Paid Health Benefits

What Is The Individual Health Insurance

What Is The Individual Health Insurance

Individual Health Insurance is any individual health care plan that is purchased from health insurance providers by a sole client. This client, by purchasing an individual health insurance plan, does so at the risk of higher costs and higher deductibles. Approximately nine percent of United States citizens have purchased individual health insurance plans. 

 

Individual health insurance plans place the full cost of coverage and benefits on the purchaser. These costs are affected by the age of the purchaser and any pre-existing medical conditions. Pre-existing medical conditions are defined as any medical ailment or disability that presents at least six months prior to receiving coverage. Costs are also affected by the level of coverage chosen and what benefits a customer wants from the health insurance provider.

Some states allow the health insurance providers to underwrite their individual health care plans and this can also affect individual health insurance premiums. If the purchaser is self-employed, he or she can receive tax deductions based on their level of health insurance coverage in addition to other tax reductions. However, the majority of individual health insurance plans that are purchased are done so because employers may not offer a health benefits package.

In addition to higher cost, there are other risks associated with purchasing an individual health insurance plan. One major risk is that the person attempting to purchase insurance may be considered uninsurable by the health care provider when simply seeking out an individual health insurance plan. Another risk is having a pre-existing condition. The degree, or severity, of the condition may also deem a person uninsurable because of costs to be attributed to the health insurance provider from hospital care and medical treatments. 

Another risk to people with individual health insurance plans is losing that coverage. This may be due to changes in the economy, the state of the person's health, or policy changes issued by the health care provider. The primary benefit associated with purchasing an individual health care plan is better coverage. Individual coverage, when juxtaposed with group coverage, provides the insured person with a better standard of care and is less likely to be dropped by the insured. The higher premiums provide these benefits.

Regulation for health care providers and individual health care plans is administered by the state in which the individual resides. These regulations have been standardized by the National Association of Insurance Commissioners (NAIC). Health insurance providers also receive less stringent federal regulations due to the McCarran-Ferguson Act of 1945. This act also limits the affect of antitrust laws on insurance companies.

Examples of two regulations administered by the NAIC are the Unfair Trade Practices Act and the Accident and Sickness Insurance Minimum Standards Model Act. States may choose to enact or decline these regulations as they see fit.

Easy to Understand Group Health Plans

Easy to Understand Group Health Plans

Group Health Plans are insurance plans that are provided
by an organization for multiple people. These plans are traditionally more cost
effective for those in the group and provide an array of benefits for said
group. Many health insurance providers prescribe these plans because there less
risks associated for the company or organization purchasing the group health
plan. 

The most common purchasers of group health plans are
employers. These plans ensure that workers remain healthy and can continue to
perform their assigned tasks while also giving an incentive to the employee to
remain with that employer. Other organizations may also purchase group health
plans such as unions, fraternities and sororities, and other social groups.
When employers, such as a company, provide a group health plan to their employees,
the employers and employees often share the cost of the health premiums. Group
health plans also provide those employees, or group members, with tax
exemptions. 

The benefits attributed to group health plans relate to
cost and acceptance for coverage. If an employer purchases a group health plan,
the insurance company must cover all employees based on their employment
qualification. This is known a “guaranteed policy”. These plans also
have rates that cost much less for each group member than if that member had
purchased health coverage on their own.

Also, an employee that has a
pre-existing medical condition is more likely to receive coverage under a group
health plan. Pre-existing medical conditions are defined as any medical ailment
or disability that presents at least six months prior to receiving coverage.
However, some plans have provisions regarding pre-existing conditions that may
delay, or deny, coverage for a period time.

The typical period of delayed
coverage is anywhere from six months to a year. Another benefit of group health
plans is that they are typically not underwritten by insurance companies as
with individual health plans. Underwritten policies may affect an individual,
but group health plans prevent this by encompassing larger number of people in
different conditions of health.


Group health plans are regulated on state and federal levels. However, due to
legislation such as the McCarran-Ferguson Act of 1945, federal strictures on
insurance companies are less stringent. On the state level, the state
government can choose accept or reject federal regulations as listed by the
National Association of Insurance Commissioners (NAIC).

While regulations
exist, they do not affect insurance companies and policies unless they are
accepted by that state. Some states also consider the self-employed as a
“group of one” and allow them to purchase a group health plan at a
reduced rate under guaranteed policy.

Depending on the size of the group, additional benefits
can be negotiated for by that group at cheaper rates. In smaller groups,
benefits become more costly if an employee falls ill or is injured. This is due
to the rates lying more heavily on each person in that group.

On average, 60 percent of United
States citizens, that are employed, receive health coverage under a group
health plan through an employer.

