Comparing Florida Health Insurance & Health Care Options

Things to Consider when Comparing Health Care Options

Choosing a health care plan is an important decision. A health care plan provides financial protection from the costs of an unforeseen event or condition. You should make sure that the company that you are purchasing coverage from, as well as the agent, are licensed. Your financial needs and your ability to absorb routine costs will affect the type of policy you purchase. Purchasing a policy that provides for first dollar protection is very expensive. You need to evaluate your financial needs and decide what level of costs you are able to handle and for what level of costs you need to purchase financial protection. The greater the cost sharing between you and the company, the lower the premium cost will be to you. If you purchase coverage at a lower premium, but the policy will not pay costs until a certain dollar value is reached, you need to be able to meet this cost responsibility. Consider the following features when comparing health care options.

What Will You Pay Out-Of-Pocket?

Premium - This is the monthly or annual amount you pay for your insurance policy.

Maximum out-of-pocket - This is a provision that limits the amount you pay out-of-pocket for covered claims.

UCR (usual, customary and reasonable) - This is the amount of a claim that the policy will reimburse based on an average range of fees for given procedures, geographic areas, etc. Often, the provision will limit the amount the company will pay, so be aware of UCR provisions. This is an important feature that should be considered. Two otherwise identical policies could provide substantial reimbursement differences based on how the company defines UCR. This is not consistent between carriers.

You will also be responsible for the deductible, coinsurance and/or copayment. For definitions, see the Glossary in the back of this guide.

What Provisions Might Affect Your Coverage?

Coordination of benefits - With this provision, you will not receive more benefits than your actual hospital and medical expenses, even though you may obtain another policy. A husband and wife with family coverage under separate group policies can't collect for the same claim twice, even if they paid two premiums.

Renewal and premium increases - This provision determines the cases when your insurance company can renew your policy or increase your premiums.

Conversion privileges - This provision allows you to convert coverage to a different insurance plan when you lose eligibility, without a medical exam to prove good health.