Health Care Insurance FAQs

What is the basic difference between individual and group health insurance coverages?

An individual policy is purchased by you directly with the insurance company. With a group health insurance policy, the group is the master insured and the insurance company contracts with the group.
What’s the difference between primary and secondary coverages?

Primary coverage is provided through the plan of which they are a member or the plan under which the member has been a participant for the longest time period. Secondary coverage, usually as a result of being covered as a dependent under someone else’s health insurance plan, provides reimbursement for medical expenses after exhaustion of coverage available through the primary plan.
What services and items might be paid for under my health insurance?

Typically doctor visits, surgeon and surgery expenses, costs of hospitalization, and follow-up therapy are covered by health insurance. Some plans provide for psychiatric care, drug and alcohol rehabilitation programs, and prescription medicines.
What variables will affect my insurance premium?

Some of these variables include (but are not limited to) deductible, co-payments and co-insurance, lifetime maximums, annual or “out-of-pocket” limits, and coordination of benefits

A mini guide on what you need to know about finding group health insurance.

- Don’t get confused between an agent and a broker, they are two completely different people. An agent represents an insurance company, while a broker represents the policyholder. An independent agent is unaffiliated with any particular insurer and represents a range of companies. Both agents and brokers can quote on your group health insurance plan.

- You may be able to fully deduct the premiums paid on your group health insurance plan. You may also reduce your payroll tax by offering health insurance coverage as part of a total compensation package.

- Group health insurance plans generally fall into one of two categories. You should become familiar with them.

*Indemnity (reimbursement) plans let your employees choose their own doctors and have their medical expenses paid totally, in part, or up to a certain amount per day for a certain number of days. These types of plans are rarely offered now because of their high cost.

*Managed care plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. These all involve an arrangement between the insurer and a selected network of doctors, hospitals, and other healthcare providers.

- A good group health insurance policy contains several types of coverage.

*Hospital expense insurance pays room, board, and incidental services costs if an employee is hospitalized.

*Surgical expense insurance covers surgeons’ fees and related costs.

*Physicians’ expense insurance pays for visits to a doctor’s office or for a doctor’s hospital visits.

*Major medical insurance protects your employees against losses from catastrophic illness or injury.

- You can get a good group health insurance rate and still retain valuable coverage for your employees through a high-deductible plan.

Here are some facts and tips on individual health insurance to help educate you on the subject so you can make an informed decision next time you shop for insurance.

- Make sure the policy protects you from large medical costs.

- Make sure there is a “free look” clause. Most companies give you at least 10 days to lookover your policy after you receive it. If you decide it is not for you, you can return it and have your premium refunded.

- Beware of single disease insurance policies. There are some policies that offer protection for only one disease, such as cancer. If you have health insurance, your regular plan probably already provides all the coverage you need. Check to see what protection you have before buying any more insurance.

- Before purchasing any individual health plan, it is important to verify that the carrier and agent are licensed

- Individual coverage may be purchased as either an indemnity or managed care plan. Indemnity plans are sold exclusively by insurance companies, and will generally cover services from any licensed health provider as long as treatment is consistent with the terms of the policy.

- Typically, managed care plans are more affordable than indemnity plans, but indemnity plans provide members with the most flexibility in obtaining health services. The trade off is essentially choice versus cost.

- Sometimes individual health insurance consumers have the option to pay extra for coverage of additional services like maternity coverage. This extra coverage is referred to as an optional rider. These are usually not covered on the basic individual health insurance plan.

- If the insurance company is unable to obtain information necessary to accurately determine the risk of a particular applicant they will assume negatively.

- Once the company has determined your health status, you will be assigned a rate class by the company and put into a pool of other insured individuals with similar health status. Your premium will be the rate charged to that entire class of customers.

- In some states, you can receive credit against a pre-existing condition waiting period if you have had prior health insurance coverage within a specified number of days. The amount of the credit against the waiting period is generally proportional to the length of the prior coverage.