Monday, June 18, 2007

All You Need to Know About Health Insurance

Let's face it--in today's world, health insurance is a necessity. With medical expenses soaring higher than a hang glider, paying for them could have you digging deep into the pockets of your jeans.

What types of health insurance are available?

Health insurance plans generally fall into one of two categories: indemnity plans (also known as reimbursement plans) and managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans.

An indemnity plan allows you to choose your own doctors and pays for your medical expenses--totally, in part, or up to a specified amount per day for a specified number of days.

Managed care plans generally provide broader coverage, but they all involve an arrangement between the insurer and a selected network of health-care providers (doctors, hospitals, etc.). For example, an HMO will require that a primary care physician in the network coordinate all of your care and refer you to specialists in the network.

No matter which type of health insurance you buy, you'll need to make sure it offers the right kinds of coverage.

What should be covered?

  • A good health insurance policy contains several types of coverage.
  • Hospital expense insurance pays your room, board, and incidental services costs if you're hospitalized.
  • Surgical expense insurance covers surgeons' fees and related costs associated with surgery.
  • Physicians' expense insurance pays for visits to a doctor's office or for a doctor's hospital visits.
  • Major medical insurance offers extremely broad coverage with a very high maximum benefit that's designed to protect you against losses from catastrophic illness or injury.

What might be covered?

When comparing health insurance plans, check to see if they provide additional benefits that you may need, including:

  • Prescription drugs
  • Preventive care
  • Mental health benefits
  • Maternity care
  • Vision care

What will it cost?

In addition to the monthly premium expense, you may have other out-of-pocket costs. These costs can really add up, especially if you have children or other family members who visit the doctor frequently. Check to see if the health insurance plan you're considering requires you to pay any or all of the following:

  • Co-payment: The amount you'll have to pay each time you visit a health insurance provider (generally required by HMOs).
  • Deductible: The amount you'll have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims (generally required by indemnity plans).
  • Coinsurance: The percentage of your medical costs you'll have to pay after you reach any deductibles that apply.

Where can I get health insurance?

You may get health insurance through a group plan at work or through another group affiliation (a school, a club, etc.) or by purchasing an individual plan on your own. By purchasing an individual plan on your own, you may even be able to customize the health plan. Shop online to compare rates from several companies to find the best plan and rate to meet your needs.

How do I decide which plan is best?

The best health insurance plan for you is the one that gives you the greatest flexibility and the most benefits for the lowest cost. Unfortunately, there's no such thing as a standard health insurance plan. As you would when making any major purchase, you'll need to shop around and get several quotes before choosing a plan. Here are a few points to consider:

  • What co-pays, deductibles, and coinsurance requirements apply?

  • How much freedom do you have to choose your own health-care providers?
  • Does the plan cover the health services that you need?
  • Does the plan cover the health-care providers you're currently using?
  • Does the plan offer family, as well as individual, coverage?
  • Does the plan cover pre-existing conditions? If so, is there a waiting period? (The average waiting period is three months to one year.)
  • Does the insurance company have a good reputation in the industry and a positive rating from a major ratings organization? (Contact your state's department of insurance for more information.)

Consumer Tips for Health Insurance

A wide variety of health plans and health related services are available to anyone with the time and inclination to take a look. The looking process is often inefficient with your valuable time and it’s imperative in these days of financial roller coaster-ing that you find a cost effective plan that best suits the health care coverage needs of you and yours.

  • Use the following list to help you maneuver through the decisions you will be faced with as you go through your search for the perfect health insurance plan.
  • Ask for advice. The friends and associates you already trust may have the exact health insurance information or tips that you are looking for.
  • Do your research. Before you begin your search, save yourself time by outlining the needs of those who you are purchasing health insurance for.
  • Don’t forget to take into consideration any special healthcare needs.
  • Know your terms. Phrases like HMO, PPO, POS, and Health Savings Accounts should all mean something to you before you begin to look for particular policies.
  • Consider whether or not you are offered a choice in physicians and whether or not you need a referral to see a specialist.
  • Remember that your geographic location may affect the availability of certain health plans.
  • If you are required to choose your provider, make sure that there are facilities accessible and convenient to where you live.
  • Consider the extras that you may want or need, things like therapy, equipment, or a certain doctor that you would like to continue to see.
  • Check out the availability of a prescription plan comes with the policies you consider.
  • Balance premium prices, co-pays, and exclusions to find the right fit.
  • Know ahead of time how to file a dispute with the insurance company should one arise. Make sure that the process is one geared toward expediting the process instead of dragging it out.
  • Remember that individual coverage is more expensive than group coverage but necessary if you are ineligible for any group plans.

  • When you’ve narrowed your choices down to two, compare the following aspects of both:

1. Deductible for individuals

2. Total deductible for the group or family

3. Deductible for providers outside of the network (if not the same )

4. Co-pay amount per doctor visit

5. Percentage of fees that insurance company pays for network providers after the

deductible is met

6. Percentage of fees that insurance company pays for providers outside of the network after the deductible is met

7. Maximum limit per claim

8. Maximum limit per lifetime

9. Medical expenses that will be your out-of-pocket expense

10. Annual fees

It's Time To Tie The Knot! But What Kind of Insurance Do You Need?

The ring is on her finger, plans are being made, and the time to tie the knot is approaching - and though most engaged couples focus mainly on their big day, they should also be taking a look at their current insurance policies to be sure their possessions, as well as their soon-to-be spouse, are taken care of. suggests engaged couples review their health, life and homeowners insurances before they hit the honeymoon-so there's smooth sailing on their road to life together when they return.

