Whether it’s a minor sickness, injury or a major disease, visit a doctor and the inflated medical bill will jolt you into looking for health insurance ASAP. Survey the market and you will find that there are two major individual health insurance plans, managed care health insurance plans and fee-for serviced plans.
The managed care health plans can be further categorized under the preferred provider organization (PPO) and the HMO. The highlight of the managed care plans is that these insurance companies manage your choice of health provider. They have a list of doctors and hospitals and only if you restrict your visits to the service providers in the list, then only will the plan cover your medical costs. This is not say, that you have no choice regarding the health provider. Under some managed care health plans, you can visit a doctor of your choice, but the financial benefits provided, you visit a listed doctor, are far greater.
Also, if you opt for the managed care health plan, you will need the nod of approval of a listed doctor, in case you have to visit a specialist. You must also keep in mind that usually there are many alternative ways to a treatment, and if a situation so arises, the general tendency of the insurance providing company would be to settle for the option that is the least expensive.
Fee-for-service plans: These are the traditional health insurance plans, and they are also known as the indemnity plans. They are costlier than the managed care plans, but their major advantage is that you can visit a service provider of your choice. This plan is especially suitable for those who are suffering from an illness and have faith in their own doctor only.
Apart from the above, the state of Texas also provides coverage to pregnant women and people with special disabilities.
There are also the Texas Health Insurance risk pool health coverage plans, which cover families whose income is high enough to exclude them from Medicaid, but at same time not high enough to buy private insurance. In act, the Texas Legislature also provides for two plans to provide health coverage to children between 0 to 19 years. These are the CHIP and children Medicaid program.
The aim of both these programs is to provide health coverage to children in terms of check-ups, immunization, preventive health care, labs tests and doctor visits.
By: Peter Emerson
Posts Tagged ‘Health Plans’
Health Insurance Plans Covering Maternity
March 14th, 2010
Many families are in search of affordable health insurance that will provide maternity or pregnancy benefits. Health carriers offer such plans, but they vary in the amount of coverage provided. Many insurers will not provide benefits to the insured for at least nine months.
As with all things insurance related, you must plan ahead. Occasionally, consumers are interested in maternity policies once they are already pregnant. They are disappointed to learn insurance cannot be purchased to cover a pregnant spouse – pregnancy is a preexisting condition. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.
When is My Pregnancy Covered?
Generally, policies will provide benefits for maternity after the insurance has been in force for nine months, but some carriers offer plan with limited benefits that begin day one. However, if you were to purchase a plan with a nine month waiting period, your pregnancy would not be covered if the child was delivered before the nine month window had expired. Again, it is prudent to plan ahead and purchase a policy with a maternity rider some months before conception.
It might be helpful to look at this from the insurance provider’s point of view. Typically, when a couple desires and pays for a maternity plan, then they are likely to use it. The insurance company is relatively certain that a claim will come in the near future. Thus, they will build the cost into the premium for the insured (you) and mandate a waiting period. That being said, some companies are offering plans that are more attractive than others.
A Popular HSA Maternity Plan with a Reasonable Deductible
One insurance company offers a Health Savings Account (or HSA) with a maternity rider and a low $1,500 individual deductible. Once the deductible has been reached and the nine month waiting period has been satisfied, the plan would cover the balance of the pregnancy. In this example, you could fund the HSA account with at least the $1,500 and write that off against your income. The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in. Currently, this HSA plan is one of the more popular policies available.
Another popular plan has no waiting period and provides more benefits the longer the policy is held. The maternity rider will cover $2,000 toward a pregnancy in the first two years. During years three and four, the policy will pay up to $4,000 and years five and on the policy provides coverage up to $6,000.
Another option is to simply self insure for a pregnancy. Many consumers will purchase traditional health insurance or possibly an HSA qualified plan and save each month in order to cover maternity expenses.
How are Pregnancies Billed?
At this point, clients often ask about pre-natal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, pre-natal care and delivery are all included as part of the pregnancy and usually subject to one, pre-determined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.
When purchasing health insurance policies covering pregnancy, you must plan ahead. There are several options available, but you will get the most from your policy if you do your due diligence and purchase the policy ahead of time.
Request a Health Insurance Quote with Maternity
By: Adam Hyers
