Posts Tagged ‘health insurance policy’

Health Insurance: What to Look for in an Ideal Policy

Friday, May 28th, 2010

Health insurance is a vital part of anyone’s  insurance portfolio. A good policy should contain some standard basics and additional perks. These are what make certain health insurance policies ideal; better than the other guys. Unfortunately, many plans today fall short of being ideal. Some even fall short of being remotely useful. Health insurance is an investment in your health and your life. You will want to get the most out of the policy you purchase. Here is what to look for:

The Basics

The basic anatomy of an ideal health insurance policy should include the following:

International Coverage

Injuries and illness can occur anytime, anywhere. If you’re ever out of the country, you certainly do not want to put your health and life at risk because you don’t have the medical coverage.

Affordable Annual Deductible

Whatever your policy maxes out at for out-of-pocket expenses, be sure it is an amount you can afford. Having an out-of-pocket deductible that you can not pay is comparable to not having insurance at all, as the insurance company won’t cover everything, and might not cover anything until the deductible is met.

Maximum Coverage

Find yourself a policy with no set limits. You really do not want one where the coverage can be exhausted. You never know what life will bring you way, and you want to be well-prepared, even for the worst possible scenario. If you can not find a limitless policy, try obtaining one that allows $1 Million per claim or $2 Million per lifetime, which is still more than you will probably need. It’s better to be safe than sorry.

No Referral Required

Why should you and your family have to see one doctor just to beg for a referral for treatment from a specialist because your primary care physician is not equipped to handle what ails you? You should be able to pick up the telephone and make an appointment without a lot of extra hassle. Health issues are hassle enough!

Coverages

A good health insurance policy will cover physician expenses, hospital expenses, surgical expenses and major medical, a high maximum benefit for those unexpected medical problems. These should also include very little out-of-pocket costs, comparatively speaking.

Perks

Depending on where you are in life and what you might be planning in the future, there are some additional perks that make a health insurance policy ideal. Not all policies will include everything, and of course, you won’t want a perk you won’t be using. Still, it’s great to have the option.

Preventative Care

Prevention is better than a cure, so you will certainly want a policy that allows for regular check-ups and screenings.

Mental Health

If you have a need for psychiatric care or therapy or there is a history of such things within your family or your spouse’s family, this is a good policy provision to have… you know, just in case.

Prescriptions

With the exception of certain generics, Rx drugs can cost an arm and both legs. The average American certainly can not afford this. Since not every medication on the market has a cheap generic version and some doctors do prefer to prescribe name brands, save you money and your health by ensuring your plan covers prescriptions.

Maternity Coverage

Planning to start a family? Maternity coverage is a smart move. It costs a lot of money to have a baby, let alone to raise one. You don’t want to get started on the wrong foot with a newborn and a ton of sky-high medical bills too.

Vision & Dental

Your eyes and your teeth are two parts of your body that you really want to take care of. Unfortunately, these are often ignored or taken care of only when the person has the cash or credit to pay for service. Vision and dental coverage can eliminate the procrastination and help you to get the regular check-ups you need.

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Health Insurance: HMO or PPO?

Wednesday, March 24th, 2010

If you’re looking into purchasing a health insurance policy, you might find yourself faced with a choice between a HMO or a PPO. This could be a difficult choice, especially for those with little experience with health insurance. How do you determine which type of policy will best suit your needs and provide you with the coverage you need? Which will give you options and affordability without sacrificing healthcare quality?

HMOs

A HMO (health maintenance organization) is a great health insurance option. Some people like them, some don’t. It’s a matter of personal opinion. It’s not advisable to choose your health insurance based on the fact that your friend or a family member has told you they don’t care for a certain company or option. It is better to look into the choices yourself, and decide which best fits your own particular needs and leave it at that. If ever you become dissatisfied, you can always make a change later.

When you choose a HMO, you will be given a list of network providers and will choose a primary care physician from among them. The PCP will then handle all of your basic medical care. Should you ever need specialized care or medical services, your PCP will then provide you with a referral to another physician within the network for this purpose. The only exception is in emergency situations.

All insurance claims will be filed by your healthcare provider, so you do not have to worry about that.

With an HMO, you will only be responsible for out-of-pocket expenses in the form of co-payments for doctor visits, prescriptions, procedures and a few other things that might require a patient co-pay. However, these expenses are minimal compared to paying every single medical expense out of your own pocket.

