There is a great benefit of having an individual PPO.  These plans usually have very large networks of doctors and hospitals.  These providers are on contract for services.  The contracted amount can be considerably less than the amount charged to persons not insured on a PPO.  It is a very good idea to have health insurance even with a high deductible.  You would receive the discounted PPO contracted rates (normally between 30-50% for doctors and 20-30% for hospitals) and would not be uninsured.  These features can be worth thousands of dollars, and save you from bankruptcy.

CoventryOne HMO (formerly Vista) is a great option for South Florida (Miami-Dade, Broward, Palm Beach, Martin, and St. Lucie Counties).  Dental and vision care coverage is included with all plans.  Hospital emergency room costs only $100 ($500 for the four “Z” plans).  You only pay an office visit co-payment for any covered service—office visits, treatment, procedures, x-rays and labs, diagnostics, etc.—performed in a doctor’s office or urgent care center. Periodic health exams, OB-GYN exams, well baby care and mammograms are provided at no charge.  Deductibles (one plan has no deductible) and daily hospital co-pays (limited to a maximum of 5 irrespective of number of days hospitalized) apply only to the hospital.  All plans provide for prescription drug coverage.

Individual health insurance is medically underwritten.  This means the company gathers the health information on the proposed insured.  The information is obtained from the answers to questions on the application, and doctor and hospital records.  After the underwriter has reviewed the information, a decision is made on whether or how the policy will be offered to the insured.  It may be offered as applied.  In that case it is usually issued and made effective.

If any changes are to be made, the insured will be notified of the proposed changes.  If the person does not want to accept the policy with those conditions, the policy would not go into effect.  Any monies sent with the application (many carriers take payment information but do not require payment with the application) would be returned. No monies can be charged or any fees kept.  The refund would come directly from the insurance company to the applicant.

Medical, standard long-term coverage versus short-term, up to 12 months [some carriers offer a maximum of 11 months] temporary coverage

Medical, standard long-term coverage

Most people select this form of coverage. This type of coverage can be renewable for multiple years and can provide continuous claims coverage over a long period of time.  Most plans of this type cover both major medical expenses (e.g. hospitalization and surgeries) and routine medical expenses (e.g. office visits), subject to deductibles and co-payments or co-insurance.

Short, up to 12 months [some carriers are offering a maximum of 11 months] temporary coverage

Short-term health insurance is a temporary health insurance plan (typically 1 to 6 months and up to 12 months with some carriers) and should NOT be used as a substitute for standard, long-term health insurance.

Short-term health insurance may be right for you if you are:

• Between jobs
• Waiting for coverage for another plan to start
• Laid off
• A recent college graduate
• A seasonal employee

BUT, please keep in mind the following:

• Short-term medical plans are intended as interim or "gap" coverage, i.e. for people who reasonably expect to have standard, long-term coverage (or coverage through an employer) at a future date.
• Short-term policies are designed to provide protection from unforeseen illness or injury; they are not meant to cover routine exams, preventive care, dental or eye care, or immunizations.
• Short-term plans are exempt from HIPAA legislation.  This means that when issuing a short-term medical policy, insurance carriers do not have to guarantee renewal, guarantee issue, or waive the pre-existing condition limitation for individuals eligible for these waivers under HIPAA.
• Most importantly, short-term medical plans provide coverage for a limited time frame only.  Once this time frame ends, you may or may not be eligible to buy additional health insurance, depending on your health at that point in time and the carrier's renewal provisions.

IF YOU ARE UNSURE THAT YOU WILL HAVE STANDARD, LONG-TERM HEALTH INSURANCE (OR INSURANCE THROUGH AN EMPLOYER) WITHIN 6-12 MONTHS, WE STRONGLY RECOMMEND THAT YOU VIEW PLANS FOR STANDARD, LONG-TERM HEALTH COVERAGE NOW, BEFORE THERE IS AN ADVERSE CHANGE IN YOUR HEALTH CONDITION.

1.  You'll want to understand the difference between a "Comprehensive" or "Major Medical" health plan and other types of health insurance.

In general, a "Comprehensive" or "Major Medical" policy covers medically necessary treatment unless specifically excluded by the policy. "Limited Benefit", "Guaranteed Acceptance," "No Medical Questions Asked," and "Hospital-Surgical" plans (which differ from each other as well as from "Comprehensive" or "Major Medical" plans) offer lesser coverage; provide limits on the amount of hospital, surgical, and other benefits provided by the plan (if permitted under the Patient Protection and Affordable Care Act); and exclude certain types of coverage provided by "Comprehensive" or "Major Medical" policies. For example, a "Hospital-Surgical" policy typically provides coverage only for hospitalization and surgery and other medical services in the hospital ONLY or for outpatient surgery in accordance with its terms and excludes all other types of benefit coverage. A "Limited Benefits" policy has limits or pays in accordance with benefit schedules on the coverage it offers (two examples would be a coinsurance for hospital benefits and payment for surgery in accordance with a schedule of benefits). Some of these types of policies only cover treatment that is specifically listed in the policy.

2.  When comparing health plans, check the exclusions and limitations carefully.

A list of plan exclusions should be clearly stated in the sales brochure—almost always at the very end. Many exclusions are typical (e.g. acts of war, self-inflicted injuries, custodial care, etc.), while others are not and should be carefully considered when comparing plans. Watch for an exclusion that says "anything not specifically listed in the policy,” be aware of any annual or lifetime maximums (almost all policies have lifetime maximums but these differ between carriers and policies), and understand limitations or exclusions for important items like outpatient or diagnostic services.
NOTE:  Comprehensive and major medical plans purchased or renewed on or after September 23, 2010 may not impose lifetime limits on the dollar value of essential benefits.  In addition, annual limits will be restricted as determined by the Department of Health and Human Services; these restrictions will not apply to “grandfathered” plans (see number 3 , below). Other rules apply to "limited benefits" and "no medical questions asked" plans and these plans DO contain these types of limitations.

3.  You’ll want to understand the implications of  retaining or changing from a “grandfathered” health plan under the Health Care Reform Act (PPACA or Patient Protection and Affordable Care Act).

If you were insured before March 23, 2010, the effective date of the new law, you will be exempt from certain requirements of PPACA unless you change carriers or make a material change to your plan.Depending on the percentage change, keeping your present plan and changing deductibles would be a material change that loses your exemption.  Click  “grandfathered” health plans to read the news release regarding the regulations that explain how grandfathering works.   You should understand the implications of losing the grandfathering exemption before changing carriers or changing plans/deductibles with your present carrier. Generally, individuals who are participants in grandfathered plans will be exempt from many of the requirements of the PPACA; this is explained more fully in the news release that you will access by clicking on the above link.  Some individuals may benefit by retaining their grandfathered status whereas others may eventually benefit by losing their grandfathered status.  You should discuss these implications with your insurance agent.

4.  The assistance of a top-notch, independent insurance professional can be invaluable - and costs you nothing!

No matter whether it's an insurance company employee, or an independent agent who completes your insurance application, your monthly premium is exactly the same.  Since health insurance can be complicated and expensive, find the best independent agent you can to help you get the most for your money.