Health Insurance ? Not As Straightforward As It Would Seem

Most of the seven million people covered by health insurance in the UK have a policy provided by their company. As such it is a useful benefit, but many of us assume that it will cover any kind of health issue and this is definitely not the case. The insurers exclude a wide variety of possible claims, and this article will explain those in detail.

Health insurance has a very specific purpose ? to get people suffering from short-term, curable health problems straight through to a consultant and to receive top quality private care in top speed time. Essentially, it's about jumping the lengthy NHS queues. However, there are many health problems that don't fit into this narrow band, and as such are not covered by a health insurance policy.

Be aware however that every policy is different, and only be reading your own policy documents will you be able to find out exactly what you are covered for. This article will give you the knowledge you need to understand your policy better.

Defining ? Chronic'

Illnesses and conditions etc fall into two main categories: ?acute' and ?chronic'. Short-term illnesses that can be fixed and cured are called ?acute', for example if you fell and broke your arm, this would be classed as acute. If, however, your problem is either incurable or deemed to be a long-term issue, then it will be classed as ?chronic' and subsequently you will not be able to make a claim.

What counts as ?acute' and what counts as ?chronic' is a hotly disputed issue between insurance companies and their customers. Diabetes and asthma are acknowledged as chronic, long-term conditions that cannot be cured.

The issues become more difficult with certain types of cancer. It often happens that the cancer is considered to be treatable at first, and then the diagnosis is changed at a later time to incurable. In this case, you would only be covered as long as the cancer was diagnosed curable. If the prognosis changes you will lose your cover. Insurance companies are allowed to reclassify an illness from acute to chronic at any time.

What about the long-term
If you need long-term treatment then you're out of luck. However insurers have different ideas on what constitutes long-term, you may be covered for 10 months or up to a year, but it probably won't be for any longer than that. Check your policy for details.

Does preventative medicine count?
Health insurance cannot be used to pay for preventative treatment, although that is another matter of contention. For example, a drug called ?Herceptin' can be used to help women who have ?HER2', a virulent form of breast cancer. The drug has helped reduce the risk of the cancer returning by an average of 50%. Many would call this an essential treatment, but some insurers call it preventative. Legal and General and Axa PPP will not pay for this treatment, however BUPA, Standard Life Healthcare, Norwich Union and WPA will.

Drugs not yet available on the NHS
You might think that it doesn't matter if the drug is available on the NHS, but it relates to the system of drug approval in England and Wales. Before a drug can be used in the NHS, it must be approved by The Institute for Health and Clinical Excellence. The problem is, if it's not approved, the insurance company won't allow you to be treated with it. Huge delays affect the introduction of new drugs into the NHS because The Institute for Health and Clinical Excellence must first ascertain if the benefits of the drug justify the financial costs of adding it to the NHS treatments. As a result, the drug you need may not be approved, and if so, it won't be covered.

Aware of this problem. the Financial Ombudsman issued a compromise which stipulates if the insurer won't cover ?experimental treatments', then it should cover the cost of the approved conventional treatment. The policyholder is then free to undergo the experimental treatment and pay the surplus if it's more expensive.

Pre-existing conditions

A ?pre-existing condition' describes a condition or illness that you suffered from before starting your health insurance policy. You will have to provide details of all these when you fill out your application form. That way the insurer is aware of what they can exclude from your policy. Be sure to be truthful in the application form as the insurer can easily contact your doctor to see your medical history, and they often do ? having requested your approval first. They will also sometimes ask people to undergo a medical examination.

What counts as a pre-existing condition is also a potentially sore subject. If you fell off your horse years ago and fractured an ankle, you may find in later life that it starts playing up again and you need an operation to fix the problem. The insurance company may reject a claim, saying that it's a condition that occurred before the policy began. If that happens, you either pay yourself, or go with the NHS.

