Insurance World

As you graduate college and head into the great, big, scary world, there are probably a lot of things on your mind. First and foremost is finding a good job, then finding a place to live, and then maybe figuring out how to pay back those student loans. One thing that might not cross your mind is health insurance. All of your life, you’ve most likely been a dependent on your parents’ coverage, but that ship is about to sail—if it hasn’t already.

We know what you’re thinking, “Why do I need health insurance? I’m young, I’m healthy, and doctor visits are few and far between. So why pay for something I’ll never use?” Hey, we understand where you’re coming from. But accidents and illnesses happen without warning, even to the strapping young adults such as you. Sure, health insurance is expensive, but not having it will cost you dearly.

First things to know

Let’s get one thing straight, health care in the United States is a nightmare, few will argue that. There are thousands of options when it comes to receiving care and paying for it, some of them good, some of them not so much. When it comes to choosing an insurance policy that’s right for you, confusion abounds. So let’s learn a little more about your options.

There are two essential categories of health insurance: managed care and indemnity plans. Though you’ll pay more for indemnity coverage, it offers much more flexibility than does a managed care plan. Through indemnity coverage, you’ll have your choice of doctor, lab, hospital or specialty clinic. When you seek medical care, you’ll have to pay an out of pocket expense—called a deductible—before your coverage will kick in. Deductibles range from a few hundred dollars up to $1,000 or more, depending on your policy. Also, indemnity plans require a co-payment on medical care; meaning you’ll be responsible for a percentage of the treatment costs along with your deductible. Generally, indemnity plans pay only for accidents or illness; they usually don’t cover preventative care.

Managed care is the complete opposite of indemnity coverage. Deductibles are usually smaller, co-payments are lower, and preventative care is usually covered. Your options, however, are limited. Through a managed care plan, you can only choose between health care providers who are contracted by your health maintenance organization. If you go elsewhere, you pay—the full amount. Since that’s a pretty rough deal, many managed care plans are offering hybrid options that include many of the desirable characteristics of an indemnity plan.

Which way to go

If you find a job that offers health insurance and you’re single, take it. It may not be perfect, but it beats anything you can find on your own. When you sign up through your employer, you’ll probably be confronted with many options. Take a good, long look at them and ask for help from a human resources representative if need be, but make sure you choose the plan that’s right for you. Chances are—if you’re young and healthy— you’ll want a plan with a low premium and higher deductible. Look for a plan that minimizes your out-of-pocket expenses. When it comes to choosing between and indemnity plan or a managed care plan, you may or may not have a choice depending on your employer. Both offer advantages and disadvantages, so make sure to crunch the numbers before committing to one or the other.

Make yourself a deal

Though health insurance is a costly part of our lives, there are ways to save. If you’re self-employed, shop around before you commit to a plan. If you’re under 50 and in good health, insurance companies will want your business, and cut rates are to be had. Also, take advantage of breaks from Uncle Sam. The self-employed can write off up to 45 percent of their insurance premiums. Some employers offer flexible spending accounts, where you can pay for premiums and costs not covered by insurance with cash that isn’t subject to taxes.

If you’re married and your spouse also can get coverage from their employer, weigh your options carefully. It might benefit you financially and coverage-wise if you measure the pros and cons of separate coverage, double coverage, or one of you opting out of your work’s plan and enrolling in the other’s.

Finally, if you’ve been healthy and believe you can get by with minimum health coverage, look into purchasing “catastrophic coverage”. This indemnity policy offers extremely low premiums, but deductibles can be very high—up to $2,500. Coverage is extremely limited to “catastrophic” events, which you’ll need to learn all about.

Twenty per cent of critical illness claims are turned down. That means for every five people making this important claim, one will have it rejected at this crucially important time.

The whole reason behind taking out critical illness cover is that, in the event of you becoming critically ill (that is being diagnosed with one of the listed illnesses described in your policy documents) a payment will be made. The reasoning behind your decision to take out what some consider being an important part of your financial planning is sound. Critical illness can affect the whole family. You may have to pay out for child care, change your home or job or even train for a completely new career. Having taken out cover, should the unexpected happen, all eventualities are covered and you have gone as far as you can to minimise financial problems and get down to the important personal matters.

Unfortunately, in a number of cases, this is not so. Failure to disclose what may seem to you to be minor, unimportant illnesses in the past may give the insurers a reason to reject your claim. Fair or not, it’s completely legal! As far as the law stands, if you have failed to disclose information which the insurer was seeking, then the insurer is perfectly within their rights to terminate the cover.

If this happens to you, not only do you have to cope with the implications of the illness, but you have to either accept that your critical illness insurance plans have totally failed you. At this stage depending on the severity of the illness, you may feel overwhelmed by the situation and unable to face challenging the decision. If you do appeal against the decision and the Financial Ombudsman Service gets involved, they will make every attempt to establish whether you deliberately misled the insurers in order to gain cover or whether the questions on the original proposal form were vaguely or poorly written.

As soon as you make a claim on your critical illness policy, your insurer will instigate an extremely thorough check on your medical records. It appears that they can go back without a time limit and if they find anything, related to your illness or not, which you’ve failed to disclose to them, they may choose to refuse your claim. There is no such search or investigation carried out when you take out the policy and some people feel that this should be addressed.

It is virtually impossible to remember every minor illness. Can you really be expected to remember and record every visit to the doctor regarding things like headaches, eye pain, stiff neck, ear infections and depression? There were recent cases where claims were rejected for these reasons – a man had his claim for prostate cancer refused because of failure to disclose an earlier ear infection and a woman whose claim failed because she’d not disclosed an earlier problem with depression.

However, for four out of five people, the insurance works. It is important to disclose your full health history and not to attempt to cover anything up. Read the terms of the insurance thoroughly and miss nothing out. Used as intended, critical care cover is a valuable financial tool.

Plenty of help is available when choosing your critical illness cover. Log on to the internet and you’ll find on-line brokers who’ll be able to offer advice, a choice of quotes and the best possible terms.