Frequently Asked Questions
The main reason for buying health insurance from JC Lewis Insurance Services is we have been assisting California residents with their Health Insurance needs for more than twenty-five years. With no charge for our assistance and carrier-direct rates from the largest carriers licensed to do business in California, you pay the lowest possible cost for the plan selected. Our web site is designed to present an array of plans for your age, location and family demographics giving you many health insurance options from major insurance carriers. And if you would like personal assistance, a few minutes with one of our licensed staff will help define your needs, answer your questions and sort through your best options from the many plans available.
You WOULD NOT save a dime purchasing direct from an insurance carrier, and your choices would be limited to that company's products. All health insurance carriers licensed in California must file their premium schedules with the California Department of Insurance. You are charged the same rate for each plan offered, regardless from whom the purchase is made. And when working through us, you are not restricted to the products of a single insurance company. You get carrier-direct rates and no additional charge for our services.
The best plan for one person might not be the best plan for you. Each person or family has there specific healthcare needs that must be considered when evaluating health plans. Our best advice is you take a few minutes and talk with an expert about your particular situation. At no cost to you, we will help define your needs and sort through your options from the many plans available. The best plan for you will be the one that will meet your current needs. You should consider such things as:
- The health of those to be insured, any medical issues, current coverage and what you like and don't like about your current health plan.
- What doctors, specialists, hospitals and other health care providers are part of the network for the plans(s) being considered.
- Your potential out-of-pocket expenses in the event of a major illness or injury (your financial risk).
- Coverage for prescription drugs and doctors visits - do you want a modest co-payment or, because you are healthy and have few medical expenses, would prefer a lower cost catastrophic type coverage.
- Perhaps the most important consideration is...don't buy any insurance based solely on cost.
A Health Maintenance Organizations (HMO) originally offered a generous benefit package without co-payments, deductibles and with few limitations. Costs and care were and still are controlled by their network of approved hospitals and providers. Over time, due to rising costs, HMOs, like all other types of health insurance, have been forced to modify benefits and even pull out of some areas in California. An HMO may still be a viable choice for you, depending on your location and the availability of approved providers and hospitals in your area. You select a primary care physician from the list of approved providers who becomes your gatekeeper and initial contact for all medical conditions. If a specialist is needed, your primary care physician will refer you to the proper specialist, usually within the HMO network.
It is important to understand that if you obtain care without first contacting your primary care physician, or obtain care from a physician outside the HMO approved network, you may be responsible for all costs incurred (excepting emergency care as defined in your policy). In California, it is not uncommon today for HMOs to have deductibles, co-payments and/or limitations on the daily hospital allowance until the maximum out-of-pocket limit is reached. Benefit limitations are often difficult to understand and we strongly recommend speaking with one of our licensed staff to assist in your evaluation and selection.
A Preferred Provider Organization(PPO), like an HMO, has a network of doctors and hospitals with whom the insurance company has contracted to limit costs to an agreed to amount. Unlike an HMO, PPO participants may choose care from within the PPO network or from providers outside the network and need not obtain a referral to see a specialist. PPO plans typically require you to pay an annual deductible and a co-payment for each service until the maximum out-of-pocket amount is reached after which eligible benefits will be paid at 100%. You will pay less for services from a member of the PPO network than from a non-network provider. For example, you may receive 80 percent of the expenses incurred with a PPO provider and only 60 or 50 percent from non-PPO providers. Benefits and their limitations are often difficult to understand and we strongly recommend speaking with one of our licensed staff to assist in your evaluation and selection.
A Health Savings Account (HSA) works something like an IRA, except that funds used to pay eligible medical expenses are with pre-tax dollars (tax-free) with unused funds saved for retirement on a tax-deferred basis. For example, you get a relatively inexpensive high deductible health insurance plan and then a tax-deductible savings account to cover qualified medical expenses including prescription drugs, dental and vision expenses, copayments and deductibles. ou can deposit as much as $2,850 for individuals or $5,650 for families annually. Annual amounts limits can change per federal guidelines. Any unused money in your HSA at the end of the year may continue to grow in your account or may be rolled over to other approved investments where they will continue to grow tax-deferred until used or withdrawn. For additional details on HSAs, we suggest The United States Treasury Department site www.treas.gov/offices/public-affairs/hsa/pdf/hsa-basics.pdf
Individual and Family Health InsuranceWhat is a Individual Family heatlh insurance plan?
Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available
The reasons for needing health insurance when you are healthy are numerous. Listed below are four significant reasons you must insure yourself before getting sick or injured:
- If you wait until you are sick or injured, it is too late to apply.
- You must be healthy to apply for an Individual and Family health insurance Plan (IFP). The underwriters will base the acceptability of your application and your rates on your medical records and health at the time the application is submitted. They could rate you up or decline you if you have certain medical conditions.
- A large percentage of bankruptcies are due to catastrophic medical costs. Comprehensive health insurance plans, both PPO and HMO, protect your assets from catastrophic medical expenses with annual in-network out-of-pocket maximums.
- When you have insurance, you will be charged the negotiated fees with in-network providers. The negotiated fees provide substantial savings even with high deductible plans as, in most cases, you will receive those discounted fees whenever you use in-network providers, even below the deductible, for allowable medical expenses.
Individual and family health insurance plans are usually described as either “indemnity” or “managed-care” plans. The major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different types of managed-care health insurance plans. These include HMO or PPO plans which are managed-care plans that typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.
As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion. You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills. With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.
Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork. Under an Indemnity plan, you may see whatever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician. However, this kind of freedom will cost you. You'll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the "usual, customary and reasonable (UCR) rate" for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.
Legislation establishing Health Savings Accounts (or "HSAs") took effect on January 1, 2004. HSAs and HSA-eligible health insurance plans are becoming more and more popular. Here are the basics:
- An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.
- Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
- Contributions to an HSA may be made pre-tax, up to certain annual limits.
- Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.
- Not all high-deductible plans are eligible for use in conjunction with an HSA.
A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.
Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional co-payment or deductible requirements), then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.
An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers. As a general rule, PPO and HMO plans make use of provider networks. Indemnity plans typically do not.