Some insurance companies write a moratorium provision into their policies, which allows some respite from a potential long list of pre-existing conditions. For example, you may be covered as long as you have not suffered from the condition for two years, with the condition first taking place in the last five years. These time frames are individual to insurance companies, read the small print first to see if your policy includes a moratorium provision.

The condition or illness is excluded

Health insurance is renewable on a yearly basis and at renewal time, you may find that your policy, and your premiums, have changed ? often not for the better.

If you are undergoing treatment at time of renewal, it's possible that your condition or illness will have become ?excluded' in the renewed policy, and that you will have to cover the cost of the rest of the treatment.

Because medical research is advancing so quickly, and the number of conditions considered treatable is increasing, the goalposts are always shifting as to what is chronic and what is acute.

The insurance companies are usually trying to cover their own backs. More conditions are being classified as acute, so they have to pay out more in claims. At the same time, newly introduced treatments and drugs are often expensive, so that's more expense to the insurer. To cover their losses, the insurers increase the premiums, and introduce some more exclusions. You have to watch out for this as you may renew your policy without realising that some very important details have changed.

So if have Health Insurance, or you are considering signing up to a policy, take this article into account and read the small print so you know exactly what is and isn't covered. And the golden rule: before getting treatment, always double check with your insurer first that it is covered.

About the Author: Safeguard is a uk critical illness insurance website. We provide a huge amount of information based around our products, to read more visit the critical illness information

Finding Affordable Health Insurance

Affordable health insurance - it seems, particularly today, those words just don't belong together in the same sentence. Health insurance monthly premiums are becoming the biggest single expense in our lives - surpassing even mortgage payments. In fact, if you have any permanent health problems, such as diabetes, or have had cancer at one time in your family history, your monthly cost could easily be more than the house and car payment combined.

Shopping for affordable health insurance can certainly be an eye-opener. If you have always had a health insurance benefit where you work - especially a state or federal employee - and now have to buy your own, you may not be able to afford the level of health insurance coverage you have become used to.

Affordable health insurance, however, is definitely available -if you know how and where to look.

When you are looking for affordable health insurance, you want the lowest cost per year that will fit your budget, of course. But, even more importantly, you want a company that has a good record for paying without fighting with you on every detail. Just as there is a car for just about any budget, there is also affordable health insurance. You may not be able to afford a "Cadillac" policy - but then you probably don't need all the frills anyway.

Shopping for health insurance on the internet is the easiest and best way to find affordable health insurance. Here are five reasons why.

1. You don't need a local agent to help you submit the claims for health insurance. The medical provider does it for you. You save money because the health insurance company saves money by not paying the agent commission. This could amount to an 8% to 12% savings to you. 2. All the top health insurance companies are at your fingertips on the internet. Most local agents can only quote you from the few companies that they represent. They may not offer you what is best for you financially or health-wise but only what they happen to have available. 3. Health insurance companies have to be extremely competitive because it is so quick and easy to compare them with their competitors on the internet today. In the past you would have had to visit physically eight to ten agents to do a similar comparison. Most folks just didn't have the time or desire for that. 4. You can change your coverage, deductibles, and payment options with just a few clicks rather than going through the paperwork delay with a local agent (and then finding out he/she made a mistake - more delay). 5. Charging to a credit card means you aren't going to forget a payment and be without insurance. Also, it gives you another 30 days before you actually have to pay. Also, many companies today give an additional discount for "auto-pay".

The key, however, to finding affordable health insurance is realizing that the purpose of any health insurance is to protect you from a major financial loss - not to protect you from spending small money on clinic visits and sliver removal. These small expenses may be cumbersome but they generally will not hurt you. It's the $100,000 heart operation that will break you. That's the financial disaster health insurance was originally designed to prevent.

Also, keep this in mind. Health insurance, as with any insurance, is a gamble. You are gambling that you will draw out more than you pay in. Your health insurance company is gambling they will pay out less. The odds are in their favor for two reasons. They have all the facts for millions of families to average out, so they know the risk in advance. Also, they get to set the rules and the prices. The higher you set your deductible, the more risk you take. This is not a bad thing at all. You will most likely be the winner in the long run.

