Minor accidents resulting in small fender-benders often cost more than your insurance deductible to have repaired at a traditional auto body shop. If the accident is your fault, then be prepared to pay the deductible.
Auto insurance companies contract with auto body shops for a pre-negotiated rate for repairs. Some practices include requiring low hourly labor rates or forcing the body shop to pay for a rental car if they do not complete repairs timely. These practices often tempt the auto body shop to cut corners, using lower quality materials or neglecting to complete certain steps required for proper repair.
When will the repair work be completed? Quite often, not when promised. Auto body shops like to blame this on a delay in parts delivery when the truth is they took on more business than they could handle. Check out the shop you are using to see if there have been multiple complaints about repairs being completed on time.
Car rentals can be costly; make sure your insurance company covers the type of rental car you need while yours in the shop. Your policy might limit you reimbursement on a small car when you need a minivan.
Some insurance companies prefer auto body shops that use generic or salvage replacement parts to save money. This is fine for some repairs, but original-equipment manufacturer (OEM) parts are always designed to match perfectly and in some cases may be safer. If you are in an accident and you are determined to be at fault then there could be wording in your insurance policy that requires you to use lower quality parts or pay the difference for OEM replacement parts. If you are not at fault, be sure to tell the shop to use only OEM parts.
Many foreign made cars require special equipment and a high degree of precision to perform repairs properly. If you drive a foreign car make sure the shop you choose is certified by the manufacturer to do the work. Your insurance company will not be likely to recommend these shops because they charge higher rates; however, they should be willing to pay to repair your vehicle to its original condition.
Does your insurance company provide a parts and service warranty? If so, its useless! The auto body shops guarantee is the one that is important to you; most body shops guarantee their work and the parts manufacturers guarantee the parts.
Insurance companies have negotiated so many discounts with auto body shops that in order for the shop to stay in business they do lower quality repair work. Check with the Better Business Bureau, Vehicle Information Services or other agencies that monitor the quality of work done by auto body shops to be sure you are getting good service.
Joaquin Hernandez owns Collision on Wheels, a mobile auto body shop in the Los Angeles area. He comes to you at your home or workplace to provide auto scratch and dent repair, auto painting, and collision repair. Work is done in one day or less and the charge is often less than your insurance deductible. Visit http://www.collisiononwheels.com to learn more.
Minor accidents resulting in small fender-benders often cost more than your insurance deductible to have repaired at a traditional auto body shop. If the accident is your fault, then be prepared to pay the deductible.
If My Property Suffers Damage Do I Need A Scope of Loss?
By: Ronald R. Reitz, CPPA
For many people that suffered losses to their properties following the 2007 Southern California wildfires, the phrase Scope of Loss has become an all too familiar term. However, many homeowners do not fully understand the value of a Scope of Loss and whether or not they will really need one following a disaster or fire.
A Scope of Loss is a detailed, line-item breakdown of all the items and services necessary to rebuild or repair a damaged property. One can refer generally to a Scope as the extent of the loss. Most commonly, a Scope of Loss will be broken down by room and trade so one can easily identify all damages that are being addressed. While most Scopes of Loss include the price associated with each line item, it is not a requirement they be included.
In some occasions, it may be advantageous to not include the price. For example, if you are in the process of obtaining competitive bids from various contractors and they are all bidding on the same items, it is not appropriate to share each of the contractors pricing.
Why An Independent Scope of Loss is Needed
I am often asked why it is necessary for the insured to obtain their own Scope of Loss since the insurer will be creating one. We have found that insureds often need to have an independent opinion of the cost required to rebuild their property and to have a document that includes all insured items.
There are many occasions, especially in a partial loss, where not all damage is covered under the policy. Since it is the insureds duty to prove their loss, they need to know how to properly present it to the insurance company, as well as to have a thorough understanding of what is covered and excluded. Certainly, an insured would not want to claim damages that are excluded in the policy. A Scope of Loss is limited to the damages that are covered or believed to be covered under the insureds policy.
Because a public insurance adjuster will be the expert on the coverages afforded the insured in their policy, the ideal solution is for a public insurance adjuster to work in conjunction with a contractor to produce a Scope of Loss.
