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Health Insurance Basics

Choosing a health insurance plan that is right for your family can be a bit daunting…but it doesn’t have to be. Becoming familiar with the different health insurance plans that are available both for individuals and families will help you navigate the health care insurance field and make an better informed decision concerning health insurance. Read on to learn some of the health insurance basics.

HOW TO CHOOSE THE BEST INSURANCE PLAN FOR YOUR NEEDS

First, determine if short term or long term health insurance is what you need. If you are unemployed, yet hope to be hired in a few months with a company that offers group insurance, than perhaps short term health insurance is for you. Also some companies require a new employee to work for three to six months before they are eligible for health benefits. Short term could offer the temporary coverage you need. Next, decide if basic health-care coverage or comprehensive health care coverage will better meet your needs.

BASIC HEALTH CARE COVERAGE

This plans covers inpatient hospitalization and out-patient surgery in case of a major accident or illness. The monthly health premiums are lower and are generally the choice for those who are primarily interested in coverage in case of severe accident or illness.

COMPREHENSIVE HEALTH CARE COVERAGE

This plan covers preventative care, Dr’s visits, prescriptions, along with hospitalizations and out-patient surgery. Comprehensive health care coverage has a higher monthly premium, and it generally has a low co-pay at the time of a Dr’s appointment. This plan may be the better choice appropriate for those who have reoccurring medical expenses.

AVAILABLE INDIVIDUAL AND FAMILY INSURANCE PLANS

Health care plans usually fall into two categories, indemnity or managed-care plans. They differ in regard to how bills are paid, ability to choose health care providers and out-of pocket expenses. Generally, you’ll have a broader choice of health care providers with indemnity health-care plans and less out-of -pocket expenses and less paperwork with a managed-care health insurance plan.

MANAGED CARE PLANS

HMO’s (Health Maintenance Organizations), PPO’s
(Preferred Provider Organizations), and POS’s (Point of Service Plans) are all managed health-care insurance plans.

INDEMNITY PLANS

Under this plan, insurance companies pay their share of the cost for services after they receive a bill. This may mean that you will have to pay your bill for medical care at the time of service and then seek reimbursement from your health insurance company.

WHAT ARE SOME OF THE ADVANTAGES AND DISADVANTAGES OF AN HMO PLAN?

– Lower out of the pocket expenses

– Fewer choices in regard to physicians and hospitals than other health insurance plans

– A PCP (Primary Care Physician) is required and will meet most of your health-care needs

– A referral is needed from your PCP before seeing a specialist

WHAT ARE SOME OF THE ADVANTAGES AND DISADVANTAGES OF A PPO PLAN?

– Health insurance companies offer a network of preferred doctors and hospitals

– These health care providers offer the members services at discounted rates

– Usually an annual individual or family deductible must be paid before the health insurance companies begins to pay out money for medical bills.

WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF A POS?

– Combines features of both the HMO and PPO plans

– Members are usually required to choose a Primary Care Physician (PCP)

– PCP services are not usually subject to a deductible

– Preventative care visits are generally covered

HEALTH INSURANCE TERMS

As with any genre, health care insurance is filled with jargon exclusive to its field. The following is a list of terms and their meanings that will hopefully give you good grasp of health insurance terms.

COINSURANCE

The percentage of medical costs you have to paying after meeting the deductible amount that is attached to your plan.

CO-PAYMENT

This occurs under an HMO plan and requires a specified dollar amount be paid to the health insurance provider on each visit.

COVERED BENEFITS

A covered benefit must always be a medical necessity. The determination of whether something is a medical necessity or not is made by the health insurance company.

DEDUCTIBLE

The amount you must pay in medical expenses before your insurance company will begin to cover your medical bills.

DEPENDENT

A dependent is someone other than yourself who is covered under your health insurance plan. This could include a spouse, child, unmarried partner. For children there are age limits at which they are no longer covered under a parent’s health policy.

DISABILITY

In the event that you are unable to work for an extended period of time due to an injury or a medical condition, disability insurance provides funds to cover your living expenses in a specified amount.

GATEKEEPER

Another title for your Primary Care Provider (PCP)

GROUP INSURANCE

Employers often offer group insurance plans. Under group insurance an employee can generally obtain a much more affordable plan.

IN NETWORK/OUT OF NETWORK

In network refers to those physicians who have been contracted under a health care plan to provide services to their members. Staying in network allows lower charges and a smaller percentage of out of pocket expenses. Conversely, going out of network generally means charges are higher and you will have to pay a greater percentage of out of pocket expenses.

GRACE PERIOD

This is a specified period past the due date of a premium during which coverage may not be canceled. This prevents health insurance companies from canceling your policy if payment should arrive a few days late.

OPEN-ENROLLMENT PERIOD

Generally, this is a once-a-year period of time that allows you to make changes to your existing health insurance coverage. (A change in marriage status or the birth of a child also allows you to modify your health insurance plan.

PRE-CERTIFICATION(Pre-authorization)

Before surgery or hospitalization, the insurance company must be contacted to get approval for a medical service to take place. Failure to do so typically means the insurance company will NOT pay for the service. This does not apply in an emergency situation, although the insurance company should be contacted as soon as possible.

PRE-EXISTING CONDITION

A medical condition that existed before an insurance policy became effective. Most insurance companies require a three month to one year waiting period before a pre-existing condition can be covered under their plan.

PREMIUMS

Monthly payments for insurance coverage. Monthly payments can easily reach $100 for singles and two to three times that amount for a family.

REFERRAL

A written form from your Primary Care Provider to another Dr. (usually a specialist) giving consent for you to go to them for medical services.

SECOND SURGERY OPINION

On occasion an insurance company will ask you to be seen by a second Dr. to determine if the recommended procedure is necessary or if an alternate method could accomplish the same result.

URC (Usual, reasonable, and customary)

URC refers to the dollar amount an insurer will usually pay for a service or procedure based on what is customary for the area in which you live. An insurance company will not pay $800 for a procedure that costs only $300.

Secrets to Finding Health Insurance Deals

It is easy to find health insurance deals across the Unites States presently, because many health insurance providers offer buyers an affordable and beneficial health insurance deals.

It is necessary for people to have health insurance coverage, as the future is unpredictable. Hence, if people have a health insurance, it would help them prepare for all the uncertainties. Currently, health issues are major problems in the United States. This is why the American government insists that people buy health insurance.

People may wonder about how and where they can find deals. Here are several helpful resources that can help health insurance buyers zero in on the right insurance plan for his needs. If buyers wish to have affordable and beneficial health insurance deals, they may take the help of local insurance dealers, who address such health insurance coverage. The other alternative for people is to just sit at home and find health insurance deals to suit them.

Yes, this is possible. Many health insurance dealers have set up their web sites on the Internet to offer comfortable and convenient service to the insurance buyers. Therefore, individuals can simply browse the Internet and find deals, which suit their financial needs.

