Tuesday, July 22, 2014

Holiday in US - Must have Health Insurance

                         INDIVIDUAL HEALTH INSURANCE
                                                                               WHILE TRAVELLING IN USA

--Luke S. Brown

            If you are going to visit the US for any extended period of time, it is a very good idea to plan ahead for the chance that you will become ill or suffer an accident that requires medical care. If you are coming to the US to work, you may have the opportunity to participate in your employer’s group health insurance program. But if work is not the reason that you are coming, you are probably on your own and may want to purchase individual health insurance to protect you while you are here. By “individual” I am not referring to a policy just for you; the term refers to a private insurance policy for one person or a family.

Here is a basic checklist of how to go about the process:
1.  Find a health insurance agent (sometimes called a “broker” if he/she represents multiple insurers) with whom you can work and whom you feel a sense of trust. You can get a referral from a friend, consult the telephone directory, check the internet or locate someone whose office is nearby. You will want to make sure that the agent is licensed to sell “life and health” insurance, although he/she may also be licensed to sell “property & casualty” insurance. Licensure can be verified by calling the Department of Insurance in the state in which you live (usually located in the Capitol, there will be an office in the Department of Insurance that can verify agent licensure)

The agent does not have to become your best friend, but he or she should not treat you as just “another customer”.  Look for someone who takes an interest in and understands your needs and objectives—especially because you are unfamiliar with dealing with insurance in the US. This may take some time, and may involve meeting with a few agents.  There are many good online sources by which to find and secure coverage, but an online transaction is often less personal and more mechanical. 

2.  When you decide on the agent that you are going to use, discuss alternative kinds of health insurance. For example, historically, the main kind of health insurance was called “fee for service”. This involved going to whatever healthcare provider you wanted to go to, the provider submitting his/her bill to the insurer and the insurer paying it. This has mostly been replaced by forms of “managed care” where the insurer has implemented various kinds of cost-savings devices such as requiring permission to see a specialist, or by providing annual “wellness check-ups” without requiring you to pay a deductible (which would be required for other kinds of doctor visits).

Sometimes you can buy health insurance without going through an agent. This is often the case if you wish to enroll in a form of health insurance called a Health Maintenance Organization (HMO). There are various kinds of HMO’s, differing mostly in the amount of choice you are given in the selection of a healthcare provider. It is not really a question of one being better than another—it is more a question of differences in how they operate and what you feel most comfortable with. It may also be a question of cost, because the ones that put the greatest limitations on choice are often the least costly (but that is not the case all of the time or everywhere).
It is very important that the insurer to which you will apply is licensed to conduct insurance business in your State; this is referred to as being “authorized”.  Call  Insurance Department to make sure. There are many scams, and you do not want to get caught in one.

3. Determine how much of the financial risk of illness or injury you can or are willing to absorb.  This will have a bearing upon the premium that is charged for your insurance in a few ways:

●  Lifetime policy limits:  Although it is hard to predict future healthcare needs, health insurance can be purchased with different lifetime limits.  This is the maximum that the insurer will be obligated to pay for covered expenses while the policy is in force during your lifetime.  In general, the higher the lifetime limits, the higher the premium.  The limits are sometimes expressed in terms of an amount per person, or an aggregate amount if multiple people are covered (such as a family).  Once the limits are exhausted, you will be responsible for the excess.  This may not be a big issue if you are planning on leaving the US after a relatively short time, but there is no telling the amount of medical expenses that can be incurred in that time.

●  Deductibles:  A deductible is fixed amount of money that you are responsible for paying before the insurance company’s obligation to pay for covered services is triggered.  The deductible is usually expressed as an annual amount.  There can be different deductibles within the same policy, such as a separate deductible per hospital admission (instead of or in addition to the annual deductible).  Deductibles may vary based on whether care is received from a provider who is on a list approved by the insurer or not.  You may choose the deductible that best suits your financial circumstances from those offered by the insurer.  Generally, a higher deductible will mean a lower premium.

●  Copayments:  A copayment divides or shares responsibility for medical costs between you and the insurer.  It requires you to pay a fixed dollar amount when a medical service is obtained, and the insurer is responsible for the remainder.  Based upon the medical services obtained, different copayments may apply.  Generally, a higher  copayment can translate into a lower premium.

●   Coinsurance:  This refers to the percentage of covered medical expenses that the insurer pays after the deductible has been met.  Common coinsurance rates are 20-30% of the amount the insurer has approved for the healthcare service.  This means that the insurer will pay the remaining 70-80%.  Some health insurers offer optional higher coinsurance amounts, which, if selected, usually reduces premiums, but means that you will be responsible for a greater portion of the charges.

4.  Answer all questions on the insurance application truthfully.  The importance of this cannot be stressed enough.  If you withhold information or lie, the insurance company may have the right to cancel coverage retroactively.  If that happens, it will be as though you never had insurance.  What’s more, depending upon the circumstances, you may be treading dangerously near to insurance fraud, which is a crime.

Luke S. Brown is a retired insurance attorney who lives in Tallahassee, Florida. He assists people with consumer and business problems including those involving insurance, healthcare, government benefits and others. He helps by untangling issues, making calls, writing letters and achieving mutually satisfactory outcomes. He may be reached at Brownknows01@gmail.com, and invites you to his website at www.YourProblemSolvers.com.