Don’t we all have some pre-existing condition? To quote from an unknown author, “No one is prefect…that’s why pencils have erasers.”So what is a pre-existing condition?Imagine you contact a car insurance agent on a Monday morning to tell him you need car insurance to pay for repairs on your car that is currently in the shop being fixed because of an accident you had on Friday night. Your agent tells you that he would be happy to help you take out car insurance for future accidents–after the vehicle is fixed and drivable. Even car insurance companies look at pre-existing conditions as a huge concern. Why? Simply put–we all “follow the money.”Think about it, if insurance companies would cover all pre-existing conditions, then we would not purchase car insurance, homeowners insurance, life insurance, health insurance, or any other type of insurance until we “needed it.” By the time of our accident, it is too late to purchase insurance.A pre-existing condition then is exactly what it sounds like. In the case of health insurance, it is a health condition which the person already has when applying for health insurance. Whether it has been diagnosed by a doctor or known only by you, whether it is untreated, being treated or under control…. It is all the same.Here’s where we need to be reminded of what insurance actually is and does for us: (1) “A contract whereby an insurer promises to pay the insured a sum of money or some other benefit upon the happening of one or more uncertain events in exchange for the payment of a premium. There must be uncertainty as to whether the relevant event(s) may happen at all or, if they will occur (e.g., death) as to their timing.”(2) “A system to protect persons, groups, or businesses against the risks of financial loss by transferring the risks to a large group who agree to share the financial losses in exchange for premium payments.”So who is the authority on whether or not we have a pre-existing condition?Easy–medical doctors! Every time your medical doctor writes information on your medical chart, that becomes “gospel,” and only that doctor or another doctor can change it. So it is vital to get copies of all your medical information when you visit your doctor. You need to read over them and file them away for future needs. If you have taken prescriptions for medical reasons, than those medical issues can also be classified as pre-existing conditions.How can I keep pre-existing issues at a minimum when purchasing health insurance?(1) Buy group insurance through your employer, because most of the time pre-existing conditions are not an issue. But this will make your group insurance more expensive.(2) Purchase a strong “top of the line” individual insurance plan. Good insurance companies will have solid plans where you will not need to be changing every year or so for another plan. It is important to stick with one insurance plan for five to six years, and then research other options to see if you can find a better plan for a lower premium.(3) Purchase health insurance when you are young, before you get a debilitating pre-existing condition. If you are a parent reading this, please help your adult children (ones that are no longer under your health insurance) get affordable health insurance. Remember, the higher the deductible, the lower the premium.(4) Negotiate with the insurance company. They may reject you for health coverage, but then they may not. You may have to pay higher premiums, or you may have to “waive” away your right to be treated for the pre-ex, while still getting health coverage for everything else. Remember, some health insurance is better than no health insurance.As an insurance agent/broker, I hope that our government will eradicate pre-existing conditions on all individual and group health insurance plans. Yes, we realize the premiums will increase a bit because of that; but if we force everyone to have health insurance, than it can help keep health insurance premiums lower. The more people insured means the risk is shared across the board– which helps keep the premiums lower.So the good news is that we have choices to fit our individual needs. So to keep pre-existing insurance issues at bay, purchase a good solid insurance plan before medical problems happen to you.
Buying individual health insurance and what you need to know. With all the technology and the internet it has never been easier to buy individual health insurance. There are hundreds of places where you can get coverage for yourself or for your family. There are three ways how you can purchase individual health coverage. You can get it through health insurance broker, directly through medical insurance company and through one of the online websites. One thing to keep in mind is that you cannot find a better deal buying individual health insurance through insurance company directly. No matter where you apply for you plan you will pay the exactly the same price for the same plan. Health care is regulated by Health Insurance Commissioner in every state. Each medical insurance company files with Commissioner every plan that they offer with explanation of benefits and how much that plan cost for every age of the person and every zip code. Medical Insurance Companies are strictly regulated by the commissioner, some people might say not enough and some might say that they are regulated to much. It is all the matter of personal opinion.One of the best ways to be buying individual health insurance is through a broker, preferably trusted broker, the one that has been around for a while. Keep in mind that you never pay the broker, in fact it is illegal for health insurance broker to accept any kind of compensation. The reason that you want to be buying individual health insurance through the broker is that a good broker know what are the best plans available for your situation in your state and that are in your budget. Having a good broker by your side comes in handy when you might have a claim issue or you would like to change your plans. In most cases broker can take care of that for you and it is always free to you. You would not have to call the insurance company and sit on hold for hours and get transfer to different places. One phone call to your broker and he or she will take care of you. It is like having attorney by your side that represents you to the insurance company and best of all it is one hundred percent free to you.The second way to be buying individual health insurance is through online website. It is extremely fast convenient and a lot of the website online are insurance brokers or agencies. That means you will still have some one on your side when it comes to dealing with the insurance company. Some of the website have a large staff of people working for them that are there to assist you with any questions that you might have. There is another great benefit to work with agency or broker is that they represent multiple if not all the medical insurance companies in your state. They would know what is the best solution for you. One thing to look out for is that there are a lot of medical insurance website that collect your information and sell it to many places. The problem with that is you will get a barrage of phone calls and emails. There is really no solid way of finding that out. I will make some suggestions at the bottom of where you can get some quotes, compare plans, buying individual health insurance and no one is going to call you. In fact you do not even have to give out any of your information other than your zip code and age.Our last option is to go through insurance company directly. You do have that option if that is what you want to do. If you know what you want and you think you can handle this on your own then buying individual health insurance directly might be the way to go. If this is your option make sure that when you are applying for health coverage directly that you are actually applying directly with insurance company. There are a lot of websites that look like official insurance company website but they are not. They are perfectly legal and strictly regulated and constantly revived by insurance companies’ compliance departments. The owners of those website definitely do not want to deal with lawyers from the insurance company. Now you have the general idea in buying individual health insurance.
