In these tough economic times, lots of workers who have been laid off have opted to start their own businesses rather than seek new corporate jobs. More »
Best Health Insurance.
To make sure you get the best health insurance rates work with an insurance broker. A broker will work to find the best possible insurance plan for you and to get you a rate that’s within your price range. Because brokers work with a network of insurance companies, they can often find deals that aren’t available to the general public.
Best Health Insurance Plan.
When searching for the best health insurance plan for your specific needs, consider using the services of an independent insurance broker. A good broker will understand the fine points of a wide range of insurance policies and can help with the legwork needed to shop around for the best rates. In addition, a good broker is likely to know of a much broader swath of plans and providers then you will find on your own. Just make sure any broker you consider is credentialed with the National Association of Insurance Commissioners (NAIC).
Hire an insurance broker to find you the best health insurance, should you not have the time and inclination to do it yourself. Researching the best health plans can be a time consuming and complicated matter. With so many choices, you will probably find an insurance broker to be a godsend.
Understand your state’s laws and regulations when looking for health insurance. Some states offer protection for people with pre-existing conditions, while others don’t. By knowing the rules, you will be sure to get the best health insurance possible.
To make sure you have the best health insurance, don’t let your policy lapse while you’re looking for new coverage. If you lose your insurance for some reason, you may be eligible for COBRA. This is a government program designed to let you continue with your insurance until you can find a new policy.
Read several unbiased articles online about how to find the best health insurance at the greatest rates. You will be able to find a wealth of great information and this will help ensure that you are not paying more than you should be for the protection that you need for your health.
A great health insurance tip is to simply shop around for the best health insurance coverage suitable for you. Some insurance policies will charge you extra because of your lifestyle. Shop around to see what works best for you.
Best Health Insurance Companies.
Check your health insurance policies for loopholes. Even the very best health insurance companies and policies can have major loopholes. These loopholes can prevent your claim from being paid in certain cases. It is wise to get to know your policy very well to avoid a potential case of personal financial ruin.
It might sound a bit out of the box, but some people go to an insurance broker to find the best health insurance provider. Many brokers have a very large network at their fingertips, and they will try their best to get you the best deals and find you someone that fits all or most of your specifications.
If you find the world of health insurance overwhelming, hire the services of an insurance broker. A good broker finds the optimum policy for you at a price level you can live with. In addition, insurance brokers are knowledgeable with regard to your state’s regulations. Before selecting an insurance broker, compare their fees.
As mentioned above, best health insurance doesn’t only protect your health, it protects your wallet, too. Best health insurance gives you the freedom to take care of yourself when you need to. With the advice from this article, you should be more informed about best health insurance and ready to make decisions regarding your status.
While there are different types of insurance in all areas of the world, most often independent contractors and others need health insurance self employed. As such, one may want to review a variety of companies offering such services online. For, while there are many companies who offer such insurance, not all are as good as providing response to various claims which one may file over time.
As such, one may want to consider performing an online review of a number of companies offering such insurance. For, while getting a tax deduction is one thing, assuring that one is covered in the event of accident or illness is the most important factor when it comes obtaining and paying for such insurance. Of course, to obtain the best rates in such insurance, one may also want to do a comparison through one of the many cost comparison websites relating to such insurance now on the web.
Although, while it may be easy to calculate the premiums one has to pay for such insurance, calculating the deductions one can get on taxes by making such payments is a different story. For, often such calculations can be so complicated that one need hire a tax professional to assist in doing so. Still, by using such an adviser, one can often prevent mistakes which can in turn be more costly than the deductions if one has to pay fines or penalties in relation to such a mistake.
Of course, depending on profit and loss statements and other issues, one may or may not be eligible for such deductions. As such, it becomes even more important that if one owns any form of business, especially one which relates to a Schedule C, that one obtain professional guidance in filing such claims. Otherwise, one may find oneself paying far more in fines and penalties than one would have ever had to pay in taxes.
For, unless one or other family members have been covered on a separate policy during any time of the year, most often one is going to qualify for such a deduction. However, one may still want to consider hiring a professional when it comes to filing as a self-employed individual for there are many other areas related to such filings with which a professional can also be of assistance. Of course, the most important role such a person can play is assuring that all information on such forms is accurate and correct before filing such records with local, federal or state tax boards.
