Importance of medical insurance and its features

Financial planning is very important part of your life as it helps you create cash reserves for your future needs. Just like you plan for good future your health is also an important goal to achieve. If you have good health you can work well, prosper, look after your family, enjoy life and perform the duties with full responsibility. However, in today’s time of growing uncertainties and hectic lifestyle maintaining an exceptionally good health is a myth. Therefore, owning a suitable medical insurance policy is very much important along with your financial planning goal. While you’re young and just started to earn, it will be a right time to give equal importance to health.

At younger age, you medically fit and not prone to any disease therefore, you get better coverage at low premium rate.  But however, as you gradually grow old your health gets impacted and finally you will have to bear the pain of your hard earned money spent on hefty hospitalization charges. Also, inflation is an added burden take affects your financial savings. Therefore, it becomes essential to have a proper medical insurance plan in place that would take care of your health if required by taking care of financial implications.

A medical insurance is basically a contract between the insured and the insurance company where you promise to pay a certain amount as premium towards your policy and in return the insurance company promises to pay for your medical expenses in case of hospitalization if you want to undergo treatment.

There are various types of medical insurances available for everyone as per their pockets and affordability. Insurance companies have introduced online tools where you can compare the policy in terms of benefits & features, discount and deals, premium payment flexibility, claim settlement ratio, preferred specialists, etc. and purchase the one as per your requirement and the one that fits into your budget.  It is advisable to go for a comprehensive medical plan as it covers some of the most important charges such as Cashless facility in network hospital, Ambulance charges, Pre and post hospitalization expenses up to specified time, Lab and investigating report charges and Easy claim process.

A proper policy in place helps you ease out the financial strain thus giving ample time to focus primarily on the health. Always remember that the insurance is after all a commitment between the purchasing party and the company. So, just signing and sitting back won’t be sufficient. You will have to understand that once you sign the form means you declaring that you’ll abide the rules and agreed with all the clauses. So, it becomes very important that you read the documents calmly and carefully.

Your information and declaration are basis on which the medical insurance companies will customize your health plan, evaluate risks and estimate the premium to insure that risk. At the time of claims, insurance companies in India checks the authenticity of these declarations.

Some factors that will determine the coverage amount for your medical insurance plan would be your income source, risk appetite, family members, place of living, occupation, pre-existing or hereditary disease, etc.

All about Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can't land on an affordable health plan that could cater to the medical care needs.

Let's discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer's group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September and December, may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida Kid Care program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer's group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman's Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can't have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children's Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent's health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health insurance coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

Source: http://ezinearticles.com/?All-About-Affordable-Health-Insurance-Plans&id=7744773

Exclusions In A Health Insurance Policies

What does a health insurance not cover i.e. exclude?

The moment of truth in an insurance policy is at the time when a claim arises. One of the most common reasons for a health insurance claim not being paid by an insurance company is when they say that the particular disease is not covered by the policy and is “exclusion". It leaves a bitter taste in the mouth of the policyholder and can sometimes put the policyholder in great financial difficulty. Thus, it is very important to know in detail about the exclusions in a health insurance before purchasing it. In our opinion, it is a far more important variable than price. A policy might be 10% cheaper than a competitor's policy but might have many more exclusion clauses-in such a case, the policy with the lesser number of exclusion clauses would be the better choice for the policyholder.

In this article, we deal with some of the common exclusion clauses in a health insurance. Of late, we are seeing some innovation in this area with the new companies not excluding certain ailments which had traditionally been within the exclusions area

Maternity: In most cases, maternity and maternity related expenses are not covered in an individual or family floater health insurance. Maternity is typically covered in a group policy. In certain cases, we are seeing maternity being covered after 5 years into the policy.