The much-maligned health insurance industry has not always deserved the contempt it receives. These companies are usually accused of caring only for profits, but those profits are not as great as most of us imagine. There is room for some improvement in the industry, but such improvements will not reduce health costs significantly. A clear understanding of your policy will go far to reduce the hostility many feel towards this essential industry.Most commercial health insurance companies have three objectives: collect dollars from premiums, pay off overhead with what’s collected, pay off claims, and have about 3 to 6 percent of the total collected remaining as net profit. This profit goal is relatively modest. Americans pay $2 trillion dollars a year on health care, including the operating costs and profits of health insurance companies. This averages out to approximately $6,551 for each man, woman and child in the United states, or approximately $537 a month. At a 6 percent profit, the industry is earning $120 billion a year. This averages out to $387 a year, or $310 million in total from what Americans pay towards the insurance companies’ profits, or $32 a month. A mere 5 percent of what you pay each month for health insurance goes to the profits of the insurer. You pay that percentage to a taxi cab driver as a tip. Obviously, the health insurance companies are not charging their customers an excessive percent of the total for health insurance. Yes, they are in it for the money, but they’re not gouging us.All organizations have some leakage of cash, and the health insurance industry is no exception. Their organizations spend a great deal on administrative costs, streamlining their operations, and increasing efficiency of operations. All this may go to reduce their operating expense and thus, the cost of insurance for us, but we can’t expect significant savings here.Yet the new Health Reform law is requiring health insurance companies to spend 80 percent of those $2 trillion on medical treatments. That means they’ll have $400 billion left over. Subtracting their profits ($120 billion), they’ll have $280 billion to cover overhead. If they are able to reduce operation costs by just 1 percent, or $2.8 billion, and turn that into premium reductions, the $537 each person now pays is then reduced to $528, a savings of $9 a month or a savings of $108 a year. Although every penny counts these days, these numbers aren’t too significant to most of us.Health insurance companies have been mandated by the new Health Reform Law to modify some of their policies, which may raise the cost of insurance. They are now prohibited from dropping people from insurance while they are sick. Now, they cannot deny coverage to children with pre-existing conditions. They can no longer impose a cap on the amount they will pay during a person’s lifetime. In 2011 they have to start paying 80 percent of their earnings towards medical treatment. In 2014 they can no longer refuse to sell policies to anyone, with or without a pre-existing condition, and the price they set for policies can’t be based on the customer’s health condition. So, by 2014, no one will be excluded from obtaining health insurance in the United States.These measures, particularly the provision that doesn’t allow insurance companies to deny insurance based on a person’s health status, will go a very long way in reducing our overall health care costs. With universal coverage, many illnesses can be cured in their early stages, thus avoiding the most expensive treatments, those in the emergency room.All of us should pursue a clearer understanding of the purpose of health insurance companies. They are not humanitarian, non-profit organizations, but businesses with the objective of making a profit. Much of the misunderstanding is fostered when an ailing patient is told by the insurer that their medical requirements are not covered by their policy. It is therefore absolutely imperative that you’re clear about what your policy will cover before you enter into an agreement for coverage. Nobody likes to spend money needlessly, but when it comes to spending money on your health, without an insurance company, you could do worse. Know your policy and expect health insurance companies to strictly abide by it. Whether we like it or not, we can’t do without them, and they can’t do without us. You’ll appreciate them most when that $13 thousand dollar bill comes in following a brief visit to the emergency room, and you don’t have to pay a dime. Then spend or save that $13 thousand for your future needs, such as college or retirement!