In addition, when one is self employed, had a profit for the year and files a Schedule SE, most likely one is going to be eligible for such deductions. However, to get a better sense of exactly how much one is eligible to deduct overall, one must either calculate such information oneself, use an online tax program or seek professional assistance. Of course, where possible, the latter is always the more preferable to assure that all information being filed is accurate and correct.
As such, while self employment insurance can be quite expensive, often one can recoup some of the expense through a deduction on annual taxes. However, for those who have lost money through a Schedule C business, often such individuals are not eligible for such deductions in addition to losses filed. Although, for those who do qualify for such deductions, the high cost of such insurance can often offset filings to the point in which one can see a return.
To this end, while being self employed allows one a great deal of freedom, one can often find it difficult to find affordable health insurance self employed. However, with the tax deduction available for self-employment insurance premiums, one can now at least see some relief in relation to the cost of such insurance. Of course, to be sure one is calculating such deductions correctly, one may want to obtain the services of an accountant or other tax professional when filing such claims.
Health Insurance Rates.
Compare many health insurance rates. If you take the time to compare health insurance rates between companies, you may find one healthcare provider will cost far less than another. Make sure you carefully examine their prices to make sure the one that costs less actually does, and isn’t just charging higher deductibles.
Group Health Insurance Rates.
If you are the sole proprietor and only employee of your business, you may be able to negotiate group health insurance rates in some states. In this case, you would be considered a “business-of-one”. If you are self-employed, in need of health insurance and just cannot afford private insurance rates, be sure to ask your insurance agent if your state offers this option.
To make sure you get the best health insurance rates work with an insurance broker. A broker will work to find the best possible insurance plan for you and to get you a rate that’s within your price range. Because brokers work with a network of insurance companies, they can often find deals that aren’t available to the general public.
To get good health insurance rates when you don’t get insurance through an employer, affiliate yourself with a group. Group rates are the reason the health insurance rates employers offer are often so much lower. If you’re self-employed, try the Freelancers Union. Seek out any options that might be available to make sure you get affordable insurance.
Health Insurance Rates : The Cheap Health Insurance.
You need to belong to some kind of group or association to have access to cheap health insurance. Perhaps you can join a union related to your occupation, or an alumni association. Ask a representative from the group of association you are considering joining about the benefits. Make sure the health insurance they are affiliated with meets your needs.
Health Insurance Rates : The Expensive Health Insurance.
Health insurance is an important thing for every person to have. Hospital bills can be absurdly expensive for some treatments and can absolutely ravage a person’s finances, especially in the case of serious diseases such as cancer. Similarly, hospitalizing a person who has been in a serious car crash can be extremely expensive. Health insurance cuts down the cost of treatment significantly.
Before buying a health insurance policy you should shop around and visit state websites to see if you qualify to any special insurance programs based on your income. Many times these state websites will list companies that offer low cost health insurance programs rather than more expensive health insurance plans.
Now you know! Hopefully, you read some ideas that will help you with health insurance decisions. Understandably, with the cost of insurance in general rising, you need to have the proper coverage at the right price. Use the health insurance rates tips that apply to your own circumstances.
A lot of people say, “I don’t like sales,” “I don’t want to talk to somebody into something.” Well, if you are trying to sell someone something they don’t want or need, you are a con man not a professional salesman. Professional salesmanship is truly helping someone to find a way to get exactly what they want out of life. What you should do is help them figure out how to get exactly what they want. If it is one of your health club products or health club services or they want to be a member of your health club, you need to be prepared on how to get them excited and have a positive emotional feeling associated to making a buying decision of purchasing a health club membership today. This can be done in numerous ways and there are several things that you need to learn to be able to do this.
For example, the first place to start is finding out exactly what the customer wants. One of the things on our health club free download that we provide on our website (http://www.healthclubconsultant.com/hc-free-download/) is the “Tour Sheet.” One of the first questions is, “what exactly would you like to accomplish by coming to our health club?” The reason why you should ask this question is you want to know what it is that serves as the driving force of the guest. You want to know what they want to accomplish by coming to your health club. Do they want to lose weight, do they want to improve their well-being, are they looking to improve their social life, etc. You want to make sure that you are able to find out what their goal is so that you can make sure you have the exact health club product and/or health club service to offer them.
