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4919 Route 22, Amenia, NY 12501518-789-8700 • 800-562-2139 • FAX 845-373-6360www.greyhouse.com • e-mail: [email protected]
Financial Literacy Basics: G
uide to Understanding H
ealth Insurance Plans2017
Box Set: 978-1-68217-614-6
Financial Ratings Series
Financial Literacy Basics:
Guide to UnderstandingHealth Insurance Plans
G R E Y H O U S E P U B L I S H I N G
2 0 1 7
basics_healthinsurance.indd 1 5/22/17 11:11 AM
Financial Literacy Basics:
Guide to Understanding Health Insurance Plans
Financial Literacy Basics:
Guide to Understanding Health Insurance Plans
2017 Edition
GREY HOUSE PUBLISHING
Grey House Publishing Weiss Ratings 4919 Route 22, PO Box 56 4400 Northcorp Parkway Amenia, NY 12501-0056 Palm Beach Gardens, FL 33410 (800) 562-2139 (561) 627-3300 Copyright © Grey House Publishing and Weiss Ratings. This publication contains original and creative work and is fully protected by all applicable copyright laws, as well as by laws covering misappropriation, trade secrets and unfair competition. Additionally, Grey House Publishing and Weiss Ratings have added value to the underlying factual material through one or more of the following efforts: unique and original selection; expression; arrangement; coordination; and classification. None of the content of this publication may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means (electronic, print, mechanical, photocopying, recording or otherwise) without the prior written permission of Grey House Publishing. “Weiss Ratings” is a trademark protected by all applicable common law and statutory laws.
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Table of Contents Understanding Health Insurance Plans ................................................. 1 What is a Health Insurance Plan ........................................................... 1 Health Insurance Policy ........................................................................ 3 Sample Private Health Plan Benefit Costs ............................................ 5 Sample ACA Benefit Plan Costs ........................................................... 6 Insurance Card ...................................................................................... 11 Types of Health Insurance Plans ........................................................... 14 Managed-Care Plans ............................................................................ 14 Pros & Cons of Managed Care Plans ................................................... 15 Common Exclusions ............................................................................. 16 Fee-for-Service Plans ............................................................................ 17 COBRA ................................................................................................. 17 Military Health Care .............................................................................. 18 Disability Insurance ............................................................................... 18 Dental & Vision Insurance ..................................................................... 19 Medicaid ............................................................................................... 19 Medicare ............................................................................................... 20 Shop Around ........................................................................................ 21 Weiss Ratings’ Recommended Health Insurers by State ...................... 22 Weiss Ratings’ Weakest Health Insurers by State ................................ 37 Appendices ........................................................................................... 53 Helpful Resources ........................................................................ 54 State Insurance Commissioners .................................................. 55 Application for Health Coverage & Help Paying Costs .............. 56 Sample Private Health Insurance Enrollment Form ..................... 64 Glossary ....................................................................................... 65 Sources ........................................................................................ 67 What Our Ratings Mean .............................................................. 68 Terms & Conditions ..................................................................... 69
Welcome!
Grey House Publishing and Weiss Ratings are proud to announce its newest series, Financial Literacy Basics. Each volume in this series provides readers with easy-to-understand guidance on how to manage their finances. Designed for those who are just starting out and for those who may need help handling their finances, volumes in this series outline, step-by-step, how to make the most of your money, which pitfalls to avoid, and what to watch out for, and give you the necessary tools to make sure you are fully equipped to manage your finances.
Volumes in this series take the guesswork out of financial planning—how to manage a checking account, how to stick to a budget, how to pay back student loans quickly—information necessary to get started on your financial future. Each volume is devoted to a specific topic. Combined, they provide you with a full range of helpful information on how to best manage your money. Individual volumes are:
Guide to Understanding Health Insurance Plans How to Make and Stick to a Budget How to Manage Debt Starting a 401(k) Tips for Paying Back Student Loans Understanding Renters Insurance What to Know About Auto Insurance What to Know About Checking Accounts
Filled with valuable information alongside helpful worksheets and planners, these volumes are designed to point you in the right direction toward a solid financial future, and give you helpful guidance along the way.
Guide to Understanding Health Insurance Plans 1
Financial Literacy Basics: Guide to Understanding Health
Insurance Plans Understanding Health Insurance Plans
No one wants to suffer a sickness or
an injury. But we all do at some point.
Even if you’re young and lead a healthy lifestyle, you’ll need medical attention one day. You might come down with the flu or fall and break your arm. You might even suffer a serious illness.
If you get sick or are injured, you’ll need to see a doctor and might even require a hospital stay. You’ll also need medication. Medical bills and prescriptions are extremely expensive—they are one of the leading causes of bankruptcy in the United States.
This is where health insurance comes into play. Health insurance helps you pay for routine preventative care such as checkups and vaccinations. It helps you pay medical bills. In most cases, it helps you pay for prescription medications. Health insurance helps cover your medical expenses if you need serious care.
What is a Health Insurance Plan?
A health insurance plan is an agreement with an insurance provider to pay some or all of your medical expenses.
These expenses can range from simple doctor visits to life-changing events such as pregnancy, major surgery, or serious illness.
Most health insurance plans fall into three broad categories:
Private Health Plans Medicaid Medicare
Private health plans are offered through your employer or can be purchased individually. As the name suggests, they are typically run through a private business such as an insurance company or health-care provider. Private health insurers offer numerous plans, each offering a range of benefits that vary by cost and
2 Guide to Understanding Health Insurance Plans
services covered. According to 2015 figures from the Centers for Disease Control and Prevention, about 66 percent of Americans under age 65 had some form of private health insurance.
Medicaid is a government-run health-care plan designed to help low-income individuals and families. Medicaid is funded by the federal government but run by state governments, so eligibility and coverage rules vary by state. See page 19 for more information about Medicaid.
Medicare is a government-sponsored plan for people 65 and older or those who are disabled or suffer from a long-term illness. Medicare is divided into four parts that help cover hospital expenses, doctor visits, and
prescription drug costs. See page 20 for more information about Medicare.
In 2010, the US government passed the AAffordable Care Act (ACA) as a way to increase access to health care for more Americans. The ACA, which is often referred to as Obamacare (after former President Barack Obama), is not a health-care plan in itself. It was designed to provide coverage to millions of uninsured Americans, lower health care costs, and improve efficiency in the health-care system. The Act set up health-insurance marketplaces as a way for individuals to compare and shop for coverage. It also required all Americans to have a health-care plan or face a tax penalty.
The ACA provides tax breaks and financial help for eligible individuals
ACA Health Insurance Plan Cost Breakdown by Tier
Metal Tier Portion you pay out of
pocket Portion of bills your
plan pays
Bronze 40% 60%
Silver 30% 70%
Gold 20% 80%
Platinum 10% 90%
Source: https://www.nerdwallet.com/blog/health/metal-tiers-health-insurance-work/
ACA PLAN COSTS
Guide to Understanding Health Insurance Plans 3
who cannot afford to pay the full cost of a plan.
Another provision of the act is that young people covered under a parent’s health care can stay on that plan until their twenty-sixth birthday. This means that if you are under twenty-six, you have the option of staying on your parent’s plan even if you find a new job, move out of the house, or get married.
Health Insurance Policy
When you sign up for health insurance,
you enter into an agreement with the insurance carrier to provide specific services and coverage in return for a relatively small fee. This fee is paid either by you, your employer, or a combination of both. The terms of this agreement are written in a document called your health insurance policy.
The chart above shows the change in Worker and Employer contributions to health insurance premiums from 2006 to 2016. During that time Premiums increased 38 percent, Worker contribution increased 78 percent and Employer contribution increased 51 percent. Source: http://kff.org/report-section/ehbs-2016-summary-of-findings/
4 Guide to Understanding Health Insurance Plans
This policy can sometimes be confusing and contain many unfamiliar terms. If you have any questions, it is always best to talk to your insurance provider.
The following section explains some of the more common terms on the policy:
Premium
A premium is a monthly fee you pay to an insurance company or health-plan provider to keep your policy active.
If you have an insurance plan through work, your employer will usually pay a portion of the premium. You would be responsible for the rest, an amount taken directly from your paycheck.
Premium amounts vary by plan, but the US Congressional Budget Office estimated that the average premium for an employer-based plan in 2016 was about $6,400 a year to cover a single individual and about $15,500 for family coverage.
Typically, the more you pay for your premium, the lower your costs will be for other services.
Source: https://www.cbo.gov/publication/51130
Guide to Understanding Health Insurance Plans 5
Sample Private Health Plan (EPO) Benefit Costs Plan Cost Sharing Highlights Annual Deductible $600 Person/$1,200 Family Annual Out-of-Pocket Maximum $4,000 Person/$8,000 Family Primary Care Physician Office Visits $10 copay* Specialist Office Visits $40 copay* Preventative & Well Care Services
Well Child Care & Immunizations
Covered in Full
Adult Annual Physical Mammography Prostate Cancer Screening Annual Pap Test & Ob/Gyn Exam Immunizations for Adults Colonoscopy Bone Density Tests
Physician Office Services Diagnostic Laboratory Services PCP: $10 copay*/ Spec. $40 copay* Diagnostic X-ray PCP: $10 copay*/ Spec. $50 copay* Advanced Imaging Services PCP: $0 copay*/ Spec. $150 copay* Rehabilitative Services $40 copay* Allergy Services $40 copay* Chemotherapy $40 copay*
Inpatient Services-Hospital Medical/Surgical Admissions $800 copay* Surgical Services $50 copay* Inpatient Physical Rehabilitation $800 copay*
Outpatient Hospital Services Hospital Rehab Services $40 copay* Diagnostic Laboratory Services $40 copay* Diagnostic X-ray $50 copay* Advanced Imaging Services $150 copay* Ambulatory/Outpatient Surgery $100 copay*
Prescription Coverage Tier 1 Pharm: $10 copay/ Mail: $25 copay Tier 2 Pharm: $35 copay/ Mail: $87.50 copay Tier 3 Pharm: 50% coinsurance/ Mail: 50% coinsurance Prescription Drug Deductible None
Emergency Care Emergency Room (ER) Visit $250 copay* Urgent Care Centers $40 copay* Ambulance $250 copay*
Behavioral Health Services Mental Health Inpatient Hospital $800 copay* Mental Health Outpatient $10 copay* Substance Abuse Inpatient Hospital $800 copay* Substance Abuse Outpatient $10 copay* Residential Treatment $800 copay* Psychiatry Office Visits $40 copay*
Maternity Services Prenatal Care Covered in Full Physician Delivery $50 copay* Inpatient Hospital Services $800 copay*
Other Services Skilled Nursing Facility $800 copay* Home Health Care $40 copay* Hospice Inpatient: $800 copay*/Outpatient: $40 copay* Durable Medical Equipment 50% coinsurance* Diabetic Supplies & Equipment $10 copay* Chiropractic Benefit $40 copay*
Vision Care Adult Vision Care Not covered Pediatric Vision Care $40 copay*
*Deductible applies to this benefit
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Sample ACA Benefit Plan Costs
MEDICAL COST SHARES
Coverage Category Bronze Silver Gold Platinum
Covers 60% average annual cost
Covers 70% average annual cost
Covers 80% average annual
cost
Covers 90% average annual
cost
Annual Wellness Exam $0 $0 $0 $0
Primary Care Visit $70* $45 $35 $20
Specialty Care Visit $90* $70 $55 $40
Urgent Care Visit $120* $90 $60 $40
Emergency Room Facility Full cost until out-of-pocket maximum is met
$250 once medical deductible is met $250 $150
Laboratory Tests $40 $35 $35 $20
X-Ray and Diagnostics Full cost until out-of-pocket maximum is met
$65 $50 $40
Deductible
Individual: $6,000 medical $500 drug
Family: $12,000 medical $1,000 drug
Individual: $2,250 medical $250 drug
Family: $4,500 medical $500 drug
N/A N/A
Annual Out-of-Pocket Maximum
$6,500 individual and $13,000 family
$6,250 individual and $12,500 family
$6,200 individual and $12,400 family
$4,000 individual and $8,000 family
Benefits shown in blue are not subject to a deductible.
