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Health insurance helps you with the cost of general health care and helps you protect yourself and family against illness, injury and accidents.
Health plans pay specifies sums for medical expenses or treatment and they can offer many options and vary in their approaches to coverage.
The focus of this page is on health plans that provide coverage for major medical expenses, which include the cost of hospital bills and medical bills
(both in and out of the hospital). For help with your specific concerns, you may want to talk with your employerʼs benefits department, an independent
professional advisor, or contact MIDʼs Consumer Services Division.
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Purchasing health insurance is a very important decision. Many tend to base their entire insurance purchasing decision on the premium amount. As well as
obtaining a good value, it is also vitally important that you deal with a company that is financially stable.
As the Health Insurance marketplace changes due to Healthcare Reform, understanding the health insurance you are purchasing is more important than ever.
There are several different kinds of health insurance. Traditional insurance often is called a “fee for service” or “indemnity” plan. If you
have traditional insurance, the insurer pays the bills after you receive the service. Managed care plans use your monthly payments to cover most
of your medical expenses. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most common managed care organizations.
Managed care plans provide health care in a more structured way than traditional insurance. Managed care plans encourage and in some cases require consumers
to use doctors and hospitals that are part of a network. In both traditional insurance and managed care plans, consumers may share the cost of a service.
This cost sharing is often called a co-payment, co-insurance or deductible.
Many different terms are used in discussing health insurance. “Covered persons” or “enrollees” are individuals who are enrolled in a health insurance plan.
“Providers” are doctors, hospitals, pharmacies, labs, urgent care facilities and other health care facilities and professionals.
Whether you are considering enrolling in a traditional insurance plan or managed care plan, you should know your legal rights. Mississippi law requires all
insurers to clearly and truthfully disclose the following information in their insurance policies:
A health plan may refuse to pay for health care services that relate to a health condition you had before joining your health plan. This is called a
“pre-existing condition exclusion period”. State laws limit how long preexisting condition exclusion periods can be for individual and group health plans.
You may not have to serve a pre-existing condition exclusion period if you are able to get credit for your health care coverage you had before you joined your
new plan. This is called “creditable coverage” and generally applies to group insurance. Ask your plan for more information. Your health insurer must
renew your plan if you want to renew it. The insurer cannot cancel your policy unless it pulls out of the Mississippi market entirely, or you commit fraud or
abuse or you do not pay your premiums.
All health care plans must have written procedures for receiving and resolving complaints. These are often called grievance procedures. Grievance procedures must
be consistent with state law requirements.
If your health insurer has refused to pay for health care services that you have received or want to receive, you have the right to know the exact contractual,
medical or other reason why.
If you have a complaint about a health insurer or an agent, please refer to our File a Complaint Page. MID keeps track of the complaints that are filed.
However, remember that when you are comparing companies and asking for the number of complaints that have been filed against a company, you must be aware that
generally the company with the most policies in force will have more complaints than companies that only have a few policies in place.
Here are some useful tips about managed care plans:
When shopping for health insurance it is important to make sure that you are buying the health care plan you want and can afford. You should make a list of
your needs to compare with the benefits offered by a plan you are considering. You should compare plans to find out why one is cheaper than another. Listed
below are some questions you should ask when shopping for health insurance:
Not all plans cover all of the benefits listed above. Be sure to ask about benefits.
Recent research conducted by the National Association of Insurance Commissioners (NAIC) indicates that cost and confusion regarding health insurance are
significant issues for consumers across all life stages, even for those with access to health insurance through their employers or government programs like
Medicare. According to the NAIC survey:
Health insurance – whether provided by an employer or purchased by individuals – is expensive. Following are some ways consumers can control their costs.
The NAIC’s consumer web site, Insure U, explains the different types of health insurance and gives focused tips to consumers based on their likely needs in
different life stages. For example:
If we can be of assistance, please see the Request Assistance Page for information on how to contact us.