Diseases or illness contracted within the first 30 days of the policy. The insurance company does this to safeguard itself against customers buying a policy immediately after a disease has been detected

Cataract, Prostrate, Hernia, Piles, fistula, gout, rheumatism, kidney stones, tonsils and sinus related disorders, congenital disorders, drug addictions, non allopathic/alternate treatments, self-inflicted injuries, hysterectomy, fertility related treatments, etc. are normally not covered under a health insurance. Dental treatment and cosmetic surgery is also typically excluded. Contact lenses cost is also not covered. HIV/AIDS is excluded, which has been a subject of great debate and criticism in the last few weeks. Some insurance companies do not cover treatment incurred outside the country, so you should check once before buying the policy

Preexisting diseases are not covered in a health insurance. Preexisting means a disease that you have had prior to joining a health insurance. The policyholder may or may not have been aware of the pre-existing disease. Further complications which arise due to the preexisting disease are also not covered. For example, renal problems which arise due to a person having diabetes at the start of the policy would not be covered. This can sometimes lead to a lot of confusion and heartburn. Someone gets admitted for a kidney related treatment, and the insurance company turns down the claim saying the kidney problem has arisen because the patient had diabetes, and rejects the claim. It can get a little grey here as medical science cannot sometimes clearly pinpoint the root cause of a particular disease outbreak. In most cases, preexisting diseases are covered after 3 or 4 consecutive policy years. This is the single biggest reason why one should buy a health insurance at a young age, and continue with the same insurer. Because if you shift to a new insurer, you lose your previous credit and a disease that was being covered by the old insurer might be treated as a pre-existing disease by the new insurer. We have noticed that insurance companies start facing more claims from the health insurance customers from their 4th or 5th policy year, as preexisting begins to get covered and the profitability of the portfolio goes down

Most policies do not cover day care, but a few like Max Bupa cover daycare, although the premium is higher in this case

War related health insurance claims are mostly excluded from the policy coverage

Abortion related health expenses are not covered in a health insurance

Please do note that with competition heating up, some of the exclusions mentioned above will begin to get covered by a company or two so that it can be used as a selling point. Thus, the lists mentioned above are subject to change. The moot point here is that 10 minutes spent to read the exclusions list of the health insurance policies you are considering to buy could save you a lot of headache buyer. Is an informed buyer- there will be no else to blame but you.

Source: http://youknowitbaby.com/article/14111/exclusions_in_a_health_insurance.html

Medical Insurance Companies: Heroes or Villains?

Physicians are expected to be hostile to insurance companies.  Indeed, a prior Whistleblower post directed arrows in their direction.  They are an easy target, often vilified for their greed and perceived indifference toward those they insure.  Ask most of us if we think insurance companies favor profits over patients, and most of us will respond that profits prevail.

Insurance companies are businesses, not charitable undertakings.  Sure, we all like free stuff.  Or, if it’s not free, we prefer that someone else pays for it.  We are outraged at the costs of chemotherapy, hepatitis C treatment and biologic treatments such as Humira and Remicade, leaving aside the zillions of dollars it takes to research, develop, manufacture, market and monitor innovative new drugs.

No person, business or organization is wrong all of the time.  Consider the following practices.  Whose side are you on here?

A patient has chronic back pain and ran out of his pain medications on the weekend.  He calls the doctor and is connected to a weekend covering physician who declines to refill the medicine.  The patient then proceeds to an emergency room, where he is evaluated and given the desired prescription.  Who should pay for the ER care?

A patient is seen in the office and prescribed a 2 week course of antibiotics for diverticulitis.  The medicine nauseates him and he stops them in 3 days.  He does not contact his physician.  Ten days later, he develops severe abdominal pain and fever and needs to be hospitalized for severe diverticulitis.  He is in the hospital for 5 days and is seen by numerous medical specialists.  Who should pay the costs of this hospitalization?

A 55-year-old individual has never had a colonoscopy performed.  His primary care physician advises him to proceed, but the patient declines.  A decade later he is discovered to have colon cancer and needs to be hospitalized for surgery and evaluation by an oncologist.  Who should pay for the costs of his care?

If a patient with high blood pressure, skips appointments and his medications, and a complication develops…

I’m not carrying water for the insurance companies.  I am pointing out, however, that we often expect them to pay for medical insurance care that is either inappropriate or should not have been necessary.  That’s not reasonable or fair.   Don’t we have a responsibility to be personally responsible?

Source: http://mdwhistleblower.blogspot.in/2016/05/medical-insurance-companies-heroes-or.html