How To Find Health Insurance Deals:

Discussed below are a few resources to find the most economical and useful health insurance deals:

  1. Contact the State Department of Insurance: There are people who offer customer service on these bureaus. They have a good knowledge of the different kinds of insurance products in their state. Thus, they can steer an insurance buyer to the best-suited companies and products that meet their exact requirements.
  2. Work with a broker or an insurance agent: Agents or brokers are the best resources to know the available health insurance products in the market. They help insurance buyers in finding cost effective health insurance deals. They help to find favorable deals on health insurance with low insurance premium.
  3. Check out Professional/Trade Organizations: Such trade organizations may offer health insurance coverage to insurance buyers at an affordable rate. Since every province has its own health insurance terms and conditions, the coverage offered by the Chamber in Bozeman, Mont may not be same as the Chamber in Tulsa, Oklahoma. Hence, it is necessary to review the insurance terms of such organizations carefully before purchasing insurance.

Things to Remember:

Before signing on the dotted line, find out the insurance company’s ratings issued by Dun and Bradsheet. Ratings by Dun and Bradsheet depict the company’s financial stability and its claim-paying history. Hence, it is best to choose a highly rated company to secure a good health insurance deal.

The Scary Truth Behind Health Insurance

In present times, insurance buyers may easily obtain health insurance applications. As many health insurance companies and brokers have established their own official web sites over the Internet, it is possible to get health insurance applications with a single mouse click. Alternatively, insurance buyers can get the health insurance applications offline, as well.

Insurance buyers may wonder how and where to apply for health insurance coverage, but be cautious, as an application is a later stage in the approval process of health insurance.

Before sitting down to fill up health insurance applications, insurance buyers need to collect information that is likely to help in filling up health insurance applications. These include names and residential address of physicians, dates of recent visits, and some details of recent insurance coverage.

How to apply for health Insurance Coverage:

It is wise to apply through an employer. If insurance buyers apply through their employer for health insurance coverage, they certainly do not need to submit a medical report. However, they have to wait for the firm’s next enrollment period before applying. For a new employee, it may take a long time for approval.

The application process to join a group health coverage is simple, since most insurance coverage may sign up everyone irrespective of previous and present health state.

For instant approval of health insurance coverage, people need to fill up the application form with certain information. This includes information such as name, residential address, social security number, description of the insured and dependents (together with names, date of birth, age, social security number of all dependents), and employment details such as date of appointment and kind of intended health insurance plan. At times, health insurance companies may ask for any previous health insurance policies, including policy numbers and insurers.

Once buyers fill up all necessary details, the completed application form goes to the insurer, where coordinators are present to process and approve it. Once coordinators feel that all details are up to par, they recommend approval of health issuance coverage for applicants. Hence, it is always best to fill up the application form with correct information.

If buyers wish to apply for group insurance coverage, procedures are similar. However, in such cases, applicants need to manage all paper work themselves. A few insurance companies send insurance agents to negotiate and help in the application process of health insurance approval. The agents help to gather all required documentation, organize an in-home medical test, and collect a pre-payment check.

Health Insurance Money Saving Strategies

How does anyone get the best value with health insurance? Answer: Combine Health Insurance Plans. To explore the principles at work, many people should understand how combining health insurance is a sound solution to a serious problem. It may appear obvious that combining insurance improves coverage, but few people truly understand how combining plans leads to thousands of dollars in potential savings over time. With so many health insurance plans available and over 1 million insurance agents actively licensed today, it leads one to question why no one knows how combining plans saves money.

Today, too many people are learning the hard way that they are under-insured when it comes to health insurance. This happens because competitive health insurance agents bid lower and lower amounts in an inflated market, leading to more gaps in coverage that less experienced agents often fail to comprehend well enough to explain. There is a simple truth to understand about the rising costs of health care.

Health Care Costs Will Continue to Rise When No Regulation is in Place

Hospitalvictims.org conducted research on hospital charges nationwide. These charges were compared to those of Johns Hopkins Hospitals, one of the most respected health care institutions in the nation. What were the results?

The vast majority of hospital charges average between 300% and 400% above the institutions’ costs for treatment. Johns Hopkins Hospital’s average charges are 117% above its costs. For every $1 charged, Johns Hopkins pays $0.85, or earns a profit of $0.25 for every dollar charged.

The average U.S. hospital pays $0.27 for every dollar it charges. The average hospital is paying $25 Million in costs while charging $95 Million to patients. The average profit margin is around $70 Million annually. The greatest of these charges are credited to surgical supplies and the administration of anesthesia.

In an ever-inflating health care industry, a solution does exist. While politicians continue making promises to solve the health care crisis, individuals and families continue to expect more than the insurance market can bear. But many self-employed individuals and families can find comfort in knowing they can do something to secure assets by simply doing the legwork and becoming informed about health insurance.

The solution is based on a very simple principle of insurance. Insurance is an Agreement to Share the Financial Risk of Loss Between Individuals and Companies

This basic concept is more important for individuals to understand now than ever. Health insurance companies, like individuals, cannot afford the rising costs of health care on their own today. Many health insurance companies have developed their focus to specific areas where they can offer more competitive coverage at very affordable prices. This is where people can save significant amounts of money by adjusting to this trend. It is no longer the case that a single health plan can offer full, comprehensive coverage at a competitive price because health care costs are out of control.

Today it takes multiple health plans from multiple health insurance companies to have the best coverage at the lowest price. This follows the trends associated with investing in the economy. One creates greater risk for their financial performance in the market by investing all funds in one stock or trade. The safest, most secure investment is a diversified portfolio. Health insurance is no different today.

Why You Do Not Know

Is it surprising to learn that many insurance professionals have no idea how to give individuals and families the best coverage and the greatest savings on health insurance? The majority of health insurance agents today are captive to one company. This means that most insurance agents are only trained to present the products of the health insurance company they represent.

Independent agents are less restricted to one plan, but a large number of these professionals still have limited access to the competitive plans available to individuals and families. While this explanation is complicated, the simple answer is that most agencies earn the majority of their profits from the volume of product sales per company, not the volume of sales overall. Some general agency contracts offer higher incentives to the agency, which can influence what products agencies offer.

So, it comes down to the individual shopping for health insurance to find the policies that create the greatest coverage and savings.

A Well-Structured Health Insurance Portfolio is the Key to Having the Best Coverage for the Lowest Price

Combining health insurance plans is the best way to improve coverage save money on health insurance long term. Health Insurance Money Saving Strategies is a 10-week campaign to spread the word to self-employed individuals and their families looking for private health insurance. A well-structured Health Insurance Portfolio is the best way for people to protect their assets and be comfortable knowing their insurance adequately protects them from the worst medical situations. The benefit is knowing that this type of approach to health insurance saves people money.

Health Insurance Facts to Know

How can health insurance help you out? Being an investment, it is imperative that people prioritize this expense along with many other financial responsibilities. Health insurance coverage should be there to support you and your family in times when you need immediate health care. Think of it as a nest egg where you can get funds from to pay for the various costs of medical treatment, hospitalization, medication, and more.

There are various types of health insurance plans that you can obtain, and there is an equally innumerable number of firms that offer such services. It can be a little challenging to choose one that is right for your budget, as well as tailor made to suit your health needs. Note that you don’t have to spend a fortune to be able to get insurance coverage. There are ways by which you can earn discounts and save, while at the same time receiving quality and reliable services from your insurance provider. All it takes is the right knowledge to be able to evaluate your health insurance priorities and lock down your choice of provider.

