Personal Health Insurance

When it comes to choosing the right health insurance plan, the variety of options and plans available can be so confusing that it is nearly impossible to figure out what to do. Is my spouse covered by my employer’s plan? What is the difference between PPO’s and HMO’s? Medicare and Medicaid? There is no need to burden yourself with these questions. Let us do the work for you. Give us a call and speak to a representative and we will find the policy that best complements your situation. Meslee Insurance works with the widest selection of the most prominent health insurance companies. Whether you are a single adult, married couple or have kids, we will educate you and find the plan that meets your needs. With all of these options at our fingertips, we guarantee to find a plan that will offer you premium quality and value. Give us a call to speak to an agent or fill out a quick quote and one of our agents will contact you.

 

Understanding Key Terms in a Health Insurance Policy

  • Deductible: Refers to the amount of money that you will have to pay before any benefits from the health insurance policy can be used.

  • Co-Insurance: Refers to the percentage amount that is your responsibility. For example, an 80/20 split means that the insurance company will pay 80% while you are responsible for the remaining 20%.

  • Co-Payments: A fixed amount that you are required to pay at the time of service. This usually refers to doctor visits and prescriptions.

  • Out-of-Pocket: Total annual cost you will pay out of pocket. These expenses refer to payments such as deductibles, co-payments and co-insurance.

  • Lifetime Maximum: The most amount of money the health insurance policy will pay for the entire life.

  • Exclusions: Items that the health insurance policy will not cover.

  • Pre-Existing Condition: Refers to an illness or problem that you have before obtaining insurance.

  • Waiting Period: Time you have to wait until certain health coverages are available.

  • Coordination of Benefits: Refers to situations where you may have more than one policy that covers a particular claim. In these instances, the two insurance companies will coordinate and each pay a portion.

  • Grace Period: Refers to the minimum amount of time that you have after the payment due date in order to pay your premium balance before insurance is cancelled.

 

Four most common types of Health Insurance Plans

  • Indemnity Plans: Indemnity Plans, also referred to as “Fee for service plans”, are one of the most common types of health insurance. With this plan, covered individuals are free to choose the physicians and hospitals of their choice without having to deal with provider networks. Policy holders can choose to be treated by any doctor that they wish to see and typically pay for services up front. In turn, the insurance company will reimburse the policy holder for the medical services that were provided. You might be asking yourself why anyone would choose not to go with an indemnity plan. The answer, not surprisingly, is that flexibility and freedom come along with a higher price. Indemnity plans are considered the most expensive type of health insurance plan. Common subscribers may include individuals that have special trust in certain doctors, people with serious or chronic medical conditions or simply those who can afford paying for the freedom of choice. Lastly, there are three types of indemnity plans; basic, major medical and comprehensive. Basic generally covers the cost of hospital room and care, some hospital services, cost of surgery and doctors visit while major medical policies covers the cost of basic healthcare and adds coverage for expenses of long-term illnesses and injuries as well as in-patient/out-patient expenses. Comprehensive Plans generally combine the coverages of Basic and Major Medical into one.

  • HMO (Health Maintenance Organizations): HMO’s provide health insurance coverage through a network of hospitals, physicians and other health care providers that have contracts with the Organization. As opposed to an indemnity plan where you pay for each individual service that you receive, members of an HMO pay a set premium in return for health benefits from providers in the HMO network. Because there are so many members, HMO premiums are fixed and much lower. Besides the lower cost, another benefit of being an HMO member is that you normally do not have to file claims and wait for reimbursements. HMO members choose a primary care physician (PCP) who serves as that member’s general doctor. The primary care physician serves as the member’s primary contact to make healthcare decisions for the patient and refer patients to in-network specialists should they be needed. HMO’s are frequently offered to groups of employees via the employer because it allows for a lot of members to join the group at once. With HMO’s, you have the benefit of paying less premium but in turn are restricted to providers within the network unless referred to them by your primary care physician.

  • PPO (Preferred Provider Organization): PPO’s are essentially hybrids between indemnity plans and HMO’s. In the PPO’s setup, the organization negotiates with doctors, hospitals and other health care providers to offer discounts to the PPO members. In return, the health care providers become members of the PPO network and receive referrals from the organization. PPO’s are similar to HMO’s in that members pay a fixed premium on a monthly basis; however, the major difference is that PPO enrollees have more freedom of choice when looking for health care providers. Unlike members of HMO’s, enrollees of PPO’s can seek medical care outside of the network and still receive some coverage. Furthermore, another big advantage is that enrollees do not need to get referrals from primary care physicians in order to see other specialists. Of course, these added advantages make PPO a much more flexible yet expensive option.

