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What you need to know before buying Health Insurance  

Is pregnancy a Pre-Existing condition? Maternity Insurance

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Which insurance company and health plan should you choose?

Oxonia's selection of carriers is wide ranging and so are the health plans available from nationally rated companies like Aetna, Assurant Health, Golden Rule a United Healthcare company,Humana Health Plans, and PacifiCare, to name a few.

Carrier's individual and family health plans include popular insurance benefits from office copayments, unlimited doctor's visits, diagnostic labs and x-rays, prescription coverage, to an array of choices of primary and specialty physicians for adults and children, hospital services including centers of excellence nationally recognized for their specialties with specific illnesses.

Carriers also have optional supplemental benefits that aren't included in the basic health plan. Maternity, accidental injury and life insurance, dental, preventive care, are the typical add-on options available in health plans.

Asking questions gets us to where you want to be

In order to determine your coverage needs and increase your chances of acceptance , Oxonia's licensed insurance professionals will ask a set of pre determined questions that may be unusual or expected - but must be asked.

The fact is that an insurance companies' competitive edge are not just their health plans but their diversified eligibility criteria as well.

Golden Rule's Health Insurance Plans criteria differs than of Aetna's or Assurant Health, while one carrier may accept a medical condition such as high blood pressure or high cholesterol at higher readings, the other may exclude it for coverage, accept it with a surcharge on the premium or increase the annual deductible.

Do you qualify?

Eligibility or qualifying for coverage is a fine science. Though there are some commonalities amongst carriers of unacceptable medical conditions such as, AIDS, HIV, Hepatitis C, Paralysis, Psychosis, there are eligibility variances amongst other conditions and state specific laws and regulations that need to be followed. In the states of Louisiana, Michigan and Utah, for example, ridering (excluding) a common medical condition from coverage is not permitted.

Unlike other agencies that manually sift through carrier guidelines handbooks trying to establish where to place their client; Oxonia, in a matter of few minutes, through its automated proprietary web tool, has resolved and positioned the client with an insurance company based on the answers given.

Let's get personal

The accuracy of personal and medical information is critical to carrier selection and acceptance of coverage. Insurance companies based their decision not only on the answers provided on the application for insurance but subscribe to other sources that gather information on a proposed insured's health.

The Medical Insurance Bureau (MIB) is a consumer reporting agency of medical and avocation information for which health and life insurance companies subscribe and report to. This information is obtained from consumers who have applied for life or health insurance with member MIB companies.

Medical conditions usually contributed to the MIB are blood pressure, EKG readings x-rays, height and weight. In addition, lifestyle habits impacting insurability such as risky driver's records are also included.

If you would like to know if the content is accurate and complete on your MIB Consumer File, you have the right to request an annual free disclosure. In addition, if the information on the record is inaccurate or incomplete, you have the right to dispute it and have it corrected in accordance with the procedures given by the Federal Credit Reporting Act.

US residents can request disclosures by calling the MIB at 866- 692- 6901, for the hearing impaired TTY 866-346-3642 or you may submit your request in writing to:
MIB, Inc.
50 Braintree Hill Park, Suite 400
Braintree, MA 02184-8734

Why a licensed insurance professional?

Contact an Oxonia Insurance professional to help you through the eligibility, carrier selection process and major medical plan choices.

A licensed insurance professional is knowledgeable on state-specific regulations, experienced to interpret numerous underwriting assessments and familiar with possible actions taken by insurance companies based on the medical and personal history presented.

Liz Kenneally is the vice president of business development for Oxonia Insurance Group, Inc , a national health insurance agency offering major medical health plans in 46 states for individual, family and groups. In addition, Oxonia is the exclusive distributor of CHCA association memberships that include programs with insurance benefits and guarantee acceptance for ages 18-64 For more information please contact 1-800-254-1047.. If you are a producer and would like information on marketing our products, please contact her by email at ekenneally @ oxoniainsurance.com or call 866-416-7350

Why do you ask?

1. Do you need temporary or permanent health insurance?

• Permanent health insurance is continuous and is guaranteed renewable as long as you continue paying your monthly premiums on time your insurance plan can't be cancelled.

• Short term medical, or temporary insurance is health coverage that lasts for a fixed amount of days 30, 60, 90 120, 180, to maximum of one year.

• Temporary or short term insurance is an ideal solution for in-between life situations such as a job lay-off, college graduate, or employment benefit waiting period.

• Short term health insurance requires proof of insurability every time you apply for another term; unlike, permanent major medical where evidence of insurability is not required after approval and as long as you continue paying your monthly premiums on time.

2. What is your zip code?

• Insurance companies vary their premiums based on numerous variables. One of them being the geographical area in which you reside. Medical costs vary from one zip code to another in the same city as well as from one county to another within the same state.
• Hence, carrier's insurance premiums take into consideration the cost of medicine in your area.

3. Do you need single or family coverage?

• Insurance carriers vary on their health insurance premiums with some having better individual or family premiums in a given area.

4. Why do you ask if I have a checking, savings or credit card?

• Insurance carriers vary on paying methods. While one may accept credit cards as the form of payment, it will only do so for the initial and not the subsequent payments.

5. When would you like your new coverage to become effective?

• Insurance carriers may change rates. As insurance professionals we are aware when carriers may increase or decrease rate in your area.
• Insurance companies underwriting time varies. The sooner we can submit your application for evaluation, the better the chances are to have an approval confirmed prior to the effective date of coverage.

