Should we avail Health Insurance Facility?

• If you have a lot of resources then it is a good for you to get a comprehensive individual health insurance plan that includes everything from a small deductible for hospital visits to full dental and vision coverage.

• But If you are on a very tight budget, then you should consider getting a smaller plan. If you don’t have any dependents and don’t need to make regular hospital visits for any reason, consider whether you really need a full health insurance plan that gives you complete coverage. Paying more than you need for health insurance can be a heavy financial burden, so it is worth thinking creatively and realistically about what you really need and if it is possible to get the care you require without shelling out a large monthly payment to a health insurance provider.

• Many people find that through a combination of free clinics and minimal health insurance coverage, they are able to get by spending much less money than they would pay for comprehensive health insurance. It is still a smart idea to have coverage that will help alleviate the financial burden if you suddenly develop a condition or meet with an injury that requires emergency care. However, it is a good idea to look into what kinds of plans are available, as one of the many plans designed specifically to give you emergency coverage may be a much better choice than a plan that will leave you generally well insured.

• It is never a good idea to gamble with your health care, so make sure that you if don’t opt for the maximum amount of insurance that you can afford, that you have a plan for how to meet any medical expenses that may arise. Think about other ways that you can designate money for your health care needs, such as starting a savings account where you store away the money you would be paying for insurance every month. This will help you make sure that you are prepared for anything. Don’t forgo coverage entirely though. At the very least purchase a high deductible plan that will cover you in the case of a serious illness or injury. Otherwise one serious illness or injury could wipe you out financially. Many people think the best way to get health insurance coverage is simply to get the most complete coverage one can afford. This is, to some extent true, and if you have a lot of liquid resources it is a good idea to get a comprehensive individual health insurance plan that includes everything from a small deductible for hospital visits to full dental and vision coverage. However, if you are on a very tight budget, you may want to consider getting a smaller plan than you can afford and paying for some of your medical expenses out of pocket.

• Many people find that through a combination of free clinics and minimal health insurance coverage, they are able to get by spending much less money than they would pay for comprehensive health insurance. It is still a smart idea to have coverage that will help alleviate the financial burden if you suddenly develop a condition or meet with an injury that requires emergency care. However, it is a good idea to look into what kinds of plans are available, as one of the many plans designed specifically to give you emergency coverage may be a much better choice than a plan that will leave you generally well insured

Individual Health and Group Insurance

In Case Of Group Plans:

If you’re going to buy health insurance, you will see a lot of health plans and insurance companies are available in the market. As part of a group plan, you can enjoy a significant discount on premiums as well as comprehensive policies.

In Case Of Individual Plans:

You can also buy individual policy that will also cover your whole family.
There is no guarantee that an insurer will take you on. Individual plans are medically underwritten and the insurer may reject your application or attach exclusions to your policy if you have health problems. However, some states don't allow this practice and require that any insurer selling individual health plans must offer you a policy, no matter what medical problems you have.
However, your premiums are still likely to be substantially higher. People enrolled in individual plans pay premiums more in line with their expected health costs, so the premiums will be higher for those who are older or less healthy. To find out what your rights are, contact your state insurance department. You can find the contact information by selecting the state in which you live from the pull-down menu at the top of this page.
Crunching the numbers
Pricing is probably the most bewildering aspect of individual health policies, so it's worth your while to shop around. For instance, the premiums for similar products from different insurers can vary by as much as 50 percent for the same person. What's more, the rules and regulations about individual health insurance vary from state to state, making comparison-shopping difficult for the consumer.
If you're faced with finding individual insurance, don't let the confusion tempt you to go without. Even if you're healthy, you could fall off a ladder or have a serious car accident and be financially ruined. Plus, you'll lose your pre-existing-conditions coverage in most states if you go without insurance for more than 63 days.
Finding the right balance of coverage and cost can be challenging, but it's a necessity. So take your search one step at a time. The first step is to evaluate your needs and understand your health insurance options. For some, that may mean buying COBRA coverage from their former employer

History About Health&Group Insurance

Health insurance:

It Started in 1930 in America provided by employer first.This was was originated by Blue Cross Hospital.Then H.J. Kaiser offered prepaid group health insurance plan to employees of his construction company.


Group insurance:

Term used as the combination of the pool of people who are healthy and adds few who require costly medical aid. Thus pool of large number accounts for balancing the expenditure of few people, who actually need them. This phenomenon makes group insurance viable and beneficial for both employer as well as employees. Health insurance through employer also provides significant tax benefits to both.In health insurance plans provided by employer where total premium is borne by him is generally cheaper, compared to plans if purchased by employee himself.
This plan has many disadvantages workers are unable to pay their portion of premium for policies provided by their employers. In case of lay-off or relinquishing service means loosing health coverage for self and family. Circumstances like change in type of job retirement or divorce can lead to cut in the group health insurance sponsored by employer.