Health Insurance

When it comes to health insurance, married couples tend to have less expensive insurance policies than individuals. With that being said, compare your policies and see if there is a difference in monthly premiums, deductibles, co-payments, and any other additional features you may have. In doing so, you can see which health insurance plan is more cost-effective, offers you more for your money, or may offer better features, such as dental and vision.

It is more difficult for unmarried couples to get coverage if one is uninsured, because many employer health insurance plans don't offer domestic partner coverage. The plans that do have that coverage are considered taxable income, so it may be more affordable to purchase separate health insurance plans at that point.

Life Insurance

When you're married, the most important thing to you is your family, and you will want to be sure they are protected in the event of your death. That is why it is important to discuss life insurance with your soon-to-be spouse. If either of you already has a life insurance plan, you will want to review it and possibly change who the beneficiary is and how much coverage you have. In essence, you will want to hope for the best but prepare for the worst-and in doing so, you are ensuring that your spouse and family doesn't lose a stream of income if one of you dies.

Homeowners Insurance

When you're married, both of your property is covered under your homeowners insurance policy, but before you're married, this may not be the case. It is important to discuss this with your homeowners insurance agent to see if you can get your coverage extended for both of you. Also, if you are living in an apartment, you will want to check your renters insurance to make sure you have adequate liability coverage.

To start your happily ever after right way, log on to and apply for a homeowners or renters insurance quote. Here you will be able to evaluate multiple rates from best-in-class homeowners and renters insurance providers - helping you find the best homeowners insurance coverage for yourself, as well as your spouse-to-be. You can also find great life insurance rates at, too.

How to Find Affordable Health Insurance

The premiums charged for health insurance are filed with and regulated by the Department of Insurance for each state. This means that no matter where the policy holder purchases his or her insurance, the price will be the same. This offers the reward and ease that comes with online shopping with Health-Insurance-Carriers as well as the confidence of knowing that, no matter what, you will get the best prices available.

All our information and services are available free of charge. Choosing a health insurance plan through our broker network means that you will pay no more than the usual premium to the health insurance provider you choose and nothing to us. Insurance providers cover our costs with commissions, which are built into the premium amount.

What can you do to help yourself save money on health insurance? How about:

  • Organize your family's health insurance plans to insure that you aren’t paying double for any services.
  • Choose the health insurance policy that offers the best value for your situation. Cheaper isn’t always better.
  • Become familiar with the rules of your chosen health insurance plan before you buy. Be sure that you can follow them.
  • Take advantage of the tax breaks offered through some health care services and plans.
  • Quit smoking, lose weight, and exercise more. Being healthy makes for lower health costs and, in some cases, lower premiums.
  • Take advantage of free and low cost health screenings.
  • For lower premiums, raise your deductible or co-pay. For a lower deductible, opt for a higher premium.
  • Comparison shop. Take the time to research your options

Health Insurance for Unmarried Partners

Generally, and unfortunately, if an employer offers health insurance coverage to the spouses of employees, they usually don’t extend the coverage to unmarried partners too. Under the Employee Retirement Income Security Act (ERISA), employers are not required to offer health insurance to any employees, spouses, or "domestic partners" (this term is often used to include same-sex couples and unmarried opposite-sex couples, as well as common law marriages). ERISA also does not compel employers that provide health insurance for employees and legal dependents to extend coverage to domestic partners.

Nevertheless, thousands of employers across the country have begun offering domestic partner benefits in the last several years, and the number continues to grow. Employment experts predict that this trend will continue, as small companies start to follow the lead of large employers that have introduced domestic partner benefit plans in recent months.

In addition, some state and local laws have recently been passed in favor of domestic partner rights. San Francisco, Los Angeles, and Seattle have ordinances requiring all businesses with municipal contracts to offer same-sex benefits if they offer benefits for married couples. Vermont recently enacted the country's first "civil union" law, which grants same-sex couples nearly all of the benefits to which the state's married couples are entitled. Provisions regarding health insurance are still being written, and it is not yet known what they will entail.

When benefits are offered to domestic partners, the level of coverage varies depending on the employer. Domestic partner benefits may include long-term care, group life insurance, family and bereavement leave, and most commonly, health, dental, and vision insurance. The definition of domestic partner may also vary from employer to employer. Some companies include same-sex couples, unmarried opposite-sex couples, and common law marriages. Others cover only same-sex partners on the grounds that opposite-sex couples can receive spousal benefits by getting married, while same-sex couples do not have this option. Regardless of how the term is defined, employers typically require domestic partners to sign an affidavit stating that they are in a lasting, committed relationship. They may also require that a couple live together for a specified period of time before they become eligible for domestic partner benefits.

Comprehensive Benefits Site Efficiently Bridges Seniors with Assistance

Internet-savvy senior citizens now have a new resource to make getting healthcare benefits a little easier. A single website,, allows seniors to sign up for multiple benefits assistance programs online. The site showcases tools for locating benefits sources (health care, transportation, financial support, meals, etc.), determines eligibility, and provides vital application information and instructions. The site's services are also free and confidential.

The concept for the BenefitsCheckUp site, which was formulated by the National Council on Aging and some collaborating companies (AOL Time Warner, Lucent Technologies, and New York Life, among others), took several years to make, due to the process of compiling benefits information from all 50 states. But the results prove beneficial to seniors, by making important medical and financial benefits more accessible. The Internet is everywhere, and even seniors without direct access can view their personal benefits data through public connections or with the help of a family member, care provider, or friend.

More Seniors Are Getting Wired Online

Despite the stereotypical view of senior citizens as "out of touch" with technology, more and more mature adults are looking to stay in touch with friends, family, and loved ones via the Internet. The idea to create a comprehensive benefits website is an extension of the stay-in-touch mentality that many seniors rely upon for their social connections.