In line with this, this article presents some interesting statistics that you might want to keep in mind regarding health insurance plans in the United States. Knowing these important notes will help you make a wise decision with regards to choosing a plan for you and your family. Mentioned here is also vital news regarding the direction that the health insurance system in the US is headed.

How many people in the United States are without health insurance? Regardless of how important it is to be covered, there is a significant percentage of the population who has no resources to obtain their needed health policies. As the Centers for Disease Control and Prevention (CDC) reports, about 45 million people in the US have no health insurance. And that translates to roughly 15 percent of the population. The Hispanics have the most number of uninsured children and adults, which is about 32 percent of the total Hispanic population. On the other hand, 19 percent of the total African American population does not have health insurance, and around 10 percent of all whites are uninsured as well.

If you are interested to know, there are specific states that contribute the most to the uninsured adult statistics in the country. If nearly 20 percent of Americans aged 19 to 64 have no form of health insurance, which states significantly add to that number? To be more precise, Texas and New Mexico have almost a third of the total aged 19 to 64 population uninsured. On the other end of the spectrum, Massachusetts has the least number of uninsured adults in that age group, with only about 10 percent accounted by the Kaiser Health Foundation statistics.

How many children in the US are without any form of health insurance? This age group is considered as the minor group, comprised of children aged 18 and below. The CDC stated in a 2007 report that about 10 percent of the total minor population does not have health insurance. That means that there are 7 million children out there who may not be able to get afforded medical treatment. Which states have the most number of uninsured children? The Kaiser Health Foundation accounts that Texas ranks at the top of the list, with about 22 percent of the ages 0 to 18 population having no health insurance. Massachusetts is still the state with the least number of uninsured children, with only about 5 percent having no coverage.

In terms of the performance of insurance companies in the country, which are the ones that write the most number of health policies? As of the year 2007, the National Association of Insurance Commissioners reports ten of the largest insurance firms in the US, with respect to their market shares. Topping that list with approximately 12 percent of the market share is the UnitedHealth Group. Second is WellPoint, Inc, having almost 10 percent of the market share. The third largest with 7.7 percent market share is the Kaiser Family Foundation. Blue Cross, which is among the oldest health insurance providers in the country, ranks ninth, with a market share of 1.7 percent.

On a final note, what does the American government intend to do in response to the ever growing health insurance needs of the country? Among the highest priorities of the new Obama administration is to focus on revamping and further developing the health insurance system in the US. About $150 billion is expected to be allotted for provision of more accessible and more affordable health insurance options for the population. In line with the recession which led to the loss of over 7 million jobs, $25 billion will be used to cover for nearly 65 percent of health insurance premiums for these employees.

To be able to answer to the health needs of children, it is expected that 5 million kids will be granted health insurance, as $87 billion will be for funding state health insurance programs, including the SCHIP or State Children’s Health Insurance, which assists minors from low income families as well. The rest of the funding will be for modernization of medical facilities, including access to records, as well as research for diseases such as cancer, Alzheimer’s, diabetes, and heart conditions.

Get Cheap Health Insurance

Cheap health insurance may look like a bargain, but what happens if you have a major medical problem? You don’t want to be caught off-guard if an unexpected major medical problem arises. Cheap health insurance means one thing to one person and something else to another. While the idea of getting cheap health insurance is very appealing, no one wants to deal with the repercussions of bad or inadequate health insurance. Cheap health insurance has become the issue of the moment in South Carolina and across the country. More small businesses are increasingly unable to provide cheap health insurance plans to their employees because of the rising cost and the lack of federal and state legislation that would allow small businesses to purchase cheap medical insurance in pools.

Cheap health insurance is your access to the best options in the market. This is because you no longer have to spend so much time searching for the product that will suit your health care needs. Cheap health insurance rates work so much better when you know what you are supposed to be looking for. Get some tips on what you should look for when dealing with a health insurance plan. Cheap health insurance quotes can help you to find the best and the most inexpensive coverage that is available. You will be covered, and relieved to know that if anything happened to you, you will not have that major financial stress of paying full price for your injuries or illnesses.

Medicare supplemental insurance offers senior coverage for health care costs that are not covered by a traditional Medicare plan. By having Medicare supplemental insurance, seniors can rely on consistent, constant and comprehensive coverage when they need it. Medicare supplemental insurance is designed for people on Medicare, who wish to have more comprehensive coverage. These supplemental plans may include Managed Care HMO plans or Medigap PPO plans that provide you with greater access to participating physicians. Medicare and Medicaid are both excellent programs for those individuals who qualify, but they are no substitute for a system which allows us all to access basic private medical insurance cover at a cost which we can afford.

Medical Insurance also known as health insurance is a protection to individuals and their families against unforeseen expenses. In the process, there are two parties namely the insurer and the insured. Medicaid is for people who come under the low income’s bracket. Every person is eligible for it and having a job does not affect one’s eligibility. Medical terms can be confusing, and before speaking with an insurance agent, you should make sure you understated his or her language. Make sure you read our overview of health insurance companies to get a better idea of each provider’s identity.

Individual companies are free to evaluate the risks to insure you in whatever manner they see fit. Each health insurance company employs people (actuaries) that try to calculate the statistical risks involved in insuring you, and not surprisingly, has a slightly different view of the statistics. Individual health insurance works differently. It generally can’t be terminated just because you use it, but you can be turned down in the first place if you do not pass health underwriting; you can be rated up if you have a history of illness or obesity; and your premiums can be and often are increased if you suddenly have a major illness. Individual health insurance covers different types of injuries as well. An active lifestyle increases the risk of accidental injuries and repairing broken bones can become very expensive.

Individual health insurance is State specific. Each state has slightly different laws and regulations governing the implementation of private individual health insurance.

Hospitalization, medicines, doctor fees can be very high and if the patient cannot get a suitable insurance cover, it is very difficult. Health insurance can be a tough battle for cancer patients. Hospitals have an extraordinary ability to save life and without health insurance you could be medically saved but financially ruined. Hospital cash plans are a form of medical insurance that takes care of everyday medical costs. Many will pay for dental or optical treatment up to a set limit every year; physiotherapy; specialist consultations etc.

Comparison of your options: To be able to find an affordable health insurance you must have an idea of all. What is available in the market? After you have shopped enough get hold of a broker who can help you in comparing the policies. Comparing health insurance is a case of finding the right health insurance provider to cover your particular circumstances as well as comparing the types of policy provided by each health insurer.

Comparing Medical Insurance isn’t just a case of finding a handful of brand names and trusting they have everything covered in their policies. The cover varies wildly, as will your medical insurance quotes. Compare several plans from top rated medical insurance companies and apply online.

