Supplemental Insurance with Health Insurance

Being an Employee Benefits Insurance Broker, I often get the question “Why do I need Supplemental Insurance if I have good Health Insurance?”  Well, the best answer is that if you have good insurance or bad insurance, your health insurance plan is going to pay doctors, hospitals, pharmacies, etc.  Your health insurance company is not going to pay you.  Normally a supplemental insurance policy will pay the policyholder directly, it covers out-of-pocket expenses and services that typically your health insurance does not pay for.

Some supplemental insurances will pay for out of pocket expenses such as deductibles, coinsurances, and copayments.  Others may provide you with a cash benefit paid out over a period of time or in a lump sum.  The cash can be used to cover lost wages, transportation related to your health condition, or used to pay for food, medication and other unexpected expenses you have due to an illness or injury.

The important thing to remember is Supplement Insurance is just a supplement.  It by no means is meant to replace your health insurance.  It is meant to enhance your health insurance plan.

Most common types of Supplemental Insurance policies sold are Accident, Critical Illness and Hospitalization.  These are cash benefit plans and are typically made available through your employer by payroll deduction or you may purchase them independently through an Insurance Agent.  Currently, our agency is offering these products through Assurant Health, Humana and Unum.

Accident:  pays for medical costs resulting from an accident.  Some of these policies will even cover your extended homecare services and travel and lodging expenses for family members.

Critical Illness:  some policies will separate out the cancer and critical illness policies instead of lumping them together but they are one in the same in the fact that they pay due to a disease specific diagnosis.  Both policies are meant to ease the financial burden of a serious illness.

Hospitalization:  pays a cash benefit if you are “confined” to a hospital due to an illness or injury.

BE AWARE, although many of these supplemental coverages are fairly inexpensive duplicate coverage may be unnecessary.  It is always good to sit down and review all of your current insurance policies with your agent prior to purchasing any new insurance.  Here are a few questions to ask yourself if you are thinking you might need supplemental insurance:

  1. If I or a family member gets into a serious accident or develops a serious illness, will our insurance policy cover all costs for treatment?
  2. How likely is it that I or a member of my family will get into an accident or develop a serious illness?
  3. Does the extra cost of the supplemental insurance make sense over time?

Additionally, when purchasing supplemental insurance; it is important to understand the limitations and benefits.  For example, it could impose benefit waiting periods or limits on how much the payments will be over a period of time or per accident/illness.

Before signing on the dotted line, just make sure you understand the benefits in full.  Ask all questions.  Remember there are no dumb questions when it comes to your insurance benefits!


What is Uninsured Motorists Coverage? And why do I need it??

How many times do you get a quote from the insurance company and you see the additional line item of Uninsured Motorists or Underinsured Motorist Coverage?  Do you ever think…”oh I can cut that out and save money”!  All agents automatically include this in their quotes as it is our duty to make sure all of our covered policy holders are fully protected in the event of an accident.  

What does this cover?  Uninsured/Underinsured motorists coverage protects you should you get in an accident with someone whom has no insurance or not enough insurance.  This coverage can pay for injuries to you and any of your passengers; and even property damage should there be another driver deemed at fault with either no insurance or not adequate insurance.

What is the difference in Uninsured and Underinsured Motorists?  An uninsured motorist is a person who does not carry the state mandated limits of liability or has NO insurance at all.  An underinsured motorist is a person who carries insurance and meets the minimum state mandated limits of liability; however, does not have payment limits high enough to cover the costs of the damage he/she has caused.

Is this required coverage?  Each state is different.  It is best to ask your agent if this is required in your state and if so, what limits are required.

It is important to note that if you are in an accident whether it is with an fully insured driver, uninsured driver or underinsured driver, ALWAYS contact your insurance to see what is the best way to handle an accident.  It is never a good idea to try to settle on a payment with another driver by yourself.  If you do settle on payment by yourself, you will NOT be able to file any claim against your insurance for that incident.  

Why do you want this coverage?  You want Uninsured/Underinsured motorists coverage because if you are in an accident with someone who doesn’t have any insurance or does not have adequate insurance, you want to be made financially whole again.  You have to protect yourself first!

Paying Yourself First

Ways to “Pay yourself first”  …set up an Emergency Fund

1.  Talk with your bank.  Ask them to set up a Savings Withdrawal out of your Checking Account Monthly.   Rule of thumb is 5-10% of your income.

  • Allows you to:
    • Build up Emergency Fund
    • Earn Interest
    • Have money available in an emergency instead of having a credit card at high interest rates

2.  Cut down on un-needed expenses.  Bring a lunch.

  • Average American spends $5 per day on sodas, candy or fast food.
    • $140/month
    • $1,820/year

3.  Revisit all of your bills.  You might be paying more for a service that you can get cheaper elsewhere and still have the same product.

4.  Purchase Generic Products when possible over brand name products.

  • If you take generic Prescription Drugs visit Wal-Mart, Walgreens and other pharmacies to see if that prescription is on their plan to pay a smaller copay than what you pay on your insurance.

