Posts Tagged: Health Insurance

What is Life and Health Insurance Exactly?

The first use of insurance was to insure property for over sea voyages. Soon after there was insurance for property that didn’t move, buildings, inventory, raw materials, and the like. It wasn’t until recently that life insurance has come into its prime. In the beginning of the 20th century limited life insurance policies were written to cover the cost of funerals but that was as far as they went. Then in the 1950’s people began to realize the need for health and life insurance as a means to offset unexpected occurrences.

The reason that health and life insurance started to become commonplace is that for all of the time that people were insuring their property they weren’t insuring their greatest asset. Unless someone is independently wealthy the greatest asset they have is their ability to earn money. This ability to secure a paycheck far outweighs any current asset that someone may have.

What is Economic Death

Any unforeseen event that limits the ability of an individual to secure a paycheck is considered an economic death. Even if the event is not substantial enough to force a person completely out of work, if it significantly lowers the income attainable, it can be construed as a partial economic death.

For example, Joe Smith works at a factory where he makes $50,000 a year. If he works for 40 years he can safely assume he’ll make $2,000,000. With a little financial planning this should be enough to assure him a nice retirement.

However, there are several circumstances that could limit this potential income. There are potential accidents, illnesses, or economic situations that may cause him to either not be able to perform his job or cause his company to go out of business. These situations, these risk factors, are considered his exposure.

Three Types of Economic Death

  • Physical Death – This is the one that most people think of when life insurance is talked about. This is meant to compensate for the lost income of the insured upon premature death.
  • Retirement Death – This is when the insured reaches retirement age without having amassed enough cash to sustain a living after no longer being able to work. There are multiple different policies designed specifically to help an individual compensate for a shortfall of income during the working years.
  • Living Death – This is the term for a person who has suffered, through injury or illness, a disability. In this case the insured has not dies so although the income has stopped coming in the expenses have not. Disability insurance is often packaged with medical insurance because the two occupy the same financial area.

How Can an Individual Respond to Risk

There are four universal responses to risk. These responses, and the actions they produce, define the probability of an individual succeeding or failing in the avoidance of serious risk repercussions

  1. Avoidance – This is the most impractical of the choices. For instance, it makes no sense to try to avoid illness by not going out into public and staying locked in a home. This limits earning potential almost as much as the illness itself would have.
  2. Reduction – Trying to reduce the risks involved in life is a reasonable alternative. Eating healthy, exercising, and staying up to date on immunizations are all good ways to reduce the chances of becoming ill. Choosing a career that involves less dangerous activities would also apply here.
  3. Retaining – There is also the option of retaining the risk and offsetting it by setting aside individual assets to cover in case of an emergency situation. This is the “rainy day fund” scenario and may work on a short term basis but is lacking if the emergency becomes permanent.
  4. Transfer – This is what health and life insurance is about. Individuals purchase policies to transfer the risk of economic death to an insurance company for a set premium. This premium is dependent on several factors and generally is higher the longer one waits to employ it.

Risks that are Often Insured Against

There are an almost unlimited number of risks that can be insured against. Lloyd’s of London has become infamous for insuring celebrity body parts from Keith Richards two million dollar hands to Mariah Carey’s one billion dollar legs (CalgarySun.com 9). These are far from the norm but anything can be insured for a price. For those of us without such outlandish salaries the most common risks that are covered are accident and sickness.

These risks are monetarily offset in a legal contract that sets a premium (payable at a set interval) for an individual to obtain a lump sum disbursement upon either the completion of a set term or upon the occurrence of the risk that was being contracted to offset.

How to Cut Your Health Insurance Costs and Cope with Challenges

Health insurance coverage is important because one never knows when one will become ill. Granted, health insurance can be costly. Also, there are life circumstances which can make it seem impossible to get adequate health insurance coverage or payment of costs. For instance, denial of claims, reduced retirement benefits, job layoffs, and pre-existing conditions can be burdensome. Fortunately, there are ways to deal with these challenges.

Health Insurance Enrollment Choices and Subsidies

If working for an employer who offers health insurance coverage, during the open enrollment period, sign up to get a flexible spending account. The benefit of this is that one can use up to $5000 tax free to pay for out-of-pocket medical expenses. Also, participate in a mail-order prescription opportunity which enables payment of half of what one normally might pay for prescriptions at a drug store. In addition, purchase generic prescriptions when possible.