Yes, finding affordable health insurance is much easier than most people think.

By adding more of the risk with higher deductibles, spending a little time on the internet comparing eight to ten different companies, and deleting coverage that you will not likely need (such as maternity for many people) will make it likely for you to find your own affordable health insurance.

Daniel J Lesser is the creator of HotHealthInsuranceSecrets.com. A whole world awaits those healthy enough to see it. Find out how to stay healthy at an affordable price www.hothealthinsurancesecrets.com.

Health Insurance ? Not As Straightforward As It Would Seem

Most of the seven million people covered by health insurance in the UK have a policy provided by their company. As such it is a useful benefit, but many of us assume that it will cover any kind of health issue and this is definitely not the case. The insurers exclude a wide variety of possible claims, and this article will explain those in detail.

Health insurance has a very specific purpose ? to get people suffering from short-term, curable health problems straight through to a consultant and to receive top quality private care in top speed time. Essentially, it's about jumping the lengthy NHS queues. However, there are many health problems that don't fit into this narrow band, and as such are not covered by a health insurance policy.

Be aware however that every policy is different, and only be reading your own policy documents will you be able to find out exactly what you are covered for. This article will give you the knowledge you need to understand your policy better.

Defining ? Chronic'

Illnesses and conditions etc fall into two main categories: ?acute' and ?chronic'. Short-term illnesses that can be fixed and cured are called ?acute', for example if you fell and broke your arm, this would be classed as acute. If, however, your problem is either incurable or deemed to be a long-term issue, then it will be classed as ?chronic' and subsequently you will not be able to make a claim.

What counts as ?acute' and what counts as ?chronic' is a hotly disputed issue between insurance companies and their customers. Diabetes and asthma are acknowledged as chronic, long-term conditions that cannot be cured.

The issues become more difficult with certain types of cancer. It often happens that the cancer is considered to be treatable at first, and then the diagnosis is changed at a later time to incurable. In this case, you would only be covered as long as the cancer was diagnosed curable. If the prognosis changes you will lose your cover. Insurance companies are allowed to reclassify an illness from acute to chronic at any time.

What about the long-term
If you need long-term treatment then you're out of luck. However insurers have different ideas on what constitutes long-term, you may be covered for 10 months or up to a year, but it probably won't be for any longer than that. Check your policy for details.

Does preventative medicine count?
Health insurance cannot be used to pay for preventative treatment, although that is another matter of contention. For example, a drug called ?Herceptin' can be used to help women who have ?HER2', a virulent form of breast cancer. The drug has helped reduce the risk of the cancer returning by an average of 50%. Many would call this an essential treatment, but some insurers call it preventative. Legal and General and Axa PPP will not pay for this treatment, however BUPA, Standard Life Healthcare, Norwich Union and WPA will.

Drugs not yet available on the NHS
You might think that it doesn't matter if the drug is available on the NHS, but it relates to the system of drug approval in England and Wales. Before a drug can be used in the NHS, it must be approved by The Institute for Health and Clinical Excellence. The problem is, if it's not approved, the insurance company won't allow you to be treated with it. Huge delays affect the introduction of new drugs into the NHS because The Institute for Health and Clinical Excellence must first ascertain if the benefits of the drug justify the financial costs of adding it to the NHS treatments. As a result, the drug you need may not be approved, and if so, it won't be covered.

Aware of this problem. the Financial Ombudsman issued a compromise which stipulates if the insurer won't cover ?experimental treatments', then it should cover the cost of the approved conventional treatment. The policyholder is then free to undergo the experimental treatment and pay the surplus if it's more expensive.

