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| The 7 Facts Every Person In America Should Know Before Buying Any Health Insurance Plan! |
| Health Care is a hot topic in America. When you buy a health insurance policy, never make your decision based on price alone. This report will reveal to you some facts about health insurance that should be considered when making your buying decision. FACT #1: All Health Insurance Companies Are Not The Same Before you purchase your next health insurance policy, you should know something about how insurance companies are rated. The A.M. Best Company is the oldest, most experienced rating agency in the world and has been reporting on the financial condition of insurance companies since 1899. The ratings the A.M. Best Company assigns are: • A++ and A+ (Superior) • A and A- (Excellent) • B++ and B+ (Very Good) • B and B- (Fair) • C++ and C+ (Marginal) • C and C- (Weak) • D (Poor) • E (Under State Control} • F (In Liquidation) Solution to the Problem Ask your agent to show you a current copy of their company’s A.M. Best Report. Get the A.M. Best Report at the library or call A.M. Best at 908-439-2200 to request a rating on a health insurance company. FACT #2: All Health Insurance Companies Do Not Pay Claims The Same Way There are two main methods by which claims may be considered for payment: 1. The insurance company decides how much they should pay. 2. An independent third party in the industry decides. Commonly, the insurance company decides what they want to pay, using wording like: • We pay reasonable charges • We pay normal charges • We pay prevailing charges • We pay average charges • We pay permissible charges • We pay regular charges • We pay a negotiated fee • We pay an allowable amount • We pay a limited fee schedule Only the company knows what the meaning actually is. Frequently it is not what the hospital, doctor or policyholder feel it should be, resulting in misunderstanding. Solution to the Problem The American Medical Association (AMA) recognizes a term called USUAL AND CUSTOMARY CHARGES. It sets the highest standard for ALL health insurance claims. These charges are based on what the majority of costs are for the same or similar service within the geographic area. Usual and Customary Charges are NOT decided by ANY insurance company. They are decided by a recognized, neutral third party. Choose an insurance plan that pays Usual and Customary Charges after deductibles or co-payments have been met. Beware of companies that add extra Make sure you can NOT be singled out for rate increases on an individual words like Usual, Customary and Reasonable charges (UCR) which may create loopholes for the company to decide how much it will pay. Fact #3: All Health Insurance Companies Do Not Cover Pre-Existing Conditions When you are accepted by a health insurance company, you will normally have a waiting period before any pre-existing condition is covered. A waiting period of 12 months is typical for most plans in the industry. Under some circumstances, companies must give you credit for waiting periods satisfied on your previous policy. If you have a health condition that is unacceptable, a company may offer you a rateup or an exclusionary rider in order to issue your policy. A rate-up means that your premium will be increased to include coverage for your condition (although the preexisting condition limitation may still apply). An exclusionary rider means that a specific condition will not be covered. If you choose an exclusionary rider, make sure any major system of your body is not excluded. Solution to the Problem Make sure you know exactly how and when your pre-existing condition will be covered and about any waiting periods. Some states have different laws regarding pre-existing conditions. Be sure your agent is knowledgeable about the state you live in. Fact #4: Some Health Insurance Companies Do Not Cover Every Doctor Some plans limit you to the medical care chosen by the insurance company instead of giving you the option to choose your physician. Solution to the Problem Consider a health insurance plan with the greatest flexibility in choosing doctors and hospitals. Even though your doctor may be on their list, be sure that you have easy access to specialists and other doctors that you might want to see. Fact #5: Some Health Insurance Plans May Not Travel Well Some plans will not cover you if you are outside of the United States. Even more restrictive, some plans limit your benefits if you use them outside a particular jurisdiction, such as a state or county. Solution to the Problem Choose a plan that does not have any geographical limitations. The only thing worse than having a medical problem while on a vacation or a business trip is finding out that it is not covered. Ask your agent what would happen if 1) you chose to go out of state for medical treatment and 2) how a medical problem would be handled if you were in a foreign country. Remember, your health plan should cover you in the worst case scenario. Fact #6: Some Health Insurance Companies Do Not Cover On The Job Injuries Business owners, self-employed people and independent contractors are not always covered by worker’s compensation plans, and many health plans exclude on-the-job injuries. People who work several jobs or have businesses on the side are usually not covered by their primary employer’s insurance. Plans that exclude work related medical problems may: 1) not pay for anything that happens at or because of work and 2) put off paying ANY claim while they “investigate” whether it was work related or not. Solution to the Problem If you are not covered by Workers’ Compensation or similar plan or law, be sure that you choose a plan will cover you 24 hours a day, whether you are working or not. Fact #7: All Health Insurance Companies Do Not Increase Rates The Same Way Some companies may have a provision in their plans which allows them to single individuals out for rate increases independently of all the other policyholders. They may raise your rates because you have caused them to pay out a lot of money for claims. The purpose of a rate increase is to offset claims loss and inflationary increases. Since all insurance companies are subject to paying claims and economic variances, there will always be a need for periodic rate increases. However, when the need arises, you don’t want to be “singled out” due to your age or health status. Solution to the Problem Make sure you can NOT be singled out for rate increases on an individual basis. Buy a plan that performs any necessary rate increases on all the policyholders of the same type in your particular state. Summary of Report Many people find out how their health insurance policy works when they submit a claim. Sometimes it is a rude awakening. Few people take the time to understand the fine print until it’s too late. As such, it is worth your time to understand the facts presented in this report. Choose a health insurance plan based on the quality of the company and the plan first. Then adjust the rates by increasing your deductible or co-payment amount to make it affordable. Don’t make your buying decision based on low cost prescriptions, doctor visits and the monthly premium alone. Buy from a professional, licensed agent in whom you can have complete trust and confidence. Find out how long it takes the company to pay its claims. Have your agent explain the general list of exclusions and limitations of the plan. Get the phone number of your agent and your insurance company’s customer service division for help and assistance. |
7 Facts You Should Know