Health Insurance Plan
[The typical group health insurance plan allows changes once a year on the anniversary of the original employer purchase (unless changed to another date for some special reason). Annual open enrollment for an employer health insurance plan is usually at that time. However, the first eligibility on an employer health insurance plan is at the end of the employee's initial waiting period after being hired. - ed.]
2. Where Do I Get These Health Plans?
Group Policies
You may be able to get group health coverage—either indemnity or managed care—through your job or the job of a family member.
Many employers allow you to join or change health plans once a year during open enrollment. But once you choose a plan, you must keep it for a year. Discuss choices and limits with your employee benefits office.
Individual Policies
If you are self-employed or if your company does not offer group policies, you may need to buy individual health insurance. Individual policies cost more than group policies.
Some organizations—such as unions, professional associations, or social or civic groups—offer health plans for members. You may want to talk to an insurance broker, who can tell you more about the indemnity and managed care plans that are available for individuals. Some States also provide insurance for very small groups or the self-employed.
[For similar benefits, an individual health insurance plan may actually cost less than group coverage in some states. That occurs when individual plans can decline applications, or issue exclusion riders, because of pre-existing conditions, but group plans cannot. That raises the relative claims cost of group plans, and therefore raises the premium. - ed.]
Medicare Health Insurance Plan
Americans age 65 or older and people with certain disabilities can be covered under Medicare, a Federal health insurance program.
In many parts of the country, people covered under Medicare now have a choice between managed care and indemnity plans. They also can switch their plans for any reason. However, they must officially tell the plan or the local Social Security Office, and the change may not take effect for up to 30 days. Call your local Social Security office or the State office on aging to find out what is available in your area.
[Relative to a Medicare supplement (indemnity), the least expensive Medicare health insurance plan is likely to be from an HMO (managed care), if available, because of the greater cost control and the premium paid to the HMO by the Federal government. -ed.]
Medicaid
Medicaid covers some low-income people (especially children and pregnant women), and disabled people. Medicaid is a joint Federal-State health insurance program that is run by the States.
In some cases, States require people covered under Medicaid to join managed care plans. Insurance plans and State regulations differ, so check with your State Medicaid office to learn more.
[Medicaid is welfare covering medical expenses rather than a health insurance plan for which premium is paid. - ed.]
A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period. However, a new law—called the Health Insurance Portability and Accountability Act—changes the rules.
Under the law, most of which goes into effect on July 1, 1997, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered—without additional waiting periods—even if you have a chronic illness.
If you have a pre-existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months.
To find out how this new law affects you, check with either your employer benefits office or your health plan.
[This pre-existing rule applies to a group coverage, but not necessarily to an individual health insurance plan which can permanently exclude specifically identified pre-existing conditions, if not prohibited by state law. - ed.]
Next - Health Insurance Benefits Return to Contents - Health Insurance