Insurance
Rental Reimbursement Coverage
If you need to rent a car while yours is being repaired, having this coverage can offset the expense because it pays a set daily amount for a rental car if your car is stolen or is being repaired because of damage covered by your policy.

Health Insurance
If you’re like other newcomers, a top priority is finding a new physician for you and your family. So, how do you learn about your health care options and find a family doctor? Of course, your employer should be your first stop. Your company’s human resources office can usually provide you with brochures about hospitals and doctors that will accept the company’s insurance. Following are a few resources in the LA area:
  • Los Angeles County Medical Association Physician Finder consists of physicians in a wide variety of specialties who are members of the society and choose to participate in the referral program. Call (213) 683-9900 or visit www.lacmanet.org.
  • DoctorFinder by the American Medical Association (AMA) provides basic professional information on virtually every licensed physician in the United States, which includes more than 814,000 doctors. AMA member physicians are offered an expanded listing that contains additional information, such as office hours, accepted insurance providers, education history and other helpful information. Visit www.ama-assn.org/aps/amahg.htm.
  • California Medical Association provides information on California Medical Association members only. Call (800) 786-4262 or visit www.cmanet.org.
  • Medical Board of California can help you find public information about a medical doctor, physician assistant, acupuncturist or surgical assistant licensed in California. Information available for consumers includes name, license number, licensure status, disciplinary status, honors and awards and malpractice history. The Enforcement Division receives and evaluates complaints on physicians, physician assistants and acupuncturists. Call (800) 633-2322 or visit www.mbc.ca.gov.
  • American Board of Medical Specialties allows patients, when searching for a physician, to make sure the doctor is board certified. All U.S. board-certified physicians are listed with the American Board of Medical Specialties. Visit www.abms.org or call (866) 272-2267.
  • Also refer to the Health & Wellness chapter of this guide for other Physician Referral Services.
  • Family, friends and coworkers also are a good resource for finding a physician. Ask what people like best and least about their doctors.

Health Plan Basics
Today in the United States, it is essential for everyone to have health insurance and pay into the system. Uninsured people seeking free services ultimately put a bigger strain on the resources of the government. If everyone pays in, even a minimum amount, more funds become available for those who truly need them. Many people receive health-care coverage as a condition of their membership in a group, such as a place of employment, professional association or other umbrella organization that offers coverage. Others not associated with such groups must buy individual health coverage directly from an agent or insurer. Health-care costs are expensive, and an insurance plan will pay for most and sometimes all of the treatment costs for your illnesses and injuries.

What any particular plan provides—as far as benefits, access to care and out-of-pocket expenses—varies depending on the type of plan and how and where you got it. Generally plans fall under one of two categories: fee-for-service or managed care. The following outlines the basics of these plans and what you can expect from them.

— Fee-for-Service Health Plans
Having a fee-for-service plan means you can seek treatment from any doctor or provider as well as any specialists without requiring a referral. Sold by traditional insurance companies, fee-for-service plans sometimes are called to as “indemnity plans.” For medical conditions the policy covers, this type of plan generally pays for most, but not all, of the costs of treatment.

On fee-for-service plans, sometimes the insured must pay the bill at the time of the treatment then file a reimbursement claim accompanied by appropriate receipts and records with the insurance company. Other times, the provider bills the insurance company first for its share of the health costs and charges only the supplementary amount to the insured patient. As required by California law, insurance providers must be prompt in repaying filed claims, but “prompt” can mean up to 45 days for an HMO and up to 30 days for other plans depending on the nature of the claim.

If you have a fee-for-service plan, you will pay the following:
  • Premiums are fees paid on a cyclical basis (e.g., semimonthly, monthly, quarterly) that go into the system, and this enables you to receive coverage when you need it. Premiums for plans obtained through an employer likely are deducted automatically from your paycheck. The benefit of insurance through an employer is that many employers contribute a percentage or all of the premium as an employment perk, but law does not require them to do so.
  • Deductibles are the maximum out-of-pocket amount you pay before the insurance provider begins to pay, and your progress toward meeting it resets at the beginning of each plan year (may differ from the calendar year). The deductible varies depending on the plan’s stipulations and often the preference of the insured; however, in general, the deductible functions inversely with premium costs. If you generally are healthy and will not use the insurance often, choose a higher deductible because it means paying a lower premium every cycle. However, if you have a serious illness or chronic medical needs requiring extensive treatment, a lower deductible (with a higher premium) means the insurance will begin to pay sooner. With family plans, although some assign each person a separate deductible, others have one deductible that applies to the entire family.
  • Coinsurance comes into effect after you meet the deductible amount from out-of-pocket expenses. After that point, you pay only a percentage of the remaining costs on covered health services for the plan period while the insurance company pays the rest. The amount of coinsurance in your policy also varies across plans and relates inversely to the amount you pay in premiums. In California, law requires plans to pay at least 50 percent of the coinsurance costs, but some pay as much as 70 or 80 percent of the cost, leaving you to pay only the balance.

Most fee-for-service plans have a “lifetime maximum,” which means they only pay up to a certain amount, such as $1 million, toward your total lifetime medical expenses or for certain medical conditions.

   
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