The contractor will be much better versed on current prices, on construction costs and changes to building codes than the adjusters. It is true that many construction companies that focus their business on insurance restoration work are able to prepare a Scope of Loss but since contractors are not trained and licensed to understand the complex nature of insurance policies, they are at a disadvantage relative to coverages. By the way, when looking for a public insurance adjuster, remember that not all public adjusters know how to create a Scope of Loss.
Many times an insurer and insured disagree on the extent or scope of their loss. In addition, the insurer and insured also have different opinions on the coverages their insurance policy affords them.
A Scope of Loss is a great tool for the insured to help narrow those differences.
If you only have one opinion (the insurers), how are you able to determine the reasonableness of an insurers settlement offer? An independent opinion is a much better way to truly know how fair the settlement offer is. A properly prepared Scope of Loss is also great tool for the insured to know whether an offer from their insurance carrier to settle their claim is reasonable.
I would encourage anyone that has suffered an insured loss to obtain an independent Scope of Loss so that you can make informed decisions about settling your claim.
Author Bio – Ronald R. Reitz, CPPA, President of Quality Claims Management, http://www.qualityclaims.com, pioneered the National Hazard Insurance Claims business of GMAC-RFC (now GMAC-ResCap). Mr. Reitz left GMAC-ResCap in January 2007 after ten years of managing the Insurance Services group. He is the past President of the California Association of Public Insurance Adjusters (CAPIA) and is currently an officer on the Board of Directors of the National Association of Public Insurance Adjusters (NAPIA). Recognized as a leading expert on hazard claims, he is serving on many industry panels, as well as providing consulting and training services industry-wide.
Quality Claims Management Corporation provides hazard claim recovery services to investors, mortgage servicers, homeowners and businesses. All claims are adjusted by licensed insurance professionals for an equitable settlement and accelerated resolution timelines. Quality Claims is nationally licensed as Public Insurance Adjusters or Insurance Consultants and complies with Department of Insurance Regulations
Insurance acts like guards and protects the individual and his property. It is always advisable to get insurance done for complete safety and assurance. It is a protection against the unexpected. It helps cover costs from accidents or any unforeseen situation.
All businesses require some kind of insurance in order to protect their business from any damage or loss. These owners gain advantage over the insurance plan which is intended to financially protect them from various damages. Any business has its costs and can be risky too. Getting insured safeguards and leaves you tension free. Because of the uncertainties of life it becomes imperative to get insurance done.
The different insurance companies offer different insurance plans for your benefit. You just have to choose the right one and the one which suits you and your business best.
Insurance policies are a vital part of your business. Any insurance company providing any insurance is entitled to understand the requirements of its client and should be able to provide maximum entitlement. In most insurance companies the cost of the premiums are based on the type of work that you do, number of employees you have, and your claims history.
Why is commercial insurance necessary?
Commercial insurance is necessary because it saves you from many hazards that can destroy or damage the building. For instance… a storm, a short circuit, the wrath of nature in the form of tornado, tsunami or even an earthquake can bring the whole building into rubble. So to safeguard your assets and to lessen the financial risk it is always advised to get the insurance done.
Insurance companies act like guards and give you the opportunity to fulfill your dreams with a relaxed mind and allow you to concentrate on your goals. They secure your dreams. The insurance companies know that insurance is all about peace of mind.
Imar in Australia insures any kind of business, trade and buildings. It is a company committed to providing their clients with maximum and the highest level of service, so that when you take out a policy you receive much more. imar covers all transit damage, product liability, underground services, result of faulty workmanship etc. The company also relieves you from the burden of paper work, managing mostly on their own.
The company is very confident of its policy and the offers that they give. They even guarantee to refund back your complete premium if you wish to withdraw your policy within 21 days of taking it. Everything is fair and handled with utmost care and ingenuity.
The company has a dedicated team who works efficiently and with full dedication. The experts of the company very well understand your needs and the types of policies you need. If unfortunately some disaster occurs, imar helps you instantly, quickly just at one call of yours.
They offer the commercial property insurance at the best price. To understand more please click to http://www.imar.com.au/
The primary explanation why you need an affordable wellness insurance coverage should be to assist you program ahead in case of unexpected costly emergencies. The only way you can achieve that is to evaluate rates from most leading insurance coverage firms as well as picking a well being insurance strategy that most effective suits you. Back inside the days, acquiring a affordable overall health insurance coverage strategy was just unaffordable. But lately, folks, smaller groups, families and students can choose a overall health insurance strategy that is certainly best for them, e.g. like acquiring a enable insurance coverage program that ensures that a person affected by any prior health-related condition will not be excluded.