BenefitsCheckUp makes the process simple: Seniors can log on, answer a survey of questions regarding personal information, and the program will automatically match them with which benefits they are eligible to receive. This will be determined by comparing their results to the corresponding eligibility requirements for their local, state, and federal assistance programs, such as Social Security, food stamps, and Medicare/Medicaid. The program then tells them precisely how they can go about applying- all in one efficient, printable report.

What's Missing? 10 Benefits Many Seniors AREN'T Getting

The National Council on Aging reports that an upwards of three million Americans are eligible for assistance programs, such as food stamps, Medicaid, and other services, that they aren't using. Here is a look at the ten most common programs:

  • Health counseling for insurance benefits
  • Food stamp programs
  • Medicaid/Medicare
  • Benefits for pharmaceuticals
  • Tax assistance for property for low- and middle-class seniors
  • Meal assistance programs
  • State health and educational benefits for veterans
  • Supplemental income programs
  • Veteran's Administration programs offering financial assistance
  • Home energy programs offering free or low cost service to seniors

Shopping around for the best rates on health insurance is beneficial and important at any age, and if you're interested in getting a health insurance quote, log on to Here you will be able to evaluate multiple rates from best-in-class health insurance providers - helping you find the best health insurance coverage.

Choosing a Group Health Plan for Your Business

Finding the right group health plan for your business can be downright intimidating: sorting through lists of insurance companies and plans; checking and re-checking the dollars and totals for deductibles and co-pays; making sense of plan limitations and exclusions; deciphering a dictionary’s worth of insurance-speak. It’s enough to make anyone feel like a high-school freshman again.

You don’t have the time for all this research and number crunching. But can you really afford to leave it on your “maybe someday” list? As the cost of medical care rises, the risks of not having health insurance are more apparent than ever. Today a single injury or illness if uninsured can leave a family in financial ruin. Moreover, group health coverage is a key benefit of employment. You may not be able to hire and keep the best employees without offering health coverage. The point is: don’t procrastinate!

But take heart: a little basic knowledge can help you shake off those freshman jitters. Here are three quick lessons to help you find high-quality insurance at a reasonable price:

Know the type of benefits you need

Have a good understanding of your employees’ healthcare needs before you start shopping. Do they require frequent medical care or do they rarely see the doctor? Are they more concerned about preventive checkups or coverage in case of emergency? Are prescription or maternity benefits important to them? This is an essential first step. You want to purchase a plan that offers the medical benefits your employees need, without a bunch of “extras” your employees won’t take advantage of. You’ll pay for these “extras” in the form of higher premiums.

Get multiple quotes from multiple insurance companies

Comparison-shopping really pays off. Don’t limit yourself to the options available through a single insurance company. And if the thought of calling all the insurers in your area sounds tedious, find a licensed agent to help you. An agent can discuss the pros and cons of the various insurance companies and plans in your area, provide you with quotes for each, and offer valuable advice based on your group needs. The simplest way to get in touch with an agent is through the Internet, but make sure that any agent you work with is licensed in your state.

Take full advantage of all available tax benefits

There are significant tax benefits for employers who offer group health insurance to their employees. For example, businesses can generally deduct 100% of the premiums they pay on qualifying group health plans. You’ll also want to look into the newly approved Health Savings Accounts (HSAs). These are tax-favored savings accounts that can be used to pay for medical expenses. Be sure to ask your agent for more information on how to take advantage of HSA-eligible plans in your area.

Do Your Homework When Buying Group Health Insurance

With any group health insurance plan that you choose, there are always going to be limits to that plan, and before you purchase a particular group health insurance plan for your company, you will want to do your homework. For instance, you will want to find out what is offered and covered under the proposed group health insurance policy and if the health insurance company is financially sound. If they are in the midst of a merger for example, or not as financially stable as you would like, their delivery of service may not be as good as is promised.

It is also important to understand what kind of features and benefits will be provided in the health plan that you are buying. In some cases, a group health insurance plan will be presented with a summary of benefits, but this is just a summary. For complete details as to what the plan consists of, or to get information on the exact ins and outs of the plan, you will need to request the information from your health insurance representative.

To help you narrow down your decision between health insurance plans, we have listed some questions and helpful tips below. These questions and tips will help keep you on track with what kind of plan you initially set out to purchase for your organization.

What happens with claims and appeals?

Traditional health insurance plans and PPOs may require employees to file claims for reimbursement. HMOs typically require less paperwork. How fast can claims and appeals be taken care of?

Emergency room services.

Is prior approval needed for an emergency room visit? Or does the plan follow the "any prudent layperson" standard-that means that if any person reasonably believes he or she is suffering from a medical emergency, the HMO cannot deny payment?

What is considered an out-of-pocket expense?

Are there expenses for different kinds of health care? What are the co-pays and deductibles? What is the maximum annual and lifetime payout?

What is the grievance and appeals process?

Is the appeals process internal or external? Is there a third-party arbitration for difficult issues? How much time does it take to settle a problem? What is the process for members to appeal claim denials or file other grievances?

What are the limitations or exclusions?

Be sure to read the fine print. Know what services are covered under the particular group health insurance plan you are looking to purchase. Make sure you ask your healthcare provider if there are limitations or exclusions on things like experimental procedures, transplants, infertility treatments, laser eye surgery, bariatric surgery, preventative scans, mental health coverage, rehabilitation, drug therapies, and durable medical equipment.

Check with the Better Business Bureau (BBB) or the state insurance department, or ask for the latest member-satisfaction survey and see if there are any complaints against the health insurance company you are considering working with. In addition to calling the BBB, request the names and phone numbers of other companies and organizations who have the group health insurance plan you are considering. Call and find out why these companies have this group health insurance plan, why they like it, if they've encountered any problems, and if so, how the health insurance company handled it.

