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Insurance FAQ

If I'm healthy, why should I purchase health insurance?
A health insurance plan protects you if you ever become ill or have an accident. It's important to cover your health just as you would your home or vehicle.

Can I obtain family health insurance if I'm self-employed?
This depends on the particular state in which you live because requirements vary across the country. Some insurance companies will provide a basic level of coverage to all small businesses, whereas others don't provide any coverage. Try to find a company that specializes in finding coverage for small businesses.

What should I do if my children and I are currently covered under my spouse's group health plan and we are getting divorced?
You should check with your attorney to inquire if the divorce settlement can include a provision for health insurance. As a temporary measure, you may quality for the federal COBRA program, but you may need to purchase additional health coverage to protect you and your children.

Do I have to pay my deductible before I visit my doctor?
Although some insurance policies require you to pay your deductible beforehand, most policies allow you to visit doctors or specialists or fill prescriptions with a copay.

Can my employer require me to join the company health plan as a condition of employment?
Yes, your employer may require you to participate in the health plan if they pay part or all of your health insurance premium.

What is a copayment?
This is the specified amount you must pay to the medical provider if you're a subscriber to a managed care plan for covered health care services.

Can my health insurance company reduce my benefit payments because I didn't pre-certify my hospital stay?
Yes, if your contract states that you must pre-certify a hospital stay, your insurance provider may reduce or deny your benefits according to your particular policy.

What is a conversion plan?
Individuals who terminate their group policy can continue coverage by purchasing an individual health plan that is called a conversion policy.

What is a waiver?
If you choose a waiver of premium, you must pay more each month for your premiums. However, if you become sick and can't pay your premium, your insurance company will pay it.

Is routine dental and vision care covered under a major medical plan?
No, they are not. However, dental and eye surgery or care required for treatment of an injury is generally covered.

What are limitations and exclusions?
You will be required to pay for some services such as mental health care or cosmetic dentistry that are not covered by your health insurance. Other items are limited such as the length of your hospital stay.

If I apply for a conversion policy under my group contract, can I pay on a monthly basis instead of a quarterly premium?
Check with your insurance company to see if you can pay by monthly bank draft. Many companies don't allow monthly billing because of the cost involved.

What is a major medical plan?
This plan applies a deductible to your initial expenses which normally ranges between $100 and $500 annually. You are usually reimbursed 80% of eligible expenses up to a specified maximum, and some will provide unlimited lifetime benefits.