*Copay is for any combination of the first three visits. After three visits, they will be at full cost until the out-of-pocket maximum is met.
DRUG COST SHARES—30 DAY SUPPLY
Generic Drugs (Tier 1) up to $500, after deductible is met $15 or less $15 or less $5 or less
Preferred Drugs (Tier 2) up to $500, after deductible is met
$50 after drug deductible $50 or less $15 or less
Non-preferred Drugs (Tier 3) up to $500, after deductible is met
$70 after drug deductible $70 or less $25 or less
Specialty Drugs (Tier 4) up to $500, after deductible is met
20% up to $250 after drug deductible 20% up to $250 10% up to $250
Guide to Understanding Health Insurance Plans 7
Coverage
The risks and liabilities the insurance company has agreed to cover. This includes the specific health issues the company is responsible for covering and the amount of money it will pay. Health-care coverage usually pays for services such as doctor visits, hospital stays, and prescription medications.
Deductible
A deductible is the amount of money you must pay each year for medical expenses before your insurance plan starts paying. Deductibles also vary by plan and can range from zero to more than $10,000. In 2016, the average deductible for a work-related health plan was $1,478. This means that if you went for X-rays and the cost was $500, you would be responsible for the entire amount. If you later spent time in a hospital and your bill was $4,000, you would only have to pay the first $978 of the bill. Your plan would cover the remaining $3,022. Many plans cover simple procedures such as doctor visits or flu shots without you having to pay from your deductible.
Copayment
A copayment, or copay for short, is a fixed and often small fee that you must pay when you receive certain medical services. For example, each time you visit your doctor for a checkup, you may have a copay of
$20. You are usually responsible for paying that amount at the time of the visit. Your insurance company will cover the rest of the cost. Copays may also apply to the cost of prescription medication.
Coinsurance
Coinsurance is similar to a copay except that the fee you are responsible for is a percentage of the cost of the services rather than a fixed amount. In most plans, you will not be responsible for paying coinsurance until after your deductible is met. If you have to spend time in the hospital, for example, you may have to pay 20 percent of the cost while your insurance company covers the remaining 80 percent.
Network Provider
A network provider is a member of a group of doctors, hospitals, pharmacies, and other health-care facilities that is under contract with an insurance company to provide services at discounted rates. These providers can range from your primary-care physician to the lab facilities you go to for blood work. Your copay, coinsurance, and overall cost of services will be lower if you see a provider in your network.
Out-of-Network Provider
This is a provider who is not a part of your insurance company’s contracted
8 Guide to Understanding Health Insurance Plans
group of doctors and health-care facilities. In most cases, you will have to pay higher prices for services at out-of-network providers. Be aware that some insurance plans do not even cover services outside their network.
Out-of-Pocket Maximum
This is the maximum amount you would have to pay for covered medical services each year. This cost includes all copays, coinsurance, and deductibles but does not cover premiums. The out-of-pocket maximum varies by plan, but for health-care marketplace plans covered by the ACA, the 2017 maximum was $7,150 for an individual and $14,300 for a family. This means that if you had a serious medical condition, the most you would have to pay per year would be $7,150; the insurance company would pay all the costs over that amount.
EExplanation of Benefits (EOB)
After you use your health-care plan, your insurer will send you a statement notifying you how your claim was processed for payment. An EOB can sometimes be confusing because it looks like a medical bill even though it is only meant to explain the costs your insurer picked up and the costs you are responsible for paying. To avoid confusion, an insurer will often include
the words “this is not a bill” on an EOB.
An EOB typically includes the following information:
Date of service Place of service Type of service (sometimes in the form of medical billing codes) Amount billed to your insurance Amount covered by your plan Amount not covered by your plan Codes explaining the reasons a service was not covered Your copayment Your deductible The amount your insurance company will pay The amount you are responsible for paying
Preauthorization
In some cases, your insurer will want to know that a specific treatment, type of service, or prescription drug is medically necessary before it will agree to cover the cost.
Preauthorization is typically coordinated between your insurer and your health-care provider. Emergency services and most basic medical needs do not require pre-authorization.
Guide to Understanding Health Insurance Plans 9
Source: https://marketplace.cms.gov/outreach-and.../c2c-sample-explanation-of-benefits.pdf
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Services and procedures that usually do require pre-approval include:
Gastrointestinal tests such as endoscopies and colonoscopies Home health-care services such as skilled nursing and hospice visits X-rays, computerized tomography (CT) scans, and ultrasounds Sleep studies Surgical procedures Non-emergency ambulance services Specialty drugs Durable medical equipment Inpatient hospital services
Drug List (Formulary)
A list of prescription drugs covered by a specific health plan is called a formulary.
Each health-care plan has its own formulary consisting of generic and brand-name drugs approved by a panel of doctors, nurses, and pharmacists.
If a drug is on your plan’s formulary you will typically have a lower copay; drugs not on the list will cost you more.
Most formularies are divided into a tiered system with specific copays or deductibles attached to each tier. For
example, your copay for a tier 1 drug may be much less than a tier 2 drug.
Tier 1: These drugs are usually generic medications. Generic drugs are copies of brand-name drugs with the same active ingredients, dosage, effects, and safety considerations as their counterparts.
Tier 2: These drugs are usually preferred brand-name medications. Brand-name drugs are named and marketed by the pharmaceutical companies that developed them. After the drug patent runs out, other companies can make generic copies of the medication.
Tier 3: These drugs are usually brand-name medications that are not preferred by the health plan. A drug may be placed in this tier if it is new and not fully proven safe, or if there is an equally effective drug at a lower tier.
Tier 4: These are usually specialty medications for use on patients with serious conditions such as cancer or multiple sclerosis.
Guide to Understanding Health Insurance Plans 11
Primary Care Provider
This is the health-care professional you see first to treat common medical conditions. In most cases, this will be your personal doctor but it can also be a physician assistant or nurse practitioner.
Specialist
This is a doctor who has received additional education and advanced training in a specialized area. Cardiologists, for example, specialize in treating heart-related conditions; dermatologists treat issues relating to the skin.
Excluded Services
These are medical services that your plan will not cover. Excluded services vary by plan, but are typically services your insurer does not consider medically necessary. These may include cosmetic or plastic surgery, weight-loss surgery, or infertility treatments.
Preventive Services
These are services to help prevent illness or detect more serious conditions at an early stage.
Preventive services include a wide range of procedures such as flu shots, mammograms, cancer screenings, and alcohol and drug counseling.
Many health-care plans will cover these services without charging you a copay or coinsurance. All marketplace plans sold under the ACA are required to cover preventive services at no charge to you.
Insurance Card
When you sign up for a health plan, your insurer
will give you an insurance card. This card is about the size of your driver’s license and serves the same basic function.
Any time you receive medical services, you’ll need to show your insurance card to the health-care provider. This not only acts as proof you have health insurance but also lets the provider know where to send the bill. In some cases, your doctor’s office may make a copy of your insurance card to keep on file. This may allow you to skip a step when you visit your doctor for a checkup, but you’ll still need to show your card for many other services.
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Different insurers use different formats for their cards, but all cards contain the same basic information. Among the most common pieces of information on your card are the following:
Insurance company name
Your name or the policyholder’s name: This can be a parent or spouse if you are covered under their insurance. Some cards may also include your date of birth.
Member identification number: This is a unique ID number assigned to you. This allows doctors or health providers to verify your insurance information.
Group number: This is a unique ID number assigned to the employer that purchased the health plan. This number allows your health provider to identify the benefits of your plan.
Type of plan: This tells your health provider what type of plan you have. Some of the most common plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and exclusive provider organizations (EPOs). If these plans sound like alphabet soup to you, don’t
worry. They will be discussed later on.
Copayment: These are the various out-of-pocket amounts you owe at the time of service.
Phone numbers: These are usually toll-free numbers for you or your doctor to contact your insurance company with any questions about your plan.
Prescription copayment: The out-of-pocket amount you owe for your prescription medication.
Guide to Understanding Health Insurance Plans 13
Source: https://marketplace.cms.gov/outreach-and-education/downloads/c2c-sample-insurance-card.pdf
14 Guide to Understanding Health Insurance Plans
Types of Health Insurance Plans
With the many types of health-care plans available, making a
final decision can be difficult.
Selecting the right one depends on your needs, how much you can afford, and how much freedom you want in choosing your own doctor.
Managed-Care Plans
Just like the name suggests, a managed-
care plan uses a network of health-care providers to manage the cost of health care within the network.
A managed-care network consists of a group of doctors, hospitals, clinics, and other health-care providers that have agreed to reduce the cost of medical services for members of an insurance plan. In return, plan members may be required to stay within the network when seeking care.
The four most common types of managed-care plans are:
1. Health Maintenance Organization (HMO)
An HMO is usually the least expensive type of managed-care plan but also gives you the least amount of freedom in choosing a doctor or hospital.
An HMO requires you to select a primary care physician (PCP) from within its network. You can make this choice from a list provided by your plan provider. If you just signed up for an HMO or transferred from another type of plan, this may mean you will have to change doctors.
