When purchasing an individual health insurance plan, understanding the terminology is more important than the cost of the insurance so you know exactly what you are receiving.
Shopping for individual health coverage can definitely be a bit overwhelming because of all the options available, all the different companies and the confusing insurance terminology they use. To help get you through this here are a few of the most common health insurance terms you will run across when shopping for your individual health insurance so you know what's being offered:
* Benefit - This is the amount payable by the insurance company to the claimant of the service.
* Carrier - The insurance company who is offering a health plan.
* Claim - The request made by the person holding the insurance or their care provider to the insurance company for payment of services rendered.
* Co-Insurance - This is the money the individual is required to pay for services received after the deductible has been met. A normal payout ratio is 80/20 with the insurance company paying 80% of the bill and the individual paying 20%.
* COBRA - This is a bit of federal legislation, which allows you to keep the insurance you had with a previous employer for a certain amount of time and a specific price.
* Deductible - This is the amount of money the insured will have to pay before the insurance company will begin coverage and cover the costs.
* Denial Of Claim - This happens when an insurance company refuses to pay for the services rendered to the insured.
* Dependents - Someone who is the spouse or child of the insured.
* Out Of Pocket Maximum - This is the amount an insured must pay before the insurance will cover 100% of all costs.
* Maximum Dollar Limit - This is the total amount an insurance company will pay for all claims in a specified time period. Once this number is reached, the insured is responsible for all related costs.
Now, there are a lot more terms you will run across when shopping for individual health insurance but these are some of the most important you will want to know about. These terms will help you understand what you are looking at and how they will affect you in the long run.
A couple of things to point out:
If You Are In Good Health
You may want to look for policies having a lower premium since you will most likely be going to the doctor only a couple of times a year.
If you are in poor health
You may want to look into plans with the lowest out of pocket expenses per year since. This way your visit expenses will be lower and you will not have to spend as much per visit.
What's The Worst That Can Happen?
Let's say you do a lot of traveling or have a play a lot of sports. This places you at some risk to accidents, which can be very costly in a hospital. You want to think worst-case possibilities when shopping for your individual health insurance so that, if the worst happens, you are prepared for it.
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Two of the giants in the health care industry are United Healthcare and Blue Cross Blue Shield. For many years, the latter was the number one health insurance provider in the country. Today, however, other companies have surpassed it, although they are still considered to be a first rate carrier of group health insurance.
No Cut-Rates Here!
In addition to group health policies, Blue Cross Blue Shield (BCBS) also offers individual based health coverage. You are not looking at HMO insurance or cut rate health insurance when you choose either United Healthcare Insurance or BCBS. Both of these carriers are considered to be tops when it comes to quality health plans.
Most of the time, the person who is enrolled in BCBS or United Healthcare does not make a choice when it comes to getting health care coverage as the insurance is provided to them by their employer. In other cases, a person who seeks out health policies can do so by looking for an agent who will sell them the insurance that they want.
Universal Acceptance with United Healthcare and BCBS
Both group health insurance plans that are being offered by United Healthcare and BCBS are top notch plans and are accepted at most health facilities across the nation as well as in some other countries. Most doctors will accept United Healthcare and BCBS, although they do have their limitations. There are some doctors who will not accept United Healthcare and Blue Cross, although they are few and far between. This is the case with all health care carriers.
Before you get health care insurance, it is always a good idea to make sure that your health care provider accepts the type of policy that you are obtaining so that you can be covered. For the most part, however, both of these prime insurance companies are accepted by most medical care providers.
Weighing the Pros and Cons between United Healthcare and BCBS
When it comes to cost, you may spend a bit less when you get BCBS. The amount that you pay for a premium depends upon the coverage that you get and how many people are in your group. BCBS is still considered to be the top insurance company for those who need to buy individual health packages and who are not covered by group insurance policies as it is reasonable and covers a great deal.
United Healthcare is also a very well known company that is accepted at most of the places where you will see Blue Cross. United Healthcare is a little bit tougher when it comes to pre-existing conditions, although the cost of premiums for those without any pre-existing conditions and who have had a physical in the past 5 years is less than the cost of premiums for those who opt for BCBS.
The choice you make when it comes to health insurance coverage between United Healthcare and BCBS depends on whether you have pre-existing conditions, how much you want to spend for a premium and what type of coverage that you want. Both these companies offer quality coverage that you can purchase on your own or as part of a business group insurance.
There is a growing number of Americans out of work these days. As this number increases the number of people who are uninsured increases also. Why? The cost of COBRA (Consolidated Omnibus Budget Reconciliation ACT) has proved to be too expensive for the majority of American workers.
