Individual Health Insurance FAQs

What is a co-payment?

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What is a deductible?

What illnesses and conditions are not covered by a policy?

When you read through a health insurance policy, make sure you understand which injuries and diseases are covered and which are not. There may be strict limits, for example, on the amount paid for treatment for mental illness. Some medical services may be excluded, such as procedures like acupuncture, cosmetic surgery or bone marrow transplants. Some policies do not cover physical therapy, vocational retraining and other such rehabilitation.

Can I keep my own doctor?

Some health plans require you to use only doctors and medical providers that are network members. If you sign up for this kind of policy, you may have to choose a new doctor.

What is the maximum amount the policy will pay out?

Many policies have a maximum amount, such as $250,000, that will be paid toward any one event or illness. People undergoing treatment for cancer, heart disease, spinal cord injuries, organ transplant and other serious conditions can easily accumulate medical bills of over a million dollars.

Do I have to pass a physical examination to get health insurance?

Most insurance companies will not require physical examinations unless you indicate you have a medical condition on the application you fill out. Then, in certain cases a paramedic examination may be required. The company also uses your medical history and your family history to determine your risk of getting sick. Other factors used are age, weight, height, sex, lifestyle choices such as smoking and drinking, and dangers in your job environment to assess your insurability.

Does the policy cover a preexisting condition?

If you already have an ongoing health condition, your policy may exclude coverage for that one problem. However, there may be a time limit on the exclusion, such as one year or even five years. After that period of time passes, your insurance company may consider removing the exclusion.

Can the insurance company cancel my policy if I get sick?

There are laws in many states that do not allow an insurance company to cancel your policy just because you get sick or injured. They are required to pay your claims if you paid your premiums regularly. However, the company has the right to raise your rates or not renew your policy for another term unless you have a "non-cancelable, guaranteed renewable" policy.

How can I determine which policy is the best one for me and my family?

It is very hard to compare insurance policies. Each one offers a different plan at a different price. You have to decide which aspects of the plan are most important to you and what you are willing to pay. One family may be willing to pay more to be able to use certain doctors, hospitals, pharmacies and other services. Another family may be willing to assume some risks themselves by taking a high deductible. Another family may want the choice of going to specialists without first consulting their family doctor. All these factors affect the cost and quality of the policy.

How can I determine which are the best insurance companies?

Insurance companies are rated by Standard & Poor, A.M. Best and other such services. You want a high rated company with a strong record of paying its claims. Some state agencies even keep records of consumer complaints against insurance companies.