(This Content is provided as "general overview only" - not insurance law.)
There are many health insurance carriers offering individual policies in the state of Wisconsin.
This
makes having a basic understanding of health insurance products very
helpful and important, as you search for the product best suited to your
own needs.
There
are many different types of individual plans to choose from.
(1)
Major
medical - typically a deductible and coinsurance type plan in
exchange for reduce premiums.
(2)
Preferred
Provider Organization Plans
(PPO's) - offering premium savings for agreeing to use a specific
network of providers who have pre-agreed to a pricing schedule for their
services. Many PPO products are a major medical type product with the
enhancement of copays for doctor visits and copays for prescription
drugs, etc.
(3)
Health
Maintenance Organization (HMO)
- not a fee for service type of coverage.
In general, hmo's collect premium and disperse the premium to
its provider members monthly whether you visit a provider as a patient
or not. This is the reason that
hmo's often keep you assigned to a specified provider or
provider facility.
(4)
Health
Savings Account (HSA's)
- a two product concept
that combines a high deductible major medical type of plan at reduced
costs and a tax deductible account (similar to an IRA).
The
insured / account holder may contribute dollars to his tax deductible
HSA account and withdraw from it to pay eligible medical expenses
without penalty. What makes the Health Savings Account a great product is: (1) the list of
eligible expenses allowing withdrawal of funds, far exceed the covered
items of most insurance plans. An example: eyeglasses, contact lenses,
dental treatment, braces, dentures,
birth control pills, vitamins (if prescribed), hearing aides and
the list goes on and on (with pretax dollars - are you seeing the value
here???!!!). (2) You own your HSA account - at age 65, your unused portion of the Health Savings Account has the
potential to provide a healthy retirement supplement.
As
a general product overview:
(1)
Major Medical plans typically offer the most flexible provider choices
while leaving you more upfront out-of-pocket costs in the form of
deductibles and coinsurance.
(2)
PPO's typically offer greater premium savings combined with flexible
provider choices but also typically impose penalties when leaving the
provider network.
(3)
HMO's typically provide the lowest out-of-pocket costs for routine
care such as: office visits, routine exams, prescription drugs,
maternity benefits, etc., however they also tend to be more expensive
and much more restrictive when offering referrals or allowing
non-network services and non-network specialty providers. (if at all).
There
are now many variations of the above mentioned products available to the
potential insurance buyer.
Major
medical that offer copays, PPO's that impose huge out-of-network
penalties, and HMO's offering deductible type plans. For these reasons
it is very important to have a full time health insurance professional
assist you, to define your individual health insurance needs against the
affordability of premiums to be paid.
When
a resident of the state of Wisconsin makes application for an individual
health insurance policy.
The
insurer may issue the
policy: (1) standard as applied for, (2) issue with a rate-up of
premium, (3)
issue with a rider(s) - excluding a specific preexisting condition(s),
(4) issue with a rate-up and a rider(s), or
(5) decline a person for coverage, based on prior medical history.
Health Insurance made available to uninsurable residents
of Wisconsin.
State of Wisconsin HIRSP
- (Health InsuranceRisk
Share Plan)
Phone: 1-800-828-4777
Blue Cross & Blue Shield United of Wisconsin
151 North RiverCenter Drive
P.O. Box 3015
Milwaukee,WI 53201-3015
