Utah Individual and Family Health Insurance
What is the difference between "Individual" or "Family" and "Group" Utah health insurance?
Individual health insurance plans in Utah are purchased by persons who may want or need an alternative to what is offered at work, or are self employed, their employer does not offer coverage or just want to control the benefits and cost for their personal and family needs.
Utah Group health insurance plans are offered by the employer and are available to most full time workers at that particular business. Advantages: - Simply put, you are in control. You get to choose the health insurance provider and type of policy that suits your needs! The policy options and carriers are decided by you instead of your employer, and you don't pay for additional benefits that may not be necessary for your situation. Your coverage is "portable", so even if you are no longer working for that particular employer, you can keep your health insurance coverage in force. The premiums are based on your health history (also, your spouse and family if coverage is purchased for them), so you are not paying extra premiums based on the age and health of persons in an employer group. Premiums can sometimes be less than group health insurance for this reason. Disadvantages: - With individual health insurance, you are responsible for the entire premium. There is no subsidy from your employer. Pre-existing health conditions are generally subject to a 12 month waiting period (unless waived by the provider at policy approval). If you have major health issues, premiums may be charged at a higher rate than normal.
Certain illnesses may be not be covered for a certain or indefinite period of time (known as a rider), or you may be declined coverage under an individual health insurance plan. (If you cannot obtain coverage, however, because of health issues, you may be eligible for a state funded health insurance plan, such as HIPUtah . We will be able to get you coverage through that plan as well Group health insurance plans in Utah (Small Business) are offered by the employer and are available to most full time workers at that particular business.
Advantages: - Your employer pays for a portion or sometimes (very rarely) the entire health insurance premium. Some employers even pay for your spouse and dependents. For persons with major health issues, a group health insurance plan may be their only option for affordable coverage, because they are not eligible for individual health insurance. Disadvantages: - Many self-employed people cannot qualify for group health insurance if they do not have a spouse that has group coverage where they work. Even if your spouse has coverage, many group health plans do not pay for any portion of the health insurance premiums for spouses, partners or dependents. With the cost of group health insurance plans increasing dramatically (especially in the last few years!), many companies have passed more of the cost onto their workers or even dropped health insurance coverage altogether! Remember, the employer can change coverage and benefits at any time.
Important tips when buying health insurance in Utah!
1. Make certain you purchase real insurance, NOT a discount or limited benefit plan.
You may see advertising that offers health discounts for a low monthly fee. These plans are NOT health insurance and are sold to unsuspecting persons who do not realize what they have bought until they find out they have no real coverage. Avoid at all costs!
2. Avoid most limited benefit plans.
These plans are usually sold by an agent that only represents one specific company as a cheap alternative to major medical plans. Beware, in most cases you can be exposed to significantly large out pocket expenses. (sometimes in the hundreds of thousands of dollars), because the benefits are limited to a certain amount for specific illnesses or calendar year.
3. Watch for "association plans".
They are sold to persons on the basis that you are part of a "group" that can negotiate lower premiums. Their so called group of "self-employed" is little more than a way for a poorly rated company to sell insurance.
Some association plans are set up this way to avoid insurance regulation in Utah.
These plans are NOT group insurance and do not have the same rights and protections of group policies, such as premium rates and mandated coverage for specific conditions.
Some of these plans are limited benefit plans sold by unscrupulous agents with little knowledge and are represented as major medical plans. Get information on the specific health insurance plan and not just the association.
4. Remember the warning signs of fraud:
Agents who use high pressure or will not let you compare plans from other companies.
Agents who tell you this is a "special offer" or "discount rate" good only for today.
When you see the words "health plan" without the word "insurance" anywhere in the literature.
Agents who tell you that the plan is guaranteed issue to everyone regardless of health. This usually means the plan has very limited benefits.
If you feel that you need to file a complaint against the insurance company or agent, please go to http://www.insurance.utah.gov/index.html for more information. If you wish to look up any health insurance provider for Utah, you can look them up at National Association of Insurance Commissioners website at https://eapps.naic.org/cis/