Until 2014, purchasing low cost group health insurance coverage via a professional association is one option to reduce health insurance costs if one is self employed or if an employer has suddenly cut health insurance benefits. However, in 2014, individuals with low income or middle income will be able to get subsidies that will enable them to purchase health insurance.

Stick With Medicare for Health Insurance as a Senior Citizen

If one has an illness and wants to be able to see any physician of choice, it is better to stick with traditional Medicare coverage. Also, most likely, getting Part D coverage for prescriptions along with Medigap can be a helpful choice to cover deductible costs and co-insurance costs.

Of note, some senior citizens have been signing up for private Medicare Advantage plans rather than the typical Medicare coverage. However, the fees to the plan administrators are going to be cut and there are concerns that some of these administrators will cut benefits or leave the health coverage market totally. That is why staying with Medicare coverage could be the best bet.

If Health Insurance Claims are Denied Keep Trying

If a claim is submitted and it gets denied, try again. In fact, chances are strong that the claim could get paid if one is very exact in going through the process described in the denial note. Always appeal in writing and send it via certified mail. In a formal letter, include documentation and be specific in the response to the reason that was given for the rejection of payment of the claim.

Also, include discussion of what the illness was, previous treatments that failed, consequences of not being able to receive care, medical records, and also put into the packet a note from the doctor. If the medical procedure was experimental, attach a copy of a medical journal article which says that the treatment can be an effective treatment. Or, if all else fails, go to the state insurance department and ask to get a patient advocate.

If things go far enough, the case will likely be reviewed by an independent review board. The review board may get involved through an employer’s health insurance plan or through the state insurance regulatory board. In the meantime, also negotiate with the physician and work out a payment plan which stretches payments out over time and makes treatment more financially affordable.

Health Insurance Options If Laid Off Work or If You Have A Pre-Existing Condition

Joining a health insurance group plan that one’s employed spouse is already a member of is an option for health insurance coverage if one has no job. Or, thanks to Consolidation Omnibus Budget Reconciliation Act (COBRA) requirements, one could remain in the group health insurance policy provided by one’s employer for 18 months after the job was ended although companies with fewer than 20 workers might be exempt from having to provide this.

Having a pre-existing condition or having a condition which is not included in coverage means that it might be necessary to be a part of the state high risk health insurance pool. In addition to the state high risk pools, there is also now a national high risk coverage pool that one can join as a result of health reform law.

Also, healthcare such as medical tests and medical exams are available at Walgreens or other drug stores these days. Medical evaluation may be done by a nurse practitioner instead of a physician. However, the medical care is available. Also, going to a community health care center is an option because community healthcare centers in many urban areas provide free medical care for those without health insurance or those who have low income.

Consumers Versus Health Insurance Companies

On September 23, 2010, several very important provisions of the Affordable Health Care Act, signed by President Barack Obama on March 23, 2010, became effective. This Act is part of the healthcare reform agenda of the currently in-office Democrats. These provisions provide greater protection to the consumer by reigning in long practiced atrocities committed by greedy health insurance companies. The following is a list of what insurance companies can no longer do, followed by what consumers can now do.

Insurers cannot:

  • Deny coverage to children with pre-existing conditions, such as asthma, diabetes or heart disease.

  • Place lifetime limits or caps on benefits.

  • Cancel a health insurance policy without proving fraud.

  • Deny medical claims without providing the consumer with a chance to appeal the decision.

Consumers can now:

  • Receive free preventative services such as immunization shots and office visit check-ups.

  • Keep their children on their parents’ medical plan up to the age of 26 years old.

  • Select their own primary care, OB/Gyn and pediatrician without interference from the insurance company.

  • Use the nearest emergency room without being penalized by the insurer.

Furthermore, individual states can offer a Pre-Existing Condition Insurance Plan. These plans focus on people with pre-existing health conditions and who have not been able to be approved by any other insurer for any other reason but for their health condition; the person must be a U.S. citizen or national, and must not have been able to be approved for insurance for at least the prior 6 months. This plan covers a wide range of pre-existing health conditions, provides primary and specialty care, hospital benefits, and prescription drugs.

Unfortunately, the prohibitive part of the Pre-Existing Condition Insurance Plan is its cost. For a family of four, the premium can be close to $1,000 per month, which is still beyond the means of most consumers.

Consumer Suffering

Many citizens have suffered at the hands of the health insurance companies. Insurers have cancelled or completely revoked policies from the policy date of inception for inconsequential reasons.