Private wellness insurance coverage plan is completely an unrestricted open marketplace, so those that do not yet have a wellness insurance plan must take into account taking out a plan. For all those who are seeking excellent medical wellness insurance coverage system, having a single is attainable by means of the enable of particular corporations which specializes in offering health care insurance coverage for folks and also meeting their needs and also staying within your budget.
Also for individuals who usually do not choose to use a organization, then they will use the net. One significant way Americans get overall health insurance coverage coverage is mainly through their employers. Numerous employers them receive well being insurance coverage coverage for their workers for any limited time hence enabling them get wellness insurance coverage. The internet gives an choice for a more affordable overall health insurance coverage. There are lots of firms that present all types of well being insurance plans, producing it attainable for you and your family to possess a particular affordable and reasonably priced health care insurance program. Obtaining out what kind of reputation the business has and how long the organization has been in small business is actually a wise idea.
Obtaining a sort of best they’ve for you is advisable also making sure they’ve been licensed inside your state, because it can be of no use getting an insurance coverage using a kind which has no license and cant get the exact wellness insurance coverage you need, many agents will assist perform tough for you, so you could have an inexpensive health insurance coverage plan which you and your family could live with devoid of terrific cost. Every person desires the top health insurance both for themselves and for their households, but only the most effective wellness care insurance can do this with low premiums and complete coverage.
Obtaining the proper and the greatest wellness care Insurance Lyndhurst NJ is tough. In order not to get confused, a single must choose which the top is by carrying out their study thoroughly. The first step to take incorporates checking out the credentials as well as their past performances of the quite business you will be considering. Just as on insurance coverage outfits does a background check of folks just before accepting proposals, one should really also review the economic status such as the customer care solutions from the insurer, by so carrying out; you stand the likelihood to understand which well being insurance coverage company’s greatest for you. One particular major way for you to get ratings of these agencies like A.M best or Moody’s is by utilizing the greater small business bureau. Lots of employers use the health insurance scheme to either attract or perhaps retain their high-quality employers. The overall Hime Insurance Rutherford NJ coverage may be a individual scheme or even a group scheme organized.
Did you know that an insurance broker can actually get you a far better deal on your insurance?
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What is the difference between an Independent Insurance Agent Brokerage like SURVIVAL INSURANCE and a privately owned company such as State Farm Insurance, Progressive Insurance or Allstate insurance? What exactly are the auto insurance rules?
To make it simple, the major difference is that a brokerage represents multiple insurance companies competing with each other and offering brokers a discounted rate to sell their product, whereas a “Captive Agent” from a company such as State Farm insurance, Allstate Insurance or Farmers Insurance can only represent his or her own agency’s prices.
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Healthcare costs have risen dramatically over the course of the past two decades. Indeed, in different parts of the world, concern over potential healthcare and medical costs is the biggest worry of a significant segment of the population. You may be one of those people who carry the burden of worrying about how you will pay for medical bills and healthcare costs that you might face in the future. As a result, you may be interested in identifying reliable health insurance. In this regard, the Internet and World Wide Web can be useful tool in your personal hunt for health insurance.
As you begin your search for reliable health insurance on the Internet and World Wide Web, your first stopping point should be one or another of the independent insurance reference and information websites that are maintained on the Net. There are a variety of different websites that have been established by different associations and organizations that provide independent evaluations of different types of insurance products, including health insurance policies.
In addition to spending time evaluating the information provided at websites operated by independent organizations and associations on the Net, you will also want to pay a visit to the Internet venue maintained by the Commissioner of Insurance in your home state. Each and every Insurance Commissioner in the United States operates a consumer assistance division within his or her office. These divisions are established to assist consumer in better understanding the different types of insurance products that are available in any given state. (The availability of insurance policies and products differs from state to state.) Through these Internet websites, a consumer such as yourself can order useful handbooks and other materials that can assist you in locating valuable health insurance and in selecting the health insurance coverage that best meets your needs.
After you have spent some time online amassing some independently prepared information about various insurance products and health insurance, you will be in a position to turn your attention to examining what is available from specific insurance companies. Every major insurance company in the United States — and in many other locations around the globe — maintain Internet websites that provide detailed information about their products and services.