HMOs also cover a wider range of preventative services. Out-of-pocket charges such as deductibles and copays are generally lower than in other plans and many HMOs do not require a deductible at all. The tradeoff is that HMOs typically do not cover any out-of-network services except in the case of an emergency. In an HMO, all your health-care needs must be coordinated through your PCP. In most cases, if you need to see a specialist you must first get a referral from your PCP. The specialist must also be within the HMO network. For example, if you have an ear problem you will need to be examined by your PCP. If your PCP cannot treat the issue, he or she will
Guide to Understanding Health Insurance Plans 15
refer you to an ear, nose, and throat specialist within your network. Women who need to see an obstetrician/gynecologist do not have to get a referral from their PCP to see an in-network OB/GYN.
2. Preferred Provider Organization (PPO)
A PPO also has a network of health-care providers but you are not required to choose a PCP or stay within the network for care. You do not need a referral to see a specialist and you are free to choose one either in-network or out-of-network.
The “preferred” in the plan’s title means that the PPO encourages you to stay within the network by offering lower rates, full coverage, and smaller copays for in-network services. While deductibles and copays can be higher than an HMO, they are considerably less than if you venture outside the network for care.
3. Exclusive Provider Organization (EPO)
An EPO is similar to an HMO but with a small degree of flexibility. An EPO plan does require you to stay within a network, but does not always require you to choose a PCP. You also do not typically need a PCP referral to see a specialist. EPOs tend to offer more
coverage with lower rates and copays than PPOs, but they do not cover out-of-network service except in an emergency.
4. Point-of-Service (POS)
A POS plan combines many of the features of an HMO and PPO.
A POS usually requires you to designate a PCP and you will need his or her referral to see a specialist. Services from your PCP are typically not subject to a deductible.
While you can see health-care providers outside the plan’s network, doing so will cost you more in higher deductibles and copays. Some services may also not be covered if you use an out-of-network provider.
Pros and Cons of Managed Care Plans
The main benefit to managed-care plans is that they tend to keep your medical costs down.
Premiums, deductibles, and copays are almost always lower and most in-network services are covered under the plans. Because most services are conducted within a network, you will
16 Guide to Understanding Health Insurance Plans
often have less claims to file and less paperwork to fill out.
Some plans may also offer free preventive services such as doctor checkups and immunizations. A major drawback with the plans is that they offer limited personal choice in choosing where you receive your medical care.
If you have been seeing a family doctor for many years you may be forced to switch to a less-familiar physician within the plan’s network. If you need to see a specialist, you may also have to go through the extra step of first getting your PCP’s approval. The specialist you see may also not be one of your choosing.
While most managed-care plans allow out-of-network providers to cover emergency services, some services may not be covered. For example, if you go to the emergency room at an out-of-network hospital, the emergency room visit may be covered but follow-up care by the hospital’s doctors may not be.
Common Exclusions
Managed-care plans typically cover more types of services than other plans, but not all plans are alike.
Each plan has its own list of approved services it will pay for and those it will not cover. While exclusions vary, here are some common medical expenses that most managed-care plans will not cover:
Cosmetic Surgery: Also called plastic surgery, these types of procedures can include liposuction surgery and rhinoplasty, more commonly known as a “nose job.”
Non-Traditional Treatments: Also called alternative medicine, these may include acupuncture, chiropractic treatments, and energy therapy.
Home Care and Private Nursing Care: These can include in-home visits by a private nurse and long-term care such as a nursing home for the elderly.
Guide to Understanding Health Insurance Plans 17
Fee-for-Service Plans (Indemnity Plans)
Fee-for-service plans are the oldest form of health insurance and allow you almost complete freedom in choosing your medical care.
When you visit a doctor or go to a hospital for a medical issue, the health-care provider will submit a claim to your insurance company for payment. Your insurer will pay a predetermined percentage of the costs. You will be responsible for the rest in the forms of deductibles, copays, and coinsurance up to an out-of-pocket maximum.
In many cases, you have to pay the costs up front and your insurance company will reimburse you its share afterwards. You have no restrictions on the doctors you choose and do not need a referral for a specialist.
You will generally have to pay higher premiums, deductibles, and copays and have more paperwork to process.
COBRA
This rather intimidating name comes from the Consolidated
Omnibus Budget Reconciliation Act of 1985.
It is a special type of insurance coverage for people who have lost their jobs. If your employer offers a group health plan and has more than 20 employees, it must allow you the option to continue to receive that health coverage even after your employment ends.
To qualify for COBRA, you must either have been fired or laid off, or a spouse or parent who had you on his or her policy must have been fired or laid off, gotten divorced, or died. Under COBRA, your benefits would stay the same as when you were employed, with the same coverage limits, copays, and deductibles.
Your premiums would rise considerably because you would be paying the full price rather than sharing the cost with your employer.
Coverage begins the date you sign up for COBRA and can last for 18 months. If you become ill during this period, coverage can be extended another 18 months.
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Military Health Care
All active-duty military personal, retired military personnel, National Guard and Reserve members, and eligible members of their families are covered under a military health-care program called TRICARE.
TRICARE covers all seven branches of the United States Uniformed Services: Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the Public Health Service, and the National Oceanic and Atmospheric Administration.
The three most basic TRICARE programs are:
TRICARE Prime: This program works similarly to an HMO in that it usually has lowers costs, is coordinated through a primary care manager, and offers less freedom of choice. All active-duty military personnel must sign up for TRICARE Prime.
TRICARE Extra: This program also requires you to choose a provider within a network, but also offers a fee-for-service option. You do not have to sign up for TRICARE Extra and it is only available in the United States.
TRICARE Standard: This is a fee-for-service program similar to TRICARE Extra except that you do not have to choose a network provider. It is available worldwide.
Disability Insurance
This type of health insurance is intended to
replace some or all of a worker’s salary in the event he or she becomes disabled.
It does not cover medical care or provide for long-term care. Short-term disability usually covers a person up to two years while long-term disability can extend from several years up to a person’s death.
Guide to Understanding Health Insurance Plans 19
Dental and Vision Insurance
Depending on your health
insurance plan, you may be covered for a wide range of services from a basic checkup to fixing a broken leg.
However, two of the most common types of service people need on a regular basis—dental and vision care—are typically not covered under traditional insurance plans. While some plans include dental and vision in their main coverage, many require you to purchase additional insurance to cover your teeth and eyesight.
These standalone plans can be bought through your employer or on your own. In many cases, they have the same characteristics as traditional types of insurance. They may be similar to an HMO, PPO, or fee-for-service plan and may require a premium, deducible, and copay.
Alternative plans offer you discounted dental and vision services in exchange for a monthly or yearly fee. These are not considered true insurance plans but are similar to buying a membership in a retail store club and receiving a percentage off your purchase.
Medicaid
Medicaid is a health-insurance program for financially struggling
families and individuals. It is run by a cooperative effort between both federal and state governments, which means that each state is allowed to make up its own eligibility guidelines.
Medicaid covers children, the elderly, blind people, disabled people, and others who are eligible to receive federal assistance. In thirty-two states, people who receive Supplemental Security Income (SSI) payments are automatically eligible for Medicaid. SSI is a federal government program that provides some living expenses to low-income seniors, the blind, and disabled people.
While coverage varies by state, the federal government requires that all states cover certain services including inpatient and outpatient hospital services, physician services, pediatric services, laboratory and X-ray services, and nursing and home-health care services.
To qualify for Medicaid, people must meet the following basic guidelines:
Maintain their disabled status.
20 Guide to Understanding Health Insurance Plans
Have been eligible for SSI payments for at least one month.
Meet any other eligibility rules imposed by a state, including a resources test to determine financial eligibility.
Need Medicaid in order to work.
Have total earnings insufficient to replace SSI, Medicaid, and any publicly funded care.
Medicare
Medicare is a federal health-insurance program
for people who are older than 65, people who are disabled, and people suffering from permanent kidney failure that requires either a transplant or dialysis.
Medicare is funded through a 1.45 percent payroll tax removed from the paycheck of every working American. Employers must contribute another 1.45 percent for a total of 2.9 percent.
If you look at your paycheck or paystub, you may see an amount of money with the letters FICA next to it. This stands for the Federal Insurance Contributions Act and it is your contribution to the Medicare fund.
Medicare is broken down into four parts:
Medicare Part A: This covers inpatient hospital services, nursing home services, and hospice care. No premium is required if the patient has paid into the FICA fund for at least ten years.
Medicare Part B: This covers outpatient services such as doctor’s visits, medical equipment, physical therapy, and some preventative care. Part B coverage requires a monthly premium, which in 2016 was $121.80 for the average person. High-income individuals would pay more.
Medicare Part C: Also known as Medicare Advantage, this is a health plan run by Medicare but offered through private insurance companies. As with any private plan, coverage may vary, but the plan must at least provide the same coverage as Medicare Part A and Part B.
Medicare Part D: This provides prescription drug coverage. Part D plans are offered through private insurance companies that are approved by Medicare. Each insurer has its own plan; all require some form of premium while some
Guide to Understanding Health Insurance Plans 21
plans may also require a deductible.
Shop Around
The average person will pay a significant amount of money on healthcare
throughout their lifetime. Any savings you can take advantage of will benefit you over the long run.
If you are trying to decide between two jobs, make sure you ask about health insurance benefits. If one employer has a better health plan, or
contributes more towards their employee’s health insurance, take that into consideration.
If your employer does not offer a contribution towards health care, you may be able to get a better rate if you apply for healthcare through your state’s ACA marketplace.
Depending on your income, you may also be eligible for tax breaks or subsidies through the ACA as well.
An Application for ACA Health Coverage & Help Paying Costs is included on page 57 of this volume for your convenience.
22 Guide to Understanding Health Insurance Plans
Weiss Ratings’ Recommended Health Insurers by State
The following pages list Weiss Ratings’ Recommended Health Insurers (based strictly on financial safety) licensed to do business in each state. These insurers currently receive a Weiss Safety Rating of A+, A, A-, or B+, indicating their strong financial position. Companies are listed by their Safety Rating and then alphabetically within each Safety Rating grouping. If an insurer is not on this list, it should not be automatically assumed that the firm is weak. Indeed, there are many firms that have not achieved a B+ or better rating but are in relatively good condition with adequate resources to cover their risk. Not being included in this list should not be construed as a recommendation to cancel a policy. To get Weiss Safety Rating for a company not included here, go to https://greyhouse.weissratings.com. Weiss Safety Rating Our rating is measured on a scale from A to F and considers a
wide range of factors. Highly rated companies are, in our opinion, less likely to experience financial difficulties than lower-rated firms. See "What Our Ratings Mean" in the Appendix for a definition of each rating category.
Name The insurance company's legally registered name, which can
sometimes differ from the name that the company uses for advertising. An insurer's name can be very similar to the name of other companies which may not be on this list, so make sure you note the exact name before contacting your agent.
City, Address, State The address of the main office where you can contact the firm
for additional information or for the location of local branches and/or registered agents.
