Entries from January 2010 ↓

Insurance is a slightly nonstandard business in that all the major regulatory functions are left to the individual US states. Federal government has decided to abandon its normal role as the regulator of business to protect the consumers’ rights. Such regulation as does exist is down to the political climate in each state and the will of the lawmakers to take on the economic power of the insurance industry. That said, all Departments of Insurance start off equal. Their primary function is to license companies to sell insurance in their state. Unlike other businesses, an insurance company is licensed state-by-state. No company can sell a policy across state lines. That means every national insurer must establish separate subsidiaries in each state and each company must hold a license. There are also minimum capital holdings set by the Department to protect the solvency of the local companies. There must always be enough money held by each company to pay out on the claims made. Some states require actual cash to be available. Others have a formula to prove the availability of money as required. But, for the most part, this is historical. The major players established their presence in multiple states years ago and newcomers moving across state lines are rare. In fact, the general lack of competition in state markets gives no incentive for companies to seek new licenses.

Once all the players hold their licenses, the personality of the Commissioners in charge comes to the fore. Many view their role as political either to run the Department with the lowest possible level of regulation or to be an effective watchdog to protect consumer rights. You can tell which way your local Department is run by logging on to your state’s website. Some sites are very pro consumer, offering detailed help and advice on how to buy insurance and get a good deal. But the key test lies in the way complaints are handled. Without exception, all Departments accept complaints from people holding policies. In theory, they should all investigate these complaints and apply a judicial process to decide whether the insurer is at fault and, if so, what the remedy should be. For example, Road Island has just imposed a fine of $5,000 on a leading insurer. Following a traffic accident, the insured wanted the repair work done at his regular auto body shop. This was refused by the insurer because the shop was not on their list of approved body shops. Local regulations drawn up by the RI Department allow the insured a free choice of repair facilities. The fine of $5,000 and publicity for it represents a small penalty in itself. But if there were many such fines, the cumulative bad publicity would damage this insurance company’s reputation and its market share would fall. Continue reading →

When dealing with a health insurance plan, whether a new one or the one you have already purchased, the specific language of its contents can be confusing for most people. All these provisions, coverage options and payments make little sense unless you are an insurance expert. And it’s not that rare that a person asks what does their policy provide even after having it for some time.

Don’t worry, we are here to help you. Below you will find the most commonly used health insurance terms you will find in any policy with brief and comprehensive explanation that will help you understand your insurance policy better.

Deductible

Deductible is the sum of money the policy-holder has to pay out of pocket before the policy benefits will kick in. This amount is typically set on an early basis, meaning that a certain part or the whole deductible in the current year, this amount will be renewed in the next one. Certain services provided by the insurance policies such as physician visits are available free of deductible. If you have your family members included into your policy, there’s usually a separate distinction between individual and group deductible amounts.

Co-insurance (Co-payments)

The sum of money you have to pay on your own before your policy starts covering you in addition to the plan’s deductible. Certain plans will require only co-insurance payments for some types of services without requiring you to pay the deductible.

Out-of-Pocket

It’s a general term denoting all payments that you have to make on your account before the policy coverage kicks in. This usually refers to deductibles, co-payments and co-insurance. When speaking of annual out-of-pocket maximum this term refers to the overall costs of the insurance policy during the year minus the premiums. Continue reading →

This is being written as we approach Thanksgiving and most people will be meeting up with family and friends to celebrate. As we plan for these big holidays, the main focus tends to be on planning the menu for the feast, buying the food and deciding who’s going to be responsible for laying in the alcohol. Not that many take out the auto policy to check nothing will go wrong with their insurance. This is a mistake. There will be bumper-to-bumper traffic on all the main routes as everyone gets on to the road to get where they are going. These are the busiest times of the year on the road. At peak times on regular days, the usual suspects are making their commuter runs to and from work or dropping off the kids at school. These are the seasoned drivers with years of experience. Switch to a national holiday and you have a completely different look and feel to the roads.

The moment more drivers spend more time on the road, the chances of an accident increase dramatically. Instead of making short runs along familiar roads, whole families are suddenly loaded into cars for longer journeys along less familiar roads. There are a lot of weekend drivers all around you. With one driver and no passengers, it’s easier to concentrate and, with fewer distractions, there’s less risk of an accident. Fill the back seat with kids and the distractions are hard to ignore. The short, boring commuter trip is suddenly converted into a stressful epic. Worse, some drivers never think to have their vehicles go through a routine maintenance before setting out. The family car may be alright on short runs, but curl up and die when asked to cruise at high speeds down an interstate. Precautionary time in a repair shop will reduce the risk of an engine or tire blow-out but, in a recession with family budgets under pressure, most give this a miss. Those who are worried about their vehicles or know they need something bigger to fit in everyone and their baggage, rent a car. This puts them behind the wheel of something unfamiliar and the chances of an accident just increased again. Many carpool with family and friends – the people who still have SUVs find themselves in demand. Continue reading →