Naturally, you do need to keep in mind that the whole purpose behind an insurance company website is to induce you to purchase that company’s products and services. (That is the reason why it is important to arm yourself with independently prepared information and unbiased health insurance in advance of visiting these insurance industry created websites.)
By accessing individual insurance company websites, you can identify specific health insurance on an insurer by insurer basis. By taking the specific information that you will be able to glean from websites hosted by insurance companies, together with the independent evaluations and information that you have obtained from independent associations and organizations and from the Insurance Commissioner’s staff, you will be able to make very intelligent insurance purchasing decisions.
With the habit of taking improper diet and increasing number of road accidents, it has become very important to have a health insurance plan for everyone. It does not matter – whether you are a self employed or your company does not offer coverage, you can take an individual or family health insurance by contacting insurance consultants. There are a number of insurance agents helping people to get a plan suiting their requirement. Health insurance plants are vital as the coverage saves individuals from financial disaster. If you want to know extensively about a plan, then make online search now. Even you can contact professionals to relate your requirements.
Exploring health insurance plans
Before selecting such a plan, you are advised to make a widespread search through the internet to stumble upon the necessary information about the specific plans. Thereafter, you will be able to evaluate the varied benefits and coverage of the available plans. Do not purchase a plan before carrying out your primary purpose. Your primary work would be distinguishing your expectation from the plan and that should meet the priorities. If you are not capable to settle on a suitable plan, you need to take the support of online insurance consultants. They are round the clock available and can be reached within a few clicks.
Some popular health insurance plans
There are a number of plans come in the USA helping people to cover their health. Some the the popular plants frequently sold in the USA include:
COBRA Insurance Alternatives
Health Savings Account (HAS)
Copay Insurance (Copay)
Catastrophic Health Insurance
High Deductible Health Insurance
Benefits of purchasing a health plan
A health plan provider fulfills the need of every customer by providing a number of health plans, including individual health plans, family health plans and group health plans. These plans are introduced not only to fit into the budget of customers, but also go with the individual health care needs. For having a number of features for example annual physical, routine in-network physician visits and vaccination office visits, in-network covered lab work and in-network preventive dental care for covered persons, the plans has become the most adored in the USA. In fact, the plans come in with some latest features for women as well.
How to find an insurance provider?
If you are looking for an insurance provider, male online search as it has been considered as one of the easiest way to search anything. Of late, netizens want everything within the click of a mouse. So, why you are lacking behind?
An insurance quote is an estimate of how much your insurance might cost using a given firm. If you do not get several estimates, then you’ll not have a good idea of what form of a price which you need to be investing in homeowners insurance. The 2nd point that you need to be on the lookout for when searching for home insurance quotes in Shelby Townshipis that you get quoted for all the insurance that you require and not merely basic choices.
Everyone has their own small differences as it pertains to obtaining homeowners insurance. There isn’t any one size fits all strategy. Which means that when you seek house insurance quotes in Mich, you ought to be taking your time and ensuring you receive the top quotes for your situation. Bear in mind to seek multiple quotes, get cited for enough coverage to everything that you simply need covered, and never spend for a estimate.
For instance, most house plans by default will simply protect the real construction itself, and only standard challenges. Common perils are such things as locate and wind damage. This implies the fact that if something happens to your own house, it’ll likely be safeguarded under most fundamental home insurance plans. But, if something happens to your own possessions, they are going to not most likely be covered.
When you visit try to find house insurance quotes in Shelby Township, you wish to guarantee you hold a list of everything that you simply need covered. MI does not have a tendency to get lots of extreme weather, therefore you are good on that front. However, in case you’ve got numerous structures in your property or plenty of valuables inside your house, then you’ll want to make sure your quote includes all of those.
House insurance quotes in Shelby Township are merely estimations which will enable you to figure out about how much you ought to be spending money on house insurance. In case you take your time plus get multiple quotes, pretty soon you should receive a feel for just how much you should be paying for house insurance.
For a free quote call (586) 799-3149 or click here: home insurance quotes Shelby Township MI
A drunk driving charge offense as well as indictment may turn out to be truly difficult on all facets in your life. From your job to your driving status to your freedom, it can have wide-reaching impact. That being said, drunk driving has an important effect on your own monetary position by way of your own car insurance. Neglecting this can be serious, as it is essentially the most profound implications regarding this specific offense. Finally everything is determined by precisely how your own offense is classified and also it is dependent upon the quantity of you’ve had. The following is some good information concerning exactly how drunk driving can influence your current capability to acquire insurance coverage along with your insurance charges moving forward.