6. Has any person to be covered lived in the USA for less than 12 months?

• Insurance carriers generally have similar residency requirements. Usually, the length of residency for an applicant is to have a minimum of 12 months in the United States. In rare instances, some carriers allow applicants to have as little as 6 month's residency in the USA.

7. What is your height and weight?

• Insurance companies treat overweight and underweight conditions differently and vary in their definition of excess and underweight.
• Carriers may decline an over/under weight client while others may accept them for an additional amount added to the base premium, normally referred to in the industry as "rated", "rate- up", "substandard risk".

8. What is your date of birth?

• Insurance companies' premiums are based on the proposed insured's age. Additionally, all carriers have minimum and maximum ages for individual applications.

• Normally, issue ages vary by carrier, and may start from birth of aged to 64 ½ years of age.

9. Why do you ask if my child is a dependant or a full-time student if they are over the age of 18?

• Classification of dependants by age also varies by company and from one state to another. Most define a child as a dependant up to the age of 24 and must be a full-time student at an accredited college or university in order to add them to a family policy. While in some states, a full time status is not required.

10. Have you used tobacco products within the last 12 months?

• The use of tobacco is considered an increased risk to the insured's health resulting in a higher premium than a non tobacco user. Normally, if you haven't smoked in the past 12 months you are not considered a smoker.

11. Are you pregnant?

• If a woman is currently pregnant, it is considered a declinable pre-existing medical condition with major medical insurance carriers. However, ask Oxonia for alternative programs, such as, Intelicare Health, that helps expectant individuals or families alleviate some of the costs associated with maternity and delivery.

12. Is your spouse pregnant or any member of your immediate family?

• Insurance is in the business of taking on risk. The carriers technically are taking on the risk of unpredictable medical expenses when considering a proposed client for insurance.

In the case of pregnancy, insurance companies consider this as a pre-existing condition; however, the unknown risk is a premature birth with complications or the health of the unborn at the time of birth. The parents may apply for family or individual coverage after the birth of the baby.

13. In the past 12 months, have you taken any prescription medications, excluding birth control?

• Insurance carriers vary with their underwriting actions on prescription use. Dependant on the type of medication being taken, each carrier may accept, rate-up, accept with a waiver, exclude, or decline potential insured's coverage.

14. Do you need coverage for dental, prescription, maternity or preventive care?

• Not all insurance carriers include dental, prescription, maternity or preventive care benefits in their base policy; rather, they offer them as add-on's or commonly referred to as "optional rider benefits" at an added expense.

15. Have you ever had treatment for problems related to any of the following medical conditions: digestive system, female reproductive system, back/spine, high cholesterol, lipids, high blood pressure, psychological/psychiatric disorder or asthma?

• Insurance carriers vary with their underwriting actions for certain medical conditions. Dependant on the treatment or medical condition, carriers can accept, rate-up, exclude condition for coverage or decline.

16. How much out-of-pocket are you comfortable paying each year for medical expenses before the insurance company begin paying?

• Most insurance plans have an annual deductible and a co- insurance percentage.

• An annual deductible is the amount of money you will pay for medical expenses before the insurance company participates in their share of the cost.

A co-insurance is a percentage of the bill that you will share with the insurance company up to a certain amount after you meet your annual deductible. Thereafter, the carrier will pay 100% up to the lifetime maximum of the plan benefit.

• The rule of thumb is that the higher the deductible the lower the monthly premium will be and the higher the out-of- pocket or coinsurance the lower the premium will be.

• Monthly insurance premiums can be adjusted dependant on the number of choices available within a given health plan. Such as the annual deductible, copayments, benefits and lifetime maximums.

• If you are shopping around, you may get different quotes for the same health plan.

Yes, this is possible because carrier's health insurance plans have built- in benefit choices to accommodate different budgets and needs.

However, rest assured that health insurance premiums are regulated by your states Department of Insurance and the different quotes given are based on the choices selected.

17. Do you have a doctor or hospital that is important to you?

• Insurance carriers' have their own provider networks or they lease well known networks with a large e selection of providers nationally, regionally, or locally.

• Beechstreet, PHCS, Great West Healthcare, are examples of provider networks.

• Physicians, hospitals, or other medical providers may choose to contract with one or more networks or none at all.

18. What is your occupation?

• The type of job you do for a living may be hazardous to your health. Insurance companies evaluate the applicant's occupation's risk.

For example, a coal miner is exposed to a higher risk of health
related issues than an office administrative assistant.

• There are some occupations that are declinable and vary by carrier.

19. Do you have any hobbies?

• Yes, hobbies are evaluated for risk as well.
• If you rock climb in the gym for exercise versus mountain climbing in the great outdoors, the greatest potential for risk, of course, is the latter.
• Keep in mind that the frequency or exposure to that risk is what determines if the carrier will accept or decline your application for insurance.

20. Have you been diagnosed with an illness or disease in the past 10 years?

• Insurance companies, like, Aetna, Goldenrule, Humana, Assurant Health, have different underwriting thresholds for certain medical conditions that are acceptable or declinable, or for those that will be rated or excluded for coverage.

• For example a diabetic that is non insulin dependant and within a healthy weight is accepted by one carrier and may be not be with another.

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