Disability insurance is very important for many people and even for the people who don’t need it. One never knows what can happen, so to have this available is extremely important. A non-cancelable disability contract guarantees that your policy cannot be canceled or have the rates change as long as you continue to pay on time. Another type, a guaranteed renewable contract, ensures that the terms of your policy stay the same, but the cost can change over time. The last kind of disability contract is an optionally renewable policy. This policy can be canceled by the company at renewal time and require exams. These types of policies help those with disabilities obtain and keep medical coverage. There can be a grace or waiting period but usually you will be reimbursed for anything accrued at that time.
The waiting period is the time from your first claim to the day you get your first disability check. Your insurance premium will be based on your benefit amount, the more you get each month the higher your premium will be. The longer you collect disability the higher your premium will be as time goes on. A doctor to determine eligibility will obtain your current health status and medical history. If you have any pre-existing conditions or injuries, it doesn’t mean you are not going to get it. You need for it now relies on what happened to make you disabled.
You are defined as disabled when the condition that is keeping you from being able to work is defined and in your employee manual. This definition will also tell you what you qualify for and how to obtain it. It will also inform you of whether or not you are entitled to a new job till you are better or have to be out of work completely. Some companies offer easier jobs that pay the same instead of losing an employee and having to pay. Everyone should have some disability coverage. If you get hurt on the job and can’t continue your current position you need to have protection that will keep you from not being able to live. You want to make sure you know what your business’s policy is in case you need it at some point. Many companies have group policies that cover all employees that are working there. One would need to find out if the policy covers injury and illness or just injury. Also what the time frame is and will you possibly require more. Most of these will only cover you if you are injured at work and for a minimal time period. Some companies don’t even have this type of insurance and you would be out of luck if injured. While others have several types of disability, including long and short term.
If you do get injured on the job the first step is to be seen by your employer’s doctor. This is whom you will be seeing for as long as you are disabled and collecting disability. You will be examined and told what is wrong as will your employer. A determination will be made as to what needs to happen and who is responsible. If you are declared injured and cannot return to your normal job, another position must be found for you or you will be paid while on leave, if this is in the company’s guidelines. Not all employers will pay so make sure you are working for a company that has extensive disability insurance that covers both short and long-term issues. Also see if they cover illness and injury that is not work related. Many people lose their jobs because they cannot go back to work for a long time after an injury and the injury didn’t happen at work.
Your coverage will begin after you have been examined and given a diagnosis. Once all the necessary documents have been filed and what you are required to do has been set, a new position or payment will be assigned at that time. You must make sure that if you are going to be out of work for a long term disability you must pay the agreed premium to keep the benefits coming and make all appointments and requirements set by your employer. To breech any of this could terminate your claim. Make sure you know what is in store at your job in case of illness and injury you may need it someday.
Aug 10, 2007
Disability Insurance
Discount Plans vs. Health Insurance
A woman thought she was buying health insurance. It looked and sounded like health insurance. The woman is not 65 yet, which means she can't get Medicare. So, she went online looking for health insurance. She ended up finding something called Healthcare Advantage, and signed up after paying $100. Come to find out, this was not medical insurance at all and the sales representative never told this poor lady. She found that out when her cards arrived in the mail. In tiny writing at the bottom, it read, “not an HMO, PPO insurance or managed care company”. This was a discount plan. These plans do not have the same coverage as a full medical health insurance policy. Make sure you know what you are getting and if it fits your needs.
So what is a discount plan? The plans claims to save people money by offering discounts on physician visits, prescription drugs, dental work, eye care and other treatments for a monthly fee. Unlike normal health insurance, which is very costly and very selective about who it covers, a discount health plan accepts everyone, no matter what health conditions they may have. You will use a list of doctors that are willing to charge discounted rates to the subscriber. Discount is not the same as coverage, and so you will pay more for visits and other services that you wouldn’t with a regular medical plan. The average savings is only 25% that could be very expensive if you have to see a specialist or require surgery. These networks claim to have as many as 400,000 doctors and 50,000 hospitals available to choose from, but what if none of them are near you? You can get a savings of up to 30% on both generic and brand name drugs, which can also be costly if you have multiple prescriptions or they are costly ones. So if you have a health plan already but have a high deductible, this extra plan may help save you some money. But to use as a complete health plan, it really isn’t designed for that and will cost you more than a great HMO.
