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Questions
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Why
do I need Health Insurance ?
Illness
or disease can do more than sent you to the hospital, it also can
be financially devastating.
More insurance products are emerging to protect against the financial
pain of health-care lost.
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What
is the best plan for me ?
The
hardest part of the decision making process whe considering health
care coverage is what type of plan is the best for yourself, your
family or your business.
In order to answer this question, you first have to get the answer
to a few other questions like this:
1.Who’s
to be covered? Is this for an individual, a family or an entire
company?
2.What will my monthly budget afford?
3.How much financial risk can I stand in case of catastrophe?
4.What style of medical care do I want?
A
plan that might be just right for your neighbor or your cousin,may
be all wrong for you.
To get information for the plan just right for you talk to a broker
who is an expert you trust and know.
Whichever plan you choose, it is important that you fully understand
the type of insurance you have selected, the setting and quality
of care provided and what, if any,payment from you are required.
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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.
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What
can be covered ?
Here are some of the things to look at when choosing and comparing
health insurance plans.
Covered medical services:
· Inpatient hospital services
· Outpatient surgery
· Physician visits (in the hospital)
· Office visits
· Skilled nursing care
· Medical tests and X-rays
· Prescription drugs
· Mental health care
· Drug and alcohol abuse treatment
· Home health care visits
· Rehabilitation facility care
· Physical therapy
· Speech therapy
· Hospice care
· Maternity care
· Chiropractic treatment
· Preventive care and checkups
· Well-baby care
· Dental care
· Other covered services
After all, you may not mind that pregnancy is not covered, but you
may want coverage for psychological counseling.
Do you want coverage for your whole family or just yourself?
Are you concerned with preventive care and checkups?
Or would you be comfortable in a managed care setting that might
restrict your choice somewhat but give you broad coverage and convenience?
These are questions that only you can answer.
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When I apply for insurance, what will they ask ?
Personal
information to determine your eligibility.
Companies screen applicants for individual health insurance, so
you’ll fill out an application and answer questions on your medical
and/or dental history.
If your information is incomplete ot inaccurate regarding health
history or age, the company may have th eright to deny benefits
or rescind your coverage.
Companies frequently ask physicians for medical records and they
some times require physical exams or blood tests.(However they can
not ask you for an HIV Test, except for disability income insurance).
People with anything serious in their medical history will likely
be charged a higher rate for coverage or may get a “limited benefit
schedule”.
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What about “pre existing conditions” ?
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.
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Can I return my policy ?
Yes. If you are accepted for coverage by an insurer, you have a
“free look” or review period that varies from 10 to 30 days.
If you decide you don’t want thr policy, return it by certified
mail and request a full refund of any premium paid.
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What
is a insurance rating system ?
It indicates the stength and stability of insurance companies.
While there are rating services for many health carriers, not all
are rated for a very good reason: Not all are insurance companies.
Companies such as Kaisers, Blue Cross, Blue Shield, PacifiCare,etc.
won’t have a rating because they are “service organizations” and
some are even “non-profit-corporations” not insurance companies.
Remember,just because a plan isn’t “rated” by a service doesn’t
mean it isn’t a quality health –care plan.
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How
do I successfully file claims ?
Keep good records! By this I mean, every time you
talk to anyone at an insurance company or health provider, broker,
keep a careful record of whom you spoke to, what was said and when
it was discussed.
Make copies! Of all your bills and correspondence
from your doctor(s), clinic and hospital.
Use black ink! When filling out any and all forms.
Blue ink and pencil siply won’t show up well when photocopied by
you and th einsurance company.
File your claims promptly! Take care of this right
away and there will be less of a chance the carrier will deny the
claim.
If at first you don’t succeed call me as your broker, I will help
you to try again.
Persistency pays when dealing with insurance matters.
I understand the system, and I work to make the system working for
you. I’m just a phone call away.
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What
happens to my insurance if I lose my job?
If
you have had health coverage as an employee benefit and you leave
your job, voluntarily or otherwise, one of your first concerns will
be maintaining protection against the costs of health care.
You can do this in one of several ways:
First, you should know that under a federal law (the Consolidated
Omnibus Budget Reconciliation Act of 1985, commonly known as COBRA),
group health plans sponsored by employers with 20 or more employees
are required to offer continued coverage for you and your dependents
for 18 months after you leave your job.