Pre-existing conditions

A ?pre-existing condition' describes a condition or illness that you suffered from before starting your health insurance policy. You will have to provide details of all these when you fill out your application form. That way the insurer is aware of what they can exclude from your policy. Be sure to be truthful in the application form as the insurer can easily contact your doctor to see your medical history, and they often do ? having requested your approval first. They will also sometimes ask people to undergo a medical examination.

What counts as a pre-existing condition is also a potentially sore subject. If you fell off your horse years ago and fractured an ankle, you may find in later life that it starts playing up again and you need an operation to fix the problem. The insurance company may reject a claim, saying that it's a condition that occurred before the policy began. If that happens, you either pay yourself, or go with the NHS.

Some insurance companies write a moratorium provision into their policies, which allows some respite from a potential long list of pre-existing conditions. For example, you may be covered as long as you have not suffered from the condition for two years, with the condition first taking place in the last five years. These time frames are individual to insurance companies, read the small print first to see if your policy includes a moratorium provision.

The condition or illness is excluded

Health insurance is renewable on a yearly basis and at renewal time, you may find that your policy, and your premiums, have changed ? often not for the better.

If you are undergoing treatment at time of renewal, it's possible that your condition or illness will have become ?excluded' in the renewed policy, and that you will have to cover the cost of the rest of the treatment.

Because medical research is advancing so quickly, and the number of conditions considered treatable is increasing, the goalposts are always shifting as to what is chronic and what is acute.

The insurance companies are usually trying to cover their own backs. More conditions are being classified as acute, so they have to pay out more in claims. At the same time, newly introduced treatments and drugs are often expensive, so that's more expense to the insurer. To cover their losses, the insurers increase the premiums, and introduce some more exclusions. You have to watch out for this as you may renew your policy without realising that some very important details have changed.

So if have Health Insurance, or you are considering signing up to a policy, take this article into account and read the small print so you know exactly what is and isn't covered. And the golden rule: before getting treatment, always double check with your insurer first that it is covered.

Safeguard is a uk critical illness insurance website. We provide a huge amount of information based around our products, to read more visit the critical illness information

Finding Affordable Health Insurance

Affordable health insurance - it seems, particularly today, those words just don't belong together in the same sentence. Health insurance monthly premiums are becoming the biggest single expense in our lives - surpassing even mortgage payments. In fact, if you have any permanent health problems, such as diabetes, or have had cancer at one time in your family history, your monthly cost could easily be more than the house and car payment combined.

Shopping for affordable health insurance can certainly be an eye-opener. If you have always had a health insurance benefit where you work - especially a state or federal employee - and now have to buy your own, you may not be able to afford the level of health insurance coverage you have become used to.

Affordable health insurance, however, is definitely available -if you know how and where to look.

When you are looking for affordable health insurance, you want the lowest cost per year that will fit your budget, of course. But, even more importantly, you want a company that has a good record for paying without fighting with you on every detail. Just as there is a car for just about any budget, there is also affordable health insurance. You may not be able to afford a "Cadillac" policy - but then you probably don't need all the frills anyway.

Shopping for health insurance on the internet is the easiest and best way to find affordable health insurance. Here are five reasons why.

1. You don't need a local agent to help you submit the claims for health insurance. The medical provider does it for you. You save money because the health insurance company saves money by not paying the agent commission. This could amount to an 8% to 12% savings to you. 2. All the top health insurance companies are at your fingertips on the internet. Most local agents can only quote you from the few companies that they represent. They may not offer you what is best for you financially or health-wise but only what they happen to have available. 3. Health insurance companies have to be extremely competitive because it is so quick and easy to compare them with their competitors on the internet today. In the past you would have had to visit physically eight to ten agents to do a similar comparison. Most folks just didn't have the time or desire for that. 4. You can change your coverage, deductibles, and payment options with just a few clicks rather than going through the paperwork delay with a local agent (and then finding out he/she made a mistake - more delay). 5. Charging to a credit card means you aren't going to forget a payment and be without insurance. Also, it gives you another 30 days before you actually have to pay. Also, many companies today give an additional discount for "auto-pay".

