Insurance World

If you are a resident of New York and in need of health insurance, you can purchase individual health insurance plans directly from a health maintenance organization (HMO).

HMOs in New York are required by law to offer both standardized HMO plans and point of service (POS) to those who seek to purchase individual health insurance. An HMO is a health insurance provider that works directly with a particular network of doctors, hospitals, and other medical professionals. This means your medical care must be from someone in the network and your insurance most likely will not cover medical care from those who are not in the network. If you need to visit a specialist covered in the network you will need a referral.

HMO/POS plans are a bit more flexible because you can obtain medical care from both the HMO network and out-of-network medical professionals. Although, with an HMO/POS plan you will most likely pay more and the number of services offered is lower. You will still need a referral in order to visit a specialist covered in the network.

With individual health insurance in New York, you will be able to choose either type of plan (HMO or HMO/POS) at any time and not be denied coverage due to health reasons. If you have a pre-existing health condition that was diagnosed and treated within the six month period before you applied for individual health insurance coverage, you may be required to wait up to a year before your health insurance will cover the pre-existing health condition. However, if you have a pre-existing health condition but you were previously insured, the waiting period will most likely be reduced as long as you reapply for health insurance within 63 days of the time your previous coverage expires. This is why it is important to keep up with the expiration dates of your health coverage and prevent any time lapses between coverage periods.

In 1996 “The Health Insurance Portability and Accountability Act” (HIPAA) was enacted by the U.S. Congress. The act was instated primarily to protect health insurance coverage for workers and their respective families when their is a loss or change of employment. This is outlined in Details in Title I of HIPAA Act. As in Title II of the act, the establishment of national standards for electronic health care transactions and national identifiers for the providers, employers and health insurance plans. Along with that is the addressing the importance on the security and privacy of all health data. These standards are meant to bog the system down, but rather to improve the efficiency and effectiveness of the entire national health care system by ‘encouraging’ the increased standards of using electronic data interchange in all health care.

There has been in the past, and I’m sure there will continue to be controversy over the The Health Insurance Portability and Accountability Act, as there is in most other Acts that are passed through by Congress. Their is great benefits to be had with complete cooperation, but it does cost time and money to get started. A little bit now, for alot later is easy for us to say, when we aren’t the ones who are having to shell out the money to pay for the upgrades that may be required. Or do we end of paying with rising health care costs?