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Frequently Asked Questions About Health Insurance

Aug 17, 2007
There are many questions that people have regarding health insurance. This is because the insurance purchasing process involves many people, from the customer and the agent to the underwriter and insurance company. For the average consumer, it is easy to become baffled by the process; but, learning about the process, educating yourself, gives you much more purchasing power.

Below are some samples of questions, and answers, which are believed to be among the most common that individuals and self employed consumers of health insurance have. To learn about the health insurance process, simply scroll the list; or, to seek specific information, you can jump to that category.

Overview of insurance

There are a lot of questions normally require clarification before deciding any purchasing of insurance.

The first will be what is the major difference between group and individual insurance?

The major difference between group and individual insurance involves evidence of insurability. To purchase individual insurance, a person must generally answer a health questionnaire and undergo a medical examination to provide evidence of insurability to the insurance company. An insurer may decline coverage on the basis of the applicants personal habits, health, medical history, age, income or any other factors that bear on risk acceptance. Or the insurer may issue a policy with limitations on coverage.
Most group insurance, however, is issued without medical examination or other evidence of individual insurability because the insurer knows that it can cover enough individuals to balance those in poor health against those in good health. The risk of an insurer failing to achieve this balance is diminished as the size of the group increases, or as the insurer underwrites additional group policies and increases the total number of individuals covered. This is known as the law of large numbers.

2. What are the various ways that individuals receive health insurance protection?

Besides participating in group insurance plans, individuals may also be covered under federal and state government sponsored programs such as Medicare and Medicaid, service type plans such as Blue Cross/Blue Shield or so called alternative health care systems such as health maintenance organizations HMOs and preferred provider organizations PPO. Insurance may also be purchased privately on an individual basis, or through mass purchasing groups such as credit unions and professional or trade associations.

3. What are the advantages of group insurance over individual insurance?

For an employer that intends to provide insurance protection to its employees, the group approach ensures that all employees, regardless of health, can be covered. Those with known health problems, who might otherwise be unable to obtain individual insurance, can be covered automatically upon employment without evidence of insurability. Although some limits may be imposed on new hires for certain conditions that predate their enrollment in the plan, most employees can receive coverage as soon as they are eligible.

Group insurance offers a lower cost per unit of protection than individual insurance, because the economies of scale resulting from selling, installing and servicing one plan covering many individuals. In addition, group plans are typically more flexible and tend to provide more liberal benefits than individual coverage

4. What types of group protection do most employers provide?

Although there are many variations of each, the four major types of insurance coverage provided by employers to their employees are life, accidental death and dismemberment A D & D, disability and health or medical. Some employers also provide additional coverage, including group legal, travel accident and vision and dental care.

5. How can a labor union provide group insurance?

A labor union can provide group insurance for its members under a policy issued to the union. The union is the policyholder, just as the trust is the policyholder under a MET. A union may purchase a group policy for a large number of members who are employed by the same company, or for union members working for different companies. Group insurance purchased through a union is particularly advantageous in industries such as construction, where union members may work for many employers during a year.

Despite the opportunity for labor unions to purchase group insurance, few group contracts are issued to unions today. Organized labor more often obtains insurance benefits for its members through collective bargaining with employers. As a result, union members are usually covered under group insurance plans sponsored by one or more employers.
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