Tag: Individual

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Let’s start with the basic terminology with health medical plans (health insurance).  There are three basic coverages to a plan, the deductible and coinsurance (coins) and the frequently used copay.  I will explain them below.

Deductible: This is what you pay out of your pocket before the insurance company pays any claims. Deductibles are on an annual basis and reset every January first. This is similar to your car or homeowners insurance policy.

Coinsurance: Once you meet your annual deductible, the insurance company shares some expenses with you until you reach your annual maximum out of pocket. Plans are written as 80/20 plans or 90/10 plans, they always add up to 100%. This is not unlimited there is a stop loss for you.

 

Co-pay: A co-pay is the amount you pay for a visit to the doctor (HMO or PPO plans) or a pharmacy prescription plan. The copay has nothing to do with the annual deductible and not all plans have co-pays.

 

What should a family look for when buying health insurance?

 

If you see the doctor a lot or your children frequently need a doctor’s care you may want a Health Maintenance Organization (HMO) plan. An HMO is a type of plan that has a network of doctors and facilities that you must go to for health care. Your health insurance company will have a list of doctors for you to choose from and the doctor you choose is the doctor you must go to when you feel sick.  You the patient is responsible for when you visit a health care facility with a co-pay, this is good for an individual or family with children that need to see the doctor many times in a year.

 

If you’re a person who does not go to the doctor a lot except for a checkup, you may want a PPO plan. These insurance plans have a network of providers that you can go to receive health care at a discounted or negotiated rate. Although there is a network of doctors who agree to the negotiated rate not all do and these are considered out of network. A PPO health plan allows you to go to out of network doctors but you will be responsible for the higher non-negotiated cost of health care.

 

The greater the insurance coverage, the higher the premium that you need to pay for individual and family health insurance.

Buying Health Insurance Online

The internet is a powerful way to shop for insurance. Most health insurance quotes from websites will let you run comparisons of all types of plans from all the top health insurance carriers. You can search and purchase insurance online without the need to talk to an agent. The prices for insurance plans are state mandated and no one website can give you a better quote than another.  Buying direct from the insurance company won’t save you money either, everybody has the same price.  Working with an agent gets you free advice and helps you sort out plans that are best for you.  So shop online, there is no obligation to buy and you can complete applications right online.

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Source by Ronald Filian

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In this article we will explore the reasons that motivate employers to get group health insurance for employees and we will look at the advantages and disadvantages from both points of view.

Group Health Insurance VS Individual Private Health Insurance

Probably the most significant distinguishing characteristic of group insurance is the substitution of group underwriting for individual underwriting. In group cases, no individual evidence of insurability is usually required, and benefit levels can be substantial, with few, if any, important limitations.

Group underwriting normally is not concerned with the health or other insurability aspects of any particular individual. Instead, it aims to obtain a group of individual lives or, what is even more important, an aggregation of such groups of lives that will yield a predictable rate of mortality or morbidity. If a sufficient number of groups of lives is obtained, and if these groups are reasonably homogeneous in nature, then the mortality or morbidity rate will be predictable. The point is that the group becomes the unit of underwriting, and insurance principles may be applied to it just as in the case of the individual. To assure that the groups obtained will be reasonably homogeneous, the underwriting process in group insurance aims to control adverse selection by individuals within a group.

In underwriting group insurance, then, certain important features should be present that either are inherent in the nature of the group itself or may be applied in a positive way to avoid serious adverse selection such as:

Insurance Incidental to the Group: The insurance should be incidental to the group; that is, the members of the group should have come together for some purpose other than to obtain insurance. For example, the group insurance furnished to the employees of a given employer must not be the feature that motivates the formation and existence of the group.

Flow of Persons through the Group: There should be a steady flow of persons through the group; that is, there must be an influx of new young lives into the group and an out flow from the group of the older and impaired lives. With groups of actively working employees, it may be assumed that they are in average health.

Automatic Determination of Benefits: Group insurance underwriting commonly requires an automatic basis for determining the amount of benefits on individual lives, which is beyond the control of the employer or employees. If the amount of benefits taken were completely optional, it would be possible to select against the insurer because those in poor health would tend to insure heavily and the healthy ones might tend to elect minimum coverage.

As the group mechanism has evolved, however, insurers have responded to demands from the marketplace, particularly large employers, for more flexibility in the selection of benefits. This flexibility typically is expressed in optional amounts of life and health insurance in excess of basic coverage provided by the employer and in more health care financing choices. Also, increasingly popular cafeteria plans allow participating employees to select among an array of benefits using a predetermined allowance of employer funds. Individuals select, subject to certain basic coverage’s being required, a combination of benefits that best meet his or her individual needs.