For example, in the case of Denise and Stephen Wheeler versus Nationwide Insurance Company, Mr. and Mrs. Wheeler were approved for health insurance in December. In May 2006 Mrs. Wheeler was taken via ambulance to the hospital due to a perforated ulcer, which she was unaware existed. She endured five hours of surgery where the perforation was repaired. A short time after the surgery, her health insurance carrier requested additional health insurance information from her. According to court documents, Mrs. Wheeler had not disclosed an emergency room and Ob/Gyn visit that happened two months prior, but was caused by heavy menstrual bleeding. The insurer contended that they would not have approved the insurance had they had known of the condition with her menstrual cycle. The Wheelers were left with a $30,000 hospital and medical bill.

Another example is the case of Susan and Tony Seals versus HealthNet. In March of 2003, Mr. and Mrs. Seals applied for and were approved for health insurance through HealthNet effective April 1, 2003. Shortly thereafter, Mrs. Seals was informed that she was pregnant and gave birth to a daughter in October 2003. Mother and daughter had difficulties during the labor and delivery process where the baby had to be resuscitated immediately after birth and sustained brain damage. The Seals medical expenses came to $140,000. At this point, HealthNet decided to review their original application and determined that Mrs. Seals was two weeks off when she answered the question requesting the date of her last menstrual cycle.

The Seals brought suit against HealthNet, and won. They received $95,000 toward medical bills and $1,000,000 in a trust fund toward care of their daughter who will need constant care for the entirety of her life.

These are just two of the hundreds of policy cancellations, revocations, and lawsuits brought against the health insurance industry. They have had a choke hold on the American public long enough. Even after being fined millions of dollars in the recent past because of their underhanded practices, their practice continued.

Now, with the new portion of the Affordable Health Insurance Act finally in place, consumers can begin to feel more secure that their protection is first and foremost. By the year 2014, all of the portions of this Act will be in place, which will further protect the public from the greedy health insurers.

 

After speaking with various individuals within the medical professions, many oppose this Act. They claim that this will inhibit their treatments and care toward patients. But if you carefully read all portions of this Act, you will find that it protects the general public from underhandedness of health insurers and limits medical costs that can be charged by doctors. We, the consumers, can now be assured that we are no longer at the mercy of the giant health insurers.

Travel Health Insurance: Preparing for Medical Needs While on Vacation

Most people enjoy taking car trips to nearby getaways or flying to see entirely new vistas. And most vacations go smoothly, with only minor inconveniences. Because they don’t expect anything bad to happen on their vacations, most people travel without thinking about their health insurance.

But imagine becoming ill while visiting a foreign country. What if a family member breaks a leg while skiing? Or a fishing trip ends in a boating accident? It’s important to know whether existing health insurance would cover a medical emergency far from home.

Existing Health Insurance May Be Enough

Those who already have health insurance should review the contract, call the insurance agent who sold the policy, or contact the insurer’s customer service department to find out if benefits apply while traveling. Some major insurance carriers do provide access to medical care for their customers who are away from home, but restrictions and exclusions may apply. All travelers should carry copies of their insurance policy and member ID card with them, and find out if they should bring additional forms of identification. Also be sure to bring any special contact information for the insurance company’s out-of-town benefits program.

Get details on what services are covered while out of the home area, including hospital care, emergency room services, doctor’s office visits and prescription drugs. Something as simple as a prescription for an antibiotic could cost hundreds of dollars without valid insurance. In addition, many standard insurance policies do not cover the cost of transporting a person home after a medical emergency.

How to Choose a Travel Health Insurance Policy

Those who are not currently insured or who do not have travel benefits should consider a travel health policy. There are four general policy types, ranging from basic to deluxe international policies.