COBRA is not insurance nor an insurance company. When passed by Congress in 1986, it was a stop-gap measure to ensure laid-off or retired workers could continue to get group health insurance rates under certain conditions for up to 18 months.
In the Obama stimulus legislation is reportedly a provision whereby the federal subsidy is suppose to pick up 65% of the monthly cost for certain workers up to 12 months.
With the jobless rate approaching 8% those without jobs are at a greater risk of losing their health coverage. Some study groups have stated that COBRA premiums nationally are as much as 80-85% of a workers unemployment check.
So what are your options:
1. Check with your individual states to see if they have programs that will bring relief.
2. Check the private sector for limited benefit plans.
3. Look at the possibility of obtaining high deductible plans.
4. Look into short term plans.
5. Check out becoming a member in an association that has health care plans.
If you are really sick or have a long term condition, limited benefit plans will not help you. If you are fairly healthy, these plans are a good fix. High deductible and short term plans can be helpful in the short term.
Most consumer advocates encourage people to look at all options before buying anything.
For help finding Health Insurance for unemployed or self-employed go to: http://kpatcompany.com
Obed Kirkpatrick is a Louisiana man, born and raised. He attended grade school and high school in the North Louisiana towns of Jonesboro-Hodge and then went to Monroe, Louisiana and attended, what is known today as The University of Louisiana-Monroe.
After graduating from the university he spent 4 years in the military, three in Germany and one in El Paso, Texas. Then his alma mater called him back to Monroe to be the Director of Student Activities. Feeling the need for change and the prospect for a better income, Obed began a career in insurance and real estate. Before long he was called to Alexandria, Louisiana where he eventually became the Vice-President of a Louisiana Life Insurance Company. He became actively involved in the Junior Chamber of Commerce and a local Baptist Church, where he taught Sunday School classes, sang in the choir and eventually became Chairman of the Deacons. Within a few years he started a real estate company and after only eighteen months it had grow to be the largest in volume in Central Louisiana, and remained so until he sold the company to his partner-friend.
By: Obed Kirkpatrick
Article Source: www.ezinearticles.com
Health is everything. It impacts the present, and the future. Therefore, acquiring good health insurance is important. With rising medical and healthcare costs it is the only way to insure proper medical treatment, when it is needed the most.
Since not all healthcare policies are the same, or offer the same type benefits, shop wisely. Good health insurance will include the following:
- It will cover a good portion of the medical bills.
- It will offer protection against a financially debilitating illness.
- It will provide quality care now, as in years to come.
- It will provide the insured a choice in health care providers – even "midstream."
Finding the Right Low Cost Health Insurance for You
One desired employment perk is health insurance coverage, where the employee pays all or part of the monthly insurance premium. But persons working for businesses that do not provide health insurance, and persons who are either unemployed or self-employed, need to acquire coverage on their own.
There are various online resources for finding low cost health insurance that offer adequate healthcare policies. One such resource is American Insurance Depot. It offers a link for finding various bargain insurance providers in your area, including health insurance providers. They also offer an alphabetical listing of the various health insurances available with direct links to their web sites.
3 Basic Options when Obtaining Health Insurance
You have three basic options when it comes to health insurance:
- Spouse Coverage – as a general rule, obtaining coverage through a spouse whose employer provides group health insurance is less expensive and offers better coverage than what one could obtain on their own.
- Individual Health Insurance – a good option if you have no pre-existing medical conditions. Your health and present physical condition will be a factor taken into consideration before you are accepted. Your health will also be the guideline used for rating your coverage.
- Group Health Insurance – the main advantage of this type coverage is that you cannot be turned away because of health complications. Group health insurance is also a possible option for an individual with existing health problems, as many companies now offer health plans for "groups" of one.
How to Reduce the Cost of Health Insurance
In addition to shopping around for low cost health insurance, there are ways to reduce the high costs of health insurance in general. The hardest part of minimizing insurance costs is to determine which way of lowering the premium represents the least risk for your situation.
First, you can reduce your level of coverage. If you have no ongoing physical illnesses, and an annual trip to the doctor's office is the extent of your present healthcare plan, you don't need to pay higher premiums on insurance to cover each doctor's visit and prescription.
You can also obtain a policy with a higher deductible to save on premium costs. This might be a good option if you are reasonably healthy and don't require expensive medications. Increasing your deductible from $100 to $2,000 in many cases can cut your premium payment in half.
Paying your premium annually, instead of monthly or quarterly, will avoid service fees. Some health insurance policies also offer prepayment discounts, further enhancing the amount saved.
Other Ways to Save on Health Insurance Costs
Single persons, and those who are self-employed, can join an association that offers group insurance. The chamber of commerce, various trade and professional groups and small business associations sometimes offer its members discounted health insurance.
