Tips for Choosing the Right Health Insurance Plan

If you are someone thinking of purchasing a health insurance plan, then you have plenty of options before you. Doing a bit of homework will help you choose the right plan from among the various health insurance quotes that you may come across.

One person who can help you find the right health insurance plan would be your insurance agent. Since they would be aware of the latest health insurance products in the market they can help you choose the right one. Although they would have your best interests in mind, you must also remember that they are not in any way obliged to find you the best deal. It is up to you to make an informed decision based on an insurance agent’s suggestions.

A good place to start off your search for a health insurance plan would be your existing insurer. It could for instance a company where health insurance is one of the products. Most of the insurers are known to offer discounts, if you were to purchase multiple insurance products from them. You must try and get in touch with as many insurers as possible during your initial search phase. This will help you go through the prospectus of various different insurers. You can then make a choice after making a comparison of the coverage benefits and costs.

There are basically two types of covers offered under health insurance policies, while the first one is the basic cover for surgical or hospital expenses, the other cover is meant for a wide range of medical expenses including physician expense, hospital expenses, ambulance services and prescription medicine coverage, to mention only a few. These days you can also find health insurance plans that also provide coverage for substance abuse and even mental illness. Before you shop around for a health insurance plan, you must make it a point to learn at least a bit about the basic types of health insurance. This will help you a lot when you actually shop around for one.

With the advent of the internet getting health insurance quotes has become a lot simpler these days. No longer do you need to call up several insurance companies or fill out various different applications for getting health insurance quotes. Over the internet, at most of the health insurance comparison websites, all that you need to do is to fill up just one application form and you will be literally flooded with quotes from different insurers.

It is always preferable that you choose an insurance company that specializes in providing health insurance rather than from a company where health insurance is one of the numerous insurance products that they may be selling. You should also make it a point to go through the ‘fine print’ of the prospectus before you sign on dotted lines. This will ensure that you do no end up paying any kind of hidden charges. Once you take care of all these aspects you are well on your way to obtaining the right health insurance plan.

Getting an Affordable Health Insurance

You must purchase health insurance not only for yourself but also for your family and near and dear ones. If you fall sick, have an accident and need surgical interventions or become an invalid, you will have to shell out a lot of money to cover hospitalization charges, doctor’s fees, operation fees, medicines etc. But if you buy a suitable health insurance, your financial problems will come down quite a bit.

Getting a health insurance is easy, there are so many companies offering it. To get an affordable health insurance you have to look around and shop for it. Many people have gone bankrupt because they did not have health insurance and when tragedy struck, they had to pay from their own savings, or get a loan to pay for the medical bills. Very rarely do people have that much savings that they can cover the medical bills which can be quite exorbitant. Some people are very confident of their health and feel that they may never need health insurance, so why should they buy it and pay every month when they do not need it.

No one is so very healthy or risk free that he can take such a risk. Even a simple surgical intervention like removing an appendix can cost quite a bit and burns a big hole in your pocket. Major illnesses cost the earth. If you do not have health insurance, paying medical bills, which result from accidents or illnesses, may reduce you to a pauper. Buying medical insurance means, paying regular premiums every month or year, as per your contract. The premiums are not very high, but they have to be paid regularly without fail, for the insurance policy to have validity. Even a single delayed payment or non-payment may result in the cancellation of the policy. Some tend to forget paying so it is advisable to have reminders or arrange regular payment through the bank or credit cards.

Some people feel that it is a waste, especially if they are healthy and are also good drivers. But it is not a waste as one never knows when calamity may strike. You have to be optimistic and get insurance so that you are not worried or tense if something happens. It is a form of security. There are different types of contracts for buying medical health insurance. You should talk to people who have already bought it. Some are affordable health insurance programs. But it is not so easy to find good and cheap, as well as affordable health insurance plans. Cheap medical insurance schemes may not be bad, just as expensive ones may not really be so very good. You have to read between the lines, find out what the insurance plans cover, how they pay up, how long it takes and so on, before signing the agreement.

It is quite a challenge to find affordable coverage which also covers every exigencies but it is possible to get affordable medical insurance if you seriously look for it.

Weird Things Insured

People buy life insurance, auto insurance, medical insurance, house insurance and the like, which are normal and most companies sell them and many people purchase them. But there is another category of insurable and insured items which only a few have done and these are quite weird types of insurance.

