INDIVIDUAL HEALTH CARE

 Benefits Design Resources is there to assist health care consumers in the evaluation, selection and purchase of individual health care insurance plans.  Purchasing health care insurance should be the first step in securing your financial security; therefore, is a matter that should not be taken likely.  Individual health care insurance can be purchased directly from insurance companies or through the Internet, but these options do not provide the personal guidance offered by Benefits Design Resources to assure  consumers are making the most appropriate buying decision.

INSURANCE COMPANIES REPRESENTED

 Benefits Design Resources is selective in the insurance companies we will represent.  Currently Benefits Design Resources represents and recommends the following individual health care insurance plans: 

·       Aetna

·       Humana

·       Golden Rules (UnitedHealthcare)

·       VISTA Healthplan

These companies were selected due to the company’s financial stability, industry reputation, extensive networks, competitive prices and user-friendly underwriting process.  Each of these companies has unique features and products to accommodate the varied needs of each individual applicant.

PRODUCTS

 The companies which Benefit Design Resources recommend only offer PPO plans, which mean insured members have the option to use network or non-network medical providers.  The insured member has a lower out-of-pocket expense when using providers included in the insurance company’s network of physicians, hospital and other health care providers. Patients may also use non network provider but will incur a greater out-of-pocket expense. Additionally, insured members are not required to select PCPs; thus, members will have direct access to specialist, referrals are not required.

 The insurance coverage offered through Aetna, Humana and Golden Rules has benefits similar to insurance coverage normally seen in employer health plans.  These plans offer a variety of       co pay options for network physician office visits, prescription drug co pays, individual deductibles ranging for $500 to $5,000 and calendar year out-of-pocket maximum protection.  HSA medical plans and dental plans, on a limited basis, are also available.

 UNDERWRITING REQUIREMENTS

 Individual health care insurance plans require medical underwriting.  This means an application for insurance must be submitted to the insurance company, which requires full disclosure of applicant’s current medical status and prior medical history.  Depending on the medical status, applicants may be required to submit medical records or to complete a partial physical exam, which the insurance company will incur the expense.

  Each company has specific underwriting requirements and guidelines.  Of course applicants without any medical conditions will normally flow quickly through the underwriting process.  Applicants with current or prior health care conditions may require more assistance in the selection of the insurance company and assistance in the preparation and submission of the application.  There are some medical conditions that underwriting will not consider under any circumstance; however, other conditions may be acceptable, provided the condition is thoroughly explained on the initial applications.

 Individuals with medical conditions may or may not be acceptable to the insurance company.  Based on the severity of the medical condition, the insurance company may either:

 1. Accept the applicant at standard rates

2. Exclude a specific condition from coverage

3. Add a financial surcharge to the monthly rate, or

4. Reject the applicant.

 Our goal is to help prospective clients achieve number 1; otherwise, make sure clients are aware of their options.

WHO ARE PROSPECTIVE CUSTOMERS

Self employed individuals – Those who may not have access to a group health care insurance plan is the ideal prospective customer for an individual health care insurance plan.

Real Estate Agents, Mortgage Brokers and other contracted individuals - Individuals in these industries usually are not eligible to enroll in the health care insurance plan for the firm they represent.  An individual insurance plan may be the only option available.

COBRA Participant – Individuals who are currently on COBRA or approaching the end of their COBRA eligibility.

Alternative to Employer Health Plan – Employers usually contribute to the cost of the employee insurance but may not contribute towards the cost of the dependent health care insurance.  Consumers may find an individual insurance plan to be a cost effective alternative to cover dependents.