(Under the same law, following an employee’s death or divorce, the
worker’s family has the right to continue coverage for up to three
years.)
If you wish to continue your group coverage under this option, you
must notify your employer within 60 days.
You must also pay the entire premium, up to 102 percent of the cost
of the coverage.
If COBRA does not apply in your case—perhaps because you work for
an employer with fewer than 20 employees—you may be able to convert
your group policy to individual coverage.
The advantage of that option is that you may not have to pass a
medical exam, although an exclusion based on a preexisting condition
may apply, depending on your medical history and your insurance
history.
If COBRA doesn’t apply and converting your group coverage is not
for you, then, if you are healthy, not yet eligible for Medicare,
and expect to take another job, you might consider an interim or
short-term policy.
These policies provide medical insurance for people with a short-term
need, such as those temporarily between jobs or those making the
transition between college and a job.
These policies, typically written for two to six months and renewable
once, cover hospitalization, intensive care, and surgical and doctors’
care provided in the hospital, as well as expenses for related services
performed outside the hospital, such as X-rays or laboratory tests.
Another possibility is obtaining coverage through an association.
Many trade and professional associations offer their members health
coverage—often HMOs—as well as basic hospital-surgical policies
and disability and long-term care insurance.
If you are self-employed, you may find association membership an
attractive route.
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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.
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Why
should I use a professional broker (advisor)?
If
you don’t know insurance know your broker. Is he an established
expert that specialize in people insurance?
Insurance advisors have strong financial and professional incentives
to give their clients a lifetime of quality products and service.
Advisors seldom are salaried employees of the insurance companies
they represent.
Usually they are independent agents who represent many companies.
Most advisors are compensated on a commission basis - a percentage
of the premiums you pay your insurance company.
Others are compensated on a fee basis directly from employers. In
each case, the advisor's loyalty and compensation rests with you,
the consumer. Regardless of the method of compensation, advisors
have strong incentives to place consumers with strong, financially
stable carriers and provide superior service on an ongoing basis.
Dramatic
changes in the insurance marketplace make the professional insurance
advisor's role increasingly important to individuals and small businesses
in finding cost-saving measures and coverage options.
They provide and service insurance products while educating and
advising you on how to manage risk and make informed insurance choices.
Many career insurance advisors have completed a sequence of college
level courses leading to a professional designation, such as
§ Registered Health Underwriter (RHU),
§ Health Insurance Associate (HIA),
§ Registered Employee Benefits Consultant (REBC),
§ Certified Employee Benefits Specialist (CEBS), or
§ Chartered Life Underwriter (CLU).
Advisors are highly trained insurance professionals who will guide
you through the complex task of choosing appropriate coverage at
an affordable cost and are dedicated to serving the long-term interests
of consumers.
Insurance advisors are licensed and regulated by state insurance
departments.
Prospective advisors receive training regarding insurance and applicable
laws before taking a qualifying exam for licensing. The majority
of states now require continuing education to maintain license status.
Many career insurance advisors belong to the National Association
of Health Underwriters (NAHU), which offers seminars, workshops,
courses and other educational forums to ensure members meet the
highest standards of client service. NAHU also requires members
to subscribe to a strict professional code of ethics.
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Should
I buy insurance online ?
Buying
health insurance benefits is different than buying books and music.
Benefits are complex and they are critically important. Health care
coverage protects both a family's health and its finances. Purchase
the wrong book, and you're out a few dollars.
Purchase the wrong health care coverage, and the consequences are
far more significant.
Remember, if you buy health insurance online, there may be no advisor
to explain benefits, no advocate if problems arise and no counselor
to help you make the right coverage choices.
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What
should I expect from an insurance broker ?
An
advisor will guide you through the complex task of choosing appropriate
coverage at an affordable cost.
The following is what you should expect from a professional insurance
agent.
Use this checklist to evaluate your current advisor. Your professional
insurance advisor should:
1. Work with you to evaluate your needs for insurance coverage.
2. Explain the details of different insurance plans.
3. Make specific recommendations and tailor plans to suit your special
needs and budgets.
4. Review your plans periodically to update coverage and limit costs.
5. Serve as your advocate and advisor in dealing with insurance
companies, doctors and hospitals, and government agencies involving
claims, services and regulations.
6. Help you as a business owner communicate benefits packages to
employees and demonstrate how various provisions can complement
personal and government financial plans.
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