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Find answers to consumers' most frequently asked questions here.

Note: This section is for general information and is not specific to any insurance company or insurance plan. Information in this section is intended to assist the consumer in analyzing their insurance needs and reaching an informed conclusion.



What are the laws on COBRA?
 
COBRA is a federal law that allows an employee and his or her dependents to continue medical insurance coverage for up to 18 months after leaving a job. The law covers those who quit their job as well as those who are involuntarily terminated except for gross misconduct. An employer with subject to the law must provide written notice offering COBRA coverage to an employee following a "qualifying event" (e.g. job termination). Be aware that full cost of the insurance, plus up to a 2 percent administrative fee, must be paid by the employee. Although the insurance may be expensive, remember that coverage is purchased at a group rate and that an individual policy purchased independently may be much more expensive. COBRA coverage is typically available for up to 18 months after you leave a job. In some cases, your spouse and dependent children may be eligible for COBRA continuation for up to 3 years. Many workers use COBRA during the waiting period before health insurance benefits begin at a new job. Not all employers are subject to COBRA. You should contact your employer for COBRA information as well as information for any continuation requirements specific to your state of residence.
Do health care plans cover all prescription drugs?
 
Coverage of prescription drugs will vary from plan to plan. Some plans only cover prescription drugs administered while confined in a hospital. If the policy covers outpatient prescription drugs the general rule is that only those drugs prescribed for the treatment of an illness or injury are covered. Many plans do not cover "wellness" drugs such as nicotine chewing gum to stop smoking or contraceptive pills. However, you should always refer to your insurance documents to see what drugs, if any, are covered under the policy. If you are still uncertain call the plan’s customer service department to ask assistance on whether a specific drug is covered.
Is vision care covered by most health plans?
 
This depends on the plan. If this is important to you, you should check it out before you apply for an insurance plan. Many health plans cover only eye injuries. Some plans may cover regular eye examinations. Some plans may also provide a yearly benefit allowance for the purchase of eye glasses or contact lenses. Vision care, like dental care, is one of the benefits that some plans offer and others don’t.

Is it true the Government offers a tax rebate to people who have private health insurance?
 
The Government announced the introduction of a 30 per cent rebate on private health insurance premiums. The rebate was introduced on 1 January 1999. It is not means tested and applies to health insurance premiums for all types of coverage.

You are eligible for the incentive when you have private health insurance coverage and you are:

  • a single person with a taxable income of less than $35,000
  • a couple with a combined taxable income of less than $70,000
  • a family with a combined taxable income of less than $70,000. The family threshold increases by $3,000 for each dependent child covered by the policy after the first.

The amount you are able to get depends on the type of policy you have, and the amount of time you were covered by the policy. This table is a guide to the maximum amounts you can get.

Maximum annual incentive amounts

Policy Type Hospital coverage Ancillary coverage Hospital and ancillary coverage
Single $100 $25 $125
Couple $200 $50 $250
Family
(including sole
parents)		 $350 $100 $450

Note: You should contact your accountant or attorney for complete details and guidance specific to your situation.

What types of expenditures are commonly excluded under major medical insurance plans?
 
Although providing broad coverage, major medical insurance plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from:
  • convalescent or custodial care;
  • physical examinations, unless required for the treatment of an injury or illness (it should be noted that some plans now cover this expenditure);
  • cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect;
  • occupational injuries and illnesses that are otherwise covered under a Workers' Compensation law; and
  • routine dental and vision care (however, usually care required for treatment of an injury to the teeth or eye is covered). Other common exclusions relate to benefits provided by government agencies (e.g., VA hospitals) and expenses paid under other insurance programs, including Medicare. This is not an inclusive list of expenses commonly not covered. You should refer to your own insurance documents.

    • I'm entering college next semester as a full time student. Will I still be covered under my parent's health insurance?
     
    Possibly. Most policies cover unmarried dependent children up to age 18 or up to age 24 if a full-time student. You may not be covered if you are over the limiting age for eligibility under your policy and do not attend school full-time.

    What are out-of-pocket costs?
     
    Even though major medical insurance plans may provide broad coverage, insureds still incur certain costs. They typically include the deductibles, any applicable "per visit" copayments, cost-sharing amounts arising from the operation of the coinsurance clause, medical expenditures that are deemed by the plan to be in excess of "reasonable and customary" charges and expenses not covered under the policy. Plus if you're covered under a PPO or HMO plan you can incur higher out-of-pocket costs if you use doctors or hospitals that are not part of the Plan's Network. Only charges that are "reasonable and customary" for a specific type of service, in a particular location or geographic area, are eligible for reimbursement under medical insurance plans. The definition of "reasonable and customary" may vary from one medical expense plan to another.

    What if I have been declined for insurance before?
     
    Please share that information with your agent. Some companies are just stricter than others. He could recommend the right companies for you. All insurance companies underwrite differently. While one insurance company may have previously declined you, depending on the reason for the declination, another insurance company may approve you.

    What if I had a recent illness or injury?
     
    Most insurance companies will underwrite an individual that has had a recent illness or injury if the condition is resolved with no further treatment needed. Depending on the insurance plan, some ongoing problems may be covered right away, such as controlled high blood pressure or hypothyroidism.
    Does every plan cover maternity?
     
    No. But most medical insuranec plans cover a complication of a pregnancy. Also, many plans cover newborn children from birth. You may have an option to elect maternity coverage usually for an additional cost to you, in certain medical plans, which covers standard maternity expenses such as normal prenatal care and hospital delivery expenses.

    I recently discovered I'm pregnant and I have no health insurance. Is there any way I can get insured?
     
    Unfortunately, the insurance options for a woman who is already pregnant are slim. But don't despair; there are some possibilities for you. Medicaid is an option if you fall within its income guidelines. Call your state's insurance department to see if you qualify and learn how to apply for it. If you are a college student, your student health center may also be able to give you some leads.

    If I have health insurance can I still be admitted to a public hospital as a patient?
     
    Yes. Every public hospital has to treat you regardless of whether or not you have private insurance. However, you should refer to your insurance documents. Typically, public hospitals are not part of a PPO or HMO network and your out of pocket expenses may be higher if you're covered under an HMO or PPO plan and you use an out-of-network hospital.
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