The key, however, to finding affordable health insurance is realizing that the purpose of any health insurance is to protect you from a major financial loss - not to protect you from spending small money on clinic visits and sliver removal. These small expenses may be cumbersome but they generally will not hurt you. It's the $100,000 heart operation that will break you. That's the financial disaster health insurance was originally designed to prevent.

Also, keep this in mind. Health insurance, as with any insurance, is a gamble. You are gambling that you will draw out more than you pay in. Your health insurance company is gambling they will pay out less. The odds are in their favor for two reasons. They have all the facts for millions of families to average out, so they know the risk in advance. Also, they get to set the rules and the prices. The higher you set your deductible, the more risk you take. This is not a bad thing at all. You will most likely be the winner in the long run.

Yes, finding affordable health insurance is much easier than most people think.

By adding more of the risk with higher deductibles, spending a little time on the internet comparing eight to ten different companies, and deleting coverage that you will not likely need (such as maternity for many people) will make it likely for you to find your own affordable health insurance.

Daniel J Lesser is the creator of HotHealthInsuranceSecrets.com. A whole world awaits those healthy enough to see it. Find out how to stay healthy at an affordable price www.hothealthinsurancesecrets.com

What to Know When Shopping for Health Insurance

What to Know When Shopping for Health Insurance

Between the rising cost of health insurance and the various types of health policies, finding a plan to fit your health needs and your budget can seem overwhelming. So how can you sort though these variables and find a policy that works for you?

Doing Your Homework

Doing a little research before you start shopping for health insurance will go a long way once you start comparing quotes and policies.

You can start by reading up on the types of policies available in your area and determining what you want and need out of your health insurance--from prescription drugs to coverage of pre-existing conditions, you'll want to identify these necessities from the outset.

To learn more about health insurance in your area, contact your state's Division of Insurance (DOI). This underutilized resource was developed to educate and protect consumers on the topic of insurance and has many guides and publications to help you make informed decisions about health insurance. And the more you know, the better decisions you'll make!

Shopping Tips

Under most state laws, health insurance policies are not regulated by the government. This means that insurers can sell different health insurance policies for very different prices. While that may seem complicated for the consumer, it's actually a benefit. This means that you can get health insurance quotes from multiple insurers and select the best health insurance policy for you.

So what exactly should you be looking at when comparing policies? Here are a few important questions to ask:

Does the policy cover all major medical expenses?
What's the monthly premium?
What are the choices for deductibles?
What percentage does the insurer pay after the deductible is met?
What coverages are included in the policy?
Does the policy cover prescription drugs?
Does the policy cover preventative care?
Are your doctors and health care facilities inside of the policy's network?
What is the cost for seeing a physician outside of the policy's network?

While you will certainly think of more questions to ask potential insurers, this list should get you started. Remember, the more you know, the better decisions you'll make!

Protecting Yourself

As with most areas of business, there are a few untrustworthy insurers out there who ruin things for the good guys. That's why it's a good idea to investigate your insurer and his or her credentials before signing a health insurance policy.

You can check your agent's credentials, as well as the company's customer satisfaction rating and financial standing through consumer-serving sites like AM Best or the Better Business Bureau. Doing a little behind the scenes work on your insurer beforehand will save you the stress and financial loss of doing business with a dodgy insurer.

You can also protect yourself by knowing your rights and privileges before signing on the dotted line. Most states now require insurers to cover certain benefits, such as mammograms and prostate exams; your local DOI will have more information on mandated benefits and other rights and privileges.

Most insurers will also offer a free-look period of 10 or so days to review your policy and make any final adjustments or decisions. If you decide you don't want the policy during that free-look period, you are entitled to a full refund and your policy will be cancelled without penalty. As a general rule, if your health policy doesn't contain a free-look period, you're probably better off purchasing health insurance from someone else.