Choosing between different health insurance plans isn't always easy. There is no one "best" plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:
- Do you need long-term coverage or just something for the short-term?
If you're between jobs for 1-6 months, you may want to look into our short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.
- Are you looking for basic coverage or more comprehensive coverage?
Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness. Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.
- Would you rather pay for your services before you use them or when you use them?
Typically, the higher the monthly premium that you pay, the less you will pay per doctor's visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you're likely to have a higher co-payment or deductible. If you don't anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.
- How important to you is easy access to specialists?
Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.
- Do you have a specific doctor or hospital that you would like to visit for healthcare?
Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. You'll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.
- What is the most you could pay out in case of a serious illness or injury?
Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you've contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you're concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you're considering.
You can request that your Individual and Family health insurance plan start anytime between 1 and 90 days in the future. However, the insurance companies will typically need some time to process your application so keep in mind that the actual date for the start of your coverage may vary depending on the underwriting process and the availability of your medical records. (Underwriters will receive your application much faster if you "eSign" your application.)
Many health insurance companies require one policy per child. So if you have more than one child, try entering information for one child as the primary applicant to see a larger selection of plans and prices.
By combining the localized knowledge of a neighborhood agent with the broad experience and comprehensive understanding of a leading online health insurance source, we are able to offer our customers:
- Broad Selection
JC Lewis Insurance Services (JCLIS) offers the broadest selection of California healthcare products for you because we are a health insurance agency licensed to sell major California healthcare insurance companies plans that are best for your needs. JCLIS offers broad product selection of plans from multiple insurance companies in your area, offering a broad selection of health insurance companies and plans. You will find the plan that best fits your needs. Our licensed agents are happy to answer your questions, compare the benefits and limitations of the different plans and assist you with the application process. Just call or e-mail for assistance. There is no charge for our services.
- Best and Lowest Prices
Health insurance premiums are filed with and regulated by your state's Department of Insurance. Whether you buy from J.C. Lewis Insurance Services, or directly from the health insurance company, you'll pay the same monthly premium for the same plan. Just call or e-mail for assistance. There is no charge for our services.
- Fast Processing
JC Lewis Insurance Services offers the fastest way to apply for health insurance because our website has direct carrier links (enroll now tab) that allow applications to be submitted and signed electronically, eliminating the need to manually print and mail applications. This reduces average processing time significantly. Our licensed agents are happy to answer your questions, compare the benefits and limitations of the different plans and assist you with the application process. Just call or e-mail for assistance.
- Superior Customer Care
We believe that you'll enjoy the best customer experience available in the health insurance industry. Our licensed health insurance agents will help you make the most of your money with professional, unbiased advice.
Student Health InsuranceHow can college students meet their needs with a Student insurance plan?
No matter what your specific needs, a Student health insurance plan can provide you with a valuable health insurance solution. Here are some examples illustrating how a Student health plan (e.g. the Student Select plan offered by Assurant Health) might help you:
- College-Sponsored Plans that are too "Bare-Bones" At college, the you might be outside of the HMO network region of his parents' health insurance plan, but Jack's parents want to make sure he has adequate health coverage. They did some research and found that the health insurance plan offered through the college is too "bare bones," with lots of limitations on coverage. Your situation is ideal for Student Select. It was designed specifically for students who need greater coverage at an affordable rate while attending college. The Student Select plan offers a choice of deductibles, and because it is not an HMO or PPO plan, you can pick the doctor or hospital he wishes to visit. The plan allows for up to $1 million in protection for eligible expenses, including in-hospital and outpatient services, emergency care and surgery.
- Can't Afford a Traditional Individual Health Insurance Plan You will be attending college next semester. Your school requires that you have some type of health insurance prior to the start of school. However, you don't have health insurance through your parents. And, you just can't afford the cost of a traditional individual health insurance plan. You can't risk going without coverage, but you need a plan that will fit her tight budget. In many cases, Student Select costs less than a traditional individual health insurance plan. It was designed specifically for students who need quality coverage at an affordable rate while attending college.
- Graduate Student No Longer Eligible for Parents' Plan You are in graduate school and is about to turn 24-years old. You just found out that once you do, you will no longer be covered under your parents' health plan. Your parents are worried about you not having health insurance. Student Select is ideal for your health insurance situation. The plan is available to full-time graduate students and coverage can be obtained as early as the next day. Enrollment is simple and premiums are affordable. Best of all, Student Select is guaranteed renewable. This means that, provided that you continue to attended school full time for 31 days after the policy effective date, you can keep the plan as long as you need it, as long as premiums are paid. This is important after graduation while looking for a job.
Since a Student health plan (e.g. a Student Select plan offered by Assurant Health) is not an HMO or PPO plan, you can visit the doctor or hospital of your choice. No referrals are needed, no out-of-network penalties are incurred ... the choice is yours!
Yes. The insurance company (Assurant Health) uses an authorization service which ensures you receive the most appropriate and cost effective care available. Trained staff work with you and your physicians to review the course of treatment and advise you of your eligibility for benefits. The identification card you receive with your policy provides a toll-free number for easy access to this service.
You must be an eligible college student between the ages of 17 to 29 to purchase a Student health insurance plan. An eligible undergraduate student is defined as a person carrying at least nine credit hours. An eligible graduate student must meet the graduate student guidelines of the college or university for full-time student status. Students must attend a state-accredited college or university in the United States.
Yes, as long as you are attending school in the United States and meet the eligible student requirements defined above.
The Student insurance plans are designed for individual college students only and do not cover spouses and/or dependents. Student plans do, however, comply with any state requirements for the coverage of newborns. If you have a spouse who is also a full-time college student, a separate application can be submitted for that person
An informed answer depends on several factors. You may want to consider a separate Student plan for your child if one or more of the following apply to you:
- The HMO or PPO network for your insurance plan does not have physician or hospital coverage in the area around your child's college.
- Your child is nearing the age at which he or she can no longer be covered under your plan. Often times this is around 24 years of age, but you should check with your insurance company to find out the specific age limits for your current policy.
- The cost savings of removing your child from your insurance plan is greater than the cost of the separate Student insurance plan. To determine if this is the case, get a quote on this website for a Student plan for your child, and then compare that to the cost savings of removing your child from your standard medical plan (you may need to contact your insurance company to determine this amount).
