are the most conventional type of health insurance plans. The insurance companies bear the expenses for the medical services provided to the policyholders. Such plans normally work in two ways,
  • Non-PPO Fee-for-service plans – these traditional kinds of health insurance plan either directly pay the medical providers or approve payments after the policyholder files a claim for the medical services he has enjoyed. These plans let the policyholder visit the doctor or hospital of his preference. Non-PPO FFS plans are, however, expensive.
  • Fee-for-service plan with a PPO – FFS plans with a preferred provider organization allow the policyholder to visit the medical providers who will reduce the costs, as per the plan. In such plans, the policyholders need to bear fewer out-of-pocket expenses. Besides, they are more likely not to file a claim or do paperwork. However, such plans don’t ensure PPO advantages for every medical service taken by the policyholder. Such plans also don’t ensure a local PPO.
  • Managed Care Plans – such plans are somehow more popular in US. Through a managed care plan, the insurance companies control the costs of medical expenses. Such plans limit the medical services the policyholder can enjoy. These plans have lower co-payments and lower premiums than that of a FFS plan. The amount, however, varies from companies to companies and services to services provided even by the same company. There are usually three types of managed care plans available in our country; Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point Of Service (POS) plans.
  • Health Maintenance Organization or HMO – HMOs normally pays for almost all medical expenses against a little co-payment. HMOs allow the policyholder to choose a provider from their own network of the medical providers. Otherwise, the policyholder has to change his plan.
  • Preferred Provider Organization or PPO – a PPO is basically a combination of a FFS and a HMO. Like the HMOs, PPO plans allow the policyholder to visit the medical providers within their own network. He can control his out of pocket expenses by choosing a doctor or hospital within the network. However, the policyholder can also choose a provider out of the network; and, in such a case, he has to spend a larger amount from his pocket.
  • Point Of Service or POS – to some extent, POS plans are similar to HMO plans. In such plans, the primary care medical professionals refer the patient or the policyholder to other medical providers within the network. Even if the primary care doctor refers the policyholder to a doctor out of the network, then also the plan pays for almost entire bill. However, if the policyholder chooses an out-of-the-network doctor by his own, then he has to bear co-payments.

 

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Important Facts About Temporary Health Insurance Plans

Posted on May 12, 2011

Temporary health insurance is a special type of health insurance that provides temporary or short term, but complete healthcare coverage to the policyholder, in order to keep him from paying unpredicted medical bills. Temporary health insurance plans are affordable and perfect for those people, who are temporarily without any health insurance coverage, for some reasons. This type of health insurance is also called as short term health insurance, as it provides health coverage for only a short and limited period of time.

Temporary health insurance is normally valid from 30 days to 180 days. Some insurance plans, however, provide coverage up to 12 months. It can be purchased by paying a single premium. Monthly installments are also accepted.

Short term or temporary health insurance is a good alternative to COBRA.

Temporary health insurance plans are perfect for the healthy people, who are going through a transition. Short term insurance plans are especially designed to help the individuals belong to the below mentioned categories:

  • Newly hired individuals, who are waiting for major health benefits from their employers – newly hired employees often have to wait for as long as 90 days prior to their health coverage initiates.
  • New college graduates, who no longer can enjoy the benefits of their parents’ health insurance – most of the new college graduates are between the age group of 21 to 23. A temporary health insurance plan would be a comparatively inexpensive option for them. A temporary plan provides them catastrophic health coverage, if needed.
  • Individuals, who have recently left a job or are between jobs or on strike or laid off – temporary health insurance is simply inevitable for the persons belong to this group. Such plans also act as a temporary and inexpensive substitute to COBRA.
  • Part-time employees, temporary employees and self employed – people, without a permanent job or ready to start their own business, don’t have to worry about themselves as well as their families. Temporary health insurance plans are there to provide them and their family, the health coverage for any sort of sudden medical needs. Such plans are available at a very reasonable cost.
  • Early retirees, who are waiting for a Medicare plan to start – early retired persons don’t need to put their health insurance on hold, due to Medicare’s age-related eligibility limitations. They can highly go for a short-term health insurance plan, until Medicare starts giving them coverage.
  • US Expatriates – most of the health insurance companies implement a waiting period for the US expatriates. However, no longer they have to worry about their health insurance, as short term or temporary health insurance plans are there to help them by providing coverage.

