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Individual Medical Insurance Overview

What is individual & family medical insurance?
Individual, or family, health insurance is also commonly known as personal health insurance or private health insurance. Most insurance companies offering this product will refer to it as individual health insurance. Family health insurance, where you, your spouse and your children are all on the same plan, is still referred to as an individual health plan. This is the type of policy you would purchase for yourself and your family if your employer does not provide insurance benefits to its employees. You may also consider family medical insurance if you are self-employed, unemployed or a student. Individual and family health insurance plans are available for newborns on up to the seniors at age 65. Once a person turns 65, they become eligible for Medicare and medicare supplemental insurance, and must forfeit their individual medical insurance policy.

How are individual health insurance plans different?
The qualifications and regulations that govern individual medical insurance vary from state to state and from one insurance company to another. In all states, the primary difference between group (those plans offered through an employer) and family health insurance is that the health plans available to individuals and families are not guaranteed issue. This means that the private health insurance company may turn you down for coverage based on pre-existing medical conditions or they may approve you for medical insurance coverage but exclude benefits for treatments associated with your pre-existing condition. This is what is referred to as an "exclusionary rider," which is an addendum to the standard benefits offered under the health plan that you have selected. Some states do not permit insurance companies to place exclusionary riders on individual health insurance policies. This may seem like a good thing on the surface, but the rate of declined applications is much higher in this case because, if the personal medical insurance company is not able to exclude benefits for pre-existing conditions, they will choose not to offer you coverage. The most common example of this is California health insurance. You should research your state's regulations governing individual and family medical insurance.

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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