Group Insurance

Health insurance is purchased for self & family members, termed as individual health insurance policies or group health insurance policies, mostly provided by employer to their employees.
health insurance is as below (based on US Census Bureau).
Group insurance In millions

Group Insurance In Million
Through employer 175
Individual/ Direct Purchase 27
Uninsured 44

Role of Health Insurance In OPD area

We all of us have gotten the awareness regarding the importance of health insurance it is very important and now it becomes our necessity to protect against huge medical expenditure.Medical technology become more advance now a days and quality of health care has been improved, but it has also resulted in increase in cost of medical care.Health insurance premium has increased much rapidly compared to increase in salary of workers.
There are about 1500 health maintenance organization and health care providers in America who fund all political parties heavily, which in turn keeps them much mum on health insurance reforms.









In OPD:
Charges / fees paid to Registered General Medical Practitioner,also may be included
Homeopath or Hakeem and specialist consultation.

Treatment,Medicine and surgical dressings
physiotherapy and acupuncture.
Laboratory and X-ray examinations, ECG, EEG, EMG,ULTRASOUND
and other diagnostic tests.
Dental Treatment.

What can be Covered

In Health Insurance: It depends upon the policy of the Insurance Company; these may also vary company by company. But Standers are the following.


HOSPITALIZATION EXPENSE BENEFIT
O.T. Charges, Consultation Fee, Nursing Charges etc.): It includes
Investigation and Medicines
Miscellaneous expenses

MATERNITY BENEFIT
Following benefits are payable under this cover: It covers many areas but these may be varying company to company policy.

DREAD DISEASE

Management of Acute Myocardial Infarction (Heart Attack)
Coronary Artery By-pass grafting and Coronary Angioplasties.
Management of all type of Malignancies (Cancer)
Cerebro Vascular Accidents (CVA- Stroke)
Management of Renal Failure (Kidney Failure)
Renal and other major organ transplants.
Major Burns.
Multiple Sclerosis.
Aids Complex.
Chronic Hepatitis “B” & “C”.

Who is Covered

Medical Insurance also called Group Hospitalization Policy which covers the following.


• Out patients (OPD),
• Hospitalization,
• Surgical treatment,
• Maternity,
• Dread Diseases & Specialized Investigations.


WHO IS "COVERED"?

Health Insurance is mainly provided at corporate sector and well renowned in the business sectors like Financial Institutions, NGO’s and Multinational Firms
.
Mainly All Categories of employees are covered up to the age of 60 years may be (Extendable under special circumstances).



It covers all the employees their Spouses and children.
Special modules are designed to cover dependent parents.
In case of female children, age relaxation is till the time they get married or employed.

What Is Health Insurance

Health insurance:
It is a great facility which is provided through government sponsored social insurance program or through private companies.
This facility can obtained by purchasing it on group basis or individually. Social welfare programs funded by the government also provide for medical expenses. Health insurance estimates the total risk of health care expenses and develops a finance structure, as monthly premium that assures that enough money is available for health care benefits. Central organization, either a government agency or private not for profit entity administers the benefit.
Finding affordable health insurance is not difficult as many companies offer health insurance plans within your budget and meet your requirements. Many companies take the responsibility of getting an affordable insurance and people who don’t want to get connected to a company can search on the Internet. Increasing the amount of health insurance deductible can lower your insurance rates. Cheap health insurance can be obtained in the following way. You can purchase a group health insurance plan without your employer. You wonder how you can purchase a group health insurance plan when you are not a group. There are following three options available.
Health maintenance organization and preferred provider organizations plans at affordable rates allow you to visit a network of doctors and other health care professionals. Group managed care is long term health insurance plan where you might find an association or club created for other self employed web designers offering cheap affordable health insurance in group managed care form to its members. Association groups are similar to employer sponsored group health insurance and group managed care that offer cheap affordable health insurance through an entity.
Online health insurance companies display their policies, overages and costs on their sites for consumers. You will be able to visit many companies online in a few hours and gather their information, ask for quotes, compare the results and purchase policy of your choice.
People who are either self employed or work for small companies opt for individual health insurance. It is difficult to get individual health insurance if you are above 50 years of age. You have to pass through a medical exam for individual health insurance. Types of individual health insurance are fee-for-service insurance, open enrollment managed care plans, handled care plans, and association based health insurance and high-risk pools.
Students are often believed that they do not need health insurance. There are a number of unpredictable events such as driving, sporting accidents and other accidents that make you regret if you don’t have health insurance. Students should make sure that you are neither underinsured nor uninsured to protect themselves from adverse circumstances.
Low cost health insurance can be achieved by following these easy steps:

Always purchase health insurance policy from licensed insurers to obtain protection against fraud.