If you are interested in receiving a group health insurance policy quote for your company, log on to Here you will be able to evaluate multiple rates from best-in-class health insurance providers-helping find the best group health insurance coverage for your employees and yourself.

Knowledge of the Health Insurance and Life Insurance Agent

Under the law of agency, the knowledge and acts of the legal agent are considered to be the knowledge and acts of the legal principal. In the area of health and life insurance, your insurance agent is the legal agent of the insurance company. In other words, the insurance company is responsible for the acts of the agent when dealing with you and is assumed to have all the knowledge that the agent has. This is important for you.

For example, if your insurance agent is aware of a medical condition you have that would make you uninsurable, completes your application for insurance and, without your knowledge or consent, leaves off any mention of your uninsurable medical condition, the insurance company is regarded under the law as having knowledge of your medical condition.. Assuming no other complicating factors, in this case the insurance company, because of this, will not be allowed to assert a misrepresentation on your application to later deny a claim and void your policy.

If an insurance company is attempting to deny your claim on the basis that your medical condition existed prior to the effective date of your insurance policy (a preexisting condition excluded by the policy) or on the basis that the medical information left off of your application is grounds for voiding the policy (which, of course, makes the claim unpayable), you may be able to assert, as a defense, knowledge of the agent and, thereby, of the company.

This defense will not always work. Most insurance companies now have a statement on their applications that the agent does not have authority to alter the application. Many courts have looked to this wording in the application as a basis for refusing to attribute knowledge of the agent to the insurance company when changes have been made to the application. If the court takes that position, then the inaccurate application would be your fault, not the insurance company’s.

Other courts, however, have found the statement limiting the agent’s authority to be insufficient and have held that the agent’s actions and knowledge are those of the insurance company. In these cases, the inaccurate application would be the insurance company’s fault, not yours. Obviously, if your health insurance provider denies your claim based on medical history not shown on your application but you know the agent has knowledge of, you should seek the advice of an attorney experienced in bad faith claims to protect your rights.

Another approach to this issue taken by many insurance companies is to attach the completed application to the insurance policy when the policy is issued to you. This practice is actually required by law in many states. When an insurance company attaches a copy of the completed application to the issued policy, some courts have ruled that you, the insured, have a duty to read the application attached to the policy when you receive the policy and that you must immediately notify the insurance company of any incorrect or incomplete answers.

Whether the court will attribute the alleged actions and knowledge of the agent to the insurance company depends on the facts and circumstances of each case and on state law. Even if your completed application is not attached to your issued policy, some courts have ruled that you have a duty to read your completed application before signing it, and if you do so, it is presumed that you will notice that the agent has improperly completed it. Most applications do have a statement above the signature line whereby you acknowledge having read the completed application.

But each case depends on its own facts. Courts have been known, for example, to attribute knowledge to the insurance company even when the agent advised the insured to change information on the application so the insured could obtain the insurance. This sounds like collusion, which is a secret agreement between the agent and the insured to misrepresent information to the insurance company to defraud it. Ordinarily when collusion is found, knowledge is not attributed to the insurance company, and the courts will not allow the colluding parties to benefit from their wrongdoing.

Living Abroad and Your Health Insurance Needs

Taking an extended trip abroad requires an enormous amount of planning. Although it may not be foremost in your mind, your health insurance coverage is an important part of this planning.

Standard health insurance plans are generally not designed to cover extended periods of international travel. Most managed care plans do cover emergency treatment regardless of where it is administered, but other types of care are typically limited to a local network of providers. Health maintenance organizations (HMOs) may pay nothing if you seek routine care from a non-network provider, while preferred provider organizations (PPOs) generally cover only a portion of these costs. And most Americans do not qualify for the national health-care programs offered to citizens of many European nations. Before you go abroad, find out what coverage you will have. Tell your insurance company how long you will be overseas and what countries you will visit.

For some travelers, travel insurance may be an adequate solution. However, travel insurance may provide only limited coverage, typically for no more than six months.

If your stay abroad will last more than six months and you want to get the most comprehensive health insurance available, you may want to look into expatriate health insurance. Many larger insurers such as Lloyd's of London offer this type of insurance specifically for Americans living in other countries.

Expatriate health insurance plans can be customized in many ways. In addition to standard medical and emergency coverage, you can get a plan that includes maternity coverage, specialty treatments such as acupuncture and chiropractic, and even emergency evacuation. Choosing the right features depends on your family's needs, your financial situation, and your travel plans.

If you decide to purchase an expatriate plan, you can expect to complete an extensive application. You'll need to disclose any health problems your family members have had in the past 10 years, from broken bones to hereditary conditions to substance abuse. The cost of an expatriate plan varies depending on the features you choose; the number of family members to be covered; the age, sex, and state of health of each family member; your travel itinerary; and various other factors.

Pros and Cons of Catastrophic Health Insurance

"Catastrophic" or "major medical" plans are sometimes offered in the event an employer doesn't offer health insurance or if you simply don't want to pay for coverage that you do not need. It is characterized by high health insurance deductibles and low monthly premiums. Under catastrophic health insurance plans, you tend to pay out-of-pocket for doctor's visits and prescription drugs, but major hospital and medical expenses above a certain deductible are covered. Most catastrophic health insurance plans cover hospital stays, surgery, intensive care, diagnostic, X-ray and lab tests.

Basic Highlights of High-Deductible Health Insurance Plans

Catastrophic health insurance plans typically have deductibles starting at $500 and going up. Many have high lifetime maximum benefit payments, also referred to as "caps," between $1 million and $3 million. Once the cap is reached, your insurance company will not pay for any medical expenses and your health insurance policy will become void. Also, it should be noted that most catastrophic health insurance plans do not cover pregnancy, and other plans do not cover maternity care for a full year after your effective date.