- A separate Student plan may not be appropriate if:
You are currently satisfied with the coverage, cost, and benefits of your current medical plan
- Your child has a pre-existing medical condition. In most cases, expenses relating to pre-existing conditions will not be covered by the Student plan until the policy has been in effect for 12 months.
With a Student insurance plan you're covered year-round, not just during the school term. And, if for some reason, you have to leave school, your coverage stays with you for the remainder of the policy year... and then it's guaranteed renewable.
A Student insurance plan travels with you anywhere in the United States, its possessions, and Canada. And, although it does not cover you in a foreign country, a Student plan does cover you for an emergency medical evacuation to the home country or a facility operating within its laws.
If you need to transfer schools, your Student coverage moves with you. Student coverage is not tied to any one school. There's no need to change coverage or re-apply. In fact, you're covered when traveling anywhere in the United States, its possessions, or Canada.
No, as long you met the definition of an eligible student on the date the application was signed, you attended school full-time for 31 days after the policy effective date, and the premium is paid in full.
No, provided that you attended school full-time for 31 days after the policy effective date, your Student policy stays with you for as long as you need it and, of course, as long as premiums are paid.
You can apply as soon as you are enrolled as an eligible student. But, keep in mind the full premium must be paid with the application. The policy will be sent out as soon as it is issued. We would prefer that the application not be completed more than 60 days prior to the requested effective date.
Student health insurance is renewable as long as you need it. Whereas most college plans only cover you until you graduate or very shortly thereafter, the Student plans offered on our site can be renewed as long as they're needed... as long as your premiums are paid.
Short Term Health InsuranceWhat is a Temporary Short-Term heatlh insurance plan?
Short Term Medical is a temporary health insurance plan designed for people who are between permanent health plans. Short Term Medical can provide you with necessary health insurance coverage whether you are:
- Between jobs
- Waiting for employer group medical coverage
- A recent college graduate
- A temporary or seasonal employee
- A dependent falling off their parent's health plan
- A laid off, striking, or terminating employee
- A laid off, striking, or terminating employee
Short term health plans often can be a one time expense. Shoppers have the availability to pay on a monthly basis or have a single payment option. Short term plans are often half the price of an individual health insurance policy.
Unlike individual health insurance plans, that can often have 4-6 weeks of underwriting time, during which you are NOT covered, short term plans are usually in-force the next business day.
A lot of consumer confusion can occur when investigating their individual or group health plan details such as deductible, co-pays, and stop losses. Short term plans consist of a deductible, payment options and length of coverage. Since the plan is not an HMO or PPO, you choose your own doctors and hospitals. Short term health plan highlights include the following:
- Prescription drugs
- Intensive care
- Lab and X-ray
- Ambulance service
- Extension of benefits options such as certain disabilities
Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise. If you wish to maintain your eligibility for HIPAA plans, you SHOULD NOT purchase a short-term plan. Please consult your benefits advisor to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.
Short-term health insurance plans typically do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA, which you should seriously consider if you have an existing medical condition.
Unlike individual health insurance plans, that can often have 4-6 weeks of underwriting time, during which you are NOT covered, short term plans are usually in-force the next business day.
Coverage is available for 30 days up to 12 months, depending on your particular needs and can most often be issued immediately (effective the day following receipt of your completed application).
What is best way to apply for Temporary Short-Term health insurance plan? Enrollment can be completed by mail, fax or online from the links below:
- Assurant Health Short Term Health Plans
- HealthNet Short Term Health Quote
California Health Savings AccountWhat is a HSA heatlh insurance plan?
A Health Savings Account(HSA) is an alternative to traditional health insurance because it is a savings product that offers a different way for consumers to pay for their health care. An HSA works something like an IRA, except the money is used to pay eligible medical expenses with pre-tax dollars(tax-free) and save for retirement on a tax-deferred basis. You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account. You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You will also decide what types of investments to make with the money in the account in order to make it grow.
You must have an HDHP if you want to open an HSA. Sometimes referred to as a "catastrophic" health insurance plan, an HDHP is an inexpensive health insurance plan that generally doesn't pay for the first several thousand dollars of health care expenses (i.e., your "deductible") but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover. In order to qualify to open an HSA, your HDHP minimum deductible must be at least $1,000(self-only coverage) or $2,000(family coverage). For 2006, the amounts increase to $1,050 and $2,100, respectively. The annual out-of-pocket (including deductibles and co-pays) for 2005 cannot exceed $5,100 (self-only coverage) or $10,200 (family coverage). For 2006, these amounts increase to $5,250 and $10,500, respectively. HDHPs can have first dollar coverage (no deductible) for preventive care and apply higher out-of-pocket limits (co-pays, coinsurance) for non-network services.
- First, you get a relatively inexpensive high deductible health insurance plan and then a tax-deductible savings account to cover qualified medical expenses.
- You can deposit as much as $2,850 for individuals or $5,650 for families annually. Annual amounts limits can change per federal guidelines.
- Any unused money in your HSA at the end of the year may continue to grow in your account or may be rolled over to other approved investments where they will continue to grow tax-deferred until used or withdrawn.
An HSA is not something you purchase; it's a savings account into which you can deposit money on a tax-preferred basis. The only product you purchase with an HSA is a High Deductible Health Plan, an inexpensive plan that will cover you should your medical expenses exceed the funds you have in your HSA.
For all the details on HSAs, we suggest The United States Treasury Department following site: www.treas.gov/offices/public-affairs/hsa/pdf/hsa-basics.pdf.
Absolutely. For a discussion of available HSA plans and options please contact our licensed staff to discuss your particular needs.
California Preferred Provider Organization (PPO)What is a Preferred Provider Organization(PPO) heatlh plan?
A Preferred Provider Organization(PPO) is a collection of private-practice doctors, labs, cares facilities, and hospitals that contract with insurance companies and receive an agreed set rate for their services. PPO's have a network of healthcare providers that the insured may use, however unlike the HMO, the PPO does not require you to use that network and allows you see doctors and go to hospitals which are outside of the network. In most cases, the member healthcare providers and the PPO sponsor have negotiated the price for each type of service in advance. PPO members typically pay for services as they are provided, and the PPO sponsor reimburses them for the cost of the treatment. Though members have the freedom to go outside of the PPO and will still receive coverage, they will pay more for seeing providers outside of the network. In other words, the coverage will be less. Physicians within a PPO can make referrals, but members can also refer themselves to doctors and specialists, including those who are not a part of the network.
