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Most Indiana residents are insured through a group plan sponsored by their employers. Premiums for these plans are generally low, and are paid by the employer. Unfortunately, those who are self-employed, between jobs or not covered by an employer find it very difficult to find affordable health insurance. If you find yourself in this situation, you should consider purchasing individual health insurance.
Choosing the right health insurance company can be critical to your well-being. We recommend you ask the following questions when examining health insurance policies:
The Indiana Department of Insurance can help you determine the answers to these questions, as well as get answers to other insurance-related questions.
Examining the Market
Consider the following, most popular types of coverage when shopping for health insurance:
Fee-for-Service plans: Often called traditional or indemnity health insurance. You choose and visit a doctor, who then submits a claim to your insurance company for reimbursement for each individual service provided. (This often occurs at 80 percent of reasonable and customary charges.) You are responsible for the remaining charges, called $coinsurance.$
If your doctor charges you more than what is usual or customary for your area, you must pay the remainder.
Managed-care plans: Include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service plans (POS). These plans provide comprehensive health services and medical treatments to members. Your coverage is paid in advance, so you do not need to pay for each service individually. Out-of-pocket expenses are typically low and there are generally no deductibles or copayments; however, you must use health care providers within the provider’s network.
Talk to an insurance agent or company to determine what kind of coverage you need.
Deciding which plan to purchase involves many factors. Clarify what each plan does and does not cover to make sure you understand what you are buying before you make your final purchasing decision.
Following is a checklist of medical services you should examine your plan for. Different plans have different coverages, so make sure the services most important to you are contained within your policy.
In addition to services covered, examine the annual cost of your premium. Look for the greatest amount of coverage for the lowest price.
Getting More Information
More information about health and medical insurance is available in our health insurance FAQ section, or by contacting the Indiana Department of Insurance at 317-232-2395, or online at www.ai.org/idoi/index.html.