Applying Lessons Learned

Now that you've gotten a few pointers on shopping for health insurance, you can get started and determine your needs, get the facts, shop for health insurance quotes and compare prospective insurers for price and service. Taking things one step at a time will make the task of finding cheap health insurance less daunting--and get you on the road to savings success!

About InsureMe

InsureMe, an Englewood, Colorado-based company, links agents nationwide with consumers shopping for insurance. Specializing in auto, home, life, long-term care and health insurance quotes, the InsureMe network provides thousands of agents with insurance leads every year. For more information, visit InsureMe.com.

Megan L. Mahan is a copywriter and insurance expert based in Denver, Colorado. She holds degrees in French and English from the University of Iowa and lends her writing and editing expertise in print media and Internet communications through her informative articles.

Affordable Health Insurance...

Finding affordable health insurance is possible, there are many companies that will help you to find health insurance that will meet your requirements and stay within your budget. The fact is that many people simply do not know where to look for health insurance. Connecting with a company that is capable of hunting down health insurance providers can take the hassle out of buying health insurance. For individuals who do not want to use a company to locate affordable health insurance there is the Internet.

Thousands of people in the United States simply go without health insurance because they think they cannot find affordable health insurance. This would explain why there are many individuals in the United States who choose to go without health insurance. Those who do not have health insurance will be less likely to visit a doctor. This means that a lot of times illness and other ailments are not diagnosed until they have developed.

There are numerous different things that will determine what your monthly health insurance will be. Your health insurance rates will change depending upon the kind of policy you have. For example, do you only need health insurance for yourself, or your entire family? The answer will have an impact on any quotes you receive. Are you young, or are you in your senior years? Most health insurance companies adjust your premium based upon your age. Are you self-employed, or are you receiving health insurance through your work? This will also affect the cost of your health insurance.

You never know when an accident might happen and you need a trip to hospital for stitches or a broken bone. These bills will add up quickly but if you have health insurance, you can get the help you need without the worry of receiving a huge bill. If you can't afford to pay off your medical bills, your credit rating could even suffer. If you have health insurance, you can prevent these problems from ever happening and your credit will be protected for your financial future and your health.

Another way you can make sure that your insurance rates are lowered is to increase the amount of your health insurance deductible. High deductibles equal lower monthly premiums. Anyone that has existing health problems which require extensive medical treatment may find it necessary to have a higher monthly premium.

Simply by researching health insurance options online and spending just a couple of hours searching may well save you money every month. Get a variety of quotes from insurance companies which meet your health and budget needs and you will find affordable health insurance. You may also find that purchasing health insurance online can save you money.

For family health insurance Please visit us at http://www.4insurancehere.com

Understanding Health Insurance

Health insurance is a necessity for everyone who wishes to maintain or improve their health. Whether you use your health insurance for regular checkups, chronic and debilitating illnesses or unexpected emergencies, you will find that carrying an insurance policy can result in a significant cost savings for you and your family. Those who carry health insurance often have a difficult time understanding what is covered under their policy and where they can go to obtain the services that they require. Without this necessary information, it is likely that many health insurance holders do not receive the maximum benefit that their insurance provides.

We all need health insurance to receive financial assistance for the maintenance and restoration of our health but we don't all receive all of the assistance that we are eligible to receive. Most of us are aware that our health insurance will cover at least a percentage of certain treatments such as office visits, hospital stays and surgeries and prescription drugs that fall under their list of covered drugs but many of us don't know what is offered beyond these basic services. Not all health insurance plans cover the same treatments so the only way to fully understand what is covered in your plan is to read your policy carefully. Some examples of inclusions that are not well known include speech classes, hearing aids, gym memberships and a variety of other features. The only way to know for sure if these items are covered is to review your policy carefully or contact your health insurance provider. You may find a variety of services or treatments that are covered under your plan that could amount to a significant financial savings.