If you're young, it's prudent to realize that now is best the time to shop for affordable health insurance. Age and health are two of the biggest factors that health insurance underwriters use to base their decisions concerning policy pricing. Health insurance is meant to be purchased when you are healthly and to be used when you get sick or injured - waiting until you are sick or injuried is too late. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem, the resulting medical bills can affect the economic stability of you and your family for the rest of your life.
PPO's may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is often a deductible for out-of-network expenses and a higher co-payment.
When comparing coverage plans, it's important that you consider more than just monthly premium payments. Deductible options, co-payments (sometimes referred to as co-insurance) and out-of-pocket costs must also be weighed. You should also be aware of any pre-existing condition restrictions and exclusions as well as any waiting and grace periods. In addition, vision, dental, and prescription drug options should be factored into your decision. It is possible to spend too much time choosing between the Preferred Provider Organization plan and the Health Maintenance Organization plan. The real cost savings issues are found when you concentrate on the plan design. Do your homework; shop and compare. It's also wise to seek the help of your state health department and local agent. Ask them how they rate the plans that you're considering. Then choose the most affordable plan which matches your requirements.
PPO plans have much less restriction but usually cost you more. You have more control over your own medical needs and don't need a referral as long as the doctor you are seeing is a member of the PPO. The co-payment is higher because the plan usually covers 80% of the fees. So that makes you the insured responsible for 20% of all your fees from all medical treatment including hospital stays. You may also have a deductible to meet before your coverage starts each year. PPO's hire nurses and medical professionals to handle patient cases and make decisions about hospital visits and diagnostic tests. You have more freedom, but you end up filling out claim forms.
If you are a person with many health issues that require several different opinions, extensive tests or treatment, and need specialists, this plan gives you a better choice and fewer restrictions on what you can do. You won't have to wait months to see the specialist; you will be able to just go. It will cost you more money, but you ill have your needs met faster.
A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO. After any visit, the policy holder must submit a claim, and will be reimbursed for the visit minus his/her co-payment.
No. You don't save any money by purchasing on the internet or dealing directly with an insurance carrier. All premium amounts for each health insurance plan are set by the insurance carrier. Every plan purchased online, thru a broker, or directly with the carrrier must be reviewed by the carrier underwriter to determine any increase in premium based upon the risk of the insured. The rate you get quoted online might not be the final rate that is determined by the carrier underwriting department.
Filling out an application without the assistance or review of trained personnel prior to sending to the insurance underwriter can cause rejection or increased costs if done improperly. And once you are rejected, coverage can be difficult or impossible to obtain at any price.
Absolutely. A few minutes with our licensed staff will arm you with sufficient knowledge to make an informed decision and choose from the best two or three plans that meet your particular needs.
California Health Maintenance Organization (HMO)What is a HMO heatlh insurance plan?
The definition of a Health Maintenance Organization or HMO is a corporation financed by insurance premiums whose member physicians and professional staff provide curative and preventive medicine within certain financial, geographic, and professional limits to enrolled volunteer members and their families. HMO's is an organization of healthcare providers that have contracted with an insurance company to offer their services at a fixed prices. HMO plans tend to be very restrictive and have many rules. You will be required to select a primary care physician, who manages all aspects of your healthcare. The primary care physician(PCP) must be a member of the HMO, so you may need to switch doctors if the one you are currently seeing is not in the network. If you need to see a specialist, you will be required to see your primary care physician first to obtain a referral.
The major advantage to HMO's is the cost. Monthly premiums are typically lower than those for other types of plans and co-payments are very low, or even free. However, keep in mind that HMO's are for-profit businesses. They have to make money somehow, and often this means that doctors must see as many patients as possible each day and minimize costs for the organization. HMO's are designed to save people money while getting the entire healthcare they need. Co-pays for visits and prescriptions are usually very low and there is no or low deductible to be met. However, HMO's do have their downside. HMOs are in business to make money and if you have many health care issues, you may not be accepted or have to pay more - a lot more. Having chronic medical condition that requires many visits, tests, and treatment costs the HMO lots of money and they balance this out by keeping a tight hold on your health care. They must approve all visits prior to you going.
HMO's or Health Maintenance Organizations offer less flexibility when choosing a provider. With an HMO you are required to choose a primary care physician(PCP) who will take are of most of your healthcare needs, when you want to see a specialist you will need to be referred by your PCP.
One of the main differences in HMO is not having deductibles or having a very low one. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
Typically, HMO's have lower out of pocket expenses then PPO insurance health plans. The HMO plans that JC Lewis Insurance Services recommends range from $3000-$4000 for a single member. The PPO out of pocket plans can range anywhere from $1500-$7500 for a single member. Although many firms throughout the state of California claim HMO's to be a cheaper option, they most likely are more expensive on the average.
HMOs are usually extremely restrictive and have lots of rules that must be followed if you want them to pay. You can only see the doctors on your HMO list, and you must see your primary care doctor first, no matter what is wrong with you. If you have to go to the hospital you must have your primary doctor's permission prior to going. Many people find that way too restricting and choose to not go with HMO's for that very reason. When and if you need to see specialist, you must have seen your doctor first to make sure they can't treat you instead of going to a more expensive doctor. The HMO makes sure it is their doctor who has control over all your medical needs, not you. Most doctors are excellent and will hand out referrals and most doctors these days are enrolled in HMO plans so this isn't a problem for many people. If you are not one of the lucky ones, getting the care you need could be difficult or non-existent. HMO's can also be a bit fussy about you wanting to change your primary doctor. So be sure that you like your doctor and you have spoken to other people who are patients of him or her
Most HMO's also have a patient quota that the doctor has to comply with. He or she must see a set number of patients per day to avoid penalization or being removed from the group. This is why there is never enough time to talk with your doctor past your examination point. They need to keep it short so they can see more patients. There is also the concept of Capitation that gives contracted doctors a set amount of money for each patient each month. This is given no matter if the patient is sick or well. Lastly you must make sure any labs or tests you need are covered with your plan or they won't be covered. But for most people who have HMO's this is not a problem and their doctors are great, so they don't have any problems at all.
