Health Insurance Update

One big issue with health insurance is how some things are not clearly specified. This vagueness can sometimes lead to a lot of confusion. For example, not all health benefits are included in health insurance plans. Fortunately, things are being rectified. There are now processes in place that will help find out what important health benefits should be included in health plans that will be offered by state based insurance exchanges three years from now. The Institute of Medicine panel is currently deliberating whether infertility treatments should be included as an essential benefit that will help manage a disorder or if it is just a benefit that is life enhancing but is not absolutely essential. The panel will be preparing its recommendations soon.

The main reason that people acquire insurance coverage is to protect them from any eventuality where they may require immediate medical attention. The loss referred to by insurance coverages of course means the financial loss and in certain cases even the loss of a life of the policy holder or a beneficiary. The belief is that any insurance policy, health or any other form can be used or applied as a shield only upon the maturity of the policy. What is not commonly discussed is that even if the policy has not yet matured, a policy holder can still gain some semblance of benefit from it by taking out what is known as a policy loan. Of course, not all health insurance policies come with this built-in advantage where the health insurance is tied up with a corresponding life insurance policy. But for those who have it, this can provide a short term solution for those immediate cash requirements where the insurance policy’s total value is used as the guarantee for the loaned amount.

Although Medicare has proven to be a valuable service especially in terms of assisting in medical related expenses and has become an integral element in health planning for senior citizens, the fact remains that it was not designed as a one stop medical requirement coverage. Taking into account the rising healthcare costs, the number of expenses that are not shouldered by Medicare like outpatient hospital services, deductibles, physician’s professional fees and co-insurances are but some of the increasing expenses that a patient has to shoulder himself. Unless a patient is equipped with supplemental coverages for health insurance, the only place this payment is coming from would be from the patient’s pocket.

For this reason, the AFL-CIO was established for the welfare and interest of the retired worker’s groups for providing affordable insurance coverage in terms of Retiree Health which is described as a supplemental coverage of Medicare.

Described as an independent but highly influential Congressional agency, the MedPAC (Medical Payment Advisory Commission) is tasked with the responsibility of being Congress’ advisor in the context of the wide ranging policy issues covered by Medicare laws. In the policy recommendations for Medicare payments for 2009, the commission provides extensive information in its 355 pager report about updates on the annual payment provider, Medicare Advantage reforms and quality incentives that are in place.

The recommendations of MedPAC covered the aspects of Hospital Outpatient and Inpatient Services, Physician Services, Outpatient Dialysis Services, Skilled Nursing Facility Services, Home Health Services, Inpatient Rehabilitation Facility Services, Long-Term Care Hospital Services and Medicare Advantage Special Needs Plans among others.

by mheo soriano

Additional Comfortability

Some health insurance companies offer “extra” health services in terms of comfort. Unknown to all, comfort is also a big factor in hastening the recuperation rate of the patient, this is because a cozy environment may relieve the patient of anxiety when inside the hospital. Examples of these are single rooms, private bathrooms, air conditioning and Televisions. With this the patient will enjoy his stay on the hospital.

Packages with these options usually costs slightly higher than the regular but the difference wouldn’t be very distant. A few dollars would not hurt if the thing you’re spending it on promises you convenience.

Coinsurance
The share of your covered expenses, usually a percentage, that you must pay after the deductible is reached. For example, a policy may require you to pay twenty percent of the cost up to a certain dollar amount.

Conversion of Privileges
Allows the participant or beneficiaries to convert coverage to a different plan of insurance without providing evidence of insurability. The privilege granted by a group policy is to convert to an individual policy upon termination of group coverage.

Coordination of Benefits
Provisions in group policies that limit the total benefits payable under two or more group policies so that benefits do not exceed the actual amount of covered expenses incurred. COB is particularly important when a husband and wife each have obtained family coverage under separate group policies. Some policies may reduce the amount of benefits payable if benefits are payable under other insurance coverage.

Co-Payment
A specified dollar amount a subscriber to a managed care plan must pay for covered health care services. It is paid to the provider at the time the service is rendered.

Deductible
The initial amount of covered expenses a policyholder will have to pay before benefits are paid under the policy. Generally, higher deductible means lower premium. Remember, the deductible should not be so high that you could not afford to pay it should you become ill. Ask your agent or company representative if the deductible is a flat annual amount or if you must pay a deductible for each treatment, or for each family member. Some major medical policies have what is known as a “variable deductible” which means that the deductible will be the greater of a fixed dollar amount or the dollar amount or the total expense coverage.

(Please check http://www.ins.state.pa.us/ins/lib/ins/consumer/brochures/2003_health.pdf for further reading.)

The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

Health insurance works by estimating the overall risk of healthcare expenses and developing a routine finance structure (such as a monthly premium or annual tax) that will ensure that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization, most often either a government agency or a private or not-for-profit entity operating a health plan.

Choose the plan that best fits your individual needs.

Individual Medical Coverage

This is primary medical insurance coverage that is designed for people who don’t have this type of coverage through their employer or another group.

Learn More.

Medicare Part D Coverage

Medicare Part D is prescription drug coverage available to those enrolled/eligible for Medicare Part A and/or Part B.

Learn More.

Medicare Supplement Insurance

This is designed for the senior citizen who participates in Medicare, yet desires additional coverage to help with many of the expenses that Medicare does not pay.

Learn More.

Supplemental Medical Insurance

This is Ideal for supplementing your primary health insurance coverage. It provides you with a pre-determined benefit amount for those extra, unbudgeted expenses that arise.

Unless you tell us otherwise or benefits are assigned according to state law, the benefit is paid directly to you.

You decide how the money is spent.

Benefits may be paid for necessary:

• Hospitalization
• Accidental Injury
• Outpatient Surgery
• Extended Care
• Intensive Care

*Supplemental Medical is the marketing name for our Hospital Income, Hospital Indemnity and Hospital Confinement Indemnity policy series 97024

Check Out State Farm for more info

by: Christine Zafra

Fourth is to research on the insurance company you are planning to invest your money with. You wouldn’t want to pick a company that has bad credentials and bad comments from previous policyholders. We’re talking about your life insurance here, not anyone else’s. Check credible sources like independent monitoring bodies. Fifth is to talk to an agent from the day you bought the policy to the day until the end. With this, the agent can actually serve as a guide for you, changing your policy from time to time depending on your needs. Lastly, you have to study. Yes, studying insurance terminologies can make you wiser when it comes to choosing the insurance company/type that’s going to determine your and your family’s fate.

Photo taken from http://www.insuremeblog.com

by: Christine Zafra

If you’re a first time buyer of a life insurance policy, I suppose you don’t know anything about insurance terms or how the insurance works. Nevertheless, don’t be shy. You’re here for the first time anyway. Here are some of the guidelines you need to know before you acquire a life insurance.

First, you should take note if you need it or not. Life insurance can be beneficial if you have dependents lined after you. Second, you have to know the right amount of coverage your family needs in case you die (it’s ok if you leave more than what your family needs, but what if its insufficient?). There are various available online calculators for this, but you can do it manually by multiplying your annual salary by 8. Third is to determine the type of insurance you need.
• Term life insurance lasts for only a certain period of time.
• Whole life insurance’s coverage begins from the day you bought the premium until the day your last breath.
• Universal life insurance is almost the same as whole life, however, with this insurance policy, you have the freedom to increase or decrease your coverage.
• Variable life insurance has all these perks PLUS a lot more.

Photo taken from http://24sis.com