Under a high-deductible plan, you are expected to pay your medical needs until the expenses reach the cost of your deductible. If you eliminate your coverage to reduce your monthly premiums, you are taking a gamble on how much money you'll have to spend on self-health care. For example, if your deductible is $15,000 and you have surgery that costs under that amount, you are required to pay for the surgery out-of-pocket.

Do You Fit The Profile?

On the average, people who buy catastrophic health plans are either in their 20's, or between the ages of 50 to 65. Young adults tend to buy the coverage if they are self-employed or don't get coverage through work. On the other end of the spectrum, older adults purchase a catastrophic health insurance plan when they are concerned with financial losses in the event of a heart attack, cancer or other serious illness. They tend to be healthier, on few or no prescription medicines, and are more concerned with saving on their premiums, and would rather pay out-of-pocket for doctor's visits.

Frank McArdle, spokesperson for Hewitt Associates, said, "Companies with 1,000 or more employees typically offer higher health insurance deductible plans. Retirees who aren't yet eligible for Medicare select these plans in order to keep premiums down."

High deductible health insurance can be purchased either as a single plan or through an employer in a group plan. If you have certain pre-existing conditions, you often won't be eligible for a catastrophic health plan. Examples of such conditions are AIDS, diabetes, emphysema, heart disease, multiple sclerosis, schizophrenia, and many more.

What Does It Dover?

The types of coverage vary depending on what type of high-deductible health insurance plan you choose. Blue Cross Blue Shield of Florida offers a catastrophic health insurance plan in most counties that is called "Essential." It has deductible of $250 and an out-of-pocket limit of $2,500 after you've exceeded your deductible. The lifetime maximum is $1 million. The plan covers hospital, surgical, and X-ray expenses, but not other services, like doctor's visits, maternity care, prescription drugs, and mental health visits. An online quote showed that the monthly premium for a 21-year old, nonsmoking female to be $29.

A similar plan to Florida's Essential health plan is offered by Golden Rule Insurance Co. Its "Basic Plan" offers a high deductible health insurance plan, with deductible prices ranging from $500-$5000. It covers the same elements that the Essential plan does, but mental health and substance abuse are not covered. The Basic Plan does, however, cover hospital and surgical expenses, MRIs, CAT scans, and more, as well as having a lifetime maximum of $3 million.

Shopping Tips

  • Before buying a catastrophic health insurance plan, consider:

  • What is the cost of the premium per month, quarter, and year?

  • What is the cost of the deductible and how much can you afford?

  • How extensive do you want the coverage to be?

  • Do you require prescription medications?

  • Can you afford to pay for doctor visits out-of-pocket?

  • Do you have any pre-existing conditions?

  • Do you get sick often?

  • What is the lifetime annual benefit?

If you are interested in getting a health insurance coverage quote, log on to Here you will be able to evaluate multiple rates from best-in-class health insurance providers - helping find the best health insurance coverage for you.

The Power of Purchasing Group Health Insurance Online

As technology keeps on evolving, small businesses have become the perfect online insurance customer. With new websites offering online quotes and applications for group health insurance coverage, small businesses are taking advantage of their savvy use of the internet and seeing what the online insurance companies’ websites have to offer.

Some online health insurance providers act as brokers, while others put you in touch with brokers in your area. Site features can go from bare-bones quoting services with no insurance advice, to sites that bill themselves as “benefit portals,” providing reams of small-business benefits advice.

How Online Health Insurance Companies Can Work For You

At online health insurance websites, small business employers can select quotes based on deductibles and other plan features. Mind you, due to strict state regulations regarding insurance premium levels, buying a health plan online doesn’t always offer a better deal on health insurance premiums. The online application process requires the same amount of work as if you were visiting with a broker, and you must still interact with one before purchasing a final plan. It is more for the ease of being able to look for group health insurance online when you have time, not when it is convenient for your insurance rep.

The easiest part of this task is obtaining a price quote for your group health insurance plan. The quote will be based on basic company and employee information. You will first fill out a form where you must state your name, the company’s address, your line of business (either with Standard Industry Classification code or descriptive keyword), how many employees will be covered, and the name, age and gender of each employee that you would like covered.

You will also need to go in-depth with your employees, and obtain information pertinent for the group health insurance plan. For instance you will need to find out information like, will a spouse or children be covered under the plan? Do you want maternity coverage? Dental insurance? Deductible for hospital stays?

It is important to have all this information before you apply for a quote, because these add-ons will ultimately increase the cost. It’s also important to figure out how much of the premium you will pay, and how much will be paid by the employee.

After you’ve submitted your information and applied for the preliminary health insurance rate quote, you’ll be asked how you want to compare the plans that meet your criteria. With most online insurance companies, you can view the health insurance quotes by price, deductible, or plan features. What happens next depends on the site you visit and whether it acts as a broker or refers you to one in your area.

If you are interested in getting a group health insurance coverage quote for your company, log on to Here you will be able to evaluate multiple rates from best-in-class health insurance providers – helping find the best health insurance coverage for your employees and yourself.

STOP! Before You Request An Online Quote...

When shopping online, it is imperative for the safety of you and your family that you only give out personal information to companies of good repute. Just because a company has a professional looking website does not make them honest.

Some possible concerns include the following:

The owner of the website may not even be based in the US. Should you run into problems and want to take legal action, it will be hard enough to find a fictitious American company, much less one in another country.

The website may purport to have a worthy intention for requesting your information (like offering you good rates on health insurance) but it is possible that all they are really interested in is your personal information. Identity theft online happens all the time. Don’t let it happen to you.