Understanding Elder Health Benefits

Understanding Elder Health Benefits

The majority of health insurance for seniors, and the rest of the United States, is provided through private health care companies. These companies operate by drafting policies to provide coverage for normal health care needs based on price and services rendered. Health insurance and health care in the United States rank at number 37 on the World Health Organization’s 2000 report on the state of international health care.
Many senior citizens who are employed receive senior health insurance through their employer. In this way, the employee pays a portion of the health care costs while the employer pays the other portion. Private health insurance providers that offer policies to employers, through guaranteed issue regulations, must accept all employees under the policy regardless of age and medical condition simply based on their employment status. Furthermore, those employees receiving health care benefits through their employer receive those benefits at a far lower rate compared to people who purchase their own policies.
However, there are health insurance companies that will provide health insurance for seniors and their needs. This coverage extends to hospital stays, outpatient care, nursing homes and prescription medications. These senior health insurance policies, through private companies, are offered at affordable rates for the elderly regardless of whether they are working or in retirement. The coverage provided varies based on the policy chosen, payment rate, and the medical services utilized. For example, a policy may specify that the provider will pay for up to 3 days of overnight hospital care. This means that if the stay extends beyond that period, the beneficiary of senior health insurance must pay those expenses out of pocket. In addition to the primary health insurance for seniors that can be purchased, there are 
The first formal health insurance plan was created in 1929 in Dallas, Texas. Contracts were established with a local hospital to cover rooms, fees and procedures at a monthly rate. A few years later, health insurance companies cropped up offering plans for coverage based on the original plans created by a group of teachers in Dallas. The early forms of employer provided health care benefits began in the 1940s. Health insurance for senior citizens has evolved and expanded from those early efforts to provide affordable health care coverage.

Understanding Paid Health Insurance Benefits

Understanding Paid Health Insurance Benefits

Paid health insurance benefits in the United States are provided through private health care companies. These companies offer policies that are categorized by payment premiums, coverage limitations, and policy benefits. These policies may be provided and underwritten through provisions established by the insurance company.

Underwritten policies may restrict certain applicants or increase rates due to certain medical procedures. Overall, health insurance policies are intended to subsidize the cost of hospital visits, outpatient clinics, The majority of paid health insurance policies are distributed through employers that have contracts with health care providers.

This accounts for approximately 60 percent of the insured populace of the United States. Additionally the rates of paid health insurance policies continue to rise because of new treatments, more people seeking insurance, and other factors that health insurance companies view as potential risks.

Background

Health insurance policies were first drafted in the late 1920s. From these early beginnings, many private health insurance companies have been established and provide a variety of policies for United States citizens. Privatized health insurance began with the dawn of health insurance companies in the 1930s.

The popularity of health insurance led to the drafting of individual policies and group policies. In regard to senior citizens (citizens aged 65 or older), specialized policies exist to cover the cost of prescription medications and treatments at rates that are affordable for the retired.

Additionally, the United States government has created legislation to ensure that more American citizens can receive health coverage. Other legislation has been established to protect medical information and regulate how that information is tracked and transmitted.

Individual Health Insurance Group Health Plans

Group health plans, policies which cover a 3 or more people, are the most widely subscribed from of health insurance in the United States. Group policies are often provided through employers, fraternal organizations and other groups. These policies provide health coverage at a certain premium to be shared by those it covers. Through employers, employees pay a certain percentage while the employer incurs the majority of the cost. The primary benefit of group plans are a “guaranteed issue” policy.

This means that, for example, an employee will receive health coverage simply on the basis by being employed by a company that gives health benefits to its workers. Health insurance are often unable to underwrite these policies, nor can they refuse a group policy member due to a pre-existing medical condition.

Tax exemptions are also available to organizations with group health plans to help ease the financial weight of having a health care plan.

HMO Plans

Health maintenance organizations, or HMOs, offer health coverage plans through a network of hospitals and physicians. The HMO designates primary care facilities and doctors for its beneficiaries to receive medical care given their location and policy.

This is done through contracts with hospitals and/or private practices that agree to provide care for HMO beneficiaries. Most HMOs operate through a network of facilities. These facilities, if developed by the HMO, will only accept HMO beneficiaries. However, if private practices are contracted, the practice admits HMO policy holders in addition to its regular patients. 

HMOs are regulated on state and federal levels through various mandates and legislation to standardize policies and operations.

Other Managed Care

Managed care, or care provided through a managed care organization (MCO), is offered through plans that specify techniques and practices to be used by health care providers. Managed care was ushered in by the Nixon administration to help reduce health care costs and increase the quality of care received. MCOs function by establishing networks of physicians and medical centers that will follow the techniques and initiatives of care for MCO beneficiaries. Examples of MCOs include HMOs, PPOs and IPAs. 