PPOs

A PPO (preferred provider organization) also has a list of network providers, however, you can also choose out-of-network physicians. You will simply pay a little bit more out-of-pocket. You also do not have to select and maintain a primary care physician, nor will you need a referral for the services of any doctor, regardless of your medical needs. The catch is that some specialists will require a referral anyway before they will see you. In that case, just drop in to see a family physician, and get yourself a referral or search for a specialist who will see you without it. PPOs will also sometimes require prior approval for certain tests and procedures, such as MRIs. For the most part, your healthcare provider will file the insurance claims. However, if you choose an out-of-network doctor, you may have to pay out-of-pocket and file a claim for reimbursement with your PPO. Aside from this possible expense, you will only have to worry about paying a co-payment, the same as with a HMO. However, some PPO plans do have an annual deductible, meaning you will have to pay a set amount out of pocket before your coverage kicks in and then you would be responsible for a percentage after that. Be sure to read the fine print or search for a PPO without the deductible if this is something you wish to avoid.

Your Choice

Either way you choose to go, both HMOs and PPOs are great choices for health insurance. It’s simply a matter of your healthcare needs, preferences, and, of course, your budget. PPOs offer the greatest flexibility and are really an excellent choice for those who do not need to see a doctor on a regular basis. HMOs are a great choice for those who need to see a doctor often and those who prefer the familiarity of the same providers handling their care.  It’s always best to shop around and get all the information and a few solid quotes before you make a decision.

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Health Insurance: Are You Risking Your Health Without It?

Monday, March 22nd, 2010

We hear it all the time. Millions of Americans are living without the benefits of health insurance. many people choose to go without because their employer doe not offer it or they think they can not afford it. However, there are policies you can get for yourself and your family, without going through an employer, and frankly, the cost of not having health insurance, might be a much bigger price to pay than simply paying for an insurance policy.

Insurance vs. No Insurance

While some of us are more than willing to swallow the bill, even if we know we can not pay, and run to the ER or doctor when we have a real problem, others simply avoid it, fearing the bill and the creditor they know will soon be on their backs. While running to the doctor or ER might offer a temporary respite from that which ails us, regular medical check-ups are by far the best preventative measure for health conditions. Unfortunately, regular check-ups with decent doctors tend to become quite difficult for those without insurance. If you can’t afford insurance, how could you possibly afford to self-pay for a doctor’s visit? Right?

While there are low-income and free clinics and programs to often help people with their medications - and all of this is great, don’t get me wrong - some people have a need for specialized care, treatment and procedures that these clinics just can’t handle as well. It can be an overwhelming feeling to know you need the care of a good doctor on a regular basis. It’s a situation compounded by doctors in the ER who tell you this, but try explaining your situation to them and it seems to fall on deaf ears.

Only You Can Take Control of Your Own Healthcare

Living without any kind of medical coverage can and does put your health at risk. Regular care can help to catch conditions early. Without that care, these conditions will go untreated, often putting you at risk for more serious health problems and possibly even death. all of which is preventable with proper care. Having some form of health insurance, whether it be a state program, an employer program or a self-paid policy is one of the most important things you can do for yourself and your family.

It is up to you to decide to be proactive, take your healthcare into your own hands, and do something about it. Healthcare does not have to cost a lot. The cost of a policy is minimal compared to the bills incurred for being non-insured. Health Insurance policies can be built to fit both your needs and your budget. Don’t take a chance on your health and your life. Choose to be health insured!

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Understanding your Health Insurance Policy

Thursday, December 10th, 2009

Do you know what your health insurance policy is all about? Sure, you have the card and you pay the deductibles and premiums, but do you really understand all of the fine print that goes along with a health insurance policy?

If not, then it may pay to educate yourself a bit more on your health insurance so that you have a clear understanding of your coverage and your rights. After all, not figuring out the nuances of your health insurance policy until you land in the hospital or emergency room for the first time is probably not the best idea.

Ask yourself the following questions about your health insurance coverage and if you don’t know the answers, make it a point to learn more:

  • What is my annual deductible and does each member of my family have to pay a separate deductible? Most plans have a per-person annual deductible, but many plans may only require that you pay a two-person maximum deductible each year. This may come in incredibly handy if each member of your family requires extensive medical treatment over the course of the calendar year.

  • What is my co-insurance amount? Once you have met your annual deductible, many insurance companies will pay a certain percentage of your medical bills, leaving you to pay the remainder. However, most insurance companies have a stop-loss number, which is an amount that you are only responsible for paying up to. Anything over the stop-loss amount is covered 100 percent by your health insurance company, eliminating the need for you to pay a co-insurance amount.

  • What is my lifetime maximum benefit amount? Many individuals are unaware that most health insurance companies have a maximum lifetime benefit amount, which includes benefit caps per illness. For example, your lifetime maximum benefit amount may be $4 million, but your maximum benefit amount may be just $100,000 per illness.

  • What are my doctor co-pays and am I limited to a certain number of co-pays each year? Some insurance companies limit individuals to just a handful of doctor co-pays each year, so it pays to educate yourself on this part of your policy.

  • What are my prescription benefits? What are the co-pays? Must I meet a certain drug deductible before I begin receiving prescription drug benefits?

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