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Health insurance coverage is something you typically don’t give much thought – that is, until you or someone you love needs it. This very thing happened in my family. My husband, son and I carried group health insurance through my husbands’ employer. Shortly after we married, I persuaded my husband to switch from the Blue Cross plan (80/20) to the HMO offered by his employer. Premiums for the HMO were somewhat lower and there was better coverage for doctor visits and pharmacy.

Within 2 years of switching health plans, my husband was diagnosed with lymphoma, a slow-growing cancer. The prognosis was good, but treatments, medications, and hospital stays were exorbitant. Medical expenses would have been overwhelming had we not switched to the HMO plan. Our HMO health insurance plan covered almost all expenses we incurred with his illness. We basically only paid our co-pays, and, of course, our premiums. In fact, our health plan still pays for his treatments.

Should everyone change to an HMO health insurance plan? Not necessarily. What is important is to know basic facts about our health plan. Important questions to answer include:

What does the health plan cover? Does the coverage meet your needs? Some plans do not include wellness care and preventive care, while others do. If you require many prescription drugs, are these included in your plan?
What does the health plan NOT cover? Health insurance plans usually do not include cosmetic surgery (unless the surgery is reconstructive, repairing damage from burns, an accident, etc.). Major medical insurance plans will only cover hospitalization and other “major medical” expenses.
Who does the plan cover? Family coverage includes immediate family in most cases, spouse and minor children. Are children covered while in college, for example? Are stepchildren or children in custody of the other parent covered? Some health plans cover any child in the family, some cover stepchildren (usually only if they live with you, however). Some plans only cover children who Read more…

With health care costs soaring through the roof, the cost of health insurance premiums are increasing as well. Health insurance is a necessity, however, when you consider the costs of one visit to the emergency room, surgery to set a broken bone, scans, lab and other costs. When your budget is limited, how can you keep the costs of your health insurance premiums down? There are several steps you can take to reduce your health insurance costs and still maintain adequate medical coverage when you need it.

First step is to consider what health insurance options you have. Does your employer offer a group medical benefit? Many employers (and/or labor unions) offer health benefits to full-time employees. Group health insurance is usually the cheapest way to get medical coverage; an employer can negotiate with health insurance companies to get a group health plan at cheaper rates. In addition, many employers will pay part of the premium, reducing your health insurance cost even further. Another consideration is whether your spouse has health coverage available through their employer? If so, compare your health benefits plan to that of your spouse, and decide which health plan is the better buy. It may be possible to have one spouse carry family health insurance coverage and the other drop their health benefits. Many employers have multiple health insurance options, so review these plans as well. Choose the health plan that best meets your needs at the cheapest rate.

If no health insurance coverage is available through your employer, there are other ways to obtain health insurance coverage. Individual and family private health insurance policies are available. Shop and compare benefits and premiums from each health insurance plan. If you and your family are generally healthy, the new Health Savings Account (HSA) may be worth consideration. The HSA is an account that allows you to save tax-free dollars for your medical/health expenses. Similar to an Individual Retirement Account (IRA), you are limited in the amount that you are allowed to contribute each year; however, with the HSA, withdrawals for health expenses are not penalized, and no tax is paid on the withdrawal. When paired with a health insurance policy that has high deductibles and low rates, the HSA may be ideal for you. Save money in the HSA for deductibles and co-pays, and you’re set.

For those over 65 or permanently disabled, Medicare is available through Read more…

HSAs have a ?triple? tax advantage from a federal tax standpoint. Individuals receive full tax advantages for HSAs on their Federal Income Tax return (or through a salary reduction program in certain employer-sponsored settings) regardless of particular state?s tax treatment of HSAs.

An account beneficiary may take an above-the-line deduction (i.e. the amounts may be used to determine the individual?s adjusted gross income before any itemized or standard deductions are considered) for contributions made to an HSA during any month of the individual?s taxable year that the individual is eligible. The permitted deduction cannot exceed the sum of the ?monthly limitations? for such months. In 2006, the monthly limitation for any month is 1/12th of the following amounts:

- For those with single coverage on the first day of the month, the lesser of the annual deductible under the HDHP or $2,700.