The most important question: Precisely how can it be deemed?
The primary inquiries that you should establish regarding your driving under the influence is simply exactly how it is actually labeled. This is extremely very important to insurance coverage uses along with nearly all insurance companies. As an illustration, in case you could have simply ended up arraigned with a dangerous driving offense, your insurance coverage can increase, although not much. There are lots of lower violations that men and women can certainly plead with which won’t affect their particular insurance policies very substantially. Not until it truly is ultimately considered driving under the influence offense is the insurance plan likely to notice the true effect. That is why folks should be totally conscious of their particular condition as well as need to in addition battle regarding reduced allegations once probable.
The actual accessibility of insurance coverage
In case you have obtained drunk driving, subsequently you ought to understand the initial concern is gonna be accessibility. Numerous insurance coverage companies pick never to attach with driving under the influence convicts. These people don’t need the danger and also virtually all insurance plan deals possess a condition which allows all of them to lose you if you get cought driving under the influence. If you’re presently within a system with the insurance company, you must initially go as well as verify your own insurance coverage agreement to find out just how these people think with regards to the situation. When they have a condition that claims they’re able to eliminate your own insurance, consequently you need to prepare yourself for getting kicked outside with that particular insurer. This is not going to generally take place, yet it truly is an extremely genuine possibility which should be well prepared for thoroughly.
There may also be a big influence on the supply of completely new insurance coverage companies. You might need to search for a niche insurance company which deals with driving under the influence convicts. This will likely reduce your own selections as the customer and this will result in the total approach a lot more hard when compared with what you may have imagined. Although quite a few common providers will provide you with a possibility, the majority is not going to. Appreciate this to be able to customize your current hunt towards all those specific businesses who are going to do business together with you as well as your different circumstance.
A re-ranking of your own insurance policy
Furthermore you will need to cope with a brand new kind of auto insurance. The insurance coverage providers have got just what is called heavy risk insurance coverage. You are able to specifically continue with the same kind of insurance coverage. When it comes to numerous providers, this is what’s called SR-22 insurance coverage. It truly is insurance which includes numerous requisites and you will without difficulty forfeit this specific insurance policy coverage when you are making errors while traveling once more. Becoming deemed with SR-22 is difficult as this will certainly regularly stick to you for the time period of five-years. Although typical insurance coverage maintains items off of your own history right after 36 months, drunk motorist insurance policies are completely different.
A rise in charge
In addition to heading to SR-22 insurance policy, you will realize greater prices. The actual premium can vary dependant on which firm you might be choosing, although SR-22 is often inside the five thousand dollars each year spectrum for many people. This can be a large step-up in the one thousand each year prices that men and women are accustomed to. The actual substantial rise is because of the additional threat that the SR-22 motorist has. This can be destined to be a truth of daily life if you are planning to go on drive an automobile immediately after you may have encounter driving under the influence condition.
Understanding health insurance and the health industry is much easier if you recognize some of the basic terminology and how it applies to you and your health insurance policy. If you have a health insurance plan and arent sure how it works or what the terminology means, take a few minutes to read the explanations below. Knowing these terms and what they mean to you can greatly aid you in dealing with your health care providers, insurance company, insurance agent, or during the health benefits shopping process.
This is the 12-month period in which your benefits are calculated. Most insurance companies use a CALENDAR year, which is January 1 to December 31, but a few will use a 12 month period from when your policy goes into effect. For example, if your insurance goes into effect on June 1, the END of your benefit year is May 31. Make sure that you understand how your benefit year will be calculated.
Deductible means the amount of money you must pay out of your pocket for medical expenses EACH YEAR before your health insurance begins paying out. Deductibles are usually reset to 0 at the beginning of each calendar or benefit year. Many insurance companies offer health plans that have benefits that are not subject to having to meet your deductible each year such as doctors office visits, immunizations, wellness or routine exams, etc. An easy way to remember what this term means and how it works is this:
When you have incurred medical expenses, all bills must be sent to the insurance company. When the insurance company looks at your bills, they then look at your policy and see how things are covered. They will then add up what the combined medical expenses have been for the year to date: determine what your deductible is and how much you have already paid towards meeting your deductible for the year, and pay out according to how your insurance policy says it will.