Minimum Participation by the Group: Another underwriting control is the requirement that substantially all eligible persons in a given group be covered by insurance. In plans in which the employee pays a portion of the premium (contributory), generally at least 75 percent of the eligible employees must join the plan if coverage is to be effective. In the case of noncontributory plans, 100 percent participation is required. By covering a large proportion of a given group, the insurance company gains a safeguard against an undue proportion of substandard lives. In cases in which employees refuse the insurance for religious or other reasons that do not involve any elements of selection, this rule is relaxed.

Third Party Sharing of Cost: A portion of the cost of a group plan ideally should be borne by the employer or some third party, such as a labor union or trade association. The noncontributory employer-pay-all plan is simple, and it gives the employer full control over the plan. It …

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The internet has made it easier to compare different health insurance policies and shortlist health insurance plans. With the right health insurance policy, one can make substantial savings if a family member gets sick. Although there is no golden rule to choose the right individual plan, yet, some common tips help in the decision making process. Five keys to choosing the right individual insurance plan have been listed below:

• Determine your need and your affordability: Even before you start your online search for insurance plans, one needs to be sure about the details of the plan. You need to make sure that the benefits offered by the plan covers what you need for yourself and your family. However, the perfect plan will also come at a considerable cost. As an informed customer, you need to do a proper cost benefit analysis to make sure your trade-off between price and benefit is in the appropriate proportion. If we take into account, frequent trips to the doctors, medications and dental coverage – such scenarios eliminate unsuitable plans and makes the comparison process much easier.

• Don’t overbuy: The scenario is similar to buying a luxury car where the monthly EMI equals your home loan payment. There is no point in purchasing a health insurance policy with benefits which are unlikely to be used at a high and unviable cost. For relatively young and healthy individuals, a policy with a high deductible is more suitable. Deductibles are the amount paid by insurers before certain benefits kick in. A plan with a decent deductible will cost considerably less per month and could save money in the long run.

• Walk through several plans: It is always advisable to go through several plans. In the process, benefits associated with different health insurance plans can be reviewed and analyzed for better decision making. At first glance, some plans may look appealing. Later, the same plan turns out to be a costly affair due to cost sharing arrangement. The burden of medical cost in the future will be a big headache. Hence, going through and analyzing several plans is the best way forward.

• Co-insurance and co-payments: Several health insurance plans require the holder to contribute to the coverage payments. The contribution is called co-insurance and is the portion the customer has to pay after deductible. A co-pay is a flat fee one has to pay while paying a visit to a doctor or specialist. While choosing a personal health insurance policy, consumers should look into co-insurance and co-payments factors.

• Reputation matters: After identifying the price and need of the plan, reputation of the company should also be in the reckoning. Ideally, a company with a long haul in the market should be trusted and relied upon. There are many ways to assess the standing of insurance companies and their health insurance policies.

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Source by Amar N Tyagi

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Health is Wealth, if you have it you should take care of it because pretty much it is a deciding factor in having an enjoyable life. Life as we know is full of surprises. Health as a facet of life has a number of factors to consider. A good health now is no guarantee of a good health later.

As much as we would want to be healthy, we really do not have total control over it. We would like to think that we really are in control, and to a certain extent we do have control.

We have control in the sense that we can decide what to eat, what activities to do, the kind of lifestyle we would like to live and the type of environment that we would like to live in. When we talk about these things definitely we have control, but as to what will happen to us in the future is really beyond our control.

It is in this light that getting individual health insurance makes sense. To state briefly for early clarification and appreciation; an insurance is a means of indemnity against a future occurrence of an uncertain event. Since we are talking about health, then indemnity for reasons relating to health would be the main focus of the insurance.

There are a lot of insurance providers in the market today and that is to the advantage of the individual. If an individual has more options to choose from then the market becomes competitive and forever evolving. All of the providers certainly have their own strengths and offers that they are likely to push.

It is up to the individual there before to discern on what to get. Most of these providers would gladly give a free quote for the plan that you would ever choose. But before crossing that line, we have to understand the very nature of the need for it.

Here are a few guidelines in deciding to get individual health insurance before actually being quoted.

First of all, you must understand and know what you and your family need in terms of the health topic. Everything boils down really on this fact. This is provided to be the main reason why you are even getting health insurance. Of course you should primarily look at your family's medical records and medical requirements.

Second, you have to know what the market has to offer. To simply put it, you have to look around. If you want to get the best of looking around, then you have to put in more time in finding. This is the only way for you to get the best that any provider can offer.

Thirdly, ask for a free quotation. Having known what you need and pair that with the best offer a particular insurance provider can offer, and then seek for their assessment or evaluation.

Lastly, having diligently done steps 1-3 then the final and most important step now is to enroll or get the plan. Doing this culminates actions 1-3 and therefore makes you insured.

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Source by Chaitanya Rane

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