health insurance provider

Health Insurance Provider

Health insurance is available on an "individual" or "group" basis, but don't let the terms confuse you.

Individual insurance simply means the plan is not sponsored by an employer, union, or professional association. You may purchase an individual policy that covers your entire family. It's the main option if you're self-employed or work for an employer that doesn't offer benefits.

However, if you are self-employed, know that some health insurance companies offer group health plans for "groups of one." You may opt any plans according to your needs.

Before considering any health insurance plan it is important to investigate what coverage the health insurance provider is offering.

• First, a company without adequate reserves to pay claims should be avoided. Don't rely on funds set up by certain states to provide for insurance companies that become insolvent. They may be inadequately funded themselves.
  


• Second, consider the rate at which the health insurance provider pays claims. Good insurance companies pay claims, based upon the Reasonable & Customary or Usual & Customary Rate (R&C, UCR), that is determined by a third party company. This is based upon charges submitted for claims in a geographical area for medical treatment by all physicians and facilities. They normally will pay claims at a rate up to 75 or 80% of the UCR. The very best health insurance companies pay at the 90th percentile of the R&C charge.

Consider as your minimum standard that the insurance provider should have at least one of the top 3 ratings for financial strength, or claims paying ability, and pay at least at the 80th percentile of the Reasonable & Customary charge for medical claims.