Health Insurance Ideas

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Lets begin with some different types of health insurance plans.

 

 

Preferred Provider Organization health insurance plans. These plans are more commonly called PPO plans. With this type of health insurance plan, most times you must use a provider that has agreed to accept a scheduled fee payment from the health insurance company for a covered procedure. You may receive care outside of the network, however the costs will be somewhat higher.

 

Health Maintenance Organization health insurance plans. These plans are called HMO’s for short. Usually with an HMO plan, you must select a Primary Care Physician that belongs to the network, and be referred to a specialist. Costs are most times less expensive than a PPO, but you have a more limited selection of doctors and hospitals to choose from.

 

Health Saving Accounts, these health insurance plans are a tax-advantaged health plan. They are designed for use with a HDHP, which stands for a high deductible health plan. You pay for a greater amount out of your pocket up front, but the money put aside for these plans is done so on a pre-tax basis, and the funds, once deposited into your HSA account can earn tax free income. These health insurance plans work well if you are healthy, and don’t use health insurance benefits often. HSA’s can be either a PPO, or HMO type of plan. If you are in the 40% tax bracket, you just saved 40% on your health insurance dollars.

 

I could do a whole web site on HSA’s, someday maybe I will, but for now consult with a licensed health insurance professional in your State. HSA’s are a great tool for savings if used properly

 

Please keep in mind there are 50 states, which usually means 50 different interpretations of  what a health insurance policy must do.

 

Some States are rider States, meaning you can get health insurance coverage for a pre-existing condition, but the coverage will be ridered, or not covered for a set amount of time, or in some States not at all. Some States will call this an exclusion. The results are the same, limited or no coverage for the pre-existing condition. Some states don’t allow exclusions or riders, so you’re either accepted or declined depending on your pre-existing conditions, and or prescription drug use.

 

There are a few States where the health insurance coverage is guaranteed issue, meaning you can’t be turned down for a pre-existing condition. Other States may have a high risk pool for the un-insurable, or an insurer of last resort. While many States are working to standardize health insurance coverage nationally, I can only generalize about health insurance policies here.  

 

Please check with your States Department of Insurance, or seek the advice of a licensed health insurance professional in your State to see how your State handles pre-existing conditions.

 

OK, so before I go into a lot of detail on the working parts of a health insurance policy, I thought this might be a good spot to go over some of the potential pitfalls you may incur in your pursuit of health insurance coverage.

 

There are many factors used by the health insurance companies to determine if a person is even eligible for health insurance coverage in the first place, this of course refers to non-guaranteed issue health insurance states.

 

Some of the health insurance factors include:

 

Smoker or a Non-Smoker. Smoking can increase your rates by as much as 50%

 

BMI this stands for Body Mass Index. This is your height to weight ratio, believe it or not, it’s possible to receive a rate increase due to being underweight, as well as, overweight. Some health insurance companies will increase your rate up 10% to 40% depending on the severity of the issue.

 

And the big one

 

Pre-existing conditions. This is probably one of the most misunderstood, but highly important factors in determining not only the cost of your health insurance coverage, but how much you will pay for your health insurance coverage, and if you are even be offered a health insurance policy by the companies underwriting department.

 

Health insurance agents, if you have a good one, are on your side. Chances are, they don’t get paid if you can’t receive a policy. Beware however, if you feel you should lie, or worst yet, be encouraged by your health insurance agent to use intentionally misleading information on a health insurance application.

 

Sure, you may be off a few pounds in weight, or a half an inch in height, but that’s not what I’m talking about here. I’m talking about intentionally lying, or being misleading about smoking, recreational drug use, prescription drug use or the fact your have a known medical condition, that while you may or may not have received medical care for, that a reasonable person would have sought medical attention for that condition. The health insurance companies can, and in many cases will, deny your health insurance claim for this behavior.

 

Unlike a life insurance policy where there is a two year look-back provision for pre-existing conditions, there is no limitations on how many years back a health insurance company can go to research your pre-existing conditions. Trust me, if a health insurance company is going to pay a $500,000.00 claim for a lung cancer operation, believe me, they will take a hard look at your health insurance application after the fact.

 

Bottom line, be as truthful and honest as you can be when filling out your health insurance application.

 

Just a quick note on some of the tools, and information the health insurance companies have available to them for research when you submit an application for health insurance coverage.

 

They will run a MIB report, which stands for Medical Information Bureau, and a Prescription Drug Report. These reports are basically like a credit report about your health history. They will contain all the information of your past paid medical, and prescription drug expenses. These reports are compiled, and shared among the health insurance and life insurance companies

 

I would recommend obtaining at least three health insurance quotes, from three different health insurance companies for the same deductible amount, and the same basic benefit options. Prices can, and many times do vary greatly in each state for the same health insurance coverage.

 

That was a lot of very important information to digest, so make sure to read it again if you must to become familiar with it. Remember, our goal is to make you as knowledgeable as possible before you discuss your health insurance options with a licensed health insurance professional.

 

Now, I think we are ready to take a look at what is included in a health insurance policy, click here to continue.