Health insurance is an option for
making health care more affordable for you and your family. Purchasing health
insurance for you and your dependents will make it easier for you to get proper
health care when you need it, because your insurance will help defray the cost.
Group
or Individual
Health insurance is available
through two types of plans, Group Plans and Individual Plans. A group plan and
individual plan may provide identical coverage. The difference is in the way
the two types are accessed. Group Plans are offered through an employer or
association; individual plans are purchased independent of any affiliation.
Although most group policies are
suited to the average person, often with provisions to cover family members,
group policy premiums usually cost less than premiums for individual plans.
Choosing
Health Coverage
Consider the following features when
comparing health care coverage.
How
much will you pay out-of-pocket?
Deductible: This is the initial dollar amount you must pay before your
insurance company begins paying for health services. Usually, the higher the
deductible, the lower your premium. However, do not choose a deductible so high
that you cannot afford to pay it. The contract will dictate the specific amount
you pay per year for your family. You must pay a deductible each year, which
will vary depending on the number of people covered by the policy.
Coinsurance: Coinsurance is the share or percentage of covered expenses
you must pay in addition to the deductible. For example, your policy may pay 80
percent of covered charges after you pay the deductible. You would then pay the
remaining 20 percent as coinsurance.
Copayment: A copayment is a specified dollar amount you pay, as a
subscriber to a managed care plan, for covered health care services. It is paid
to the medical provider at the time the services are rendered.
Premium: The monthly or annual amount you will pay for your
insurance policy.
Coordination of Benefits Provision: Even if you have more than one group policy, you cannot
receive more benefits than your actual hospital and medical expenses.
Even if a husband and wife each have
family coverage under separate group policies, they cannot collect on the same
claim twice, even if they have paid two premiums.
Renewal and Premium Increase
Provisions: These provisions determine the
conditions under which you lose your eligibility, without a medical exam to
prove you are in good health.
Questions
and Answers about Premiums
Q. Why do companies raise premiums?
A. Insurance companies raise
premiums when the cost of claims they must pay increases at a faster rate than
expected. One main cause of premium increases is medical cost inflation, which
measures how much more a particular procedure costs each year.
Medical Utilization, or the number of times doctors perform a procedure each
year, can also cause premiums to increase.
Cost Shifting is also responsible for an increase in premiums. Cost
shifting occurs when hospitals charge paying patients more money for their stay
in the hospital. This offsets their cost of caring for non-paying or indigent
patients.
New technologies and medical
malpractice claims also increase the cost of health insurance.
Q. What do your premiums pay for?
A. Premiums help pay policyholders'
claims, and other expenses, such as producers' commissions, premium taxes, and
administrative expenses.
Q. How are premiums determined?
A. An insurance company considers
many factors when setting premiums. Some of these include:
Medical care costs
Coverage
Age of policyholder when policy is issued
Current age
Health
Habits (such as smoking)
Geographic area
Waivers (a waiver of premium if you choose this option,
you would pay more each month in premiums. In return, if you became sick
and could not pay your premium, the company would pay it.)
(From: ALDOI Explanation of Health Insurance)