Well-known people and film and TV stars are known to have insured their body parts. These public celebrities take no chance on getting any part of their body changed or disfigured and hence they buy insurance for it. These people depend on their bodies for their livelihood. And insurance companies offer insurance policies that will pay if something damages the appearance or the functionality of some body part.

Professional athletes too buy insurance. Peyton Manning has insurance on his right arm, it is reported. The following are some of the body parts that are known to have been insured:-

•Ken Dodd’s extremely big buckteeth for $ 7.4 million!
•13-year-old World Yo-Yo champion Harvey Lowe’s hands for $ 150,000!
•Australia’s cricket player Merv Hughes’ walrus moustache for $ 370,000!
•20th century Fox insured actress Betty Grable’s legs for $ 1 million each!
•Michael Flatley of Lord of the Dance and Riverdance for $ 47 million
•Food critic Egon Ronay’s taste buds for $ 400,000!
•Bruce Springsteen’s voice for $ 6 million
•Comedy partners Bud Abbott and Lou Costello for $250,000!
•Jennifer Lopez’s ass for $ 1 billion!

The list can go on increasing. We have tea taster’s nose and tongue being insured and so also someone’s eyes. Another not so common but weird is insuring a game of golf. They have a hole-in-one prize. Anyone who scores a shot is awarded a prize which can be cash, an automobile, a video or anything. There are many other strings to the bow and many companies think of such things. They do not lose money, in fact they and the people insured have all the publicity they want. Hence it can be worth it. For both, the insurer and the insured.

Kidnapping youngsters and even adults has become so frequent that the well to do people are buying insurance against kidnapping and ransom. People working at high risk jobs also buy insurance. These policies are held by businessmen who work in dangerous areas and they offer indemnity coverage for any loss incurred by whoever pays the ransom. This includes the ransom money, money lost in transit, expenses incurred while delivering the ransom, hiring of professionals like negotiators and rewards offered for the safe return of the victims.

Lloyd’s of London has sold insurance policies against the oddest of demands. They have sold policies for vampire bites, werewolf attacks, alien abduction and the like. There are more than 400,000 policies sold to insure against alien abduction. If you can prove it (pass a lie detector test or have a video or a witness to support the claim of being kidnapped by an alien) then compensation of one million pounds will be given by the insurance company!

Health Insurance Terms

No matter what insurance you plan on getting it is always best to know something about it. It is no different for Health Insurance. Health Insurance in the United States is a must failing which you will not be able to get or afford medical care. When you purchase a health insurance make sure that you know the terms that are used in the policy so that you know what you are entitled to and also the limitations if any.

Here are some of the common terms used in Health Insurance:

Access: It means a person’s ability to get affordable medical care on timely basis.

Accreditation: An evaluative process where a health care organization is checked for its operational procedures to see if they meet the designated criteria defined by the accrediting body and to ensure that the organization meets a specified level of quality.

Actuaries: Insurance professionals who set insurance premium rates.

Ancillary services: Supplemental services such as diagnostic services, home health services, physical therapy and occupational therapy used to support diagnosis and treatment of a patients condition.

Appropriate care: A treatment where expected health benefits exceed its expected health risks by a wide enough margin to justify the measure.

Children's Health Insurance Program (CHIP): A program, established by the Balanced Budget Act, designed to provide health help to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs.

Claim: A statement of healthcare services and their costs provided by the hospital, physician or other provider facility. Claims are submitted to the insurer for payment of costs.

Claim form: An application for payment of benefits under a health plan.

Claimant: The person submitting the claim.

Claims administration: The process of receiving, reviewing, adjudicating and processing the claims.

Claims investigation: Process of obtaining all the information necessary to determine the amount to pay on a given claim.

Closed access: Provision which specifies that plan members must obtain medical services only from network providers through a primary care physician to receive benefits.

Coinsurance: A method of cost sharing in a health insurance policy that requires a member to pay a stated percentage of medical expenses.

Compensation committee: Board of directors that sets compensation guidelines for a managed care plan.

Deductible: A flat amount a group member has to pay before the insurer will make any benefit payment.

Disease management: A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost effective, quality healthcare for a patient population who are at risk for a chronic medical condition.

Drive time: A measure of time when members of the plan’s service area have to drive to reach a primary care provider.

Fully Funded Plan: Health plan which an insurer or MCO bears the financial responsibility of guaranteeing payments and paying for benefits and administrative costs.

