www.lookinghelp.com OVERVIEW HEALTH INSURANCE by ramon de jesushernandez 2010
www.lookinghelp.com Overview Health Insurance Health insurance is an important coverage that helps protect you and your family from the devastating financial effects of unexpected health problems or catastrophic illness. Health coverage can be issued to individuals, to employees of an employer offering health coverage, or to individuals that are members of association groups. Some health coverage is provided by self insured funds, not regulated by the State of Florida. Although there are other forms of health insurance, the three main categories of health insurance are:
www.lookinghelp.com Policies that provide coverage or Comprehensive Major Medical coverage Most group health insurance policies fall into the category of major medical policies. The major medical policies are more expensive because they provide more benefits than basic policies. A major medical policy usually pays a percentage of covered expenses (typically 80%), after you pay the deductible. Insurance companies use pricing programs to determine the average cost of a procedure, however, this cost may differ from the actual cost that you receive. The disbursement ceilings restrict the amount of coinsurance you pay for. Not all policies include such limits, but those that do include pay 100 percent of remaining covered expenses after you pay the coinsurance amount established.
www.lookinghelp.com Policies to Provide Managed Care Services The system combines managed care delivery and financing of health care services. This limits the choice of doctors and hospitals. In return for this limited choice, you'll usually pay less for medical care (eg doctor visits, prescriptions, surgery and other covered benefits) than we would pay with traditional health insurance. The network of managed care controls health care services.
www.lookinghelp.com Types of Managed Health Care are:
www.lookinghelp.com Preferred Provider Organizations (PPO) PPOs offer a provider network to meet the healthcare needs of their policyholders. A traditional insurer provides health benefits. An insurer contracts with a group of health care providers to control the cost of providing benefits to policyholders. These suppliers charge lower rates than usual because they require a rapid and serving a greater number of patients. Policyholders usually choose who will provide their health services but pay less in coinsurance with a preferred supplier to a non-preferred provider.
www.lookinghelp.com Maintenance Organization (HMO) HMO members pay a monthly fixed dollar amount (similar to an insurance premium), which gives them access to a wide range of health care services. In many cases, members also pay a predetermined amount or copay for each doctor visit or emergency room and for prescription drugs instead of paying all the supplier and get some money back later. Members must use the network of HMO providers may include physicians, pharmacies and hospitals contracted by the specific HMO.
www.lookinghelp.com Plans under Point of Service (POS) In a Point of Service plan (POS, by its initials in English), the insured members can choose, at the point of service, and receive care from a doctor that is within the plan network or leave the network to receive the services. The POS plan provides less coverage of medical expenses that is provided outside the network for costs incurred within the network. In addition, the POS plan will generally require you to pay deductibles and coinsurance costs for medical care received outside the network
www.lookinghelp.com Exclusive Provider Organizations (EPO) In an array of type EPO, an insurance company contracts with hospitals or specific suppliers. The insured members must use contracted providers or hospitals to receive the benefits of these plans.
www.lookinghelp.com Policies that provide limited benefits Although there are others, better known policies that provide limited benefits are:
www.lookinghelp.com HealthInsuranceTips Verify before you buy Contact Florida Department of Financial Services to verify the license of the agent and the insurance company before signing an application for a policy. Guides toHelthInsurance The guides are excellent tools if you are looking for a specific type of insurance and want to get a better understanding of all aspects of the product before purchase. List of Small GroupInsurance A list of companies offering health insurance to Small Business Owners of Florida.
www.lookinghelp.com HealthInsuranceTips List of InsuranceforPrivatePersons A list of companies marketing health insurance policies with guaranteed issue for eligible individuals as defined in Section 627.6487 (3) of the Florida Statutes. Cover Florida provides access to affordable health service and quality. Plans are available for all applicants from 19 to 64 years, who have not had health insurance for at least six months and who are not eligible for a program of public health insurance. Read your policy carefully Know your deductible and coinsurance provisions understands. Know your liability in case you need a referral to see a specialist. Also, learn about their rights to file an appeal or grievance if a complaint which you believe should be paid, is rejected.
www.lookinghelp.com HealthInsuranceTips Individual plans have a provision for review period of 10 days. This allows you to return the policy and receive a full refund if you do not agree with the policy. An individual policy should include provision of grace period. The grace period is 7 to 31 days, depending on how much you pay in insurance premium. Individual HMOs must grant a grace period of 10 days.
www.lookinghelp.com There are other types of health-related services that are NOT health insurance plans These are: Plans Sale Medical Discount Plans, Discount Plans, Prescription Discount Plans Dental Discount Plans and Eye are plans in which consumers pay a fee to join a plan and in return, the plan offers discounts on products and certain services through participating providers. Often, members who adhere to this plan are issued a card similar to an insurance card that identifies them as members. However, these plans do not work as safe.
www.lookinghelp.com Medical Discount Plans. Considerations Before joining a plan (Medical, Prescription, Dental, Vision, etc.) Note the following:
Terminating health insurance while taking out a discount plan
may limit your ability to purchase insurance at a later date.
If you leave a health insurance, you may lose coverage of
preexisting conditions when making the request again.
Providers that are contracted by the plan can change without
advance notice to the member.
Some plans contain administrative costs and fees.
The cancellation of the plan and reimbursement policies may
be restrictive, be careful to pay all costs upfront rather than monthly.
www.lookinghelp.com Medical Discount Plans. Considerations
Plans may provide little or no benefit if you move or when
you travel outside the area.
The discounts are advertised may change or may apply only
to certain services or prescriptions. For example, many savings plans to ensure a certain percentage, but "up to 40 percent" does not guarantee savings of forty percent. Discounts are sometimes exaggerated and often include various percentages, ie 15-60% for it is often difficult to see and understand the savings.
By using a discount plan with health insurance, most
providers are not required to reduce rates with a discount card because they have already agreed to reduce its rates with a health insurance plan