Health Insurance: Plans for Secured Healthcare

by Guest » Tue Dec 01, 2009 08:17 am

Our health is precious and we do all sorts of things to keep ourselves healthy. We know how it feels to fall sick and if it is something serious, how expensive treatment can get. So that we are able to afford the right treatment and not worry about the costs getting health insurance is a good idea.

The rising cost of treatment is a matter of worry for a lot of us. If we have health insurance, it helps us plan ahead and also save for future treatment costs. We do not have to worry about bearing the expenses out of our pockets. Your need for insurance may be different from the needs of others. Hence, there are different health insurance plans to suit different needs.

Health Insurance Plans

Health insurance plans are primarily of 2 types -
  1. Indemnity Plans (fee-for-service)
    According to this plan, the insurance holder can choose the doctor he wants to be examined by. The doctor/medical professional receives a fee-for-service. This claim is made either by the doctor or the patient himself. Indemnity health insurance has several other types.
    • Indemnity health plans: As a policy holder you may go to any doctor, hospital or any other medical provider for a fixed monthly premium. You may choose the health care provider you want and the plan will reimburse you or your doctor for the service rendered. There may be a certain portion of deductible that you need to pay or simply bear a portion of the fee. Certain expensive services or hospital care or any covered services may require you to have prior authorization for them in order to be covered. To know if indemnity plans are better than HMOs or PPOs click here.

    • Flexible spending plans: This is also known as cafeteria plan and is sponsored by the employer allowing the employees to design their own package. There are several benefits for this plan like pre-tax conversion plan, multiple option pre-tax conversion plan, flexible spending accounts, medical plan and employer credit cafeteria plans.

    • Basic health plan: This is a low cost health insurance plan that provides limited benefits. These plans do not cover certain basic treatments and it is advisable that you should go through the policy document before purchasing. Premiums for such affordable health insurance plans are community rated and are based on gender, age, occupation, geographic location or health status.

    • Health Savings Accounts (HSA): This plan is designed to help you pay for your present health treatment costs and also save for future costs on a tax-free basis. You do not have to pay a premium here. Instead this tax-free account covers your out-of-pocket medical expenditure. What types of investment you should make, which third party or insurer you should rely on is completely your own decision. Generally, HSA requires you to buy a High Deductible Health Plan too.

    • High deductible health plan (HDHP): This inexpensive health plan is active only after a high deductible of a minimum $1000 is paid for an individual or $2000 is paid for a family.

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  3. Managed Care Plan
    Managed care helps minimize unnecessary costs for healthcare. The policy holders receive extensive medical coverage while also giving financial incentives to the policy holders who opt for the medical providers listed in the policy. There are several types of managed care:
    • Health Maintenance Organization (HMO): There is an already existing network of participating physicians, hospitals as well as other health care professionals and facilities that you can choose from. The doctor you choose from the given list will then provide you with the required health treatment. If you need to go to a specialist your primary care doctor will refer. Generally there is a fee or a co-payment that you need to pay in HMP plan. Your out-of-pocket are fewer here.

    • Point-of-service (POS): In this plan the primary care doctors usually have the freedom to refer other medical providers listed in the plan. If the referral is not from amongst the listed doctors, it will still be covered but then you need to pay a certain co-insurance. If the doctor is listed in the plan, then the plan provides coverage for the same.

    • Preferred Provider Organization (PPO) : In this plan the listed doctors, hospitals and health care providers are paid by the insuring company. Often these payments are discounted and hence the costs will be lower if you choose a doctor from the network of doctors provided by the insurer. However, you may still go for a doctor outside the network but you will have to pay the difference between the medical provider's fees and what the plan pays.

    Other health insurance options

    Two of your other health insurance options may include:
    1. Self-insured health plans
      A self-insured health plan or self-funded plan is one where the employer assumes responsibility (with pre-conditions) to provide health care benefits for its employees. This plan is designed such that the employers pay for the out-of-pocket claim as and when they occur instead of depositing a fixed premium to an insurance providing company. Such a self insured plan is subject to all Federal laws and Budget Reconciliation Act.

    2. Medicare
      Medicare is a federal government program designed to insure senior citizens. You can avail the benefits provided by Medicare to secure your future.

    How insurance companies determine your coverage & rates?

