Health Insurance

An individual or family health insurance plan covers one person, or a family, on one plan.

While an individual or family health insurance policy may cost more than a group policy it is better than not having health insurance coverage at all. An unexpected illness or serious injury can ruin a family financially if they do not have some basic coverage.

What kinds of health insurance are there?

There are essentially 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. Most cover prescription drugs and some also offer dental coverage

1. 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.
2. Managed Care
   More than half 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.

How do I pick a health plan?

If your employer gives you a choice of plans or you need to purchase your own coverage, it is crucial that you understand your health insurance choices and pick the insurance that is best for you and your family.

Here are some questions you should ask yourself when choosing a health insurance plan:

How affordable is the cost of care?

• What is the monthly premium I will have to pay?
• Should I try to insure most of my medical expenses or just the large ones?
• What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?
• After I've met my deductible, what percentage of my medical expenses is reimbursed?
• How much less am I reimbursed if I use doctors outside the insurance company's network?

Does the insurance plan cover the services I am likely to use?

• Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company's network?
• If I want to use a doctor outside the network, will the plan permit it?
• How easily can I change primary-care physicians if I want to?
• Do I need to get permission before I see a medical specialist?
• What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?
• If I have a preexisting medical condition, will the plan cover it?
• If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?
• Are the prescription medicines that I use covered by the plan?
• Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?
• Does the plan cover the costs of delivering a baby?