Health Insurance Questions
There are many important questions that individuals, families, and students have regarding health insurance coverage. This is because the insurance purchasing process involves many people, from the customer and the agent to the underwriter and heallth insurance company. For the average individual, it is easy to become baffled by the process; but, learning about the process, educating yourself, gives you much more purchasing power.
What is considered a preexisting condition?
Pre-existing conditions can vary between health insurance plans from being excluded to being covered fully and sometimes somewhere in-between like being covered after a specific amount of time. The Health Insurance Portability and Accountability Act ensures coverage for pre-existing conditions if you are joining a new group health insurance plan from your employer and you were insured the previous twelve months.
Can my carrier put my doctor as in-network?
In order to get your doctor to participate, contact your member services area. Have the customer service representative forward your doctor's information to PROVIDER RELATIONS. Provider relations will then contact your provider to see if he/she would like to become participating. Usually there is an application that needs to be submitted by the doctor. Then, each physician must be credentialed....that is their information must be verified and approved by a board of medical professionals who are employed by the Insurance Company. Once approved, the doctor can be added.
Can I get health insurance if I am pregnant?
The simple answer this question is, MAYBE! Getting health insurance while you are already pregnant is not an easy task. Some states (California) you will be able to obtain a health insurance policy and other states you will not. Some insurance carriers will cover a pregnancy without considering this as a preexisting condition, and some insurance companies will not.
Do insurance companies cover cosmetic surgery?
typically in order for your health insurance company to cover a plastic surgery, the surgery needs to be deemed medically necessary. Reconstructive surgery is considered medically necessary by many insurance companies if you are receiving reconstructive surgery after an accident or an additional medically necessary surgery (for example, breast reconstruction after a masectomy).
Do I have a 'preexisting condition'?
To know for certain, look at the definition of pre-existing conditions in the health insurance policy disclousures. Typical language will say some like: any condition for which you received care or treatment for the past (generally 6 or 12 months) will not be covered for the first (generally 6 or 12 months). So if you had cancer but have been treatment free for several years, in many cases it will not be considered a pre-existing condition. The language in most health insurance plans are specific so please read it carefully.
Can you get insurance for a 'significant other' ?
This is possible, but there are some issues to consider:
1) If the employer group is purchasing their health insurance from a carrier, there will likely be state laws and carrier rules to this. Each state regulates the insurance carriers within their state.
2) If this is a large company of 300+ employees, they probably 'self-insure.' This exempts them from state insurance laws and the employer gets to make most of the decisions.
3) WARNING: IF the employer pays any portion of your premium, they are required by federal law to consider the amount of money that they (the employer) pay towards your (the significant other) insurance premiums as taxable income to your boyfriend.
For example, if the employer pays 50% of the cost for dependents and the premium cost for adding you is $300 per month, then the employer pays $150 and your boyfriend will have $150 per month deducted from his pay. But he will also have the income taxes on the $150 the employer contributes deducted, too.
There is a complex reasoning the fed gov't has for requiring this. It has to do with the fact that significant others are not afforded the same tax status as spouses.
What is a variable copay?
According to one insurance company, the term "variable copay" has to do more with where services are rendered rather than by whom. Many doctors are able to practice at more than one hospital or more than one type of facility. The contracts each particular doctor has with each insurance company and with each facility affects the copay. Therefore the term "variable." Let me give an example to illustrate. Dr. Jones can practice at both Baptist and at Centennial Hospitals. If, let's say, your scheduled procedure was performed at Baptist, your copay is $100. Whereas the same procedure costs $500 at Centennial because of the agreements and "contractural amounts" agreed upon between the facility and the insurance company.
Can type 2 insulin diabetics get health insurance?
Some health insurance carriers will offer individual coverage to an insulin dependent Type 2 diabetic. The rules are fairly stringent and it will generally be at a higher rate but it is not always an automatic decline. If you are a type 2 diabetic and need an individual health insurance policy, contact us immediately.