California Group Health InsuranceWhat is the main reason for Group Health Insurance plans?
Controlling group plan medical insurance costs has become one of the most difficult tasks in running a business. It is imperative that your medical coverage maximizes your premium dollars while protecting assets and/or future earnings against major illness or injury.
Paying the highest premium does not equate to the best coverage and nor does choosing the lowest premium equate to getting the most for your dollar. Unfortunately, choosing the wrong coverage becomes painfully obvious when you need it most. Looking at hundreds of plans and benefit options can be quite daunting and if you are among the majority of businesses without an in-house risk manager, we can probably save you money and give you a choice of plans to meet your needs.
It's no secret that employees value health insurance benefits. Surveys have shown that workers value health insurance coverage second only to monetary compensation. By offering group health insurance benefits to your employees, you may find it easier to hire and retain the best workers for your company. Additionally, there are various tax incentives available to you and your employees when you participate in a group health insurance plan. For example, businesses can generally deduct 100% of the premiums they pay on qualifying group health plans and, by offering group health insurance as part of a total compensation package, you may be able to reduce payroll taxes. Plus, your employees can pay their portion of the monthly insurance premium with pre-tax dollars. Make sure that you take these incentives into consideration when determining the affordability of a health insurance plan for you and your employees.
If the employer chooses to cover them, then all similarly situated individuals must be offered coverage under the employer's benefit plan. The employee must have worked at least 20 hours, but not more than 29 hours per normal work week for at least 50% of the calendar quarter and must have completed the probationary period selected by the employer.
To add part time eligibility to an existing group, a new employer application, DE-6, and application/declinations on all eligible part time employees are required. Existing groups may add this option on their anniversary date.
To be eligible as an employee, a person must be an active employee on a full time basis and with a regularly scheduled work week of at least 30 hours per week, and be compensated for that work by the employer (subject to withholding as appears on a W-2 form). Sole proprietors, partners and corporate officers must work at least 20 hours a week to be eligible.
The group must have and maintain business licensure and/or appropriate state filings allowing the company to conduct business in the state of California. The majority (51%) of all eligible employees must be employed in the state of California. Residents of Hawaii are not eligible. And the group must employ at least two but not more than 50 eligible employees per AB 1672.
Every day we talk with business owners who clicked on a website, entered their zip code and employee demographics and got a list of 10 to 40 plans from which they made the wrong choice because it was the lowest cost. A few minutes with our licensed staff will arm you with sufficient knowledge to make an informed decision and choose from the best two or three plans that meet your particular needs. The easiest way to find the best Group Health Insurance plans available for your company and employees is to submit a Group Health Plan Quote Proposal. Spending a few minutes filling out the group detail information and submitting the proposal request has NO OBLIGATIONS to you or your company.
California Dental Insurance PlanWhat is a PPO dental insurance plan?
PPO stands for Preferred Provider Organization. PPO is used to designate a type of California dental insurance plan which insurance providers have networks of clients. Those who are covered by these California dental insurance plans must use the professionals that are part of the network in order to get full benefits. PPO is considered beneficial for everyone. Professionals essentially get referrals from California dental insurance plan providers, giving them more business. In turn, they offer special discount rates to California dental insurance companies and insurance holders. This means that insurance holders pay less and insurance companies have to pay less money out on claims.
A PPO dental plan is dental coverage that is part of a network California dental insurance system. Dentists sign up for the PPO network hoping to get more patients to treat. In acknowledgment of the referrals an insurance company provides, the dentists offer lower rates for the clients of a particular dental insurance provider. The result is lower fees for patients. Patients, however, often have to choose from a network of specific dentists or face higher fees or decreased benefits.
Many employers, employees, and even dentists prefer PPO dental coverage for the following reasons:
- Flexibility - PPO dental care allows you the flexibility to see any dentist you choose however, with most plans, you can get additional savings by using a dentist who is part of a California dental insurance provider's network of health care professionals.
- Low deductible - PPO dental coverage typically gives you a low deductible around $50. Some plans (usually HMO) have no deductible at all. This helps to make your dental coverage affordable.
- Less Hassle for Dentists - PPO dental coverage is preferred by many dentists because dentists get paid sooner and with less hassle through this type of coverage. This can mean that more dentists will agree to be part of a California dental insurance PPO network and more eager to work with patients who are part of a PPO plan.
- No Waiting Period - PPO dental coverage usually involves no waiting periods for basic services and preventive care. This allows you to use your plan as soon as you enroll. If you don't need fillings, crowns or root canals then a California dental insurance PPO is the right choice. You can still receive care for those services but there might be a waiting period of three or 12 months depending on the service.
- Less Paperwork - PPO dental coverage can save you some paperwork depending on the provider. You may have to present your insurance card but the dentist office will submit the necessary documents for you.
HMO dental coverage stands for Health Maintenance Organization dental insurance. This type of California dental insurance requires some type of prepayment from you. In exchange, you get dental care from a network of dental care providers. If you want to use a dentist outside the approved network, you must pay your entire dentist's bill yourself. This type of California dental insurance is also known as capitation dental insurance plan.
In HMO dental coverage, dentists in a network have to provide dental care to members of the California dental insurance plan they are part of. No eligible patient can be turned away. Dentists that are part of the network are paid once a month by the California dental insurance provider. Usually, this payment is a fixed monthly sum per person. An HMO dental plan covers:
- Basic dental services - such as regular dental exams, cleaning, and dental x-rays. Often, these basic services are provided cost-free to individuals covered by the HMO California dental insurance plan
- Other dental procedures - such as dental crowns, bridgework, and dentures. These slightly less common procedures often require that the patient cover some of the cost themselves.
There are several differences between HMO and PPO California dental insurance plans. While both can provide affordable California dental insurance, HMO plans make it more difficult for patients to seek dentists outside a network. While PPO plans often allow patients to select dentists outside their network, many HMO plans do not. They are completely closed, meaning that you cannot accept financial penalties and see a non-network dentist when you need to.