Tell all about your medical history "Don’t lie about your medical condition" to get the low cost health insurance.

If one insurance company does not cover you, just move to the next as companies have different criteria for health insurance coverage. If you are not up to the standards of one company does not mean that you are not eligible for the other.

DENTAL “INSURANCE” IS REALLY DENTAL “FINANCIAL ASSISTANCE”

The concept of insurance is to provide the insured against catastrophic loss. Fire insurance or medical insurance will ideally pay for the complete loss of your home or quadruple heart bypass surgery. Dental insurance is not like that because it does not pay for a catastrophic loss. Instead, dental insurance plans have a very low annual maximum that really haven’t increased in the nearly 25 years I have practiced dentistry. Dental insurance will not even cover close to the cost of even one tooth needing root canal therapy and a crown in my office. So what is it? It is really financial assistance not
insurance.
Dental insurance plans, and particularly usage of dental benefits by employees, is very statistically predictable. Insurance companies can profit on the difference between premium dollars paid in and “dental loss”, dental claims paid out. It is a relatively inexpensive perk that can be offered to employees -- if the coverage is limited. That is why it is limited. The only situation where coverage may not have a maximum is within a DMO (dental maintenance organization) discussed elsewhere, because in this special case it is the dentist, not the insurance company, that has an interest in limiting the benefits provided.

ANNUAL MAXIMUM - LIFETIME MAXIMUM with a Dental Health Insurance Plan

Nearly all dental health insurance plans have an annual maximum benefit in contrast to medical insurance plans that do not. In addition some dental insurance plans may have a separate lifetime maximum specifically for orthodontics (braces). When an insured procedure is covered under a lifetime maximum it is not counted towards an annual maximum.
Dental health insurance plans have a low annual maximum (proportional to the potential cost of dentistry) that really haven’t increased in the nearly 25 years I have practiced dentistry. Regardless, a higher premium dental insurance policy will provide a higher annual maximum.

Tax Deductions For Medical and Dental Health Expenses

By Jay D. Edelman, CPA

he patient is entitled to an itemized deduction for medical and dental health expenses paid during the tax year, to the extent the expenses exceed 7.5% of adjusted gross income. If your medical and dental health expenses do exceed 7.5% of adjusted gross income, only the portion of the expenses that exceed the threshold will be deductible.
Proper planning and timing can help to increase your potential deduction: For example, if you know you must undergo a series of medical and/or dental procedures, by planning them, and paying for them, in a single tax year, you may incur enough expenses in that tax year to generate a tax deduction. On the other hand, by splitting the procedures between two years, you may be under the 7.5% threshold in both years, thereby forsaking valuable deductions.
Other planning opportunities may exist if your income fluctuates from year to year, or if you have some control your income. For example, can you delay a bonus from December 31 to January 1, keeping income lower in a year when you might have greater medical and dental expenses? The combination of lower income and higher medical expenses in a given year maximizes the tax deductibility of the expenses, saving you the greater amount of taxes.
Medical and dental health expenses include amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease. Other allowable expenses include such items as transportation to and from medical/dental appointments and the cost of eyeglasses. Medical and dental expenses paid on behalf of a spouse or dependent may also be included. Insurance premiums may also be included.

Flexible Spending Accounts (FSAs) –Medical Dental Health Savings Accounts (DSAs)

These accounts used to allocate future medical and dental expenses from their pre-tax income in the calendar year – usually December – before it is needed. In other words, the employee will allocate $2,500 in FSAs in December 2007 knowing that they will need to use it in 2008. Patients cannot allocate and use the money in the same calendar year. In addition, whatever money is not spent during the calendar year remains with the employer plan and is lost by the patient.
A significant benefit of flexible spending accounts and dental savings accounts is that they give patients complete control over their dentistry and it can be used for most costs that are not covered by a dental insurance plan. There is typically an annual maximum for these kinds of accounts of around $5,000. When added to a high end Fee For Service dental insurance plan of $2,500 per year, a patient can get a significant total of $7,500 per year in benefits.

Insurance Plans for dental health

There are many types of medical and dental health plans.