Telephone The telephone number to call for information on purchasing
an insurance policy from the company. The following list of Recommended Homeowners Insurers by State is based on ratings as of the date of publication.
Guide to Understanding Health Insurance Plans 23
Alabama B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Alaska B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
PREMERA BLUE CROSS MOUNTLAKE TERRACE
7001 220TH ST SW WA 98043 (425) 918-4000
Arizona A+ Name City Address State Zip Telephone
BLUE CROSS BLUE SHIELD OF ARIZONA PHOENIX 2444 W LAS PALMARITAS DR
AZ 85021 (602) 864-4100
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Arkansas A+ Name City Address State Zip Telephone
HMO PARTNERS INC LITTLE ROCK 320 WEST CAPITOL AR 72203 (501) 221-1800
USABLE MUTUAL INS CO LITTLE ROCK 601 S GAINES AR 72201 (501) 378-2000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
24 Guide to Understanding Health Insurance Plans
California A+ Name City Address State Zip Telephone
BLUE CROSS OF CALIFORNIA THOUSAND OAKS
1 WELLPOINT WAY CA 91362 (916) 403-0526
CALIFORNIA PHYSICIANS SERVICE SAN FRANCISCO
50 BEALE ST 22ND FLOOR CA 94105 (415) 229-5195
A Name City Address State Zip Telephone
INLAND EMPIRE HEALTH PLAN RANCO CUCAMONGO
10801 6TH ST SUITE 120 CA 91730 (951) 335-3987
KAISER FOUNDATION HEALTH PLAN INC OAKLAND 1800 HARRISON ST 20TH FLOOR
CA 94612 (510) 393-6574
A- Name City Address State Zip Telephone
ORANGE PREVENTION & TREATMENT INTEGR
ORANGE 505 CITY PARKWAY WEST CA 92868 (714) 796-6122
PARTNERSHIP HEALTHPLAN OF CALIFORNIA
FAIRFIELD 4665 BUSINESS CENTER DR CA 94534 (707) 863-4218
SAN MATEO HEALTH COMMISSION S SAN FRANCISCO
801 GATEWAY BLVD STE 100
CA 94080 (650) 616-2151
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Colorado B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Connecticut B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 25
Delaware B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
District of Columbia A Name City Address State Zip Telephone
CAREFIRST BLUECHOICE INC WASHINGTON 840 FIRST STREET NE DC 20065 (410) 581-3000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Florida B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Georgia A- Name City Address State Zip Telephone
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
B+ Name City Address State Zip Telephone
AMGP GEORGIA MANAGED CARE CO INC
ATLANTA 4170 ASHFORD DUNWOODY RD
GA 30319 (757) 490-6900
BLUE CROSS BLUE SHIELD HEALTHCARE GA ATLANTA 3350 PEACHTREE ROAD NE GA 30326 (404) 842-8000
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Hawaii B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
26 Guide to Understanding Health Insurance Plans
Idaho B+ Name City Address State Zip Telephone
EMI HEALTH MURRAY 852 EAST ARROWHEAD LANE
UT 84107 (801) 262-7476
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Illinois B+ Name City Address State Zip Telephone
ESSENCE HEALTHCARE INC ST. LOUIS 13900 RIVERPORT DR MO 63043 (314) 209-2780
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
INDEPENDENT CARE HEALTH PLAN MILWAUKEE 1555 N RIVERCENTER DR STE 206
WI 53212 (414) 223-4847
Indiana B+ Name City Address State Zip Telephone
COMMUNITY INS CO MASON 4361 IRWIN SIMPSON RD OH 45040 (513) 872-8100
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
MERIDIAN HEALTH PLAN OF MICHIGAN INC
DETROIT 1 CAMPUS MARTIUS SUITE 700
MI 48226 (313) 324-3700
Iowa B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Kansas B+ Name City Address State Zip Telephone
HEALTHY ALLIANCE LIFE INS CO ST. LOUIS 1831 CHESTNUT ST MO 63103 (314) 923-4444
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 27
Kentucky B+ Name City Address State Zip Telephone
ANTHEM KENTUCKY MANAGED CARE PLAN
LOUISVILLE 13550 TRITON PARK BLVD KY 40223 (888) 641-5224
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
MERIDIAN HEALTH PLAN OF MICHIGAN INC
DETROIT 1 CAMPUS MARTIUS SUITE 700
MI 48226 (313) 324-3700
UNIVERSITY HEALTH CARE INC LOUISVILLE 5100 COMMERCE CROSSINGS DRIVE
KY 40229 (502) 585-7900
Louisiana A+ Name City Address State Zip Telephone
HMO LOUISIANA INC BATON ROUGE 5525 REITZ AVENUE LA 70809 (225) 295-3307
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Maine B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Maryland A Name City Address State Zip Telephone
CAREFIRST BLUECHOICE INC WASHINGTON 840 FIRST STREET NE DC 20065 (410) 581-3000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
28 Guide to Understanding Health Insurance Plans
Massachusetts B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Michigan A- Name City Address State Zip Telephone
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
PRIORITY HEALTH GRAND RAPIDS 1231 EAST BELTLINE NE MI 49525 (616) 942-0954
B+ Name City Address State Zip Telephone
BLUE CARE NETWORK OF MICHIGAN SOUTHFIELD 20500 CIVIC CENTER DRIVE MI 48076 (248) 799-6400
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
MERIDIAN HEALTH PLAN OF MICHIGAN INC DETROIT 1 CAMPUS MARTIUS STE 700 MI 48226 (313) 324-3700
PARAMOUNT INS CO (OH) MAUMEE 1901 INDIAN WOOD CIR OH 43537 (419) 887-2500
PRIORITY HEALTH CHOICE INC GRAND RAPIDS 1231 EAST BELTLINE NE MI 49525 (616) 942-0954
Minnesota A+ Name City Address State Zip Telephone
GROUP HEALTH PLAN INC MINNEAPOLIS 8170 33RD AVENUE SOUTH POBOX 1
MN 55440 (952) 883-6000
HEALTHPARTNERS MINNEAPOLIS 8170 33RD AVENUE SOUTH MN 55440 (952) 883-6000
A Name City Address State Zip Telephone
UCARE MINNESOTA MINNEAPOLIS 500 STINSON BLVD NE MN 55413 (612) 676-6500
A- Name City Address State Zip Telephone
MEDICA INS CO MINNETONKA 401 CARLSON PARKWAY MN 55305 (952) 992-2900
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 29
Mississippi B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Missouri B+ Name City Address State Zip Telephone
ESSENCE HEALTHCARE INC ST. LOUIS 13900 RIVERPORT DR MO 63043 (314) 209-2780
HEALTHY ALLIANCE LIFE INS CO ST. LOUIS 1831 CHESTNUT ST MO 63103 (314) 923-4444
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Montana B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Nebraska B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Nevada B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
New Hampshire B+ Name City Address State Zip Telephone
ANTHEM HEALTH PLANS OF NEW HAMPSHIRE
MANCHESTER 1155 ELM ST NH 03101 (603) 695-7000
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
MATTHEW THORNTON HEALTH PLAN MANCHESTER 1155 ELM STREET NH 03101 (603) 695-7000
30 Guide to Understanding Health Insurance Plans
New Jersey A- Name City Address State Zip Telephone
HORIZON HEALTHCARE OF NEW JERSEY INC
NEWARK 3 PENN PLZ E STE PP-15D NJ 07105 (973) 466-5607
B+ Name City Address State Zip Telephone
HORIZON HEALTHCARE SERVICES INC NEWARK 3 PENN PLAZA EAST, PP-15D
NJ 07105 (973) 466-5607
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
New Mexico B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
New York A Name City Address State Zip Telephone
OXFORD HEALTH PLANS (NY) INC NEW YORK ONE PENN PLAZA FLOOR 8 NY 10119 (203) 459-6000
B+ Name City Address State Zip Telephone
EXCELLUS HEALTH PLAN INC ROCHESTER 165 COURT ST NY 14647 (585) 454-1700
UNITED HEALTHCARE OF NY INC NEW YORK 77 WATER STREET 14TH / 15TH FL
NY 10005 (203) 459-6000
North Carolina A- Name City Address State Zip Telephone
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 31
North Dakota
A- Name City Address State Zip Telephone
MEDICA INS CO MINNETONKA 401 CARLSON PARKWAY MN 55305 (952) 992-2900
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Ohio A- Name City Address State Zip Telephone
CARESOURCE DAYTON 230 NORTH MAIN STREET OH 45402 (937) 531-3300
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
PARAMOUNT ADVANTAGE MAUMEE 1901 INDIAN WOOD CIRCLE
OH 43537 (419) 887-2500
B+ Name City Address State Zip Telephone
COMMUNITY INS CO MASON 4361 IRWIN SIMPSON RD OH 45040 (513) 872-8100
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
MEDICAL HEALTH INS CORP OF OHIO CLEVELAND 2060 EAST NINTH STREET OH 44115 (216) 687-7000
MERIDIAN HEALTH PLAN OF MICHIGAN INC
DETROIT 1 CAMPUS MARTIUS SUITE 700
MI 48226 (313) 324-3700
PARAMOUNT INS CO (OH) MAUMEE 1901 INDIAN WOOD CIRCLE
OH 43537 (419) 887-2500
Oklahoma B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
32 Guide to Understanding Health Insurance Plans
Oregon A+ Name City Address State Zip Telephone
PROVIDENCE HEALTH PLAN PORTLAND 4400 NE HALSEY BLDG # 2 STE #
OR 97213 (503) 574-7500
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
REGENCE BL CROSS BL SHIELD OREGON PORTLAND 100 SW MARKET ST OR 97201 (503) 225-5221
Pennsylvania A- Name City Address State Zip Telephone
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
UPMC FOR YOU INC PITTSBURGH 600 GRANT ST PA 15219 (412) 434-1200
Rhode Island B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 33
South Carolina A Name City Address State Zip Telephone
BLUECHOICE HEALTHPLAN OF SC INC COLUMBIA I-20 AT ALPINE ROAD SC 29219 (803) 786-8466
A- Name City Address State Zip Telephone
BLUE CROSS BLUE SHIELD OF SC INC COLUMBIA 2501 FARAWAY DR SC 29219 (803) 788-3860
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
South Dakota A- Name City Address State Zip Telephone
MEDICA INS CO MINNETONKA 401 CARLSON PARKWAY MN 55305 (952) 992-2900
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
WELLMARK OF SOUTH DAKOTA INC SIOUX FALLS 1601 WEST MADISON ST SD 57104 (605) 373-7200
Tennessee A+ Name City Address State Zip Telephone
VOLUNTEER STATE HEALTH PLAN INC CHATTANOOGA 1 CAMERON HILL CIRCLE TN 37402 (423) 535-5600
B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
34 Guide to Understanding Health Insurance Plans
Texas A+ Name City Address State Zip Telephone
USABLE MUTUAL INS CO LITTLE ROCK 601 S GAINES AR 72201 (501) 378-2000
A- Name City Address State Zip Telephone
COMMUNITY FIRST HEALTH PLANS INC SAN ANTONIO 12238 SILICON DRIVE STE 100
TX 78249 (210) 227-2347
B+ Name City Address State Zip Telephone
AMERIGROUP TEXAS INC HOUSTON 3800 BUFFALO SPEEDWAY SUITE 40
