At Premier Capital Management, Inc. we are independent. We can
offer our clients several different highly rated health insurance
companies. Some of those companies include:
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We offer custom planning for individual policies as well as custom
designed plans for group policies.
With today’s rising health care costs, extreme cost consciousness
threatens to erode health benefits. Whether the consumer is looking
for an individual health insurance plan or trying to decide whether
the group plan their employer offers will be sufficient for them
and/or their family, it is a maze of plans, options, requirements
and obscurities.
Health insurance is a necessity. It provides vitally important
financial protection for individuals and families. Lack of
insurance can mean going without needed health care, having to use
lower quality care, or having to pay medical expenses out-of-pocket
without insurance reimbursement.
Health insurance protection is protection that provides benefits for
covered sickness or injury. It is protection, for an agreed price,
against the cost resulting from specific health risks. It is
interesting that we have so much health insurance activity in the US
because health care does not meet many of the traditional criteria
for insurance. Usually insurance is provided to protect against an
unexpected and undesirable loss. For example, fire or theft
insurance on a residence or casualty insurance on an automobile
protect against an unpredictable and undesirable but clearly defined
adverse event. The person needs protection from the financial
burden of a loss.
Health Insurance - How
It Works
Without health insurance, a single illness can cause serious, and
often irrevocable, financial hardship.
Insurance of any kind is intended to transfer financial risk to an
insurance company in exchange for a reasonable insurance premium.
Where most insurance coverages pay once a loss has occurred, health
insurance has the added benefit of paying to keep your loss from
getting worse.
Health insurance is probably your most important coverage since it
can be the difference between life and death.
Fortunately, most employers offer some form of health insurance.
Often you will have to select from several different alternative
plans with differing coverages and premiums.
There are two broad categories of health insurance coverage. One is fee-for-service and the other is managed health care.
Under managed health care there are health maintenance organizations
(HMOs), preferred provider organizations (PPOs), and
point-of-service (POS) plans.
Fee-for-service and managed health plans have distinct differences
in the amount of control the policyholder has in choosing doctors
and hospitals. Fee for service plans offer you the greatest amount
of choices, allowing you to select doctors and hospitals based on
your needs and preferences. This greater amount of choice comes at
a cost, fee for service plans are usually more expensive than
managed care plan.
Under a fee for service plan, your doctor will submit a bill to your
insurance provider, or, if he or she does not have a relationship
with your provider, you may have to pay the bill directly and get
reimbursed by your provider. Under this plan you can see any doctor
you wish. You will most likely be responsible for a percentage of
every expense, often 20%.
Fee-for-service plans also have an annual deductible; these
generally start at $100 for individuals and $500 for families.
Generally speaking, the higher the deductible, the lower your
premiums. Before receiving the reimbursement you'll have to pay the
deductible amount.
If your doctor charges more than is "reasonable," you will have to
pay the difference. You can appeal this if you feel the doctor is
charging the same as the other doctors around your area.
Under fee for service plans there is usually a limit to how much you
will have to pay before the plan reimburses you at 100%. Some plans
also have a lifetime limit on benefits, usually at least $1,000,000.
This seems very high but it is not uncommon in serious situations
that this number is met.
There are three major types of managed care health plans: HMOs, PPOs,
and POSs. Many of these plans charge a co-payment of $10 or $20 a
visit. The disadvantage of an HMO is that you must use the doctor
and hospitals that participate in the plan. The premiums are
generally lower than fee-for-service plans.
With a managed care plan you will have to select a primary physician
who will be responsible for coordinating your care. You will need to
be approved by him to seek care by a specialist. You must also get
authorization for any hospitalization you may require. As you can
see, the lower premiums associated with managed care are the result
of allowing the managed care provider to make many of your health
care decisions for you.
PPOs and POSs differ from HMOs in that not only do they have a
network of providers, but you are also allowed to use physicians
outside the network.
If you choose not to utilize the coverage offered at work, or if no
coverage is available through your employer, you could get your own
personal policy or go through a group. Group policies have lower
premiums. Also, some group policies do not ask questions about your
health. Nevertheless, some policies will not cover preexisting
conditions for up to 12 months. You will want to understand all the
pre-existing limitations that your coverage includes. If you have
had health coverage for at least 2 years and change employment you
won't be affected by the exclusion.
If you are terminated from or leave a job where health insurance was
provided for you, the government has established guidelines for
maintaining your old coverage at your own expense until you can find
new coverage.
