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Health Insurance Buying Tips

health insurance buying tips

Here are some powerful tips intended to help you find the most comprehensive coverage and to avoid potential gaps and costly surprises.

1.  Look for the phrase - Major Medical - in writing!

The most comprehensive coverage you can buy is called "Major Medical." This type of plan covers medically necessary treatment unless specifically excluded. On the other hand, a "Basic Medical" or "Hospital/Surgical" covers only treatment that is specifically stated in the policy wording.

Look closely at the difference. "Basic Medical" or "Hospital/Surgical" plans serve a purpose and their premiums are usually lower. However, if you want the most comprehensive protection, look for the term "Major Medical" or "Comprehensive Major Medical" in the policy.

2.  How will a health insurance policy will pay your medical claims. Look for the term "Reasonable" as well as "Usual and Customary". 

Sometimes, insurance companies will pay for medical procedures based on a schedule of fees that are considered to be the "Usual and Customary" for the region. However, if an unexpected complication occurs and reasonable, extra services are required during a medical procedure from a doctor or hospital, these reasonable, extra services may not be covered under the definition of "Usual and Customary" alone.

Complications can be costly, sometimes very costly! Look for the term "usual, reasonable, and customary" for maximum protection.

3.  Check the "Exclusions" first.

When an experienced health insurance agent looks into a policy for their own use, they usually review the policy starting at the end. Often in small print, here they find the list of policy exclusions, or what is NOT covered. Experienced agents know that what is NOT covered is equally as important as what IS.

Most exclusions are typical (e.g. self-inflicted injuries, custodial care, etc.), while others are not and should be carefully considered when comparing health plans. For example, does the plan have a waiting period for certain conditions? One exclusion of a "Basic Medical" or "Hospital Surgical" plan is "anything not specifically listed in the policy."

4.  If you have a favorite doctor, does he or she participate in a PPO network?

Lower-cost health plans control costs by contracting with a "Preferred Provider Organization" or "PPO." If you have a favorite doctor who is important to you, call your doctor's office and ask in which PPO's your doctor participates. Save yourself time by only comparing those plans that offer your doctor's PPO network.

5.  Activate your memory when completing the health questionnaire. Here’s why: 

The final step in obtaining health insurance is qualifying through the health questionnaire. It’s important to remember that by nature, the human mind tends to forget or minimize past or present illness. A positive attitude can be a benefit in the healing process. However, failing to disclose a material health condition, past or present, could jeopardize your coverage entirely. 

Medical audits are often done when there is a major claim. By contract, the health insurance company can revoke coverage and return all premiums, if it can be shown that the policyholder failed to disclose a material medical condition on the application questionnaire. 

Never give the insurance company a potential way out of paying a major claim. Even though this is the last step in the process, don’t be hurried. 

Disclosing past illness or injury is not an automatic negative. When truthful, always include clearly written phrases such as "complete recovery", "no further treatment", and "well controlled." It helps to clearly state the positive in writing.

6.  "Look your best" for any insurance company medical exam.

When applying for health insurance (and life insurance), you may be asked to take a brief "paramedical exam." This exam is normally paid for by the insurance company and is conducted by a licensed nurse or paramedic. The examiner will usually come to you. It is generally best to schedule your exam in the morning before eating. For more tips on "looking your best" for this exam, see Paramedic Exams.

7. Consider lowering your premium by electing a higher deductible.

The primary purpose of insurance is to cover the BIG expenses. Most financial experts recommend lowering your premium by electing a higher deductible, while maintaining comprehensive "Major Medical" protection (see tip #1 above).

For more information and to compare Florida health insurance plans and rates, see Find Insurance.

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