Choosing Health Insurance: Important Tips You Need to Know


What kind of health insurance coverage are you carrying? Is it sufficient to protect your family? These are questions that you must ask yourself when you are choosing an insurance plan. Many employers provide insurance coverage for their workers, you will be given information on several plans through different companies when you first begin your job. Many companies afford you what is called an open enrollment once a year and at that time if you find the plan you chose is not sufficient or does not meet your needs for the future you have the ability to change plans.

When you first become employed and choose your coverage there is no pre-existing clauses in the policies this privilege is also afforded to you in open enrollment. However, if you choose to only cover yourself and then later decide to cover another member of your family then there will be pre-existing clauses afforded that person if they have medical problems. That can mean the insurance carrier will not cover expenses for a certain illness or injury if the person had received treatment for it prior to the coverage date.

When you are checking into the right kind of health insurance you need to consider the co-insurance amounts (this is the amount you pay for the service provided by doctors and hospitals and also what you pay of prescription drugs), does the insurance carrier have a mail order pharmacy program (this usually means that you get a 3 month supply of your medication for the price of a one month supply), what is the deductible (is it for each person such as $250.00 for each person and a limit of $500.00 per family), is there a catastrophic maximum (what this means is that you reach a certain $ amount and then the insurance covers all of your care at 100% for the remainder of the year), is there a lifetime maximum (this usually is $2,000,000.00).

Don’t let the lifetime maximum fool you though as it can be reached if you have a serious condition or illness. For example, a heart transplant, kidney transplant or another organ transplant can start at about $75,000.00 for the surgery alone. Then you must consider the cost of immune drugs. Or cancer in a family member, chemo drugs can run up to $3,000.00 a dose.

If you have a condition that needs other than a medical professional such as diabetes make sure that your insurance covers those professionals also. By this I mean an herbologist, acupuncturist, chiropractor, and ophthalmologist.

Perhaps the medical insurance also has a vision clause, this will not be used if you are diabetic as that falls under medical expenses. Most insurance companies don’t have very good vision and dental coverage and many employers offer separate dental coverage but not vision. Many medical insurance carriers have vision where they pay up to $150.00 for the exam and lenses, they do not cover the frames or anything for the lenses that goes over the maximum of $150.00. Keep in mind that the $150.00 is also to cover the eye exam charges.

There are many loop holes when you go to purchase health insurance, be sure to make an informed decision on it. Also if you are looking for a policy that is not related to your employment you may wish to check into an HMO carrier. They are plans that afford you healthcare with only a co-payment to be paid such as $15.00 for your doctor and $45.00 for your specialist. They are more expensive to purchase and you must have plan approval to see a specialist or have a visit that is non emergent to the hospital. They do pay for ambulance services and emergency rooms with co-pays but will not cover any elected hospitalization if it is not reproved by the plan. Prescriptions also are cheaper in the long run through an HMO. Most people find it difficult to understand that they need primary care and plan approval before seeking treatment from someone other than their primary care physician. One good point with the HMO is that there is no such clause for pre-existing illness or treatment. For example, if you had heart disease before purchase they will pay for all medical in regards to it after purchase with no waiting period.

No matter your situation be careful and choose wisely as you will at some point be locked into this insurance. Maybe even when it is time to retire, if your employer’s retirement plan has a clause for it you will be required to carry your chosen medical plan into retirement. Some retirement programs have their own insurance plans but these are extremely expensive unless you are a State or Federal employee. Almost all insurance plans that you take at retirement will cease to cover you when you obtain Medicare coverage at age 65.

You can purchase a supplemental policy through many health insurance carriers when you are of Medicare age. With these you must be very careful as most do not cover anything that Medicare does not cover and only pick up a portion of your deductibles and co-insurance costs.

The most important thing is to make an informed decision and know exactly what the insurance carrier offers. Check with the insurance company directly if you have any questions they are better equipped to answer the questions than your employer or their human resources/benefits office. So just like a film insurance, this type of coverage is often contractually required by film distributors or by your health provider.