TX 77098 (757) 490-6900
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
K S PLAN ADMINISTRATORS LLC HOUSTON 2727 WEST HOLCOMBE BLVD
TX 77025 (713) 442-0757
UNITEDHEALTHCARE COMMUNITY PLAN TX
SUGAR LAND 14141 S W FREEWAY TX 77478 (713) 778-8664
Utah B+ Name City Address State Zip Telephone
EMI HEALTH MURRAY 852 EAST ARROWHEAD LANE
UT 84107 (801) 262-7476
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Vermont B+ Name City Address State Zip Telephone
BLUE CROSS BLUE SHIELD OF VERMONT BERLIN 445 INDUSTRIAL LANE VT 05602 (802) 223-6131
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 35
Virginia A Name City Address State Zip Telephone
CAREFIRST BLUECHOICE INC WASHINGTON 840 FIRST STREET NE DC 20065 (410) 581-3000
B+ Name City Address State Zip Telephone
HEALTHKEEPERS INC RICHMOND 2015 STAPLES MILL ROAD VA 23230 (804) 354-7000
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
OPTIMA HEALTH PLAN VIRGINIA BEACH 4417 CORPORATION LANE VA 23462 (757) 552-7401
Washington A+ Name City Address State Zip Telephone
PROVIDENCE HEALTH PLAN PORTLAND 4400 NE HALSEY BLDG # 2 STE #
OR 97213 (503) 574-7500
A- Name City Address State Zip Telephone
GROUP HEALTH COOPERATIVE SEATTLE 320 WESTLAKE AVE N SUITE 100
WA 98109 (206) 448-5600
B+ Name City Address State Zip Telephone
ESSENCE HEALTHCARE INC ST. LOUIS 13900 RIVERPORT DR MO 63043 (314) 209-2780
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
PREMERA BLUE CROSS MOUNTLAKE TERRACE
7001 220TH ST SW WA 98043 (425) 918-4000
REGENCE BL CROSS BL SHIELD OREGON PORTLAND 100 SW MARKET ST OR 97201 (503) 225-5221
36 Guide to Understanding Health Insurance Plans
West Virginia A- Name City Address State Zip Telephone
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
B+ Name City Address State Zip Telephone
COVENTRY HEALTH CARE OF WEST VA INC
CHARLESTON 500 VIRGINIA STREET EAST SUITE
WV 25301 (800) 788-6445
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Wisconsin A- Name City Address State Zip Telephone
MEDICA INS CO MINNETONKA 401 CARLSON PARKWAY MN 55305 (952) 992-2900
MEDICAL MUTUAL OF OHIO CLEVELAND 2060 EAST NINTH ST OH 44115 (216) 687-7000
SECURITY HEALTH PLAN OF WI INC MARSHFIELD 1515 ST JOSEPH AVE WI 54449 (715) 221-9555
B+ Name City Address State Zip Telephone
COMPCARE HEALTH SERVICES INS CORP WAUKESHA N17 W24340 RIVERWOOD DRIVE
WI 53188 (414) 459-5000
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
INDEPENDENT CARE HEALTH PLAN MILWAUKEE 1555 N RIVERCENTER DR STE 206
WI 53212 (414) 223-4847
Wyoming B+ Name City Address State Zip Telephone
HUMANA INS CO (WI) DEPERE 1100 EMPLOYERS BLVD WI 54115 (920) 336-1100
Guide to Understanding Health Insurance Plans 37
Weiss Ratings’ Weakest Health Insurers by State
The following pages list Weiss Ratings’ Weakest Health Insurers (based strictly on financial safety) licensed to do business in each state. These insurers currently receive a Weiss Safety Rating of E+, E or E-, indicating their very weak financial position. These companies currently demonstrate what we consider to be significant weaknesses and has also failed some of the basic tests that we use to identify fiscal stability. Therefore, even in a favorable economic environment, it is our opinion that policyholders could incur significant risks. Companies are listed by their Safety Rating and then alphabetically within each Safety Rating grouping. To get Weiss Safety Rating for a company not included here, go to https://greyhouse.weissratings.com. Weiss Safety Rating Our rating is measured on a scale from A to F and considers a
wide range of factors. Lower-rated companies are, in our opinion, more likely to experience financial difficulties than higher-rated firms. See "What Our Ratings Mean" in the Appendix for a definition of each rating category.
Name The insurance company's legally registered name, which can
sometimes differ from the name that the company uses for advertising. An insurer's name can be very similar to the name of other companies which may not be on this list, so make sure you note the exact name before contacting your agent.
City, Address, State The address of the main office where you can contact the firm
for additional information or for the location of local branches and/or registered agents.
Telephone The telephone number to call for information on purchasing
an insurance policy from the company. The following list of Weakest Health Insurers by State is based on ratings as of the date of publication.
38 Guide to Understanding Health Insurance Plans
Alabama E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Alaska E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
Arizona E Name City Address State Zip Telephone
AMERICAS 1ST CHOICE HEALTH PLANS INC
COLUMBIA 250 BERRYHILL RD STE 311 SC 29210 (866) 321-3947
PHOENIX HEALTH PLANS INC PHOENIX 7878 N 16TH ST STE 105 AZ 85020 (602) 824-3700
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
CIGNA HEALTHCARE OF ARIZONA INC PHOENIX 25500 NNORTERRA DR AZ 85085 (623) 277-2171
HEALTH CHOICE INS CO PHOENIX 410 N 44TH ST STE 900 AZ 85008 (480) 968-6866
Arkansas E Name City Address State Zip Telephone
ARKANSAS SUPERIOR SELECT INC LITTLE ROCK 1401 WEST CAPITAL STE 430
AR 72201 (501) 372-1922
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 39
California E+ Name City Address State Zip Telephone
CENTRAL HEALTH PLAN OF CALIFORNIA
DIAMOND BAR 1540 BRIDEGATE DR CA 91765 (626) 388-2390
CHOICE PHYSICIANS NETWORK APPLE VALLEY 18564 HIGHWAY 18 SUITE 105
CA 92307 (626) 229-9828
EASY CHOICE HEALTH PLAN CYPRESS 10803 HOPE ST SUITE B CA 90630 (813) 206-7668
FRESNO-KINGS-MADERA REGIONAL HEALTH
FRESNO 7625 NORTH PALM AVE SUITE 109
CA 93711 (559) 540-7847
E Name City Address State Zip Telephone
ALIGNMENT HEALTH PLAN ORANGE 1100 W TOWN & COUNTRY RD SUITE
CA 92868 (657) 218-7731
GEMCARE HEALTH PLAN INC BAKERSFIELD 4550 CALIFORNIA AVE SUITE 100
CA 93309 (661) 716-8800
SUTTER HEALTH PLAN SACRAMENTO 2480 NATOMAS PARK DR SUITE 15
CA 95833 (916) 286-6562
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
WESTERN HEALTH ADVANTAGE SACRAMENTO 2349 GATEWAY OAKS SUITE 100
CA 95833 (916) 563-3183
E- Name City Address State Zip Telephone
ARCADIAN HEALTH PLAN INC IRVINE 1 PARK PLAZA SUITE 450 CA 92614 (502) 580-1575
ASPIRE HEALTH PLAN MONTEREY 23625 HOLMAN HIGHWAY CA 93940 (831) 625-4965
BROWN & TOLAND HEALTH SERVICES OAKLAND 1221 BROADWAY ST SUITE 700
CA 94612 (415) 322-9897
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
MONARCH HEALTH PLAN IRVINE 11 TECHNOLOGY DR CA 92618 (949) 923-3350
PROVIDENCE HEALTH NETWORK TORRANCE 20555 EARL ST CA 90503 (805) 705-4451
UNIVERSAL CARE WESTMINSTER 5445 GARDEN GROVE BLVD STE 500
CA 92683 (562) 981-4004
Colorado E Name City Address State Zip Telephone
NEW HEALTH VENTURES INC AURORA 11100 E BETHANY DR CO 80014 (720) 744-5100
ROCKY MOUNTAIN HEALTHCARE OPTIONS
GRAND JUNCTION
2775 CROSSRDS BLVD CO 81506 (970) 244-7760
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
40 Guide to Understanding Health Insurance Plans
Connecticut E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Delaware E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
District of Columbia E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Florida E Name City Address State Zip Telephone
AIDS HEALTHCARE FOUNDATION MCO OF FL
FT. LAUDERDALE
110 SE 6TH ST STE 1960 FL 33301 (323) 860-5200
FLORIDA TRUE HEALTH INC PALM BEACH GARDENS
11631 KEW GARDENS AVE STE 200
FL 33410 (215) 937-8000
FREEDOM HEALTH INC TAMPA 5600 MARINER ST STE 227 FL 33609 (813) 506-6000
HEALTH FIRST INS INC ROCKLEDGE 6450 US HIGHWAY 1 FL 32955 (321) 434-5600
MEDICA HEALTHCARE PLANS INC MIAMI 9100 S DADELAND BLVD STE 1250
FL 33156 (305) 670-8440
MOLINA HEALTHCARE OF FLORIDA INC
DORAL 8300 NW 33RD ST STE 400 FL 33122 (866) 422-2541
PREFERRED CARE PARTNERS INC MIAMI 9100 S DADELAND BLVD STE 1250
FL 33156 (305) 670-8438
SUNSHINE HEALTH SUNRISE 1301 INTERNATIONAL PARKWAY
FL 33323 (314) 725-4477
ULTIMATE HEALTH PLANS INC SPRING HILL 1244 MARINER BLVD FL 33609 (352) 835-7151
WELLCARE OF FLORIDA INC TAMPA 8735 HENDERSON ROAD FL 33634 (813) 290-6200
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 41
Florida (continued) E- Name City Address State Zip Telephone
OPTIMUM HEALTHCARE INC TAMPA 5600 MARINER ST STE 227 FL 33609 (813) 506-6000
Georgia E Name City Address State Zip Telephone
AMERICAS 1ST CHOICE HEALTH PLANS INC
COLUMBIA 250 BERRYHILL RD STE 311 SC 29210 (866) 321-3947
CIGNA HEALTHCARE OF GEORGIA INC ATLANTA TWO SECURITIES CENTRE 3500 PIE
GA 30305 (404) 443-8800
PIEDMONT WELLSTAR HEALTHPLANS INC
ATLANTA 1800 HOWELL MILL RD STE 850
GA 30318 (678) 505-2895
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Hawaii E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Idaho E+ Name City Address State Zip Telephone
TIMBER PRODUCTS MANUFAC. TRUST SPOKANE 951 EAST THIRD AVE WA 99202 (509) 535-4646
E Name City Address State Zip Telephone
BRIDGESPAN HEALTH CO SALT LAKE CITY 2890 EAST COTTONWOOD PARKWAY
UT 84121 (801) 333-2000
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
42 Guide to Understanding Health Insurance Plans
Illinois E Name City Address State Zip Telephone
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
HEALTH ALLIANCE-MIDWEST INC URBANA 301 S VINE IL 61801 (217) 337-8406
MOLINA HEALTHCARE OF ILLINOIS INC OAKBROOK 1520 KENSINGTON RD # 212
IL 60523 (562) 435-3666
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Indiana E Name City Address State Zip Telephone
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
INDIANA UNIVERSITY HEALTH PLANS INC
INDIANAPOLIS 950 N MERIDIAN ST STE 200
IN 46204 (317) 963-9780
Iowa E+ Name City Address State Zip Telephone
MERIDIAN HEALTH PLAN OF IOWA INC DETROIT 1 CAMPUS MARTIUS STE 700
MI 48226 (313) 324-3700
E Name City Address State Zip Telephone
HEALTH ALLIANCE-MIDWEST INC URBANA 301 S VINE IL 61801 (217) 337-8406
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 43
Kansas E Name City Address State Zip Telephone