Knowing what is covered under your health insurance plan is very important but it is equally important to understand what is not covered under your insurance plan. You should review your plan carefully to ensure that the services that you choose will be covered by your health insurance plan. Sometimes treatments that are deemed medically necessary by your doctor will not be covered by your health insurance plan. In this case it may be necessary to bear the burden of this expense in order to maintain or restore your health. If your claim is denied because your provider does not consider the treatment necessary, then you have the right to file an appeal. You should carefully review the provider's policy to ensure that you fully understand the appeal process before filing your appeal. Your claim may still be denied even if you follow proper procedure but the possibility that you will lose your appeal as a result of improper filing is greatly reduced. You should review your insurance plan carefully before undergoing preventative treatment to determine whether or not the treatment will be covered. In an emergency you may not have the opportunity to review your policy before authorizing treatment but you will have the opportunity to appeal if the treatment is not covered.

Knowing which doctors you can visit can also be confusing. Some health insurance policies allow you to visit any doctor you choose while others limit you to the participating doctors in their plan. Also, whether or not you can see a specialist is often difficult to determine. Usually, the receptionist at the doctor's office will be able to tell you whether or not they accept your health insurance policy before you schedule your appointment. You can also call your customer service representative to inquire as to whether a specific doctor will be covered.

Health insurance can literally be a life saver but understanding your policy can be a nightmare. In most cases carefully reading your policy to determine the covered treatments as well as the exclusions and limitations may help you understand your policy better. If after reading through your policy you still have general or specific questions you should contact the customer service representative for your policy. They will be able to provide you with answers that will enhance your understanding of your policy. Knowing what is covered and what is not covered are the most common misunderstandings involving health insurance. It is also important understand your provider's appeal process in case you ever incur claims that are denied. In all cases your health may necessitate treatment that is not covered and you will have to make the difficult decision of whether or not to authorize the treatment.

Ray Shelton is the editor and writer for http://www.ww-health-insurance.com

Ray Shelton is editor and writer for http://www.ww-health-insurance.com

Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

Health Insurance; COBRA; OBRA; HIPAA; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: medical insurance coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health insurance coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have ENOUGH coverage.

1) From your Human Resources Department (or wherever else you would go to get information about your health insurance) get what is called a "Summary Plan Description" (SPD). This document should be kept where you can always find it, as it contains all the information you will need about what your insurance covers and what it doesn't.

2) Look up "Coverage" and "non-coverage" in your SPD.

These will tell you what your plan covers and doesn't cover. You need to see if, perhaps, you or one of the covered members of your family has a condition or circumstance that might not be covered, where you need additional coverage. For example, let's say that your family has a history of cancer; perhaps your plan restricts the number of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get additional "cancer insurance" (I think that AFLAC might provide this type of coverage).

It would be a good idea to contact a Health Insurance benefit Broker and ask him/her to read your SPD and see if you have any gaps in coverage. They then can help you supplement coverage BEFORE YOU NEED IT!

NO HEALTH INSURANCE COVERAGE

You might be one of the growing members of our society that, through one circumstance or another, does NOT have health insurance coverage for your family. In this case, I strongly encourage you to contact a Health Insurance Broker and get immediate coverage of what is called "catestrophic" (not sure if I spelled this correctly) coverage. In this type of coverage, you will generally have large deductibles, but will have coverage if, say, one of you has to go into the hospital.

CONTACTING A BENEFITS INSURANCE BROKER

Whenever you call or email a Health Insurance Broker, it is very important to prepare ahead of time. WHAT, specifically are you looking for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your critical needs.

COBRA

COBRA is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, generally 18 additional months.

1) COBRA is "triggered" (that is, you, or a covered member of your family, become eligible for COBRA) by events such as the following: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a spouse; a covered chile's birthday makes them ineligible for coverage. These are the main "triggering" events for COBRA.

