Health insurance is available through two types of plans: group or individual. Group plans are offered through an employer or association; individual plans are purchased directly through an insurance company. (For purposes of this brochure, “individual” refers to you and, where applicable, your dependents).

If you work for a company that offers a group insurance plan, or even a choice of plans to its employees, obtaining health insurance may not be a problem. However, if you are not covered by a group plan, or if you want different or additional coverage other than that offered by your employer, you may want to consider buying individual health insurance coverage for yourself or your family, or determine your eligibility for association or government sponsored health insurance.

Source: ins.state.pa.us

Effective Period
The date health insurance protection begins.

Elimination Period
Specified number of days that you must be eligible for coverage or disabled before the policy begins to pay benefits.

Exclusions and Limitations
Conditions or circumstances in which benefits are not payable or may be limited. Some examples of exclusions are suicide or self-inflicted injuries, injuries resulting from war, on-the-job accidents covered by workers’ compensation, eye or dental treatment, cosmetic surgery, services for which no charge is made, and services that are not medically necessary. Some policies also may place limitations on or exclude treatment of mental illness or substance abuse.

Source: ins.state.pa.us

Coinsurance
The share of your covered expenses, usually a percentage, you must pay after the deductible is reached. For example, a policy may require you to pay twenty percent of the cost up to a certain dollar amount.

Conversion of Privileges
Allows the participant or beneficiaries to convert coverage to a different plan of insurance without providing evidence of insurability. The privilege granted by a group policy is to convert to an individual policy upon termination of group coverage.

Coordination of Benefits
Provisions in group policies that limit the total benefits payable under two or more group policies so that benefits do not exceed the actual amount of covered expenses incurred. COB is particularly important when a husband and wife each have obtained family coverage under separate group policies. Some policies may reduce the amount of benefits payable if benefits are payable under other insurance coverage.

Co-Payment
A specified dollar amount a subscriber to a managed care plan must pay for covered health care services. It is paid to the provider at the time the service is rendered.

Deductible
The initial amount of covered expenses a policyholder will have to pay before benefits are paid under the policy. Generally, the higher the deductible, the lower your premium. Remember, the deductible should not be so high that you could not afford to pay it should you become ill. Ask your agent or company representative if the deductible is a flat annual amount or if you must pay a deductible for each treatment, or for each family member. Some major medical policies have what is known as a “variable deductible” which means that the deductible will be the greater of a fixed dollar amount or the dollar amount or the total expense coverage.

Source: ins.state.pa.us

Health Insurance for children most of the times gets on the second priority list if they’re studying in college. However, this happenstance is just one in over 5 million college students who aren’t covered by their parents’ Health Insurance.

Colleges are now offering health insurance to their students. This is a way to entice the parents to choose them over other colleges. Unfortunately, not all college health insurance are the same and therefore the parents need to read the fine print before signing anything:

• Maximum Benefits vs. Deductibles. Most college plans have a very low benefits ceiling—often $30,000 or less. This won’t cover large medical issues such as cancer or injuries suffered in a car accident.

• Interior Caps. Some college insurance plans are structured so it is nearly impossible to take advantage of all the benefits.

• Prescription Drugs. Most plans put a cap on the coverage for prescription drugs. These caps, however, can vary from $400 to $5,000-plus.

• Exclusions. At the bottom of most insurance plans is a list of exclusions—medical issues or procedures that aren’t covered.

• Loss Ratios. Colleges seldom disclose a key statistic for judging their plans, known as a “loss ratio” or “benefits ratio.”

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For many illegal immigrants, the fear of deportation outweighs the pain of illness or injury, so they live with their afflictions until their health problems become critical which makes things worse for them, for hospitals that eventually treat them and for taxpayers who ultimately foot the bill.

The health care costs associated with treating undocumented immigrants are unclear because hospitals and community health centers do not ask patients about their legal status. According to USA Today, a recent Congressional Budget Office report found that at the state and local level, undocumented immigrants cost more in public services such as education and health care than they pay in taxes.

A lot of insurance companies have emerged during the past decade. Most of them offer quite a good package when it comes to health insurance but, only a few stand out as premiers of health insurance policies. iii, or the Insurance Information Institute released their share of the top 10 health insurance companies in the United States:

1. UnitedHealth Group
2. Wellpoint Inc. Group
3. Humana Inc.
4. Aetna
5. HCSC Group
6. American Family Group
7. Highmark Inc.
8. Independence Blue Cross
9. CIGNA Health Group
10. Blue Cross Blue Shield of Michigan Group

The UnitedHealth Group leads the race with about 12.4% of the market share. The next insurance company, Wellpoint Inc., lie 3 notches lower with a market share of 9.05%. The rest of the companies either got a 4, a 3, a 2 or a 1 percent share in the market.

Photo taken from http://www.farecompare.com

Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it’s an institution in decline. Between 2000 and 2004 the number of Americans fewer than 65 rose by 10 million. Yet the number of nonelderly Americans covered by employment-based insurance fell by 4.9 million.

The state of Kentucky has agreed upon to oblige health insurance companies to permit the parents of unmarried children under their health insurance roof until the age of 25. This House Bill 440, would require the parents to pay up an additional amount to keep their children (categorized already as adults) under their health plans.

Aside from the said coverage of the Bill, it also requires health insurance companies to give a “90 days in advance” notice to their clients if they wish to increase the amount of their premiums. The said House Bill is already in the hands of Governor Steve Beshear, and is awaiting his signature.

Photo taken from http://www.coatbankmedicalpractice.co.uk

By Aileen Banting

A good insurance system for employees launched by U.S. Department of Labor’s Employee Benefits Security Administration (EBSA), will keep away those frauds and scammers from the hard-working citizens of America. Insurance plans are regulated by the mentioned department. They formulate and implement rules that an insurance employer must follow when presenting health insurance coverage to employees. It is against the rule for an insurance employer to single out an employee because his or her hospitalization bills are too costly. In addition to this, if there are twenty or more employees at your work, COBRA continuation coverage should be offered to you upon leaving your job. EBSA works to make sure everything is in order and your rights are protected.

One of the things most people who lost their jobs (either through resignation or termination) is health insurance for them and their family. However with the Consolidated Omnibus Budget Reconciliation Act of 1985, otherwise known as COBRA, that will all changed.

For a name synonymous with snakes and poisons, it can help you weather out the storm while you look for a new way to cover health insurance for yourself and your loved ones. According to this act you have the right to continue your former employer’s group plan for individual or family health insurance for up to 18 months at your own expense.

If you’re currently employed, ask your HR personnel for more details.

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