Grievances: Formal complaints demanding formal resolution.

Health care quality: The degree to which health services for individuals and people increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Insured: The usual term for a person who purchases insurance for themselves. The insured could also be a close family member of the purchaser.

Lifetime Maximum Benefit amount: The maximum payment set by an MCO that limits the total amount the plan must pay for all healthcare services provide during the subscriber’s lifetime.

Out of pocket maximums: Amounts set by MCOs that limit the amount a member has to pay out of is pocket for a particular healthcare service.

Policy: This is the term for a contract between an insurance company and a purchaser of life insurance

Premium: A prepaid payment or series of payments made to a health plan by purchasers, and plan members, for medical benefits.

Premium taxes: State income taxes levied on an insurer's premium income.

Primary care: General medical care that is provided directly to a patient without referral from another physician. It is focused on preventative care and the treatment of routine injuries and illnesses.

Termination provision: A provider contract clause that describes how and under what circumstances the parties may end the contract.

How To Buy Health Insurance

It is absolutely essential to have health insurance. Generally, in the US, the employer or the organization on behalf of the employees as part of the employee benefit scheme takes group insurance policies and it can be a common one. In the case of individuals who want to take insurance cover, they have to research and find out the best possible one.

There are many different types of insurance policies available. Through the Internet it is possible to research the companies that offer health insurance and one has to check out the agent and the local company represented. The terms and the conditions of the insurance policies should be studied with special stress on the finer print. The insurance seeker should make sure about what the policy will pay for and what it wont as different companies offer different terms. The details of the reimbursement for visits, prescriptions and other medical services will be written in black and white and the person should read it carefully and see if it suits him. Many people have fallen prey to problems because they have not found out in advance what the insurance company will pay and what it will not.

In cases of doubt a health insurance broker who is an expert in the field can be contacted and everything can be discussed. If finding a broker is difficult, one can go through the National Association of Health writers on the Internet and find out a suitable person. He will guide and make the person get the best insurance cover. eHealthInsurance.com can also give quotes and prices offered by various health insurance companies. A visit to the state insurance department website will give more details. Once the person is satisfied with the terms and conditions he can buy the health insurance. There may be some down payments, which the person will have to pay before he signs and gets the policy.

Once that hurdle is crossed, it is very essential to pay the installments in time so that the policy does not overlap or get discontinued. There are many schemes while buying the insurance. By paying the yearly premium in one lump sum, the person may be eligible for discount or the company may waive the service fee. If the insured person and his family have been enjoying good health and have not availed of the health insurance, then he can move to a higher deductible. There could be a significant reduction in premiums.

There can be supplementary policies, which the company may advertise. It is necessary to check whether the items they pay for may be already included in the existing health insurance plan.
Individual health insurance is expensive for self-employed people. They can join some small business associations and take advantage of a group health insurance plan and save money. Even two people can form a group provided they work for about twenty-five hours a week. Once the policy has been bought and the installments paid regularly, it is advisable to review the policy again. The health care system changes continuously, it can vary from state to state and hence it is necessary to keep in touch with the latest information and update the insurance policies every year. An Internet site healthinsuranceinfo.net gives most of the latest information on health insurance policies.

However if the person has a group insurance policy taken out by the employer then there is no cause for worry, as the organization will take care of the problems. They have a standard policy especially if they have more than a thousand employees. Otherwise every state may have different rules. Some states forbid insurance companies from rejecting people based on their health condition. Others require insurers to charge everyone the same rate, regardless of age or health. This can result in some healthy people paying more than others. The insurance policy rules change with the state.

Compare Health Insurances

Majority of Americans relies heavily on health insurance schemes to pay for their medical expenses. As there is no National Health scheme or any nationally designed health insurance scheme for the average person, Americans have private and not- for- profit health insurance. 84 percent of Americans have health insurance, out of which 60 percent get it through their employers, 9 percent get it directly while various government agencies provide coverage for the rest.

Health insurance is a must as medical fees are very heavy and it is very difficult for an average person to pay through his pocket. There are several health insurance schemes. Public programs cover senior citizens and low-income groups who meet certain eligibility requirements. These public programs are Medicare, which is a federal social insurance program for seniors and some disabled persons. Medicaid covers certain very low-income children and their families and SCHIP (State Children’s Health Insurance Program) serves children who do not qualify for Medicaid but are also not capable of paying privately. Other public programs include TRICARE, which is United States military health care plan for military personnel and their dependents.