HMOs and other medical plans can offer full medical coverage at great rates. Managed care plans are the way to go for those who are limited on funds. They offer the best policies for the least amount of money. Most of these plans are available to anyone and can save you a ton of cash. You can make the plan even more affordable by asking for a deductible, which will lower your monthly expense. Most HMO’s do not have one at all but, you can request one, and most basic PPOs and POS only have a small one, usually $200 to $500 per year, which you can also asked to raised. The co-pays are also very reasonable with these types of plans. If you choose to purchase an HMO, expect to pay about $5-$10 per office visit and per prescription. With PPOs and POSs you will have a 20% co-pay with both visits and medications. The differences are how strict they are and you pay more of a co-pay to have extra flexibility. Usually a PPO or POS plan is less expensive and you have more freedom to see whom you want so the insurer makes you more responsible for payment. HMOs tend to be the least expensive and best policies for people with fixed incomes.
Make sure you know what your needs are and double-check what you are getting. If you need full medical coverage with low co-pay then a discount plan will not work for you. If you are already covered by a medical group but have a large deductible then you might benefit from the extra savings a discount plan can offer. Also, ask whether the plan is insurance that covers your treatment, or is a discount plan that still requires you to pay all medical bills yourself. Beware of slippery sales pitches. Make sure you know what's being offered. Discount health plans may only sell you access to a large mailing list of medical providers that it purchased commercially. Don't assume you're getting access to a large provider network just because your discount card displays the network's name and logo. If you plan to use a specific listed doctor, hospital, pharmacy or other provider, ask a few questions before you sign up.
State's Health Insurance Pool
State health insurance is a branch of health insurance that is for high-risk individuals with chronic and/or pre-existing conditions. Most common diseases to see on this type of insurance are HIV, AIDS, kidney disease, obesity, and diabetes. This high-risk pool is designed to act as a safety net to offer some form of insurance to these people but for a hefty premium. This program has fewer participants due to the cost. This plan is not low-income friendly. Rates can be as much as double what the normal market value for health insurance is. The pool does tend to offer better benefits but is definitely geared to those people that truly afford insurance. So, most people who fall under this category and require this type of plan are likely to be uninsured due to not being able to afford a plan. This plan is last resort for persons with such illnesses that land them for emergency or hospital care frequently, and it that case pays for itself quickly. Some of the few persons who cannot afford this are lucky enough to have a spouse in the work place that is able to add them to their policy from their employer, these plans cannot discriminate due to chronic or long-term illnesses. The State Health Insurance Pool knows its rates are high, and claims so are medical costs for the chronically ill. They have to charge more to be able to get ahead and stay afloat.
Most risk pools are nonprofit associations ran by the state. Usually they do not use taxes to operate their business. Most persons requiring this type of service usually are filling up the gap in cost of what their normal plan won’t cover or is a temporary pit stop till they can find a plan that accepts them at a lower cost. The people who qualify for this type of coverage must be a resident of the state they are applying in. Most states require you live there for at least six months and some up to one full year before reaching residency status. You also need one of several possible documents from other insurance companies. You will need proof of rejection from at least one company denying them benefits similar to the ones being asked for. You can use proof of insurance with a higher premium as well. You may also be eligible if you can show proof of insurance with a rider or rated policy. Any of the above mentioned could get you approved to apply for the risk pool in the state you reside in. A reciprocity agreement is when a person who is eligible for the plan and is currently on a similar plan, met the waiting period quota, and not used up the lifetime maximum benefits can still be eligible if they move to another state after they meet the residency requirement. Not all states, but most, have this agreement included into their plan.
