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5 Things You Must Know BEFORE You Choose Your Health Insurance!

By Charles Hopkins Published 04/21/2006 | Finance
Making a wise decision on which Health Insurance Policy to buy may seem like a confusing task, but if you consider just these five most important items you and your agent will both find that you are a Savvy Buyer! These items are your KEYS to picking a policy that's right for you:

1. The Insurance Company's Rating

Ask your agent for the Company's A.M. Best rating. If the company is highly rated at this national rating registry, then the company will have literature showing their rating with an explanation of what it means. Choose only companies that have an A or A rating.

2. The Insurance Company's Record of Complaints at your State Board of Insurance

Every large company will have some complaints. Avoid companies that have a high number of unresolved complaints. Ask your agent for the phone number for your State Board of Insurance. If he will not give it to you, this is a warning signal! You can also look up the number in any directory of your state's agencies. No matter what your agent says, CALL your State Board of Insurance and ask them for the record on any company you are considering.

3. The Limits Shown On Your Health Insurance Quote

Check your quote to see if you are comfortable with the benefit levels. You can usually change several levels to fit your needs and budget. For example, a higher deductible will cost less each month. Also, many plans give you a choice to split your medical bills with the Insurance Company either 50/50 or 80/20 (with them paying 80%). Then they will have an amount (your stop loss) where they will take over at paying 100% of your covered bills for the remainder of the year. These deductibles and other levels start over every year in most plans. Some plans, though, have a "per cause" deductible. Such a deductible means that you will be responsible for bills up to that deductible for each accident or illness. Make sure you are aware of this distinction, so you can choose a plan that's right for YOU!

4. The Limits Revealed Within The Policy

Ask your agent for a sample policy, and then check two sections: The Benefits and The Limitations and Exclusions. Many of your benefits are actually limited in the Benefits section. For example, diagnostic testing or outpatient treatment may be severely limited. These days, you could have a serious disease such as cancer, and never go into the hospital for it. You could rack up thousands of dollars in medical bills for the diagnostic and follow-up lab tests and MRIs, and then have surgery, chemo, or radiation therapy all on an outpatient basis.

Other items that may be limited are your hospital room rate and intensive care. Your hospital room rate should be at least average semi-private and your intensive care benefit should NOT be tied to your room rate, but should, instead, be covered as whatever is an average ICU rate for the area of the hospital, also. Some policies limit the ICU benefit to 3 times the regular room rate, when ICU can cost you 10 or 20 times the room rate each day. A short hospital stay with a limit like this in your policy can cost you literally thousands of dollars. A long hospital stay with a limit like this in your policy could drive you into bankruptcy. Even if your policy says it takes over at 100% after 5,000 of covered medical bills, the important term here is "covered" medical bills. If the policy only pays three times the room rate for ICU, then the rest of the ICU bill is considered an "uncovered" charge!

Look out for these types of limits!

Also, be sure to check the Pre-Existing Conditions Limitation if you already have any medical conditions, and ask your agent if the Company will be excluding your conditions permanently on your policy.

5. Pay the Insurance Company, Not the Agent, & Follow Up!

And lastly, make your check payable to the Insurance Company, and then follow up to make sure it was received. When you get your policy, check the Schedule of Benefits to verify you got the coverage you ordered, and then check to see if any special Amendments were added to your policy to exclude any of your conditions. If an Amendment exists, these conditions will always be excluded from this policy, even after the Pre-Existing Conditions Limitation expires.

Following these five tips will help you choose a health insurance policy which will protect you from catastrophic medical bills. You may think, "Isn't that what any health insurance policy is for?" Yes, that is the reason for buying any health insurance policy, but, unfortunately, many policies fall short of actually providing this protection! Be sure to take the time to choose wisely when it comes to your health insurance!