Your Needs"-- Why do you need health insurance? The answer may seem
simplistic but people have health insurance for a variety of
reasons.
Are you interested in protecting your financial assets from creditors in the
event of a costly medical problem? Are you mostly concerned about having access
to the best doctors and hospitals and not sure if your current plan allows for
that? Do you have Rx needs, maternity considerations, young children requiring
immunizations, or ongoing medical problems that require more frequent doctor
office visits?
People value these 'needs' in different ways. We help
you look for programs which best suit your needs.
"Your Health History"-- How important is that?
Well, health insurance isn't just about health. In Connecticut non-group plans,
private indemnity companies have the right to qualify people on the basis of
their health history. Looking at it in a more positive light, healthy people
have the right to capitalize on that situation. They can obtain health insurance
at a lesser cost than those who are 1. unhealthy or 2. have availed themselves
of the medical system to a greater degree than average.
Compare that to the 'good driver' program. A good driving record is considered
indicative of future good driving. Good health history is considered somewhat
correlative to future good health.
"Group Plans" are another matter. A company can insure its employees under a
group plan. All employees who wish to be included are insured, and health history
is not a consideration in either entry or premium cost.
"Affordability"-- How much do I need to spend to be adequately
covered?
This portion can be complicated. First you much determine what your needs are
in regards to insurance coverage. The least expensive plans are those that have
you pay first dollar for deductibles, co-pays etc. To the degree that you want
the insurance company to cover you more for actuarially determinable, insurable
risks (catastrophic, i.e. cancer, strokes, heart problems as compared to general
office visits, physicals, etc.) the lesser your premium will be.
Do some calculations based upon your family's past average and possible expected
usage for doctor office visits, prescriptions and minor medical claims. Compare
the additional premium for insurance coverage that these entail against what
it would cost you to pay a lesser premium and assume these costs on a out of
pocket.
The "Insurable Risk Factors"--What is your attitude toward
financial and medical risk?
Here everyone's different. Are you comfortable with a high deductible plan or
a lower deductible plan? It might be a given to assume the latter but when the
incremental premium is considered you might think otherwise. Nevertheless, some
people are more comfortable in paying the higher premium and not having to face
the high deductible in the future. Other people figure their health history has
been good and therefore they can retain or assume some of the deductible risk,
opt for lower premium and choose the higher deductible.
The only point I might add here is that insurance companies tend to over-price
very, very low deductible plans and feel more comfortable in having you assume
some of that risk.
Who's in charge? The insured (the patient!), the doctor
and hospital, or the insurance company?
What are your rights under various types of coverages? Can
you see whomever you want? Do you have to consult your 'gatekeeper'? Do you
have to 'get permission' to see a specialist even though you're spending a fortune
in premium?
HMO? PPO? Indemnity plans? You need to find out
your rights and privileges under each of these respective considerations. Every
Insurance Company has different programs and there is no general industry-wide
rule.
Is your doctor part of the plan? Will he be allowed
to direct your health plan? Will your medical providers be themselves short-changed
financially by the insurance company? In the event of a medical 'botch-up' where
can the blame be assumed?
If you have an 'indemnity' plan with a policy, it is incumbent upon you to check
carefully what your plan covers and does not cover, the plan's limitations and
exclusions. Will you be covered for recent innovation in medical technology?
What about transplants?
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