Major benefits of buying a short term medical insurance plan:

  • The cost of such plans is lower than comprehensive and conventional health plans.
  • Application process for such plans is usually shorter and easier.
  • Such plans are available for as short as one month to 12 months. However, the time range varies from state to state.
  • Belonging to a short term health insurance plan lets the policyholder become a member of Consumer Benefits of America or CBA, and a member of CBA gets a number of medical advantages.

 

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Before You Get An Individual Health Insurance Plan

Posted on April 20, 2011

An individual health insurance plan may be defined as a complete medical insurance plan that offers personal health as well as medical coverage to you, when you fell sick or are injured, and sometime to your family too. In other words, we can say that it is an individual health insurance policy bought directly by you from an insurance company. Such insurance policy does not serve as a part of a group insurance plan.

1) Getting an individual health insurance is not an easy task. When you will buy a health insurance plan as an individual, you will have to pay higher than what you pay for a group insurance plan. However, being a self-employed or an employee of an employer that does not provide the facility of group health insurance, you have no other option to get medical coverage other than buying an individual health insurance policy.

The situation becomes worse, if you are a cancer survivor and still getting treatment for your medical condition. In such a case, even if the health insurance company agrees to provide coverage to you, it will probably implement a waiting period for covering your cancer related treatment expenditures. Or, it will start providing coverage only after your treatment is over.

2) While you are planning to purchase an individual insurance plan, make sure that you are buying it from a reputed and reliable company. Also, ensure that it covers the need of your family. You can consult Department of Insurance in your respective state to get in-depth details about different health insurance companies serving in your state. Ask about some points like,

  • Whether the insurance company is licensed in the state
  • Whether there were any disciplinary actions taken against the insurance company for operating any unlawful business practice
  • Whether the claimants have had any negative experience with the health insurance company

3) Get enough information about the individual health insurance plan and choose the right one that suits your individual need and budget. While applying for an individual plan through your state, the application form will undergo an underwriting procedure including your medical history and health records. According to the underwriting report, a health insurance company will decide whether it will provide you health coverage. Sometimes, the company may provide you coverage against higher premiums, if you have medical conditions like cancer. It can also implement a waiting period for pre-existing medical conditions.

4) There are two types of individual health insurance plans available; Indemnity Health Insurance plan and Managed Care Health Insurance plan.

  • Indemnity Health Insurance Plan – Indemnity plan is also known as fee-for-service health plan. Indemnity plan lets the policyholder use any of the services provided by the plan, when required. The insurance company pays a certain percentage of the indemnity policyholder’s medical expenses. Indemnity plan allows the policyholder to select a doctor, hospital and other healthcare providers for his or her personal healthcare as per his choice.
  • Managed Care Health Insurance Plan – Managed care plan generally uses a network of certain physicians to whom the plan members can visit for healthcare services, when needed. Managed care plans normally offer lower premiums than that of the indemnity plans. However, the options of physicians, hospitals, medications and services are restricted.

 

 

 

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Health Insurance And Pre-Existing Conditions

Posted on April 15, 2011

Americans often face health insurance related challenges, because the health insurance companies regard some medical conditions of the applicants as pre-existing conditions.

A pre-existing condition may be defined as the health problem or personal illness, which existed and known prior to an applicant applies for a health insurance plan or signs a new health insurance contract. According to the University of Pittsburgh Medical Center, a pre-existing medical condition is a “medical condition, which occurred before a program of health benefits went into effect”.