COBRA, short of Consolidated Omnibus Budget Reconciliation Act, came into being in 1985, and it is also a low cost health insurance option for short-term coverage up to 18 months. It’s great for transition periods such as school age children, widowed spouses, divorced couples, and other situations where you may have been covered by employee programs previously. COBRA has an 18 month limit, or 36 months if you’re permanently disabled. Most people are under the impression that COBRA is expensive, or that it’s better to stay with a plan they know.

Again, depending on where you live, requirements may be stringent. However, it wouldn’t hurt to see if you or your family qualifies. Ask around to find out about the different agents and their policies. Many agents will work very hard to get you an affordable health insurance plan for your family at a cost you can live with. Ask if the agent will be available for phone calls and if he or she will make phone calls on your behalf if you have questions in the future. Ask your agent to be sure.

Ask for a quote from several sources, and see what kind of a deal, they can get for you. Make sure they are also licensed in your state, because it does no good getting insurance if they can’t operate in your state. Ask about policy rates, terms, services, co-pays, and claim procedures. If the representative has a difficult time answering your questions, or you just don’t think the company is legit, consider visiting your state’s Department of Insurance website to read through reviews and financial information of the company.

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Information shared here does not constitute financial, legal, or other professional advice, and no advisor-client or confidential relationship is or should be formed by use of the site. This article is intended to provide general information only and does not give advice, which relates to your specific individual circumstances. Information in this document is subject to change without notice. Any link-listing or ad-listing on this site does not constitute any type of endorsement.

Small Business Health Insurance

Saving on your small business health insurance can be a challenge. But there are ways to overcome the financial obstacles and get the coverage necessary for your business. There are two major benefits of employer-based coverage. First these plans, although expensive, usually carry the best all around protection for you and your employees. Second, providing benefits plays a key role in attracting and retaining quality employees.

Why is coverage for small businesses so much more than for large corporations?

Health insurance for small businesses cost so much because of the high quality coverage concentrated among a small group of people. Every individual within the group represents a different level of financial risk to an insurance company, and this risk is added up and spread out among the group. Large corporations pay considerably less because the risk is spread to such a large group, where small business owners can see unreasonably high increases in premiums due to one or two members. Small businesses also have to insure their employees under state mandates, which can require the policies to cover some specific health conditions and treatments. Large corporations’ policies are under federal law, usually self-insured, and with fewer mandated benefits. The Erisa Act of 1974 officially exempted self-funded insurance policies from state mandates, lessening the financial burdens of larger firms.

Isn’t the Health Care Reform Bill going to fix this?

This remains to be seen. There will be benefits for small business owners in the form of insurance exchanges, pools, tax credits, subsidies etc. But you can’t rely on a bill that is still in the works, and you can’t wait for a bill where the policies set forth won’t take effect until about 2013. Additionally, the bill will help you with costs, but still won’t prevent those costs from continually rising. You, as a business owner, will need to be fully aware of what you can do to maintain your bottom line.

What can I do?

First you need to understand the plan options out there. So here they are.

PPO

A preferred provider option (PPO) is a plan where your insurance provider uses a network of doctors and specialists. Whoever provides your care will file the claim with your insurance provider, and you pay the co-pay.

Who am I allowed to visit?

Your provider will cover any visit to a doctor or specialist within their network. Any care you seek outside the network will not be covered. Unlike an HMO, you don’t have to get your chosen doctor registered or approved by your PPO provider. To find out which doctors are in your network, simply ask your doctor’s office or visit your insurance company’s website.

Where Can I Get it?

Most providers offer it as an option in your plan. Your employees will have the option to get it when they sign their employment paperwork. They generally decide on their elections during the open enrollment period, because altering the plan after this time period won’t be easy.

And Finally, What Does It Cover?

Any basic office visit, within the network that is, will be covered under the PPO insurance. There will be the standard co-pay, and dependent upon your particular plan, other types of care may be covered. The reimbursement for emergency room visits generally range from sixty to seventy percent of the total costs. And if it is necessary for you to be hospitalized, there could be a change in the reimbursement. Visits to specialists will be covered, but you will need a referral from your doctor, and the specialist must be within the network.

A PPO is an expensive, yet flexible option for your small business health insurance. It provides great coverage though, and you should inquire with your provider to find out how you can reduce the costs.

HMO (Health Maintenance Organization)

Health Maintenance Organizations (HMOs) are the most popular small business health insurance plans. Under an HMO plan you will have to register your primary care physician, as well as any referred specialists and physicians. Plan participants are free to choose specialists and medical groups as long as they are covered under the plan. And because HMOs are geographically driven, the options may be limited outside of a specific area.

Health maintenance organizations help to contain employer’s costs by using a wide variety of prevention methods like wellness programs, nurse hotlines, physicals, and baby-care to name a few. Placing a heavy emphasis on prevention cuts costs by stopping unnecessary visits and medical procedures.

When someone does fall ill, however, the insurance provider manages care by working with health care providers to figure out what procedures are necessary. Usually a patient will be required to have pre-certification for surgical procedures that aren’t considered essential, or that may be harmful.

HMOs are less expensive than PPOs, and this preventative approach to health care theoretically does keep costs down. The downside, however, is that employees may not pursue help when it is needed for fear of denial. That aside, it is a popular and affordable plan for your small business health insurance.

POS (Point of Service)

A Point of Service plan is a managed care insurance similar to both an HMO and a PPO. POS plans require members to pick a primary health care provider. In order to get reimbursed for out-of-network visits, you will need to have a referral from the primary provider. If you don’t, however, your reimbursement for the visit could be substantially less. Out-of-network visits will also require you to handle the paperwork, meaning submit the claim to the insurance provider.

POSs provide more freedom and flexibility than HMOs. But this increased freedom results in higher premiums. Also, this type of plan can put a strain on employee finances when non-network visits start to pile up. Assess your needs and weigh all your options before making a decision.

EPO

An Exclusive Provider Organization Plan is another network-based managed care plan. Members of this plan must choose from a health care provider within the network, but exceptions can be made due to medical emergencies. Like HMOs, EPOs focus on preventative care and healthy living. And price wise, they fall between HMOs and PPOs.

The differences between an EPO and the other two organization plans are small, but important. While certain HMO and PPO plans offer reimbursement for out-of-network usage, an EPO does not allow its members to file a claim for doctor visits out its network. EPO plans are more restrictive in this respect, but are also able to negotiate lower fees by guaranteeing health care providers that it’s members will use in-network doctors. These plans are also negotiated on a fee-for-services basis, whereas HMOs are on a per-person basis.

HSA (Health Savings Account)

An HSA is a tax-advantaged account used to pay existing and future medical expenses. HSAs are used in conjunction with high-deductible health plans (HDHP), which will make some with pre-existing conditions ineligible. Also, HSAs must be funded with cash. Communicating the terms of this account to your employees is important, as a large number of HSAs are underfunded or improperly funded. The health savings accounts were signed into the law by George Bush in 2003, and have become an affordable alternative to a group health plan.

When inquiring about an HSA, there will be a few things you will want to clarify. While HSAs generally cover routine medical expenses and copays, some can provide dental and vision care as well. And since HSAs can be combined with certain compatible plans, it is important to understand how money from the account will be allocated. And finally, you will want to know about cashing out your HSA balance. The amount is taxable and could be subject to a ten percent excise tax.

