Sempal-Bel Business Blog

Posts Tagged ‘Health Insurance’

Many dual income couples, include their children on each group health insurance plan to maximize benfits. However, without some sort of system in place to help the health insurance companies coordinate benefits, it’s possible that either you or your doctor would be reimbursed for more than 100 percent of the actual cost of your claim.

To prevent this, health insurance companies typically designate one parent’s health insurance plan as the primary plan and the other as the secondary plan. (That’s why the patient questionnaire at your doctor’s office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.

THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE

The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn’t matter which spouse is older.

Like most rules, the birthday rule has exceptions:

- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.

- If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer, the plan belonging to the curently employed spouse would be primary.

- In the event of divorce or seperation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new new spouse’s coverage becomes secondary. And finally, the non custodial parent’s health insurance plan would provide a third layer of insurance protection. This order of payment can be altered by a court issued divorce decree or by agreement, but the health insurance companies must be notified.

THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW

Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit specialist or your insurer’s customer service department.

Insurance is designed to protect a person and the family from disasters and financial burdens. There are many kinds of insurance of which, the basic and most important is considered to be life insurance. It provides for the dependants after your death.

Since there are certain financial commitments you need to meet throughout life and do contribute in some way to the family income, you need to provide something even in death—to secure the home, help the family meet expenses for a while, protect dependant parents, or secure the children or spouse.

Financial obligations could include funeral expenses, unsettled medical bills, mortgages, business commitments, meeting the college expenses of the children, and so on.

How much insurance a person needs would vary, depending on lifestyle, financial needs and sources of income, debts, and the number of dependants? An insurance adviser or agent would recommend that you take insurance that amounts to five to ten times your annual income.   It is best to sit down with an expert and go through the reasons why you should consider insurance and what kind of insurance planning would benefit you.

As an important part of your financial plan insurance provides peace of mind for any uncertainties in life.

1.    Life insurance correctly planned will on premature death provide funds to deal with monies due, mortgages, and living expenses. It offers protection to the family you leave behind and serves as a cash resource.

2.    It secures your hard earned estate on death by providing tax free cash which can be utilized to pay estate and death duties and to tide over business and personal expenses.

3.    Life insurance can have a savings or pension component that provides for you during retirement.

4.    Some policies have riders like coverage of critical illness or term insurance for the children or spouse. There are certain rules regarding eligibility for riders which you will need to determine clearly.

5.    Having a valid insurance policy is considered as financial assets which improves your credit rating when you need health insurance or a home loan or business loan.

6.    In case of bankruptcy, the cash value as well as death benefits of an insurance policy is exempt from creditors.

7.    Life insurance can be planned such that it will cover even your funeral expenses.

8.    Term life insurance has double benefits, it protects and you can get your money back during strategic points in your life.

9.    Insurance protects your business from financial loss or any liabilities in case a business partner dies.

10.    It can contribute towards maintaining a family’s life style when one contributing partner suddenly dies.

Insurance is vital to good financial planning and security but you would need to assess your personal risk and long term commitments. Insurance stands a person in good stead throughout life and can be used in case of emergencies during a life time by requesting a withdrawal or loan.

A POS or Point of Service plan is kind of like an HMO and PPO combined type health care plan. You have more flexibility than a regular HMO, but pay a smaller fee and deducible than a PPO. It is perfect for those people who need more flexibility but want to pay less. You will be asked to select a general provider that is off the list of acceptable doctors. This will be your primary care physician and he or she will be the one to manage what care you receive. He or she will direct you to specialist and hospitals as needed that are also participants in the plan. Usually there are many providers from each specialization to choose from and typically covers a wide geographic area. With this type of policy, you will not have a large deducible if any, and still have a minimal co-pay on visits and prescriptions. Of course, this is if you stick with the preferred providers list. You also may want to make sure what drugs are covered under this plan and if you have to pay more for newer on not generic medications. Some doctors don’t think about what kind of insurance you have when writing out the prescription and you need to remind him or her if you are only allowed to buy generic to be covered.

You will also have a choice to see out-of-network providers when you need a specialist and they are not on the list. Most POS plans require you get a doctor’s referral prior to seeing another doctor or specialist. Once referred to a specialist within the network, you will have to be prepared to pay more. If you choose to do this, you will be billed directly and must submit the claim to the insurance company your self. Your insurance company will pay their flat rate for whatever you had done and you will be responsible for the rest. You may also be responsible at the time of service to pay the entire amount and wait to be reimbursed your self from your insurance. If you chose to see a specialist on you own, the cost will be higher and around 50% if you were not referred. You will be required to pay a higher amount if you go out-of-network. So in essence, you have the right to see whom you chose, but at your own expense. The POS plan will only pay their flat rate for specific medical issues and not above it, unless it is an emergency situation. Many people like the idea of having more say in their health care choices, while others care more about saving money and don’t care who they go to. What you chose will depend on what you personally want and what is more important.

The emphasis on this plan is prevention of illness or disease to cut the cost to both the individual and the insurer. Most other plans such as HMOs and PPOs have the same basic emphasis. You are encouraged to take an active roll in your health and do what it takes to remain not sick and disease free for as long as possible. The idea is to see the doctor less so both you and your carrier together spends less money. The idea with this plan is that if you have to put more money into your health care you will think twice at whether or not you really need to go. If you want to waist the insurance companies money you have to waist your own too to do it. Medical insurance companies are in business to make money, they want you to stay healthy so they can collect your premium and not have to pay it out to the health care provider. So, for those people who do not want to pay as high as a monthly premium tends to opt for this type of health insurance plan. This one will ensure a low rate with out having to worry about huge deductibles or co-pays if used more like an HMO. So, if you think that this sound like something you are interested in, talk to several different companies and get some policies to look at. Make sure to look at what is covered as well as the price. Do a little research in the various insurance policies that are available. The one that you need to pick will depend on your priorities.