- For those with family coverage on the first day of the month, the lesser of the annual deductible under the HDHP or $5,450.

Funds in an HSA grow on a tax-deferred basis, and distributions from an HSA are tax-free so long as the funds are used for qualified (as defined by Section 213d of the IRC) health care expenses.

How does state tax treatment of HSAs differ from federal tax treatment?

HSAs (and the enabling legislation) are federal. As a federal program, each state decides whether to: a) comply with the federal guidelines, or; b) establish their own state guidelines regarding the tax treatment of HSAs. As a result, some income that may be tax-free at the federal level may not be tax-free at the state level.

Many states harmonize their tax treatment with the federal government. Read more…

The very nature of managed care health insurance plans increases the likelihood of a legitimate health insurance claim being denied. Bear in mind that managed care (health maintenance organizations, or HMOs, and preferred provider organziations, or PPOs) exist for the purpose of controlling costs for the health insurance company. Many health care procedures, surgeries, durable medical equipment and drugs, particularly the more expensive ones, require prior authorization from the health insurance plan before the plan will pay. Claims are reviewed to determine “medical necessity” of the claim. Health care services or products deemed “not medically necessary” will almost certainly be denied for payment by the health insurance plan.

Health insurance companies do make mistakes, however, and it’s certainly possible that a covered expense will be denied. What recourse does the health plan member have when one disagrees with the decision of the health plan? Here are some steps to take in dealing with a denial of payment.

1. Review the explanation of benefits (EOB) sent to you from the health insurance company. The EOB should state what services or goods were billed and briefly why benefits were denied.

2. Review your particular health insurance policy. What benefits does the health insurance policy state for the particular service or product? Should the claim be covered according to the policy?

3. Does the health plan have special criteria to be met in order for an particular expense to qualify as “medically necessary” and be considered a covered expense? For example, many managed care plans will cover drugs on their formulary. Other, nonformularly drugs may not be covered at all, or may be covered only if the formulary drugs have been tried and failed. An expensive MRI procedure may only be covered if certain symptoms are present. Check your policy to determine whether the expense qualifies as “medically necessary” by the health insurance company. Your health care provider must submit sufficent documentation to the health insurance plan to justify the need for the expense.

4. Is the health care provider “in-network” (contracted) with your health insurance plan? If not, does your managed care plan cover “out-of-network” (non-contracted) providers? Most HMO plans do not cover “out-of-network” providers; many PPOs will pay for services by “out-of-network” providers, but usually at at lower rate than paid to “in-network” providers.

If, after reviewing the health insurance policy and the EOB, you feel that the claim should have been a covered benefit by the insurance company, you should first request in writing that the insurance company provide you with the information that they used to base their denial of benefits. The health insurance company is required to provide you with this information on request. Review this information Read more…

In general, group health insurance plans offer many advantages over individual health insurance. These include smaller premiums, better tax concessions, and extended coverage. Virtually all business owners can qualify for group health insurance.

Furthermore, because you represent a bigger chunk of business to the insurance carrier, you can usually negotiate terms and conditions quite a bit as a business owner. Hence it?s advisable to do your homework before you start negotiations. Some of the online insurance websites are quite good; they provide plenty of information for free. There are also a variety of free online calculators you can use that let you play around with various scenarios and see how it impacts your bottom line. You can also request free insurance quotes by filling out a simple form on a number of websites.

Insurance providers calculate group health insurance premiums based on many factors. Some important considerations are:
* Average age of employees
* Nature of work and occupational hazards
* History of illness amongst employees
* Coverage amount

Group health insurance plans cover normal as well as emergency medical treatment. The insuring company pays medical expenses, in part or in full. The actual amount paid to a healthcare provider depends on the type of policy you buy, but in general, more coverage will be more expensive.

Employees can often opt for additional coverage in an employer-provided group health insurance plan. Typically if an employee wants to extend the coverage to spouse, he can do so by agreeing to pay the additional payment.