The most serious difference between HMO and PPO California dental insurance, however, has to do with the way that dentists are paid. In a PPO California dental insurance plan, dentists who are part of a network agree to lower costs for patients covered by a certain insurance provider, in exchange for the referrals from the California dental insurance company that bring them more business. However, dentists get paid in full for the services they provide. With an HMO dental plan, however, dentists are paid set fees. In some cases, this can mean that the less treatment a dentist provides, the more profitable the arrangement is. In extreme cases, patients have complained that dentists have made it difficult to get the correct services through an HMO plan. Even in the best circumstances, since dentists prefer PPO dental insurance plans, many more join PPO networks. This can mean that patients have fewer dentists to choose from through HMO plans.
HMO's are plans for either health or dental treatment that require you to select a care provider. This doctor/dentist is your primary care giver. You will need get referrals from their office to get any types of specialized treatments done. They will typically send you to a physician or dentist that is within your HMO plan. So if you break your leg, you need to get a referral from your primary care doctor to see an orthopedic doctor. Same thing as getting your dentist to refer you to an orthodontist. California dental insurance PPO plans do allow you the flexibility to see who you want when you want, basically you lose the referral portion. So in the broken leg incident you go directly to the orthopedic doctor of your choice.
One thing to look into with California dental insurance PPO plans is the fact that some of these now have preferred provider networks. If your physical is in the network, you will pay less as they already have pricing agreements in place.
HMO's are good if you are set with your doctors/dentist and they are included with the HMO. You are limited to this one doctor without having a referral. Usually fees are lower for your out of pocket costs.
A California dental insurance PPO is good if you like to have the flexibility of going were you want when you want to.
Life Insurance PlanWhy should I buy life insurance?
Many financial experts consider life insurance to be the cornerstone of sound financial planning. It can be an important tool in the following situations:
- Replace income for dependents:
If people depend on your income, life insurance can replace that income for them if you die. The most commonly recognized case of this is parents with young children. However, it can also apply to couples in which the survivor would be financially stricken by the income lost through the death of a partner, and to dependent adults, such as parents, siblings or adult children who continue to rely on you financially. Insurance to replace your income can be especially useful if the government or employer-sponsored benefits of your surviving spouse or domestic partner will be reduced after your death.
- Pay final expenses:
Life insurance can pay your funeral and burial costs, probate and other estate administration costs, debts and medical expenses not covered by health insurance.
- Create an inheritance for your heirs:
Even if you have no other assets to pass to your heirs, you can create an inheritance by buying a life insurance policy and naming them as beneficiaries.
- Pay federal "death" taxes and state "death" taxes:
Life insurance benefits can pay estate taxes so that your heirs will not have to liquidate other assets or take a smaller inheritance. Changes in the federal "death" tax rules between now and January 1, 2011 will likely lessen the impact of this tax on some people, but some states are offsetting those federal decreases with increases in their state-level "death" taxes.
- Make significant charitable contributions:
By making a charity the beneficiary of your life insurance, you can make a much larger contribution than if you donated the cash equivalent of the policy's premiums.
- Create a source of savings:
Some types of life insurance create a cash value that, if not paid out as a death benefit, can be borrowed or withdrawn on the owner's request. Since most people make paying their life insurance policy premiums a high priority, buying a cash-value type policy can create a kind of "forced" savings plan. Furthermore, the interest credited is tax deferred (and tax exempt if the money is paid as a death claim).
There are two major types of life insurance-term and whole life. Whole life is sometimes called permanent life insurance, and it encompasses several subcategories, including traditional whole life, universal life, variable life and variable universal life. In 2003, about 6.4 million individual life insurance policies bought were term and about 7.1 million were whole life. Life insurance products for groups are different from life insurance sold to individuals. The information below focuses on life insurance sold to individuals.
- Term Life Insurance:
Term Insurance is the simplest form of life insurance. It pays only if death occurs during the term of the policy, which is usually from one to 30 years. Most term policies have no other benefit provisions. There are two basic types of term life insurance policies-level term and decreasing term.
- Level Term:
Level Term means that the death benefit stays the same throughout the duration of the policy. In 2003, virtually all (97 percent) of the term life insurance bought was level term. In 2003, virtually all (97 percent) of the term life insurance bought was level term.
- Decreasing Term:
Decreasing Term means that the death benefit drops, usually in one-year increments, over the course of the policy's term.
- Whole/Permanent Life Insurance:
Whole life or permanent insurance pays a death benefit whenever you die-even if you live to 100! There are three major types of whole life or permanent life insurance-traditional whole life, universal life, and variable universal life, and there are variations within each type.
In the case of traditional whole life, both the death benefit and the premium are designed to stay the same (level) throughout the life of the policy. The cost per $1,000 of benefit increases as the insured person ages, and it obviously gets very high when the insured lives to 80 and beyond. The insurance company could charge a premium that increases each year, but that would make it very hard for most people to afford life insurance at advanced ages. So the company keeps the premium level by charging a premium that, in the early years, is higher than what's needed to pay claims, investing that money, and then using it to supplement the level premium to help pay the cost of life insurance for older people.
By law, when these "overpayments" reach a certain amount, they must be available to the policy owner as a cash value if he or she decides not to continue with the original plan. The cash value is an alternative, not an additional, benefit under the policy.
In the 1970s and 1980s, life insurance companies introduced two variations on the traditional whole life product-universal life insurance and variable universal life insurance.
In most cases, if you have no dependents and have enough money to pay your final expenses, you don't need any life insurance. If you want to create an inheritance or make a charitable contribution, buy enough life insurance to achieve those goals. If you have dependents, buy enough life insurance so that, when combined with other sources of income, it will replace the income you now generate for them, plus enough to offset any additional expenses they will incur to replace services you provide (for a simple example, if you do your own taxes, the survivors might have to hire a professional tax preparer). Also, your family might need extra money to make some changes after you die. For example, they may want to relocate, or your spouse may need to go back to school to be in a better position to help support the family. You should also plan to replace "hidden income" that would be lost at death. Hidden income is income that you receive through your employment but that isn't part of your gross wages. It includes things like your employer's subsidy of your health insurance premium, the matching contribution to your 401(k) plan, and many other "perks," large and small. This is an often-overlooked insurance need: the cost of replacing just your health insurance and retirement contributions could be the equivalent of $2,000 per month or more. Of course, you should also plan for expenses that arise at death. These include the funeral costs, taxes and administrative costs associated with "winding up" an estate and passing property to heirs. At a minimum, plan for $15,000.