Identity theft is not the only option for online information thieves. Re-selling personal information is a big business. Telemarketers and direct mail and email marketing firms are always purchasing personal information for advertising purposes. Save yourself a ton of junk mail and annoying phone calls by making sure that you are dealing with a reputable company.

To make sure that none of the above happens to you, there are steps you can take to protect yourself.

  • Verify that the company who owns the website is based in the US by checking the URL registration at Network Solutions online at:

  • Before giving your social security number, credit card, or sensitive information, hesitate. Ask yourself what it is that they need the information for, especially if they don’t explain.

  • Choose companies that list “BBBOnline” or “Trust-e” on the bottom corner of the web page.

  • Before you sign on, make sure you can sign off. That is, make sure that you are offered a way to take your name off any lists and avoid solicitations should you change your mind about your purchase.

Understanding the difference between HMO, PPO, and POS


What is the difference among HMO, PPO and POS health insurance plans? Which is best for a small business?


The size, needs and financial situation of a company are deciding factors in what kind of health plan or health insurance will be offered to a company. Larger companies frequently offer a choice of health plans or insurers, while smaller businesses tend to have price restraints, and are only able to offer one insurance provider.

Health Maintenance Organization (HMO)

On average, HMOs are the least expensive health option and the least flexible. Doctor's visits, preventive care, and medical treatment are given in exchange for a monthly premium as well as a co-pay of roughly $5-$10. To keep its costs down, HMO requires that you only see doctors who are in your HMO network.

HMO Prescriptions

As an employer, you can decide what percentage of prescriptions is covered by HMO and what percentage the employee will be required to pay. The coverage price may range anywhere from a co-pay of $5 for some drugs, to a co-pay of almost the entire amount for others. It is all at the discretion of the employer.

Emergency Treatment

By law, an HMO cannot require referrals for emergency care, so the only time an HMO will pay for medical care without a referral is for emergency room treatment. HMO does require patients to select a "primary care physician," to take care of your routine medical needs. This doctor is also able to refer you to a specialist within your HMO if needed.

Preferred Provider Organization (PPO)

A PPO is more flexible than an HMO insurance plan, allowing you to visit out-of-network providers, and does not require a referral from your primary physician, but it does come with a higher premium. The $5-$10 co-pay gives you financial incentive to remain in your network. Straying from your PPO network could mean that you will have to pay for the treatment and submit the receipt to your PPO insurance provider for a partial reimbursement. A PPO generally reimburses up to 80% of out-of-network costs.

Point-of-Service Plan (POS)

The POS plan is like a combination of the HMO and PPO plans. You are required to designate an in-network physician to be your primary health care provider. You are able to go out-of-network if you so choose, but in doing so, you will have to pay most of the cost yourself, unless a primary care physician refers you to that specific doctor. In instances like that, the health plan will then pick up your tab.

If you are interested in getting a health insurance coverage quote, log on to Here you will be able to evaluate multiple rates from best-in-class health insurance providers - helping find the best health insurance coverage for you and your family.

health insurance company

If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy from a health insurance company. You can get fee-for-service, HMO, or PPO protection. But you should compare your options and shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans.

Individual health insurance is bought by the insured directly from the health insurance company, and tends to be more expensive and places more preexisting conditions upon the insured than group insurance. If you are self-employed, you have the option of purchasing individual insurance yourself or purchasing it through an association or other related group. You can also purchase long term care health insurance if you're looking far coverage far into the future. Look for rules in your state's health insurance laws that you can benefit from - for example, if you live in Texas, study the Texas health insurance laws.

If you get a noncancellable policy (also called a guaranteed renewable policy), then you will receive individual insurance under that policy as long as you keep paying the monthly premium. The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out. But it doesn't protect you from losing coverage.

When working with your health insurance company

Important points when working with your health insurance company:

  • Shop carefully. Policies differ widely in coverage and cost. Contact at least one more health insurance company, or ask your agent to show you policies from several insurers so you can compare them.
  • Make sure the policy protects you from large medical costs.
  • Read and understand the policy. Make sure it provides the kind of coverage that's right for you. You don't want unpleasant surprises when you're sick or in the hospital.
  • Check to see that the policy states: the date that the policy will begin paying (some have a waiting period before coverage begins), and what is covered or excluded from coverage.
  • Make sure there is a "free look" clause. Your health insurance company should give you at least 10 days to look over your policy after you receive it. If you decide it is not for you, you can return it and have your premium refunded.
  • Beware of single disease insurance policies. There are some polices that offer protection for only one disease, such as cancer. If you already have health insurance, your regular plan probably already provides all the coverage you need.

Tips To Choosing The Right Auto Insurance Company

By: Andrew Daigle

Are you in the market for better auto insurance rates? Or, perhaps you are simply looking for a new auto insurance company? Whatever your reason for shopping around, now is the perfect time to request auto insurance quotes from several companies who are more than eager to earn your patronage. In fact, many companies will compete for your business by way of auto insurance rates.

Your first step to choosing the right auto insurance company is to consider the type of coverage that you need. For instance, if you have a less than perfect driving record or past credit problems, you may want to compare auto insurance costs from companies who specialize in giving customers a second chance to earn discount auto insurance. If you own more than one vehicle, you may find that some auto insurance companies will offer cheap auto insurance rates in exchange for becoming your exclusive provider. In other words, transferring all of your policies to one company may result in discount auto insurance at its best.

The next step in choosing an auto insurance company is to look for one that rewards customers based on a good driving record. One of the keys to a respectable auto insurance company is flexibility when it comes to coverage selection and incentives to promote better and more responsible driving. In addition to comparing auto insurance rates and plans, take the time to review the auto insurance company's policy on discount auto insurance rates for those with a safe driving record.