2) Now, when eligible for COBRA, you will be asked to pay for 100% to 105% of the company's employee/employee and family coverage amount. You should get a letter from your company explaining what that amount will be. BEFORE YOU DECIDE TO TAKE COBRA, there are some important things for you to consider.

What will be your cost, and what will be the coverage for that cost? Sometimes the cost is too much for the coverage. In these cases, you might want to select HIPAA coverage, instead (see HIPAA below).

Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.

Part of this decision should be whether or not you or a member of your family has what is called a "pre-exisitng coverage" condition.

Here again, before automatically taking COBRA, it would be wise to contact a Benefits Insurance Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits Insurance Broker, and he is absolutely fantastic!

OBRA

What, you ask, is OBRA? I've never heard of it, you say, and no one I know has heard of it either! Well, that's because, 99% of Human Resource or Benefit folks that I know have never heard of it! OBRA is a federal law that was passed that extends COBRA for an additional 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is this important? Thanks for asking, let's see if I can explain.

If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started looking to bridge my health insurance from working to Medicare, I assumed that when I got through all of the hoops to qualify for SSDI (Social Security Disabililty Insurance) I'd IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, you have to wait for 5 months before you get your first check. AND, the rules state that, you are eligible for Medicare 2 years (24 months) FROM THE DATE OF YOUR FIRST SSDI PAYMENT. Well, if you add 24 + 5 you get, 29 months between qualifying for SSDI, and Medicare coverage.

OK, I said earlier that COBRA is for 18 months of coverage. Well guess what 18 months of COBRA + 11 months of OBRA equal - 29 months!

BUT, there are two catches to OBRA; first of all, you have a small window of 30 - 60 days to apply ( this window opens the date of your SSDI approval); and, it can cost up to 150% of your plan coverage amount. BUT, if you have a "previously existing condition" this might be the best way for you to proceed.

Again, it is important to contact a Health Insurance Broker to help you with the risk/cost ratio of all of these situations.

It is also improtant to know all of these deadlines as you plan to ensure that you and your family have important health insurance coverage.

HIPAA

HIPAA is a federal law that is called, briefly, the "portability" law for health insurance. What that means is that when you leave a group (read company-paid plan), the carrier that provided that plan, must offer to you, another plan, different from COBRA, when you leave the group coverage. Generally this will be what is called a "bare bones" plan. Again, the best thing for you to do is to call/email a Health Insurance/Benefits Broker with all of your information: SPD, COBRA info, HIPAA info, needs, cost limits, and let him/her help you find the optimum plan coverage for you.

MEDICARE

OK, now, finally, we've reached Medicare! BUT (you really didn't think it would be that easy, did you?) if you have qualified for Medicare because of disability, there are RESTRICTIONS (of COURSE there are!).

First of all, if you are qualifying for Medicare because of disability, you are probably under the age of 65 - normal retirement age.

Medicare coverage does NOT cover prescription drugs, which, those of us with disabilities probably need, and which cost lots.

But, Congress prescribed that states (all but 11) offer what is called "Medicare supplement" plans, some of which do offer prescription coverages. BUT, these plans ARE NOT REQUIRED TO, and do not, offer these medicare supplement plans that offer prescription coverages to folks who qualify under age 65! So, if you are qualifying because of disability, your medical insurance plan doesn't cover one of your primary cost expenditures!

Here again is where you need to contact a health insurance/benefit broker. Again, he/she can work with you, and your specific circumstances, to get you the coverage you need.

Hope that this information was helpful to you. If you have any questions, please feel to ask them by commenting on this blog, and I'll be happy to get you an answer.

About Disabilitykey.com & Carolyn Magura:

Disabilitykey.com is a website designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with disabilities.

Carolyn Magura, noted disability / ADA expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her “full salary” while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click here to receive Carolyn 's easy-to-read, easy-to-follow direct guide through this difficult, trying process. If you are disabled, don't let this disabiling process

 disable you. Read Carolyns Disability Key Blog.