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Do we not need uninsured motorist since we have medical insurance?

Premiums for Employer-Sponsored Health Insurance Plans to Rise in 2016.

Medical Insurance Humor.

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Tips for selecting the right comprehensive health insurance plan.

Today, with medical costs at all-time high, emergencies such as sickness, disease and accidents which may result in prolonged hospitalisation, can leave you in severe financial crisis unless you have a comprehensive medical insurance policy which takes care of all your required expenses. So how do you choose a plan that’s perfectly suitable for you and your family?

There are a lot of factors to consider when choosing an insurance plan, most importantly: what your health care needs are, and what you can afford to spend? Once you are aware of your financial strength, the next step is to identify the “ought-to-have” with anticipating certain medical needs. With the right insurance, you could save thousands, perhaps even tens of thousands, if you or a family member gets sick.

Here are some critical clauses that needs your attention to detail while buying a health insurance policy:

• Sum insured limits

The main limit in health insurance is the sum insured. Any medical expenses incurred over and above the sum insured are not payable. It is advisable to take adequate cover from an early age, particularly because it may not be easy to increase the sum insured after a claim occurs or when the age increases.

• Individual/floater policies

Most buyers often struggle to make a decision on whether to buy an “individual” policy for each family member or a “family floater policies”. While an individual policy works best in all situations, it can be an expensive option. The family floater plan on the other hand offers flexibility in terms of utilising the overall insurance coverage among the family as a group. While an individual opts for a family floater cover, the sum insured opted should be sufficiently high considering a situation where more than one person in a family needs hospitalization in the same year.

• Extent of coverage

When you are paying for a comprehensive cover, it is important to make sure that the risk covered is comprehensive as well. One should not buy a plan just because it’s cheaper than the rest but should be measured in terms of premium versus benefit comparison. Benefits such as pre and post hospitalization, day care procedures, OPD cover, maternity extensions or ambulance service, should be taken into consideration.

• Waiting period for pre-existing disease exclusions

Many individuals have health related problems that exist before you apply for a health insurance policy or enroll in a new health plan. Pre-existing condition imposes a waiting period which is also called the cooling period. Therefore, apart from the insurance premium being charged by various insurers, you also need to compare the waiting periods stipulated in the policies for covering pre-existing ailments. Some policies specify a waiting period of two years, while in case of some, it could extend to four years. Similarly, there are waiting periods for certain listed conditions like hysterectomies, cataract, kidney stones and knee replacement surgeries which may vary from one year to four years and these also need to be compared.

• Any internal sub-limits like room rent curbs, sub-limits on specific procedures

In order to avoid inflated charges that hospitals levy on patients with an insurance cover, some policies have sub-limits on room rents or certain procedures and this becomes the most critical feature when evaluating a health insurance policy. Typically the insurer places two kinds of limits, on the hospital room rent and the liability for specific diseases. Classically the room rent expenses are capped at 1% of the sum assured for a day, while ICU charges have a ceiling of 2% of the sum assured. Plans free of sub-limits are preferred as it prevents surprises at the time of claims. These sub-limits are generally seen in plans with lower overall sums insured.

• Deductibles/co-payments

Sub-limits can also take the form of co-payments, where the insurer will be asked to pay a predetermined percentage of the claim amount or deductibles, where the insurer will have a cut-off cost which you will have to bear and the insurer will come into the picture only when the bill goes beyond this limit. It is advisable to go for plans that come devoid of restrictive options, such as co-payments, limits on room rents and treatment-specific limits. They may cost a little more but evade financial risk during emergencies.

• List of exclusions

While your health insurance policy can provide relief in times of emergencies, there may also be times of trouble in case you are not aware about the ailments that are covered and those that aren’t. It is important to know the list of exclusions in your health insurance policy to avoid instances when you end up paying additionally for a service already covered in your policy or in worst case scenario, post treatment you realise that your policy did not cover the treatment of that particular illness.

• In-house claims servicing or use of TPA and service levels/market feedback

It is important to know whether the insurance company has its own in-house servicing unit or uses a TPA for servicing the policies.

Insurance companies having their in-house servicing units have a better turnaround time for claims servicing and cashless processing.

A hospital or medical institution which has an agreement with the insurance company or TPA (Third Party Administrator) to provide cashless treatment is a network hospital. While buying a health plan, make sure of the proximity of the network hospital from your place of residence or work. Opt for an insurer who has more network hospitals in geographical locations where you are likely to need medical care.

Ensure that the facilities and repute of the hospitals in the network are worthy.

• Reputation of the insurer

Traditionally, we all are inclined to go for plans that our friends and family suggest as we trust their experience and judgment.