Generally, the medical services that are not listed in limitations and exclusions section of a health insurance contract are covered by the health insurance companies. However, it is not mandatory. When an applicant with any pre-existing condition applies for a health insurance policy, the policy may come with some additional exclusion and that are usually listed in a separate deed attached along with the policy description that the applicant receives after he or she gets enrolled. This separate deed of exclusions is defined as a rider.

Normally, the additional exclusions mentioned in a rider will be in effect only for the pre-defined waiting period. This waiting period is implemented prior to the insurance policy starts. Pre-defined waiting period may be ranging from 3 months to 5 years; it depends on the state the applicant resides in. However, in some states, such as Arizona, Georgia, Alaska, South Carolina, Hawaii, Kansas, Alaska, District of Columbia, Missouri, Wisconsin and Tennessee, the span of waiting period can be unlimited.

However there are some exemptions regarding imposing a pre-existing condition as well as waiting period:

  • Pre-existing condition limitations are strictly prohibited for the HIPAA-qualified applicants, who are covered under a group insurance policy and with one and half years of uninterrupted coverage and unbroken for over 63 days. This is defined as ‘Credible Coverage’.
  • Some health insurance companies exclude pregnancy for the pre-existing condition for maternity coverage.

Health insurance companies deny an applicant from providing medical coverage for his or her pre-existing medical conditions, or implement a pre-defined waiting period, or charge higher rate of premium, or sometimes out-of-pocket expenditures.

Some common, but severe medical conditions like cardiac diseases, cancer, high BP, diabetes mellitus and asthma are always regarded as pre-existing conditions by the health insurance providers, as these are chronic and life-threatening conditions.

Health insurance companies sometimes deny an applicant from giving medical coverage even for some minor health conditions like a previous injury occurred due to an accident or even fever.

Health insurance companies do not bear the expenses for

  • Contact lenses or spectacles
  • Rehabilitation for any substance abuse
  • Treatment for infertility
  • Cosmetic surgery
  • Physical therapies

In a nutshell, we can say that it varies depending on the insurance provider as well as the health insurance policy provided by it.

U.S. Government is trying to help the people by eliminating pre-existing condition’s requirements through health reform. One of the benchmark decisions of Patient Protection and Affordable Care Act is the removal of pre-existing condition’s requirement implemented by different health insurance plans. The act was signed into the law in 2010. With effect from September, 2010; a child below 19 years and with any pre-existing conditions may not be refused to get medical coverage through their parent’s health insurance plan.

 

 

 

 

 

 

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Health Insurance Companies In The USA

Posted on April 11, 2011

Health care plays a very important role in U.S. society, economy and last but not the least, politics. And, when it comes to health care, we must talk about health insurance. Health insurance can be defined as the insurance for the risks of incurring medical expenditures. By accessing the approximate expenses for the risk of different medical conditions, a health insurance provider creates a scheduled finance composition like monthly or quarterly or yearly premium, or payroll taxes, to make sure that the money deposited will be available for medical expenses (mentioned in the insurance contract), in future.

U.S. federal government administers the medical benefits, provides health insurance and operates healthcare system through several healthcare programs like Medicaid, Medicare, Children’s health insurance program, TRICARE and Veterans health administration. However, it is mostly owned as well as run by private health insurance companies. Sometimes, some non-profit organizations also offer health insurance. The U.S. government spends more dollars per individual for health insurance purpose than any other country. In fact, a larger amount of government’s revenue is spend to health insurance purpose, as the healthcare cost in the U.S.A. is much more than any other nation. Unfortunately, still now, every American does not get health insurance.

The private health insurance company makes a deal or agreement with an applicant or individual or his or her sponsor (like employer, in case of group insurance); this deal or agreement is known as health insurance policy. Type of insurance as well as the cost of insurance that would be born by the insurers is mentioned in the agreement also known as the Evidence of Coverage.

There are many health insurance companies in the U.S.A that provide healthcare coverage or health insurance to the individuals. Below is a list of the most popular and sought after American health insurance companies.