Most families have some sources of post-death income besides life insurance. The most common source is Social Security survivors' benefits. Social Security survivors' benefits can be substantial. For example, for a 35-year-old person who was earning a $36,000 salary at death, maximum Social Security survivors' monthly income benefits for a spouse and two children under age 18 could be about $2,400 per month, and this amount would increase each year to match inflation. (It drops slightly when the survivors are a spouse and one child under 18, and stops completely when there are no children under 18. Also, the surviving spouse's benefit would be reduced if he or she earns income over a certain limit). Many also have life insurance through an employer plan, and some from another affiliation, such as through an association they belong to or a credit card. If you have a vested pension benefit, it might have a death component. Although these sources might provide a lot of income, they rarely provide enough. And it probably isn't wise to count on death benefits that are connected with a particular job, since you might die after switching to a different job, or while you are unemployed.
Many pundits recommend buying life insurance equal to a multiple of your salary. For example, one financial advice columnist recommends buying insurance equal to 20 times your salary before taxes. She chose 20 because, if the benefit is invested in bonds that pay 5 percent interest, it would produce an amount equal to your salary at death, so the survivors could live off the interest and wouldn't have to "invade" the principal. However, this simplistic formula implicitly assumes no inflation and assumes that one could assemble a bond portfolio that, after expenses, would provide a 5 percent interest stream every year. But assuming inflation is 3 percent per year, the purchasing power of a gross income of $50,000 would drop to about $38,300 in the 10th year. To avoid this income drop-off, the survivors would have to "invade" the principal each year. And if they did, they would run out of money in the 16th year.
You can buy life insurance either as an "individual" or as part of a "group" plan.
- Individual Policy:
When you buy an individual policy, you choose the company, the plan, and the benefits and features that are right for you and your family. You might be able to buy the policy from the same agent or company representative who sells you property and liability insurance for your home, auto or business. And although you won't qualify for any discounts by buying your life insurance and other insurance from the same representative, working with a single advisor for all your insurance needs can make your financial life simpler. Individual policies are typically sold through insurance agents or brokers. If you buy a policy through an agent or broker, you will pay a commission, also called a "load," that is built into the premium rate. The commission compensates the agent or broker for the time spent advising you on how much and what type of life insurance to buy, for facilitating the application process, and for any further service that's needed in future years to keep the policy up-to-date (such as changing beneficiary designations, arranging policy loans or coordinating your financial plans with your lawyer and accountant). There are two other ways to buy individual life insurance. In Connecticut, Massachusetts and New York, you can buy it from a savings bank. Or you can buy a policy directly from an insurance company or from a fee-only financial advisor-what's known as a "no load" or "low load" policy. Although there is no sales commission on these policies, the company will still have charges built into the premium to cover its marketing expenses, application processing expenses and subsequent services. Finding an insurance company that will sell you a no-load policy isn't easy; typing in "no load life insurance" on Internet search engines will in many cases lead you to an agent or broker.
- Group Policy:
You might have life insurance automatically from your employer; many large companies do this. Your employer also might offer you the chance to buy additional life insurance under a group policy. And you might be eligible to buy life insurance under a group policy from a union or trade association or other group you belong to (such as a college alumni association or an automobile club). Compared to buying an individual life insurance policy, there are several advantages to buying life insurance under a group policy:
- Group purchase can sometimes offer you a lower rate for a given death benefit either because the employer or other group sponsor subsidizes the premium or because the rates are averages weighted by people younger than you.
- There are virtually no health qualifications for getting the group coverage.
- Premium payment is usually by payroll deduction (for employer-based group coverage) or linked with other payments (e.g., credit card bills), lowering the chance of missing a payment.
Most employer group plans are term insurance, but if you leave that employer your state may require that you be allowed to convert the policy to a form of whole life insurance with the same insurance company that provides the group life insurance. You would then pay premiums directly to the company and keep the insurance in force. This can be an advantage if you are older, or have experienced deteriorating health, as it gives you the opportunity to qualify for whole life insurance without having a medical exam.
- Credit Card Life Insurance:
Credit cards and lending institutions may offer life insurance to pay off your outstanding loans in the event of your death. This is generally made available in two ways:
- As part of the loan at no extra charge. In this case the cost of the life insurance is borne by the lender and is included in its interest rate or other finance charges. If you have this type of credit life insurance, you don't need separate life insurance to pay off that loan if you die.
- As an option at an extra charge. In this case, you should usually reject the optional coverage, provided that you have some other life insurance (group or individual) that can be designated to pay off the loan if you die. If you're under age 50 and you don't have other insurance that could pay off this loan, consider buying individual life insurance for this purpose as the rates will probably be better. At 50 or over (or younger with health issues), if you have no other life insurance for this purpose, the optional credit life insurance is likely to be cheaper than individual life insurance.
A beneficiary is the person or entity you name in a life insurance policy to receive the death benefit. You can name one person, two or more people, trustee of trust, a charity, or your estate. If you don't name a beneficiary, the death benefit will be paid to your estate.
Your life insurance policy should have both "primary" and "contingent" beneficiaries. The primary beneficiary gets the death benefits if he or she can be found after your death. Contingent beneficiaries get the death benefits if the primary beneficiary can't be found. If no primary or contingent beneficiaries can be found, the death benefit will be paid to your estate. As part of naming beneficiaries, you should identify them as clearly as possible and include their social security numbers. This will make it easier for the life insurance company to find them, and it will make it less likely that disputes will arise regarding the death benefits.
For example, if you write "wife [or husband] of the insured" without using a specific name, an ex-spouse could claim the death benefit. On the other hand, if you have named specific children, any later-born or adopted children will not receive the death benefit-unless you change the beneficiary designation to include them. Besides naming beneficiaries, you should specify how the benefits are to be handled if one or more beneficiaries can't be found.
