Understanding Basic Health Plans


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When it comes to health insurance, understanding your options may seem a little daunting. We have put together this presentation to help you understand your options. The first step to choosing the right health insurance for you and your family is understanding your options.

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  • John & Mary, many people do not realize that insurance costs the same no matter where you buy it as it is regulated by the state. The advantage of working with an agent is that you have someone on your side making sure you get what you are looking for at the best price available.The advantage of working with me versus other agents is I actually work with the largest selection of carriers available. What I mean by this is most agents only work with just two or three companies and then try to find reasons why you should buy one of those companies. It is more important to me that you actually get the plan you need regardless of which company it is with. I am sure you are tired of having to shop for insurance, right?Well, you can feel comfortable that today we will find the best plan for you and you won’t have to keep shopping around. Would that be okay with you?
  • As I mentioned, we work with the largest selection of insurance companies. This is the list of companies we currently represent. Did you realize there were so many of them? It is nice to know that we are checking with all of these companies to find you the right plan and not just two or three, isn’t it? Of course it is.Who are a couple of people that you know that are struggling trying to find insurance right now? Are they open minded people? Do you think they would mind if I sent them a letter or email?Great. What are their names and address or email address?John & Mary, the information I will go through should answer most of your questions,   Option 1. But I would like you to use this notepad to write down any questions that come up so we can address those at the end. Would that be okay? GreatOption 2. But if you have a question, stop me, because I can only help if this makes sense. Fair enough? Great.
  • Understanding Basic Health Plans