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Kentucky E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Louisiana E Name City Address State Zip Telephone
LOUISIANA HEALTHCARE CONNECTIONS INC
SAINT LOUIS 7700 FORSYTH BLVD MO 63105 (314) 725-4477
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Maine E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Maryland E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
EVERGREEN HEALTH COOPERATIVE INC BALTIMORE 3000 FALLS RD STE 1 MD 21211 (443) 075-0990
44 Guide to Understanding Health Insurance Plans
Massachusetts E Name City Address State Zip Telephone
FALLON HEALTH & LIFE ASR CO WORCESTER 10 CHESTNUT ST MA 01608 (508) 799-2100
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
CONNECTICARE OF MASSACHUSETTS INC
BOSTON C/O LEBOEUF LAMB GREENE & MCRA
MA 02110 (860) 674-5700
Michigan E Name City Address State Zip Telephone
BLUE CROSS COMPLETE OF MICHIGAN SOUTHFIELD 100 GALLERIA OFFICENTRE #210
MI 48034 (313) 225-9000
HARBOR HEALTH PLAN INC DETROIT 3663 WOODWARD SUITE 120
MI 48201 (800) 543-0161
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
HEALTHPLUS INS CO FLINT 2050 S LINDEN RD MI 48532 (810) 230-2000
Minnesota E Name City Address State Zip Telephone
SANFORD HEALTH PLAN OF MINNESOTA
SIOUX FALLS 300 CHERAPA PLACE SUITE 201
SD 57109 (605) 328-7226
UCARE HEALTH INC MINNEAPOLIS 500 STINSON BLVD NE MN 55413 (612) 676-6500
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Mississippi E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 45
Missouri E Name City Address State Zip Telephone
MISSOURI CARE INC COLUMBIA 2404 FORUM BLVD MO 65203 (813) 206-6200
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Montana E+ Name City Address State Zip Telephone
NEW WEST HEALTH SERVICES HELENA 130 NEILL AVENUE MT 59601 (406) 457-2200
TIMBER PRODUCTS MANUFACTURERS TRUST
SPOKANE 951 EAST THIRD AVE WA 99202 (509) 535-4646
E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Nebraska E Name City Address State Zip Telephone
AMERIHEALTH NEBRASKA INC OMAHA 2120 S 72ND ST NE 68124 (215) 937-8000
HEALTH ALLIANCE-MIDWEST INC URBANA 301 S VINE IL 61801 (217) 337-8406
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Nevada E Name City Address State Zip Telephone
PACIFICARE OF NEVADA INC LAS VEGAS 2720 N TENAYA WAY NV 89128 (952) 936-1300
PROMINENCE HEALTHFIRST RENO 1510 MEADOW WOOD LANE
NV 89502 (775) 770-6000
PROMINENCE PREFERRED HEALTH INS CO
RENO 1510 MEADOW WOOD LANE
NV 89502 (775) 770-6679
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
46 Guide to Understanding Health Insurance Plans
New Hampshire E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
New Jersey E Name City Address State Zip Telephone
CIGNA HEALTHCARE OF NEW JERSEY INC
JERSEY CITY 499 WASHINGTON BOULEVARD 5TH F
NJ 07310 (201) 533-5001
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
New Mexico E Name City Address State Zip Telephone
UNITEDHEALTHCARE OF NEW MEXICO INC
ALBUQUERQUE 8220 SAN PEDRO NE STE 300
NM 87113 (505) 449-4131
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
New York E+ Name City Address State Zip Telephone
MVP HEALTH INS CO SCHENECTADY 625 STATE ST NY 12305 (518) 370-4793
QUALITY HEALTH PLANS OF NEW YORK INC
RONKONKOMA 2805 VETERANS MEMORIAL HWY #17
NY 11779 (813) 463-0099
E Name City Address State Zip Telephone
CDPHP UNIVERSAL BENEFITS INC ALBANY 500 PATROON CREEK BLVD
NY 12206 (518) 641-3000
CRYSTAL RUN HEALTH INS CO INC MIDDLETOWN 109 RYKOWSKI LANE NY 10940 (845) 703-6422
GROUP HEALTH INCORPORATED NEW YORK 55 WATER ST NY 10041 (212) 615-0000
SENIOR WHOLE HEALTH OF NEW YORK INC
NEW YORK 111 BROADWAY STE 1505 NY 10006 (617) 494-5353
TOUCHSTONE HEALTH HMO INC WHITE PLAINS 1 N LEXINGTON AVE 12TH FL
NY 10601 (914) 288-1000
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 47
New York (continued) E- Name City Address State Zip Telephone
ATLANTIS HEALTH PLAN EAST MEADOW 1905 HEMPSTEAD TURNPIKE
NY 11553 (212) 747-0877
CARECONNECT INS CO EAST HILLS 2200 NERN BLVD STE 104 NY 11548 (516) 465-8318
OSCAR INS CORP NEW YORK 295 LAFAYETTE ST NY 10012 (646) 403-3677
North Carolina E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
North Dakota E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Ohio E+ Name City Address State Zip Telephone
PREMIER HEALTH PLAN INC DAYTON 110 N MAIN ST STE 1200 OH 45402 (937) 499-9588
E Name City Address State Zip Telephone
PREMIER HEALTH INSURING CORP DAYTON 110 N MAIN ST STE 1200 OH 45402 (937) 499-9588
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
48 Guide to Understanding Health Insurance Plans
Oklahoma E Name City Address State Zip Telephone
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- GHS MANAGED HEALTH CARE PLANS
INC TULSA 1400 S BOSTON AVE OK 74119 (312) 653-6716
OKLAHOMA SUPERIOR SELECT INC OKLAHOMA CITY
909 S MERIDIAN AVE STE 425
OK 73108 (405) 602-5488
Oregon E+ Name City Address State Zip Telephone
TIMBER PRODUCTS MANUFACTURERS TRUST
SPOKANE 951 EAST THIRD AVE WA 99202 (509) 535-4646
E Name City Address State Zip Telephone
ALLCARE HEALTH PLAN INC GRANTS PASS 740 SE 7TH ST OR 97526 (541) 471-4106
BRIDGESPAN HEALTH CO SALT LAKE CITY 2890 EAST COTTONWOOD PARKWAY
UT 84121 (801) 333-2000
HEALTH REPUBLIC INS CO HILLSBORO 2373 NW 185TH AVE #701 OR 97124 (888) 990-6635
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
FAMILYCARE HEALTH PLANS INC PORTLAND 825 NE MULTNOMAH STE 1400
OR 97232 (503) 222-3205
HEALTH NET HEALTH PLAN OF OREGON INC
TIGARD 13221 SW 68TH PARKWAY SUITE 20
OR 97223 (888) 802-7001
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
Guide to Understanding Health Insurance Plans 49
Pennsylvania E Name City Address State Zip Telephone
VALUE BEHAVIORAL HEALTH OF PA NORFOLK 240 CORPORATE BLVD VA 23502 (757) 459-5200
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Puerto Rico E- Name City Address State Zip Telephone
FIRST MEDICAL HEALTH PLAN INC GUAYNABO 530 MARGINAL BUCHANAN
PR 00966 (787) 474-3999
MCS ADVANTAGE INC SAN JUAN STE 203 255 PONCE DE LEóN AVE
PR 00917 (787) 758-2500
MMM HEALTHCARE LLC SAN JUAN 350 CHARDON AVE STE 500
PR 00918 (787) 622-3000
Rhode Island E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
South Carolina E Name City Address State Zip Telephone
AMERICAS 1ST CHOICE HEALTH PLANS INC
COLUMBIA 250 BERRYHILL RD STE 311 SC 29210 (866) 321-3947
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
South Dakota E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
50 Guide to Understanding Health Insurance Plans
Tennessee E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Texas E+ Name City Address State Zip Telephone
COOK CHILDRENS HEALTH PLAN FORT WORTH 801 SEVENTH AVENUE TX 76104 (817) 334-2247
E Name City Address State Zip Telephone
GHS INS CO OKLAHOMA CITY
3817 NWEST EXPRESSWAY STE 300
OK 73112 (405) 316-7232
SHA LLC AUSTIN 12940 N HWY 183 TX 78750 (512) 257-6001
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
INS CO OF SCOTT & WHITE TEMPLE 1206 WEST CAMPUS DR TX 76502 (254) 298-3000
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
SENDERO HEALTH PLANS INC AUSTIN 2028 E BEN WHITE BLVD STE 400
TX 78741 (512) 978-8147
Utah E Name City Address State Zip Telephone
BRIDGESPAN HEALTH CO SALT LAKE CITY 2890 EAST COTTONWOOD PARKWAY
UT 84121 (801) 333-2000
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
HEALTH CHOICE UTAH INC SOUTH JORDAN
406 W S JORDAN PARKWAY STE 500
UT 84095 (801) 984-3388
Guide to Understanding Health Insurance Plans 51
Vermont E+ Name City Address State Zip Telephone
MVP HEALTH INS CO SCHENECTADY 625 STATE ST NY 12305 (518) 370-4793
E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Virginia E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Washington E+ Name City Address State Zip Telephone
TIMBER PRODUCTS MANUFACTURERS TRUST
SPOKANE 951 EAST THIRD AVE WA 99202 (509) 535-4646
E Name City Address State Zip Telephone
BRIDGESPAN HEALTH CO SALT LAKE CITY 2890 EAST COTTONWOOD PARKWAY
UT 84121 (801) 333-2000
SOUNDPATH HEALTH FEDERAL WAY 33820 WEYERHAEUSER WAY S
WA 98001 (866) 789-7747
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
E- Name City Address State Zip Telephone
HEALTH NET HEALTH PLAN OF OREGON INC
TIGARD 13221 SW 68TH PARKWAY SUITE 20
OR 97223 (888) 802-7001
MODA HEALTH PLAN INC PORTLAND 601 SW SECOND AVE OR 97204 (503) 228-6554
52 Guide to Understanding Health Insurance Plans
West Virginia E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Wisconsin E+ Name City Address State Zip Telephone
GROUP HEALTH COOP OF EAU CLAIRE ALTOONA 2503 N HILLCREST PARKWAY
WI 54720 (715) 552-4300
MOLINA HEALTHCARE OF WISCONSIN INC
MILWAUKEE 11200 W PARKLAND AVE WI 53224 (414) 847-1777
E Name City Address State Zip Telephone
UCARE HEALTH INC MINNEAPOLIS 500 STINSON BLVD NE MN 55413 (612) 676-6500
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Wyoming E+ Name City Address State Zip Telephone
TIMBER PRODUCTS MANUFACTURERS TRUST
SPOKANE 951 EAST THIRD AVE WA 99202 (509) 535-4646
E Name City Address State Zip Telephone
WELLCARE PRESCRIPTION INS INC TAMPA 8735 HENDERSON RD FL 33634 (813) 290-6200
Guide to Understanding Health Insurance Plans 53
Appendices
Helpful Resources............................................................................... 54 State Insurance Commissioners ............................................................. 55 Application for Health Coverage & Help Paying Costs ................................ 56 Sample Application for Private Health Insurance ...................................... 64 Glossary ............................................................................................ 65 Sources ............................................................................................ 67 What Our Ratings Mean ....................................................................... 68 Terms & Conditions ............................................................................. 69
54 Guide to Understanding Health Insurance Plans
Helpful Resources Contact any of the following organizations for further information about purchasing health insurance.