HMOs are health maintenance organizations that contract medical facilities and practices to provide care for their beneficiaries. PPOs are preferred provider organizations that will cover the cost of medical treatment after the beneficiary has paid a deductible against the cost of care. This is the most widely used form of managed care in the United States. IPAs are independent practice associations which provide care for both managed care beneficiaries and private patients. IPAs establish contracts through MCOs and private practices. 

Managed care is often debated due to the level of care provided and the rates that beneficiaries and medical practices incur by participating in these programs.

Supplemental Health Insurance

Other forms of supplemental health coverage are plans that cover specific illnesses or disabilities, prescription medications, and accidental death or dismemberment. These policies are specific to the beneficiary and their needs, but they must be available through their chosen insurance provider. The government funded  Consolidated Omnibus Budget Reconciliation Act

The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA as it is commonly known, ensures that United States citizens that leave employment may still receive health coverage through an employer. This legislation, along with other government regulations, mandates that employers amend their group health plans to extend coverage beyond the period of termination.

Despite amended health plans, COBRA beneficiaries must be eligible through an evaluation of the events that caused the termination of employment. Non-voluntary termination is the most common reason for an applicant seeking COBRA benefits.

COBRA benefits are not intended to be permanent. Most plans only last for approximately a year as beneficiaries are expected to find new employment and/or a new insurance policy. COBRA beneficiaries must pay insurance premiums just as with any other private insurance policy to receive coverage. In 2009, the Obama administration passed the American Recovery and Reinvestment Act (ARRA) to help subsidize the cost of coverage for COBRA beneficiaries. The effects of this act are currently scheduled to end in June of 2010.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created to protect privileged medical information and safeguard its transmission. HIPAA is responsible for closing gaps in insurance coverage and developing new methods of standardizing health care plans and how they are identified.

This is through Titles I and II of HIPAA legislation. Title I regulates primary health plans to reduce limitations that can be placed on insurance beneficiaries through policy underwriting. Title I also prevents policy holders from being affected by hidden exclusions in insurance policies.

Title II is responsible to establishing safeguards for medical information and regulating the electronic systems by which that information is saved and transmitted. Title II also created fines and penalties for those that commit fraud or abuse medical information. Investigators of health fraud must abide by regulations listed in Title II of HIPAA.

Guide to Supplemental Health Insurance

Guide to Supplemental Health Insurance

Supplemental health insurance are additional benefits plans offered by health care providers to cover services and needs of beneficiaries not covered in their primary health insurance plan. This supplemental insurance can reduce the cost of medical care for the beneficiary and extend coverage to the family of a beneficiary. Many people with supplemental health insurance have it as a precaution in case of a potential need. 

The most common supplemental insurance plans purchased are Dental and Vision care. Dental care covers the cost of visits to dentists and orthodontists. While the insured must pay a small co-payment fee, the insurance company pays for the majority of services rendered. Vision care covers the costs of visits to optometrists and opthamologists.

This care is meant for eye examinations and, depending on the supplemental health plan purchased, Vision care may also cover the cost of glasses and contact lenses. Dental and Vision care are provided under supplemental health insurance plans because health insurance providers do not consider these services to fall under the umbrella of primary health care. 

Other supplemental insurance plans available can cover specific illnesses. A patient can purchase insurance to cover forms of cancer, HIV/AIDS, Alzheimer’s disease, and Parkinson’s disease among other ailments. Supplemental insurance can also be provided for being blind and/or deaf. This insurance can be used to pay for hospital stays, treatments, medical equipment or loss of income because of the medical condition.

Another form of supplemental insurance is hospital indemnity insurance. While the insured is receiving hospital care, this insurance can cover out-of-pocket expenses as well as other hospital or wrongful death insurancegroup insurance plans The Medicare program also offers a form of supplemental insurance to its beneficiaries.

Medicare Supplemental Coverage, or Medigap, is available to subscribers enrolled in both Part A and Part B of the Medicare program to be eligible. Medigap offers 12 plans which are provided by private insurance providers, not through government funding. Care and coverage received under Medigap is proportionate to the premium being paid by the beneficiary. Despite being offered by private insurance companies, Medigap regulations are standardized through the federal Center for Medicare and Medicaid Services (CMS).

If the beneficiary already has Medicare coverage, Medigap supplemental health insurance plans may be bought, with no health inquiries made, under guaranteed issue policy.