    When you apply for a health insurance, your application has to undergo the insurance underwriting process. The underwriters evaluate how much of a risk you pose for the insurance company and accordingly approve or reject your application. Your rates and coverage limits are also determined if the application is approved.

    The following factors influence the health insurance rates of an individual:

    1. Age and gender of the person to be insured.
    2. Pre-existing conditions after a thorough check-up of the individual's medical history.
    3. Medical history of the family (whether or not the parents had heart disease, cancer etc.)
    4. Smoking habits of the individual.
    5. Previous records of mental health (whether the person had undergone counseling or used anti-depressants).
    6. Occupation.
    7. Choice of deductible, coverage and benefit limits, exclusions etc.
    8. Past records of health insurance applications.
    To know how the above mentioned factors have an effect on your health insurance costs, click here.

    Tips to buy affordable health insurance

    The premiums for medical insurance seem to be increasing every year. This leaves us with the question that how we can find affordable health insurance coverage that suits our pocket. It may seem very difficult but with a little research you can still look for a suitable health insurance plan. You may follow the 6 easy tips to choose a health policy which not only suits your needs, but also matches your pocket.
    1. Know your state rules: Be familiar with the rules that your state follows. This way you can make rational and mature decisions about your health insurance. Pay special attention to rules about pre-existing conditions (if any) and also about what coverage you will get.
    2. Find out your insurance needs: Knowing what type of health insurance coverage you need is important. You may need short term health insurance policy or a regular one depending on the status of your job and your family planning. Getting a cheap health insurance policy may not be the solution to all your problems. You will have to keep in mind the requirement that you have.
    3. Calculate the overall costs: Prepare a budget for yourself. Buying health insurance doesn't just mean paying premiums. There are co-payments, deductibles and also sometimes co-insurance. Keep all of these in mind when planning for your insurance.
    4. Compare your options: To be able to find an affordable health insurance you must have an idea of all what is available in the market. After you have shopped enough get hold of a broker who can help you in comparing the policies. A comparison between few different companies and their products will help you settle better with a policy.
    5. Do your insurance homework: You need to be acquainted with the jargons of the industry if you must find yourself a policy that suits you best. Do your homework; get your research done properly to be able to buy a suitable policy.
    6. Never conceal information: While doing the paper works you may have to answer a lot of questions. Don't be tempted to lie or hide facts. This will only create problems in the future for you, and raise your costs for health insurance.

    Individual Health Insurance vs. Employer Sponsored Insurance

    Most of you may have employer sponsored health insurance. But the number of people opting for individual health insurance is also increasing. This increase is due to the advantage that individual policies have over employer sponsored programs. They are:
    • Tailor-made coverage: Everyone has different health needs and individual health insurance recognizes it and provides policies to suit individual needs. Since the employer sponsored program is 'one-size-fits-all type, you may end up paying for coverage you don't need or not get a particular coverage that you may need.

    • Mobility of coverage: Unlike the employer sponsored insurance, you can still carry individual health insurance with you even if you are changing jobs.
    For more information click here.

    You must plan ahead to secure your future. With health insurance you can certainly prepare to face an undesirable situation arising from a medical condition.

    Related Readings:

    Useful letter

    Like temporary life insurance do we have any temporary health insurance options too?

    Total Comments: 105

    Posted: Wed Dec 02, 2009 10:24 pm Post Subject:

    Most health insurance policies are annual. you could look at a shorter term policy but you'd have to negotiate this with your insurer.

    Travel insurance provides short term medical insurance cover, but i don't think the cover incepts until you leave the country. how long did you want cover for, and why only a short time?

    Posted: Thu Dec 03, 2009 06:12 am Post Subject:

    It could be different in other states, but here in California, many insurers offer special policies to cover short term health insurance needs to bridge a potential gap between two employments or similar situations.

    Posted: Thu Dec 03, 2009 10:03 am Post Subject:

    Yes, I'm about to quit my current job. I'm a sales professional and I'd opted for a group health insurance plan.

    Posted: Fri Dec 04, 2009 02:47 am Post Subject:

    DeliaCC . . .

    If you are currently covered by a group plan, then you will have the right to continue the group plan at the group rate for up to 18 months under the provisions of COBRA. You'll have at least 60 days from termination to choose to continue. Currently, your employer must pay 65% of the premium, and you pay the balance. Your employer will get a payroll tax credit for the amount it pays for your COBRA continuation, so it's only an out of pocket expense for the employer for up to 3 months at a time.