It's important to realize that auto insurance rates vary from one area to the next. For instance, Pennsylvania auto insurance may be less expensive than New York auto insurance or vice versa. Regardless of where you live, however, most will agree that auto insurance is expensive and it's essential that you compare auto insurance rates to ensure that you are getting what you pay for. A good auto insurance company, for instance, will offer various deductibles, competitive auto insurance rates and some type of coverage that allows for the temporary payment of medical bills in the event that you ever become involved in an auto accident. If you are injured as a result of another motorist's negligence, many auto insurance companies will pay for your medical bills and later seek reimbursement from the faulty individual(s). This is a great relief to many, especially those who may not otherwise have health insurance.

As a final thought to choosing an auto insurance company that offers the best auto insurance rate, free auto insurance quotes and/or a flexible program that can be customized to fit your individual needs, simply take the time to shop around and compare auto insurance from more than one company prior to making a final decision.

The information in this article is designed to be used for reference purposes only. It should not be used as, in place of or in conjunction with professional financial or insurance advice relating to auto insurance quotes, discount auto insurance or auto insurance rates. For additional information or to receive an auto insurance quote, contact a local auto insurance company.

Is It Legal for Your Health Insurance Company to Cancel Your Policy?

The following is a transcript of an interview with California insurance attorney, Bob Scott, conducted on December 15, 2006. Mr. Scott, managing partner of the Advocate Law Group, has over thirty years of experience as a trial attorney in California, specializing in all aspects of bad faith insurance litigation, including life, health and accident insurance and all attempted insurance policy rescissions or cancellations. Mr. Scott has represented a diverse range of clients, from individuals victimized by insurance companies to large banks and industrial companies. In this interview, Mr. Scott discusses the rules that govern policy cancellations, particularly in California, and current developments in bad faith health insurance rescissions and health insurance lawsuits.

Free Advice: Hello Bob and welcome.

Bob Scott: Hello. Thanks for having me.

Free Advice: Before we go forward, can you explain what a plaintiff is?

Bob Scott: A plaintiff is someone in insurance law who has been denied something, usually a benefit, subsequent to making an insurance claim. Usually, in a life, health or disability setting, a plaintiff is someone who purchased a insurance policy and then made a claim under the terms of the policy that was denied. He would then come to a lawyer, who would bring an action [a health insurance lawsuit], usually on a contingent fee basis. People that have to bring such actions are called plaintiffs.

Free Advice: So it’s not the insurance company. It’s the person with the claim against the insurance company.

Bob Scott: Right, and the insurance company would be the defendant.

Free Advice: So I’m going to go forward with questions, as if I were a consumer.

Bob Scott: Right.

Free Advice: Can an insurance company cancel my insurance policy?

Bob Scott: Yes. An insurance company can cancel your insurance policy, but only under very strict terms. The most obvious cancellation would be if you didn’t pay your premiums, and there is a whole road map for that, with both payment and the cancellation set out in specific detail in the insurance policy.

Free Advice: Is that the policy I get when I buy the insurance?

Bob Scott: Right. The policy should include a heading and a section called “Cancellation” and/or “When Am I No Longer Insured,” which states those terms. Sometimes it depends on your age. That would usually apply with life or disability insurance in a situation where you grow out of the policies because you attain a certain age, upon which you are no longer covered. It works the other way too; failure to properly answer questions at the outset of the insurance policy, when they take the application, could cancel the policy.

Free Advice: So that would be an example of a legitimate reason to cancel a policy?

Bob Scott: It very well could be.

Free Advice: Are there other examples of a legitimate reason to cancel a policy, besides non-payment, or that you didn’t tell the truth when you applied?

Bob Scott: Again, the only third one would be if you grew out of the policy because your age no longer made you eligible. There could be other eligibility questions. For example, if you bought a policy through an affinity group and then no longer belonged to that group. If you retired from the profession represented by the group, and you gave up your license, then that might make you an ineligible too, because you would no longer be in the class of people insured. That could also work for people in group policies. If they’re no longer with their employer, they often lack the right to continue that insurance, although in many cases, they can transition to individual or other policies in such settings.

Free Advice: Do I always have to be given notice of any of these legitimate reasons?

Bob Scott: Yes, and it has to be in writing, and it has to be to you, and you have to receive it.

Free Advice: Are there legitimate reasons to deny benefits under my policy?

Bob Scott: Actually, there are a number of legitimate reasons to deny benefits. Usually, those denials are found in the policy terms, but because one of the small little sections in the policy at the very end is called “Conformity with State Statute Provision,” it requires additional policy terms that are not explicitly stated in the policy. There could be a number of reasons, some of which are in the policy, and some which are not, and those, frankly, are known by insurance people.

Free Advice: What other special rules apply then – when they’re canceling health insurance policies in California?

Bob Scott: Well, the most important rule when they’re canceling is in the context of a big claim. (For example, if a person went in for a heart attack or they went in for a broken leg, and there’s now a five or six figure current claim bill.) An insurance company, during the first two years (and two years only) from the effective date of the policy, can look back and see on your insurance application if you answered all the questions correctly.

If you made a material, in other words, a big misstatement, and you intended to not tell them the truth, then the insurance company could rescind – in other words, cancel the policy – all the way back to the effective date, and you would have no insurance coverage. However, that is a very technical rule, and whether or not a material misstatement was made on an application usually requires a lawyer’s review.

Free Advice: That was my next question: If that happens, how do I determine if it was fairly done?

