InsuranceKnowHow.com
> Home > Quick
Tips
Quick Tips
For Individuals & Families
Key
Concept:
Comparing price is easy. The key is being aware of the differences in coverage which account for
the differences in price. There is nothing wrong with trading some
benefits for a lower premium. The key is for you to be fully aware the trade-off.
|
Lower Premium |
Higher Premium |
|
$1,000,000 in total coverage |
$5,000,000 in total coverage |
|
Co-insurance: After the deductible, you pay
20% of the next $15,000. |
Co-insurance: After the deductible, you pay
20% of the next $5000. |
| Reimburses only medical
expenses which are "Usual and Customary". |
Reimburses medical expenses
which are "Usual, Reasonable Customary." (See
Tip 2 below) |
|
Limits on coverage for items such as intensive
care, organ transplants, mental health, and air ambulance. |
Fewer limits on medically necessary treatment.
More overall coverage, including mental health, etc.
|
|
Basic Medical Plan or Hospital/Surgical Plan with
broad medical exclusions. |
Comprehensive Major Medical Plan with fewer
exclusions. (See Tip 1 below) |
Remember that the primary purpose of
insurance is to cover the BIG expenses. Most financial experts recommend
lowering your premium by electing a higher deductible, while maintaining
comprehensive Major Medical protection.
Here are 5 powerful tips that will
help you find comprehensive coverage and help you to avoid potential gaps
and costly surprises.
1. Look for the term -
Major Medical - in writing!
In general, a "Major Medical" or
"Comprehensive Major Medical" health plan covers medically
necessary treatment unless specifically excluded. On the other hand,
a "Basic Medical" or "Hospital/Surgical" typically covers
only treatment that is specifically included on a schedule of
benefits.
Look carefully at the difference. "Basic Medical"
or "Hospital/Surgical plans serve a purpose and their premiums are
usually lower. However, if you qualify and you want the most comprehensive
protection, look for the words "Major Medical" or "Comprehensive
Major Medical" on the offering brochure or policy.
2. Check how a health
plan will pay your medical claims. Look for the term "Reasonable"
as well as "Usual and Customary".
Sometimes, insurance companies will pay for medical
procedures based on a schedule of fees that are considered to be the
"Usual and Customary" for the region. However, if an unexpected
complication occurs and reasonable, extra services are required
during a medical procedure from a doctor or hospital, these reasonable,
extra services may not be covered under the definition of "Usual and
Customary" alone.
Complications can be costly, sometimes very costly! Look
for the term "usual, reasonable, and customary" for greater
protection.
3. When comparing health
plans, check the "Exclusions" first.
One of the first things an experienced agent looks at in
a health insurance plan is the list of plan exclusions, or what is NOT
covered. Often found in small print, what is NOT covered is equally as
important as what IS.
Many exclusions are typical (i.e. acts of war,
self-inflicted injuries, custodial care, etc.), while others are not and
should be carefully considered when comparing health plans. For example,
does the plan have a waiting period for certain conditions? One exclusion of
a "Basic Medical" or "Hospital Surgical" plan is
"anything not specifically listed in the policy."
4. If you have a favorite
doctor, does he or she participate in a PPO network?
Lower-cost health plans control costs by contracting with a
"Preferred Provider Organization" or "PPO." If you have
a favorite doctor who is important to you, call your doctor's office and
ask in which PPOs your doctor participates. Save yourself time by only
comparing those plans that offer your doctor's PPO network.
5. Activate your memory
when completing the health questionnaire. Here’s why:
The final step in obtaining health insurance is
qualifying through the health questionnaire. It’s important to
remember that by nature, the human mind tends to forget or minimize past or
present illness. A positive attitude can be a benefit in the healing
process. However, failing to disclose a material health condition, past or
present, could jeopardize your coverage entirely.
Medical audits are often done when there is a major
claim. By contract, the insurance company can revoke coverage and return all
premiums if it can be shown that the policyholder failed to disclose a
material condition on the application.
Never give the insurance company a potential way out
of paying a major claim. Even though this is the last step in the
process, don’t be hurried.
Disclosing past illness or injury is not an automatic
negative. When truthful, always include clearly written phrases such as "complete
recovery", "no further treatment", and "well
controlled." It helps to clearly state
the positive in writing.
________________________________________________________
Click
Here Now
for
Health Insurance Quotes.
[ Top of Page ]
