HEALTH INSURANCE:

 
 
Health Insurance Articles & Information:

Insurance Learning Center: Health Insurance - including Health Insurance Articles, definitions, & tips for getting the most from your Health Insurance.

   
     

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How do I pick a health plan?

Whether your employer gives you a choice of plans or you need to purchase your own coverage, it is crucial that you understand your health insurance choices and pick the insurance that is best for you and your family.
Here are some questions you should ask yourself when choosing a health insurance plan:

How affordable is the cost of care?

  •  What is the monthly premium I will have to pay?

  •  Should I try to insure most of my medical expenses or just the large ones?

  •  What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?

  •  After I have met my deductible, what percentage of my medical expenses are reimbursed?

  •  How much less am I reimbursed if I use doctors outside the insurance company’s network?

Does the insurance plan cover the services I am likely to use?

  •  Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company’s network?

  •  If I want to use a doctor outside the network, will the plan permit it?

  •  How easily can I change primary-care physicians if I want to?

  •  Do I need to get permission before I see a medical specialist?

  •  What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?

  •  If I have a preexisting medical condition, will the plan cover it?

  •  If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?

  •  Are the prescription medicines that I use covered by the plan?

  •  Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?

  •  Does the plan cover the costs of delivering a baby?

    

What are my health insurance choices?


There are essentially two types of health insurance plans: indemnity plans (fee-for services) or managed care plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one "best" plan for everyone. Some plans are better than others for your or your family’s health care needs, but no one plan will pay for all the costs associated with your medical care.

Here is a brief description of the types of available health insurance plans: Indemnity Plans; Managed Care Options; and Government-sponsored Health Insurance

A. Indemnity Plans


Cafeteria/Flexible Spending Plans are employer-sponsored plans that allow the employee to design his or her own employee benefit package, choosing between one or more employee benefits and cash. Several types of Flexible Benefits or Cafeteria Plans are used by employers, including a pre-tax conversion plan, multiple option pre-tax conversion plan, medical plans plus flexible spending accounts, and employer credit cafeteria plans. For more information about these choices, contact your employee benefits department.

Indemnity Health Plans allow you to choose your health care providers. You can go to any doctor, hospital or other provider for a set monthly premium. The plan reimburses you or your health care provider on the basis of services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses, so that once an individual or family reaches the limit, the insurance covers the remaining eligible medical expenses in full. Indemnity plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services.

"Basic and Essential" Health Plans provide limited health insurance benefits at a considerably lower cost. When buying such a plan, it is extremely important to read the policy description carefully because these plans don’t cover some basic treatments, such as chemotherapy, certain prescriptions and maternity care. Furthermore, rates vary considerably because, unlike indemnity plans or a managed care option, premiums are community rated and are based on age, gender, health status, occupation or geographic location.

Health Savings Accounts (HSA) are a recent alternative to traditional health insurance plans. HSAs are basically a savings product designed to offer individuals a different way to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. Instead of paying a premium, you establish a tax-free savings account that covers your out-of-pocket medical expenses. This means that you own and control the money in your HSA. You make all decisions about how to spend the money without relying on a third party or a health insurer. You also decide what types of investments to make with the money in the account in order to make it grow. However, if you sign up for an HSA, you are generally required to buy a High Deductible Health Plan as well.

High-Deductible Health Plans (HDHP) are sometimes referred to as catastrophic health insurance coverage. An HDHP is an inexpensive health insurance plan that kicks in only after a high deductible is met of at least $1,000 for an individual or $2,000 for a family.

 
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