health benefits

This article is written to assist consumers sift through multiple options, plans, exclusions and summaries of benefits and understand what Critical questions you should ask when researching health coverage. Finding the most beneficial health insurance plan to meet your unique and individual needs is difficult. This guide will help consumers understand the basics of health insurance and what to look for when comparing plans.

14 Costy Mistakes You’ll Want To Avoid

1-FREE – Do You Have a “30 Day FREE Look Period?” Can you get your $ back if you are not happy?

2- DEDUCTIBLES: How many deductibles do I have per year? Some plans will have more than 1 deductible per person per year!

3- NETWORK RATES: Prior to your deductible being met, will your insurance company extend their discounted network rates to you? Example: Insurance Company A – 5 stitches to finger – Total cost $2000, patient responsibility, $800, or Insurance Company B – 5 stitches to finger – Total cost $2000, patient responsibility, $2000. (no network break).

4- NEGOTIATED RATE: What is the AVERAGE negotiated rate? (Sometimes referred to Network Rate – very very important!)

5- UNCLEAR TERMS Is your $100 “co-pay” for an Emergency Room visit REALLY $100? Some companies the $100 copay is more like a fee AFTER your deductible, and you’ll still pay the co-insurance and the $100.

6- LIMITS on benefits, for example: $500 limit or $250 limit on Emergency Room expenses. $50 limit on Dr. Visits. Once the Limit is reached, YOU pay everything else out of pocket. $500 limit on hospital expenses per day (quick way to bankruptcy!)

7- PREVENTATIVE – Will you have to meet your deductible, or do you have a 1 year waiting period for preventative? Do you want to wait 1 year before you can have your female exam, or a mammogram?

8- TRAVEL – If you are out of state, are you covered for illnesses? If you eat something that doesn’t agree with you and become very sick and need a doctor, will you be covered? (Not just life threatening emergencies.)

9- RATE INCREASES – I am buying a “fixed rate”. Ask yourself if it makes sense to pay extra over the next 2 – 3 years for a fixed rate? Make sure your rate is set for at least 12 months but does it make sense to pay in advance for a fixed rate? Sometimes plans will naturally go down in price, so does it make sense to pay extra to have a fixed rate?

10- SUPPORT – After I buy this plan, MAY I CALL MY AGENT’S DIRECT LINE with billing issues, or plan questions, or technical problems, or claims questions or concerns of any kind?

11- EXCLUSIONS – Read the “Exclusions” in your plan. Are the exclusions available for you to read? Is there an exclusion that you cannot live with? For example: exclude well baby visits. Is this an exclusion that you didn’t catch in the plan details?

12- MAJOR MEDICAL plans are designed to pay for MOST of your medical expenses when you become ill or injured. You’ll want a Major Medical plan from a reputable company that has “Credible Coverage.” Discount plans or Limited Medical Plans are NOT designed to protect your losses like Major Medical plans are. They are marketed as “Insurance,” but you MUST ask, is it a Credible Coverage Major Medical plan?

13 – MATERNITY – Maternity plans. Do your homework. Does your plan have an outrageous deductible for maternity? Do you have a waiting period of 12 months, 24 months, or more? How many doctors do you get to choose from “In Network” that can deliver your baby? Are you happy with the choices of Doctors in the network that will deliver your baby? What if your doctor is not on-call the night you go in for delivery?

14- MEDICATIONS – Is there a limit on how much the insurance company will pay for medications. If you become very ill, this could be a very big problem. Do your research, ask questions. Do you have a deductible on medications?

*Did you know that key information about how coverage works is not always disclosed? *When comparing plans, is the language confusing? Why is the language confusing? *Did you know that many consumers compare prices of health insurance plans, but cannot always tell if they are comparing “apples to apples.”

How to avoid Medical Bankruptcy!

According to a Harvard Law and Harvard Medical School study, they found that ½ of all bankruptcies are caused by illnesses and medical expenses. If you are a breadwinner for yourself, or breadwinner for a family or spouse, and the breadwinner gets sick, you may loose your medical coverage, and a way to pay for your day to day expenses.

When you are shopping for a health plan to protect yourself financially from medical bills and bankruptcy, there are many things to consider. Probably the most important thing is to consider is what “Type” of plan you are getting. There are several types of health plans that are available. If you buy a plan that is not “Underwritten” and is “Guaranteed Issue” you are not buying a Major Medical Plan. Major Medical plans will go through a process called “underwriting.”