There is a list of those who are not eligible in the high-risk pool besides non-residents. You are no longer eligible if you move to another state but if you have a reciprocity agreement, you can become eligible in the state you now reside after residency has been established. Most people who are eligible or receive Medicaid or Medicare are also not eligible. Many states do have a high-risk plan for Medicare eligible persons, but if you receive or could receive Medicaid than you don’t qualify. If a person has terminated their coverage in another plan and less than 132 months have passed they are not eligible for the pool till that time is up. Those who have used their maximum lifetime benefits for their plan are also not qualifying. Inmates of a public institution are also not eligible for the risk pool. Other specific exclusions can include state decided specific diseases or medical conditions that they just don’t want to cover. An enrollment cap may also be in affect so only a specific amount of persons may be actively enrolled at any given point of time. All other applicants who are eligible will be placed on a waiting list till there is an opening. There seem to be a higher list of those who don’t qualify then who do for this high-risk benefit that costs an arm and a leg anyway.
Aug 5, 2007
Point of Service (POS) Health Insurance
A POS or Point of Service plan is kind of like an HMO and PPO combined type health care plan. You have more flexibility than a regular HMO, but pay a smaller fee and deducible than a PPO. It is perfect for those people who need more flexibility but want to pay less. You will be asked to select a general provider that is off the list of acceptable doctors. This will be your primary care physician and he or she will be the one to manage what care you receive. He or she will direct you to specialist and hospitals as needed that are also participants in the plan. Usually there are many providers from each specialization to choose from and typically covers a wide geographic area. With this type of policy, you will not have a large deducible if any, and still have a minimal co-pay on visits and prescriptions. Of course, this is if you stick with the preferred providers list. You also may want to make sure what drugs are covered under this plan and if you have to pay more for newer on not generic medications. Some doctors don’t think about what kind of insurance you have when writing out the prescription and you need to remind him or her if you are only allowed to buy generic to be covered.
You will also have a choice to see out-of-network providers when you need a specialist and they are not on the list. Most POS plans require you get a doctor’s referral prior to seeing another doctor or specialist. Once referred to a specialist within the network, you will have to be prepared to pay more. If you choose to do this, you will be billed directly and must submit the claim to the insurance company your self. Your insurance company will pay their flat rate for whatever you had done and you will be responsible for the rest. You may also be responsible at the time of service to pay the entire amount and wait to be reimbursed your self from your insurance. If you chose to see a specialist on you own, the cost will be higher and around 50% if you were not referred. You will be required to pay a higher amount if you go out-of-network. So in essence, you have the right to see whom you chose, but at your own expense. The POS plan will only pay their flat rate for specific medical issues and not above it, unless it is an emergency situation. Many people like the idea of having more say in their health care choices, while others care more about saving money and don’t care who they go to. What you chose will depend on what you personally want and what is more important.
The emphasis on this plan is prevention of illness or disease to cut the cost to both the individual and the insurer. Most other plans such as HMOs and PPOs have the same basic emphasis. You are encouraged to take an active roll in your health and do what it takes to remain not sick and disease free for as long as possible. The idea is to see the doctor less so both you and your carrier together spends less money. The idea with this plan is that if you have to put more money into your health care you will think twice at whether or not you really need to go. If you want to waist the insurance companies money you have to waist your own too to do it. Medical insurance companies are in business to make money, they want you to stay healthy so they can collect your premium and not have to pay it out to the health care provider. So, for those people who do not want to pay as high as a monthly premium tends to opt for this type of health insurance plan. This one will ensure a low rate with out having to worry about huge deductibles or co-pays if used more like an HMO. So, if you think that this sound like something you are interested in, talk to several different companies and get some policies to look at. Make sure to look at what is covered as well as the price. Do a little research in the various insurance policies that are available. The one that you need to pick will depend on your priorities.
Six Top Things to Look for in a Health Insurance Plan
When deciding on health insurance, one needs to be aware of his or her needs first and foremost. Many plans are similar but slight variations in coverage and expense. Most insurance companies offer similar deductibles and cover all the standard routine issues that arise in health. Some plans are more expensive and make the insured responsible for more expense but offer a wider range of control. Some plans are designed for the budget consciences individual and has more restrictions but costs less. So look at what type of health needs you have and think about how often you need to visit a doctor. Make sure your doctor is cooperative in giving referrals when needed as well. Here are some things to think about when deciding what plan is best for you.
1) What plan benefits are offered to the insured? Most plans provide normal medical coverage. But see what other services you may need and if they are available easily or at all. Make sure that you are aware of any additional fees that might be placed on you if you see certain types of doctors or other medical professionals. Does this plan have restrictions on pre-existing conditions or chronic illnesses that can cause a premium increase or higher co-pay in the future. Know what you are getting and make sure that it works for you. If you aren’t sure call the company directly and speak to someone who can answer all your questions.
