William Penn Life, 2003 (38. évfolyam, 1-12. szám)
2003-09-01 / 9. szám
Tb your health A brief guide to the various types of health insurance from the Pennsylvania Insurance Dept INCREASES IN THE COST OF health care in recent years make the threat of serious illness or injury potentially devastating to the average person or family without health insurance. In order to protect themselves at the lowest possible cost, many consumers are beginning to shop for health care and health insurance the way they usually shop for cars, appliances and other items. The information below can help you in that process. There are many different types of policies and health care plans at many different prices. Some pay most of your health care bills for any serious injury or illness. Others pay only part of your bills or only for certain injuries or illnesses. Some pay an amount directly related to your actual health care costs. Others pay a set amount for each day that you are in a hospital, without regard to actual bills. This month, "Moneywi$e" explains some of the most common types of health insurance policies and offers tips to consider when purchasing health insurance coverage. The following coverages may or may not be combined with your current policy. It is best to check with your insurance carrier on what may already be included in your insurance policy. Basic hospital, medical and surgical insurance pays the portion of daily hospital room and board costs specified in the contract. This type of policy also pays for hospital services and supplies such as X-rays, lab tests, medicine and other items up to a stated amount. Most basic policies have time and dollar limits on benefits. For example, a policy may pay actual costs (the total billed amount for service) up to a fixed amount per day for hospital room and board for a stated number of days. Or, a policy may pay a fixed percentage of all covered hospital costs for a stated number of days. Payments for surgical expenses usually are based on a surgical fee schedule so that a maximum stated amount is paid for a specified operation. Major medical While basic hospital, medical and surgical policies stop paying benefits when certain time limits or dollar limits are reached, major medical insurance provides additional protection against the high costs of serious or continuing illnesses and injuries. Major medical policies usually provide broader coverage than basic policies. They may cover the costs of blood, drugs, and out-of-hospital costs such as visits to the doctor. Benefits are payable for longer periods and major medical policies usually have a large maximum lifetime benefit instead of the smaller dollar and time limits of most basic policies. Policyholders generally have to pay a yearly deductible before their major medical policies begin to pay benefits. This deductible can be on an individual or a family basis. These policies usually pay a certain percentage, often 80 percent, of covered expenses after the deductible is paid. The policyholder pays the remaining percentage under a co-insurance or co-payment clause. After the stated amount is paid, some policies pay 100 percent of any remaining expenses that are covered by the policy. Health Insurance Tips Check agents and companies. Make sure the agent and company you are dealing with are licensed to sell health insurance in your state. Review applications. Make sure any pre-existing conditions are listed on your application, and that all information is correct False information or misrepresentation of health conditions in your application is against the law and may result in the denial of benefits or cancellation of your policy. If the insurance agent fills out the application for you and makes a mistake, tell him or her to complete another application. If you find a mistake after the application has been forwarded to the company, notify the company in writing immediately. Do not sign a blank application. Replacing a policy. If you are replacing an existing policy with a new one, do not cancel your current policy until you are sure your application for the new policy has been approved by the new company and your coverage is in effect. Although a premium may have been paid, coverage usually does not become effective until the application has been approved by the company. Ask your agent when your new coverage will become effective. Outline of coverage. Request an outline of coverage or a brief summary of what is covered under the policy. Make sure you obtain the outline of coverage at the time the product is presented. You may use the outline to compare the coverage with products that may be available from other providers. 4 William Penn Life, September 2003
