FAQ Health

Again, if you have a question about your insurance, please call one of our experienced agents.

 

What is considered a preexisting condition?

A pre-existing condition is a medical condition that existed before you obtained health insurance. It is significant because the insurer may not cover the pre-existing condition for the duration of the pre-existing condition period. The policy will provide for a stated time period within which it will not provide benefits for the condition.

The pre-existing condition exclusion period varies by insurance company, and also by the State in which the policy is issued. Currently, State law regulates the terms and conditions of insurance policies. For example, some States have disallowed certain types of provisions, including mcertain medical conditions to which they might otherwise apply.

All of that may change if there occurs greater Federal involvement in the regulation of health insurance, but the odds are that new laws will apply only upon the expiration of existing insurance contracts and for the issuance of new contracts after such laws are implemented.

The rationale for pre-existing condition exclusions is that medical insurance works the same way other insurances do: that insurance covers fortuitous occurrences, nor ones that are planned, intentional, or predictable. Stated otherwise, you need to have coverage in place before something adverse happens. An analogy is that just like you can’t buy auto insurance after an accident to cover the cost of the accident, medical insurance only covers issues that arise unexpectedly after coverage has begun.

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Are life insurance benefits taxable.?

  • Death benefits are usually not subject to federal income tax. There are exceptions, though, if the IRS deems your insurance policy to be an investment in disguise. Your insurance agent should be able to tell you if your policy benefits will be taxable.
  • The answer is complicated, although 98% of the time, benefits are not INCOME taxable. The death benefit, however, Only when no beneficiary is named, is included in the value of the estate of the deceased, which means that estate taxes could be owed on the death benefit by the estate. Also, whenever a policy is sold (what’s known as a “transfer for value”), the benefits become income tax taxable.
  • The “interest build-up” portion of the annual increase in the policy’s cash value is not taxed. Dividends generally are considered to be a “return of premium” and are not taxable. Although life insurance death proceeds will not typically be subject to income taxation, they may be subject to federal estate taxation. If you own part or all of the policy when you die, those can be included in your gross estate for federal estate tax purposes. State inheritance taxes and federal gift taxes may also apply to life insurance policies/proceeds under specific circumstances. Contact your tax adviser regarding questions about possible income, estate and gift tax consequences surrounding any life insurance you own or are contemplating buying.

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How can you get affordable family health insurance if you are self-employed?

While the health care and health insurance debate is continually changing in our nation, the reality still remains that the individual, the small business and the self employed individual are typically overlooked in the health insurance marketplace.

Some states require all insurance companies to provide some basic level of coverage to all small businesses that aren’t strictly in business for the purpose of collecting insurance benefits (like North Carolina, but the coverage is very limited). Others have no requirements whatsoever.

There are certain companies in every region of the country that specialize in finding coverage for small businesses, and if you are incorporated, this will likely be your best option.

Local insurance brokers will be happy to help you, but try to find one that is experienced, and preferably a part of a larger agency that has a strong reputation.
Here is more information and advice:

  • I am a licensed health insurance agent. What you should do is find a small local broker in your area who deals with several different insurance companies, ex: Anthem, Medical Mutual, American Community, etc. Have him/her do some quotes for you and see what they have for the best price. You may also want to consider an HSA, which is a high deductible plan, starting at $1000 and you contribute, if you wish to a savings account for qualifying medical supplies, such as eye wear, contacts, band-aids over the counter drugs, peroxide. It rolls over each year and is tax free. Some plans also will pay 100% after your deductible is met and some will pay only 80%. It’s your choice. When you call a broker, they can give you more information regarding these plans for your state.
  • Watch out for the so-called National Association for the Self-Employed. There have been many complaints against this arm of the MEGA Life Insurance Company.
  • I too am a licensed insurance agent. Do find a local independent agent, preferably one that specializes in health care. A good starting place is the National Association of Alternative Benefit Consultants. This organization specializes in Consumer Driven Health Plans (CDHPs) and is the organization that trains and certifies Chartered Benefit Consultants. It is the only insurance certification that specializes in CDHPs. They have a searchable database of agents by state qualified and trained in this area.
  • Go to your State Dept of Insurance and look up complaints filed against ANY insurance company you are considering. Then look up the same information for the major carriers in you state. See if the product someone is trying to sell you have an inordinately large number of complaints. Also, always get quotes from multiple carriers. Anyone who tells you that there is only one carrier with a suitable product for you generally has an interest in you not seeing what the open market can offer. Be an informed consumer.

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How do you accelerate the insurance claim process?

First, document when and to whom you spoke, and what about from the first report of the claim to every subsequent conversation. Next, call the claims office of the adjuster and let them know you want an answer or you will have to call their supervisor. If you hear nothing back after a day’s time, call the claims office and ask for the supervisor. Explain the situation. Give that supervisor another day to find out what is going on then call back. If you still get no answer, you can call that person’s supervisor or even your state’s insurance department. All of this may or may not get a settlement to you quicker but you can be certain that complaints to supervisors and the insurance department are taken seriously.¬†Insurance companies see a claim as their chance to perform, to prove the value of their service. Happy insurees stay with their company and sometimes even recommend the company to others.

Also, there are provisions in your policy that detail how a loss will be handled – so make sure you read it over carefully! The policy and state law spell out how long an insurance company has to furnish forms to you by which you can document the value of your loss, etc. From there, the impetus is upon the insurance company to settle the claim promptly, taking what time is needed to properly handle the claim, but no more.

Is this length of time too long to take to settle this claim? Well, what are the details of the loss? Is there something unusual about your loss that is preventing prompt settlement – such as indications of fraud, unusual or rare, i.e. hard to value items damaged, or have you been uncooperative in interviews or in completing any forms they requested you complete?

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