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Please read... Considerations for individual health insurance….  ANY Questions???....  PLEASE  call me, Sam Schoppenhorst 520-318-4800

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In my opinion…

CONSIDERATIONS WHEN APPLYING FOR INDIVIDUAL HEALTH INSURANCE

By Samuel Schoppenhorst

Since 1989, many companies have withdrawn from the Arizona market or went out of business.  My #1 consideration in choosing individual coverage is carrier stability.  Some important questions to ask when considering a plan are:

How long have they been in business?

How long have they been active in Arizona?

Does this carrier have a history of pulling out of markets?

Before a company issues an individual policy they evaluate the risk.  It is simply not profitable to take on high risk policyholders.  Initially new enrollees are in good health, and a certain percentage of those healthy policyholders will develop health conditions that will incur large claims.  If a carrier incorrectly forecasts this percentage they will be paying out more money than they are taking in.  This creates an incentive to withdraw from that state. 

Withdrawing from a state can happen in two ways 1) premiums increase to the point where only policyholders who are unable to find new coverage are left or 2) the insurance company may notify the state they are going to stop doing business in the state and cancel all policyholders.

Policyholders who are currently being treated for major conditions will find themselves unable to purchase new coverage with other companies.  In addition, Arizona does not have a state plan for individuals unable to find individual coverage.  This is why it is important to go with a company that has a long standing history and relationship with the state of Arizona and its population.

Make sure you:

 ¨   Always read the exclusions and limitations to the policy you are considering.  Some examples being…

 o    If organ transplants are covered, what are the limits?

 o    If mental health & substance abuse are covered, is it inpatient, outpatient or both? And what is the lifetime maximum benefit?

 o    Well care coverage, what is the benefit limit, is there a waiting period, is coverage before or after the deductible?

 ¨   Prescriptions should not have annual limits.  The only limit should be the maximum policy benefit for all conditions.

 ¨   Understand the meaning of coinsurance.  If you have an 80/20 plan then you are responsible of paying all of your deductible.  After that the insurance company pays 80 percent and you pay 20 percent.

 ¨   Know your out of Pocket maximum.  This is the annual dollar limit of the 20% you are responsible to pay.  At this point the plan starts paying 100% of the approved/covered medical costs. 

 ¨   Understand how the plan handles pre-existing conditions, what is the waiting period. They can range from none to never.

 ¨   Understand out of network benefits and the penalties when using non-network providers. Out of network penalties are severe.

 ¨   Know how maternity is covered; know the waiting periods that are in place.   

      Applying for coverage...   All companies have lists of specific conditions that require the applicant be denied coverage, or specific conditions be excluded from coverage or coverage postponed for a set time. They also have height & weight charts.   

     This is a basic list and is in no way all inclusive.  Every person has different wants and needs in an insurance policy.  This is why it is important to have a broker that is knowledgeable and trustworthy.  I encourage you to not only in read the policy brochures but to read the actual policy after you have enrolled.

  In my opinion, by Samuel C. Schoppenhorst-          Questions???....  PLEASE  call me, Sam Schoppenhorst 520-318-4800

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