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Some extra knowledge about health insurance plan

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Some extra knowledge about health insurance plan

Some extra knowledge about health insurance plan

There is no perfect plan or best plan available for anyone even the self employed people. Still we need to know the basics before opting for any plans. Each plan has its own negativity as well as positive points. People i.e. self employed persons are supposed to choose based on their own needs and also on the basis of whether they can pay the premium money. It also depends whether you want an individual health plan, group plan or family plan for yourself. Each plan keeps on changing from year to year. As such anyone who needs to decide on insurance should first start by calling up insurance provider and have some ready to ask questions at their hand to get themselves acquainted.

With each health plan there is some amount that needs to be paid by the client. This payment varies from plan to plan and as such client is to decide the choice of plan based on who is paying and whether the total cost to be paid by him is heavy on his/her pocket.

In many health plans there is one primary care doctor who takes most of the decision for the client. Even if specialist is required that should be referred by the primary care doctor. In POS and in HMO the choice of primary doctor can be made by the client from the list of doctors under the plan but PPOs allow client to have doctors outside the network (though at higher cost) and indemnity allows any doctors to be used by the client.

Type of policies

The health plans can be managed in the following way:

Group policies can only be acquired through job i.e. company job. These plans can be changed during open enrollment but any plans acquired have to be kept for 1 year. The choices and benefits can be discussed too with the employee benefit office.

Individual policies are opted when you do not work for a company and you are self employed. Individual policies are costlier than group policies and are sometimes offered by union or civic groups. Even some states allow insurance to small group or self employed people.

Medicare on the other hand are used by senior citizens aged 65 and above or people who have disabilities. It is a Federal health insurance and people covered under it can choose between managed care and indemnity insurance. This can be done by officially notifying the social security office. The change or choice takes into effect after 30 days of notification. The reason can be anything for the choice.

Medicaid on the other hand covers people who belong to the low- income group like children or pregnant people who are not even under the age group of 65 and above for Medicare. Medicaid comes under the joint Federal –State health insurance program. Since each state have different regulation and insurance plans for their people. So it needs to check out from the State Medicaid Office.

LAW: Under the law (Health Insurance Portability and Accountability Act) that took into effect from July 1, 1997; a person will be covered for his /her pre-existing condition without waiting period if he/she was insured earlier for about 12 months or so. Pre-existing condition is one in which a medical condition is diagnosed before joining into a new plan. Earlier such facility was not given to people without some waiting period. So it proved to be a concern for people changing jobs. Clients still got to wait for the service if they were not insured for the previous 12 months.

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