Health Insurance Information
Individual and Family Health Insurance
What kinds of health insurance are there?
There are essentially two kinds of heath insurance: Fee-for-Service and Managed
Care. Although these plans differ, they both cover an array of medical, surgical
and hospital expenses. Most cover prescription drugs and some also offer dental
These plans generally assume that the medical professional will be paid a
fee for each service provided to the patient. Patients are seen by a doctor
of their choice and the claim is filed by either the medical provider or the
- Managed Care
More than half of all Americans have some kind of managed-care plan1. Various
plans work differently and can include: health maintenance organizations
(HM0s), preferred provider organizations (PPOs) and point-of-service (POS)
plans. These plans provide comprehensive health services to their members
and offer financial incentives to patients who use the providers in the
What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find
themselves in need of help with eating, bathing, dressing, toileting or
continence, and/or transferring (e.g., getting out of a chair or out of bed).
These six actions are called Activities of Daily Living–sometimes referred to as
ADLs. In general, if you can’t do two or more of these activities, or if you
have a cognitive impairment, you are said to need “long-term care.”
Long-term care isn’t a very helpful name for this type of situation because, for
one thing, it might not last for a long time. Some people who need ADL services
might need them only for a few months or less.
Many people think that long-term care is provided exclusively in a nursing home.
It can be, but it can also be provided in an adult day care center, an assisted
living facility, or at home.
Assistance with ADLs, called “custodial care,” may be provided in the same place
as (and therefore is sometimes confused with) “skilled care.” Skilled care means
medical, nursing, or rehabilitative services, including help taking medicine,
undergoing testing (e.g. blood pressure), or other similar services. This
distinction is important because generally Medicare and most private health insurance pays
only for skilled care–not custodial care.
What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and
Long-Term Disability (LTD):
- Short-Term Disability policies (STD) have a waiting period of 0 to 14
days with a maximum benefit period of no longer than two years.
- Long-Term Disability policies (LTD) have a waiting period of several
weeks to several months with a maximum benefit period ranging from a few
years to the rest of your life.
Disability policies have two different protection features that are important
- Non-cancelable means the policy cannot be canceled by the insurance
company, except for nonpayment of premiums. This gives you the right to
renew the policy every year without an increase in the premium or a
reduction in benefits.
- Guaranteed renewable gives you the right to renew the policy with the
same benefits and not have the policy canceled by the company. However, your
insurer has the right to increase your premiums as long as it does so for
all other policyholders in the same rating class as you.
In addition to the traditional disability policies, there are several options
you should consider when purchasing a policy:
- Additional purchase options
Your insurance company gives you the right to buy additional insurance at a
later time for an additional cost.
- Coordination of benefits
The amount of benefits you receive from your insurance company is dependent
on other benefits you receive because of your disability. Your policy
specifies a target amount you will receive from all the policies combined,
so this policy will make up the difference not paid by other policies.
- Cost of living adjustment (COLA)
The COLA increases your disability benefits over time based on the increased
cost of living measured by the Consumer Price Index. You will pay a higher
premium if you select the COLA.
- Residual or partial disability rider
This provision allows you to return to work part-time, collect part of your
salary and receive a partial disability payment if you are still partially
- Return of premium
This provision requires the insurance company to refund part of your premium
if no claims are made for a specific period of time declared in the policy.
- Waiver of premium provision
This clause means that you do not have to pay premiums on the policy after
you’re disabled for 90 days.
Group Health Insurance
What is group health insurance?
Group health insurance is a single policy issued to a group of people, offering uniform healthcare benefits to all members. In most cases, these policies are purchased by employers and offered to eligible employees and their families as part of an employee benefits package. Enrolling in group health insurance generally costs participants less than what they would pay for an individual healthcare policy for two main reasons:
The risk is spread over the whole group, as opposed to just one individual.
Many employers pay a portion of employees’ premiums.
What are the benefits of group health insurance?
For employees, the benefits of group health insurance include the reduced price of healthcare and the ease of enrolling through their employer. For employers, the benefits range from attracting quality workers to the tax credits they can receive.
Is your business required to purchase group health insurance?
Large businesses with 50 or more employees are now required to offer group health insurance under the Affordable Care Act. Small businesses with fewer than 50 employees are not required to offer coverage, but they can qualify for tax credits to help offset the cost if they choose to offer healthcare and pay for at least half of each employee’s premium.
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1 - Source : MANAGED CARE AND THE STATES