HRA (Health Reimbursement Arrangement)

An HRA is exactly what it sounds like. The employer reimburses the employee for health care. As an employer, you will usually have the option to contribute to a reimbursement fund, or to pay fees as they are incurred. These reimbursements can be deducted from your taxes, and are tax-free for your employees, saving you both money.

Some providers empower employers by giving them more options. HRAs, unlike HSAs, don’t have to be funded with cash money, placing a book keeping entry on your balance sheet is enough. You can usually control aspects of your arrangement such as reimbursement limits, whether you or your employee pays first, and if the previous year’s funds roll over.

HRAs are becoming a more popular option because of the control it has given small businesses. Combined with a high deductible health plan (HDHP), an HRA could be the most cost-effective solution to your small business health insurance problems. It’s always best to compare these plans to PPOs, HMOs, and EPOs to know what works best.

Fee for Service (FFS) or Traditional Indemnity

A fee for service plan is the most flexible small business health insurance option. You choose your doctor, and your hospital. You can see a specialist without a referral. This flexibility, however, comes with more out-of-pocket expenses and higher insurance premiums.

The typical FFS plan has a deductible ranging anywhere from five to fifteen hundred dollars. After this amount is reached, the provider will pick up eighty percent of your medical bills, and require you to pay the remaining twenty percent. Because of the rising costs of health care, and the potential for a small number of doctor’s visits to cost thousands, these plans can become incredibly expensive.

Flexible Spending Account (FSA)

A flexible spending account is a savings account to be used for medical expenses, and is funded by pre-tax dollars. Using pre-tax dollars means that your employees will actually show that they have less income, and will therefore have less taxes withheld. As an employer, you set the limit on contributions to the account per year. In addition to the employee contribution, you can also credit the account, or fund it completely from your general assets.

An FSA, especially if combined with an HDHP, can significantly reduce the costs of small business health insurance.

You should be forewarned, money from FSA accounts cannot be rolled over. They are, however, available to use for two years and two and half months after the benefit year. A terminated employee won’t be able to use leftover funds, unless there is a positive remaining balance and COBRA is elected.

Small business health insurance providers have made significant improvements in their services to simplify the administration of your plan. With HRAs, FSAs, and HSAs, your employees can use debit cards for medical transactions. Be sure to research this thoroughly. You will want to be sure your debit card plan is IRS compliant, and that you can use a large number of pharmacies. You should also pick a plan that can verify eligibility on the spot. Talk with your agent about linking transit, parking fees, and prescriptions to the same card. When picking the debit card options, please be sure to clarify the details of the substantion process. This is IMPORTANT! With other plans, the provider may assign someone to manage your plan. Or you may have to hire someone. Still, you should be able to login to your account and print insurance cards, important papers etc.

The next thing you can do is thoroughly assess your needs. Being that every member of your small business plays a key role in its success, it is vital that their needs are met. And understanding these needs is crucial to finding the right plan. Find out about chronic illnesses, and additional information related to past health issues. Know what your employees think about health insurance, and get them involved in the process.

Hiring an agent or a broker

Finding and understanding small business health insurance can be a daunting task. While some choose to go it alone, others need some professional assistance. You need to understand the difference between an agent and a broker, and how you can get the most from either of them.

A broker

Brokers function independently and usually work for several different companies. Since they have a variety of resources, they can usually provide more options and a better overall view of the marketplace. Brokers will assist you by evaluating the costs and designs of plans from your local major carriers. The cost isn’t everything, you want to get the coverage that you need.

Ask the broker how he or she is getting paid for their services. They should readily divulge that information. Some brokers may charge you a flat free. Some receive a fee from an employer, while others receive a commission from the insurance provider. Any commissions could be reflected in your premiums, but not to the point that you should worry.

An agent

Agents typically provide services for one company. They have a closer relationship to the insurance company than a broker would, giving them more leverage to make alterations to your plan. In some cases they can offer a particular plan for less than a broker, and may have access to additional services like worker’s compensation. To find out what different providers have to offer, talk to more than one agent. It may be time-consuming, but it could bring you closer to the most cost-effective solution for your small business health insurance.

One of the common options presented by agents is the employee-elect option. This is an arrangement where employees pick the plan they prefer. Those who don’t need as much coverage won’t be forced to pay so much, and those who do need it can get it without increasing the financial burden of the company as a whole.

How to Save On Your Small Business Health Insurance Plan

What’s important to remember is that there really is no inexpensive solution to health care. Even if your initial premiums are reasonably low, they could rise significantly at your next renewal. So saving money on small business health insurance is about doing a combination of things simultaneously to get good rates, and to then maintain those rates.. And it will require a consistent effort from you, your employees, and your insurance provider.

First, you can save yourself money by reading the fine print. You need to know exactly what your plan does and DOESN’T cover. There are also state mandated coverages. For example, in states like Illinois, your insurance must cover mammograms. Also, understanding the ins and outs of your plan will give you and your employees a better idea of how to deal with your insurance.

Next, you should shave unnecessary benefits. After reading all about your plan, you will find coverage for things you may not need. Eliminating these benefits can significantly drop monthly small business health insurance premiums. For example, eliminating coverage for brand name medications can reduce costs by more than 25 percent.

Wellness program have worked wonders for small businesses. A wellness program is any program designed to promote healthy living within the organization. Weight loss competitions benefit every participant. Add a financial incentive for further motivation. Stock the work fridge with water, and leave literature about healthy living lying around. Search the internet for calorie counting charts. Raising awareness entice workers to make positive changes. Active, exercising, diet-conscious employees have stronger immune systems, more vitality, and more productive workplaces. They also don’t deal with as many health issues. Fewer doctor visits and hospitilizations will help maintain lower annual premiums, because it will prove to your insurance provider that your business is a low financial risk.

Increasing your co-pay and deductible can go a long way towards cutting costs. For instance, raising co-pays by just ten dollars has saved companies as much as thirteen percent on their premiums. A higher deductible will significantly reduce your monthly premium. To lessen the financial burden of high-deductible health plans (HDHPs), combine them with an HSA. Combinations like these have saved both business owners and employees bundles of cash.

Check into getting a nurse hotline. A nurse hotline is a toll free, 24-hour-a-day, seven-day-a-week service. Employees can get medical advice from qualified, registered nurses. This method has deterred a large number of people from emergency visits, and it can also be used for preventative care as well. Insurers like Nationwide have them, or you may have to purchase from a third-party provider.

Increase the size of your group to reduce your monthly small business health insurance premiums. In a survey by America’s Health Insurance Plans, small businesses who employed ten people or less paid forty three more dollars on average than businesses with twenty six to fifty employees. Check around with other businesses owners, or fellow members of business organizations. Some states also have small business groups and pools for this purpose. Check with your state Chamber of Commerce and Department of Insurance.

