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HEALTH INSURANCE -
Factors To Consider When Buying Health Insurance (continued)
b. As a side note, if you utilize COBRA, the rules allow you to delay premium payments for about three months, and still be covered from the first day you are out of work. During those three months, if medical expenses are incurred, you can pay the premiums retroactively at that point and still be covered for the medical expenses. If no major medical expenses occur during that three month period, and you have since arranged new coverage, simply let the COBRA coverage lapse for lack of premium payment. This is a handy way to have coverage essentially at no cost for a ninety day period when you are between jobs and medical coverage.
12. Often, when both spouses work for different employers, coverage is offered by both employers to families and dependents. Consider the following factors:
a. Having the same family member covered by two different healthcare plans (duplicate coverage) will generally not provide better coverage. It generally just causes problems. While it is true that sometimes costs not covered under one plan will be covered by the other, insurance companies do not like duplicate coverage, and will probably squabble over who pays for what. In addition, the existence of duplicate coverage will need to be disclosed to the insurance companies. Therefore, duplicate coverage is very rarely worth the extra cost.
b. Make sure to evaluate the cost and type of coverage provided if the entire family is covered under one plan, or if spouses are under separate employer plans, with the kids covered under one of the plans. There will usually be a best way to go, given the premiums charged by the employer under different options, and the type of coverage provided.
c. However, do not make your decision based just on amount and types of coverage
and cost. Also evaluate how long you are likely to be working for a particular employer.
If one job is very steady, and the other job is likely to change in the future,
you may want to consider getting all of your insurance through the more stable employment
relationship. Keep in mind, if you or your family members do not initially enroll
in the employer’s plan at the initiation of employment, it may be difficult to get
into the plan in the future, due to pre-
13. If planning on enrolling in a group plan, make sure you know when the next enrollment period is for the plan, and what you need to do to sign up.
14. If you have adult children you may be able to continue to insure them under your health insurance coverage. Generally, children are dropped from their parents’ health insurance coverage when they reach the age of 27 under the new federal guidelines. But some states now require insurers to continue to cover dependent children even to thirty years of age. These new rules can help cover adult children who do not otherwise have health insurance through their job, or if individual health insurance would be very expensive due to health problems. Generally, to qualify, children have to be unmarried and live in the same state as their parents, but they do not need to live with their parents or be considered dependents for tax purposes. However, keep in mind that if your child is healthy individual health insurance coverage is generally not very expensive, and could be less than the incremental cost of keeping your child on the parents’ health insurance policy. However, if you already have other children on your policy, the incremental cost of keeping your adult child on your policy may be very small. For a list of each state’s age requirements for dependent coverage, go to the National Conference of State Legislatures’ web site at ncsl.org.
15. The Consumers Union web site has a worksheet for comparing health insurance policies. It can be found at ConsumersUnion.org. Click on “Health Care” at the top left then on “Health Resources” then on ”Health Insurance” then on “Individual Policies” and finally on “Consumer Reports: Plan Cost and Coverage Worksheet.”
Disputing A Denied Healthcare Claim
It is not unusual for a health insurance claim to be either partially or fully denied. If this happens to you, consider the following approach to dispute a denied claim.
1. Contact your insurer and ask that a claims adjuster review the denial and explain the reason for the denial. Ask how the issue can be resolved and the claim processed and paid. It may be as simple as a wrong diagnostic code being entered. Be sure to keep a record of your call including date, time, who you spoke to and what was discussed.
2. If talking to the claims adjuster does not solve the problem, ask for a formal claim review to be initiated.
3. Seek help from your human resources department if your healthcare coverage is purchased through your company. They may be able to intervene to solve the problem. You might also ask your doctor’s office if they can contact the insurance company to try to solve the problem and explain why you needed the care.
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