Missouri Health Insurance

Health insurance is one type of insurance you're pretty much guaranteed to use. We all need medical attention from time to time, and some of us need it quite frequently. When care is needed, you want to focus on getting better not on how you're going to come up with the money to pay your medical bills. A good health insurance plan allows you to focus on what's most important, your physical well being.

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Health Insurance who needs it?

Is there anyone who doesn't need health insurance? Not really. Even if you're young, healthy and haven't had to see a doctor in years, you never know when you might be involved in an accident or be diagnosed with a serious medical condition. While your health insurance coverage will pay for things that aren't too costly like routine doctor's visits or lab tests, the main reason to have coverage is to have protection against the potentially catastrophic expenses of serious illness or injury.

Without health insurance you may be charged a higher price by the doctor or hospital

If you go to a doctor or hospital you may be charged a higher price if you don't have health insurance. The reason for this is because the health insurance companies have contracts with doctors and hospitals in their networks to only charge agreed upon amounts for each procedure. Each time you use these doctors and hospitals you benefit from the lower negotiated rates.

Answers to Your Health Insurance Questions

Can my health insurance carrier continue to raise my premium rates?

Yes. Missouri is an open competition state and, as such, we do not have the authority to regulate premiums on most types of health insurance. Our state relies on competition among companies to determine the premium rates. Medicare supplement insurance premiums are subject to some regulatory oversight.

Can health insurance companies deny my application for individual insurance due to a health condition?

Yes, the company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage, your policy can only be terminated for one of two reasons. The company can cancel your policy for failure to pay your premiums in a timely manner. If you misrepresent information on the application or fail to disclose known information, the company may rescind the policy for material misrepresentation.

What is a preexisting condition?

This is normally a physical or mental condition for which medical advice, diagnosis; care or treatment is recommended or received before the effective date of the policy. The definition can vary from policy to policy.

What is an HMO?

HMO stands for Health Maintenance Organization, a managed care plan where you have the ability to choose your primary care physician (PCP) from a list of network providers. Your PCP is responsible for management of all aspects relating to your health care. If you require care from any network provider other than your PCP, you may need a referral from your PCP to see that provider. Check with your plan to see if your PCP is also the "gatekeeper" for access to other network providers. You must obtain care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is generally not covered, or covered at a reduced level.

What happens to my group health coverage if leave my employer?

If your employer has more than 20 employees, it is subject to the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) law and entitled to a minimum of 18 months of continuation coverage. Under each of these options, you will have to pay the full premium yourself even if your employer paid part of your premium while you were employed. You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Pension and Welfare Benefits Administraton website or by calling 816-426-5131.

What options do I have if my employer isn't large enough to be affected by COBRA?

If your employer has less than 20 employees, you are entitled to 9 months of continued group health coverage with your employers group plan under Missouri law (376.428 RSMo).

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