Health Insurance 101 for Individuals and Families

The changing healthcare and health insurancepre-existing condition clause and policy exclusions so
landscape in the United States has resulted in morethat you will not be surprised down the road if a claim
individuals and families purchasing health insuranceis denied. This is important whether you are purchasing
coverage on their own. Rather than touch on thea standard medical, temporary, or student health
number of reasons why this is the case, I would like toinsurance policy.
provide individuals and families finding themselves in this6. Does the insurance company you are considering
position with ten basic ideas to assist them with gettinghave a substantial network of preferred doctors and
the best health insurance policy for their specifichospitals in your area? In addition to family doctors,
situation. Below is a combination of ten questions andwhat type of access will you have to specialists and
suggestions that will provide the tools necessary to getthe best hospitals in the event you or a family member
a medical insurance policy that will best work for youis diagnosed with an illness that requires specialized
and your family.care? Also, what are your options for preferred health
1. What are your typical health and medical carecare providers when traveling?
expenses in a calendar year? Most people are7. If you need to go "out of network", will you still have
surprised when they go through this exercise to learncoverage? Most insurance policies will have coverage
that they would be financially better off in most yearsin the event you need to go outside of their network
to purchase a high deductible health insurance plan andfor care. However, review how these out of network
use the premium savings to directly offset heath careclaims will be paid. Will there be an additional
expenses throughout the year.deductible? How are reimbursement levels determined
2. How long do you anticipate needing the healthfor out of network claims? What is your maximum out
insurance coverage? For example, many companiesof pocket for out of network claims?
sell temporary policies that can be put in force for 1-68. Are you looking for an opportunity to reduce your
months and they are relatively inexpensive. If you aretaxable income? If so, make sure your plan qualifies as
in between jobs or in a waiting period for employera high deductible health plan and look into all of the
coverage, this may be your best option.aspects of a Health Savings Account. In the right
3. What is your budget? If your budget is tight, having asituation, HSAs can be an excellent way to pay for
$1000, $2500 or even $5000 deductible is better thaneligible health care expenses, reduce your taxable
having no coverage at all. The ability of doctors andincome and save for retirement.
hospitals to save and prolong life in the United States is9. What are the financial ratings of the insurance
in many cases extraordinary. However, their treatmentcompany you are considering? A.M. Best, Standard &
is not free and going without health insurancePoor's, and Moody's are organizations that rate the
coverage can in some cases result in you and/or yourfinancial stability of insurance companies.
family losing an entire life's worth of savings and10. What type of customer service will you get from
assets.your insurance agent? Do they specialize in health
4. Be careful to choose a plan that covers the "biginsurance? Do they have a staff that is willing and able
stuff". It is nice to have a policy that covers items suchto assist you in the event you have a claim, billing, or
as: physician office visits, routine physicals, outpatientother customer service problem?
testing, and blood work. However, it is essential toIf you do not have the time or patience to look into all
have coverage for major services such as cancerof the items mentioned above, develop a relationship
treatment, transplants, critical illness, traumaticwith an independent insurance agent that specializes in
accidents, and infectious diseases. Find out the lifetimeevaluating and servicing health insurance policies. A
maximum amount as well as if the policy containsgood independent insurance agent will be able to save
"internal" dollar limits.you time, money, and be an excellent resource for
5. Always carefully read and understand theevaluating all of the items mentioned above.