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Frequently Asked Questions
Find
answers to consumers' most frequently asked questions here.
Note: This section is for general information and is not specific
to any company or plan. Information in this section is intended
to assist the consumer in analyzing their needs and reaching
an informed conclusion.
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| Health
Insurance
Life
Insurance
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What
are the laws on COBRA? |
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COBRA is a federal law that allows an employee and his or her
dependents to continue medical insurance coverage for up to
18 months after leaving a job. The law covers those who quit
their job as well as those who are involuntarily terminated
except for gross misconduct. An employer with subject to the
law must provide written notice offering COBRA coverage to an
employee following a "qualifying event" (e.g. job termination).
Be aware that full cost of the insurance, plus up to a 2 percent
administrative fee, must be paid by the employee. Although the
insurance may be expensive, remember that coverage is purchased
at a group rate and that an individual policy purchased independently
may be much more expensive. COBRA coverage is typically available
for up to 18 months after you leave a job. In some cases, your
spouse and dependent children may be eligible for COBRA continuation
for up to 3 years. Many workers use COBRA during the waiting
period before health insurance benefits begin at a new job.
Not all employers are subject to COBRA. You should contact your
employer for COBRA information as well as information for any
continuation requirements specific to your state of residence.
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Do
health care plans cover all prescription drugs? |
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| Coverage
of prescription drugs will vary from plan to plan. Some plans
only cover prescription drugs administered while confined in
a hospital. If the policy covers outpatient prescription drugs
the general rule is that only those drugs prescribed for the
treatment of an illness or injury are covered. Many plans do
not cover "wellness" drugs such as nicotine chewing gum to stop
smoking or contraceptive pills. However, you should always refer
to your insurance documents to see what drugs, if any, are covered
under the policy. If you are still uncertain call the plan’s
customer service department to ask assistance on whether a specific
drug is covered.
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Is
vision care covered by most health plans? |
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This depends on the plan. If this is important to you, you should
check it out before you apply for an insurance plan. Many health
plans cover only eye injuries. Some plans may cover regular
eye examinations. Some plans may also provide a yearly benefit
allowance for the purchase of eye glasses or contact lenses.
Vision care, like dental care, is one of the benefits that some
plans offer and others don’t.
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Is
it true the Government offers a tax rebate to people who have
private health insurance? |
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| The Government
announced the introduction of a 30 per cent rebate on private
health insurance premiums. The rebate was introduced on 1 January
1999. It is not means tested and applies to health insurance
premiums for all types of coverage.
You are eligible for the incentive when you
have private health insurance coverage and you are:
- a
single person with a taxable income of less than $35,000
- a
couple with a combined taxable income of less than $70,000
- a
family with a combined taxable income of less than $70,000.
The family threshold increases by $3,000 for each dependent
child covered by the policy after the first.
The amount
you are able to get depends on the type of policy you have,
and the amount of time you were covered by the policy. This
table is a guide to the maximum amounts you can get.
Maximum
annual incentive amounts
| Policy
Type |
Hospital
coverage |
Ancillary
coverage |
Hospital
and ancillary coverage |
| Single |
$100 |
$25 |
$125 |
| Couple |
$200 |
$50 |
$250 |
Family
(including sole
parents) |
$350 |
$100 |
$450 |
Note:
You should contact your accountant or attorney for complete
details and guidance specific to your situation.
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What
types of expenditures are commonly excluded under major medical
insurance plans? |
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Although providing broad coverage, major medical insurance plans
typically contain a number of exclusions. Common exclusions
include medical expenditures arising from:
convalescent or custodial care;
physical examinations, unless required for
the treatment of an injury or illness (it should be noted
that some plans now cover this expenditure);
cosmetic surgery unless required to correct
a condition resulting from an injury or a birth defect;
occupational injuries and illnesses that
are otherwise covered under a Workers' Compensation law; and
routine
dental and vision care (however, usually care required for
treatment of an injury to the teeth or eye is covered). Other
common exclusions relate to benefits provided by government
agencies (e.g., VA hospitals) and expenses paid under other
insurance programs, including Medicare. This is not an inclusive
list of expenses commonly not covered. You should refer to
your own insurance documents.
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I'm
entering college next semester as a full time student. Will
I still be covered under my parent's health insurance?
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Possibly.
Most policies cover unmarried dependent children up to age 18
or up to age 24 if a full-time student. You may not be covered
if you are over the limiting age for eligibility under your
policy and do not attend school full-time.
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What
are out-of-pocket costs? |
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Even though major medical insurance plans may provide broad
coverage, insureds still incur certain costs. They typically
include the deductibles, any applicable "per visit" copayments,
cost-sharing amounts arising from the operation of the coinsurance
clause, medical expenditures that are deemed by the plan to
be in excess of "reasonable and customary" charges and expenses
not covered under the policy. Plus if you're covered under a
PPO or HMO plan you can incur higher out-of-pocket costs if
you use doctors or hospitals that are not part of the Plan's
Network. Only charges that are "reasonable and customary" for
a specific type of service, in a particular location or geographic
area, are eligible for reimbursement under medical insurance
plans. The definition of "reasonable and customary" may vary
from one medical expense plan to another.
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What
if I have been declined for insurance before? |
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| Please
share that information with your agent. Some companies are just
stricter than others. He could recommend the right companies
for you. All insurance companies underwrite differently. While
one insurance company may have previously declined you, depending
on the reason for the declination, another insurance company
may approve you.
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What
if I had a recent illness or injury? |
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Most insurance companies will underwrite an individual that
has had a recent illness or injury if the condition is resolved
with no further treatment needed. Depending on the insurance
plan, some ongoing problems may be covered right away, such
as controlled high blood pressure or hypothyroidism.
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Does
every plan cover maternity? |
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| No. But
most medical insuranec plans cover a complication of a pregnancy.
Also, many plans cover newborn children from birth. You may
have an option to elect maternity coverage usually for an additional
cost to you, in certain medical plans, which covers standard
maternity expenses such as normal prenatal care and hospital
delivery expenses.
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I
recently discovered I'm pregnant and I have no health insurance.
Is there any way I can get insured? |
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Unfortunately, the insurance options for a woman who is already
pregnant are slim. But don't despair; there are some possibilities
for you. Medicaid is an option if you fall within its income
guidelines. Call your state's insurance department to see if
you qualify and learn how to apply for it. If you are a college
student, your student health center may also be able to give
you some leads.
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If
I have health insurance can I still be admitted to a public
hospital as a patient? |
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| Yes. Every
public hospital has to treat you regardless of whether or not
you have private insurance. However, you should refer to your
insurance documents. Typically, public hospitals are not part
of a PPO or HMO network and your out of pocket expenses may
be higher if you're covered under an HMO or PPO plan and you
use an out-of-network hospital.
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