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health insurance life quote
Provider: Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.
If COBRA does not apply in your case—perhaps because you work for an employer with fewer than 20 employees—you may be able to convert your group policy to individual coverage. The advantage of that option is that you may not have to pass a medical exam, although an exclusion based on a preexisting condition may apply, depending on your medical history and your insurance history.
Pre-existing Condition: A health problem that existed before the date your insurance became effective.
Additionally, using the all-cause method there is usually carryover provision that allows you to carry over expenses from the last three months of one calendar year to the next. If your policy covers the entire family, then a family deductible will apply rather than individual deductibles. In other words if a policy’s individual deductible is $200 a family deductible might be $400. This can be very advantageous because a six member family would only have to meet $400 rather than $1200 individually.
HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning. For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to amore cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.
Businesses that offer group coverage are subject to certain provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Terminated employees of companies that regularly employ more than 20 people may be eligible for extended group health insurance coverage after they leave their jobs.
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