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  Family Medical Insurance Overview-Getting Family Health Insurance Through a Private Health Plan

Families that do not have access to group health insurance through an employer must rely on a private health plan. There are many insurance companies in each state that offer a private, individual health insurance plan on which you can include your family members as dependents. There are several premium classes for individual health insurance plans: subscriber only, subscriber and spouse, subscriber and child, subscriber and children, and family. Like a group plan, the insurance company will publish a different premium for each of these combinations. The rates are often based on the age of the "subscriber", who is called the primary applicant. For this reason, you will probably want to make the youngest spouse the primary applicant when shopping for rates or applying for coverage. In some states, this will not make a difference in premium because the insurance companies will consider the rate of each adult independently in determining the family medical insurance premium. Ask your insurance company or agent how the rates are calculated prior to choosing which parent to list as the primary insured.

Insuring Under Separate Policies

In some cases, it might make sense to insure your family members under separate policies. You should especially look into this option if you and your spouse have only one child. The insurance company may charge you the "family" rate if all three of you are included on the same policy. In this situation, you want to look at various rate combinations to determine which is the most cost effective and offers the lowest total combined premium. Here are the rate combinations to consider in this situation:

  • Family
  • Subscriber (Husband) and Child + Separate Single Adult (Wife)
  • Subscriber (Wife) and Child + Separate Single Adult (Husband)
  • Subscriber and Spouse + Separate Child Only

Multiple Plans Under One Family Policy

Some insurance companies that offer individual and family health insurance may allow you to select different plans and still remain under the same policy. This can be a convenient and cost effective option if you have family members with different health care needs. For instance, you may want just basic hospital coverage for the father, coverage with maternity benefits for the mother, and comprehensive coverage with preventive care benefits for the children. Not all insurance companies offer this multiple plan choice option. Ask you insurance company or agent if this option is available. You may also want to contact a broker that represents several different insurance companies, since they can help you look at many different individual health plan options for your family. There is no additional cost involved in using the services of a broker that is licensed to sell health insurance in your state.

Know The Details of Your Policy

When you are shopping for family health insurance, the plan details that are available to you are just an overview of the details of the policy. You are provided with a summary of benefits, but not all of the details of the policy. This may be available to you upon request, but is typically not provided until you have been approved for coverage and become a plan member. For group health insurance, the insurance company will send you the health plan details once you have enrolled in the group health plan. The plan details, also referred to as "evidence of coverage," is a booklet that provides you with all of the details about the plan in which you are enrolled. This will include a list of all the medical benefits that are covered under your family health plan, but in much greater detail than a standard benefit summary.

Evidence of Coverage

The Evidence of Coverage booklet will usually be mailed to you along with your insurance cards upon enrollment in a new health plan. In many states, there is a "free-look" provision for all health insurance policies that allows you to cancel your coverage and receive a full return on your premium if you are not satisfied with the details of the plan, as provided in the Evidence of Coverage. Although the plan details can be confusing and tedious to read, always take the time to review these policy details within the "free-look" period. Knowing the plan details will help you to understand the requirements and benefits of your new family health insurance policy. This is essential in getting the most benefits from your new insurance.



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