Your state department of insurance - See next page for a specific contacts
National Association of Insurance Commissioners - www.naic.org
Insurance Information Institute - www.iii.org
Independent Insurance Agents & Brokers of America www.independentagent.com/default.aspx
Weiss Ratings, LLC provides financial strength ratings for health insurance plans nationwide: www.weissratings.com
COBRA Insurance Telephone: 1-877-279-7959 www.cobrainsurance.com HealthCare.gov: Official website of the Affordable Care Act marketplace. Telephone: 1-800-318-2596 www.healthcare.gov
Health Insurance Portability and Accountability Act (HIPAA): Legislation passed by the US Congress in 1996 to protect the privacy of Americans’ medical information, limit exclusions for pre-existing conditions, and ensure health coverage if a person loses a job.
United States Department of Labor Telephone: 1-866-4-USA-DOL www.dol.gov HIPPA Information from the DOL: https://www.dol.gov/general/topic/health-plans/portability National Coalition for Health Care: The NCHC is a coalition of about 100 businesses, labor unions, consumer groups, insurance providers, and health-care providers with a stated goal of improving the health-care landscape in the United States. Telephone: (202-638-7151) www.nchc.org TRICARE Insurance www.tricare.mil
Guide to Understanding Health Insurance Plans 55
State Insurance Commissioners' Departmental Contact Information
Application for Health Coverage & Help Paying CostsApply faster online at HealthCare.gov
Use this application to see what coverage you qualify for
•
•
•
You may qualify for a free or low-cost program, even if you earn as much as$97,200 a year (for a family of 4).
Who can use this application?
•• Apply even if you or your child already has health coverage. You could
be eligible for lower-cost or free coverage.• HealthCare.gov•
•
What you may need to apply
•
•
••
Why do we ask for We’ll keep all thethis information? information you provide private and secure, as required by law.
HealthCare.gov
What happens next?
If you don’t have all the information we ask for, sign and submit your application anyway. you may receive a call from the Marketplace if we need more information
Get help with this application
• Online: HealthCare.gov• Phone: 1-800-318-2596
1-855-889-4325• In person:
HealthCare.gov 1-800-318-2596
• En Español: 1-800-318-2596.• Other languages:
1-800-318-2596
www.cms.gov/about-cms/agency-Information/aboutwebsite/ cmsnondiscriminationnotice.html1-800-318-2596 1-855-889-4325
PRA Disclosure Statement:
Page 1 of 7
Please print in capital letters using black or dark blue ink only. Fill in the circles ( ) like this
STEP 1: Tell us about yourself.
STEP 2: Tell us about your family.
Who do you need to include on this application?
For adults who need coverage: Include these people even if they aren’t applying for health coverage themselves: •••
For children under age 21 who need coverage: Include these people even if they aren’t applying for health coverage themselves: ••••
Complete Step 2 for each person in your family.
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 2 of 7
STEP 2: PERSON 1 (Start with yourself.)
SELF
Social Security Number (SSN)
We need a Social Security number (SSN) if you want health coverage and have an SSN or can get one. socialsecurity.gov
Do you plan to file a federal income tax return NEXT YEAR? You can still apply for coverage even if you don’t file a federal income tax return.YES. If yes, NO. If no,
If yes,
If yes,
If yes,
If yes,
Do you need health coverage? Even if you have coverage, there might be a program with better coverage or lower costs.YES. If yes NO. If no,
U.S. citizen U.S. nationalnaturalized derived citizen (This usually means you were born outside the U.S.)
YES. If yes, NO. If no,
If you aren’t a U.S. citizen or U.S. national, YES. See instructions.
(Select “yes” if you or your spouse takes care of this child.)
Optional: (Fill in all that
apply.)
19. If Hispanic/Latino, ethnicity:
20. Race:
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 3 of 7
STEP 2: PERSON 1 (Continue with yourself.)
Current job & income information
Employed: Not employed: Self-employed:
Current job 1:
$Current job 2:
$In the past year, did you:
If self-employed, answer a and b:
$See instructions.
Other income you get this month: NOTE: don’t
$ $
$ $
$ $
$ $
Deductions:
NOTE:
$ $
$Complete this question if your income changes during the year
this year next
$ $ Thanks! This is all we need to know about you.
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 4 of 7 Note: If this person doesn’t need health coverage, just answer questions 1–11 on thisSTEP 2: PERSON 2 page. Make a copy of pages 4–5 if there are more than 2 people in your household.
See instructions.
We need this if you want health coverage for PERSON 2, and PERSON 2 has an SSN.
If no,
Does PERSON 2 plan to file a federal income tax return NEXT YEAR? (You can still apply for coverage even if PERSON 2 doesn’t file a federal income tax return.)YES. If yes, NO. If no,
If yes,
If yes,
If yes,
If yes,
Does PERSON 2 need health coverage? (Even if PERSON 2 has coverage, there might be a program with better coverage or lower costs.)YES. If yes NO. If no,
U.S. citizen U.S. nationalnaturalized derived citizen (This usually means they were born outside the U.S.)
YES. If yes, NO. If no,
If PERSON 2 isn’t a U.S. citizen or U.S. national, YES. See instructions.
(Select “yes” if PERSON 2 or their spouse takes care of this child.) (These can be the same children listed on page 2.)
Please answer these questions if PERSON 2 is 22 or younger:
If yes
21. If Hispanic/Latino, ethnicity: Optional: (Fill in all that 22. Race:
apply.)
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 5 of 7 Tell us about any income PERSON 2 gets.STEP 2: PERSON 2 Complete this page even if PERSON 2 doesn’t need health coverage.
Current job & income information
Employed: PERSON 2 Not employed: Self-employed:
Current job 1:
$Current job 2:
$In the past year, did PERSON 2:
If PERSON 2 is self-employed, answer the following questions:
$ See instructions.
Other income PERSON 2 gets this month: NOTE: don’t
$ $
$ $
$ $
$ $
Deductions:
NOTE:
$ $
$Complete only if PERSON 2’s income changes during the year,
this year next year
$ $ Thanks! This is all we need to know about PERSON 2.
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 6 of 7
STEP 3: American Indian or Alaska Native (AI/AN) family member(s) Are you or is anyone in your family American Indian or Alaska Native?
NO. If no, YES. If yes,
STEP 4: Your family’s health coverage
YES, premium tax credits were reconciled. Fill in the circle only if ALL of these apply to you: • • • healthcare.gov/help/reconciling-your-tax-credit/
Was anyone on this application found not eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in the past 90 days? (Select yes only if someone was found not eligible for this coverage by your state, not by the Marketplace.)
Or, was anyone on this application found not eligible for Medicaid or CHIP due to their immigration status since October 1, 2013?
Did anyone on this application apply for coverage during the Marketplace open enrollment period?
Check yes even if the coverage is from someone else’s job, like a parent or spouse, even if they don’t accept the coverage.
YES. NO.
Is anyone enrolled in health coverage now? YES. If yes, NO. If no,
Information about current health coverage. (Make a copy of this page if more than 2 people have health coverage now.)
(Don’t tell us about TRICARE if you have Direct Care or Line of Duty.)
PERS
ON
1:
Type of coverage
If it’s employer insurance: (You’ll also need to complete Appendix A.)
If it’s another kind of coverage:
PERS
ON
2:
Type of coverage
If it’s employer insurance: (You’ll also need to complete Appendix A.)
If it’s another kind of coverage:
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
Page 7 of 7
STEP 5: Your agreement & signature Do you agree to allow the Marketplace to use income data, including information from tax returns,for the next 5 years?
If no,
Is anyone applying for health insurance on this application incarcerated (detained or jailed)?If yes
If anyone on this application is eligible for Medicaid: •
••
•
•HealthCare.gov 1-800-318-2596
•
•
What should I do if I think my eligibility results are wrong?
•
••
HealthCare.gov/marketplace-appeals/ 1-800-318-25961-855-889-4325 Health Insurance
Marketplace
PERSON 1 should sign this application.
STEP 6: Mail completed application
www.eac.govDept. of Health and Human Services 465 Industrial Blvd. London, KY 40750-0001
Health Insurance Marketplace
NEED HELP WITH YOUR APPLICATION? HealthCare.gov 1-800-318-2596 1-800-318-25961-800-318-2596 1-855-889-4325
SAM
PLE
PRIV
ATE
HEA
LTH
INSU
RA
NC
E EN
RO
LLM
ENT
FOR
M
TO B
E C
OM
PLET
ED B
Y EM
PLO
YER
G
roup
#
Sub
gro
up#
Ef
fect
ive
Dat
e
Prod
uct
ID#
Pr
oduc
t ID
#
Em
plo
yee
Cla
ss
Emp
loye
e D
ept.
