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Family Health Insurance Plans

When it comes to family health insurance plans there are really only two choices, a group plan set up by an employer or an individual health insurance plan.  Most people think “I don’t need an individual health plan. I need one to cover my entire family.”  When you think individual health insurance plan, think in terms of individual families, not individual persons. A family health insurance plan is something no family should be without.

Health insurance regulations change from state to state and often times between insurance companies in the same area.  The major difference between a group health insurance plan from an employer and an individual health insurance plan is that the individual insurance plan is not guaranteed.  Group polices offered by employers do not have exclusions for pre-existing conditions (as long as ther person joining the plan has maintained continuous health insurance coverage prior to enrolling in the plan).  Individual plans that you purchase on your own often do.  You can be turned down or offered a limited policy that does not cover pre-existing conditions.  In those areas where the law states that you can not be turned down because of pre-existing conditions, you can be charged much higher premiums because of those conditions.

It is very important when shopping for a family health insurance plan that you compare plans from at least 3 different insurance companies. Each insurer has different underwriting standards and rate guidelines so it can pay to shop around. To compare health plans for families from some of the top insurance companies that offer coverage in your area just input your zip code into our free tool at the top of the page to get started. Get started finding family health insurance today!

Types Of Family / Individual Health Insurance Plans

  • Fee for Service plans – These are most traditional of all health insurance policies.  You pay for your doctor or other medical coverage up front then submit a claim to your insurance company to be reimbursed.  Most likely you will not get full reimbursement, only a percentage depending on your policy and your health insurance company.

  • HMO – (Health Maintenance Organization) HMOs are pre-paid plans where the insurance company has arranged lower cost for medical care with select doctors, hospitals and clinics.  As long as you visit one of these doctors you will not have any out of pocket costs for services outside of your premium.  Some HMOs even have their own privately run fully staffed clinics for their policyholders.

  • PPO – (Preferred Provider Organization) PPOs allow patients to use their own doctor.  If you are changing insurance companies that means you don’t have to change doctors.  PPO’s have in network and out of network doctors.  In network doctors, including specialists, have agreed to accept as payment what the insurance company feels is reasonable.  Using an in network doctor will only cost you a co-pay.  Using a doctor that is out of network is subject to deductibles and you will be responsible for a percentage of the bill.  Most commonly it’s split 80/20, where the insurance pays the greater portion after the deductible has been met.

  • POS – (Point of Service) The insurance company provides you with a list of doctors that you can pick from.  You are required to designate a primary care physician and all medical care will have to be authorized by that doctor first.

  • If you can not find traditional individual health insurance, depending on your income and other factors you may be eligible for government Medicare or Medicaid.  Medicare is available to the disabled and those over 65 years of age.  Medicaid is state funded medical insurance that is available to children under the age of 18 and pregnant women.  Under most circumstances Medicaid and/or Medicare will not cover everyone in the family.

General Individual And Family Health Insurance Plan Exclusions

Every health insurance plan is different but here are some of the most common family health plan exclusions:

  1. Routine, convenience, and comfort items such as humidifiers and over the counter medications.

  2. Fertility treatments – The insurance companies that do offer this have limitations on cost and number of treatments.

  3. Reconstructive/Cosmetic Surgery – The only exceptions to this rule are breast reduction where there are related problems; reconstruction after radical cancer treatment; as well as radical cosmetic surgery related to things such as car accidents.

  4. Home Care, Private Nursing and/or Hospice

  5. Dental Care, Hearing and/or Vision Aids – You can often purchase additional policies for these

  6. Elective Abortions

  7. Reversals of Vasectomies or Sterilization

  8. Learning and/or Behavioral Problems – This includes ADD/ADHD and autism.  Sometimes insurance companies are willing to cover the cost of the initial testing since it is for diagnostic purposes but will not cover any related treatment or therapy.

  9. Experimental Treatments and Medications

  10. Sex Change Surgery

Compare Family Health Insurance Plans Now!

Use our free tool at the top of the page to get started comparing family health insurance plans from top insurance companies side by side.  Get started finding family health insurance now!