Every New Yorker is guaranteed the right to buy health insurance. New Yorkers cannot be discriminated against because of their health status or age. However, a pre-existing condition waiting period may be imposed on you for up to 12 months if you let your insurance lapse for more than 63 days. You should always make sure you have continuous health insurance coverage in order to avoid such a waiting period.

You have three basic options for obtaining health insurance as an individual other than employer or union plans in New York:

1. Private Health Insurance
2. Health Insurance through Associations
3. Health Insurance through Income Eligible Programs

Private Health Insurance
There are two types of plans that are available to purchase as an individual/couple/family:

HMO – You must use providers (doctors, hospitals, labs) participating in your HMO. Your HMO network is local and you must get referrals from your Primary Care Physician before you can see specalists.

POS – You may see doctors outside of your plan’s network, but you will be responsible for at least 20% of the cost of your care in addition to your copay, plus a deductible as high as $1, 000. Additionally, the premiums will be much higher for the POS plans.

Health Insurance through Associations
If you cannot afford any of the plans listed above, you may want to consider the option of joining an association and purchasing insurance as one of its members. When you purchase health insurance at a “group” rate, you usually have a lower premium. Working Today and Media Bistro are two such associations that offer HMO plans in New York. Each of these organizations has its own eligibility requirements.

Income Based Health Insurance Programs
If you cannot afford private insurance or insurance through associations, you may be eligible for goverment subsidized programs that have been designed to help keep New Yorkers healthy and insured.

Source: ahirc.org

1. Health Saving Accounts

Health Saving Accounts is money that you put into an account for future medical expenses. Not only that you could prepare for an emergency, these accounts also offer tax deductions for medical expenses.

2. Higher Deductible Brings Lower Costs

A deductible is the amount you pay out-of-pocket for medical bills. If you have a high deductible, your premiums will fall. Consider the risks to your lifestyle and your medical history before you opt for a high deductible plan.

3. Protect your Health

The healthier you are, the less you’ll pay for health insurance. Many insurance companies offer lower premiums to people who lead healthy lives. Eat fruits and vegetables, exercise regularly and get proper rest.

Pre-Existing Condition
An illness or condition which was treated or diagnosed before the policy was issued. Many policies will not pay benefits for pre-existing conditions, or will only cover treatment of them after the policy has been in force for a specified period of time. This varies based on whether the policy is group or individual coverage.

Renewal and Premium Increase
Determine the conditions under which your policy may be renewed or the premiums increased. Ask what type of renewal provision applies to your policy.

Waiting Period
The amount of time you must wait after buying a policy before coverage begins.

Fee-for-Service Plans
Fee-for-Service plans often are called traditional or indemnity health insurance. Here, the health insurance company pays all or a portion of the bills after services are received by the insured. Other characteristics of a fee-for-service plan include: 1) no connection between the insurance company and the people who provide health care; 2) no restrictions on the doctors or hospitals you must use to receive health care; 3) a deductible may have to be paid before the policy begins to pay; and 4) co-payments may have to be paid each time you have a claim.

Source: ins.state.pa.us

Individual Insuance
Individual insurance includes health insurance coverage you can purchase on your own directly through an insurance company. Many health insurance companies offer individual health coverage to people who either are self-employed or work for a business that does not offer health insurance.

All Pennsylvania residents can buy individual health insurance through the Blue Cross and Blue Shield plans on a guaranteed issue basis. However, your choice of health plans may be limited and you may face a pre-existing condition exclusion period.

Other insurers that offer individual health insurance coverage can medically underwrite applicants and do not have to offer coverage to everyone who applies. You have limited guaranteed access to individual health insurance in most other states.

Employee Sponsored Group Insurance
Employer Sponsored Insurance is group health insurance coverage offered by your employer. The group health insurance coverage purchased by the employer can be through a private insurance company or coverage that is �self-funded� or �self-insured,� meaning that the employer will use its own money to pay for the health care expenses of its employees. It is important to know whether the health insurance coverage under your employer�s group policy is purchased through an insurance company or whether it is self-funded. While self-funded plans may provide excellent health coverage, they are regulated by the federal government and are not required to offer the same benefits as private insurance plans that are regulated by state insurance laws.

Source: ins.state.pa.us

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.”

Source

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.

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