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Frequently Asked Questions
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Where can I find results of crash tests? |
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insure.com - the consumer insurance guide |
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What can I do to protect myself against uninsured drivers? |
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Purchasing uninsured/underinsured motorist (UM/UIM) coverage can protect you against uninsured drivers. In many states, UM coverage is required by law.
UM coverage will pay for medical bills and pain and suffering if you are hit by an uninsured driver. In some states, UM property-damage coverage is available. If your car is crunched by an uninsured driver and you have UM property-damage coverage, you'll be able to get your car fixed under this coverage, rather than using your collision coverage.
Generally speaking, UM property-damage coverage carries a lower deductible than collision coverage. For the states where UM property damage coverage is available, read How to buy uninsured motorist property-damage coverage.
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What should I do if I just had an auto accident? |
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You should inform your insurance company right away. Make sure you've gotten a copy of the police report and the other party's (or parties') insurance information. Remember, just because you inform your insurer of an accident doesn't mean you're making a claim.
READ MORE
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Help! My HMO dropped my cancer specialist from its network. Don't I have any rights here? |
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You may have some rights, yes, but not necessarily extensive rights.
As part of managed care reform efforts, some states have begun passing laws to promote greater continuity of care. These laws require health plans to let certain people continue to be treated by their regular doctors after they're dropped from the network. Usually people who qualify under those laws are women who are in their third trimester of pregnancy, those with cancer, and people with a terminal disease.
To find out if your state has passed a similar law, contact your state insurance department.
Even if your state doesn't have such a law, you might have recourse through the HMO itself. Some health plans have their own policies that will allow you a specified number of visits to your former doctor, such as ob-gyns, neurologists, and psychologists, when they are dropped from the network or you enroll in a new health plan. Make sure you get preapproval (in writing, if possible) from the HMO to see them, lest you find yourself saddled with mounting bills that the health plan refuses to pay.
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Are employers legally required to provide their workers with health insurance? |
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In general, there are no state or federal laws that require private U.S. employers to initially offer health insurance benefits to any employees at all. However, it is common practice, especially among larger employers, to offer health insurance benefits, especially as a means to attract loyal workers during tight labor markets.
Because private employers aren't required to offer health insurance, it is up to each company to decide which employees will be offered health coverage, as long as it is done equitably (READ MORE ABOUT THIS BELOW).
Many employers offer health benefits only to full-time employees. The number of hours an employee must work each week to qualify as a full-timer depends, again, on the individual employer. In general, most have a cut-off in the 30- to 35-hour a week range. More generous employers might offer benefits to those working just 25 or so hours a week, however.
According to the Health Insurance Association of America, an industry trade group, nearly 152 million Americans are covered under employer-sponsored health plans. Still, a large percentage of workers do not have employer-sponsored insurance. According to the philanthropic Commonwealth Fund, the number of uninsured workers is expected to reach 30 million, or 63 percent of the uninsured population, by 2005.
Among those most likely not to have health insurance are young adults in the 18- to 24-year-old age group, people with lower levels of education, people of Hispanic origin, those who work part time, and people born in another country, says a 1999 U.S. Census Bureau report.
It's interesting to note that although private employers are not required to offer health insurance initially, once they do offer such coverage, they become subject to a variety of state and federal laws that dictate such things as what kind of benefits to provide and continuation of coverage.
For instance, employers with more than 20 full-time workers that offer health insurance must offer continuation coverage called COBRA under certain circumstances. (For more, read Know your COBRA rights at insure.com.) Another law, known as HIPAA, guarantees certain rights for people who have pre-existing medical conditions. (For more on that, read The HIPAA law: Your rights to health insurance portability at insure.com.)
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When an employee is injured, can they go to any physician they choose? |
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The employee has the right to select a doctor of their choice which includes any physician, psychologist, chiropractor or podiatrist who is licensed to practice in Wisconsin.
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When do they start getting reimbursed for lost time? |
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To eliminate minor claims for temporary disability, the law requires a three day waiting period for all disabilities lasting seven days or less. Temporary disability benefits are not paid for the day of injury.
