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| Please click one of the following questions to see the answer or ask a question here. |
Questions:
• What types of health insurance plans exist?
• What is COBRA coverage?
• Can I purchase an individual policy?
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What types of health insurance plans exist?
A: Basically, there are two kinds of heath insurance: Fee-for-Service and Managed Care.
Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Many cover prescription drugs, while some also offer dental coverage.
•Fee-for-Service
These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
•Managed Care
More than fifty percent of all Americans have some kind of managed-care plan. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs), and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.
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What is COBRA coverage?
A: If you change jobs, or become unemployed, you can bring your previous employer's coverage with you by law.
You have the RIGHT to carry your group health insurance coverage with you, after leaving your old job for many reasons, and for up to 18 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
You must pay the full premium, but at group rates that were based on your former employer's experience PLUS an administrative fee by your former employer for managing this transition.
FULL PREMIUM means that you will be paying whatever portion of the premium that your employer "may" have been paying before you left the company, in addition to what you were previously paying. In some cases, the employer's portion is a "significant" portion of that premium.
Health insurance under COBRA is available if you are in the following situations:
•You leave a company and become unemployed or self-employed for up to 18 months.
•You are a widow or widower or child of an employee who dies while working for the same company for three years or more.
•You are the divorced spouse or child of an employee who has left the company he or she was employed at for at least three years.
•You are the child of an employee who left a job and have not yet reached age 23.
SPECIAL NOTE: If you need COBRA benefits, you must fill out the appropriate forms from your employer’s employee benefits department within 60 days of leaving your job. If you do not act within that time, you may be denied coverage.
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Can I purchase an individual policy?
A: Yes. If you are unemployed, self-employed, or decide to return to school you may want to buy an individual health insurance policy.
Here is a list of some important options to consider:
•If you just recently became unemployed, ask your employer's health insurance company if you can convert its group policy to an individual policy. You will probably pay a higher rate than you did before, and your benefits may be limited, but the total terms "may" still be better than if you buy your own policy. This assumes that your former employer's group experience was for a healthy population, and your employer was paying a large percentage of the full health insurance premium.
•If you are married, see if your spouse’s employer will add you to its group plan.
•Try to join a group health plan through a trade or professional association, as well as an alumni group which "may" offer reasonable rates. If you are over age 50, you can join the American Association of Retired Persons (AARP), which offers plans to their members. Even some credit card companies offer health insurance coverage, however, at rates and terms that are sometimes onerous.
•Finally, you can buy an individual policy. The rates and coverages will be relative to your health condition, and the strength of the insurance company who your Gold Mountain agent recommends, but it is important that you be protected against financial catastrophe if you or your family are hit with a major illness or injury. If you are self-employed, most of the health insurance premium will be tax-deductible.
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