Beware of heavily discounted plans. First, there are numerous scammers trying to get your money. They promise low rates, and usually cover little to nothing at all. The internet is notorious for swindlers trying to hustle you out of a buck. If you are going with a company you aren’t familiar with, please do your research. On another note, even reputable companies present problems. In an attempt to gain market share, Blue Cross offered small businesses discounted rates in 2008. For 2009, some of these same businesses were set to see increases of as much as 47% in their premiums. As the costs of medical care increases, the costs are shifted from the insurer to the insured, and discount plans become overpriced plans quickly.

Shop around. As mentioned before, talking to different agents will expose you to the best that insurance providers have to offer. Ask other small business owners about their providers. You can use trusted online resources like Netquote and Ehealthinsurance to shop around instantly. These services also let you compare plans side by side, and allow you to purchase your plan online. Even after you get your initial plan, it’s good to annually reevaluate your coverage. This will keep you on the up-and-up about what the market is offering. Keeping costs down is an ongoing effort, especially with rates and plans changing all the time from company to company.

Share some of the costs with your employees. Raising employee contributions isn’t a popular option, but it may be one of the only ways to absorb costs and maintain small business health insurance coverage. Communicate with your employees about how to keep costs down, and remind them that their increase is your increase as well.

Health Insurance Know the Facts

When it comes to preparedness, health insurance will always be your best bet. Because one cannot easily determine when he or she will need medical help, having a reliable health insurance plan will be very helpful in covering the costs of treatment and care. There are many factors one must consider before signing up for a health insurance policy. Since there are different types available, one needs to carefully assess his needs and also manage his allotted budget.

What do you need to know about health insurance? How can this help you and your family in times of need? Read on to learn about interesting facts about policies and coverage, so you can make the informed choice when buying health insurance for you and your family.

o In the United States, it has been reported that nearly 45 million Americans have no form of health insurance whatsoever. This accounts for about 15 percent of the total population as of the year 2006. As mentioned by the Centers for Disease Control and Prevention (CDC), among the total population of Hispanics, 32 percent were uninsured. This is compared to 19 percent of all African-Americans, and 10 percent of all whites who do not have health insurance coverage.

o Of all the uninsured persons in the United States, about 7 million were minors, below the age of 18. This accounts for about 10 percent of the below 18 population of the country, as reported by the CDC. According to the new health insurance plan proposed by the administration of President Barack Obama, about $87 billion of government funds will be allotted for the improvement of state insurance programs, as well as the SCHIP, or the State Children’s Health Insurance Program. This will expect to reduce the number of uninsured children in the country by up to 72 percent, giving minors better opportunities for health care.

o More on the uninsured: what percentage of the population ages 19 to 64 (non-elderly) do not have health insurance? The Kaiser Health Foundation reports that approximately 20 percent of adults in this age group are without any form of health insurance, as of the year 2007. Which states have the most number of uninsured adults? The same site reports that New Mexico and Texas top the list, with about 30 percent of people in this age group without health coverage. On the other hand, Massachusetts has the least uninsured adults, which only comprise about 10 percent of the total age group.

o Which states have the highest number of uninsured children, who are from ages 0 to 18 years old? As the Kaiser Health Foundation statistics present, Texas has about 22 percent of children without health insurance, with Florida following with 19 percent. Massachusetts also has the least percentage in this category, with only about 5 percent of children without health coverage.

o According to the Insurance Information Institute (III), about 34 percent of the nation has their own private health insurance plans, while nearly half of the population rely on government funded insurance programs. To be more specific, 19 percent are under MediCare, 15 percent under MedicAid and SCHIP, and another 12 percent from other select public insurance providers.

o The National Association of Insurance Commissioners reported in 2007 the insurance companies who have written the most premiums as of that year. Topping the list were UnitedHealth Group owning 11.7 percent of the market share, and WellPoint Inc. Group, with 9.75 percent of the market share. Kaiser Family Foundation follows in third with 7.7 percent market share in that same year. Among the oldest health insurance providers in the country, Blue Cross, is the ninth on the list, with approximately 1.72 percent of the market share.

o When comparing individual insurance plans and group insurance plans, you can expect to save more if you purchase multiple policies. However, according to some people who choose individual policies, they are able to tailor their plans to be in tune with their specific health needs. You can learn more on the pros and cons of these two types of health insurance when you consult with an insurance agent.

o During the economic recession in the United States, there were millions of people who have become unemployed. However, thanks to the new administration and the initiatives of President Obama, these employees can still reap the benefits of their health insurance plans, as the government intends to allot $25 billion. These will cover for as much as 65 percent of each employee’s health insurance premiums, according to a report by Reuters.

o Speaking of employment, even the insurance industry is responsible for contributing to the number of jobs available for people in the United States. In two of the largest states in the country, hundreds of thousands are able to find work through many opportunities provided by the state. In California, about 300,000 employees are in the insurance sector, while in Texas, the figure has reached above 216,000 as of 2006. Other states included among the top in the list are Florida, New York, Pennsylvania, and Illinois.

Before Choosing Health Insurance

Understanding Health Insurance

This article is written to assist consumers sift through multiple options, plans, exclusions and summaries of benefits and understand what Critical questions you should ask when researching health coverage. Finding the most beneficial health insurance plan to meet your unique and individual needs is difficult. This guide will help consumers understand the basics of health insurance and what to look for when comparing plans.

14 Costy Mistakes You’ll Want To Avoid

1-FREE – Do You Have a “30 Day FREE Look Period?” Can you get your $ back if you are not happy?

2- DEDUCTIBLES: How many deductibles do I have per year? Some plans will have more than 1 deductible per person per year!

3- NETWORK RATES: Prior to your deductible being met, will your insurance company extend their discounted network rates to you? Example: Insurance Company A – 5 stitches to finger – Total cost $2000, patient responsibility, $800, or Insurance Company B – 5 stitches to finger – Total cost $2000, patient responsibility, $2000. (no network break).

4- NEGOTIATED RATE: What is the AVERAGE negotiated rate? (Sometimes referred to Network Rate – very very important!)

5- UNCLEAR TERMS Is your $100 “co-pay” for an Emergency Room visit REALLY $100? Some companies the $100 copay is more like a fee AFTER your deductible, and you’ll still pay the co-insurance and the $100.

6- LIMITS on benefits, for example: $500 limit or $250 limit on Emergency Room expenses. $50 limit on Dr. Visits. Once the Limit is reached, YOU pay everything else out of pocket. $500 limit on hospital expenses per day (quick way to bankruptcy!)

7- PREVENTATIVE – Will you have to meet your deductible, or do you have a 1 year waiting period for preventative? Do you want to wait 1 year before you can have your female exam, or a mammogram?

8- TRAVEL – If you are out of state, are you covered for illnesses? If you eat something that doesn’t agree with you and become very sick and need a doctor, will you be covered? (Not just life threatening emergencies.)

9- RATE INCREASES – I am buying a “fixed rate”. Ask yourself if it makes sense to pay extra over the next 2 – 3 years for a fixed rate? Make sure your rate is set for at least 12 months but does it make sense to pay in advance for a fixed rate? Sometimes plans will naturally go down in price, so does it make sense to pay extra to have a fixed rate?

10- SUPPORT – After I buy this plan, MAY I CALL MY AGENT’S DIRECT LINE with billing issues, or plan questions, or technical problems, or claims questions or concerns of any kind?