Consolidated Omnibus Budget Reconciliation Act

Consolidated Omnibus Budget Reconciliation Act

The Consolidate Omnibus Budget Reconciliation Act of 1985, or COBRA, is a bill passed under the Reagan administration to provide insurance for United States citizens after leaving employment. Although the bill was officially passed in 1986, it is still referred to as the COBRA act of 1985. This includes employees that have been terminated from employment, have changed employers, or have become disabled.

COBRA insurance benefits may also be applied to the immediate family of the employee receiving those benefits. COBRA requires employees coverage to be extended to employees, their spouse and dependent children after having left employment due to certain circumstances. It also applies to a majority of federal health plans

         Inpatient hospital care;

         Outpatient hospital care;

         Surgery;

         Prescription drugs;

         Dental care;

         and Vision care.

Health care provided under the Consolidated Omnibus Budget Reconciliation Act is not designed to be permanent. Benefits may last for a period of 18 months up to a total of 36 months. The family of COBRA beneficiaries may receive benefits for period of time up to 36 months. This includes dependent children, children older than the age of dependency but have a disability, and spouses (married, divorced or widowed).

During the period of coverage, beneficiaries may be required to pay a rate of coverage totaling their original payments, the payments of the employer, and an additional 2 percent for administration costs. Rates may also increase if the health plan’s rate increases. However, COBRA rates are generally set in advance for a period of a year. Payments can be made monthly, quarterly or weekly. If a beneficiary is unable to make their payments after a certain period of time, that beneficiary will lose COBRA benefits.

COBRA insurance benefits can be in conjunction with other health care providers, such as The other coverage is required by COBRA or was received prior to COBRA benefits;

         or, the other coverage is being received due to a pre-existing medical condition.

In 2009, the American Recovery and Reinvestment Act (ARRA) made it possible for the cost of COBRA insurance benefits to be subsidized for a period of 9 to 15 months. The subsidy rate may be up to 65 percent of the cost of benefits. The ARRA only applies to employees that were victims of involuntary termination. ARRA was designed to end on December 31, 2009, but was later extended to end on March 31, 2010. Under the Continuing Extension Act, ARRA subsidized rates continue through June 2, 2010.

Health Insurance Portability and Accountability Act

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act of 1996, or HIPAA as it is commonly known, is a bill that was passed by Congress to protect medical insurance for employees. This protection also extends to the employee’s family even if that employee should change jobs or is terminated from employment. HIPAA also ensures that an employee’s health coverage is transferable and can be continued regardless of employer. 

The Health Insurance Portability and Accountability Act is broken down into two sections, Title I and Title II. Title I of HIPAA modifies both the Employee Retirement Income Security Act (ERISA) and the Public Health Service Act. In this way, it ensures that regulations are applied to group and individual health plans to those with insurance and those seeking it.

Title I also reduces periods of restrictions imposed by insurance companies on insurance applicants. For example, if someone goes for a period of time without insurance, experiences a break in coverage (minimum of 63 days), or has a pre-existing medical condition, the insurance company may accept the applicant but decline providing coverage for a period of time. The Health Insurance Portability and Accountability Act helps to reduce that restrictive period for applicants and amends health plans that would potentially decline someone with a pre-existing medical condition.

A pre-existing medical condition is any ailment or disability that presents at least six months prior to seeking health care benefits. The scope of Title I regulations does not apply to all health care plans. Supplemental health insurance plans such as Vision and Dental are exempt as they are not an integral part of the primary insurance policy; however, if they are included in the primary policy then HIPAA regulations do apply. 

Title I under the Health Insurance Portability and Accountability Act also invalidates any hidden, or uniformed, exclusion periods in health insurance plans in order to protect beneficiaries. 

Title II of outlines what constitutes health care fraud and the associated penalties. This is to protect medical information and create initiatives to prevent cases of health care fraud from happening. Along with the Department of Health and Human Services (HHS), HIPAA creates regulations and objectives to standardize health care and how medical information is to be saved and transmitted. The five main tenets of Title II are the Privacy rule, the Transactions and Code Sets rule, the Security rule, the Unique Identifiers rule, and the Enforcement rule. These rules have been established to safeguard medical information and how it is tracked.  

         The Privacy rule ensures that only certain medical information can be disclosed by specified persons. 

         The Transactions and Code Sets rule establishes numeric codes for electronic claims filed by the insurance company. 

         The Security rule establishes safeguards for personnel and electronic systems to coincide with HIPAA regulations. 

         The Unique Identifiers rule establishes specific acronyms and coded identifiers for insurance providers to determine health care providers and their plans. 

         The Enforcement rule establishes fines and penalties for those that violate HIPAA regulations in addition to creating guidelines for those investigating health care fraud.

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