Ap
pro
ved
by
Emp
loye
r ID
#
1.
INFO
RM
ATI
ON
AB
OU
T YO
UR
SELF
INST
RU
CTI
ON
S TO
EM
PLO
YEE:
Plea
se p
rint
or t
ype
and
com
ple
te S
ectio
ns 1
thr
oug
h 5.
Emp
loye
e N
ame
(Las
t, F
irst,
Initi
al, S
uffix
) M
arita
l Sta
tus
Sin
gle
M
arrie
d
Ad
dre
ss
City
St
ate
Zip
C
ount
y
Ph
one
Emp
loye
r D
ate
Emp
loye
d
Act
ive
R
etire
e D
o yo
u or
any
oth
er fa
mily
Ye
s If
yes,
by
Spou
se’s
hea
lth in
sura
nce
C
over
age
Ind
ivid
ual
Spou
se’s
hea
lth
mem
ber
s ha
ve h
ealth
insu
ranc
e?
No
who
m?
Car
rier
(if o
ther
tha
n yo
urs)
le
vel
Fam
ily
Insu
ranc
e ID
#
El
igib
le fo
r M
edic
are?
Ye
s
No
Emp
loye
e ID
# Sp
ouse
ID#
Em
plo
yee
A E
ffec
tive
Dat
e B
Eff
ectiv
e D
ate
Spou
se
A E
ffec
tive
Dat
e E
ffec
tive
Dat
e
2. E
NR
OLL
MEN
T/C
HA
NG
E FO
R a
dd
ress
or
Prim
ary
Car
e Ph
ysic
ian
chan
ges
, cal
l our
cus
tom
er s
ervi
ce d
epar
tmen
t or
vis
it ou
r w
ebsi
te.
3. C
HO
OSE
CO
VER
AG
E A
N
ew A
pp
lican
t R
easo
n B
T
erm
inat
ion
HM
O*
EPO
Nam
e C
hang
e N
ew H
ire
R
emov
e D
epen
den
t(s)
onl
y (p
leas
e sp
ecify
) P
PO
Pre
scrip
tion
Dru
g O
nly
C
OB
RA
O
pen
Enr
ollm
ent
In
dem
nity
H
igh
Ded
uctib
le E
PO
A
dd
Dep
end
ent
CO
BR
A/S
tate
Con
tinua
tion
R R
easo
n:
Den
tal
Hig
h D
educ
tible
PPO
Plan
Tra
nsfe
r Q
ualif
iyin
g E
vent
(des
crib
e)
T
erm
inat
ion
of E
mp
loym
ent
O
ptin
g fo
r O
ther
Cov
erag
e
PO
S*
A
dd
ress
Cha
nge
Oth
er
M
oved
from
Are
a O
ther
___
____
____
____
___
* C
hoos
e a
Prim
ary
Car
e Ph
ysic
an fo
r ea
ch a
pp
lican
t in
Sec
tion
4.
Dep
end
ent
to 3
0
Ef
fect
ive
Dat
e of
Cha
nge
___
____
____
____
____
____
____
____
___
Ef
fect
ive
Dat
e of
Cha
nge
____
____
____
____
____
____
____
___
4. I
NFO
RM
ATI
ON
AB
OU
T A
LL F
AM
ILY
MEM
BER
S YO
U W
AN
T EN
RO
LLED
UN
DER
YO
UR
PLA
N
(if
you
are
ap
ply
ing
for
an H
MO
or
POS,
you
mus
t ch
oose
a P
rimar
y C
are
Phys
ican
for
each
fam
ily m
emb
er)
1.
Nam
e (F
irst,
Mid
dle
, Las
t)
Rel
atio
nshi
p t
o Em
plo
yee
(sel
f)
Mal
e Fe
mal
e D
ate
of B
irth
____
_ /
____
_ /
____
_ So
cial
Sec
urity
#___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
Prim
ary
Car
e Ph
ysic
ian
(Firs
t, L
ast)
PC
P#
2.
Nam
e (F
irst,
Mid
dle
, Las
t)
Rel
atio
nshi
p t
o Em
plo
yee
(sp
ouse
)
M
ale
Fem
ale
Dat
e of
Birt
h __
___
/ __
___
/ __
___
Soci
al S
ecur
ity#_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
Pr
imar
y C
are
Phys
icia
n (F
irst,
Las
t)
PCP#
3
. N
ame
(Firs
t, M
idd
le, L
ast)
R
elat
ions
hip
to
Emp
loye
e
Mal
e Fe
mal
e D
ate
of B
irth
____
_ /
____
_ /
____
_ So
cial
Sec
urity
#___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
Prim
ary
Car
e Ph
ysic
ian
(Firs
t, L
ast)
PC
P#
4.
Nam
e (F
irst,
Mid
dle
, Las
t)
Rel
atio
nshi
p t
o Em
plo
yee
M
ale
Fem
ale
Dat
e of
Birt
h __
___
/ __
___
/ __
___
Soci
al S
ecur
ity#_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
Pr
imar
y C
are
Phys
icia
n (F
irst,
Las
t)
PCP#
5. S
IGN
ATU
RE
I hav
e re
ad a
nd a
gre
e to
the
aut
horiz
atio
n of
the
rev
erse
sid
e of
thi
s fo
rm
Si
gna
ture
Dat
e
64 Guide to Understanding Health Insurance Plans
Guide to Understanding Health Insurance Plans 65
Glossary This glossary contains the most important terms used in this publication. COBRA Short for the Consolidated Omnibus Budget
Reconciliation Act of 1985, it is a type of health insurance coverage for people who have lost their jobs.
Coinsurance A predetermined percentage of the cost of
medical services that must be paid by the policy holder.
Copayment A small predetermined fee that must be
paid by the policy holder for certain medical services.
Deductible The amount of money that must be paid by
the policy holder out-of-pocket before an insurance plan begins paying.
Drug List A list of prescription drugs covered by a
specific health plan. It is also called a formulary.
Excluded Services Medical services that are not covered by an
insurance plan. Explanation of Benefits A statement sent to a policy holder by an
insurance company detailing how a claim was processed for payment.
Fee-for-Service Plan Medical services not coordinated through a
network of health-care providers. Health-care providers are paid per services rendered. Insurance companies either pay the provider directly or reimburse the policy holder.
Insurance Card A card issued by an insurance provider that
acts as proof of insurance and contains
66 Guide to Understanding Health Insurance Plans
important information such as policy details and identification numbers.
Managed-Care Plan Medical services coordinated through a
network of health-care providers. Managed-care plans may require a policy holder to stay within a network for the services to be covered.
Network Provider A member of a group of doctors, hospitals,
pharmacies, and health-care facilities under contract with an insurance company to provide services at discounted rates.
Out-of-pocket Maximum The maximum amount of out-of-pocket
costs a policy holder is responsible for paying each year.
Preauthorization An assurance from a health-care provider
that a treatment, service, or prescription drug is medically necessary before an insurance provider will agree to cover the cost.
Premium A monthly fee paid to an insurance company
or health-plan provider to keep an insurance policy active. If an insurance plan is issued through work, in many cases an employer will pay a portion of the premium.
Preventive Services Services to help prevent illness or detect
more serious conditions at an early stage. Primary Care Provider The health-care professional a patient sees
first, such as a personal doctor. Specialist A doctor who has received advanced
training in a specialized area. TRICARE Health insurance coverage for active-duty
and retired military personnel, members of the National Guard and Reserve, and eligible members of their families.
Guide to Understanding Health Insurance Plans 67
SOURCES
https://www.cbo.gov/publication/51130
http://kff.org/report-section/ehbs-2016-summary-of-findings/
https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/51130-
Health_Insurance_Premiums_OneCol.pdf
https://www.healthcare.gov/glossary/
https://resources.ehealthinsurance.com/individual-and-family/different-types-health-insurance-plans
http://www.webmd.com/health-insurance/types-of-health-insurance-plans#1
http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-
works/difference-hmo-ppo-epo.html
https://www.nerdwallet.com/blog/health/dental-insurance/
http://www.military.com/benefits/veterans-health-care/military-medical-benefits-overview.html
https://www.healthpocket.com/healthcare-research/infostat/top-10-excluded-services-obamacare
https://www.cdc.gov/ncbddd/disabilityandhealth/hcp.html
https://www.ehealthinsurance.com/health-plans
https://www.cdc.gov/nchs/fastats/health-insurance.htm https://www.medicaid.gov/medicaid/benefits/list-of-benefits/index.html https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-
medicare.html http://money.cnn.com/retirement/guide/retirementliving_healthcare.moneymag/index3.htm
68 Guide to Understanding Health Insurance Plans
Weiss Ratings: What Our Ratings Mean A Excellent. The company offers excellent financial security. It has maintained a
conservative stance in its investment strategies, business operations and underwriting commitments. While the financial position of any company is subject to change, we believe that this company has the resources necessary to deal with severe economic conditions.
B Good. The company offers good financial security and has the resources to
deal with a variety of adverse economic conditions. It comfortably exceeds the minimum levels for all of our rating criteria, and is likely to remain healthy for the near future. However, in the event of a severe recession or major financial crisis, we feel that this assessment should be reviewed to make sure that the firm is still maintaining adequate financial strength.
C Fair. The company offers fair financial security and is currently stable. But
during an economic downturn or other financial pressures, we feel it may encounter difficulties in maintaining its financial stability.
D Weak. The company currently demonstrates what, in our opinion, we consider
to be significant weaknesses which could negatively impact policyholders. In an unfavorable economic environment, these weaknesses could be magnified.
E Very Weak. The company currently demonstrates what we consider to be significant
weaknesses and has also failed some of the basic tests that we use to identify fiscal stability. Therefore, even in a favorable economic environment, it is our opinion that policyholders could incur significant risks.
F Failed. The company is deemed failed if it is either 1) under supervision of an
insurance regulatory authority; 2) in the process of rehabilitation; 3) in the process of liquidation; or 4) voluntarily dissolve after disciplinary or other regulatory action by an insurance regulatory authority.
+ The plus sign is an indication that the company is in the upper third of the letter grade. - The minus sign is an indication that the company is in the lower third of the letter grade. U Unrated. The company is unrated for one or more of the following reasons: (1) total assets are
less than $1 million; (2) premium income for the current year was less than $100,000; or (3) the company functions almost exclusively as a holding company rather than as an underwriter; or, (4) in our opinion, we do not have enough information to reliably issue a rating.
Guide to Understanding Health Insurance Plans 69
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70 Guide to Understanding Health Insurance Plans
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