When you are in professional health club sales your job is to find out the customer’s wants and desires and find a way your health club products and health club services can meet and fulfill those wants and desires. You will be able to partner your business with their needs and desires if you will simply listen to them. They will tell you what they want and if you know your health club products and health club services well enough, you will be able to lock up the relationship which is in essence, closing the sale.
In these tough economic times, lots of workers who have been laid off have opted to start their own businesses rather than seek new corporate jobs. While this choice can be enormously satisfying and empowering, it comes with significant disadvantages, and one of them is finding health insurance self employed alternatives.
Some 2.6 million independent workers have individual policies, while 3.5 million get health insurance through their own business group policy, according to the Employee Benefits Research Institute. The following suggestions can help anyone who’s currently self-employed or intends to start a business in the near future identify health insurance options.
If you have the time to plan your departure from a corporate job, then consider maintaining health insurance coverage through the company’s group policy. All workers whose employers have 20 or more employees have this right under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. COBRA provides that unless they’re fired, former employees can keep their group coverage for up to 18 months after leaving their employers.
This option comes with a hefty price tag, however, since self-employed people must pay the full premium cost of their health care insurance. Most employees pay an average of 28 percent of their insurance premiums, while their employers pick up the rest of the tab. Taking on that additional 72 percent can put a big dent in the wallet. Details on COBRA are available through human resources or from the US Department of Labor.
Rely on Your Spouse. Many self-employed people swear by an old saying: The best way for a freelancer to be successful is to have a spouse who works as an employee. This is especially true when it comes to health insurance in the United States, where some 3.3 million self employed workers are covered by their spouse’s health insurance. It’s likely that signing up under an employed spouse’s health plan will be much less expensive than many other options, including coverage through COBRA.
If you’re single, or your employed spouse has no health insurance, then you’re forced to strike out on your own. This means doing research, and a lot of it. There are two options here: buying health care coverage on your own through the Internet, or working with an insurance agent. The do-it-yourself route requires more work, because even with the many websites that offer insurance comparisons, the individual still has to do the math on prices and coverages. There’s also work involved engaging an insurance agent. The wise consumer interviews at least three agents, and checks the performance of all of them through the state insurance commissioner’s office.
Whether going it alone or working through an insurance agent, don’t make any deals until you’ve thoroughly investigated the performance of your most likely candidate for health insurance. An insurance company with lousy customer service, even if its prices are the lowest, is no bargain. The state insurance commissioner’s website typically provides information on how many customer complaints an insurance company receives, and what those complaints entailed. If the health insurance company you’re considering has a poor service record, move on to a new candidate.
Finally, although you’re working for yourself, don’t forget the strength of numbers. Many self-employed people find that it helps enormously to seek health care coverage through professional organizations. Two of the top organizations in this regard are the National Association of the Self-Employed for independent contractors and the National Association of Professional Employer Associations for business owners. Either can provide additional information on finding health insurance self employed alternatives.
No one knows when they will get into a car accident or face a sudden illness such as cancer. With all the uncertainty in life, it is important you have your finances in order to pay for medical care in case of an emergency. That is why you need health insurance coverage. You can find the best policy today by getting a health insurance quote.
You can purchase insurance coverage from thousands of companies around the world. Each policy has its own rules and requirements so it can be a little confusing when you are choosing one. To begin, request a quote from three or four companies that you are most interested in.
When you request an official quote, the insurance company will send you some paperwork to fill out. You should always answer questions honestly because the insurance carrier will probably send out a nurse to verify your information. You will need to write down if you use nicotine or if you consume alcohol. You will also be asked to list any prescriptions you take on a regular basis.
The insurance company will want to know if you have any chronic medical conditions as part of your history. They will definitely verify that you are telling the truth so make sure you answer questions honestly. You might be presented with pre-existing condition clauses on new policies if you are not moving from group to group insurance coverage so be aware of that.
