Why do you need health insurance?
Health insurance is designed to help offset the cost of medical, dental, and vision care, along with additional options for supplemental health, long-term care and disability insurance (for maintenance of income while under medical care) for you and your family. Unless covered by Medicare or Medicaid, current healthcare reform requires individuals to now have medical health insurance, whether carried under an employer plan or individually, under tax penalty.
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What does health care reform encompass?
The Patient Protection and Affordable Care Act (PPACA), signed into law in 2010, is predominantly focused on lowering the number of uninsured Americans and reducing the cost of health care in the United States.
How will health care reform affect you?
- Health care will be available and affordable for individuals with pre-existing conditions. Starting in 2014, cancellations and non-renewals based on chronic illness are illegal. This includes both adults and children.
- Preventative services, such as diabetes and blood pressure screenings, will be available at no cost.
- Children can remain on their parents’ plan until age 26.
- Small businesses will receive a tax credit to offset the burden of offering health care in comparison to larger companies that can afford employee benefits.
- An 80/20 rule will force insurance providers to spend at least 80 percent of premium dollars on medical treatment, rather than advertising and executive bonuses. If they do not meet this requirement, they must offer a rebate to customers.
- Lifetime and annual dollar limits on essential medical treatments will be phased out by 2014, which means that consumers will no longer be denied coverage once their medical expenses reach a certain dollar amount.
- The gap, or donut hole, in Medicare’s Part D prescription drug program will close in 2020, making drugs more affordable. Until then, seniors will receive savings on both brand-name and generic drugs.
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Our agency can help you select a health care policy to both cover your needs and meet government requirements. Times of drastic change can be confusing. We are here to answer your questions and guide you to a viable solution. Call us to today to get started!
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Health (Medical) Insurance
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
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
- Managed Care
More than half of all Americans have some kind of managed-care plan1. 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
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Supplemental Health Insurance
What is supplemental health insurance?
Health insurance goes a long way toward paying your medical expenses. Plus, it’s now required by law. However, even if you have a health insurance policy, you can still face out-of-pocket expenses like deductibles, co-pays and treatment. Supplemental health insurance can reduce that burden.
What are the benefits of supplemental health insurance?
Supplemental health insurance is not meant to replace primary health insurance. But, it can help pay some medical expenses once your primary policy has paid. These policies help cover expenses like the following:
- Outpatient services and hospital stays
- Critical illnesses and emergencies
- Private rooms and private duty nurses
- Deductibles and co-pays
- Unexpected childcare
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Dental insurance is rather unique. The price of maintaining a healthy mouth can cost hundreds ... even thousands of dollars. With, typically, low cost dental insurance, it makes dental care highly affordable for individuals and families. Dental insurance encourages and generally pays for regular check-ups (preventative care) and additional services. Should you ever need costly care, from filings and crowns to periodontics and orthodontics, your dental insurance will be there to provide benefits when needed (In some case, a waiting period may apply for additional services to be covered. Be sure to talk with your agent about any known upcoming services needed or concerns and your coverage potential.). So, if you buy dental insurance, you will probably use it. And, like millions of Americans who have protection, you'll probably be glad you did.
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Vision insurance refers to a contract between a consumer and an insurance organization which provides vision care in return for a premium. In exchange for their premium payments, consumers usually receive eye examinations (given by doctors and clinics contracted with the insurance organization) and corrective eyewear. Exactly how much of the fees are covered varies according to the specifics of the plan.
Even if you have perfect vision, proper preventative eye care is an essential practice towards ensuring the health of your vision in the years to come . The most important step is receiving routine examinations from a qualified eye care professional. Individuals between the ages of 20 to 40 are recommended an exam every 5 years or so, provided no visual changes or injury has occurred. Individuals over the age of 40 should have an exam every 2 years or so.
Plan features and benefits will vary depending on the provider, but features typically discounted include:
- Eye examinations
- Surgical procedures - including Lasik procedures where available.
- Contact Lenses
- Non-prescription sunglasses
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Long Term Care Insurance
What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find
themselves in need of help with eating, bathing, dressing, toileting or
continence, and/or transferring (e.g., getting out of a chair or out of bed).
These six actions are called Activities of Daily Living–sometimes referred to as
ADLs. In general, if you can’t do two or more of these activities, or if you
have a cognitive impairment, you are said to need “long-term care.”
Long-term care isn’t a very helpful name for this type of situation because, for
one thing, it might not last for a long time. Some people who need ADL services
might need them only for a few months or less.
Many people think that long-term care is provided exclusively in a nursing home.
It can be, but it can also be provided in an adult day care center, an assisted
living facility, or at home.
Assistance with ADLs, called “custodial care,” may be provided in the same place
as (and therefore is sometimes confused with) “skilled care.” Skilled care means
medical, nursing, or rehabilitative services, including help taking medicine,
undergoing testing (e.g. blood pressure), or other similar services. This
distinction is important because generally Medicare and most private health insurance pays
only for skilled care–not custodial care.
What is long-term care insurance?
Long term care insurance helps cover the costs of the individual care while in a long term care facility. It will cover.....
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What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and
Long-Term Disability (LTD):
- Short-Term Disability policies (STD) have a waiting period of 0 to 14
days with a maximum benefit period of no longer than five years.
- Long-Term Disability policies (LTD) have a waiting period of several
weeks to several months with a maximum benefit period ranging from a few
years to the rest of your life.
Disability policies have two different protection features that are important
- Non-cancelable means the policy cannot be canceled by the insurance
company, except for nonpayment of premiums. This gives you the right to
renew the policy every year without an increase in the premium or a
reduction in benefits.
- Guaranteed renewable gives you the right to renew the policy with the
same benefits and not have the policy canceled by the company. However, your
insurer has the right to increase your premiums as long as it does so for
all other policyholders in the same rating class as you.
In addition to the traditional disability policies, there are several options
you should consider when purchasing a policy:
- Additional purchase options
Your insurance company gives you the right to buy additional insurance at a
later time for an additional cost.
- Coordination of benefits
The amount of benefits you receive from your insurance company is dependent
on other benefits you receive because of your disability. Your policy
specifies a target amount you will receive from all the policies combined,
so this policy will make up the difference not paid by other policies.
- Cost of living adjustment (COLA)
The COLA increases your disability benefits over time based on the increased
cost of living measured by the Consumer Price Index. You will pay a higher
premium if you select the COLA.
- Residual or partial disability rider
This provision allows you to return to work part-time, collect part of your
salary and receive a partial disability payment if you are still partially
- Return of premium
This provision requires the insurance company to refund part of your premium
if no claims are made for a specific period of time declared in the policy.
- Waiver of premium provision
This clause means that you do not have to pay premiums on the policy after
you’re disabled for 90 days.
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1 - Source : MANAGED CARE AND THE STATES