Health Insurance Plans-1
This type of medical or dental health insurance plan offer coverage to patients who choose their own out of network doctors or dentists. In this type of coverage doctors or dentists are allowed to charge their prevailing fee but the insurer will only pay up to a fixed amount. The difference between what the insurer pays and the doctors or dentist’s fee is usually paid out of pocket by the patient.
Most doctors and dentists will either accept payment directly from a medical insurance company or will at least fill out the paperwork for patient reimbursement. This type of plan will allow patients the freedom to see the greatest number of dentists and with the highest amount of dental benefits but this coverage comes at a much higher cost in premiums to the patient and/or employer. Some patients may not be willing or able to pay the higher premium and the same is true for employers.
Even with this type of premium medical or dental health insurance plan patients may find that their covered benefits and annual maximum still keep their overall reimbursement lower than hoped. This is because the benefits patients receive, including the nonsensical UCR (usual, customary & reasonable) rate, annual lifetime maximum and covered/excluded procedures is again directly related to the premium paid. These other terms are discussed elsewhere in this series.

Medicare

Types of Medicare:

Medicare comes in four parts, with variations, and can be supplemented with other health insurance options purchased privately or from an employer retirement plan. The four parts of Medicare have evolved over time.

· Medical

· Medicare Advantage

· Prescription.

· Hospitalization

Medical

Unpredictable medical expenses can make your financial life a mess. Medicare Part B, Medical Insurance, is intended to balance out the financial ups and downs to help you stay financially sound in the face of medical needs, including outpatient services, doctor visits, and some home health care. It specifically does not include vision, dental, routine foot care, hearing aids, and routine doctor visits.

Premium: $100 a month or more Out of pocket: You pay 20% of the total allowable charges, Medicare picks up 80%.

Supplement: Medigap

The Medigap supplement reduces the difference between what is paid by Medicare and what is charged by the healthcare providers. This can really make a difference once you look at the out of pocket costs of Medicare Part A and Medicare Part B. Since it is purchased from private insurers, the quality of the insurance company should be foremost.

Premium: It varies. For a 65+ in excellent health, insurers in my county are charging from $60 to $250 a month per person.

Out of Pocket: It also varies

Medicare Advantage from a private insurer

When managed care was introduced for Medicare recipients, many insurers entered the market only to withdraw after a few years, leaving their policyholders unable to get coverage at the same rates. While this market has settled down, there is still a slight risk that this might happen again. Medicare Advantage Policies cover parts of A (hospitalization), B (medical), and D (prescription) and may cover other things, such as vision or dental. These are purchased from a private insurer and feature a "network" of authorized medical providers, much like an HMO or PPO, that restrict which providers you may see in order to be covered.

Premium: Varies, perhaps slightly more than A+B+D together

Out of pocket: It also Varies

Restricted to a network of providers. Utilization outside of network may result in higher costs or denial of coverage.

Prescription

Anyone who is taking significant prescriptions or who may take significant prescriptions may want this coverage. While the premium may exceed the cost of prescriptions while healthy, you may find that it works well if you need medication due to an illness. This is a particularly tricky one to figure out the point at which you break-even on the premiums due to the complex nature of the way it pays for medication.

Premium: Varies, less than $100 a month

Out of Pocket: Varies. An example, after a deductible near $250 a year, you pay 25% until you've paid over $500, and then you pay about another $1500 before you get benefits again: where you pay 5% of prescriptions. Confusing? Yes!

Most pharmacies are the prioviders

Hospitalization

If you end up in the hospital, you're likely to have significant medical bills. Medicare Part A, hospitalization insurance, is intended to help you reduce your liability for those charges that occur when you are in a hospital, a skilled nursing facility, or hospice, along with some home health care expenses.

Premium: Varies based on your eligibility. Can range from nothing to several thousand dollars depending on whether you've worked the minimum 10 years to qualify.

Out of pocket: You must pay an annual deductible that is close to $1000 for the first 60 days of hospitalization. For 61-90 days in the hospital, you must pay about $250 a

day. For 91-150 days in the hospital, you're on the hook for about $500 a day. Go over 150 days and you pay it all.

Your Medicare Mileage will vary...

It may take some work to figure out the best Medicare options for you and your spouse. There are a few other things to keep in mind before jumping in:

• Get a good insurer - if you're selecting Medigap or Medicare Advantage, you'll be working with a private insurer - and there is variance in satisfaction.
• Make sure you play by the rules - ask first, don't assume, make sure it is necessary or covered when possible.
• Know when to appeal - to the insurer, to the government.
• Never miss a payment - if you do, you may not be able to get back into the plan, and if you can you may have to wait or pay a higher rate.

What is and is not payable under the plan is always changing - new items are added regularly, and things that you might have had last year may no longer be covered. You should check with your provider to determine what they believe is covered - and hold them to it. If in doubt about coverage of specific items,