Healthcare Insurance

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Individual Health Insurance Plans

 
If your group plan doesn't meet all your health insurance needs or if you don't have access to a group health insurance plan, your only choice, other than paying for all medical expenses yourself, may be to purchase an individual health insurance plan. When you select a plan, whether individual or group, avoid surprises. Carefully read the policy, contract, and/or plan document and make sure that you understand it. Before you purchase the plan, confirm that it includes a “free-look” clause. Many insurance companies include this clause, which gives you at least ten days to review the policy after you receive it. If you choose to return the policy, the company will refund your premium. 

Buying an Individual Plan

You can buy individual health insurance plans from an insurance agent or broker, or directly from the insurance company. Start with the agent or broker who handles your car, life, homeowner's, or renter's insurance. Ask friends, neighbors, and work associates about their agents. Check out at least three agents. Call insurance companies, HMOs, and PPOs directly to ask them direct questions about the plans. Search the Internet or check out insurance company Web sites for more information. If you don't have a specific type of health plan in mind, ask the company representative to explain the types and cost of plans the company sells. 

Applying for and Enrolling in an Individual Plan

When you leave a job, most group plans allow you to continue your coverage with the same benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). You may also be able to convert your group plan to an individual plan, which may offer benefits that differ from the group benefits. The advantage of this option is continuity of coverage. You don't have to repeat the enrollment process, so you won't have to qualify or worry about a waiting period based on a pre-existing condition (a medical condition that is actively being treated during the application process). 

When you apply for coverage in an individual plan, you will need to be prepared to answer many questions in detail about your medical history and the history of family members you want to cover. You may have to take a physical and/or release medical records to the insurance company. Depending on your (or a dependent's) health condition, an insurance company may write a plan that excludes a pre-existing condition, or the company may charge a higher premium for the policy. 

Understanding Costs

Don't be surprised at the much higher price and lower benefits (including prescription benefits) of an individual plan.  You simply won't have the advantage of group purchasing marketplace clout. However, in an effort to keep costs down, you may be able to work with the insurance company to customize a plan that fits your specific needs. For example, you can choose a higher deductible to lower your premium costs. With a noncancellable policy, your coverage continues as long as you keep paying the monthly premium. Under this type of policy, the insurance company can increase your premiums but can't cancel your coverage. Another type of policy is a conditionally renewable policy. This qualification allows an insurance company to cancel all policies similar to yours but protects your policy from being individually selected for termination. 

Resorting to a High-Risk Health Insurance Pool

In some cases, insurers may consider you a high risk, perhaps because of a pre-existing condition. If you can't get health insurance anywhere, you may be eligible for your state's high-risk pool.  High-risk pools make health insurance available to everyone, regardless of their health. Costs are high, coverage may be minimal, and you may have to pay higher deductibles and coinsurance, so consider this type of coverage only after you exhaust other possibilities. The structure of high-risk pools varies from state to state, so be sure to check with your state's insurance department for specific information. If you want to insure dependents who aren't high risk, finding another health insurance plan is much more economical. 

Blackburn Group, Inc.
Penfield, NY 14526-0052
(585) 586-4530,  (585) 586-7479 fax,  Email: sales@blackburngroup.com
  

RiskPro is a registered trademark of Blackburn Group, Inc. 

Copyright 2006 Blackburn Group, Inc. All rights reserved.