| Terms and Conditions - Health Insurance Contract Overview |
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| Written by Sean Johnson |
| Friday, 22 April 2011 08:55 |
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Shopping for the perfect insurance plan can be time-consuming and frustrating. Your job doesn't end when you decide on an insurer, however. If you do not read the fine print, you could be unpleasantly surprised later. Make sure to read your health insurance contract's terms and conditions before you sign.
Shopping for the perfect insurance plan can be time-consuming and frustrating. Your job doesn't end when you decide on an insurer, however. If you do not read the fine print, you could be unpleasantly surprised later. Make sure to read your health insurance contract's terms and conditions before you sign. There are many variables to consider including the exclusions, limitations, terms, provisions, and a host of other items such as procedures that may or may not be covered at all. Also, get a clear understanding of the proposal being outlined for your consideration. Insurance contracts are usually contracts of adhesion, meaning you adhere to their principals once you except their terms. So be patient and take your time. The definition of terms helps de-mystify some of the legalese used throughout the contract. This section should define what a "covered member" is as well as what your insurance company considers "medically necessary." Several other definitions may or may not be included in this part of the terms and conditions, but are still helpful to know. For example, co-insurance is simply how you and your insurance company will split the cost of a given procedure. A co-pay refers to the payment required when you visit a doctor or buy prescriptions. Many online resources list these and other insurance-related terms as well. The schedule of benefits should include a table or list of covered procedures and services. This part of the terms and conditions will also explain your payment responsibilities. Many procedures are covered through co-insurance, as mentioned above. Although policies differ, payments are often split 80/20 between the insurance company and you. The schedule of benefits will also list your deductible amount. You should also look for the annual maximum out-of-pocket expense. This is the most you will be expected to pay in a given year. Another important feature is your maximum lifetime coverage. Your insurance company will cover this amount over your lifetime. Read carefully and take heed of any uncertain and unclear items not previously discussed with the insurance agent, financial advisor, or sales person who sold you the policy. Chances are if you do not investigate fully before the policy inception and effective date, you will not have the time to review during your ten day free look period. Although it is a lot of home work, it is definitely in your best interest to get all the paperwork to review as much as you can before you sign the dotted line! DISCLAIMER: This article is provided as information only and is not to be taken as financial advice. Sean L Johnson is a journalist for Health Insurance Buyer a referral service that connects consumers to the insurance carriers that can best fit their wants or special needs. Click on link for your free instant Quote, at a reduced price |