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January 2006

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Researching and purchasing individual and family health insurance can be a confusing and time-consuming project. This ebook provides several questions to ask yourself and issues to consider prior to beginning your health insurance research. Everyone�s objective should be to procure the best possible health insurance coverage for the lowest monthly premium. Hopefully, these tips will assist you in achieving that objective.

  • Do I Qualify?
  • As health insurance costs skyrocket, many carriers are paying stricter attention to pre-existing medical conditions and medications prescribed for these conditions. Current prescriptions may be more costly than the amount of the monthly premium, thus leading to a carrier declining issuance of coverage. Insider tip: wait at least six months after completion of treatment for a temporary declinable condition before applying for coverage. Ask your insurance consultant about any conditions that may affect your ability to receive health coverage. Being honest and forthright will save time and money in the long run! Also inquire about state guaranteed coverage and medical discount plans should you have a pre-existing declinable medical condition.
  • Establish Budget!
  • The belief that health insurance is unaffordable is largely a myth. Health coverage is an important facet of every individual and family�s existence and should be budgeted as such. Set up a budgetary amount per month that is affordable within your household expense structure. Then discuss with your insurance consultant the amount that you have budgeted to spend for health insurance. Insider tip: those on tight budgets can purchase low-cost major medical coverage and self-insure for physician visits and prescription coverage or supplement major medical coverage with a medical discount plan. Be sure to discuss various cost saving options with your insurance consultant.
  • Set your own Personal Risk Quotient!
  • Purchasing health insurance is all about assuming risk! The more risk that one is willing to assume, the lower the premium cost. Everyone should attempt to obtain catastrophic and major medical coverage, however deductibles and co-insurance may be adjusted to control premium costs. Insider tip: Compare major medical deductibles with copay percentages. A 60/40 copay plan in which the carrier picks up 60% of the cost with no deductible may be less expensive than a 70/30 copay plan with a high major medical deductible. Also, some plans include physician visits under the major medical deductible in order to lower monthly premiums.
  • Decide if you want to Continue to see your Current Physician!
  • PPO (preferred provider) plans offer considerably better benefits for �in-network� physicians. If continuing with a current physician is important, be sure to have your insurance consultant check to make sure that your physician is a preferred network provider on all insurance plans quoted. Also, be aware that HMO networks are far more restrictive and limited as far as individuals choosing their physician.
  • Read the Fine Print!
  • insurance! Unfortunately, many people purchase policies without fully understanding what is actually covered and to what extent under their policy. Make sure that you understand coverage limitations, what co-insurance means, deductibles and individual and family maximums, and maximum out-of-pocket expense. Your insurance consultant should review this information in-depth with you prior to your purchasing a policy. Insider tip: Be wary of agents from companies you are not familiar with who attempt to hard sell at the conclusion of the presentation. There are far too many occasions when clients find about a deficiency in a policy at the time they expect a claim to be paid that may not be actually covered.
  • Between Jobs or Just Graduated?
  • Use short-term health coverage to bridge the gap while waiting for permanent health insurance. You decide on the length of coverage from a minimum of 30 days. Streamlined underwriting requirements provide immediate approval in the majority of cases. Insider tip: Consider a 30-day short-term policy to provide coverage during the underwriting/approval process if uninsured at time of application for permanent coverage. Underwriting can take up to 30 days, so this coverage provides a valuable safeguard.
  • Don�t Forget Dental!
  • There are several extremely economical dental plans available in today�s marketplace. HMO dental plans offer a more restrictive choice of providers but usually offer better benefits than PPO plans. Insider tip: Be sure and ask about orthodontic coverage if there are young children in your family. Plans that offer this coverage can wind up saving you thousands of dollars.

    Glossary and Terms

  • Coinsurance: The amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.
  • Copayment: Another way of sharing medical costs. You pay a flat fee every time you receive a medical service (for example, $20 for every visit to the doctor). The insurance company pays the rest.
  • Covered Expenses: Most insurance plans, whether they are fee-forservice, HMO�s, or PPO�s, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures the insurer agrees to pay for. They are listed in the policy. Deductible: The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.
  • Exclusions: Specific conditions or circumstances for which the policy will not provide benefits.
  • HMO (Health Maintenance Organization): Prepaid health plans. You pay a monthly premium and the HMO covers your doctors� visits, hospital stays, emergency care, surgery, checkups, lab tests, x-rays, and therapy. You must use the doctors and hospitals designated by the HMO.
  • Maximum Out-of-Pocket: The most money you will be required to pay a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.
  • PPO (Preferred Provider Organization): Physicians and hospitals that contract with a particular insurance carrier to offer that carrier�s negotiated rates to patients. When you use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. You can use other doctors, but at a higher cost.
  • Preexisting Condition: A health problem that existed before the date your insurance became effective.
  • Premium: The amount that you pay in exchange for insurance coverage.
  • Provider: Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.
  • Health insurance coverage is an integral necessity for every family! As a special bonus for those receiving this ebook, we offer a second no-charge, no-obligation ebook entitled �Top Ten Things to Look For When Buying Insurance Online.� You will receive this second ebook within a week of receiving our first offer. Good luck with your health insurance research!!!

    Website: www.low-cost-health-insurance-programs.com

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    John F. Pack represents all major California and Arizona health insurance carriers and works with individuals, the self-employed and small business groups to assist in finding them the best Health Insurance Coverage for the money. He also specializes in showing small businesses, including family and home based business, how to qualify for a group health plan.

    See John F. Pack's Listing on Experts.com.

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