  • AETNA Insurance Company
  • AFLAC
  • American Family Insurance Compnay
  • American Medical Security
  • American National Insurance Company
  • Anthem Insurance Company
  • Amerigroup
  • Assurant, Inc,
  • Asuris Northwest Health Insurance
  • Blue Cross and Blue Shield Association
  • CIGNA Health Insurance Company
  • Celtic Insurance Co.
  • Continental General Insurance Co.
  • College Health IPS
  • Copventry Health Care
  • Centene
  • Connecticare Inc.
  • Group Health Cooperative
  • Golden Rule Insurance Co.
  • Group Health Inc.
  • HUMANA Health Insurance Company
  • Health Markets
  • Harvard Pilgrim HealthCare
  • Intermountain Health Care
  • Insurance Services of America
  • Kaiser Permanente
  • LifeWise Health Plan of Oregon
  • LifeWise Health Plan of Arizona
  • LifeWise Health Plan of Washington
  • Medical Mutual
  • Medica Minnesota
  • Oxford Health Plans, Inc.
  • Oregon Health Insurance Company
  • Principal Financial Group, Incorporated
  • Shelter Insurance Co.
  • United Health Group, Inc.
  • Unicare Health Insurance Co.
  • Universal American Health Insurance Company
  • Vista Health Plans
  • Well Point
  • Walter Jarvis Insurance Service
  • WPS Health Insurance Company

AETNA INC, CIGNA Corporation, Blue Cross and Blue Shield Association, WellPoint Inc. and United Health Groups Inc. are the top American health insurance providers.

All the insurance companies mentioned above offer online and free health insurance quotes for the applicants to let them choose the most appropriate health insurance policy as per the person’s individual need and budget.

 

 

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Some Facts About Group Insurance

Posted on March 10, 2011

Group insurance can be defined as the healthcare coverage plan, which provides coverage to a group of individuals, who are generally employees of one common employer, members of same society of professionals from a common profession or group. In a nutshell, we can say that the policyholders of a group insurance get coverage under one single ‘master policy’.

  • The key feature of a group insurance policy, for which people want to get coverage under a group insurance plan, is the cost of premium that has to be born by an individual isn’t risk-based. And, since a group insurance plan covers so many contributors, the premium rate is much lower than that of an individual insurance plan. All the group members or the contributors of the group insurance plan have to pay the same premium, irrespective of risk factors. Moreover, the contributors become entitled to get more coverage for a lower price. However, the rate of premium can rise considerably without any prior notice. If some of the contributors have to undergo costly treatments, then rest of the group members have to bear the cost over time.
  • Group insurance plans usually don’t require the members to endure physical tests, prior to issuing the master policy. And that is the reason that lets many people with pre-existing medical conditions purchase group insurance plan.
  • A major problem that the health insurance applicants often face is the procedure of underwriting. Even if the applicant has the ability to afford the cost of premium, he or she is still refused by the insurance companies due to his or her medical condition. Although legally an insurance company can’t deny coverage to an applicant, even if he or she has any pre-existing medical condition. With group insurance, an applicant is entitled to get coverage, in spite of the risk factors or medical conditions associated with the applicant.
  • Another important and lucrative feature of group insurance is that every individual member of a group insurance plan can remain under a group insurance plan and get the advantages of the plan, until he or she works for the respective employer as well as pays the premiums accordingly. The contributors are eligible to enjoy the benefits of renewal of a group insurance policy. However, in case of an individual insurance plan, the insurance company has got the right to deny renewal depending on the risk factors related to a specific individual.
  • One more significant and special feature of group insurance plan is COBRA or Consolidated Omnibus Budget Reconciliation Act program. COBRA allows an employee to continue with his or her group insurance policy even after the employee leaves the job of the specified employer. The employee will be eligible to get coverage under the group insurance plan provided by previous employer for up to one and half years, after he or she leaves the job or the employer. However, the premium, whether monthly or yearly, should be born by the respective employer; as the employer will not bear it any more.

 

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