After you get the quotes from several companies, you can start comparing their services and coverage plans. You will find a wide variety of comparisons depending on whether you will be part of a corporate policy or an individual policy. You should make sure that the insurance policy will be accepted by health care providers in your area before you sign up.
You should also ask the insurance company for any additional policy options that could be added. Some companies provide bundled insurance packages where you can purchase dental insurance, life insurance, and even vision insurance all at once. While you are getting health coverage, check into these other areas.
As you look through the quotes, read all the information you are given and don’t hesitate to ask questions. Find out how often the company changes their rates and make sure your original price is going to remain in place for awhile. Ask about how payments are broken up and whether you can make monthly payments or even quarterly payments.
One of the important things you need to look at is the way a policy actually operates. Look for key numbers such as co-pays and deductibles. If you have small children or require frequent doctor’s visits, the co-pay is more important and you should choose a policy with a low co-pay. On the other hand, if you are in good health and mainly need coverage in case of accidents, a higher deductible will give you a more affordable policy.
If you are sick often and require a lot of medical care, consider a policy with low deductibles and a lower out of pocket maximum. Even if you have to pay a little more on a monthly basis, it could save you money over time. Take some time to get a health insurance quote from a few companies and then you can determine which policy will be best for your needs.
Health insurance can be intimidating to tackle as far as looking into. But as long as you know where to start, a health insurance quote can actually be easy to acquire. Whether you want to pursue it online or over the phone, there are some general things to keep in mind when going after this information.
When you decide to pursue a quote online, you have a wide variety of companies to choose from, as well as custom plan options. These run fairly competitive because they all know of each other’s online presence. They are widespread across the nation and this actually helps them to to be able to offer greater discounts on increased coverage.
Whether you are married, single or a student also plays into the rates you are going to pay. Single people pay less, and oftentimes need much less coverage. Usually, if you’re going to get an individual health plan, it’s only going to pay for major medical coverage. When you’re healthy, you don’t need so many doctor visits per year.
Going to school at any age can be a benefit since students get great discounts as well. Getting an education also means working with a small budget, and thankfully, the insurance companies are aware of this. Sometimes the school you are attending will offer a health plan also to choose from, giving you yet another financially smart option in the face of so many plan increases.
Alongside the big name insurance companies, there are also discount brokers who offer plans at a discounted rate simply because they are independent brokers. They work with several companies at once, and when you let them know what your budget is and what your must-have needs are, then they will find plan within that range and go from there. There are also discount plans, which are not actual insurance, but can give you a special rate no matter what procedure you are having done.
These are very nice because you are not required to be accepted; you just buy into the plan. You can choose your doctor, you can choose your timing, and it’s completely up to you as to what you have done. There is also no choice of being denied coverage due to previous existing conditions or whatever other criteria the company might be dealing with.
If you’re self-employed, you can still get insurance, it just works on a slightly different way. Basically, it’s an individual plan and you can write if off from your business. So you are providing yourself health insurance, receiving a tax break for it, and you combine the benefits of coverage with the benefit of running a business from your home.
Technology is helping us in many ways every day, and getting a health insurance quote is easier because of it. By being able to get one online or call someone in person, or even talk to a discount broker about this, you’re going to be able to acquire this information easily. In case of a medical emergency, it will give you peace of mind to know that no matter what happens, you and your family will be taken care of.
Dating back more than 4,000 years, Chinese green tea diet has been long revered as a tasty drink that can ward off diseases and improve one’s well-being. There are only a few herbs that can surpass its impressive history.
Since its first recorded use during the time of Emperor Shen Nung, the link between Chinese green tea diet and good health has never been severed. Today, further studies are made to test the benefits of the remarkable health elixir.
Traditional Health Benefits of the Diet
According to tradition, this diet could cure anything from headaches, body aches, and pains to constipation and depression. Over the centuries, more health claims are made on account of the Chinese green tea diet.
It detoxifies the body. The presence of polyphenols, a naturally occurring antioxidant in this particular tea, is said to combat harmful free radicals and help keep the body free from diseases. In this regard, Chinese green tea helps maintain the overall well-being of the body. It fights against the anti-aging process because the antioxidants can boost immunity, preserve young-looking skin, and brighten the eyes.