 

  1. 1) Basic Policy. A basic travel medical policy should protect a traveler (and family, if applicable) from the financial consequences of an illness or accident that strikes when they’re far from home. The policy should cover hospital and surgical costs, physician visits, medications and dental care, and should also include evacuation insurance.
  2. All-inclusive Travel Insurance. The next level of coverage is a trip protection policy. These comprehensive plans provide the same type of hospitalization and office visit coverage of a basic policy, with the important additions of trip cancellation and interruption insurance, medical evacuation services, baggage protection and other benefits. Travelers may also choose add-ons like emergency cash advances, translation services, access to legal assistance, extra protection for airline accidents and acts of terrorism, and help in recovering lost tickets or passports.
  3. Specialized Insurance for Students. Americans age 64 or younger who are studying or conducting academic research abroad — or international students traveling to the United States to study — may be interested in a health insurance policy designed especially for international students. These policies usually offer benefits comparable to a traditional major medical plan, as well as medical evacuation coverage, repatriation (sending home) of remains in the event of a death, translation assistance and specialized health and security information related to the country being visited.
  4. International Travel Health Insurance for Long-term Visits. A fourth type of travel policy is a renewable international plan for individuals or families who will be staying in a foreign country for a year or more, such as for an extended job assignment.

Buying Travel Health Insurance Online

Purchasing a travel policy on the internet has advantages and disadvantages. Information and convenience are the biggest benefits of online shopping. Customer service is less strong.

Many internet travel sites also sell travel health insurance policies. But insurance is not their main focus, so they may offer fewer choices of benefits or rates. Travelers who already have a relationship with a travel agent may wish to ask if the agency also sells travel health policies. Many licensed travel agents offer these policies, and because travel is their specialty, they can advise on what type of policy and what level of benefits are right for each client.

Customer service is the heart of a travel agent’s business. An agent can be a valuable source of personal help in a crisis. He or she will likely have industry contacts and experience in dealing with people and organizations in distant places. If a client forgets to bring important documents or contact information on a trip, the travel agent will have that information available and should have a toll-free phone number that clients can call for help.

Those who don’t have an existing relationship with a travel agent may want to check with one of their professional trade associations, such as the American Society of Travel Agents (asta.org) or the Institute of Certified Travel Agents (icta.com). Another industry website at TravelSense.org offers visitors a way to search for an agent with specialized credentials.

Buying Travel Coverage Through a Credit Card

Some credit card companies offer health insurance as an addition to other services. For example, travelers who hold American Express business cards may be eligible for travel accident insurance and the company’s “global assist program” for international emergencies. A traveler who is planning to book a trip using a credit card should check with the company’s customer service to find out about these added services.

Hopefully, the very worst thing that happens on a vacation will be something as simple as a misplaced suitcase. And if so … a good travel insurance policy includes the baggage replacement benefit to cover it!

Business Health Insurance Choices: Before You Buy Guide: Small Business Group Health Coverage Plans

There are a number of choices available for small business group health insurance. Taking the time to do some research can make the process of finding a solid employees’ healthcare plan a lot easier.

Determine Small Business Group Health Insurance Needs First

It’s pretty pointless for a small business to purchase a pricey group health insurance plan, to then find out that half of the employees like their spouse’s health insurance just fine, thank you, and have no intention of switching plans. Determine what coverages and policy types are needed first. Surveying employees to find out what they’re looking for in a healthcare plan can help.

Verify Business Health Insurance Company Licensure

Check with the state department of insurance to ensure that a business health insurance company is properly licensed. Never, ever deal with any small business health insurance company that isn’t licensed, no matter how good the deal. It’s no deal if there’s a group health insurance claim.

Rate the Health Insurance Company before Buying an Employees Healthcare Plan

Quickly find out how a business health insurance carrier stacks up by visiting www.ambest.com. The A.M. Best Company supplies ratings for insurance companies based upon financial strength and credit obligations. Moody’s, Ward’s and Standard & Poor’s offer even more information about employees’ healthcare plan companies.

Ask for Small Group Health Insurance Referrals

Existing clients of a new insurance agent or small group health insurance company can attest to their quality of service. Other business owners can provide information about who they use for business health insurance companies and provide company contacts who can offer information about billing, claims and customer service. It’s worth the time to get referrals and more information before buying an employees’ healthcare plan.

Look for Small Business Group Health Insurance Companies Online

Review small business group health insurance company websites. It only takes a minute to do, and provides a wealth of information about insurance providers. Find out if a small group health insurance is Web-enabled, allowing online payments and questions. Old press releases can tell the tale of how the small business group health insurance company reacted during Katrina and other natural disasters. Investor information, products insured and the claims and customer service sections of a business health insurance company website can provide further detail.

Getting the Most from Small Business Group Health Coverage

Sometimes, the best deal for small business group health coverage isn’t a good deal at all. Finding an employees’ healthcare plan depends upon more than just cost. Cost-savings should be married with a small business group health coverage plan known for its superior customer service.