Overview of Insurance Products
When you buy, or enroll in, a health plan, the insurance company agrees to pay for preventive services to help you stay well, plus part of your medical bills when you need a checkup, get sick or have an accident. These include things like doctor or hospital visits, prescription drugs, tests, maternity care and other medical services you may need. That’s called “coverage.”
Premiums are payments you make each month to your insurance company for your health insurance coverage. Keeping these payments up-to-date ensures that you will have coverage when you need it, whether it’s an unexpected illness or a chronic condition. When you apply for coverage and make your first month’s premium payment, you are issued a health plan policy with a date that your coverage will start.
Source: How Health Insurance Works, by Florida Blue BCBS.
Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD).
There are four main “parts” of Medicare insurance: Part A, Part B, Part C, and Part D. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together make up Original Medicare. Medicare Part C, also known as Medicare Advantage, and Medicare Part D (prescription drug coverage) programs that let you get Medicare plans through private insurance companies that contract with Medicare. There is also Medicare Supplement insurance (also called Medigap), which is sold by private companies.
For more information: Medicare Guide, by Centers for Medicare & Medicaid Services.
For more information: Medigap Guide, by Centers for Medicare & Medicaid Services.
Affordable Care Act Plans (Obamacare)
The Affordable Care Act (ACA) requires all healthcare plans offered in the individual and small group markets to cover ten categories of essential health benefits: ambulatory care, emergency care, hospitalization, maternity and newborn care, mental health and substance use care, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive care, chronic disease management, and pediatric dental and vision care. The Act prohibits pre-existing condition exclusions.
Premium tax credits may be available for individual/families with income falling below certain levels. Individuals who are eligible for public programs, including Medicare, Medicaid, CHIP, or for employer sponsored coverage that meets affordability and minimum value standards are not eligible for tax credit.
Source: Summary of the Affordable Care Act, by The Kaiser Family Foundation.
Employee Benefit Plan
A cafeteria plan (IRS Section 125) is a written benefit plan offered by an employer in which all participants are employees; and participants can choose cafeteria-style, from a menu of two or more cash or qualified benefits, using pre-tax contributions to pay for the premiums.
.A qualified benefit is a benefit that the IRS does not consider part of an employee's gross income. Qualified benefits include, but are not limited to:
accident and health plans (including medical plans, vision plans, dental plans, accident and disability insurance)
group term life insurance plans (up to $50,000)
dependent care assistance plans
certain stock bonus plans under section 401(k)(2) of the Internal Revenue Code
Source: Cafeteria Benefit Plans, by Social Security Administration.
Term Life Insurance provides life insurance protection for a specified period of time. Term life is sometimes convertible. Term insurance provides protection for a defined period of time and pays benefits only if death occurs during that period.
Whole Life Insurance is a form of permanent life insurance that can remain in force for your entire lifetime. Whole life (ordinary life) is the most traditional type of cash value insurance. Generally premiums and death benefits stay the same over the life of the policy. The policy’s cash value grows at a fixed rate.
Universal Life Insurance is a form of permanent life insurance characterized by its flexible premiums and face amounts. Universal life gives you flexibility in setting premium payments, underlying investment options (variable life insurance), and the death benefit.
For More Information: Life Insurance and Annuities, by FL Dept. of Financial Services.