Getting Health Insurance Outside of Open Enrollment

The Obamacare Open Enrollment Period ended about a month and a half ago, and many people still find themselves without health insurance. Some may not be able to comfortably afford a plan, couldn’t make a decision on what to buy, and maybe some just plain forgot. Now many people find themselves wondering how to go about getting health insurance outside of Open Enrollment.

Qualifying Life Event

In order to enroll in a major medical plan outside of Open Enrollment, individuals must have a qualifying life event, such as getting married, having a baby, moving to a new state, and other scenarios. When such an event occurs, this triggers a Special Enrollment Period, allowing someone to enroll in a plan.

If a qualifying life event does not occur, but someone is still interested in getting health insurance, there is an alternative. Short-term health insurance has some key differences from major medical health insurance, but still offers some great benefits to tide a person over until they can get other coverage.

Short-term Health Insurance

A short-term plan will function similarly to a major medical plan. When reviewing available plans, there is a breakdown of deductible and copayment amounts, maximum coverage limits, etc. available for each plan. They will vary by plan, which provides the health insurance shopper with many options. If someone is just looking for basic coverage that protects against big, unexpected emergencies, there will be a plan that works well for that scenario. Others who know that they will want copayments for office visits and prescriptions can find a plan to fit those needs as well.

Regardless of why someone cannot enroll in a major medical plan, one of the biggest benefits of a short-term plan is that it typically costs much less than a major medical plan. As with any plan, prices will increase with a short-term plan as the coverage amount increases. For instance, a low deductible will likely result in a higher premium. This is the case with virtually any type of plan. The more protection you have, the more it costs. Again, though, generally speaking you will pay less for a short-term plan than for a major medical plan.

These plans are no doubt helpful when traditional major medical insurance is not an option, and some people may even prefer a short-term plan over major medical. However, as its name implies, short-term insurance is not intended to be a permanent insurance solution. For this reason, many plans are only available up to a year. However long the term, once the plan ends, it must be reapplied for. There is no guarantee it will be approved.

Another key factor to note when considering this insurance is the fact that pre-existing conditions are not covered. If someone applying for a plan has diabetes, anything related to that condition will not be covered. However, even without pre-existing conditions being covered, new conditions will be. Having protection for new ailments is definitely more than anyone would have without any sort of health insurance, and that’s important to remember.

Finally, remember that you are required to have an Affordable Care Act-compliant health plan. Short-term health insurance plans do not fall into this category, so depending on your specific situation, you may face a penalty at tax time for not having ACA-compliant health insurance.

Whatever the reason you can’t get major medical insurance, keep short-term plans in mind. They definitely offer enough coverage to tide you over until you can get a major medical plan, and you can select the amount of coverage that works best for you. The benefits of short-term plans definitely outweigh the cons of not having any health insurance.

Difference Between Health Insurance And Mediclaim Policy

The first thing to understand is that mediclaim has a more specific focus while health insurance policies have a broader coverage.

When deciding whether to choose a mediclaim or a health policy, it would be wise to first understand what your requirements are, what is the existing health condition of family members, and what are the hereditary diseases in the family. This should play a major role in deciding what options to choose in either a health insurance policy or a mediclaim policy.

A mediclaim policy has a premium that is calculated based on the sum assured amount. It usually covers expenses for hospitalization, the illnesses that have been specified previously (which would be under a specific limit in the sum assured amount), as well as accidents.

Health insurance policies, on the other hand, especially those that are currently offered by numerous life insurance companies, offer more far-reaching benefits and wider options. Depending on the company issuing the health insurance policy, there could be health coverage for up to 30 different critical illnesses, which would cover most of the major illnesses that are currently affecting the population worldwide or specifically in the country. Health insurance companies also offer several features that help policy holders, such as reducing the premium after a certain period of time, reducing the sum assured after a certain period of time, and reducing the policy term after a certain period of time has lapsed.

Both mediclaim and health insurance policies provide policy holders the added benefit of getting tax exemption. This is usually under the Income Tax Act 1961 Section 80D. For mediclaim, the tax exemption is applicable for a sum not exceeding 15,000 INR. If the mediclaim is taken for parents who are senior citizens, the tax exemption benefit is for a premium up to 20,000 INR and for a premium of 15,000 INR for parents who are not senior citizens.

Other differences between mediclaim and health Policy are that mediclaim requires a compulsory hospitalization for it to be paid or reimbursed as it only covers hospitalization expenses. The coverage is also limited to not more than 5 lakh INR for the sum insured. Mediclaim also only reimburses the hospitalization expenses to the patient, as it works on indemnity. The claimant can make any number of claims until the sum insured amount is completely finished.

Health insurance policies cover expenses before and after a hospital stay, including charges for ambulance and even compensation for income lost. A claim can be made even without hospitalization, with just a diagnosis, in the case of critical illnesses. The sum insured upper limit can be up to 60 lakh INR. Also, the total sum assured can be given in case of any eventuality as there are riders for critical illness accidents or disability.

