A Primer On Finding & Selecting Medical Insurance

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At one time, only a few such as the self employed really had
to know much about selecting medical insurance because for
many years, the majority of the working population was
working in “employee” status and Medical Insurance was a
company benefit, and one that had very few choices involved.
Today that benefit is either disappearing or being offered
with choices ranging from family plan to PPO to HMO to no
participation; choices also include the amount of payroll
deduction based on plan choice, and it’s a complex situation
to decide.. does one opt for the plan with a $500
person/$1000 max deductible which has virtually no payroll
deduction, or the plan with the $250/500 but with a $25 per
month deduction. Of course those figures are arbitrary for
the purpose of the article and cited only as examples.
But there are choices that can and need to be made.. in
fact, some times those choices now come down to “where can I
get my own insurance… period?” as so many companies have
either layed people off or cut the Medical Benefit entirely.
Let’s say you are one of those people.. hopefully not, but
we need to cut to the chase.
The first thing to see is if a spouse is working, is
insurance offered from their employer? Possibly they were
not on a family plan, but this is now required.
Usually even with an employer requiring a contribution, a
employer provided plan is less costly than going out 100%
percent on your own. This should really be checked out.
Employer group rates are generally less than an individual
getting their own insurance.
But let’s say this does not apply. But the principle of bulk
or group purchasing does. Your next step is to see if there
is a group that you can join that offers group rates. If
you are self employed or have your own business, chances are
that your business or profession may have a professional or
trade organization that offers Medical Insurance through the
group.
The writer of this article resides in Pittsburgh, Pa where
he has been involved quite indirectly in the construction
industry. When we say “quite indirectly” we are talking
about being in sales and having a sales business which
provides pumps and equipment to contractors. Because of
that association, the writer qualified for membership in the
local Builder’s Association which had pooled its many
members to obtain group rates. This is cited in this article
because you as a reader may not have an apparent direct
connection to a group, but you might qualify through an
association as the writer has done. If you need to provide
your own medical insurance, by all means check this out.
Are, or were you involved in federal or military service?
You may find a group association here.. try your VFW, your
TROA, your American Legion. One company that advertises for
the self employed is NASE. I’ve never checked them out, but
I do hear advertising.
So let’s assume you have found a supplier, regardless of
your status. Most suppliers offer a choice of programs
ranging from HMO to PPO. What may seem to be the best deal
may not be so at all because of length of time to coverage.
BE ABSOLUTELY CLEAR ON THE PRE-EXISTING CLAUSES. Even if you
consider yourself healthy and not under treatment, if you
had a past work related physical or other physical and a
condition was noted as detected.. but you felt it was not
worth pursuing treatment for, and in fact, you are not
having a treatment or medication… if it’s on the record
SOMEwhere and you subsequently have a claim… if it’s
related to the diagnosis, not only could that claim be
denied, but your entire policy voided under the provisions
of fraudulent application if you did NOT state a pre-
existing condition.
Yes, insurance companies want your money and to have you as
a client, but they are there as profit makers first, and if
they can find a way to NOT pay you that they are legally
entitled to… you won’t get a claim paid. You MUST have
everything in writing including any exceptions to a
precondition. Better to be turned down up front than
canceled when you need them.
Lastly, if you can not get or pay for insurance, but have a
family with minor children: Many states have programs that
will insure your minor children at no or nominal fees. These
state programs will not necessarily seek you out and sign
you up.. you need to do your research. Do not hesitate to
call your county health association or your state insurance
commissioner. Someone will know.
We hope that this article, and the fact you probably found
it on the Internet will help. Be sure and use Internet tools
and search engines and you’ll probably find more resources
than you ever thought existed. Search terms such as
“discounted medical insurance” or disease/condition specific
insurance will yield results. don’t spend another day
unprotected.
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