There are also other programs for low-income people. One of the oldest forms of organized health care is the Health maintenance Organization, which gives its members a wide choice of health care benefits, which also include preventive care. Doctors here are employees who operate from a centralized clinic of a medical center and the patients go there for treatment. The patients can also select doctors from the Individual Practice Associations (IPA) where the doctors have contracts and agreements with the HMO and have their own consulting rooms where patients can visit. If the insured person needs specialized care he can coordinate with the primary care physician and this would mean co-payment of the expenses.

Preferred Provider Organization (PPO) has contracts and agreements with hospitals and other medical service providers who charge less for the insured persons than their normal rate. Some people prefer self-referrals whereby they utilize the services of doctors from outside the PPO network but in this case the payment would be reimbursed by only seventy percent.

In the case of another facility called the Point of Service, the patient has to do all the paperwork himself. Completing the documents, preserving the medical bills and keeping a tab on medical care receipts have to be done by the patient himself in return for the facility of self direct care to the insured patient. The primary care doctor can be chosen from a network of doctors who will take care of the patient.

All these medical insurance schemes have their own plus and minus points. Every individual has to go through the documents and the paperwork meticulously and choose the best and the most suitable one. Some offer payments only for medical treatments and not for other procedures like plastic surgery or body sculpting unless there is a strong medical reason for the procedures. One has to think and plan carefully before signing for the insurance schemes.

The employers and the organizations of the individual offer some; some have to do it on their own. But medical insurance is a must for all, in the face of exorbitant medical treatments.

Various Types of Health Insurance

Basically there are two types of health insurance plans available in the United States. One is the Fee for Service health insurance and the other is the Managed Care Health Insurance. Though they differ from each other, they both cover prescription drugs, dental care and also medical, hospital and surgical costs.

In the fee for service plan, the insured patient can be examined by the doctor of his choice, and the medical professional receives a fee for each check up or any service he has provided the insured patient. This fee for service health insurance claim can be filed either by the patient himself or the doctor. In the Managed Care Health Insurance Plan, which the majority of Americans opt for, there are many types working differently, providing medical services to their customers and offering financial incentives to insured persons who choose to go the doctors mentioned in the managed care plan.

The first type is the Health Maintenance organization (HMO), which is the oldest form of organized health care. For predetermined charges, the HMO offers its members a choice of a wide variety of health care benefits. These also include preventive care. The insured person can opt for a group model HMO where the doctors are the employees of the health plan and they visit the patients at centralized clinics or medical centers. Or the Individual Practice Associations (IPA) where the HMOs enter into contract with physicians or doctors who could be consulted in their private offices. If the patient needs a specialist, he will have to coordinate with the primary care physician referred by the HMO. He will have to pay a predetermined sum of money for that visit in an expense sharing agreement and later most costs as a result of this visit will be covered by insurance.

The Preferred Provider Organization (PPO) is an organized health care that has agreements and contracts with hospitals that charge a lesser fee to the insurer than the usual. In this type, the patient has the freedom to make self-referrals, consulting with doctors from outside the PPO network. Here the patient would be reimbursed for only 70 per cent of the cost. The patient will also have to meet the difference in the charges between what the plan offers and what the provider charges.

Another variation is the Point of Service (POS). This facility is commonly seen in plans where the HMO offers a self-direct care to the insured patient. This is in place of a primary care physician, which the HMO offers. The primary care physician can be chosen from a network of doctors who monitor the health care of the patients. He can refer the patient to a doctor from outside the network but then he would only get a portion of the compensation. A co-payment will then have to be paid. Since the patients who opt for POS healthcare plans can choose their own doctors they have to understand the financial import of their choice. For all this, the paperwork has to be done by the patient who has chosen POS, which means that filling forms, sending medical bills and keeping an account of medical care receipts is the patient’s responsibility.

Earlier all Americans had an indemnity assurance coverage where they could go to any medical doctor and the insurance company would pay the medical bill along with the patient according to the contract signed in the beginning. Today health care has made such long strides that there are many choices for patients and the health insurance policies come in affordable and comprehensive packages.

Uses of Health Insurance

Medical care in the US is of very high quality and naturally it is also very expensive. When a person falls sick in the US he needs medical assistance. There are very few free services and most medical care is expensive even for a common cold.

