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A description of individual & family medical insurance.
 Individual, or family health insurance is often referred to as "personal health insurance" or "private health insurance". Family health insurance, in which for example you, your spouse and your children are all on the same plan, is still referred to as an individual health plan. This is the type of policy you would purchase for yourself and your family if your employer does not provide insurance benefits to its employees or you loose such coverage. You may also consider Individual or Family medical insurance if you are self-employed, unemployed or a student. Individual and family health insurance plans are available for newborns on up to the seniors at age 65. Once you turn 65, you become eligible for Medicare and Medicare Supplemental Insurance, and discontinue your individual medical insurance policy. If you you are currently on a Group Plan from your employer and are paying a premium for your spouse and children, you may find that Indiviudal plan premiums may be less expensive for those family members.
How are individual health insurance plans different?
Qualifications and regulations that govern individual medical insurance can vary between states and from one insurance company to another. A primary difference between group (those plans offered through an employer) and family health insurance is that the health plans available to individuals and families are not guaranteed issue. Thus, private health insurance company may turn you down for coverage based on pre-existing medical conditions or they may approve you for medical insurance coverage but exclude benefits for treatments associated with your pre-existing condition. This is what is referred to as an "exclusionary rider," an addendum to the standard benefits offered under the health plan that you have selected. Exclusionary riders on individual health insurance policies are prohibited in some states but are permitted in NC.
How much does individual medical health insurance cost?
The premiums that are charged for individual health insurance plans are influenced by numerous criteria. These will include your zip code, your age, your health status and your lifestyle habits. For example, smokers will typically pay more for personal health insurance, as will people that are overweight or have certain pre-existing conditions. Due to these additional risks, persons are charged a higher premium. An excellent attribute of a family or individual medical insurance policy is that you may not be singled out for a rate increase based on claims history. If the private health insurance company increases your rate, it must increase the rates of all existing plan members covered under the same family health insurance plan. (Thus, the individual rate increases you have experienced or heard about, are do to adjustments based on inflation or the rising cost of delivering health care, NOT your individual or family claims). Also, insurance companies may not cancel your coverage for excessive claims. However, your policy may have a maximum annual and maximum lifetime benefit. If your claims exceed the maximum lifetime benefit as defined in your health plan policy, the insurance company may legally cease paying benefits toward any further medical treatments above that limit. When this occurs, your policy will terminates and you cease making payments for the plan and you would need to begin coverage with another carrier who would accept you.
What types individual health insurance plans are?
Among individual and family health insurance policies, there are several different types of private health insurance plans available, such as indemnity (fee-for-service) health insurance, health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, point-of-service (POS) plans, and health savings account (HSA) plans. The key differences between these includes two key features: cost and choice. Typically, the more freedom you want in choosing your own doctor and hospital, the more expensive the plan will be. Naturally, you need to consider When selecting what type of health plan is best for yourself and your family, as well as that which best meets your budget. You should compare health insurance quotes for each health plan type and shop carefully because coverage and costs vary from company to company and between various plan types. (Again, we emphasize, if you have questions, please call us to discuss them). |
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