So in a nutshell, the insurance company is deducting your financial responsibility for medical expenses each year from the total combined medical expenses before they have any responsibility to pay outhence the term deductible.
A co-pay is an amount that is paid by the patient to a provider at the time of service. It will either be a flat fee (like $15 or $20) or it can be a percentage of the service provided. The percentages or fee may vary depending on the type of service provided. A co-pay is different than coinsurance see next.
Coinsurance is the percentage paid by the insurance company after you pay the deductible. Example: Your health insurance pays 70%, you pay 30%. The insurance company pays 70% coinsurance, you pay 30% coinsurance. Most health insurance policies will have a limit on the amount of coinsurance you have to pay out each year this is known as your Annual Coinsurance Maximum or Stop-loss.
Annual Coinsurance Maximum
After paying your deductible and after paying your coinsurance (classically 20% or 30% of medical expenses) to a certain dollar amount, your health insurance will pay 100% for the remaining costs in the calendar year. Example: After you pay your deductible, your health insurance pays 70% of medical expenses and you pay 30%. Once you reach the coinsurance maximum, you no longer pay 30% of the medical expenses because the insurance pays 100%.
Out of Pocket Maximum or Stop Loss
Stop Loss is the maximum amount of money you will have to pay out of your pocket in the benefit year.
This is the limit of the money the health insurance will pay out over your lifetime. Most major medical health insurance policies will be a $2 million lifetime maximum, while others will go as high as a $12 million lifetime maximum. In general, it is not recommended to have a policy with less than a $2 million lifetime maximum.
When you visit a doctor in their office they normally bill the health insurance company for an “office visit.” Most health insurance plans pay office visit expenses at the coinsurance (generally 70% or 80%) after the deductible. Some health insurance plans pay office visit expenses at the coinsurance rate but waive the deductible, which means you dont have to reach the deductible amount before they will cover their portion of the expense. Still other health insurance plans pay office visit expenses in full after a co-pay (usually $25 or $30). It should also be noted that office visits can be classified in two different categories. One category is usually called Routine Care, Wellness visits or Preventative care (see definition below). The other type of office visit is deemed as Medically Necessary (see definition below). Certain health insurance policies cover each of these types of visits differently and other plans do not cover them at all. If having these types of office visits covered by your health insurance policy is important to you, make sure you let your agent know so that they can help find the right plan for you.
Preventive Care is classically defined as routine exams, immunizations, well child care, and cancer screenings. These include your yearly exams and checkups for things such as physicals, pap smears, mammograms, etc. Not all plans cover preventive care. It may not be a wise use of your money to have preventative care included in your plan if you never go to the doctor. A good health insurance agent can help you determine if this is necessary coverage for you.
These are the visits utilized for your smaller ailments such as colds, flu, ear infections or minor accidents. Not all plans cover medically necessary visits, so make sure you know if your policy includes these exams if you need them covered. You may consider purchasing accident insurance or adding a rider (explained below) to your policy to cover these types of issues.
Diagnostic Lab and X-Ray
These are tests involving laboratory or imaging services (such as x-ray, CAT scan, etc.) to diagnose a health problem. These services are usually paid at the coinsurance (typically 70% or 80%) after the deductible.
When you visit a chiropractor for spinal manipulation or other services, these expenses are customarily paid at the coinsurance rate (70% or 80%) either after the deductible is met, or by waiving the deductible. Most health insurance plans limit the number of chiropractic visits/services to 10 or 12 per year especially if the deductible is waived. After this, additional visits are not paid by the health insurance plan, and you will be responsible for the full amount of the bill.
Inpatient or Outpatient Care
When you receive care from a hospital (inpatient or outpatient services), these expenses are customarily paid at the coinsurance rate (70% or 80%) after the deductible has been met.
When you receive care from a hospital emergency room, these expenses are customarily paid at the coinsurance level (70% or 80%) after the deductible. Most health insurance plans also require you to pay an additional co-pay (commonly $75-$100) for each emergency room visit. A number of plans waive this additional co-pay if you are actually admitted to the hospital through the emergency room and the plan will pay as an inpatient service. A plan can sometimes be structured to have separate coverage for accidents as an additional rider (see definition below) to your policy.
