Thursday, November 5, 2009

Are You Really Covered With Your Health Care? - Part 2


  • Follow The Rules. Every major insurance carrier offers many plans, each with distinct rules and requirements. Again, check you Summary Plan Description to make sure you know exactly what yours are because if you don't follow them, it could cost you. For example, you might be covered for an operation in the hospital but you don't realize that one of your attending physicians is not part of your health plan. Then, you'll be paying more than you expected. If you aren't sure whether a particular doctor participates in your health plan, check not only with the insurance company but also with the doctor's billing staff.
  • Don't Get Locked Out. under HIPAA, insurers can't deny your complete coverage as long as you switch from one plan to the next within 63 days (more in some states) and your earlier coverage lasted for at least a year. Do what you can to avoid that 63-day gap, for example, by joining your spouse's plan or continuing with your old job's health plan under federal COBRA rules.
  • Understand COBRA. (Consolidated Omnibus Budget Reconciliation Act) allows you to continue your group coverage after you leave your job (unless your group is less than 20 people). But you generally have to pay the entire premium, including the portion that your employer used to pay. If you have serious condition, COBRA might be the only coverage you can get. You can usually stay with COBRA for 18 months. It's as well helpful for young adults who "age out" of their parent's plan; they can keep COBRA for up to 3 years.
  • Fight Back. You have certain rights under state or federal law to appeal health-plan decisions you think are wrong.