Insurance Guide...

How medical insurance works

Once you purchase insurance, the insurance company will give you an insurance identification card for you to use when you seek care from a hospital or doctor.

The insurance company will also provide written instructions for reporting and documenting medical expenses ("filing a claim"). The insurance company will evaluate any claim you file and make the appropriate payment under your policy. In some cases the insurance company pays the hospital or doctor directly; in others the company will reimburse you after you have paid the bills.

Factors while purchasing insurance

• The reliability of the insurance company. Does it treat people fairly? Does it pay claims promptly? Does it have staff to answer your questions and resolve problems?
• Deductible amounts. Most insurance policies require you to cover part of your health expenses yourself (your part is called the "deductible"), before the company pays anything. Under some policies the deductible is annual, and you pay only once each year if you use the insurance. Under others, you pay the deductible each time you have an illness or injury. In choosing insurance, you should think carefully about how much you could afford to pay out of your own pocket each time you are sick or injured and weight the deductible against the premium before you decide.
• Co-insurance or copayment. Usually, even after you have paid the deductible, an insurance policy pays only a percentage of your medical expenses. The policy might pay 80 percent, for example; the remaining 20 percent, for which you are responsible, is called the coinsurance or copayment. Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $400 deductible and 20 percent copayment would cover $2,080 (80 percent of $2,600).
• Specific limits. Some policies state specific dollar limits on what they will pay for particular services. Other policies pay "usual" or "reasonable and customary" charges, which means they pay what is usually charged in the local area. Be very careful in evaluating policies with specific dollar limits; for serious illnesses, the limit might be far too low and you might have large medical bills not covered by your insurance.
• Lifetime/per-occurrence maximums. Many insurance policies limit the amount they will pay for any single individual's medical bills or for any specific illness or injury. Exchange visitors must have insurance with a maximum of no lower than $50,000 for each specific illness or injury, which may be enough for most conditions. Major illnesses, however, can cost several times that amount.
• Benefit period. Some insurance policies limit the amount of time they will go on paying for each illness or injury. In that case, after the benefit period for a condition has expired, you must pay the full cost of continuing treatment of the illness, even if you are still insured by the company. A policy with a long benefit period provides the best coverage.
• Exclusions. Most insurance policies exclude coverage for certain conditions. The J regulations require that if a particular activity is a part of your exchange visitor program, your insurance must cover injuries resulting from your participation in that activity. Read the list of exclusions carefully so that you understand exactly what is not covered by the policy.
• Pre-existing Conditions. Many insurance policies do not cover pre-existing conditions. If you arrive with a condition that will need medical attention, verify the pre-existing aspect of the policy that you are reviewing.

Choosing an insurance policy

One can compare all the major insurance policies, select and purchase a policy that best suits your preferences using our friendly online insurance quote/compare facilty.

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