Health Insurance 101
Residents of the Beach Cities of San Juan Capistrano , San Clemente, Dana Point, Laguna Beach, and surrounding areas Orange County face a bewildering array of health care choices and you don't know the half of it! Health insurance companies have hundreds of health insurance programs unknown to the general public. San Juan Capistrano Health Insurance navigates through these uncharted waters to find the best health insurance benefits for each member of your family. Sometimes that means creating a group health insurance plan for your family. Sometimes it means putting different members of the family into different health insurance plans. San Juan Capistrano Health Insurance keeps at it until you have coverage you can afford. Here are a few health insurance principles to keep in mind:
1. Affordability. Some people fall into the trap of thinking that their health insurance should cover every health issue that could possibly arise from the common cold to brain surgery. The more exhaustive the coverage, the greater the expense, until you reach a point of diminishing returns. Remember, the purpose of insurance is to keep you out of debt, not to drive you into it. San Juan Capistrano Health Insurance will work with you to set a reasonable health insurance budget, then maximize the benefit of every health insurance dollar you spend.
2. Familiarity. If you had health insurance but recently lost it, you might want to stay with the team of doctors your have been visiting. Friar Health insurance will find out if your doctor belongs to an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service), or IPA (Individual Practice Association). Once we have identified the networks your doctor belongs to, we will evaluate the various health insurance plans to your family's needs. If your doctor is not in any network, we will look for an affordable indemnity or "fee-for-service" health insurance plan.
Under an indemnity health insurance plan, you visit any physician you wish. Normally an indemnity play will cover only a portion of the medical charges usually 80 percent. You would have to pay the other 20 percent. In addition, the health insurance company will pay only fit its "usual and customary" rates for services and procedures. If your physician charges more, you are responsible for paying the difference.
3. Pre-existing Conditions. Any medical condition that exists before your enroll with a new health insurance plan is considered "pre-existing." If you are seeking individual health insurance, the health insurance company can declare a waiting period for coverage relating to the pre-existing condition, or it can deny coverage altogether. California is not one of the five states that has made the denial of individual health insurance coverage illegal. The solution for residents of San Juan Capistrano, the Beach Cities, and surrounding areas is to enroll in a group plan. California state law requires health insurance companies to cover pre-existing conditions without a waiting period. San Juan Capistrano Health Insurance has innovative ways to help you find or create a health insurance group plan.
4. Prescription Mediations. One major difference between health insurance plans often comes down to prescription drug benefits. Some plans cover prescription drugs immediately, often requiring only a co-payment. Many plans will not pay for prescription medications until the plan member has met an annual deductible amount. San Juan Capistrano Health Insurance "runs the numbers" on the co-payment charges vs. annual deductibles to ensure that you get the medications you need at the lowest possible "true" cost.
