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individual health insurance plan texas
Self-insurance is a situation where an employer provides health benefits to its employees by depositing money in a special self insured fund which pays for reimbursement of medical expenses from the fund. This is not a viable option for most employers which must be large enough to have a base from which to predict expected expenses.
If your policy is per-cause you will pay a single deductible for all expenses you incur for the same injury or illness. Your benefit period for each cause begins when deductible has been meant for that injury or illness. This can sometime run as long as one or two years. It is important to understand the per-cause stipulation. Let’s look at an example. If you are ill in May and then are injured in an accident in July those are two separate causes and deductible must be met for each of them separately. However, if your policy is based on an all-cause deductible, the expenses for various injuries or illnesses are accumulated to meet your deductible in one calendar year. Once that is met, the rest of your charges are paid for that calendar year.
How premiums are paid depends on which of two different types of plans a group selects. The two types are contributory and non-contributory. In the case of non-contributory, the employer pays the full cost of the premium, while the contributory type requires a shared cost between the employer and employee.
Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. Starting July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. Your prior health insurance coverage will be credited toward the preexisting condition exclusion period as long as you have maintained continuous coverage without a break of more than 62 days. Pregnancy is not considered a preexisting condition, and newborns and adopted children who are covered within 30 days are not subject to the 12-monthwaiting period.
Deductibles are the amount of the covered expenses you must pay each year before the insurer starts to reimburse you. These might range from$100 to $300 per year per individual, or $500 or more per family. Generally, the higher the deductible, the lower the premiums, which are the monthly, quarterly, or annual payments for the insurance.
Although you can select a plan or buy a policy that should cover most medical, hospital, surgical, and pharmaceutical bills, no single policy covers everything. Moreover, you may want to consider additional single-purpose policies like long-term care or disability income insurance. If you are over 65, you may want a Medicare supplement policy to fill in the gaps in Medicare coverage.
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