Health Advice
Buying Tips
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 and would not be uninsured. These features can be worth thousands of dollars, and save you from bankruptcy.
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 new "Z" plans that have been recently introduced). You only pay an office visit co-payment for any covered service--office visits, treatment, procedures, x-rays and labs, diagnostics, physicals, PAP smears, PSA tests, etc. -- performed in a doctor's office or urgent care center. Mammograms are provided at no charge. Deductibles (some plans have none) and either co-insurance or daily hospital co-pays limited to a maximum of five (plans have either co-insurance or hospital co-pays but not both) 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 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 moneys sent with the application (many carriers take payment information but do not require payment with the policy) would be returned. No moneys 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 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 and annual exams), subject to deductibles and co-payments or co-insurance.
Short, up to 12 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 "Major Medical" health plan and other types of health insurance
Understanding terms such as a "Basic Medical", "Hospital/Surgical" or "Limited Benefit" is very helpful. In general, a "Major Medical" or "Comprehensive Major Medical" health plan covers medically necessary treatment unless specifically excluded in the policy. On the other hand, a “Basic Medical”, “Medical and Surgical Expense”, or “Limited Benefit” plan typically covers only treatment that is explicitly listed in the policy and provides limits on the amount of hospital, surgical and other benefit charges for which the plan will pay. Look carefully at the difference. The latter type of plans serve a purpose. However, some are designed to look like a "Major Medical" plan and are aggressively marketed. If you qualify and you want the most comprehensive protection, look for the phrase "Major Medical" or "Comprehensive Major Medical" on the offering brochure or policy.
|
2. When comparing health plans, check the exclusions carefully.
A list of plan exclusions should be clearly stated in the sales brochure - almost always at the very end. Many exclusions are typical (i.e. acts of war, self-inflicted injuries, custodial care, etc.), while others are not and should be carefully considered when comparing plans. For example, does the plan have a waiting period for certain conditions? Also, watch for the typical exclusion of a "Basic Medical" plan - "anything not specifically listed in the policy."
|
3. A "stop-loss-limit" restricts the amount of medical charges you pay. NOT all policies include such a limit.
After you pay the deductible, major medical insurance normally pays a portion of the covered charges (i.e. 80%) and you pay the other portion, known as "co-insurance", until your out-of-pocket expense equals the amount stated in the policy (this is called the "stop loss" limit). Once you've paid your limit, the policy then pays 100% of the covered charges up to the policy maximum. Be sure you're protected with a stop-loss-limit. In a PPO, you should check for a stop-loss-limit on both "in-network" and "out-of-network" as well as annual and lifetime charges.
|
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.
|
|