And, once again, the wonderful world of the web offers various resources for finding a low cost health insurance plan. And because there are no broker or agent fees, premiums are often lower.
Health Insurance Options for the Self-Employed
Many self-employed persons are provided the opportunity to save on the high cost of insurance under the Health Insurance Portability and Accountability Act (HIPAA). This is done through a medical savings account (MSA).
It works like this. Health insurance premiums are reduced by replacing a low-deductible policy with a high-deductible one. The premium amount saved is applied as a tax-deductible contribution to the MSA.
These pre tax dollars can then be used to pay for medical expenses up to the limit of the deductible of the insurance policy. More information on this "double-dipped savings" for the policy holder can be found at the Institute for Health Freedom.
Short-Term Health Insurance
Short-term health insurance is a good money-saving option for healthy persons in transition. For instance, if you are: temporarily unemployed, temporarily working part-time, graduating from college, an early retiree, or waiting for other health insurance to "kick in."
As the name implies this is a low cost short-term health insurance. It provides the holder with medical coverage for a limited time. Usually, for six months. Some plans offer coverage for up to 12 months.
With an application process simpler than standard health insurances, short-term health insurance is designed to protect against unforeseen accidents and illnesses. They do not usually provide coverage for preventative care or pre-existing medical conditions.
Because of its long list of limitations and exclusions, however, it is advisable to read the coverage guidelines carefully before signing on.
Health Savings Account
Passed by the U. S. Congress and effective January 1, 2004, Health Savings Accounts (HSA) are tax-favored accounts used in conjunction with a qualifying health insurance plan. HSAs provide more affordable healthcare while saving tax dollars.
Similar to IRAs, aspects of an HSA include:
- Pre-tax money deposited into the HSA can be withdrawn at any time. with no penalty or taxes to pay for qualified medical expenses.
- HSA funds that remain in the account earn tax-free interest.
- Even though the account belongs to you, your employer can contribute money to your HSA account.
A Word about Health Maintenance Organizations
Instead of health insurance, some persons rely on health maintenance organizations (HMOs) for their healthcare needs. Although some HMOs provide good service, this type healthcare plan is best for handling standard, well-known illnesses and other common health care problems in persons under 50.
Older persons and those with more complicated illnesses, or a combination of common illnesses, will benefit more from some other type healthcare plan. Why? The answer is simple.
HMOs' advertising thrust to seniors in the mid 1990s was, "Sign your Medicare over to us…you'll get unlimited care from our doctors." They guaranteed better care, and better coverage.
Despite their promises, however, over 2.5 million senior citizens have been dropped by HMOs since 1999, even though the government increased Medicare payments to HMOs during those same years.
The short of it is this: older persons with ongoing pharmaceutical drug and healthcare needs, and persons with complicated medical conditions, are not profitable for HMO purposes. Acquiring good health insurance coverage is essential, especially for these type persons.
By taking into consideration all these options, and with careful research and by shopping around, you can obtain a good healthcare policy. One with adequate coverage to meet your health needs, as well as your budget!
Source : Internet
1. Good ratings
Good ratings are especially important if you are purchasing your policy from a new or unfamiliar company. Of course, it is always wise to check out every potential provider's health insurance ratings to ensure you are dealing with a valid and trustworthy business. Remember, before insurers agree to supply anyone with health insurance, they investigate every applicant and their background to protect themselves from fraud. You should put them to the test as well. Look for insurer and health insurance ratings through A.M. Best, Moody's, or Wiess rating agencies. (
eHealthInsurance does this for you, free, before you apply for your
free quote.)
2. The Lifetime Payout
In the event of a catastrophic illness, your policy needs to provide a sufficient amount of health care coverage. However, to protect itself from ever having to pay too much, your insurer limits the lifetime payout. Therefore, lifetime payout is the maximum amount of reimbursement the health insurance company provides during your lifetime.A $1 million lifetime payout is a good rule of thumb. Anything less and you run the risk of prematurely depleting the entire compensation for health care costs available to you, while aiming for a higher limit might make finding an inexpensive health insurance plan too difficult.
3. Largest deductible and co-payment you can afford
Setting a high deductible and high co-payment will lower your premium payments significantly. Although this will raise your out-of-pocket medical expenses, remember that the higher your deductable and co-payments are, the lower your premium will be. The question you want to ask yourself is how much can you afford to pay out-of-pocket in an unforseen medical emegency?
4. Reasonable out-of-pocket limitThis policy provision limits your out-of-pocket payments over the course of a year. It is especially important in the event of a serious illness, and we recommend that you consider only policies that carry one. However, it's wise to consider that setting a low maximum will increase the amount you pay in premiums. Try to establish a reasonable out-of-pocket maximum to balance risk with cost.
