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Health Insurance Points

This comprehensive guide covers the essential points related to health insurance, including the selection of a reputable company, choice of coverage, why insurance is necessary, familiarization with key aspects, dollar awareness, sources for coverage, likely coverage options today, accessability, alternative physicians, and detailed coverage components. It also addresses requirements for a second opinion, appeal procedures, pricing, plan components, coverage scope, and terms. The guide provides insights into cancellation, continuation of group coverage, rehabilitation coverage, pre-existing conditions, pregnancy/abortion coverage, mental illness, and various aspects of insurance terms and cost containment.

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Health Insurance Points

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  1. Health Insurance Points PERSONAL FINANCIAL PLANNING Dr. AA Neidermeyer

  2. SELECTION OF A COMPANY • Should have been in business > 25 years • Should receive > $50 million in premiums annually

  3. CHOICE OF COVERAGE • Freedom of selection of care givers • Reimbursement if care outside of network • Type of coverage you/your family requires

  4. INSURANCE NECESSARY • Because 60% of diagnosed illnesses result from • Smoking • Alcohol • Drugs • Improper diet • Inadequate sleep / exercise

  5. FAMILIARIZATION • Selection of a primary care physician • Learning the ropes: accessing • Interfacing with the appeal process

  6. DOLLAR AWARENESS • Deductibles • Coinsurance amounts • Internal limits of the policy • Coordination clause

  7. Sources for Coverage • Employer • Workers’ Compensation • Automobile Medical • Veterans’ Benefits • Individually-purchased • Social Security

  8. Today’s Likely Coverage • HMO • PPO • EPO • POS

  9. Accessability Convenient Hours Alternative Physicians Requirements for a Second Opinion Scope of Coverage(s) Appeal Procedures Pricing Plan Components

  10. Plan Coverages • Physician Charges • Surgeon Fees • Hospital/Clinic Charges • Dental Fees • Vision

  11. Persons and Places Cancellation Continuation of Group Coverage Rehabilitation Coverage Pre-existing Conditions Pregnancy/Abortion Coverage Mental Illness Terms of Coverage

  12. Pre-admission certification Continued stay review Inside/Outside aggregate limits Reasonable, customary Charges Maximum limits: per cause, per calendar year or lifetime Stop-loss provision Cost Containment Steps

  13. Minimum Coverage • Hospital/Physician uniform customary charges • Hospital inpatient charges for 120 days • $250,000 lifetime maximum per family member

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