    Depending on the state in which you reside, you should have the option to elect individual coverage with the same insurer as the group plan with no proof of insurability. The benefits will be different (lesser, usually) and the cost will be different (probably less, too).

    Alternatively, if you apply for new medical insurance under HIPAA within 63 days of the last day your group medical insurance was effective, you can obtain a Guaranteed Issue policy with any other HMO/PPO or other indemnity medical insurance plan. It's important that you not goof and pass the 63 day limit, otherwise you will lose your entitlement under HIPAA. Most insurers have special GI plans with lesser benefits than some of their other plans.

    And many carriers have "bridge" plans to help you with any temporary insurance needs while you're in between employers, if that's the case.

    Your present group insurer/employer is required by law to provide you with a HIPAA Certification of Group Coverage following your termination of employment. If you don't get it on your last day of employment, don't let more than a week go by without receiving it. You'll need it to obtain the GI coverage from another insurer.

    Posted: Sat Dec 05, 2009 06:12 am Post Subject:

    Good info!

    Your present group insurer/employer is required by law to provide you with a HIPAA Certification of Group Coverage following your termination of employment.

    In that case I think it's better to approach the employer. But who's gonna issue the Hipaa certificate? Is it the state dept. of insurance?

    Posted: Sat Dec 05, 2009 09:10 am Post Subject:

    Your employer is required by (federal) law to provide you with the HIPAA certification. The health insurer normally agrees to do that for the employer.

    The certificate will show your date of hire, date of eligibility for coverage, and date coverage began, and length of any preexisting condition exclusion/probationary period in the coverage.

    The latter two are most important because they serve to show how many months of continuous coverage you have had. If you have prior coverage for a period longer than the "preexisting condition exclusion/probationary period" of the new coverage (the period of time that preexisting conditions/new illnesses would not be covered -- commonly 6 months), then you must be fully covered from Day 1 -- no exclusions. If you don't have as many months as necessary, you must be credited with a month-for-month reduction in the exclusion period (Example: old group policy covered you for 5 months, new policy has a 12 month exclusion -- you would be credited with 5 of the 12 months, and only need to wait 7 more before full coverage applied to you).

    Again, don't let more than a week go by without getting that certificate after you terminate. If you've give them 2 weeks' notice of your term date, that's plenty of time for them to prepare/get the certificate for you.

    For more information on COBRA and HIPAA, go to (US Dept. of Labor). You will find all their current resources and publications on COBRA, HIPAA, and ERISA there.

    Posted: Mon Dec 07, 2009 05:31 am Post Subject:

    My friend, in case you have a pre-existing condition your coverage application may be denied of short-term health insurance. Otherwise, this coverage is pretty much like policies that cover surgeries, x-rays and other emergency services. The deductible is expected to be low and you could be free to choose your hospital and doctor.

    Posted: Mon Dec 07, 2009 07:53 pm Post Subject:

    Guaranteed issue (GI) policies under a HIPAA certificate of creditable coverage will not have preexisting condition exclusions unless something is excluded in general by the policy itself (such as maternity coverage, elective cosmetic surgery, etc.), as long as your former group coverage has been in place at least as long as the GI policy's probationary period (typically only 6 months).

    New applications for insurance not guaranteed by HIPAA are always subject to medical underwriting, and may contain preexisting condition exclusions, or applications may be declined on the basis of health status.

    That's why it's important to be sure to get the Certificate, and leverage your rights under HIPAA.

    Posted: Tue Dec 08, 2009 12:01 am Post Subject:

    One good thing about short-term coverage is that it is usually quick-issue (if approved).

    Post edited and link deactivated as per forum rules, thanks. Ohio Short Term Health Insurance plans are only 5-8 questions and are issued within 24 hours (if approved, of course). I assume most states are similar.

    Posted: Tue Dec 08, 2009 05:49 am Post Subject:

    It's very important that we don't overlook the disadvantages of carrying a temporary health policy. In order to avail certain medical services you may need prior certification. You must clarify that the deductible that you're needed to pay should occur only once ( and not for each occurrence of accident and illness).

    Some times the use of an illness coverage may be referred to as a "pre-existing condition" when its applicable for a separate temporary policy. This might cause further loss of insurance.

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