FAQ Health

Maybe. Many factors must be considered, such as: Do I plan to remain at my current job? Do I feel secure in my current job? What current benefits does my employer provide, and do I feel they are sufficient? Are there certain benefits that are not provided, or limited in a way I feel leaves a gap to be filled in my coverages? Are there members of my family who are not adequately covered, or are ineligible, for my group benefits?

Discuss these issues with your Henry O. Baker agent and he or she can make a recommendation as to the best choices to assure your medical coverages are adequate for your needs.

This is the most common form of individual or group health insurance is a major medical health policy. It provides benefits for sickness or injury, regardless of whether the care is provided at a doctor’s office, clinic or hospital. The types of sickness and injury covered are typically broad, although there are always limitations that should be discussed with your Henry O. Baker agent prior to purchasing the coverage. Major medical policies normally have an annual deductible and a lifetime maximum amount of benefits that will be paid.

A deductible is an amount you must pay before the insurance company begins to pay your bills. This is an annual amount per insured person, although typically there will be a maximum amount of deductibles you will have to pay in a given year. For example, if your “per person” deductible is $500, and you have five people in your family covered under your health insurance, the maximum family deductible will usually be $1,500. Once three of the people in your family have paid out a $500 deductible, no more deductibles will apply to any member of the family for the remainder of the year. This can vary, so be sure to discuss the specifics of your policy with your Henry O. Baker agent.

Disability income is a form of health insurance that is designed to provide you with an income during the time you are unable to work due to illness or injury.

In its simplest sense, it means you are unable to work. But it’s important you realize the definition of the term under a given disability income policy will be specified by that policy. The broader the definition of disability, the higher the cost and increased limits to the underwriting restrictions. For example, some policies will define disability to mean the inability to reasonably perform the duties of your occupation, while another will define it as the inability to reasonably perform the duties of any occupation. How significant is this difference in a single word? To use an extreme example, if you were a highly trained surgeon, the first policy would pay you if you were sufficiently injured that you couldn’t perform surgery. The second would refuse to pay if you could perform any job even sweeping floors or answering phones. Despite the obvious loss of income when going from surgeon to receptionist, the policy definition of disability will determine whether you will receive benefits for a specific policy. As you might guess, the second policy is likely to be a great deal less expensive. Also, you can see your current occupation is the single most important factor in determining what type of disability policy and coverage options you will be eligible for.

This stands for Preferred Provider Organization. Basically, this is a network of healthcare providers who have agreed to provide certain services at agreed-upon costs for individuals whose coverage is a part of the network. (Some suggest it is best described as a discount-buying club for medical care.) You are free to use any medical provider within the network, and all will honor the agreed services and fees. If you choose to use a provider who is not an approved member of the network, your coverage may be diminished, your personal cost higher or, in some cases, benefits for non-emergency services may be totally denied. Be sure to discuss with your Henry O. Baker agent if your coverage will utilize one or more PPOs, who are the current approved providers, and how utilizing an out-of-network provider will affect your coverage.

This stands for Health Maintenance Organization. Unlike a PPO network of independent care providers, HMOs are typically fixed facilities, and benefits are designed to cover services obtained at the HMO facilities and supplied by HMO personnel. HMO coverage plans must specify how and under what circumstances services may be obtained from non-HMO providers, and this information is crucial to determining the value of the HMO under your particular circumstances. Your Henry O. Baker agent can assist you in determining whether there are good HMO options available in your area, their benefits, and any limitations for you to consider in making your final medical coverage choices.

By assembling a network of providers who agree to provide services at a discount (PPO) or by requiring you to get all of your services from a specific provider, with an emphasis on preventative care (HMO), the hope is to provide you the best possible care at the lowest possible costs. A downside is such benefits and discounts require a great deal of control over your healthcare options by the PPO or HMO, and not all the limitations are popular or convenient. And whether these approaches are always successful is subject to the ongoing debate, and results can vary greatly by where you live.

You can buy health insurance that basically says go to whomever you want and have them send us the bill (often referred to as indemnity coverage), but it lacks the negotiated cost discounts and overview of services (meant to dissuade providers from over-treating and over billing) that PPOs and HMOs utilize to try and keep costs lower. Thus an indemnity policy may be readily available to you but may be significantly more expensive than a coverage plan utilizing a PPO or HMO. Ask your Henry O. Baker agent for your options and possible premiums, and then choose the coverage method that best meets your personal preferences and needs.