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Eight Most Common Health Insurance Questions

By: Kingston J. Amadan

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Understanding health insurance plans is very confusing for most consumers. It doesn’t matter whether you buying health insurance for the first time or just want to consider changing plans. We spoke to some of the industry experts and got answer to some of the most frequently asked questions.
What kinds of individual and family insurance plans are available?
There are three types of Individual and family health insurance plans described as either “indemnity”,"PPO" and "managed-care" plans. Put broadly, the major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, PPO plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different types of health insurance plans. These include HMO, PPO, and POS plans. HMO’s are managed care as the insurance company determines who your doctors are and what care you will receive. POS plans are geographically focused plans that are a cross between a HMO and PPO. PPO’s make use of healthcare provider networks and you are free to choose your own doctors within the network. Healthcare providers within a network agree to perform services for PPO plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a PPO health insurance plan. You’ll have an even broader choice of healthcare providers with an indemnity plan because there is not network; it’s any doctor, any hospital, anywhere.
When can I start making appointments with my physician?
For individual insurance coverage, it depends on how long it takes for your enrollment papers to be processed through underwriting and how long it takes to review your medical records for preexisting conditions. It may take anywhere from two weeks to three months after you have submitted your enrollment paperwork plan carrier to complete underwriting. This delay depends on how long it takes to get records from your physician. Your policy only becomes effective when underwriting is completed and the insurer has agreed to issue a policy. You may see your physician after the effective date.

My spouse is losing his/her job and won't have insurance. When can I add him/her to my health insurance?
If you have group insurance, you may add you spouse during the open enrollment period. But for individual insurance, you may submit you spouse’s application and proceed through the enrollment process at any time.

How do I change health plans?
Each year during the open enrollment period, you may elect to change your health plan carrier under group insurance. You may change your plan at anytime if you have individual insurance.
Are there preexisting condition limitations if I change health plans?
There is no preexisting condition limitation under your new plan when you transfer plans under group insurance. Any condition for which you are receiving treatment prior to your coverage change will be covered immediately by your new plan.
What happens to my health insurance when I retire?
This can be a scary situation. Retirement typically means you are older and may have a possible accumulation of preexisting conditions, which could make you uninsurable, or your preexisting conditions could be excluded. Meaning, you suddenly have to cover the cost of expensive meds or care. Fortunately, Colorado is one of 26 states that provide a safety net through a high risk uninsurable pool. If you have had coverage within 60 days, your preexisting conditions are covered immediately. Otherwise your preexisting conditions will be covered within six months as long as you are a resident of Colorado. You may find further information about this type of coverage at www.covercolorado.org
What happens to my health insurance when I resign from a job?
You are entitled to continue the health coverage for up to 18 months under a Federal law referred to as COBRA. Cost of coverage is borne fully by the employee.

We will be having a child soon. How do I add this child to my health and dental insurance coverage?
You may notify and add new born children within 30 days of their birth date. Adopted children may be added after they fill out an application and go through the enrollment process.
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CORE Magazine is Colorado’s largest source of online information for health insurance in Denver. Visit us for a free issue of CORE and learn more about how to select the best health insurance in Denver.

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