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Individual and family policies may be purchased directly from an insurance carrier such as a Blue Cross Blue Shield company, or through an insurance agent licensed to do business in your state and appointed by insurance companies to represent them. Insurance companies are legally required to charge the same premium whether you purchase your policy directly from the carrier or through a licensed health insurance agent. You should always get quotes from several carriers before choosing a policy and choose an agent appointed by several of the major carriers in your state, particularly if a member of your family has a health issue. See Chapter 4 for step-by-step instructions on how to buy your own low-cost, high-quality individual/family policy. Today, most medical providers, from local pediatricians to big-city hospitals, charge patients who don't belong to their health insurance network far higher prices (sometimes 10 times higher) than they charge to those in their network for the exact same service. How Medical Provider Networks Work—HMOs and PPOs Health Maintenance Organizations (HMOs)—More Restrictions, Lower Cost Preferred Provider Organizations (PPOs)—Fewer Restrictions, Higher Cost Indemnity Plans, EPOs, and POS Plans Choosing between a PPO or HMO How to Choose a Medical Provider Network When Buying Health Insurance Beware—Many Health Benefits Products Are Not “Health Insurance” Financial Protection—What to Look for in a Health Insurance Policy Comparing Different Health Insurance Policies Comparing Policy Features Submitting Your Application—Be Careful! What Health Insurance Companies Look For in Your Application Licensed Independent Health Insurance Agents: Whether to Use One and How To Choose One This is why about 20 percent of the millions of applications submitted every year for individual/family health insurance are formally rejected. Applying and being rejected is very bad because it will be recorded on your permanent health insurance record (your “MIB” report is discussed later in the chapter). This could make it more difficult to get insurance or could permanently raise your premium. Missing or Inaccurate Information on Your Application Could Cause Your Policy to Be Canceled When You Need It Most How Underwriters Verify the Information on Your Application The Medical Information Bureau Insurance underwriters often check the information you put on your application against your Medical Information Bureau (MIB) report. Your MIB report is to your medical history what your credit report is to your financial history or what a Dun & Bradstreet rating is to the creditworthiness of your business.
Virtually every application for individual/family health insurance asks whether you or other family members have ever been rejected for health coverage, have been uprated, or have had an exclusion placed on an offer for a policy. If the answer is yes, you are asked to list the name of the insurance company, reason, and date. My experience has been that the percentage increase on approvals with upratings can sometimes be negotiated to a lower rate. If the underwriter thought that your family was a bad health risk, you would have been rejected. The approval with uprating says the carrier wants you as a paying policyholder.
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| ADDITIONAL RESOURCES FOR THE NEW HEALTH INSURANCE SOLUTION |
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