Some plans will pay a certain dollar amount for a procedure, or a certain dollar amount per day while in the hospital. IT IS CRITICAL you understand the implications financially if choosing a non Major Medical plan. Your chance for greater personal losses including Bankruptcy exist with non-Major Medical plans. If you are shopping price with health insurance, and you decide on a discount or limited liability plan, YOU HAD BETTER UNDERSTAND WHAT YOUR RISKS ARE if you end up needing to use that “insurance.”

Major medical plans are designed to cover most of your hospital expenses if you become hospitalized.

Do you have a disability plan? This type of plan will pay your day to day expenses if you loose your job due to an injury or illness. This should be a very important consideration when getting health insurance. If the breadwinner loses his/her income while injured or ill, how will the day to day expenses be paid for?

The 6 costly misconceptions about Health Insurance

1 – I don’t need medical insurance, I’m a healthy person, I eat right, exercise and take care of myself. This is risk-taking. You are gambling your financial future.

2- I’m not getting insurance because There is no benefit before my deductible. Some Major Medical Plans will A) extend their network rates to you before the deductible is met, but not all. Another benefit before your deductible is met is B) the copays for Dr. Visits and C) Copays for Prescription coverage. Again, check the individual plan.

3- If I get sick, or now that I’m pregnant I’ll get insurance. Once you are ill or pregnant, depending on the illness, you may or may not be eligible for health insurance. Certainly once pregnant, you will not be eligible for an individual plan. The insurance company will always reserve the right to underwrite your medical condition and elect to take you on as a risk, or not. You wouldn’t expect to run out and get auto insurance after you’ve banged up your car and have them pay for it. For this reason, it is important to not let your Major Medical insurance lapse for more than 63 days.

4 – I will get stuck with a bill that I thought should have been paid for, or the insurance company should have paid. Here again, you must do your homework on the plan you intend to purchase. Look for Limits, deductibles, exclusions, co-pays, and understand these details. Also, if you come into a plan with pre-existing conditions and did not have continuous “credible coverage,’ you can expect to pay for your pre-existing conditions for 1 full year.

5- I want excellent care at a cheap price. If you want Major Medical, shop between the competitors, and get the most for your money, but don’t expect the same benefits in a discount plan as in a Major Medical Plan.

6- I’m waiting for the President to take care of this mess. It is not a good idea to wait to purchase medical insurance ever!

Important to Know:

Many People Feel That Health Insurance Companies are Greedy and Corrupt According to the Wellpoint Institute of Health Care Knowledge:

“Popular theories suggest that health insurance premiums are driven by an aging population, excessive insurer profits or medical malpractice. Objective research, however, clearly indicates that these factors have a minimal impact on the high price of health insurance premiums.

If meaningful health care reform, including health care cost containment, is to occur, emphasis must be placed on the real drivers of increased health care costs and concomitantly, health care premiums. These include the following key factors: such as

* Advances in medical technology and subsequent increases in utilization

* Price inflation for medical services that exceeds inflation in other sectors of the economy

* Cost-shifting from people who are uninsured and those receiving Medicaid to the private sector

* High cost of regulatory compliance

* Patient lifestyles, such as physical inactivity and increases in obesity.”

Other Important Facts

Will they check my credit score. NO

Will they require a physical or blood work? In most cases, NO.

All insurance companies are the same. No they are not.

My Premiums keep going up. You can do very little about increases in health care costs. You may want to change plans or increase your deductible to try and save money. Try and find a company that will guarantee their rates for at least 1 year. No need to pre-pay for future rate increases.

Definitions:

DEDUCTIBLES (Phase 1)- Money that you pay out of your pocket before traditional insurance begins. Ranging traditionally from $0 to $10,000. Usually if you choose a lower deductible, your premiums will cost more, if you have a higher deductible, your premiums will be lower (you are assuming a higher risk in exchange for lower premiums).

CO-INSURANCE – (Phase 2) – After you meet your deductible, you’ll pay a “co-insurance.” “Co” meaning 2, two entities will share the burden of the bill; usually you’ll see “co-insurance” as a 70/30, 80/20, 50/50, 60/40, 90/10. The larger portion of the co-insurance the insurance company will pay, the lesser portion you will pay.

MAXIMUM OUT OF POCKET – (Phase 3) – After you’ve paid your deductible, and then your portion of the co-insurance, you finally reach your maximum out of pocket. From this point on, the insurance company will pay the rest of the bill. (Major Medical Plan.)