11- EXCLUSIONS – Read the “Exclusions” in your plan. Are the exclusions available for you to read? Is there an exclusion that you cannot live with? For example: exclude well baby visits. Is this an exclusion that you didn’t catch in the plan details?

12- MAJOR MEDICAL plans are designed to pay for MOST of your medical expenses when you become ill or injured. You’ll want a Major Medical plan from a reputable company that has “Credible Coverage.” Discount plans or Limited Medical Plans are NOT designed to protect your losses like Major Medical plans are. They are marketed as “Insurance,” but you MUST ask, is it a Credible Coverage Major Medical plan?

13 – MATERNITY – Maternity plans. Do your homework. Does your plan have an outrageous deductible for maternity? Do you have a waiting period of 12 months, 24 months, or more? How many doctors do you get to choose from “In Network” that can deliver your baby? Are you happy with the choices of Doctors in the network that will deliver your baby? What if your doctor is not on-call the night you go in for delivery?

14- MEDICATIONS – Is there a limit on how much the insurance company will pay for medications. If you become very ill, this could be a very big problem. Do your research, ask questions. Do you have a deductible on medications?

*Did you know that key information about how coverage works is not always disclosed? *When comparing plans, is the language confusing? Why is the language confusing? *Did you know that many consumers compare prices of health insurance plans, but cannot always tell if they are comparing “apples to apples.”

How to avoid Medical Bankruptcy!

According to a Harvard Law and Harvard Medical School study, they found that ½ of all bankruptcies are caused by illnesses and medical expenses. If you are a breadwinner for yourself, or breadwinner for a family or spouse, and the breadwinner gets sick, you may loose your medical coverage, and a way to pay for your day to day expenses.

When you are shopping for a health plan to protect yourself financially from medical bills and bankruptcy, there are many things to consider. Probably the most important thing is to consider is what “Type” of plan you are getting. There are several types of health plans that are available. If you buy a plan that is not “Underwritten” and is “Guaranteed Issue” you are not buying a Major Medical Plan. Major Medical plans will go through a process called “underwriting.”

Some plans will pay a certain dollar amount for a procedure, or a certain dollar amount per day while in the hospital. IT IS CRITICAL you understand the implications financially if choosing a non Major Medical plan. Your chance for greater personal losses including Bankruptcy exist with non-Major Medical plans. If you are shopping price with health insurance, and you decide on a discount or limited liability plan, YOU HAD BETTER UNDERSTAND WHAT YOUR RISKS ARE if you end up needing to use that “insurance.”

Major medical plans are designed to cover most of your hospital expenses if you become hospitalized.

Do you have a disability plan? This type of plan will pay your day to day expenses if you loose your job due to an injury or illness. This should be a very important consideration when getting health insurance. If the breadwinner loses his/her income while injured or ill, how will the day to day expenses be paid for?

The 6 costly misconceptions about Health Insurance

1 – I don’t need medical insurance, I’m a healthy person, I eat right, exercise and take care of myself. This is risk-taking. You are gambling your financial future.

2- I’m not getting insurance because There is no benefit before my deductible. Some Major Medical Plans will A) extend their network rates to you before the deductible is met, but not all. Another benefit before your deductible is met is B) the copays for Dr. Visits and C) Copays for Prescription coverage. Again, check the individual plan.

3- If I get sick, or now that I’m pregnant I’ll get insurance. Once you are ill or pregnant, depending on the illness, you may or may not be eligible for health insurance. Certainly once pregnant, you will not be eligible for an individual plan. The insurance company will always reserve the right to underwrite your medical condition and elect to take you on as a risk, or not. You wouldn’t expect to run out and get auto insurance after you’ve banged up your car and have them pay for it. For this reason, it is important to not let your Major Medical insurance lapse for more than 63 days.

4 – I will get stuck with a bill that I thought should have been paid for, or the insurance company should have paid. Here again, you must do your homework on the plan you intend to purchase. Look for Limits, deductibles, exclusions, co-pays, and understand these details. Also, if you come into a plan with pre-existing conditions and did not have continuous “credible coverage,’ you can expect to pay for your pre-existing conditions for 1 full year.

5- I want excellent care at a cheap price. If you want Major Medical, shop between the competitors, and get the most for your money, but don’t expect the same benefits in a discount plan as in a Major Medical Plan.

6- I’m waiting for the President to take care of this mess. It is not a good idea to wait to purchase medical insurance ever!

Important to Know:

Many People Feel That Health Insurance Companies are Greedy and Corrupt According to the Wellpoint Institute of Health Care Knowledge:

“Popular theories suggest that health insurance premiums are driven by an aging population, excessive insurer profits or medical malpractice. Objective research, however, clearly indicates that these factors have a minimal impact on the high price of health insurance premiums.

If meaningful health care reform, including health care cost containment, is to occur, emphasis must be placed on the real drivers of increased health care costs and concomitantly, health care premiums. These include the following key factors: such as

* Advances in medical technology and subsequent increases in utilization

* Price inflation for medical services that exceeds inflation in other sectors of the economy

* Cost-shifting from people who are uninsured and those receiving Medicaid to the private sector

* High cost of regulatory compliance

* Patient lifestyles, such as physical inactivity and increases in obesity.”

Other Important Facts

Will they check my credit score. NO

Will they require a physical or blood work? In most cases, NO.

All insurance companies are the same. No they are not.

My Premiums keep going up. You can do very little about increases in health care costs. You may want to change plans or increase your deductible to try and save money. Try and find a company that will guarantee their rates for at least 1 year. No need to pre-pay for future rate increases.

Definitions:

DEDUCTIBLES (Phase 1)- Money that you pay out of your pocket before traditional insurance begins. Ranging traditionally from $0 to $10,000. Usually if you choose a lower deductible, your premiums will cost more, if you have a higher deductible, your premiums will be lower (you are assuming a higher risk in exchange for lower premiums).

CO-INSURANCE – (Phase 2) – After you meet your deductible, you’ll pay a “co-insurance.” “Co” meaning 2, two entities will share the burden of the bill; usually you’ll see “co-insurance” as a 70/30, 80/20, 50/50, 60/40, 90/10. The larger portion of the co-insurance the insurance company will pay, the lesser portion you will pay.

MAXIMUM OUT OF POCKET – (Phase 3) – After you’ve paid your deductible, and then your portion of the co-insurance, you finally reach your maximum out of pocket. From this point on, the insurance company will pay the rest of the bill. (Major Medical Plan.)

CO-PAY – A flat dollar amount to be paid at the Doctors office. Sometimes referred to as a “first dollar benefit” (before deductible). Meaning, you pay a flat $30 or $20 or $40 dollar copay, or whatever the copay is, and the visit is paid in full. WATCH FOR LIMITS! Make certain the copay is a flat dollar amount paid BEFORE your deductible.

HMO is Health Maintenance Organization, usually a limited regional/geographical area, with a certain number of providers in the HMO. You will select 1 Dr to manage your care, and your Dr. will “help you decide” if you need a referral or not. HMO’s usually have very low deductibles and copays.

