subject: Common Insurance Schemes: A Know-How [print this page] Common Insurance Schemes: A Know-How
To Avoid Becoming a Victim
Insist on delivery of documents within 30 days of the application.
Call the company yourself to confirm coverage.
Read the documents you receive and ask questions. Make agents and companies reply to inquiries in writing.
Remember, Medicare insurance will NEVER call or visit your home to solicit personal information such as such as your social security number or your credit card numbers.
In order to make a wise purchase, it is important to become familiar with the terms used by Medicare and Medicare insurance policies. You may wish to familiarize yourself with the following terms:
ASSIGNMENT: The transfer by the policyholder of some or all of his or her rights under a policy to another party. If assignment is noted on the claim form, the insurance company will pay the health care provider directly. Medicare assignment means the provider will accept the Medicare-approved amounts for covered services as payment in full. The beneficiary would then be responsible for any unmet deductible applied to the charge, for the co-insurance and for any services that were not approved.
COPAYMENT: Your portion or percentage of a health expense. For example, the insurance would pay 80 cents of every dollar on the provider's charges. You pay the remaining 20 cents. With Medicare, the coinsurance would be based on Medicare-allowable charges.
DEDUCTIBLE: The amount of covered expenses you must pay before benefits become payable by the insurers.
EXCLUSIONS OR LIMITATIONS: Specified conditions, circumstances or services not covered by the policy.
GUARANTEED RENEWABLE: The insurance company agrees to continue insuring you so long as you pay the premium. The company reserves the right to non-renew all contracts in the state.
MEDICARE-ALLOWABLE CHARGES: The amount deemed reasonable by Medicare for a given medical service. Benefits are based on Medicare-allowable charges, which may be less than the provider's charges.
PRE-EXISTING CONDITIONS: A physical condition that existed before the policy became effective. Federal law does not allow Medicare supplement polices to exclude coverage for more than six months after the effective date of the policy on the grounds that a condition existed prior to the effective date of coverage.
Companies that replace a Medicare supplement policy must waive the pre-existing waiting period on the replacement policy. If the insured has not completed the waiting period on the first policy, any period of time that was completed must be credited on the new policy.
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