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Slide 1: Your Top Ten Checklist •Buying Individual Health Insurance Ohio • Tracy McManamon • One Source Benefits • 877-549-1212
Slide 2: www.onesourcebenefits.com 1. Cost is More Than Premiums 22
Slide 3: www.onesourcebenefits.com 1. Cost is More Than Premiums Premiums based on many different factors • Type of coverage • Deductible and other costsharing features • Network • Health status • Age • Gender (where permissible) • Geographic location 3
Slide 4: www.onesourcebenefits.com 1. Cost is More Than Premiums Deductibles Amount you pay out of your pocket 4
Slide 5: www.onesourcebenefits.com 1. Cost is More Than Premiums How much are you comfortable paying? Lower deductible = higher premium Higher premium = lower deductible Higher Premium Lower Deductible Higher Deductible Lower Premium 55
Slide 6: www.onesourcebenefits.com 2. How Coinsurance and Copays Work Coinsurance • Health insurance plan pays percentage, you pay percentage • Coinsurance may apply only to certain items like hospitalization • Use of “in-network provider” services reduces your coinsurance costs • Look at your maximum out-of-pocket expenses 6
Slide 7: www.onesourcebenefits.com 2. How Coinsurance and Copays Work Copays You pay fixed dollar amount for doctor visit or prescription 77
Slide 8: www.onesourcebenefits.com 3. Hospital Coverage 88
Slide 9: www.onesourcebenefits.com 3. Hospital Coverage Review limits • Length of hospital stays • Outpatient treatments • Tests • Doctor or specialist visits, medication while in hospital, and any inpatient hospital deductible 9
Slide 10: www.onesourcebenefits.com 4. Importance of Networks Provider Networks • Contracted doctors, hospitals, pharmacies, etc. • Health insurance plans distinguish benefits and costs by networks • “In network” often less expensive than “out of network” 10
Slide 11: www.onesourcebenefits.com 5. Preventive Care Look for: Preventive care • Blood pressure • Certain cancer screenings, • Type 2 diabetes screenings • Vaccinations Annual physicals Routine GYN exams • 100% coverage • No copay, no dollar maximum • No deductible, no waiting period 11
Slide 12: www.onesourcebenefits.com 5. Preventive Care Eyewear Hearing aids and services Acupuncture, massage therapy, vitamins Gym memberships * Look for: Discounts and savings * At some clubs, participation in this program may be restricted to new club members. 1212
Slide 13: www.onesourcebenefits.com 6. Prescription Medication • Work with a pharmacy that is in your health insurer’s network • Generics usually cost less than name brands • Look for difference in price from generic to name brand • Lower copay for generics • Check formulary for specific medications 1313
Slide 14: www.onesourcebenefits.com 6. Prescription Medication • Mail order Rx convenience • Specialty drugs like insulin delivered to your door 14
Slide 15: www.onesourcebenefits.com 7. Types of Health Insurance Plans • Broader-based health insurance plans have most coverage • Available in lower and higher deductibles • Higher deductible = lower premium • Health Savings Account (HSA)compatible high deductible plans – Out-of-pocket can go up to $5,950 for individuals 15
Slide 16: www.onesourcebenefits.com 7. Types of Health Insurance Plans Health Savings Accounts (HSAs) • Deposit money into special account at bank • In 2010 up to $3,050 for single and $6,150 family • Pay no tax on amount deposited, grows tax-free • No tax on earnings for qualified health care expenses • Must use money for health care expenses to qualify for tax breaks 16
Slide 17: www.onesourcebenefits.com 7. Types of Health Insurance Plans Health Savings Accounts (HSAs) • Can roll over year after year • Must have annual deductible of at least $1,200 single, $2,400 family 1717
Slide 18: www.onesourcebenefits.com 7. Types of Health Insurance Plans Limited benefit plans • Also referred to as “hospital plans” • Less expensive than broader-based coverage • Might be right for people who: – Want to save money – Consider themselves relatively healthy – Want to protect themselves from hospital stays 18
Slide 19: www.onesourcebenefits.com 7. Types of Health Insurance Plans Limited benefit plans • Do not usually cover doctor visits or medications • May cover generics • Know what you’re buying 19
Slide 20: www.onesourcebenefits.com 7. Types of Health Insurance Plans What to consider • Overall health • Need for doctor visits, tests, hospitalization • Medication now, in future 20
Slide 21: www.onesourcebenefits.com 8. Applying for Health Insurance Plans • You’ll be asked for medical history • May deny you or charge higher premium based on history • Agent should pre-qualify before applying • Consider your situation: job transition, early retirement, own business 21
Slide 22: www.onesourcebenefits.com 9. Health Care Reform Most changes not until 2014 2010 changes include: • Temporary government program for those denied due to pre-existing condition • Lifetime limits to be lifted • Companies cannot cancel or discontinue your coverage retroactively except for non-payment, fraud, or intentional misrepresentation of material fact. • No pre-existing coverage exclusions for enrollees under the age of 19 2222
Slide 23: www.onesourcebenefits.com 9. Health Care Reform Most changes not until 2014 2010 changes include: • No out-of-pocket max for calendar year • Will not have to share cost of in-network “recommended” preventive care • Eligible dependent children okay to stay on plan until 26th birthday 2323
Slide 24: www.onesourcebenefits.com 10. Who to Work With Professionals • Registered, licensed agent • Reputable, stable company Will help you • Get the right health insurance plan for what you need • Analyze your situation Time and advice, no extra charge 2424
Slide 25: www.onesourcebenefits.com Your Top Ten Checklist 1. Cost Is More Than Premiums 2. How Coinsurance, Copays Work 3. Hospital Coverage 4. Importance of Networks 5. Preventive Care 6. Prescription Medication 7. Types of Health Insurance Plans Available 8. Applying for Health Insurance Plans 9. Health Care Reform 10. Who to Work With 2525
Slide 26: www.onesourcebenefits.com Aetna Advantage Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company (Aetna) directly and/or through an out-of-state blanket trust or Aetna Health Inc. In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. To the extent permitted by law, these plans are medically underwritten and you may be declined coverage in accordance with your health condition. This material is for information only. Plans may be subject to medical underwriting or other restrictions. Rates and benefits vary by location. Plans not available in all states. Health insurance plans contain exclusions and limitations. Investment services are independently offered by the HSA Administrator. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc. that operate through mail order. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Information is believed to be accurate as of the production date; however, it is subject to change. 2626
Slide 27: Thank You. Visit Us At www.onesourcebenefits.com 13.25.300.1 (10/10) 27