Additional health benefits of the green tea is it increases the blood flow throughout the body. Because it contains a little caffeine, ingesting this drink stimulates the heart and allows the blood to flow more freely through the blood vessels. For the same reason that tea stimulates blood flow, it also stimulates mental clarity.
For many years, men of science remained skeptical about the health claims made by Chinese green tea diet enthusiasts because the health benefits are truly vast in number. Their doubt was changed to a more positive reception when subsequent researchers proved its disease-preventing attributes and confirmed most of the health claims.
Study after study has shown that drinking green tea and eating polyphenol-rich foods reduces the risk of any heart complications. It helps strengthen the blood vessels that provide oxygen and valuable nutrients to the heart and brain. It has also been researched that men who use the diet have a 75 percent less possibility of having a stroke than those who don’t use the diet.
The green tea diet helps lower total cholesterol levels and improve the ratio between LDL cholesterol and HDL cholesterol. Study shows that men who drink nine or more cups of Chinese green tea daily have lower cholesterol levels than those who drink fewer than two cups. While nine cups may seem a lot, break it up through out the day and you’ll realize it’s not that difficult to drink that many cups. You could have one during and after each meal and during your breaks.
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The role of the ‘Chinese diet’ in promoting longevity has been investigated upon by many researchers. They found the premise of their study on observing Japanese women who are greater-than-average green tea drinkers; have lower mortality rates compared to others. This led the researchers to believe that the diet has “a protective factor against premature death.”
The polyphenols found in the diet may be held accountable. With its high amount of polyphenols, it seems to have a stimulating effect on the immune system. A stronger immune system as a result of drinking the green tea helps reduce risks of obtaining many illnesses.
If these health benefits of doing the Chinese green tea diet don’t motivate you to start drinking this miracle in a cup, chances are you’ll never become motivated to loose weight. So start today and drink up. The health benefits go well beyond weight loss!
You know how important it is to have health coverage when you you have been sick or injured. But if you’re confused about what kind is best for you, you’re not alone.
If your employer offers you a choice of health plans, what should you know before making a decision? What types of health coverage are available? In addition to coverage for medical expenses, do you need some other kind of insurance? What if you are too ill to work? Or, if you are over 65,will Medicare pay for all your medical expenses?
These are questions that today’s consumers are asking; and these questions aren’t necessarily easy to answer.
This booklet should help. It discusses the basic forms of health coverage and includes a checklist to help you compare plans. It answers some commonly asked questions and also includes thumbnail descriptions of other forms of health insurance, including hospital-surgical policies, specified disease policies, catastrophic coverage, hospital indemnity insurance, and disability, long-term care, and Medicare supplement insurance.
While we know that our guide can’t answer all your questions, we think it will help you make the right decisions for yourself, your family, and even your business.
Making Sense of Health Insurance
The term health insurance refers to a wide variety of insurance policies. These range from policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care. Even disability insurance – which replaces lost income if you can’t work because of illness or accident – is considered health insurance, even though it’s not specifically for medical expenses
But when people talk about health insurance, they usually mean the kind of insurance offered by employers to employees, the kind that covers medical bills, surgery, and hospital expenses. You may have heard this kind of health insurance referred to as comprehensive or major medical policies, alluding to the broad protection they offer. But the fact is, neither of these terms is particularly helpful to the consumer.
Today, when people talk about broad health care coverage, instead of using the term “major medical,” they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you’ll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.
While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.
The section below is designed to acquaint you with the basics of fee-for-service and managed care plans. But remember: The detailed differences between one plan and another can only be understood by careful reading of the materials provided by insurers, your employee benefits specialist, or your agent or broker.
This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient – you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for “covered” medical expenses, the ones listed in your benefits summary.
When a service is covered under your policy, you can expect to be reimbursed for some, but generally not all, of the cost. How much you will receive depends on the provisions of the policy on coinsurance and deductibles. Here’s how it works:
The portion of the covered medical expenses you pay is called “coinsurance.” Although there are variations, fee-for-service policies often reimburse doctor bills at 80 percent of the “reasonable and customary charge.” (This is the prevailing cost of a medical service in a given geographic area.) You pay the other 20 percent – your coinsurance. However, if a medical provider charges more than the reasonable and customary fee, you will have to pay the difference. For example, if the reasonable and customary fee for a medical service is $100, the insurer will pay $80. If your doctor charged $100, you will pay $20. But if the doctor charged $105, you will pay $25. Note that many fee-for-service plans pay hospital expenses in full; some reimburse at the 80/20 level as described above.
