Normally a group plan or an employer sponsored plan is going to be your best bet. In most cases they are not medically underwritten, usually the premiums are lower, and the best part is your employer shares the cost. But this is not always available.
If you find yourself needing to purchase Individual Health Insurance here are some basic things to consider:
- Approval of the plan can take anywhere from 30 – 45 days, so start early! Always allow enough time to make sure you are approved before you let your other coverage expire.
- Currently, Individual Insurance is Medically Underwritten, meaning the carriers can approve your application with an increase in their base rates, or even decline your coverage all together, due to pre existing conditions & your medical history.
- Always be honest and answer every question to the best of your ability. Do not leave out any information, doctor visits, prescriptions, etc. The carriers quite often verify information with your doctors office, but not always. Come claim time, if you have misrepresented information on your original application, it could lead to a denied claim!
- HMO, (Health Maintenance Organization) plans require you to select a Primary Care doctor on your application; where PPO, (Preferred Provider Organization) plans do not. If you have a particular doctor or medical group that you like, make sure that the plan you are considering includes them.
- Does the plan you are considering include a good Prescription benefit? Prescriptions are one of the most used benefits of a health plan. Generic drugs are almost always included since they are inexpensive. But be sure the higher cost drugs are also included. This normally includes a brand name formulary list that the carrier has, usually a higher co pay then generic, but also make sure other brand name drugs are covered. These are the most expensive drugs and even if you have a deductible or much higher copay, you need to have them covered. The cost without the benefit could be astronomical!
- If you are looking to cut costs, look at higher out of pocket costs in your co pays and deductibles, don’t strip down to a basic Hospital Only plan. Your coverage there would be very limited and most likely not pay for anything unless you are hospitalized. Better to have a comprehensive plan with a higher deductible.
- Stick with the larger carriers that are A rated, such as Blue Shield, Anthem Blue Cross, Aetna, etc. Or ask your doctor who they recommend based on their claim payment history.
We realize this is only a brief guideline, and there are lots of options out there. Feel free to click on our “Health” button and run some quotes yourself or contact one of our San Diego Health Insurance Agents, we would be happy to assist you through the process!
