10 Most Important Things You Want In Health Insurance

By: Louis Neal
Submitted: 2007-01-17 16:15:25
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Buying health insurance does not have to be complicated. Indeed, many people feel over whelmed when they look at an insurance brochure. In order to help simplify the process here are ten things you should look for when shopping for a health insurance policy.

• 1. Amount of your deductible. This is the dollar amount you pay up front for medical services before the policy begins paying any benefits. If the coverage is to be for more than one family member check to see if everyone to be covered has an individual deductible or if everyone is covered under just one deductible. If there is a deductible for each person on the policy, most companies will set a maximum of three people who must meet the deductible. After that, they will consider the year's deductible to be satisfied. Usually, the higher the deductible you choose is reflected in the cost of the premium. You would pay more for a deductible of $500 than for, say, $1500.

• 2. The amount of your out-of-pocket expense. This is the dollar amount of what you will have to pay before your insurance policy will begin paying 100% of your medical expenses. This is tied directly to the amount of deductible you have chosen since some policies don't include the deductible in the maximum out of pocket.

• 3. The cost of prescription drugs is, perhaps, one of the first things that people look for in a health insurance policy. Many companies will include a discount prescription drug card with the policy at no additional cost. However, if you want a set price (called co-pay amount) for generic and brand name drugs, you will have to pay more for this type of prescription plan. Also, there may or may not be a separate prescription drug deductible you must meet annually before your co-pay for prescriptions takes effect.

• 4. Your co-insurance amount will also affect the cost of your premiums. It is also part of your out-of-pocket expenses. If, for instance, you are willing to pay 50% of the first $10,000 of medical expenses then your premiums will be lower than if you are only willing to pay 80% of the first $5,000 of expenses. This co-insurance is usually shown in brochures as 50/50 or 80/20, respectfully, and will show the dollar amount to which the percentage applies.

• 5. Since many emergencies involve the use of an ambulance, you need to know if your policy covers ambulance fees. You should also note if there is annual cap on what the policy pays for ambulance use and if it will cover both ground and air service.

• 6. Since most policies require the use of a Preferred Provider Organizations (PPO), you should be sure your doctor, hospital or other medical service provider is a member of the PPO. This is shown in the brochures as "in network" and "out of network" coverage. Policies that do not require you to use a PPO are called indemnity policies. As a general rule, but not always, you will pay more for an indemnity policy. Some indemnity policies have a PPO which you can still use, however, in order to help you limit the cost of your medical expenses.

• 7. Look over the list of exclusions very carefully because this tells you specifically what the policy will not cover. Most health insurance companies won't pay benefits for cosmetic surgery, for example, or benefits related to sex change. The list of what is not covered is usually the last page of your brochure.

• 8. Also under the exclusions you will find the company's policy on "pre-existing conditions". If, for example, you have been treated for high blood pressure in the last twelve months, the company may not cover anything related to that until you have had the policy for six to twelve months. Some states have set time limits on how long the insurance companies can make you wait for coverage of pre-existing conditions.

• 9. If you are changing insurance companies, there is also something you should look for under pre-existing conditions. You should see if you will be given credit for any money already spent for medical expenses that would have been covered by your existing insurance company. Many companies will give credit for up to four months of expenses you may have already accrued.

• 10. Check to see if there are "wellness benefits" for you and your family. Many plans will pay for an annual physical after you've had the policy for a year. Likewise, many plans will pay for children's immunization shots or to help you quit smoking or lose weight.

These are just a few of the items should take note of when shopping for health insurance. You may also want to check the maximum amount of benefits that will be paid, options on how you pay premiums and whether or not there will be a co-pay if you have to go to the doctor's office.

Louis Neal is an independent insurance agent selling health and life insurance online at his website: http://www.lowhealthinsurance.com He is a member of National Association of Health Insurance Underwriters.

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