5.  Avoid IMPULSE buying…if you think you need an item, wait a few days and if you still need it; then shop around for the best price.

6.  Stop Smoking…

  • Average American pays $8 for a pack of cigarettes.
    • By stopping smoking that is a $2,920 savings per year for those that smoke 1 pack /day.

7. Review your interest rates on credit cards.

By following some of these basic steps, you could build up an Emergency Fund in order to assist you with the unknown expenses that come around when you least expect them.  Deductibles on health insurance are only getting higher and medical costs are on the rise.  It’s better to prepare for the unexpected.


Emergency Room VS. Urgent Care

When trying to settle medical bills, don’t be afraid to negotiate.  Emergency rooms are not always the fastest choice for your medical care needs—and certainly not the most cost-effective. For conditions that aren’t life-threatening, you may be able to save time—and money—by going to your local urgent care facility.  These freestanding walk-in centers usually offer extended hours, and their doctors can treat non-life-threatening medical situations, perform basic X-rays and lab work, and dispense prescriptions. 

Emergency room vs. urgent care facility
Franz Ritucci, MD, president of the American Academy of Urgent Care Medicine, recalls a Florida woman in her 40s who came to him with chest pain and heart palpitations. He took her medical history and did a physical exam, including a 3-D electrocardiogram and a check of her blood-oxygen levels. In less than an hour, she was diagnosed with a panic attack, given a prescription for anxiety medication, and discharged. Her cost: less than $400. 

Had she gone to the emergency room with the same symptoms, the routine treatment would be far more intensive. “She would get a full panel blood work, probably cardiac enzymes, serial EKGs,” says Dr. Ritucci. “She would be on a heart monitor, probably have a cardiology consult, and maybe an admission to the hospital of less than 24 hours. The standard of care might be excellent, but the costs can quickly get out of hand.” Estimated bill: $2,000 or more. 

Emergency room
When to go: If you have symptoms of heart attack or stroke, or feel that your “life or limb” is in danger, go immediately to the emergency room. Also, if you think you might be having a medical emergency, but aren’t sure, go to the ER. According to the American College of Emergency Physicians, you should visit the ER if you have any of the following warning signs: 

  • Chest pain or pressure
  • Uncontrolled bleeding
  • Sudden or severe pain
  • Coughing or vomiting blood
  • Difficulty breathing or shortness of breath
  • Sudden dizziness, weakness, or changes in vision
  • Severe or persistent vomiting or diarrhea
  • Changes in mental status, such as confusion

If you have a chronic condition, discuss in advance with your primary care doctor under what circumstances you should go to the ER. 

How to find one: If you have a choice of emergency rooms nearby, ask your primary care physician which he or she recommends before you need to go. Also, check with your insurer to see which facilities belong to your insurer’s network, and whether the amount of ER coverage differs at in-network and out-of-network hospitals. 

See how the hospital rates on important quality measures including care for heart attacks, heart failure, pneumonia, or surgery, by checking the U.S. Department of Health & Human Services’ consumer-oriented Hospital Compare online tool. 

Cost: According to the federal Agency for Healthcare Research and Quality, the average cost of an emergency room visit in 2003 (the most recent year for which statistics are available) was $560. 

Urgent care center
When to go: Urgent care facilities are for non-life-threatening conditions that need attention right away. These include minor traumas such as cuts, sprains, eye injuries, flu, fever, insect bites, and simple fractures. Patients are usually seen on a walk-in basis, and many centers have extended hours. (By administering an EKG or adjusting your diabetes medication, urgent care centers can even help manage your chronic health conditions after normal business hours, when your family doctor may not be available.) 

Most urgent care centers have computerized radiology equipment and the ability to do lab work such as a complete blood count (CBC) test or electrolyte test. They can also run diagnostic tests for conditions such as mono, strep, pregnancy, flu, and viruses, according to Dr. Ritucci. In some states, urgent care centers can dispense the same medications as a pharmacy. 

Many urgent care centers are staffed with at least one board certified physician. But they often use “physician extenders,” such as nurse practitioners, who are certified to treat certain ailments, and physician assistants, who generally work in tandem with an MD. “In our center, anytime a patient requests it, they can see the doctor rather than the physician assistant or nurse practitioner,” says Phillip Disraeli, MD, a physician and part owner of Metro Urgent Care in Frisco, Texas, and the director of clinical programs for the Urgent Care Association of America. 

How to find one: It’s a good idea to locate an urgent care facility close by so you know where to get quick help when you need it, and to research what its medical capabilities are. Pay a visit and ask about their facilities for treating your condition, such as the ability to do lab work, CT scans, or life support if the situation demands it. 

To locate urgent care facilities in your state, visit the website of the Urgent Care Association of America(UCAOA). Look for one that is accredited, which indicates that it meets industry standards for ambulatory care. 

Cost: As a rule of thumb, one-third to one-half that of an emergency room visit, according to Dr. Ritucci. Urgent care centers usually accept many types of insurance, and many offer discounts to those paying cash.

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