PPO Insurance is Preferred Provider Organization. You may visit anyone you wish in the network, still you must know the geographical area of your Network, even with a PPO plan. If you are on vacation and become ill, will your plan out of state cover you (in network)?

CREDIBLE COVERAGE In order to cover your pre-existing conditions when moving from one plan to another, you must have a Credible Coverage Major Medical plan. It is a document given to you from your insurance company as proof that you had a Major Medical plan protecting you from a start date to an end date. You must not go further than 63 days from one Major Medical Insurance coverage to the next, if you do go beyond the 63 days, you will have a pre-existing condition clause in your new policy that states you will not be covered for any of your pre-existing conditions for 1 full year (at a minimum.)

If you go beyond 63 days without “Credible Coverage,” the new insurer will look to your previous 6 months (average) health history and condition, and not cover you for any ailment you have (pre-existing.)

Now don’t be mistaken, that when you want to go from one insurer to the next, if you were covered with “credible coverage” that you are automatically guaranteed a plan. This is not true. You will still need to be underwritten, and the new company is not obligated to take you on as an insured if you don’t fit their underwriting guidelines.

Please Note: This Free Consumers Guide is meant to be used as informational only. The author herein will not accept liability for any circumstances in which an outside company may define their features and benefits differently than in this document. Consumers will accept this document as informational only, and not a legal document. Consumers will be held responsible for their own purchases, and not hold the authors in this document liable for any actions taken by any consumer. Consumers must verify the plan in which they purchase, and will not hold the information in this document as a specific reason to take or not to take a certain action. This document is produced by a licensed health agent. The 14 Costly mistakes you should avoid when selecting your health plan.

Health Insurance Buyer’s

Buying Shopping for health insurance can leave many people confused. Knowing which insurance company to choose or which insurance plan is the best may seem daunting impossible. But once you know the basics of health insurance, choosing the right health insurance plan is simple easy.

This article will provide some of the most basic and helpful tools and explanations for health insurance shoppers. First, it is important to learn about helps to understand the different types of health insurance plans and their benefits and drawbacks. Plans differ in the amount you pay out-of-pocket, which doctors you can visit, and how the your insurance bills are paid. Besides just helping you choose the most efficient and cost-effective plan, we’ll teach you about another way you can save on health insurance: a Health Savings Account. Additionally, it is important to learn about dental insurance as well. Many health insurance plans do not include dental insurance under their benefits, so we’ll go over how to shop for and obtain separate dental coverage. Then it is important to learn about ways you can save on health insurance. There are several ways you can save including Health Savings Accounts and Discount Cards. LastlyAnd finally, don’t forget to compare plans before you make your decisionwe’ll explain why it’s so important to put your new knowledge to good use by comparing health insurance plans.

Types of Health Insurance Plans

Health Maintenance Organization (HMO) Plans

Generally, HMOs have low or even no deductible and the co-payments will be relatively comparatively low as well. You pay a monthly premium that gives you access to coverage for doctor appointments, hospital stays, emergency care, tests, x-rays and therapy. You will have to choose a primary care physician (PCP) within your insurance provider’s network of physicians, and in order to see a specialist you need to receive a referral from your PCP. Under an HMO plan, only visits to doctors and hospitals with the insurance company’s network of providers are covered; you’ll have to pay for visits if you go to an out-of-network doctors or hospitals your insurance will not cover the costs.

Preferred Provider Organization (PPO)

Plans Under a PPO plan, you will use the insurance company’s network of doctors and hospitals for any services or supplies you need. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Generally, you will be able to choose doctors and specialists within this network without having to choose a primary care physician or get a referral. Before the insurance company will start paying for your medical bills you will usually need to pay an annual deductible. Also, you may have a co-payment for some services or be required to cover a percentage of the total medical bill.

Point of Service (POS) Plans

A POS plan is a combination of the features offered by HMO and PPO plans. You are required to choose a primary care physician, whose services are not usually subject to a deductible, but your PCP can refer you to out-of-network specialists whose services will be partially covered by your insurance company. Additionally, POS plans usually offer coverage for preventive healthcare, which includes regular checkups. Your PCP will be able to give you referrals for any specialists. If these specialists are out-of-network you will need to pay out-of-pocket and then apply for reimbursement from the insurance company. With a POS plan you will benefit from some of the savings of an HMO and will have greater flexibility in choosing healthcare providers, similar to PPO.

Dental Insurance

It is important to get a dental insurance plan along with your health insurance plan. In order to keep your teeth and gums health you need regular visits to the dentist. Without dental insurance, the cost of dentist appointments will be much higher making it difficult to keep up with the payments. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals. In order for the insurance company to cover your dental expenses you will need to send them a claim before they reimburse you for covered services. As a result, you will have to pay more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. On the other hand, managed-care plans will provide you with a dental provider network and you will need to visit dentists within this network in order to get coverage for these services. With a dental care network, the insurance company has arranged pre-negotiated rates that you will receive when you visit these dentists. With a managed-care plan, the dentists will submit the claim for you, lowering your out-of-pocket expenses.

Save on Health Insurance

Health Savings Account

Health Savings Accounts (HSA) are tax-free savings accounts designed to help consumers pay for healthcare services while limiting premium expenses for unwanted benefits. The plans have lower premiums and higher deductibles than other insurance plans because they offer fewer benefits and require you to use the money in your HSA to pay for certain qualified medical services. However, if you don’t need to visit the doctor frequently and don’t anticipate requiring regular medical attention, HSA plans are a cost-effective method of insuring against the worst without paying for coverage you won’t use. In order to open an HSA, you’ll need to have an HSA-compatible health insurance plan. You may only use the funds in your HSA to pay for qualified medical expenses. Usually, your HSA plan will have a deductible that, once met, requires your insurance company to pay for any additional qualified medical expenses for the rest of the year.

Dental Insurance

Health insurance typically does not cover dental services, but in order to keep your teeth and gums healthy, you need regular visits to the dentist. Without dental insurance, regular dentist appointments can prohibitively expensive. Make sure your mouth is covered by shopping for both health and dental insurance. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals for special services. In order for the insurance company to cover your dental expenses you will need to send them a claim for reimbursement. You’ll end up paying more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. By contrast, managed-care plans limit you to the doctors and services within a dental services network, and you will need to visit doctors within this network in order to get coverage for their services. Within the dental care network, your insurance company has arranged pre-negotiated rates that you will receive when you visit dentists in the network. Your dentist will submit your insurance claim for you, keeping your out-of-pocket expenses lower than with an indemnity plan.

Compare the Plans

Comparing insurance plans is an important step in buying health insurance. It will save you money in the long run if you take the time to compare premium prices, out-of-pocket costs, plan benefits, the network of physicians available with different plans, and the quality of insurance providers. If you have a favorite physician, make sure your health insurance covers visits to him or her. If you don’t need to see the doctor very often, don’t pay a high premium for low office visit copayments. Health insurance plans are designed to address specific healthcare needs, and you’ll save money and get the most effective coverage by comparing plans to find the health insurance plan that best fits your budget and lifestyle.

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