5. Waiver of premium provisionA waiver of premium provision allows you to skip premium payments during lengthy illness. Although this potential aspect of your health insurance policy is not absolutely necessary, the provision is helpful, sometimes vital, should an illness prevent you from working for an extended period of time.
6. Renewable provisionThe renewable provision is an absolute must when it comes to finding your perfect health insurance policy. This provision guarantees your health insurance plan can not be canceled because you become ill. You may or may not be required to continue paying your premiums while ill, depending on whether or not you health insurance plan includes the waiver of premium provision, but you won't lose your coverage right when you need it most.
7. Timely coverage of pre-existing conditions
Often insurers require a waiting period before covering the health care costs for pre-existing health problems. Although it is standard for them to assign a waiting period, it should never be over a year, and my be as little as three months. After picking through all the health insurance plans that satisfy your other requirements, check to see that the waiting period is not more than a year.
8. Emergency coverageAnother must for your health plan is coverage of your emergency medical services. In the past, some managed care plans were criticized because they required the primary care physician to approve emergency health care. This tactic may save money, but emergency care shouldn't be jeopardized. Read through your health insurance plan paying special attention to the definition of emergency and verify with the health insurance company what is exactly covered. If you have access to health insurance ratings, take note of this factor.
9. Few prerequisites
Prerequisites are requirements you must first fulfill before receiving medical attention. Health insurance plans with too many prerequisites are too restrictive. A policy with a few prerequisites is fine - it's how the company survives (and how you get a low cost health insurance policy), but good health care should never be sacrificed. Deciding on what is too many is a bit subjective, but if it seems to you that the policy requires you to jump through too many hoops, than you may want to look elsewhere (or simply at a slightly different policy from the same insurer).
10. Use online resources to find the best health insurance plansOur favorite rule! The internet is a great source for health insurance ratings, learning centers, and comparisons, but it's a great place to shop too. You won't feel pressured into buying a "hard sell" policy, and you can take your time and really comparison shop for the best low cost health insurance policy.We have two great partners who will help you further:eHealthInsurance lets you compare all managed and fee-for-service plan side-by-side, and even gives you the financial ratings up front. Learn more about the many
health insurance providers they represent or
get an instant online quote with comparisons now.Or, if you prefer a more personal approach, visit
NetQuote, a service that will put you in touch with several agents who compete to provide you with the lowest premiums and best service possible.
Health insurance is a kind of protection that provides payment of benefits for covered sickness or injury. Included in health insurance are various types of insurance such as accident insurance, disability income insurance, medical expense insurance, and accidental death and dismemberment insurance.
Before sign the health insurance policy make sure that you have read thoroughly the benefit’s section. Take note of any health care service that is not covered by your health insurance policy. Also, pay specific attention to how the health insurance policy is worded. Sometimes, health insurance companies hide the health insurance coverage exclusions within the definitions of words.
For instance, a health insurance company may define the term ‘emergency’ as anything that is life threatening condition that cannot be reasonably treated by a primary care physician. Whereas, your definition of ‘emergency’ may be anything that requires quick medical attention.
Clearly, there is conflict for the two definitions. If you find yourself in an emergency situation where you incur a broker arm, for instance, your insurance company may deny coverage for emergency room treatment of a broken arm for the reason that the broken arm does not fall under the life threatening category.
Therefore, you should read over carefully the health insurance policy definitions, paying close attention to the seven key words:
medical emergencymedically necessaryaccidental injuryexperimental or investigationalpre certificationpre-existing condition, andreasonable and customary
These words and any words that are open to interpretation should be regarded with wariness. Find out how your health insurance company defines each of these.
Finally, find the section describing the procedures you must follow in order for your insurance company to reimburse you. These policy conditions or prerequisites are typically worded in a positive tone. Read through each condition carefully, make notes and call your health insurance company with any questions.
You should also compare health insurance contracts before you sign one. In order to compare exclusions, take two policy contracts and find the exclusions sections. If you want to compare a number of health insurance contracts then you could use an online service.
After you obtain your free quote for the health coverage you desire, apply for it online, and you'll obtain all the information that you'll need to compare exclusions of each health insurance policy (though sometimes this will require more research.)
About the Author:
Mike Spencer recently became unemployed and moved into self employment. He was forced to find his own health insurance plan to protect his family. It wasn't as easy as he first thought. Here he shares the pitfalls of various plans and what you need to look out for when picking a good plan for you:
http://www.1st-for-health-insurance.com/articles/what-is-hea lth-insurance.html