CO-PAY – A flat dollar amount to be paid at the Doctors office. Sometimes referred to as a “first dollar benefit” (before deductible). Meaning, you pay a flat $30 or $20 or $40 dollar copay, or whatever the copay is, and the visit is paid in full. WATCH FOR LIMITS! Make certain the copay is a flat dollar amount paid BEFORE your deductible.

HMO is Health Maintenance Organization, usually a limited regional/geographical area, with a certain number of providers in the HMO. You will select 1 Dr to manage your care, and your Dr. will “help you decide” if you need a referral or not. HMO’s usually have very low deductibles and copays.

PPO Insurance is Preferred Provider Organization. You may visit anyone you wish in the network, still you must know the geographical area of your Network, even with a PPO plan. If you are on vacation and become ill, will your plan out of state cover you (in network)?

CREDIBLE COVERAGE In order to cover your pre-existing conditions when moving from one plan to another, you must have a Credible Coverage Major Medical plan. It is a document given to you from your insurance company as proof that you had a Major Medical plan protecting you from a start date to an end date. You must not go further than 63 days from one Major Medical Insurance coverage to the next, if you do go beyond the 63 days, you will have a pre-existing condition clause in your new policy that states you will not be covered for any of your pre-existing conditions for 1 full year (at a minimum.)

If you go beyond 63 days without “Credible Coverage,” the new insurer will look to your previous 6 months (average) health history and condition, and not cover you for any ailment you have (pre-existing.)

Now don’t be mistaken, that when you want to go from one insurer to the next, if you were covered with “credible coverage” that you are automatically guaranteed a plan. This is not true. You will still need to be underwritten, and the new company is not obligated to take you on as an insured if you don’t fit their underwriting guidelines.

Please Note: This Free Consumers Guide is meant to be used as informational only. The author herein will not accept liability for any circumstances in which an outside company may define their features and benefits differently than in this document. Consumers will accept this document as informational only, and not a legal document. Consumers will be held responsible for their own purchases, and not hold the authors in this document liable for any actions taken by any consumer. Consumers must verify the plan in which they purchase, and will not hold the information in this document as a specific reason to take or not to take a certain action. This document is produced by a licensed health agent. The 14 Costly mistakes you should avoid when selecting your health plan.

7 Reasons the U.S. Education System Is Failing!

Recently, today actually, I saw a post of a video on Facebook that detailed simple questions posed to university students regarding BASIC social and historic facts, events and the people who govern our country. The results were astounding to say the least! Abject failure and an inability to name or identify ANY of the people, places and events. Let me repeat… NONE.

The formal education system in the U.S. was designed to meet the demands of the industrial revolution by providing basic education to the masses. Pretty simple right? So why is it that we fail to recognize or refuse to acknowledge that the demands are different today? There has not been a calculable redefinition or evolution of the educational system since. This is scary as it will define the failure of our country step-by-step and bit-by-bit until we are reduced to a social collection of ignorance.

Let’s examine the cause and solutions.

1. Closed for Business!

Schools find their existence tied to community standards and financial restraints based on the community support… or lack of. The result is that schools are closing at an alarming rate across the country. The decision to close a school rarely reflects the needs of a community or, more importantly, the needs of the students!

There seems to be less concern for the needs of the communities children’s education than the economic demands of the location of the school or the resources available. Where is the federal government when this happens? Well, they are partially to blame. The government rhetoric details the need for affordable, quality education while they demand that school systems adhere to specific federal mandates that tie the school administration’s hands to comply with political wants. So much for federal support.

2. Two-Gallons of milk in a one-gallon jug!

So, how many kids can you cram into a classroom and still teach effectively? That depends on whether you are looking to teach the children or be a daycare service. I know, pretty harsh but look at the function of schools today. They take your children and house them and feed them for about 6-7 hours a day. Mostly providing them with basic discipline and food that they rarely get a t home! Oh yes, admin it. Teachers are required to discipline your children in a crowded atmosphere where safety is no longer guaranteed and education takes a back seat to providing basic needs that parents are unwilling to, uneducated to or unable to provide. Wait, what about education? Well, there is so little time for that that caring for them takes priority over teaching them.

Secondarily, because of the constraints of federally-mandated guidelines, the children are taught in a cookie-cutter style standard of personality-limiting, creative-minimizing and individually-restrictive processes to get them to their adulthood. Basic education with basic performance that aligns children to basic standards that align with everyone else’s basic needs. Sad because it is done in crowded classrooms where teachers are forced to “teach” more children than one person could attend to. How effective is that?