Prescription medications can be classified as generic, brand name, or non-preferred brand name (see below for definitions). Please Note: Not all health insurance plans pay for prescription drugs, so if you already take prescription drugs or think you will need help in the future with prescription drugs, you will want to make sure that you are purchasing a plan that includes this coverage. Prescription drugs may be covered at the coinsurance rate (70-80%) after a deductible specifically for prescription drugs is met, other plans may include Prescription drugs in the total deductible for the plan.
Drug manufacturers are permitted to sell a generic version of a medication after the patent expires for the brand name medication (generally 20 years after the brand name medication was registered). Generic medications are equivalent to the corresponding brand name medication, but are much less expensive than the brand name medication. Health insurance plans frequently provide better payment for generic medications as an incentive for you to ask for the generic version. About half of all prescription medications filled in the United States are filled with generic medications.
Brand Name Medications
Brand name medications are more expensive than generic medications. Most health insurance plans create a limited list of brand name medications that they will pay for and many health insurance plans also provide less coverage for brand name medications than for their generic counterparts.
Non-Preferred Brand Name Medications
Most health insurance plans create a limited list of brand name medications they will pay for. If your brand name medication is not on this list, it might be paid at a lower level under “Non-Preferred Brand Name Medications.”
Some health insurance plans cover the cost of maternity, which includes doctor and hospital charges for prenatal care as well as labor and delivery. Maternity is expensive to add into a health insurance policy because it is considered a guaranteed expense for the insurance company. If a woman becomes pregnant, it is a safe bet that there is going to be medical expenses incurred! If there are no complications and the birth goes well, the insurance company will be out a large monetary portion of the cost of delivery and even more if there are problems with the delivery or the newborn. Insurance companies price maternity so that they can still maintain profits. In some cases it may be best to save your money and pay for the prenatal care and the delivery out of your own pocket (or on a credit card) and let the insurance cover the catastrophic events. The difference you save in the monthly cost of having maternity coverage may be well worth it to you. Remember, once you have a policy that covers maternity, you cant just remove the maternity coverage after the pregnancy is done! You will continue to pay for that maternity coverage for as long as you have that policy.
Mammography is a specific type of imaging that uses a low-dose x-ray system for the examination of breasts to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms. Current guidelines from the American Cancer Society (ACS), and the American Medical Association (AMA) recommend a screening mammography every year for women, beginning at age 40. Various plans will have automatic coverage for mammograms but some will not. Several states (like Washington State, for example) have specific guidelines that require companies to have coverage for mammograms in their policies as an automatic benefit.
Outpatient mental health services include visits to a licensed counselor, therapist, or psychiatrist. Inpatient mental health services include admission to a psychiatric hospital. Many plans do not cover mental health services.
Rehabilitation therapy may include physical therapy, occupational therapy, speech therapy, message therapy, cardiac rehabilitation, and chronic pain therapy. Most health insurance plans limit rehabilitation therapy to a certain number of visits per calendar year or to a certain dollar amount that they will pay for rehabilitation for either the year or for a lifetime.
Anything that changes the way your policy acts by default is called a Rider. A rider can be anything from an exclusion of coverage for a medical condition, or additional coverage for potential conditions. (As in an accident rider mentioned earlier in this report)
Occupational Coverage/On the job coverage
The largest portion of health insurance plans do not cover occupational related medical expenses. This can be a HUGE pitfall for self employed people. Always make sure that if you need to be covered while you are working that your plan will give you on the job coverage. If you get injured or sick while you are on the job and you do not have Workmans Compensation or Labor and Industries accident coverage, you may have to pay for ALL medical expenses out of your own pocket.
Vision coverage is usually broken into two parts: vision exam, and vision hardware. Vision exam benefits include the cost of a refractive exam used to test vision acuity (20/20, 20/40, etc.). Vision hardware represents the cost of eye glasses or contact lenses. A number of health insurance plans do not cover vision exams or hardware. However, medical issues relating to the health of the eye (like Glaucoma) are almost always covered under the regular medical portion of the health insurance plan.
Each insurance company will have a list of doctors that the company has negotiated terms for payment of services with. You can go to the insurance company’s website to find a listing of contracted preferred providers.
This information may help you understand a policy that you already have, or aid you in understanding a policy that you may be thinking about purchasing. The more knowledge you have about what the industry jargon means, the more you will be able to make informed decisions about the insurance you choose to use.