    1. 1. When an Apple a Day Isn’t Enough…<br />
    2. 2. <ul><li>Most Americans either receive health insurance coverage through their employers or are covered by a family member’s policy.
    3. 3. If you leave your job you will lose your employer-supported group coverage.
    4. 4. Not every employer offers health insurance, especially small businesses.
    5. 5. You may not be eligible for health insurance through your company if you work part-time. </li></ul>http://healthcompare.org/<br />
    6. 6. COBRA (Consolidated Omnibus Budget<br />Reconciliation Act) allows for an extension of<br />coverage through the group health plan for a<br />specified length of time, although the premium<br />is usually higher. <br />HealthCompare.org<br />
    7. 7. Indemnity health care plans offer a greater choice of care providers. You are not restricted to a specific group of physicians, hospitals, specialists or other health care providers. <br />HealthCompare.org<br />
    8. 8. Managed care plans work  within a network of doctors and hospitals or “providers.” To receive the benefits of the discounts negotiated with specific doctors, hospitals and health care providers, you must use services from providers in the health plan’s network. <br />HealthCompare.org<br />
    9. 9. You’ll find some indemnity plans that offer managed care-type options, and some managed care plans that allow for members to use providers who are "outside" the plan’s specific network.<br />HealthCompare.org<br />
    10. 10. Three common types of managed health care plans<br /><ul><li>PPO plans
    11. 11. HMO plans
    12. 12. POS plans</li></ul>HealthCompare.org<br />
    13. 13. <ul><li>Health plans negotiate discount agreements with doctors, hospitals and other providers, and pass along the negotiated or discounted prices to plan members.
    14. 14. HMOs use restrictions to control costs.</li></ul>HealthCompare.org<br />
    15. 15. You may need to select a primary care physician from a register of area physicians. Use as a gateway for all your health care needs and decisions, including referrals to obtain specialized medical treatment so costs can be managed easily.<br />HealthCompare.org<br />
    16. 16. Health Maintenance Organizations (HMOs) often require you to see a provider within the network and to obtain referrals from a primary care physician. <br />HealthCompare.org<br />
    17. 17. Questions to compare plans:<br /><ul><li>How do I determine which doctors are accepting new patients?
    18. 18. Can I change doctors?
    19. 19. How are referrals handled if I need care from a specialist?
    20. 20. How is emergency care handled?
    21. 21. What services are covered, including preventive care?
    22. 22. What if I need services not provided by the HMO network?
    23. 23. Are there additional fees or co-payments required for office visits, emergency care or other services and, if so, how much are they? </li></ul>HealthCompare.org<br />
    24. 24. Preferred Provider Organizations (PPO) are a form of managed care plan. <br /><ul><li>PPO does not necessarily require that you choose a primary care physician to supervise and make decisions for your health care.
    25. 25. In addition, with a PPO, you may be able to access providers and services outside of the “preferred” provider network. </li></ul>HealthCompare.org<br />
    26. 26. It is important to note that PPO plans will likely involve more out of pocket costs than an HMO.  <br /><ul><li>PPOs typically involve deductibles, co-payments, and coinsurance amounts. 
    27. 27. The increased financial responsibility with a PPO is a trade-off for the higher level or flexibility that you have in choosing a provider and accessing care.</li></ul>HealthCompare.org<br />
    28. 28. <ul><li>Selecting your Doctors:
    29. 29. How many are in the network?
    30. 30. Who are they and where are they located?
    31. 31. What are the processes and restrictions for referral to specialists?
    32. 32. Review hospitals:
    33. 33. What hospitals are available through the plan?
    34. 34. Where is the nearest one in the network?
    35. 35. How is emergency care handled? </li></ul>HealthCompare.org<br />
    36. 36. <ul><li>What services are covered?
    37. 37. What are the deductible, copayand coinsurance amounts?
    38. 38. What is the out-of-pocket maximum.
    39. 39. What are the coinsurance amounts for non-preferred or out of network providers?
    40. 40. Are there per-visit fees or other types of co-pays for in-network services?
    41. 41. What is the cost difference between using in-network and out-of-network doctors, and what costs are associated with care outside of the PPO? </li></ul>HealthCompare.org<br />
    42. 42. Short-term major medical insurance is temporary health insurance that offers gap coverage to guard against high costs of emergency medical bills. <br />HealthCompare.org<br />
    43. 43. Short-term major medical insurance is appropriate for:<br /><ul><li>Recent graduates who are between parental and employer coverage.
    44. 44. Employees who are on extended leaves of absence.
    45. 45. Employees who have been laid off or former employees between jobs.
    46. 46. New employees who are not yet eligible for the employer’s group coverage.
    47. 47. Early retirees.
    48. 48. People who leave a group policy and want an alternative to COBRA.</li></ul>HealthCompare.org<br />
    49. 49. <ul><li>High deductible health plans (HDHP) are policies that require a higher deductible than most health plans, typically at least $1,000 for single insurance coverage and $2,000 for family coverage.
    50. 50. High deductible plans generally have lower monthly premiums than more comprehensive health plans. </li></ul>HealthCompare.org<br />
    51. 51. What are High Deductible Health Plans?<br />When comparing HDHP costs with the costs of other plans, consider the potential premium costs relative to your potential health spending for the coming year to determine which plan works best for you and your family.<br />HealthCompare.org<br />
    52. 52. Who is HealthCompare:<br />HealthCompare is your online one-stop-shop for health insurance where you can research and compare plans online from over 150 national carriers.<br />We Promise:<br /> To give you the best results for YOU, we never promote one carrier over the other. We just assess your needs and show you the best options from national carriers with plans in your area.<br />Our Commitment is to YOU:<br /> As a division of The Word & Brown Company who has been the leading source for small group health insurance for over 20 years, we have leveraged technology to build an easy-to-use research tool, supported by a world class customer service team. <br />Our<br />Promise<br />#1<br />HealthCompare.org<br />
    53. 53. 1. You can enter your information anonymously<br />HealthCompare.org<br />
    54. 54. 2. You can review your plan options online in seconds<br />HealthCompare.org<br />
    55. 55. 3. You can even compare plans side-by-side<br />HealthCompare.org<br />
    56. 56. 4. Then, you can apply online or call one of our trained Benefits Advisors for help!<br />HealthCompare.org<br />
    57. 57. Call toll free <br />877-641-1101<br />to speak to a trained <br />Benefits Advisor <br />or…<br />Go to HealthCompare.org today!<br />HealthCompare.org<br />
    58. 58. When an Apple a Day Isn’t Enough…<br />
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