Deductibles are the amount of the covered expenses you must pay each year before the insurer starts to reimburse you. These might range from$100 to $300 per year per individual, or $500 or more per family. Generally, the higher the deductible, the lower the premiums, which are the monthly, quarterly, or annual payments for the insurance. Policies typically have an out-of-pocket maximum. This means that once your expenses reach a certain amount in a given calendar year, the reasonable and customary fee for covered benefits will be paid in full by the insurer. (If your doctor bills you more than the reasonable and customary charge, you may still have to pay a portion of the bill.) Note that Medicare limits how much a physician may charge you above the usual amount. There also may be lifetime limits on benefits paid under the policy. Most experts recommend that you look for a policy whose lifetime limit is at least $1 million. Anything less may prove to be inadequate.
The major types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.
Managed care plans generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for each service that you receive, your coverage is paid in advance. This is called prepaid care.
For example, you may decide to join a local HMO where you pay a monthly or quarterly premium. That premium is the same whether you use the plan’s services or not. The plan may charge a copayment for certain services – for example, $10 for an office visit, or $5 for every prescription. So, if you join this HMO, you may find that you have few out-of-pocket expenses for medical care – as long as you use doctors or hospitals that participate in or are part of the HMO. Your share may be only the small copayments; generally, you will not have deductibles or coinsurance.
The interesting things about HMOs is that they deliver care directly to patients. Patients sometimes go to a medical facility to see the nurses and doctors or to a specific doctor’s office. Another common model is a network of individual practitioners. In these individual practice associations (IPAs), you will get your care in a physician’s office.
If you belong to an HMO, typically you must receive your medical care through the plan. Generally, you will select a primary care physician who coordinates your care. Primary care physicians may be family practice doctors, internists, pediatricians, or other types of doctors. The primary care physician is responsible for referring you to specialists when needed. While most of these specialists will be “participating providers” in the HMO, there are circumstances in which patients enrolled in an HMO may be referred to providers outside the HMO network and still receive coverage.
PPOs and POS plans are categorized as managed care plans. (Indeed, many people call POS plans “an HMO with a point-of-service option.”) From the consumer’s point of view, these plans combine features of fee-for-service and HMOs. They offer more flexibility than HMOs, but premiums are likely to be somewhat higher.
With a PPO or a POS plan, unlike most HMOs, you will get some reimbursement if you receive a covered service from a provider who is not in the plan. Of course, choosing a provider outside the plan’s network will cost you more than choosing a provider in the network. These plans will act like fee-for-service plans and charge you coinsurance when you go outside the network.
What is the difference between a PPO and a POS plan? A POS plan has primary care physicians who coordinate patient care; and in most cases, PPO plans do not. But there are exceptions!
HMOs and PPOs have contracts with doctors, hospitals, and other providers. They have negotiated certain fees with these providers – and, as long as you get your care from these providers, they should not ask you for additional payment. (Of course, if your plan requires a copayment at the time you receive care, you will have to pay that.)
Always look carefully at the description of the plans you are considering for the conditions of payment. Check with your employer, your benefits manager, or your state department of insurance to find out about laws that may regulate who is responsible for payment.
Your employer may have set up a financial arrangement that helps cover employees’ health care expenses. Sometimes employers do this and have the “health plan” administered by an insurance company; but sometimes there is no outside administrator. With self-insured health plans, certain federal laws may apply. Thus, if you have problems with a plan that isn’t state regulated, it’s probably a good idea to talk to an attorney who specializes in health law.
HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning.
For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to amore cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.
Almost all fee-for-service plans apply managed care techniques to contain costs and guarantee appropriate care; and an increasing number of managed care plans contain fee-for-service elements. While the distinctions among plans are growing increasingly blurred, the number of options available to consumers increases every day.
How Do I Get Health Coverage?
