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| Insurance |
Even if you purchase your insurance plan or your health savings account through your employer, you still own your account. You make the decisions on how much to contribute to your account and which medical expenses you will use to pay the funds. When you change jobs or move, the account remains intact. Any unspent balances remain in your account earning interest until you spend them on medical care.
An HSA can be a comforting safety net if you have a high deductible plan (remember, your plan won’t begin paying out until your financial responsibility is met). In the event that you lose a job, must seek uncovered medical services or just want to exercise your right to seek a specialist not contracted with your insurance plan, the funds in an HSA may one day be your saving grace. If you are a consumer who desires security and values freedom, an HSA is an option you should research.
— Self-Directed Health Plans (SDHP)
SDHPs also can be called consumer directed health plans, and they are a way to organize, purchase and finance health-care services. These plans succeed in providing consumers with a method by which they can design and implement their own health-care plans that can be customized to their specific needs, health-care philosophies and circumstances.
Since January 1, 2002, insurers have offered plans that give patients and their physicians the autonomy to make decisions about what medical services they want and who they want to administer these services. Familiar elements of managed care, including gatekeepers (administrators who define what is “medically necessary” and thus covered by their plans), preauthorization processes and network provider limitations, are replaced with SDHPs that make consumers the controllers of their own destinies. Patients and their doctors decide how insurance funds should be spent.
SDHPs represent a new direction in health care that utilizes the new technologies of today’s world. With SDHPs you keep your medical records on special software and research medical services, medical providers and fees using the Internet. SDHPS are a different solution for those with the time and the desire to manage their own health care and tailor it to their own health-care needs and philosophies.
— Application Process
When you apply for coverage, fill out the application accurately and completely. If you knowingly provide incorrect, incomplete or misleading information, especially about a pre-existing condition, your coverage could be canceled or your benefits could be denied.
When purchasing an individual plan, never sign a blank policy application, and verify any information filled in by an agent. Make payments by check or money order payable directly to the insurance company or HMO (not the agent), and insist on a signed receipt on the carrier’s letterhead. Make sure you have the full name, address and phone number for both your agent and your carrier.
Never pay more than two month’s premiums until you have received a copy of your policy, HMO certificate or group membership certificate. California state law requires that you have a 10-day “free look” to evaluate any individual coverage policy. During this time you can change your mind and receive a refund. If you return a policy, send it by certified mail and request a return receipt.
DENTAL INSURANCE
Dental insurance differs from other types of insurance. Oral health care is fairly routine and predictable, which characteristically does not describe what insurance is intended to cover. The term “dental plan” more accurately describes what most would call dental insurance. With the help of dental predictability, consumers are able to make calculated decisions about dental plans that suit them best.
The most commonly utilized types of managed dental plans are direct reimbursement (DR), preferred provider organization (PPO), dental health maintenance organization (DHMO) and discount or referral.
Direct reimbursement (DR) plans are designed for its members to have the freedom to choose any dentist and for employers to offer a plan customized to their budget by deciding what percentage to reimburse at each level of cost. Employees choose a dentist, pay for the treatment and are reimbursed a certain percentage of the dollar amount. Some plans also establish “flex” accounts into which employees pay their share on a before-tax basis.
Preferred provider organization (PPO) plans require a monthly payment that entitles the member to a network of dentists who have agreed to discount their fees. Nonparticipating dentists usually still can be visited for a higher deductible and copayment.
Dental health maintenance organization (DHMO) plans pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or individual, regardless of utilization. In return, the dentists agree to provide specific types of treatment to the patient. The patient may be required to pay a copayment. Theoretically, the DHMO rewards dentists who keep patients in good health, thereby keeping costs low.
Discount or referral options are arrangements in which a limited number of providers who have agreed to discount their normal fees in exchange for the expectation of a larger patient pool. There is no reimbursement to the patient or to the provider. Many individuals and families that do not receive dental insurance from their employers turn to discount dental plans to reduce their out-of-pocket expenses.
An HSA can be a comforting safety net if you have a high deductible plan (remember, your plan won’t begin paying out until your financial responsibility is met). In the event that you lose a job, must seek uncovered medical services or just want to exercise your right to seek a specialist not contracted with your insurance plan, the funds in an HSA may one day be your saving grace. If you are a consumer who desires security and values freedom, an HSA is an option you should research.
— Self-Directed Health Plans (SDHP)
SDHPs also can be called consumer directed health plans, and they are a way to organize, purchase and finance health-care services. These plans succeed in providing consumers with a method by which they can design and implement their own health-care plans that can be customized to their specific needs, health-care philosophies and circumstances.
Since January 1, 2002, insurers have offered plans that give patients and their physicians the autonomy to make decisions about what medical services they want and who they want to administer these services. Familiar elements of managed care, including gatekeepers (administrators who define what is “medically necessary” and thus covered by their plans), preauthorization processes and network provider limitations, are replaced with SDHPs that make consumers the controllers of their own destinies. Patients and their doctors decide how insurance funds should be spent.
SDHPs represent a new direction in health care that utilizes the new technologies of today’s world. With SDHPs you keep your medical records on special software and research medical services, medical providers and fees using the Internet. SDHPS are a different solution for those with the time and the desire to manage their own health care and tailor it to their own health-care needs and philosophies.
— Application Process
When you apply for coverage, fill out the application accurately and completely. If you knowingly provide incorrect, incomplete or misleading information, especially about a pre-existing condition, your coverage could be canceled or your benefits could be denied.
When purchasing an individual plan, never sign a blank policy application, and verify any information filled in by an agent. Make payments by check or money order payable directly to the insurance company or HMO (not the agent), and insist on a signed receipt on the carrier’s letterhead. Make sure you have the full name, address and phone number for both your agent and your carrier.
Never pay more than two month’s premiums until you have received a copy of your policy, HMO certificate or group membership certificate. California state law requires that you have a 10-day “free look” to evaluate any individual coverage policy. During this time you can change your mind and receive a refund. If you return a policy, send it by certified mail and request a return receipt.
DENTAL INSURANCE
Dental insurance differs from other types of insurance. Oral health care is fairly routine and predictable, which characteristically does not describe what insurance is intended to cover. The term “dental plan” more accurately describes what most would call dental insurance. With the help of dental predictability, consumers are able to make calculated decisions about dental plans that suit them best.
The most commonly utilized types of managed dental plans are direct reimbursement (DR), preferred provider organization (PPO), dental health maintenance organization (DHMO) and discount or referral.
Direct reimbursement (DR) plans are designed for its members to have the freedom to choose any dentist and for employers to offer a plan customized to their budget by deciding what percentage to reimburse at each level of cost. Employees choose a dentist, pay for the treatment and are reimbursed a certain percentage of the dollar amount. Some plans also establish “flex” accounts into which employees pay their share on a before-tax basis.
Preferred provider organization (PPO) plans require a monthly payment that entitles the member to a network of dentists who have agreed to discount their fees. Nonparticipating dentists usually still can be visited for a higher deductible and copayment.
Dental health maintenance organization (DHMO) plans pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or individual, regardless of utilization. In return, the dentists agree to provide specific types of treatment to the patient. The patient may be required to pay a copayment. Theoretically, the DHMO rewards dentists who keep patients in good health, thereby keeping costs low.
Discount or referral options are arrangements in which a limited number of providers who have agreed to discount their normal fees in exchange for the expectation of a larger patient pool. There is no reimbursement to the patient or to the provider. Many individuals and families that do not receive dental insurance from their employers turn to discount dental plans to reduce their out-of-pocket expenses.
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