Health Insurance

Health Care ReformPlans

Definitions can be found on page: Health Terms

Individual & Family

Health insurance policies that are not part of a business group. They require full underwriting. In other words, the insurance carrier will look at your full medical history and any existing conditions. Based on their assessment of your past and current health status they may issue a policy at the standard rates, offer you insurance at a rate increase or decline your application.

Standard health insurance premium rates are generally less than a comparable small group because they are not guarantee issue, there is typically is no maternity coverage and people with chronic health conditions will usually pay more.

Health Savings Accounts; Are they right for you?

Small Group

Usually consists of either a minimum of 2 employees or a sole proprietor. These plans are generally guarantee issue which means that employees or family members will not be denied coverage because of pre-existing conditions. Some conditions may not be covered for up to 6 months if the participant did not have credible coverage in the prior 63 days.

Rates for small groups are generally higher because they are guarantee issue and they cover maternity which most individual and family plans do not. The employer is required to contribute a minimum specific amount or percentage towards the employee only premium.

Health insurance premiums are pre-tax deductions which reduce the employee’s and employer’s calculated payroll taxes.

Self Employed/Small Business

Health Savings Accounts (HSA) have been a favorite for self-employed and sole proprietor business owners. HSA’s allow the participant to make regular contributions to a HSA account. This contributions grow tax-free and roll over from year to year. There are maximum contributions per individual or family each year. All contributions are deducted from the first page of the Federal tax return. This adjustment to the adjusted gross income may or may not have a significant on the participants tax liability.

HSA plans usually have a deductible of approximately $5000. There are no covered benefits (excluding preventive office visits at no charge) until the deductible is met. Once the maximum out of pocket deductible amount is met, all benefits are covered for the year.

Dental

Most health insurance plans have the option to include dental coverage. A few offer limited vision coverage. It is also possible to enroll in an individual or family dental plan without having health insurance.

Dental plans will come in either Preferred Provider Organizations (PPO) or Dental Health Maintenance Organizations (DHMO). PPO plans allow you to go any dentist in the network. With DHMO you must select the dentist at the time of enrollment. DHMO usually have an office copay and very little waiting periods for work to be performed. PPO plans may have a waiting period for any major dental work to be covered at no charge or cost sharing.

All good plans will usually provide you with 2 cleanings and exams per year and X-rays once a year at no charge. Most plans do not include orthodontics but you can upgrade coverage or plans.

Medicare Supplements (Medigap)

Medigaps are folks who have Parts A & B of original Medicare. All the plans offered by a variety of carriers all standardized and regulated by Federal and state governments. The most comprehensive plan will cover all deductibles, copays, and coinsurance incurred under original Medicare.


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