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My employer offers health insurance through an HMO, but it's not available to all the employees. Is that legal? |
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Although it might not sound fair, it is perfectly legal. Employers are allowed to determine which classes of employees, if any, are offered a health plan. A manufacturing plant, for instance, can choose to offer a health plan to executive employees or managers and not to shop floor workers. However, all of the employees in the designated class must be offered the health plan; the employer cannot offer the health plan only to select employees in that designated class.
In addition, once an HMO or insurance company extends an offer of coverage to an employer, no employee in that class can be excluded from coverage simply because he or she has health problems. The health plan can screen the health history of the individual employees in the group, but only to determine whether it will accept or reject the entire group for coverage or what group premium to charge.
When it comes to small employer group coverage, many states now require "guaranteed issue," which means an insurance company or HMO cannot refuse to cover a group, even if one or more employees or their dependents have health problems. The health status of the employees can be reviewed, but only to set the premiums for the group.
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How can we provide health insurance for our kids when we just can't afford to pay the premiums? |
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Your kids might be eligible for health insurance through a joint federal-state program called the Children's Health Insurance Program (CHIP).
CHIP is designed to provide coverage for children whose parents, for whatever reason, can't afford health insurance but make too much money to qualify for existing welfare programs. CHIP is funded by matching federal and state funds, and administered by each state separately. Covered benefits and income eligibility requirements vary by state. Several states don't have CHIP plans but might run other insurance programs for qualifying children.
For more information about eligibility or availability, call (877) KIDS-NOW or visit Insure Kids Now.
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I have Medicare, but it doesn't cover all of my health insurance needs, such as prescription medications. What can I do? |
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Consider buying a supplemental Medicare policy, known as Medigap. There are 10 standard Medigap policies available in the United States, lettered A through J, with A having the fewest benefits and costing the least, and J having the most benefits and costing the most. Plans H, I, and J all offer prescription coverage, at varying levels.
Read about the 10 standardardized Medigap plans at the insure.com website to learn more about the specific benefits offered by each one.
Bear in mind that while the plan benefits might be standardized across the country, the premiums are not. That means it'll pay you to shop around, as some plans can vary in price by hundreds of dollars.
Insure.com also has an informative multi-part story about buying a Medigap plan that offers tips and warnings about buying the best plan to suit your needs.
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I have Medicare, so I don't need long term care insurance, right? |
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Unfortunately, you probably will need long term care insurance.
That's because Medicare doesn't adequately cover the expenses of long term care. Instead, it's recommended that you get a combination of Medicare, Medigap, and long term care insurance to secure your financial future.
You have to be careful when choosing a long term care policy to in order avoid the common pitfalls. Insure.com has a long term care library with a wealth of articles, including what to look for in a policy, how much they cost, salespitches to run from, and a shopping checklist to keep track of your long term care rate quotes.
To learn more about Medicare and what it covers — and doesn't cover — check out insure.com's list of helpful Medicare links. Once you're done there, you can better assess what your Medigap needs are, which will then help you choose the right combination of plans to cover your future long term care expenses. Insure.com offers a tutorial about Medigap and a look at the 10 standardized Medigap plans.
One other thing: Bear in mind that you should not count on Medicaid. It used to be that some wealthier folks would use "creative" estate planning to impoverish themselves so they could qualify for Medicaid, and use that to finance their long term care needs. However, the feds caught on and implemented changes in the law that make it a lot less likely you can use welfare to pick up the tab for you.
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What percentage of health insurance costs do employees pay? |
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There are several consulting firms and health insurance trade groups that study the issue of employer-sponsored health coverage. The percentage that employees must pay for their health insurance varies by region, business sector, number of employee dependents, and health plan type.
A survey project led by the health care division of KPMG in 1999 showed that two-thirds of Fortune 1000 companies said they paid 76 percent to 100 percent of the total health care plan costs for their employees.
In December 1999, the consulting firm William M. Mercer Inc. released a study showing that the overall cost of employer-sponsored health plans jumped 7.3 percent, from $3,817 per employee in 1998 to $4,097 in 1999. Costs were expected to increase by 7.5 percent in 2000.
