Group and Private Insurance

Private medical insurance can be daunting for those who have always been insured by their employer’s group plan. I’ve specialized in helping my clients find good healthcare insurance for well over ten years now and have been a Connecticut insurance agent since 1985. I’d like to share with you the process I use when helping my clients find the best health insurance plan to cover themselves and their families.

The three things we look at are price, coverage and company.

• Company – Your health insurance company should be stable financially and have a good record for paying claims.
• Coverage – The medical coverage must meet your needs. It should cover doctors, hospitals, labs and prescriptions. It should also have doctors and hospitals in their networks that are convenient to you.
• Price – Your healthcare plan must be priced fairly relative to the benefits provided.

The basic process we use is to:

1. Determine which private medical companies are worthy of being considered.
2. Determine which plans offered by those healthcare carriers offer adequate coverages
3. Determine which plans are priced best relative to the health insurance benefits provided

Health Insurance Companies

Private medical insurance companies should have good AM Best ratings and be in good standing with your state’s insurance department. You may also want to do a Google or Yahoo! search for complaints.

For example you might search for "Mega Life and Health complaints" before completing an application with them. Every insurance company has some complaints. Just by virtue of the volume of clients they have. However, a red flag should go up in your mind if the complaints are too numerous.

Another thing to look at is how much they pay in benefits as a percentage of the premium they take in. A good company will spend about 80% of the money they take in to pay for their clients’ medical claims.

Coverage – What does your health insurance plan cover?

There are two aspects of coverage. One is the procedures that are covered. The second is the network’s list of doctors that the insurance plan includes.

Covered Medical Procedures

Your health care policy should cover you in both the doctor’s office and the hospital and should have a good lifetime maximum benefit. I suggest at least 5 million dollars of coverage. You should read through your insurance plan’s outline of coverage or official brochure to see how doctors, hospitals and prescriptions are covered.

Health Insurance Exclusions and Limitations

Most if not all health insurance policies will have a list of procedures and services that are not covered. Most of the items in this section are reasonable and are included in the contracts of their competitors. Policies typically will not cover cosmetic surgery for example. However, there are often exclusions that you will find in one contract but not in others. Maternity insurance is one example of this. Most plans will not cover the costs of a normal pregnancy. The ones that do tend to be more expensive when compared to otherwise similar plans that don’t cover maternity. The exclusions and limitations section of your policy or its brochure should be read carefully before you commit to purchasing any health insurance plan.

Health Insurance Networks

Knowing which medical professionals are in your insurance plan’s network is important for obvious reasons. You should be able to find a list of doctor’s who accept a given insurance plan online or by calling your health insurance broker.

Price – Finding the best low cost health plan

It is easy to compare private health insurance prices, but harder to make sure that you are getting good value for your money.

Comparing Health Insurance Plans

When you are eliminated the bad insurance companies and have eliminated the plans offered by those companies that don’t meet your needs, you are ready to compare plans and prices.

You may need the help of a professional to do this, however one way that I use to eliminate bad choices is to compare similar plans that have different deductibles.

I compare the annual costs of the policies and see if the difference in costs is less than the difference in annual deductible. If a plan costs $1,000 more per year but does not lower your annual deductible by at least $1,000, I remove that plan from consideration.

The Best Health Insurance Coverage for the Money

The best medical insurance coverage, may not be the best plan for you. Often the best plan is overpriced and does not offer an extra dollar in medical benefits for each extra dollar it costs. Make sure that any plan you purchase is:

• Provided by a good health insurance company
• Will cover your healthcare needs well
• Is priced well for the health care benefits it provides