One of Health Insurance’s Best Kept Secrets

Before I jump into explaining what critical illness insurance is, and why I personally believe it’s a good investment, let me first confess that before I began working for a health insurance brokerage, I had NO idea what critical illness insurance was.

When I first started my job with the health insurance brokerage, I would hear agents talking to customers about plans that offered tens of thousands of dollars in coverage, should they wind up with something like a heart attack or a stroke. I was baffled and many-a-time wondered, “Does my health insurance do that, too?”

The answer was no, because the insurance they were explaining was a critical illness plan, which is frequently bought along with a major medical or short-term health plan. All I had was one plan, a major medical plan. So no, I did not have it, but I’ll tell you why I think it’s a great thing to have in a minute.

How Does This Plan Work?

First, what does critical illness insurance do? In the event of a major illness, like a heart attack, stroke, or cancer, the plan will pay out a lump sum of cash for that covered illness. The money could go to a multitude of uses. It could of course be used to cover medical expenses, like co-payments, deductibles (which have been on the rise recently), out-of-network providers, and experimental treatments that aren’t always covered by insurance. Under the same umbrella, it could go toward any travel expenses associated with your condition. If you decide to seek care out of town, you could use the money for transportation or hotel accommodations for you and anyone traveling with you.

It could also be used to help you pay for your normal day-to-day expenses. If you get cancer, there’s a good chance you won’t be working, or won’t be working as much. That money can help pay what you would normally pay with your income- rent, utilities, car payment, credit card payments, etc. It seems that when we think about major illnesses, we think about how we would pay our medical bills and forget about all of the other bills that will still come due, regardless of our health.

Everyone’s First Question: The Cost

At this point, I know you’re probably thinking about how expensive it is just for a major medical health plan, let alone adding this on. Surprisingly, for the amount of coverage you get, it’s not a very high price. It’s nothing compared to paying your traditional premium for a major medical plan and prices will obviously vary depending on the coverage amount that you opt for.

Everyone’s Last Thought: The Reality

Thinking about a major illness plaguing your life isn’t something many of us spend time thinking about. It’s something we like to believe won’t happen to us, but the unfortunate reality is that no one who gets cancer or has a heart attack ever expects it. It’s a terrible situation all around, but the one of the best measures you can take is to be prepared should it happen. The last thing you want to be worrying about when you have a heart attack or cancer is your financial situation. Critical illness coverage will ensure that you can focus on what’s most important- your recovery!

Understanding Policy Clauses In Health Insurance

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.

Sub-limits are another factor which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

Five Tips for Choosing the Right Health Insurance Plan

One of the best ways of safeguarding your personal well-being is by having a health insurance plan. Due to the large number of companies that offer this type of insurance policy, choosing the right one can be a daunting task. Here are five tips to help you find the best plan on the market today.

Check the Networks of Different Plans

If you have a select group of doctors whom you prefer, ask them which insurance networks they are part of. You can also use one of the many accredited online directories to know the networks that each plan on your list has. On the other hand, if you just relocated to a new city and you do not have a preferred doctor yet, choose a plan that has a large network of health practitioners.

Know the Maximum Premium Budget

Consider your average monthly expenses to know the amount of money that you can spend on the policy without compromising your financial capability. Low premiums often result in high out-of-pocket costs. Hence, what appears to be the cheapest plan may really be the most expensive, as you will be forced to pay for most of the services. One of the best ways of choosing the right premium is by estimating the total amount of money that you spent on health care last year, including out-of-pocket expenses and premiums. Then, choose a plan that has similar monthly deductibles, copays, and premiums. A high premium plan will save you thousands of dollars on out-of-pocket costs if you require expensive procedures or frequent medical care services.

Look for Additional Benefits

In a bid to attract more clients, insurance companies usually offer policies that have additional benefits apart from medical coverage. Based on this fact, it is wise to check the summary of benefits of each policy on your list until you find one that has your preferred scope of services. For instance, some policies provide better coverage for mental health and physical therapy care while others have more comprehensive emergency coverage.

Research Plan Structure

Once you have an estimate of your monthly premium, your next step is determining your ideal plan structure. Some of the most common plans are HMO, EPO, POS, and PPO. The plan that you select will determine which doctors you can see and your costs. More often than not, plans that have referrals, such as POS and HMO, require that you first consult a primary care physician before booking an appointment with a specialist. If you already have a network of doctors that you prefer to see, eschew plans that they do not take.

Compare Out-of-Pocket Costs

Your preferred health insurance plan should clearly indicate the services that you will be required to pay for and the amount. The sum amount includes coinsurance, co-pay, and deductible. A plan that has low out-of-pocket costs is an ideal choice if you regularly need emergency services, take expensive medications, have scheduled upcoming surgery, or were recently diagnosed with a chronic condition such as cancer or diabetes.