In today?s group health insurance plans, the employer usually pays from 25% to 50% of the premium and the employee pays the rest, but there are some companies that pay 100% of the premium. Plans like fee for service, HMO, PPO, POS are all available to groups, though each employer will most likely pick a subset of these to offer to their employees.

AFFORDABLE HEALTH INSURANCE: INDIVIDUAL AND FAMILY

The popular adage – ‘Health is wealth’ is proving to be increasingly true as medical and hospitalization costs continue their seemingly relentless rise. If you can manage to stay healthy, you can save tens of thousands of dollars in lower insurance premiums and medical cost-avoidance. But that?s not always under our control. Thus, making the health insurance purchase decision is a critical one. With so many options, and so many stakeholders involved, choosing the right health insurance can be an extremely frustrating task.

While the fee-for-service type of managed care plan has been around for a while now, managed care plans are also very popular. Fee-for-service insurance requires you to pay a certain part of your medical expenses in advance and then submit the remainder of your medical bill to the insurer for reimbursement. While fee-for-service insurance gives you the freedom to visit health service provider or hospitals of your choice, the downside is that you may have to file claims, track payments and end up paying higher out-of-pocket costs.

Managed care plans necessitate an agreement between the insurer and a network of selected healthcare providers who must meet certain quality standards. Managed care plan policyholders are offered financial incentives to use the services of (only) the healthcare providers in the network. Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) are the two types of managed care plans. A HMO is a prepaid health plan wherein you pay a monthly premium. While costs may be low, the HMO decides which Read more…

Many of us think of Critical Illness Insurance and Disability Insurance as something that would be nice to have but not really fitting into our budget. We somehow rationalize that $5 cup of gourmet coffee in the morning, but not the few dollars per week we could spend to protect our finances and our loved ones should we ever find ourselves in a pickle with our health. The peace of mind that Critical Illness Insurance and Disability Insurance can provide at such a time is priceless.

It is important to take a look at your life and finances when choosing a policy. There are many different types of policies to choose from. With the help of your representative, you will find the one that suits you and your life the best. You want a quality policy that if you should need to file a claim would start the benefits quickly and have enough benefit paid to you that your lifestyle is not greatly changed and your finances are not overburdened. Critical Illness Insurance and Disability Insurance works with your major medical policy, helping you to pay any out of pocket expense and your regular household bills while you focus on just your recovery.

When filing a claim for Critical Illness Insurance or Disability Insurance, if independent medical examinations are mentioned do not be alarmed. Insurance companies often request that you are seen by a doctor other than your regular doctor to be sure that you are receiving the proper treatment (a second opinion scenario) and also to be sure that your claim is valid. This is no way a slur directed at you personally. Independent medical examinations serve two purposes. The first is to be sure that you are on the right road to a quick and healthy recovery. The second is to prevent those would try to receive fraudulent benefits. Fraud, if allowed, could raise Read more…

The first question from one just terminated from his job is: What is COBRA and what are my rights and my options. Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986. First of all, COBRA can only be offered to employees and or their dependents if the employer has 20 or more employees. An employer can not legally keep an employee on his insurance plan if he or she is not a full time employee unless he or she qualifies for COBRA benefits. The employee and or his dependents can only stay on the past employers plan for up to 18 months unless the employee was released do to a disability. In the case of a disability the employee can stay on the plan for up to 29 months. In the case of employee death, legal separation, divorce or separation, or if the spouse becomes entitled to Medicare, the spouse and dependant children are entitled to 36 months of coverage. If a dependant child looses dependant child status he or she would also be eligible for 36 months of continued coverage. The down side to the COBRA option is that if you develop a medical condition while on the plan you may not be able to get the individual plan of your choice. The other negative is that the employer can charge up to 102% of his cost for regular COBRA and up to 150% of the last 11 months if you qualify as being disabled. I know this seems backwards, but that?s the way it is. Often COBRA is more expensive than an individual plan, but on the plus side if you enroll in another group plan with no more than a 62 day lapse in coverage there is no waiting for any preexisting condition. If there is a lapse in coverage of more than 62 days, preexisting condition will have a one year wait before being covered. Remember that you must decide within 60 days of the qualifying event if you want to take the COBRA coverage. Then you have 45 days to make your first payment from the date you elect to take Read more…

