Sweetwater Reporter (Sweetwater, Tex.), Vol. [114], No. [297], Ed. 1 Sunday, December 30, 2012 Page: 4 of 11
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Sunday Focus
Sweetwater Reporter Sunday, December 30, 2012 ■ Page B1
Choosing Health Insurance
FAMILY FEATURES
Tk JT illions of working Americans are still
l\/l without health insurance, and many
-LV .A. more worry about whether they’ll be
able to afford their existing coverage due to
rising health costs.
“With the rising cost of care, individuals
want more affordable options when it comes to
health insurance,” says Scott Krienke, senior vice
president, marketing and product lines at Assurant
Health. “Consumers want coverage tailored to their
budget and how they manage their health. Before
choosing a health insurance plan, it’s important
to understand all the options to find the best fit for
your needs.”
What You Need to Know
Whether you’re looking for additional coverage to supplement
your employer’s plan, or want an individual plan because
you’re self-employed or uninsured,
here are a few tips to get you started.
Major Medical
Under the Affordable Care Act, major medical plans now cover
100 percent
of many preventive services. Many people are familiar with
major medical insurance, which can be offered by employers
and which is usually most comprehensive in covering serious
illness or injuries. Major medical plans generally offer the
broadest protection and protect against large, unexpected
medical expenses.
Fixed-Benefit Plans
In general, fixed-benefit plans pay a set amount of money
when you have a covered medical service, regardless of the
actual cost. For example, if the plan pays $50 when you have
an X-ray, but it costs $125, after applying the plan payment of
$50, you would owe $75.
Unlike a traditional plan that has deductibles, coinsurance
and copays, fixed-benefit plans pay a benefit for covered
services immediately. Some provide access to network
discounts that can significantly decrease the total cost of care.
These plans can cover a range of services from everyday office
visits, preventive care and prescriptions, to hospitalization
and surgery. Check to see if there are pre-existing condition
limitations for the first 12 months of coverage.
Fixed-benefit plans can offer significant coverage. For
example, hospitalization reimbursement can be as much as
$6,000 per day depending on the plan. Some even offer tools to
help manage costs, like guaranteed cost estimates for common
services and treatments.
Analyzing Your Insurance Needs
How do you decide what type of plan is right for you? It
depends on your needs, what’s most important to you, and
sometimes the tradeoffs you are willing to make to get the
coverage you want at an affordable price. Here is information
on those types of plans to help in your decision-making:
Identify Supplemental Insurance
Plans You May Want to Round Out
Your Plan
Once a decision is made to purchase a major medical plan
or fixed-benefit product, supplemental plans can be used
to fill gaps in coverage and create additional protection.
Supplemental insurance, which can be offered through the
workplace or sold individually, offers limited coverage for
specific health care needs such as
in-hospital care, dental checkups or vision.
“Do your homework, and weigh your options — there
are affordable plans
that can fit into your budget and give you the coverage
you need to help protect yourself and your family,” said
Tim Knott, senior vice president of strategic markets and
product management for Assurant Employee Benefits.
“Supplemental insurance provides a wide array of benefits
that can help employees cope with out-of-pocket expenses
including those associated with serious accidents or
illnesses.”
Plans may include:
THAT MEETS YOUR NEEDS
Comparing health and
supplementary insurance
coverage
To do a comparison of costs and
coverage with any plans you’re
considering, it’s wise to look at:
■ Premiums, which are the amount
paid each month for your plan.
■ Coverage/benefits.
■ Access to doctors, hospitals and
other providers.
■ After-hours access and emergency
care.
■ Out-of-pocket costs.
■ Exclusions and limitations.
Fixed-Benefit Plan
■ Gives you help with everyday, common
medical needs that you are more likely
to have.
■ Helps you pay for immediate expenses
that you are most likely to encounter.
■ Gives you more control over your monthly
medical expenses. You are willing to
take the risk that out-of-pocket costs may
exceed the amount of the fixed benefit,
and that you would be required to pay
remaining balances.
Major Medical Plan
■ Provides major medical pro-
tection and coverage for your
unexpected health care expenses.
■ Protects your assets and income
while you pay for everyday
smaller costs.
■ Helps you prepare for unexpec-
ted medical expenses. You
pay premium, deductibles and
coinsurance in exchange for
knowing your costs are capped.
and treatment, which can contribute to better overall
health. Many plans provide benefits for additional
services
such as crowns and orthodontia.
Vision — Generally will cover vision
exams and pay a portion of glasses and contact lens
expenses. Some also provide network discounts.
Accident — Provides benefits for medical care
necessary due to an accident. Some also provide
benefits for death expenses, dismemberment and
disability.
Critical Illness and Cancer — Provides benefits
for diagnosis and treatment of specifically named
diseases such as cancer, heart disease and stroke.
Many provide a lump sum payment upon diagnosis.
Hospital Indemnity — Provides benefits for a period
of continuous in-hospital care. Some provide benefits
for certain outpatient services and costs associated
with necessary surgery.
Dental — Provides benefits for dental checkups
Learn more about choosing health and supplemental
insurance plans at www.assuranthealth.com and www.
assurantemployeebenefits.com.
How to design a custom,
affordable health insurance
plan that’s right for you
■ Decide what’s most important to you — paying
for everyday health care needs or catastrophic
coverage that caps your costs.
■ Check to see if a high-deductible plan with lower
premiums is right for you. If you choose this
option, you may want to look into the benefits of
a pre-tax Health Savings Account to cover out-
of-pocket costs.
■ If you choose a higher deductible plan, you may
want to use a portion of the money saved on
premiums for supplemental coverage that can
help pay your deductible or other expenses if you
have a costly accident or critical illness.
■ Consider a no-copay plan. Under the Affordable
Care Act, major medical plans now cover 100
percent of many preventive services, so copays
may not be worth the additional cost.
UcM K
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Sweetwater Reporter (Sweetwater, Tex.), Vol. [114], No. [297], Ed. 1 Sunday, December 30, 2012, newspaper, December 30, 2012; Sweetwater, Texas. (https://texashistory.unt.edu/ark:/67531/metapth851751/m1/4/: accessed May 14, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting Sweetwater/Nolan County City-County Library.