Page 51 - Book5E

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.
Where Can I Get Coverage?
Most Americans who have health insurance receive it through their employer. Because employers typically negotiate group rates and pay a portion of the premiums, this is usually the most affordable way to get coverage. Unions, professional associations, and other organizations may offer health insurance as well.
One of the great benefits of group health coverage is cost. Premiums are frequently lower than with individual coverage because economies of scale in large groups make administration less expensive. And with group coverage, the employer usually pays a significant part of the premium.
Another plus is eligibility. Group insurance policies usually don’t require a medical exam or other evidence that you are insurable. Enrollment occurs when you take the job (although coverage may not take effect for several weeks or months), and you can change your coverage during a specified period each year, called open enrollment. Some employers offer a choice of fee-for-service and managed care plans, as well as prescription and dental coverage.
Portability, which means the ability to keep your coverage in force if you leave your job, is another nice feature of group insurance. Because of a federal provision called COBRA (Consolidated Omnibus Budget Reconciliation Act), most employers with more than 20 workers are required to give you the opportunity to continue your cover-
Maintaining Appropriate Levels of Health Insurance
43