actuary - a mathematician in the insurance field. Responsible for calculating premiums, developing plans and defining underwriting risk. agent - a licensed individual who represents several insurance companies and sells their products. benefit - reimbursement for covered medical expenses as specified by the plan. brand-name drug - prescription drug which is marketed with a specific brand [...]
If you get health care coverage at work, or through a trade or professional association or a union, you are almost certainly enrolled under a group contract. Generally, the contract is between the group and the insurer, and your employer has done comparison shopping before offering the plan to the employees. Nevertheless, while some employers only [...]
In addition to broad coverage for medical, surgical, and hospital expenses, there are many other kinds of health insurance. Hospital-surgical policies, sometimes called basic health insurance, provide benefits when you have a covered condition that requires hospitalization. These benefits typically include room and board and other hospital services, surgery, physicians' non surgical services that are performed [...]
Whether you end up choosing a fee-for-service plan or a form of managed care, you must examine a benefits summary or an outline of coverage - the description of policy benefits, exclusions, and provisions that makes it easier to understand a particular policy and compare it with others. Look at this information closely. Think about your [...]
Q What is the first thing I should know about buying health coverage? A Your aim should be to insure yourself and your family against the most serious and financially disastrous losses that can result from an illness or accident. If you are offered health benefits at work, carefully review the plans' literature to make sure [...]
If you have had health coverage as an employee benefit and you leave your job, voluntarily or otherwise, one of your first concerns will be maintaining protection against the costs of health care. You can do this in one of several ways: First, you should know that under a federal law (the Consolidated Omnibus Budget Reconciliation [...]
While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense. Very few plans cover eyeglasses and hearing aids because these are considered budgetable expenses. Very few cover elective cosmetic surgery, except to correct damage caused by a covered accidental injury. Some fee-for-service plans do not [...]
Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. Starting July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. [...]
Health insurance is generally available through groups and to individuals. Premiums - the regular fees that you pay for health insurance coverage - are generally lower for group coverage. When you receive group insurance at work, the premium usually is paid through your employer. Group insurance is typically offered through employers, although unions, professional associations, and [...]
HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning. For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or [...]
Your employer may have set up a financial arrangement that helps cover employees' health care expenses. Sometimes employers do this and have the "health plan" administered by an insurance company; but sometimes there is no outside administrator. With self-insured health plans, certain federal laws may apply. Thus, if you have problems with a plan that isn't [...]
The three major types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans. Managed care plans generally provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for [...]
This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient - you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits [...]
The term health insurance refers to a wide variety of insurance policies. These range from policies that cover the costs of doctors and hospitals to those that meet a specific need, such as paying for long-term care. Even disability insurance - which replaces lost income if you can't work because of illness or accident - is [...]
If you have ever been sick or injured, you know how important it is to have health coverage. But if you're confused about what kind is best for you, you're not alone. What types of health coverage are available? If your employer offers you a choice of health plans, what should you know before making a [...]