Bob Scott: Well, first of all, in over 30 years of seeing rescission cases, I’ve never seen one in which the insured did not know that they didn’t make a material misrepresentation. It was something they never thought about; a trip to the emergency room that they never gave a second thought to; something the agent told them. None of those reasons are legitimate bases for the insurance company to rescind. So you have to look at those very, very carefully.

Free Advice: What would be an example in those kinds of cases? What is a legitimate reason to rescind coverage?

Bob Scott: Let me give you a classic one in California. It’s a California appellate decision that I always refer to as the mole case. It involved a person who had a tendency to grow cancerous moles on their skin, and they had had a number of the moles burned off. A couple had to be literally dissected off of their skin because they were cancerous. That person knew what a cancerous mole was because they had that history, as I’ve suggested.

Well, they saw another mole growing on themselves, and they quickly ran in to get insurance without saying they had treatment or had any worry about this new mole. The Court of Appeals said, “No, in that setting, you knew that you had a condition. Because of the prior experience of having these cancerous moles excised, you intentionally failed to give the insurance company that information. If the company had such information, they would not have written you this insurance; therefore, the company can legitimately get off of this risk and rescind.”

Free Advice: You said that you’ve been looking at these cases for 30 years. Why has there been a recent increase in California health policy cancellations then?

Bob Scott: That’s a really good question. I think it’s because the insurance companies see that their brethren are doing it and get away with it, so they all try to do it. The only reason that I can think of why there has been a recent upswing in this is because the insurance companies, through merger and acquisition, are no longer entities that have grown up and had their management and their claims philosophy all in tune with California law. Now, many companies in the health insurance field are owned by distant parent multi-national corporations, and bean counters tell claims people to cut down claims. So they go back into their old bag of tricks, pull out the rescission card and try to play it.

Free Advice: Is this only happening in California or other states as well?

Bob Scott: Other states as well. These corporations control these health entities across many states.

Free Advice: Which insurance companies have been canceling California health insurance policies?

Bob Scott: Kaiser, Blue Cross, Blue Shield, Health Net, and PacifiCare.

Free Advice: What type of policies have the insurance companies been targeting?

Bob Scott: Individual policies. The difference is the individual policy would be something you would buy from an insurance broker across the proverbial kitchen table, when the broker comes to your house. In today’s world, that kitchen table is substituted for the internet. People buy individual insurance on the internet. If you are afforded your insurance through your employer, then they are subject to a group, because you’re buying it through the group called the employee group. Those usually do not have this rescission issue, because the employer group policy takes everybody [with or without pre-existing conditions– and there is no health application associated with the policy issuance.

Free Advice: So this is for individual, privately-purchased policies in particular?

Bob Scott: Right, and that’s an important distinction to make.

Free Advice: What has been the basis of the decision process for these cancellations, and is it intentional?

Bob Scott: Well, the insurance companies certainly intend to do what they’re doing – no question about it. And changes in the company’s philosophy do not happen by chance. It is intentional. They simply don’t want to pay out $300,000.00-$400,000.00 in claims, per claim. They want to deny the claim and see if they can get away with it.

Free Advice: Intentionally?

Bob Scott: Oh, yes.

Free Advice: Now, how can they get me to accept a policy cancellation?

Bob Scott: Well, if they tell you that the policy has been rescinded, and you don’t do anything about it, they win. If they tell you the policy has been cancelled, they might make you sign something acknowledging that cancellation, and perhaps give you some of your premium back, and tell you that if you cash that check, you will have agreed to the rescission. In that case, they may get away with it. That would be then characterized as an “accord and satisfaction” in law, but all cases

Free Advice: So they would send me back a check from the premiums I already paid, and if I cash that, then I’ve agreed to the cancellation?

Bob Scott:Possibly. Not all the time, but it gives them a better argument, and frankly, anybody reading this should know – never cash that check if you feel that you have been harmed and done wrong by the insurance company in the claim and in its attempted rescission. Do nothing. Agree to nothing. Sign nothing. And get to a lawyer that’s focused on this area of law as quickly as possible.

Free Advice: What is the California Department of Insurance doing about these cancellations?

Bob Scott: Well, there are two regulatory agencies. The Department of Insurance regulates the insurance folks, and the HMOs are regulated by the Department of Managed Care. Both of them have been very proactive, and we’ve been dealing with them and assisting them in getting after, penalizing, and in some cases fining, some of these companies for the conduct we’ve described today.

Free Advice: What are my remedies, if my policy was cancelled?

Bob Scott: If your policy was improperly rescinded, find the right [health insurance] lawyer, someone who knows what he’s doing in this field. Then bring an action for bad faith denial of claim and bad faith rescission, and litigate that claim in the courts to either conclusion or to settlement.

Free Advice: If I go forward in one of these cases, will I be able to get health insurance again?

Bob Scott: Very probably yes, because one of the by-products of the case will be the agreement by the company that the rescission was improper, or at least a tacit agreement it was improper via an agreement to pay you money and not state that any policy had ever been rescinded concerning you in the future, which is a very important thing.

Free Advice: So, could you then just briefly recap – If my policy’s cancelled, what should I do?

Bob Scott: Well, first of all, do nothing that in any way accepts the insurance company’s conduct. Write them and tell them it’s wrong, and be sure to immediately make a claim with your state insurance or managed care regulatory agency, though they don’t have any real power to get your wrong righted. After making that claim, seek the help of a skilled attorney who knows what they’re doing in this field of law, and get after that insurance company. That means a lawsuit and discovery. You have to beat them back. They hire very good lawyers who are on staff to try to fight you, and it becomes a battle of wills. As long as you have good facts on your side (and a good plaintiff’s [health insurance] lawyer will know whether you have a good case), you should prevail.

Free Advice: Alright. Thank you for your time.

Bob Scott: Thank you.