Although employers have tried to hold down their health care costs by placing more of the payment burden on employees, the Mercer survey says that such cost-shifting is lagging behind the increases in health insurance costs because companies fear driving away good employees during the ongoing tight labor market. Employee contributions dropped from 24 percent of the cost of a health plan in 1998 to 20 percent in 1999, Mercer says.
And the Health Insurance Association of America says that employers paid 69 percent of the premium costs for a traditional, indemnity-style family health plan in 1998, 72 percent of the premiums for an HMO, 73 percent for preferred provider organizations, and 73 percent for point-of-service plans.
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I was laid off from my job. What happens to my health insurance? How does COBRA work? |
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Most likely you will be able to temporarily continue your health insurance benefits.
The federal law known as COBRA (sometimes called "continuation coverage") protects the health care rights of workers who are laid off, as well as spouses and dependents in certain situations. It enables you to keep your exact same benefits for 18 months, and sometimes up to 36 months, depending on the circumstances.
While the law is pretty generous, there are several conditions that must be met for you to be eligible for COBRA coverage. For instance, your company is required to provide COBRA only if it has at least 20 employees total (full-time and part-time) and continues to offer a health plan to its existing employees. And you won't be eligible if you were dismissed for "gross misconduct" on the job.
Learn more about how to get COBRA and what to do with it once you've got it at insure.com. This story explains how your company must notify you of your rights, what to do if you're a part-timer, and who gets "custody" of the health benefits when there's a divorce.
So what's the catch with COBRA?
You will be responsible for paying the full monthly premiums that your employer previously paid, plus a slight administrative fee. For a single person, premiums could easily top $200 a month, and make that $600 or so for a family.
While those payments might come as a shock to your wallet, the alternative is trying to find an individual health plan until — or if — you can get into another group plan. An individual plan (which, despite its name, can cover a family) is going to be more expensive than COBRA for the same benefits. And if you or any dependents have any sort of illness, it's highly likely the insurance company will show you the door. This is why COBRA is an especially good option for someone with an existing illness.
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My husband and I have health insurance concurrently. Coverage overlapped for about one month. I submitted claims to my husband's insurer for services performed in that month. Both policies were family plans. |
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Your health plan should know how it coordinates benefits with other plans; I'm surprised it tells you it doesn't know what the "deciding factor" is. Your benefits handbook should spell out the procedure for coordination of benefits (COB) — or whether your plan simply doesn't have such a procedure.
As you might know, COB is not a law; rather, it's a widely practiced industry standard. The "birthday rule" to which you refer typically applies only to children. For details about COB for children, read "Birthday rule" at insure.com It determines whose health plan covers your kids.
Coordination of benefits can be complicated, especially if you have one type of plan, such as an indemnity plan, and your spouse has an HMO. Here's how COB generally works when you and your spouse are covered under each other's plan:
First, the primary plan pays your claims as if there were no secondary insurance. The secondary plan then pays for what the primary plan didn't, but only as long as the medical treatment or services are covered benefits under that plan. For example, if your visit to the doctor cost $50 and your primary plan pays $30 of that, your secondary plan would pay the remaining $20 (if the benefits are covered).
The plans will not pay more than 100 percent of the cost of treatment, nor will they pay for treatment that isn't covered.
In determining which plan is primary and which is secondary, a plan without a COB provision is generally considered primary. When both plans have COB rules, the plan in which you are enrolled as an employee or as the main policyholder is primary. The plan in which you are enrolled as a dependent — on your husband's plan, for example — is secondary.
In addition, if you have COBRA coverage as well as coverage with another plan in which you are enrolled through an employer, your COBRA plan would be secondary and the employer plan primary. (For more about COBRA, read Know your COBRA rights at insure.com.)
If none of the above provisions determines which plan is primary, the plan covering you the longest is typically considered primary (although some insurers might say the claims are shared equally by both plans).
I don't have enough details about your situation to determine which of these provisions applies, but you can use these guidelines to help sort it out.
A final note: Dual coverage can be expensive, and if one of your plans is an HMO, be especially certain that it makes financial sense to pay for them both. You don't want to pay more than you'll ever get back in benefits by having dual coverage.
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