GARYANDLANA

Is there such a thing as cheap health insurance? It hardly seems possible when you look at the rise in hospital costs and physician services. Insurance companies have the task of underwriting the medical risk for insurance. The insurer then issues and delivers the policy to the insured once they are accepted into the plan. The policyholders then receive the policy declaration pages that list all of the benefits and features.

What are those benefits and features? How do they work after a hospital stay? When you begin to find the answers to those questions then you begin to understand what makes up the total premium. When you receive your first benefit statement after a hospital stay then you will begin to understand how the deductible is applied and how the coinsurance works.

Simple claims analysis

1. Total inpatient expense for 4 days in the hospital including physician services amounts to $4000.

2. Your policy has a $500 deductible with an 80/20 coinsurance clause with a maximum out of pocket $2000.

3. You must pay the first $500 for your stay leaving a balance of $3500.

4. You will pay 20% of that $3500 or $700 and the insurance company will pay $2800.

When your 20% reaches $2000 then the insurance company pays 100% of the remaining costs up to a million dollars (or 2 million etc).
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Health insurance- whether provided by your employer or purchased by you-can be both expensive and complex. To better understand your options and control your health insurance costs, consider these tips and suggestions from the National Association of Insurance Commissioners (NAIC), a voluntary organization of state insurance regulatory officials:

Know Your Options

• Married couples in situations where both spouses are offered health insurance through their jobs should compare the coverage and costs (premiums, co-pays and deductibles) to determine which policy is best for the family.

• Always stay in-network when possible, making sure to get referrals and pre-certifications as required by your plan.

• Keep all receipts for medical services, whether in- or out-of-network. In the event you exceed your deductible, you may qualify to take a tax deduction for out-of-pocket medical bills.

• Consider opening a Flexible Spending Account (FSA), if your employer offers one, which allows you to set aside pretax dollars for out-of-pocket medical expenses.

• If you lose or change jobs, be aware of your rights to continue your group health coverage from your old employer for up to 18 months (though you have to pay the premiums), as provided under COBRA (the Consolidated Omnibus Budget Reconciliation Act).

Health Insurance Tips for

Different Life Stages

The NAIC’s consumer Web site, Insure U, (www.InsureUonline. org), explains the different types of health insurance and gives focused tips to consumers based on their likely needs in different life stages. For example:
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