In other countries there are national Health services or government sponsored health care but in the US there is only Medicare for people who are over 65 years of age and Medicaid for the economically weaker sections of society. The rest have to bear the medical expenses themselves. If health insurance is applied and the policy signed by the relevant authorities, then the organization which has entered into the agreement with the individual pays either part or bears the full expense of the illness and the treatment. Health insurance is bought to bear the expenses of illness, surgery or any health related emergency.

Medical health insurance is generally given by the employer or the organization which has group insurance for all the employees. The self-employed individuals have to apply for insurance coverage themselves. They can form a group, even if the group consists of only two individuals, so that the premiums to be paid are less.

Most insurance plans provide basic medical coverage. There are different types of plan and the person has to select the best one and the most suitable one for him (if he has a choice). An average type of an insurance plan will cover the physical exams and health screenings, care by specialists, hospitalization and emergency care, prescription drugs, vision care, dental services and others.

People buy health insurance to protect themselves financially. With health insurance a person protects himself and his family in cases of expensive medical care. Some years are good and the medical bills may be low but in the event of illness, the bills can be high. If health insurance is there, then many of the costs are covered by the insurance company. Even during pregnancy and childbirth, there are many tests which can be very expensive but are absolutely necessary. Monthly checkups, blood tests, sonography, medicines, the actual delivery, hospitalization etc costs a lot of money. For many, specialized care may be necessary. Insurance covers most of these expenses; otherwise it is very difficult for any individual to manage.

An insured person can avail of medical facilities and then present the bills to the insurance company for claiming the payment. The organization will carefully go through the bills and sanction the amount when it is fully sure that the claim is legitimate. In some cases it may be part payment of the expenses, in other cases it could be full payment.

There are a few medical procedures, which may not be covered by health insurance. Plastic surgery, cosmetic surgery, procedures like liposuction, body lifts and others, which can be included in the category of body sculpting procedures, may not be covered by insurance. However if it can be proven that some of these procedures are essential for health reasons, and then maybe some insurance companies will bear the cost.

It is necessary for the person who is buying the insurance to make sure of what he is getting and for what purpose.

What is Health Insurance

Health insurance is a form of insurance, which pays for medical expenses. It may even include insurance covering disability or long term nursing or custodial care. It may be provided by the government through a social insurance program or by private companies.

As the United States does not have a national Health Care system as in Britain, it is necessary to have health insurance coverage, if a person does not want to pay high medical expenses through his pocket. Sometimes medical bills can be so high that an individual finds it very difficult to pay for his illness. Hence a person should be covered by necessary insurance as soon as possible and should not wait for a catastrophe to happen.

Insurance covers health care for medical problems or other problems only from the time a person has his policy. As no one knows when he may fall sick or have an accident or other health related problems, it is always better to have an insurance policy soon. Health insurance can be purchased on a group basis when the organization or the employer pays for the entire group or it can be purchased by the individual customer, especially if he is self-employed. In each case the group or the individual pay the required premium regularly to protect themselves from high or unexpected healthcare expenses. Social welfare programs funded by the government may also give similar benefits for paying medical expenses.

Serious illnesses can run up heavy bills and if a person is covered by health insurance, the insurance company will cover his bills. Most people in the United States are enrolled in some health insurance plans. There are different types of managed care like the Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), point of service (POS) and fee for service plans. The individual may have a choice of health insurance covering policies and he should study all the options, terms and conditions before he signs on the dotted lines. Some companies give money only on health grounds while others may give insurance money for plastic, cosmetic or body sculpting surgeries.

Individuals enrolled in health care plans pay monthly or quarterly fees. Health insurance estimates the overall risk of health care expenses and calculates a finance structure whereby the person, his employer or his organization pays a monthly or annual tax that will make sure that money is available to pay for the healthcare benefits specified in the insurance agreement. This benefit is administered by a central organization, which can be a government agency or a private or a not-for-profit entity operating a health plan.

About 84% Americans have health insurance, 60% obtain it through the employer and 9% purchase it directly. The rest of the people have various government agencies to provide coverage. There are public programs, which provide the main coverage of medical expenses to senior citizens and for low-income families. These are Medicare which is a federal social insurance program for seniors and disabled individuals; Medicaid which is funded by the federal government and the states but administered at the state level and SCHIP which helps children and families who cannot afford private coverage but do not qualify for Medicaid.