2) Physical exams and health screenings as a form of entry into a plan. Does this work for you or not, and do you not want to disclose your medical issues prior to getting a quote. Many insurance companies want to have you seen by one of their physicians to make sure you won’t cost them money by having any chronic illnesses. If you have some medical conditions that require frequent visits and treatments you may not want to look at these providers for help with coverage.
3) Care by specialists. If you require the care of specialists, such as a cardiologist, nutritionist for diabetes or obesity, or any other type, you want to make sure this is fully covered on your chosen plan. You don’t want to just sign up for a plan that is in your price range and then find out you can’t see the doctors you need to. Be sure to see all the information on added coverage above and beyond just basic needs.
4) Hospitalization and emergency care. Most HMOs require a referral from your primary care doctor before you may go to the hospital. Some insurance companies will not pay for hospital visits on the weekends unless the doctor was called and gave the referral prior to you going. Some will even require that you wait till the next available business day to see your doctor first if it isn’t a life or death emergency. If you have conditions that might require a trip to the hospital, be sure that your policy works for you. In the middle of a panic attack is not a good time to wait for the “on-call” to call you back, give permission, and call the hospital for you. You need to know that are safe to call and get emergency care and get the referral the next business day.
5) Prescription drugs and what will the company pay for? You might want to take into account how many prescriptions you need and what the cost of each one is. If you are used to small co-pay, it can be a slap in the face to find out you have to pay 20% of a $150 prescription. Many people who require some or lots of daily medications will benefit more from a HMO that has a small fee like $5 or $10 per prescription and/or a small deductible.
6) Vision care and dental services. Find out if these are included in your plan or whether you need to purchase one or both separately. Many plans will include yearly and emergency eye exams and visits. Also many offer some coverage on eyewear to some extent. Most dental plans are separate and require a separate insurance or slightly higher monthly fee to be added.
Aug 1, 2007
Long Term Care Insurance
Long-Term Care Insurance is still fairly new on the market and a lot of people don’t know that it even exists or what it covers. Even those who have heard the term don’t know always when benefits are paid, how they are designed, and who qualifies or needs coverage. Many people don’t think about this type of coverage until it is too late to get a great rate and higher benefits. They wait till they are past retirement age and closer to needing to cash in the benefits instead of investing earlier and maximizing your options. It is becoming more of a common practice for people to start thinking about what will happen 30, 50, or more years ahead. Many people invest in 401Ks, IRAs, stocks and bond, and other types of investments to prepare for the future. Many people think this will pay for living expenses and leisure activities once retired. Things don’t always go according as planned.
What happens in the unfortunate incidence of an accident and you need help with your daily living activities? Or, you get to a point in your elder years that you require home care, as you grow older? You may decide you would rather live in you home for a long as possible and would need to have enough for personal home care. Some seniors enjoy assisting living facilities that provide 24 hour nursing care, but still let you be as independent as you can. There are also those unfortunate instances where nursing home facilities are need to tend to varying degrees of illness. Long-term care is designed to provide you help with these services due to a long-term illness or disability. The average cost of these types of care can cost around $40-$100 thousand per year and sometimes more. It is a very quick way to eat your saving and social security benefits. If you think Medicaid or Medicare will help, think again. Even if and when you qualify, your saving is now gone and they will only pay up to 50% of the cost, someone has to come up with the rest. Long-Term Care insurance can help with these costs in the unfortunate event you require nursing care.
Who should consider Long Term Care Insurance? If you think you will not qualify for Medicaid or full Medicare benefits due to a large saving, assets, or high income, this is a program for you. You do not want to end up having your children to pay for these expenses while you have to have them and possibly well after your death. It will keep you able to leave your loved ones a little something instead of sucking all your assets dry. Also if you can afford to pay the premiums you will likely not qualify for assistance so would truly benefit. If you currently have chronic health issues or have a family history of a long-term illness you would be off purchasing now than waiting. It will be too late to get a policy after you have already developed a long-term illness or disability. If you think at any point you might fall into any of the categories you might want to consider getting a plan earlier to be safe and covered. You can purchase a policy from most large insurance companies. As always, every state has different insurance regulations, therefore it is best to check with your state on specific determining factors and qualifications.
