Understanding health insurance plans is very confusing for most consumers. It doesn’t matter whether you buying health insurance for the first time or just want to consider changing plans. We spoke to some of the industry experts and got answer to some of the most frequently asked questions.
What kinds of individual and family insurance plans are available?
There are three types of Individual and family health insurance plans described as either “indemnity”,”PPO” and “managed-care” plans. Put broadly, the major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, PPO plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different types of health insurance plans. These include HMO, PPO, and POS plans. HMO’s are managed care as the insurance company determines who your doctors are and what care you will receive. POS plans are geographically focused plans that are a cross between a HMO and PPO. PPO’s make use of healthcare provider networks and you are free to choose your own doctors within the network. Healthcare providers within a network agree to perform services for PPO plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a PPO health insurance plan. You’ll have an even broader choice of healthcare providers with an indemnity plan because there is not network; it’s any doctor, any hospital, anywhere.
When can I start making appointments with my physician?
For individual insurance coverage, it depends on how long it takes for your enrollment papers to be processed through underwriting and how long it takes to review your medical records for preexisting conditions. It may take anywhere from two weeks to three months after you have submitted your enrollment paperwork plan carrier to complete underwriting. This delay depends on how long it takes to get records from your physician. Your policy only becomes effective when underwriting is completed and the insurer has agreed to issue a policy. You may see your physician after the effective date.
My spouse is losing his/her job and won’t have insurance. When can I add him/her to my health insurance?
If you have group insurance, you may add you spouse during the open enrollment period. But for individual insurance, you may submit you spouse’s application and proceed through the enrollment process at any time.
How do I change health plans?
Each year during the open enrollment period, you may elect to change your health plan carrier under group insurance. You may change your plan at anytime if you have individual insurance.
Are there preexisting condition limitations if I change health plans?
There is no preexisting condition limitation under your new plan when you transfer plans under group insurance. Any condition for which you are receiving treatment prior to your coverage change will be covered immediately by your new plan.
What happens to my health insurance when I retire?
This can be a scary situation. Retirement typically means you are older and may have a possible accumulation of preexisting conditions, which could make you uninsurable, or your preexisting conditions could be excluded. Meaning, you suddenly have to cover the cost of expensive meds or care. Fortunately, Colorado is one of 26 states that provide a safety net through a high risk uninsurable pool. If you have had coverage within 60 days, your preexisting conditions are covered immediately. Otherwise your preexisting conditions will be covered within six months as long as you are a resident of Colorado. You may find further information about this type of coverage at http://www.covercolorado.org.
What happens to my health insurance when I resign from a job?
You are entitled to continue the health coverage for up to 18 months under a Federal law referred to as COBRA. Cost of coverage is borne fully by the employee.
We will be having a child soon. How do I add this child to my health and dental insurance coverage?
You may notify and add new born children within 30 days of their birth date. Adopted children may be added after they fill out an application and go through the enrollment process.
By: Bruce D Hunter
Posts Tagged ‘Common Health’
Choosing a Health Insurance Plan to Benefit Your Health
November 7th, 2009
The health insurance market offers lots of choices these days. Choices are great because individual and family health needs are diverse. However, with so many choices, it can be hard to understand which plan will be the best one for you and your family. Let me try to explain the most common health plans in simple language.
Preferred Provider Organizations (PPO) are probably the most common type of plan. The name refers to a network of medical service providers which which the company prefers that you use. In return, you will get the lowest cost and most coverage inside of this network. However, you will still be covered if you choose a provider outside of the network. In most cases, the insurer will make an exception for emergencies or in the rare case where you need a type of medical care that is not included in the network. If you need an outside provider, you should get the procedure approved before getting the service if it is possible. PPO plans offer cost savings and flexibility.
Health Maintenance Organizations (HMO )plans are similar to PPO plans because they include a network. However, the rules are more restrictive because most of the time services will not be covered at all outside of the network. As with PPO plans, emergencies and cases where there is no network provider may be covered outside of the network. Again, if possible, these exceptions should be approved ahead of time. HMO plans can be restrictive, but provide a large coverage benefit.
Heath Savings Account (HSA) plans are high deductible health insurance policies that work with a savings account. The savings account allows tax deductible contributions, though the government imposes limits for each year. And it can be used for a variety of medical services, like dental and vision, which are not covered by some medical plans. Any unused money rolls over until the next year. In addition, unused money can be withdrawn at retirement without a tax penalty. HSA plans are good options for disciplined savers who want control over their health care dollars.
Specified benefit plans provide specified benefit amounts for covered benefits. For instance, a benefit amount of $1200 might be allowed for a compound fracture, or $50 might be allowed for a visit to a primary care providers. Sometimes these plans are called mini-medical or limited benefit plans. They usually do not provide the most complete coverage, but may have affordable premiums and allow applicants with health conditions that the other major medical plans will not accept.
By: Marilyn Katz
