Frequently Asked Questions on Health Insurance
Written by Tina Phu, Yun Yang   


1. What’s the difference between primary and secondary coverages?
Primary coverage is provided through the plan of which they are a member (such as the spouses both covered through their respective employment - the primary coverage is provided under the plan provided by the employer of each spouse) or the plan under which the member has been a participant for the longest time period.

Secondary coverage, usually as a result of being covered as a dependent under someone else's health insurance plan, provides reimbursement for medical expenses after exhaustion of coverage available through the primary plan.

2. I don’t want my policy. Can I give it back?
Depends on what the policy says and the type of insurance bought. Medicare supplement insurance have a 30-day period during which you can review the coverage, and if dissatisfied, cancel and have your money refunded. On the other hand, other policies have a “free look” period when you can cancel coverage. And still others do not offer this feature. Check out the front policy of the page for the “word”.

3. I’m between jobs. What are my insurance options?
As a stop-gap measure, you could invest in a short-term policy. Written for a two to six month period, they generally cover hospitalization, intensive care, surgical and doctors’ care in and out of the hospital, X-rays and lab tests. Or, if you belong to any professional organization or group, or a trade union, you may try to get a policy at a low group rate.

4. I’m vacationing outside the United States for several months. What are my insurance options?
For starters, check out your own individual policy for such specifics. Insurance companies differ in coverage for out-of-country visits. You might also want to consider picking up a short-term medical evacuation policy to pay your return to the US in case of a medical emergency.

5. Does my employer have to provide health care coverage?
No. But if so, certain state and federal regulations may apply as well as certain requirements, such as full-time status, may be imposed.

6. I belong to an HMO, but I want to see an out-of-network specialist. What can I do?
In most cases, HMOs do not pay for services administered by an out-of-network specialist. Try asking your primary care physician (PCP) to refer you to the out-of-network specialist you want to see and explain to your PCP why you need to see that specialist. If he/she refuses, what you can do is either pay for the out-of-network service out of your pocket, or switch to a PCP who would refer you. You can appeal to your HMO, and if you appeal persistently, your HMO pay end up paying for the out-of-network service.

7. What is considered a preexisting condition?
A preexisting condition is whatever the insurance company says it is. If you don’t like or agree with one company’s definition of a preexisting condition, look for health insurance at another company. A preexisting condition is usually a condition you are currently being treated for, or a condition you treated in the past few years and there is a gap in medical insurance.

8. How long does it take for a company to pay a medical claim?
The company has 45 days to either deny or pay a claim once proof has been received.

9. Will my insurance company cover plastic surgery?
Health insurance companies typically cover plastic surgery that is considered medically necessary, such as reconstructive surgery after an accident or breast reconstruction surgery after a mastectomy. However, health insurance companies do not cover cosmetic plastic surgery such as rhinoplasty, breast implants, face-lifts, liposuction, etc.

10. Will chiropractic care be covered by my health insurance policy?
Check your health insurance coverage plan or call the customer service department of your insurance company to ask. Many insurance companies cover chiropractic services, and as chiropractic care is becoming more mainstream

11. How about health insurance for kids heading off to college?
Health insurance plans generally cover your kids until your kids are somewhere between 20 and 24 years old. Consider getting a health insurance plan through your child’s college. Student health insurance plans are generally low in cost.

12. Can/should I get disability insurance if I am self-employed?
Yes, you can get disability insurance if you are self-employed—it is actually recommended. If you are self-employed and cannot work due to a sudden disability, you wouldn’t have paid sick leave to cover you for the time you’re not working. Disability insurance would be able to cover this period of time that you’re not able to work. Hence, if you are self-employed, consider getting disability insurance and check whether you have enough cash reserves to carry you through a period of disability.

13. My insurance company rescinded my policy. What does this mean?
Rescission means that your policy will be null and void from the beginning. This may have occurred due to inaccurate or incomplete information submitted on the application, or due to your omission of information on your application. All premiums you paid will be refunded to you.

14. My insurance company is delaying a claim I made, stating that they were checking for a preexisting condition. I know I don’t have a preexisting condition. What should I do?
If your policy is less than two years old, they have a right to check for a preexisting condition. If your policy is more than two years old, they don’t have a right to do this. You can file a complaint to your state department of insurance.
Last Updated on Sunday, 26 December 2010 20:22