3. If You Do What You’ve Always Done… You’ll Get What You’ve Always Gotten!

How can we expect our children to excel when their parents are minimally educated. One must understand that this cycle of poor education will produce more poorly educated children who will produce more poorly-educated children and so on and so on. Parents are so busy struggling to make a living today because of a poor economy or a lack of opportunity that there is little time to attend to their children’s education at home let alone at school. Involvement is also critical especially when the parents are minimally educated because they lack the foresight and experience to guide a young person to the right path. The result is a continually-repeated system that fails students and undermines this country’s future. It matters not whether you are poor and struggling to make a living that doesn’t allow for time to teach your kids at home OR whether your well off and struggle to maintain a career that doesn’t allow for time to attend to your kids at home. Either way, the education suffers.

4. Once Stated Always Abated!

I was once told that I was stupid. I was told that I could never learn because I lacked the basic ability to understand or comprehend anything that a normal person was expected to know. Can you imagine? Well, today I am in pursuit of a doctorate in education. Highly educated holding several degrees and formally recognized for my teaching abilities and performance as an educator. So there, take that!

If a child is to be challenged then the child has to recognize their worth and value as an individual. EVERY child is talented and gifted in something and should be recognized for it immediately and consistently. Oh yes, failure happens but that is part of the lesson as well. Individualized learning platforms and initiatives are crucial to the support and future of educational success. The talented and gifted programs require that a child be recognized and advanced because of their special gift instead of the initiative being available to ALL students. I believe that EVERY child has the opportunity to reveal their gift if given the opportunity to allow it to reveal itself. Why limit other children’s opportunity to excel because someone didn’t recognize their talents? Beyond me.

This lack of diversity in basic education is driven by personal prejudices and the nuances of social conformity and economic availability in a school district. Shameful that every student doesn’t have the same opportunity to be recognized for their inevitable contribution to society.

5. There’s a Step to the Prep!

According to the U.S. Bureau of Labor Statistics and the U.S. Education Department, 80% of all high school students graduate and student graduation rates are at an all-time high. This sounds great doesn’t it? Well, no it doesn’t because about 80% of high school seniors cannot pass basic proficiency exams or read at a basic level. The fundamental and core foundation for a successful future lies in their ability to read and comprehend and it is failing miserably. Because of a politically-correct mindset and an unwillingness to admit that we are failing we are passing kids without prejudice. What is the dynamic here? Money, acknowledgment, standards, social constraint?

With fewer than 40% of graduating students able to perform basic reading and math skills, what will their future look like? Poor at best because they are set up for failure and aren’t educated enough to know it. They are not prepared for any part of life let alone future education without the basic skills to learn. It seems a path to socialism.

6. Teacher to Preacher!

With the lack of people who are willing to sacrifice their future for low-paying academic careers there is little to choose from in the way of well-educated teachers. Enter teachers. As student education becomes more technology-supported so must teacher innovation education. A once-proud career, teachers are opting for more industrial careers using their basic educational achievements because it pays more and is less restricting. A lack of qualified teachers translates to a lack of quality education from under qualified teachers. The cultural shift in classrooms demands an academic shift in recognizing and utilizing qualified teachers who must meet higher-level standards before being allowed to teach.

Alas, distance learning take the personalization from the process, individualism from the practice and allows for lesser-educated teachers to perform office-like academics instead of teaching-like practices. Poorly educated teachers who are not held to the highest standards will produce poorly-educated students who will perpetuate the same. Pay teachers better and demand more from them and we will produce quality educated people. There is something askew when ball players make millions and teachers make nothing! Time to rethink this one.

7. Girls Will Be Girls and Boys Will Be Boys!

Or will they? There is a huge nationwide divide in the gender makeup of the student population today in schools. The STEM program is experiencing a narrowing range of student diversity as of recent examinations of student diversity in education. Formerly male student dominated academics and careers are changing to a more female dominated academic showing. Women are now able to perform as well or better than their male counterparts in science, technology engineering and math… previously neglected and they have always had the ability but unrecognized or acknowledged.

A globally competitive market demands equal and qualified individuals to perform and defend the right of opportunity regardless of gender, race, creed or social standing. As we develop our more-diverse communities, so should we develop our academically-driven future with better-educated people… no matter what!