The HSA or Health Savings Account plan is a high deductible plan as defined by the Federal Government. The deductible will increase a little each year depending on the inflation factor. This type of plan meets my definition of true insurance, which is protection against an unforeseen catastrophic financial loss. In addition to giving true insurance, this plan gives important and significant tax advantages. If you have a qualified HSA plan you are eligible to put money into a HSA savings account tax free. The amount you can put into the account is lesser of the deductible or $5450 per year for a family or $2700 a year for an individual. Deductibles start at $1000 for an individual and $2000 for a family. For many HSA plans, the deductible is a family deductible as opposed to an individual deductible for traditional plans. The Savings can be used to pay for traditional medical expenses as well as the insurance deductible, but not the premium except in specific circumstances (see section 213d of the IRS code). Some other examples are: Office Calls, Prescriptions, Acupuncture, Braces, Chiropractors, Contact Lenses, Hearing Aids, and Sterilization. Other little know examples are: Wages for nursing services, Capital expenses for equipment or improvements to your home needed for medical care, Special school or home for mentally or physically disabled persons, Cost of lead-based paint removal and Cost and care of guide dogs or other animals aiding the blind, deaf and disabled. The savings can go into an interest bearing savings account or even a mutual fund. The advantages of a HSA plan are two fold.

First the cost of the insurance is much less than traditional health insurance and second, the tax savings. To appreciate the tax savings make sure you consider all the taxes involved, including State, Federal and Social Security taxes. To illustrate, assume your Read more…

Celtic Insurance has put together the type of plan that 90% of the paying public wants. From personal experience the cost is one of the most competitive. Despite being very competitive price wise it is very benefit rich. First of all the lifetime maximum is $7,000,000 as compared to the usual $5,000,000 for most other companies. Office calls are just a $15 copay for the first 6 visits per year in the ppo plan. Most companies are putting a limit to the number of visits under the copay, but I think 6 visits per year is a reasonable allowance. The trend for most health plans is not to include Lab and X-ray under the copay. This plan covers the first $200 for lab and X-ray for non-preventive office visits plus when the Plus Option is selected, $300 per year for preventive care, which includes $50 for an eye exam. Also included in the Plus Option is the prescription copay option which can also be purchased as an option all by itself. The copay is $20 for Generic and $40 for preferred brand drugs after a $100 annual deductible on brand only. Also included in the Plus Option is Supplemental Accident coverage. This covers accidents and injuries 100% up to $500 per person per occurrence. The one benefit that sets this plan apart from all the rest is the Healthy Lifestyle Program. This is not an option. It is included with the base plan. This benefit encourages healthy lifestyles as the name implies. The insurance company will pay 25% of eligible programs that improve physical health up to $300 per person per year. Read more…

If you’ve found your way here, you’ve no doubt decided you need to purchase a new insurance policy or add to your existing level of insurance. It can be a little confusing deciding just what you need. So let’s cover some of the most popular types of insurance.

Critical Illness Insurance

Heart disease, stroke and cancer are just a few of the critical illness that bring a chill to your spine when you are diagnosed. The good news is that with the advances with modern medicine many illness that even recently were almost always fatal can now be treated and life goes on as normal. However, in a worst-case scenario, critical illness insurance helps you cope with the expense of your illness while you are treated and helps your loved ones to go on unencumbered by the financial burden left by a long illness should you lose the battle.

Disability Insurance

One of the most popular forms of supplemental insurance, Disability Insurance pays you a percentage of your income as a benefit should you become disabled. You use these benefits to help with out of pocket expenses not covered by your
major medical policy and to pay your household bills while you recover from a temporary disability or a lump sum payment or a life long benefit in the case of a permanent disability.

When shopping for a Life Insurance quote, Term Life Insurance and Whole Life Insurance are the two most popular choices. Let’s explain each of these:

Whole Life Insurance

When shopping for a Whole Life Insurance quote you will find that, the policy remains in force during your entire lifetime as long as the premiums are paid. The type of life insurance also builds what is commonly called a cash value that Read more…