FAQ – Health Insurance
Que: How group health insurance is different from Individual Health Insurance?
Ans: Individual health insurance can be purchased by an individual after completing the laid down formalities like medical examination. Individual has to pay the complete premium himself. Health insurance provider may deny you to participate in the health insurance plan on the basis of affecting factors such as age, health condition, paying capacity, personal habits etc. In individual health insurer has the advantage over insured as he reserved the right to reject the application or issue a health plan with limited coverage.
Group Health Insurance caters for employees of company or even group of family members. Usually, employees are not required to undergo medical examination while applying for group health insurance. If you are a member of group health insurance established by your employer, your employer pays certain portion of your insurance premium. Normally, insurance providers do not deny health insurance to group of potential insurance seekers. More the number of group members, more the benefits and lesser premium.
Que: What are the different ways to acquire protection through Health Insurance?
Ans: Apart from becoming member of a group insurance plan, you can obtain health insurance protection through federal and state government aided insurance programs such as Medicaid and Medicare. You have the option to acquire a health insurance plan through alternate health care channels like PPO and HMO. You can also choose to purchase a health insurance plan from private health insurance providers.
Que: How group health insurance is beneficial than individual health insurance?
Ans: The main advantage of group health insurance is that participating individuals need not to produce evidence of health condition; hence there are negligible chances of your proposal being turned down by the provider. In Individual Health Insurance, you have to produce the evidence of your health condition and the insurance provider has the right to reject your application on the grounds of personal habits, poor health and even paying capacity. However, individuals with known health problems, though could be enrolled in the group insurance plan, may have health insurance plan with certain limitations. Premium rates of group health insurance plan are comparatively low than that of individual health insurance plan. The premium gets even lower in some cases as the employer pays some portion of the premium. As the group health insurance plan members increase it facilitate you to get more benefits and flexibility when compared to individual health insurance plan.
Que: What are the different types of health protections provided by the employers?
Ans: There are number of types of health care protections provided by employers to their employees. The plan varies from one employ to another. However, mainly protection plans like life insurance; disability/medical insurance, accidental death insurance are preferred by the employers. Some employers also provide special package like vision insurance, dental care and travel insurance.
Que: Which type of individual health plan is most suitable for me?
Ans: Individual health insurance plans are classified in two categories namely Managed Care Plans and Indemnity plans. Earlier includes HMOs, PPOs and POS. Indemnity plan permits you to select a doctor of your choice and reimburses your medical expenses. Managed card plans such as HMO and PPO have their doctors or a network of empanelled doctors and hospitals that provide you the medical care.
Que: Which plan is better for me?
Ans: Both types of health insurance plans have their benefits and drawbacks. If your doctor is a member of HMO network managed care plan may prove to be more advantageous for you. If he is not a member it is advisable to opt for a PPO plan. Irrespective of your doctor’s affiliation to network you can secure medical coverage for you. There is another advantage of PPO plan. If you are in need of specialized treatment, unlike HMO plan, PPO plan allows you to obtain specialized treatment directly without referral from your primary health provider. Co-payments and deductibles are comparatively lower in HMO plans. Choosing a suitable health insurance plan depends upon your health conditions and your medical needs.
Que: What if I want to obtain specialized treatment from a specialist who is affiliated to HMO program?
Ans: There are two ways to overcome this problem. First is that you have to bear all expenses on acquiring such specialized treatment from a specialist who is not affiliated to the program. Secondly, you can ask your primary health provider for referral to the specialist. If he does not refer you, you can consider of changing your primary health provider to another, who you think will do the needful.
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