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Health Insurance Information

What kinds of health insurance are there?

Health insurance is divided into individual policies and group policies. Individual policies will include a single person up to the members of an immediate family unit (under the age of 26),  while a group policy will include many individuals as well as their immediate family members (under the age of 26).  Group policies are underwritten for businesses, associations, or other people with the commonality of employment. 

  1. Individual Insurance can be subdivided into ACA qualified plans, Short Term Plans, and Health Share/ Co-Op plans.  All of these plans have a value if and when they are issued correctly.  For this reason we always advise that you talk to an Agent who is educated on all health insurance options with multiple Insurance Carriers. 
  2. Group Insurance has the ability to be tailored to a company's specific needs.  Many people think that a small group is at a disadvantage but, they would be wrong.  We at Eden Insurance have sought out Insurance Carriers that can bring advantages to groups of any size. Group Insurance policies can be underwritten for businesses large and small, tradesmen and realtors with 1099 employees, industrial or office businesses. 

For all of your Health Insurance needs contact one of our Health Insurance Agents today!

 

Long-Term Care and Disability

Related to Health Insurance, there are also Long-Term Care policies along with Disability policies.

What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”

Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.

Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.

Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because generally Medicare and most private health insurance pays only for skilled care–not custodial care.

What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):

  1. Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
     
  2. Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand.

  1. Non-cancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
     
  2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.

In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:

  • Additional purchase options
    Your insurance company gives you the right to buy additional insurance at a later time for an additional cost.
     
  • Coordination of benefits
    The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
     
  • Cost of living adjustment (COLA)
    The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
     
  • Residual or partial disability rider
    This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
     
  • Return of premium
    This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
     
  • Waiver of premium provision
    This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.

     

1 - Source : MANAGED CARE AND THE STATES

 

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