Individual
Health Insurance: Help When You Need It
Anyone who has been on group health insurance and has suddenly
needed to find individual insurance has probably felt a bit overwhelmed.
When you are trying to interpret the terms yourself and are trying
to get a reasonable price for the medical coverage you need, you are
likely to think the best part of your former job was the health coverage.
Fortunately, while it may not be simple, finding affordable, individual
health insurance is not impossible. We can help you find the health
care plans that best fit your needs, whether you want a low priced
HMO or PPO or would prefer a traditional insurance that lets you choose
your own doctors and maintain more control over the care you get.
The following
points should be on your list of questions to ask the company or
agent with whom you apply for a policy.
- What is the deductible?
Can you lower your premium by opting for a higher deductible?
- How are claims paid?
The amount the company will pay for each claim could be "as
charged," meaning it will pay whatever the doctor charges
after your deductible is met. The other option is "usual and customary,"
which is actually a payment schedule designed by the government
for use when determining Medicare payments. While most insurance
companies pay the doctor more than Medicare pays, they still usually
base the payment on the "usual and customary" rate schedule.
- How quickly are claims
paid?
- Pre-existence clause.
Most private insurers have clauses that exclude payment for a
condition you already have. Check to see how long you must have
the insurance before pre-existing conditions are covered.
- Is pregnancy included?
At what rate of coverage? Does it require an additional rider?
- Are organ transplants
covered?
- Does the policy include
any wellness benefits such as a membership in your local fitness
organization?
- How soon can you
expect a rate increase? Are you likely to get a rate increase
if you have a major illness?
- What type of policy
is it? Is it a PPO, HMO, traditional Fee for Service, or something
else?
- If the policy is
the type that uses a network of caregivers—such as an HMO, is
your doctor in the network?
- Are prescription drugs
included? At what copay?
- What are the restrictions
for surgery or emergency care? Is prior approval required in order
for the company to pay for care?
- What is the lifetime
maximum?
The most important part
of looking for individual health insurance is in understanding what
you want and need. Too often, people do not know what they have
until they try to use it and find that what they thought they had
simply isn't in the policy or is written differently than they expected.
Most health insurance
companies will allow you to apply and receive a policy before sending
in the first premium. This will give you a chance to go through
the policy carefully and to ask questions about anything that seems
ambiguous. Be sure to take advantage of our free service to assist
you in finding the policy that best fits your needs.
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