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Health Insurance And Insurance Brokers

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Health Insurance And Insurance Brokers

If you are in the market to purchase your own health insurance coverage you can save yourself precious time and money by shopping and comparing policies right online. Sites dedicated to giving you quotes on various types of insurance make it very easy for you to get an idea of what your coverage and costs will be. However, please be forewarned that there are some pitfalls in using an insurance broker as I discovered within the past year.

As a self employed person, I carry my own health and life insurance for my family. When making the move from New Jersey to North Carolina in 2004 I knew two things about our health insurance:

1. I would have to shop for a health insurance provider covering North Carolina.

2. Rates would be cheaper than in New Jersey, with costs being about half of what I had been paying and with slight better coverage.

Several weeks before we moved I contacted a well known internet insurance broker and received quotes. We selected one company and received the paperwork from the broker about ten days before our move. Quite frankly, I wish I had started the process a little earlier as all of our free time was dedicated toward preparing and making the move. So, I ended up packing the paperwork with my personal stuff and was only able to fill it out and submit it one week after our arrival in North Carolina.

Dealing with the online insurance broker was a simple task, but I soon discovered that they were an extra step in the application process, one that only slowed down our approval.

Once the paperwork was received by the broker, they acknowledged the same via email and mentioned that they would review our package before forwarding it to the health insurance company.

Over the next couple of weeks we received messages from the insurance broker stating the following:

1. We are in the process of reviewing your application.

2. We have sent your application off to the insurance company.

3. The insurance company has your application and will be reviewing it in about one week.

4. The insurance company expects a delay in reviewing your application due to the high volume of applications received.

5. Please do not contact the insurance company directly; we will keep you posted as to the status of your application. Yeah, right.

Originally, we were assured by the insurance broker that the health insurance company would review and approve our application within two weeks. Follow up phone calls by us to the broker along with several exchanges of emails revealed that this was not going to happen. In addition, when we contacted the health insurance company directly – at the encouragement of the broker – the health insurance company had difficulty finding our application. Within a few days the application was found sitting in another department; our contact at the health insurance company blamed the broker for sending the information to the wrong address.

As it turned out, the original insurance quote we received online was off by just over 20%. Once the health insurance company determined that certain pre existing conditions needed to be factored in our rates rose accordingly. Of course, when working with the internet broker we knew that the rate quoted wasn’t ‘absolute’ but the big jump was still a bitter pill to swallow.

Among our thoughts at that point in the process were:

1. Had we known ahead of time that our “final rate” would be so high, we would have shopped around some more.

2. Because of the delays and the passage of time, we needed to complete the application process as our coverage with the NJ health provider would need to be canceled, preferably by the end of the year.

By the middle of December, a full ten weeks after we submitted our paperwork, we received official notification that our application was approved and that we were covered. During the last couple of weeks of the lengthy application process we contacted the health insurance company directly several times to learn what the status of our application was. At no time during the process were we assured that we would receive approval; essentially we were told that coverage would begin pending approval.

In conclusion, I offer the following recommendations for shopping for health insurance:

1. Comparison shop online. Get quotes through the online brokers to get a general idea of what your costs will be. If you have pre-existing conditions, the prices quoted will not be reflected in your quote.

2. Narrow down the list of companies quoted to three and then contact them directly. Bypass the broker as they are an unnecessary additional step in what certainly is not a quick approval process.

3. If you need insurance by a particular date, apply well in advance to allow for delays, for misplaced paperwork, changes in your application, etc. Our insurance coverage was approved effective a specific date, but we were able to move it to another date to coincide with the dropping of our NJ health care provider.

In all, the experience was wearisome at times and a real eye opener. I know you see ads all the time for online insurance quotes. I am not saying to avoid the sites, but please consider what we went through before using an online broker exclusively.

5 Basic Facts About Health Insurance Policies In A Bad Economy

1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?

Many health insurance plans have specific exclusions that eliminate your benefits for anything that could have been covered under Workers Compensation or similar laws. Now read that last sentence again.

COULD HAVE BEEN COVERED!?

That is correct. Most self employed people and even some small business owners do not carry Workers Comp on themselves.

There are designed insurance plans that will cover you on and off the job — 24-hours a day, if you are not required by law to have Workers Compensation coverage.

2. ARE YOU WRITING IT OFF?

Independent contractors (1099’s), home based business owners, professionals and other self employed people generally are not taking advantages of the tax laws available to them.

Many people who are paying 100% of their own costs are eligible to deduct their monthly insurance payments. Just that alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accounting professional if you are eligible and/or check out the IRS website for more information.

3. INTERNAL LIMITS
All true insurance plans use some form of internal controls to determine how much they will pay out for a particular procedure or service. There are two basic methods.

-Scheduled Benefits

Many plans, some of which are specifically marketed to self employed and independent people, have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hr. period. This structure is usually associated with “Indemnity Plans”. If you are presented with one of these plans, be sure to see the schedule of benefits, in writing. It is important that you underst and these type of limits up front because once you reach them the company will not pay anything over that amount.

-Usual and Customary

“Usual and Customary” refers to the rate of pay out for a doctor office visit, procedure or hospital stay that is based on what the majority of physicians and facilities charge for that particular service in that particular geographical or comparable area. “Usual and Customary” charges represent the highest level of coverage on most major medical plans.
4.YOU HAVE THE ABILITY TO SHOP!

If you are reading this you, are probably shopping for a health plan. Every day people shop, for everything from groceries to a new home. During the shopping process, generally, the value, price, personal needs and general marketplace gets evaluated by the buyer. With this in mind, it is very disconcerting that most people never ask what a test, procedure or even doctor visit will cost. In this ever-changing health insurance market, it will become increasingly important for these questions to be asked of our medical professionals. Asking price will help you get the most out of your plan and reduce your out-of-pocket expenses.

5. NETWORKS AND DISCOUNTS

Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In broad strokes, networks consist of medical professionals and facilities who agree, by contract, to charge discounted rates for services rendered. In many cases the network is one of the defining attributes of your program. Discounts can vary from 10% to 60% or more. Medical network discounts vary, but to ensure you minimize your out-of-pocket expenses, it is imperative that you preview the network’s list of physicians and facilities before committing. This is not only to ensure that your local doctors and hospitals are in the network, but also to see what your options would be if you were to need a specialist.

Ask your agent what network you are in, ask if it is local or national and then determine if it meets your own individual needs.