For example, suppose you have two children and you name each one to receive half of the death benefit. If one of the children dies before you do, do you want the other child to get the entire death benefit, or the deceased child's heirs to get his or her share? If the death benefit goes to your estate, probate proceedings could delay distributing the money, and the cost of probate could diminish the amount available to your heirs.
Choosing beneficiaries, and keeping those choices up-to-date, is an important part of owning life insurance. The birth or adoption of a child, marriage or divorce can affect your initial choice. Review your beneficiary designation as new situations arise in order to make sure your choice is still appropriate.
Medicare Health PlanWhat are the important dates for Medicare Enrollment?
Listed below are the most important dates when it comes to "Medicare and You" for 2008.
- October - Prepare and Compare:
- Prepare: Watch your mail for the "Medicare and You" handbook and for information about plans in your area. Gather all of the information you'll need to make a decision. If you are currently enrolled in a plan, the plan will send you important information about your coverage, benefits, and costs next year. Be sure to review this material.
- Compare: Complete your Medicare Enrollment Review. In mid-October, review and compare plans based on cost, coverage, and customer service by visiting www.medicare.gov on the web. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
- November 15 - Enrollment Begins Decide: November 15 is the first day you can change your Medicare health or prescription drug coverage for next year. This is the one chance this year most people with Medicare have to make a change in their health and prescription drug plans. Enroll as early as possible-the earlier the better-to avoid any issues at the pharmacy counter in January.
- December 31 - Enrollment Ends: In most cases, December 31 is the last day you can change your Medicare coverage for next year.
- January 1 - Coverage Begins: Your new coverage begins if you switched to a new plan. If you stay with the same plan, January 1 is the date that any changes to coverage, benefits, or costs for the new year will begin.
Listed below are the Medicare Part A and Part B Premiums for 2008:
- Part A: (Hospital Insurance) Premium:
Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. The Part A premium is $233.00 for people having 30-39 quarters of Medicare-covered employment. The Part A premium is $423.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
- Part B: (Medical Insurance) Premium:
$96.40 per month for individuals earning less than $82,000 per year or married couples filing a joint tax return earning less than $164,000 per year
Listed below are the Medicare Deductibles and Coinsurance amounts for 2008 broken into their appropriate categories:
- Part A:
Pays for inpatient hospital, skilled nursing facility, and some home health care. For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2008 = $1,024) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
- Each benefit period:
You pay a total of $1,024 for a hospital stay of 1-60 days. $256 per day for days 61-90 of a hospital stay. $512 per day for days 91-150 of a hospital stay (Lifetime Reserve Days). All costs for each day beyond 150 days
- Skilled Nursing Facility Coinsurance:
$128.00 per day for days 21 through 100 each benefit period.
- Part B:
Covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment $135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)
Most people will pay the standard monthly Part B premium of $96.40 in 2008. Some people will pay a higher premium based on their modified adjusted gross income. Your monthly premium will be higher if you file an individual tax return and your annual income is more than $82,000, or if you are married (file a joint tax return) and your annual income is more than $164,000. If you meet these criteria, Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago).
For example, the income reported on your 2006 tax return will be used to determine your monthly Part B premium in 2008. If your income has decreased since 2006, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria. At the end of each year, Social Security will send you a letter if your Part B premium will increase based on the level of your income and to tell you what you can do if you disagree.
For more information about Part B premiums based on income, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty
|You Pay||Single(yearly income)||Married(yearly income)||Married File Seperate(yearly income)|
|$96.40||$82,000 or less||$164,000 or less||$82,000 or less|
|$238.40||Above $205,000||Above $410,000||Above $123,000|
New Medicare premium and coinsurance rates come out each fall and become effective in January. If you get Social Security premiums or Railroad Retirement benefits, new rates are sent to you each year with your December cost of living adjustment notice. You can get new Medicare rates each fall on this website or by calling 1-800-MEDICARE (1-800-633-4227).
Choosing the right Medicare coverage can be a confusing and overwhelming task. Below are listed four groups of Medicare healthcare coverage that should be considered when evaluating your Medicare healthcare needs:
- Original Medicare Plan:
A fee-for-service plan that is managed by the Federal Government. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new patients, or to any hospital or other facility. The Original Medicare Plan has two parts: Part A (hospital) and Part B (medical). You will be in the Original Medicare Plan unless you choose to join a Medicare Advantage Plan (like an HMO or PPO). Most people get their coverage through the Original Medicare Plan.
- Medicare Advantage Plans
Health plan options that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called "Part C." Some of these plans include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Preferred Provider Organization (PPO) Plans:
you pay less if you use doctors, hospitals, and providers that belong to the PPO plan network.
- Medicare Health Maintenance Organization (HMO) Plans:
in most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list except in an emergency or certain other urgent situations.
- Medicare Private Fee-for-Service (PFFS) Plans:
you may go to any Medicare-approved doctor or hospital that accepts the plan's payment.
- Medicare Special Needs Plans:
Provides more focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or have certain chronic medical conditions.
- Medicare Medical Savings Account (MSA) Plans:
a two-part plan that has an HMO or PPO with a high deductible, and a Medical Savings Account.
- Medicare Preferred Provider Organization (PPO) Plans:
- Other Medicare plans:
there are some types of Medicare plans that provide health care coverage that aren't part of Medicare Advantage, but are still part of the Medicare Program.
- Medicare Cost Plans:
A type of HMO that is available in certain areas of the country. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under the Original Medicare Plan (your Cost Plan pays for emergency services, or urgently needed services).
- Demonstrations/Pilot Programs:
Demonstrations are special projects that test improvements in Medicare coverage, payment, and quality of care. Pilot programs are designed to reduce health risks, improve quality of life, and provide savings for people with Medicare with one or more chronic illness.
- PACE (Programs of All-inclusive Care for the Elderly):
A joint Medicare and Medicaid program that combines medical, social and long-term care services for frail elderly people who live in and get health care in the community.
- Other Coverage:
- Medicare Prescription Drug Coverage (Part D):
Medicare prescription drug plans (Part D) are run by insurance companies and other private companies approved by Medicare.
- Medigap (Medicare Supplement Insurance) Policies:
Health insurance sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage.
- Medicare Prescription Drug Coverage (Part D):