But the market is flooded with products and marketing gimmicks to lure customers. While deciding on a health plan, it’s important to conduct a due diligence on the insurance company — keeping track of how smooth their claim settlement is, how many claims have been settled, time efficiency and network.

Employers cutting worker hours to avoid PPACA.


About one in five U.S. employers either have reduced hours for workers they consider to be part-time, or will do so, in response to requirements of the Patient Protection and Affordable Care Act.  That’s what a survey of some 740 human resources professionals conducted by the Society for Human Resource Management found.

The vast majority — nearly three-quarters — of respondents haven’t altered schedules to avoid providing health insurance for part-timers working 30 or more hours a week on average. But 14 percent have, and another 6 percent told SHRM they intend to.

It’s still a significant number as some previous studies have found that most large employers will not circumvent coverage extension by reducing full-time workers’ hours. SHRM’s survey results come as PPACA marks its 5th anniversary this week.

PPACA mandates large employers offer health care coverage to employees working 30 hours or more per week or face a penalty.

When it comes to trying to reduce full-time worker hours or reducing the number of full-time employees to duck under the requirement, SHRM reported that only about 10 percent have considered going down that road.

“As organizations learned more about the law, they found that their coverage levels were already the same or more than what the law required, minimizing the adjustments that some anticipated employers would need to make when the ACA was created,” said Evren Esen, director of SHRM’s survey programs.

Among other outcomes:

  • 54 percent of employers require employees to work 30 hours a week to be eligible for coverage, an increase from 44 percent in 2014 and 39 percent in 2013. Another 26 percent require employees to work more than 30 hours a week to be eligible.
  • 66 percent said their organization offered the same level of health care benefits as before PPACA was enacted.
  • 77 percent said that their health care coverage costs increased from 2014 to 2015, and 6 percent saw a decrease.

The Advantage of Having an Independent Insurance Agent.

We are often asked about the advantages vs. disadvantages of using an independent insurance agent and whether a customer can  truly feel confident in the recommendations by someone they don’t actually know.

So, is using an independent agent a good idea?  While some people may find particular comfort in using a particular insurance agent who knows them on a first-name basis and takes care of all their insurance needs, the bottom line is that they may pay more for the relationship than what they need to pay for insurance.

With our economy still struggling, many  families are continuing looking for ways to cut corners and reign in expenses. One way to potential accomplish lower costs is to utilize an independent insurance agent. What’s the difference?

If you utilize a particular agent represent XYZ Company, for example, that representative should be thoroughly knowledgeable about policies, rates and any discounts or plans related to that company only.  So, if you call or meet with your agent, you’ll most likely spend your time determining which of the company plans works bests for you.  An independent agent, however, is not limited to a particular company and typically represents a range of between five and 10 companies in the area.  That means there  could potentially be great flexibility to pick plans, and hopefully create a package that meets all your needs while saving you money.

Utilizing an independent agent can also be to your advantage if  you are seeking a particular style of plan and have definite ideas of what you want in terms of price, coverage, availability and  quality.  After all, not everyone has the same needs when it comes  to insurance.  Since an independent agent has more companies to work with to find a combination that works best for you, the likelihood of getting exactly what you want is higher.  That’s not to say you can’t get good quality insurance or find discounted rates by going with an agent who represents a particular company.  If you are either looking for new insurance or considering making  a change to your current plan, consider at least contacting an independent agent to get some price comparisons.  You may be surprised about the money you can potentially save!              

Individual Health Insurance

Frank West Insurance Services | Individual Health Insurance, Family Health Insurance, HTH Travel Insurance, CA Medical Insurance, Affordable San Diego Health Insurance, Insurance Quotes, Whole & Term Life Insurance Policies, Medicare Supplement Insurance, Medigap Plans, San Diego Medical Insurance, Medical Coverage, Health Care Reform & Affordable Care Act Assistance, CA Health Insurance Exchange, Group Health Insurance, Business Health Plans, Health Care Insurance, Long Term Care, Group Health Insurance, Employee Benefits, Dental Insurance, Disability Insurance, San Diego Life Insurance, Anthem Blue Cross, Aetna, Blue Shield of CA, Cigna, Health Net, Kaiser Permanente, San Diego, Coronado, La Jolla, Pacific Beach, Rancho Penasquitos, Poway, Rancho Bernardo, Oceanside, Solano Beach, Pacific Beach, Cardiff-by-the-Sea, Encinitas, Carlsbad, Carmel Valley, Del Mar, Olivenhain, Rancho Santa Fe, Aviara, Lakeside, San Diego County CA, Southern California | 309 Miami Trail, Oxford OH 45056 | (858) 484-1894