This coverage will help provide nursing-home care, home-health care, personal or adult day care usually for individuals above the age of 65 or with a chronic or disabling condition that needs constant supervision. LTC insurance offers more flexibility and options than many public assistance programs. Long-term care is usually very expensive, which is why most people need insurance. For example, on average, nursing facilities providing skilled care charge $150 to $300 per day, or over $80,000 a year or more. Even custodial home care at three visits per week, can cost over $9,000 a year. Most LTC insurance policies will cover only a specific dollar amount for each day you spend in a nursing facility or for each home-care visit. Thus, when considering an LTC insurance policy, read the policies carefully and compare the benefits to determine which policy will best meet your own needs.
Battling an Unfair Health Insurance Claim
Are you having trouble getting your insurance company to pay your medical health costs? Join the club. When managed care entered the insurance scene a decade ago, its mandate was to contain rising medical costs. One way to do that is to deny claims, even when claims are legitimate. The consumer backlash led to many states establishing independent review panels and requiring insurance companies to develop in-house appeal procedures. Forty-two states now have independent review boards whose decisions can override those of insurance companies. Most consumers don’t even realize these review boards exist.
Another problem is that too many people just give up when their insurance claim is denied initially. The appeals process can be long and frustrating and many people don’t have the patience or time to pursue a claim no matter how legitimate. People must be persistent and they can win. Particularly if there’s substantial money involved, the time you dedicate to appealing insurance company decisions can pay off usually more quickly than you think. A Kaiser Family Foundation study recently found that 52% of patients won their first appeal for each claim made. The insurance companies aren’t getting with out paying anymore.
If your first appeal gets turned down, press on. The study found that those who appealed a second time won 44% of the time. Those who appealed a third time won in 45% of cases. Which means the odds are in your favor no matter how long it take. Remember that every time you appeal it costs the insurance company more money to fight you and they are not only going to lose money to you, but also in court costs. Medical health benefits are particularly tricky because insurance companies usually have a cap on the amount of money they’ll spend in a given year, or on the amount of visits they’ll pay for. But there’s often some flexibility when you can document that you or your child’s health warrants more care than your policy usually covers. Here’s how to get started:
Do Your Homework
Read your Policy: What are the benefits? Which kinds of services are included? Outpatient or inpatient care? Is it a serious or “non-serious” diagnosis?
Know the law: Contact your local Health Association to determine your states legal requirements regarding insurance payments for all illness. Does your state require full or partial parity? Are parity benefits available only to patients with “Serious Illness” or is a so-called non-serious illness also included?
Provide written documentation: Some insurance companies may not consider some diagnosis’s serious. In this case, you will need documentation to validate required services. Obtain a letter of medical necessity from your doctor and get test results showing the medical need for you or your child to receive certain services, based on the diagnosis.
Keep good records: Remember, you’ll be dealing with a bureaucracy. Keep the names and numbers of everyone with whom you speak, the dates on which you spoke, and what transpired in the conversation.
Start early: If you can, start the appeals process prior to initiating treatment. If the doctor says your child will need to be seen once a week for a year, begin immediately to appeal your insurance company’s policy of reimbursing only 20 visits a year.
Call and Ask the Insurance Company:
What are the prerequisites for receiving health benefits?
How many visits are allowed annually for you or your child’s diagnosis? Can multiple services be combined on one day and be counted as only one day or one visit?
Which services must be pre-certified--by whom?
Be positive, polite and patient with the customer service representative. Remember that he/she is only the messenger, not the decision-maker. They are the gatekeepers and can either provide you with access to a decision maker or make your life miserable, depending on how you interact with them.
Be persistent. There are no magic bullets. Be like a dog with a bone and don’t give up until you get the answer you want. If you get nowhere after several calls, ask for a supervisor or a nurse in the pre-certification department.
Remember that you do have the right to appeal if your claim is denied. Most consumers get discouraged and will not continue to pursue a claim that should or could be paid. Insurance companies count on that happening, so get out there and claim what’s justifiably belong to you.
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