What kinds of health
insurance are there?
There are essentially
two kinds of heath
insurance:
Fee-for-Service and
Managed Care. Although
these plans differ, they
both cover an array of
medical, surgical and
hospital expenses. Most
cover prescription drugs
and some also offer
dental coverage.
-
Fee-for-Service
These plans
generally assume
that the medical
professional will be
paid a fee for each
service provided to
the patient.
Patients are seen by
a doctor of their
choice and the claim
is filed by either
the medical provider
or the patient.
-
Managed Care
More than half of
all Americans have
some kind of
managed-care plan.
Various plans work
differently and can
include: health
maintenance
organizations
(HM0s), preferred
provider
organizations (PPOs)
and point-of-service
(POS) plans. These
plans provide
comprehensive health
services to their
members and offer
financial incentives
to patients who use
the providers in the
plan.
What is 'long-term
care'?
Because of old age,
mental or physical
illness, or injury, some
people find themselves
in need of help with
eating, bathing,
dressing, toileting or
continence, and/or
transferring (e.g.,
getting out of a chair
or out of bed). These
six actions are called
Activities of Daily
Living–sometimes
referred to as ADLs. In
general, if you can’t do
two or more of these
activities, or if you
have a cognitive
impairment, you are said
to need “long-term
care.”
Long-term care isn’t a
very helpful name for
this type of situation
because, for one thing,
it might not last for a
long time. Some people
who need ADL services
might need them only for
a few months or less.
Many people think that
long-term care is
provided exclusively in
a nursing home. It can
be, but it can also be
provided in an adult day
care center, an assisted
living facility, or at
home.
Assistance with ADLs,
called “custodial care,”
may be provided in the
same place as (and
therefore is sometimes
confused with) “skilled
care.” Skilled care
means medical, nursing,
or rehabilitative
services, including help
taking medicine,
undergoing testing (e.g.
blood pressure), or
other similar services.
This distinction is
important because
Medicare and most
private health insurance
pays only for skilled
care–not custodial care.
What are the types of
disability insurance?
There are two types of
disability policies:
Short-Term Disability
(STD) and Long-Term
Disability (LTD):
-
Short-Term
Disability policies
(STD) have a waiting
period of 0 to 14
days with a maximum
benefit period of no
longer than two
years.
-
Long-Term Disability
policies (LTD) have
a waiting period of
several weeks to
several months with
a maximum benefit
period ranging from
a few years to the
rest of your life.
Disability policies have
two different protection
features that are
important to understand.
-
Non-cancelable means
the policy cannot be
canceled by the
insurance company,
except for
nonpayment of
premiums. This gives
you the right to
renew the policy
every year without
an increase in the
premium or a
reduction in
benefits.
-
Guaranteed renewable
gives you the right
to renew the policy
with the same
benefits and not
have the policy
canceled by the
company. However,
your insurer has the
right to increase
your premiums as
long as it does so
for all other
policyholders in the
same rating class as
you.
In addition to the
traditional disability
policies, there are
several options you
should consider when
purchasing a policy:
-
Additional purchase
options
Your insurance
company gives you
the right to buy
additional insurance
at a later time.
-
Coordination of
benefits
The amount of
benefits you receive
from your insurance
company is dependent
on other benefits
you receive because
of your disability.
Your policy
specifies a target
amount you will
receive from all the
policies combined,
so this policy will
make up the
difference not paid
by other policies.
-
Cost of living
adjustment (COLA)
The COLA increases
your disability
benefits over time
based on the
increased cost of
living measured by
the Consumer Price
Index. You will pay
a higher premium if
you select the COLA.
-
Residual or partial
disability rider
This provision
allows you to return
to work part-time,
collect part of your
salary and receive a
partial disability
payment if you are
still partially
disabled.
-
Return of premium
This provision
requires the
insurance company to
refund part of your
premium if no claims
are made for a
specific period of
time declared in the
policy.
-
Waiver of premium
provision
This clause means
that you do not have
to pay premiums on
the policy after
you’re disabled for
90 days.