Health insurance is generally available through groups and to individuals. Premiums – the regular fees that you pay for health insurance coverage – are generally lower for group coverage. When you receive group insurance at work, the premium usually is paid through your employer.
Group insurance is typically offered through employers, although unions, professional associations, and other organizations also offer it. As an employee benefit, group health insurance has many advantages. Much – although not all – of the cost may be borne by the employer. Premium costs are frequently lower because economies of scale in large groups make administration less expensive. With group insurance, if you enroll when you first become eligible for coverage, you generally will not be asked for evidence that you are insurable. (Enrollment usually occurs when you first take a job, and/or during a specified period each year, which is called open enrollment.) Some employers offer employees a choice of fee-for-service and managed care plans. In addition, some group plans offer dental insurance as well as medical.
Individual insurance is a good option if you work for a small company that does not offer health insurance or if you are self-employed. Buying individual insurance allows you to tailor a plan to fit your needs from the insurance company of your choice. It requires careful shopping, because coverage and costs vary from company to company. In evaluating policies, consider what medical services are covered, what benefits are paid, and how much you must pay in deductibles and coinsurance. You may keep premiums down by accepting a higher deductible.
Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. Starting July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. Your prior health insurance coverage will be credited toward the preexisting condition exclusion period as long as you have maintained continuous coverage without a break of more than 62 days. Pregnancy is not considered a preexisting condition, and newborns and adopted children who are covered within 30 days are not subject to the 12-monthwaiting period.
If you have had group health coverage for two years, and you switch jobs and go to another plan, that new health plan cannot impose another preexisting condition exclusion period. If, for example, you have had prior coverage of only eight months, you may be subject to a four-month, preexisting condition exclusion period when you switch jobs. If you’ve never been covered by an employer’s group plan, and you get a job that offers such coverage, you may be subject to a 12-month, preexisting condition waiting period.
Federal law also makes it easier for you to get individual insurance under certain situations, including if you have left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 62 days.
If you have not been covered under a group plan and have found it difficult to get insurance on your own, check with your state insurance department to see if your state has a risk pool. Similar to risk pools for automobile insurance, these can provide health insurance for people who cannot get it elsewhere.
What Is Not Covered?
While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense.
Very few plans cover eyeglasses and hearing aids because these are considered budgetable expenses. Very few cover elective cosmetic surgery, except to correct damage caused by a covered accidental injury. Some fee-for-service plans do not cover checkups. Procedures that are considered experimental may not be covered either. And some plans cover complications arising from pregnancy, but do not cover normal pregnancy or childbirth.
Health insurance policies frequently exclude coverage for preexisting conditions, but, as explained, federal law now limits exclusions based on such conditions.
You should also remember that insurers will not pay duplicate benefits. You and your spouse may each be covered under a health insurance plan at work but, under what is called a “coordination of benefits” provision, the total you can receive under both plans for a covered medical expense cannot exceed 100 percent of the allowable cost. Also note that if neither of your plans covers 100 percent of your expenses, you will only be covered for the percentage of coverage (for example, 80 percent) that your primary plan covers. This provision benefits everyone in the long run because it helps to keep costs down.
A Final Word
If you get health care coverage at work, or through a trade or professional association or a union, you are almost certainly enrolled under a group contract. Generally, the contract is between the group and the insurer, and your employer has done comparison shopping before offering the plan to the employees. Nevertheless, while some employers only offer one plan, some offer more than one. Compare plans carefully!
If you are buying individual insurance, or any form of insurance that you purchase directly, read and compare the policies you are considering before you buy one, and make sure you understand all of the provisions. Marketing or sales literature is no substitute for the actual policy. Read the policy itself before you buy.
Ask for a summary of each policy’s benefits or an outline of coverage. Good agents and good insurance companies want you to know what you are buying. Don’t be afraid to ask your benefits manager or insurance agent to explain anything that is unclear.
It is also a good idea to ask for the insurance company’s rating. The A.M. Best Company, Standard & Poor’s Corporation, and Moody’s all rate insurance companies after analyzing their financial records. These publications that list ratings usually can be found in the business section of libraries.
And bear in mind: In some cases, even after you buy a policy, if you find that it doesn’t meet your needs, you may have 30 days to return the policy and get your money back. This is called the “free look.”