  • POS (Point of Service Plan): POS plans combine elements of both HMO’s and PPO’s and are considered the least restrictive type of managed care. When medical care is needed, you typically have three options. You can go through a primary care physician and be covered under HMO guidelines, access care through a PPO provider and be covered under the PPO guidelines or you can obtain services from a provider outside of the HMO and PPO networks. In this last scenario, services will be reimbursed according to our of network rules. In essence, a POS plan allows you to choose whether to receive medical treatment within your plan’s network or outside the network right at the time that you need the medical care. Generally speaking, the cost of Point of Service plan is less than the fees associated with a Preferred Provider Organization. If you choose this type of plan, it is important to be well aware of the financial aspects of your choices as guidelines may change depending on the provider that you choose.

 

Two Tips when looking to buy Health Insurance

    1. Ask your favorite doctors which insurance plans they accept. If you find that one or more of them do not accept any insurance plans, then you may want to consider a plan that allows you to go out of network.

    2. Make a list of all the services that you and your family are likely to use. Find out how each plan will cover these services and what they will cost.

 

Health Insurance in California & on the Federal Level

  • For the most part, health Insurance is mostly regulated on a state level. As a result of the population and circumstances pertaining to Californians, the state has created several programs that are designed to meet the healthcare needs of certain groups of people. Some of these programs are outlined below:

  • COBRA (Federal): Providers some former employees, retirees, spouses and dependents the right to buy temporary continuation of group health plan at group rates. This option is generally reserved for people who have been laid off work.

  • HIPPA (Federal): Provides protection for you and your family when you need to buy, change or continue your health insurance. HIPPA incorporates limits on the use of pre-existing conditions and typically guarantees that you can renew coverage regardless of family health issues.

  • Medicare (Federal): A social insurance program funded at the federal level focusing primarily on the older population (65 and older) as well as individuals under 65 with certain disabilities.

  • Medicare Supplement Insurance: Supplemental insurance to Medicare providing additional coverage to help with many of the expenses that Medicare does not pay.

  • Medicare Part D: For those who are enrolled or eligible for Medicare, adding Medicare Part D coverage will give you access to prescription drug coverage.

  • Medicaid & Medi-Cal: Medicaid is the United States Health Program for people with and families with low income and resources. Medi-Cal is essentially Medicaid for Californians.

  • Healthy Families: A low cost insurance plans for children and teens providing health, dental and cision coverage to children who do not have insurance and do not qualify for Medi-Cal.

  • AIM (Access for Infants & Mothers): Provides low cost health care coverage for pregnant women and may include coverage for their newborns. Generally reserved for middle-income families who don’t have health insurance but do not qualify for Medi-Cal because their income is too high.

  • CHDP (Child Health & Disability Prevention: Prevention program offering periodic health assessments and services to low income children. CHDP helps with medical appointment scheduling, transportation and access to diagnostic and treatment services.

  • PCIP (California Pre-Existing Condition Insurance Plan): If you are a U.S. Citizen or residing in California legally, PCIP may provide health coverage for those who have been uninsured for at least six months, have pre-existing conditions or have been denied health coverage because of health conditions.

  • HICAP (California Health Insurance Counseling and Advocacy Program: Free and unbiased counseling program provided by the California Department of Aging.

 

Other Information

  • The State programs and types of health insurance plans listed above are the most common types. There may be other options and plans available that are not listed here such as Health Savings Accounts (HSA) or High Deductible Health Plans (HDHP). Please feel free to contact us for more information to find the plan or program that best suits your needs.

  • Please visit our insurance glossary tab for a full list of insurance terms and definitions.

  • There are many discounts available to help reduce your premium. Please visit our learning insurance discounts page to find out more information on how to maximize your savings.

 

This page contains only a general description of coverages and is not a contract. Details of coverage or limits may vary in some states and by carrier. All coverages are subject to the terms, provisions, exclusions, and conditions in the policy itself and in any endorsements.


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