An individual health insurance policy is your own personal policy that is not tied to an employers group plan. Premiums are based on your sex, age, zip code, health status and your lifestyle habits. For instance, smokers and overweight individuals will pay more for personal health insurance than someone with no negative health factors at all. Presently, insurance companies will underwrite your situation and can decline coverage for anyone who is eighteen and over. As of 1/01/2014, the Patient Protection & Affordable Care Act (PPACA) law will prohibit insurance companies from discriminating against individuals with preexisting conditions and coverage will be guaranteed. The Health and Human Services secretary will further define this law as time goes on. But at present, full underwriting continues with some consumer protections and benefit enhancements from the new law. Once you are approved, the insurance company can not cancel your coverage for excessive claims.
Lately, many employers have been paying less and less for the employees coverage on a group plan, or cancelling group coverage all together. If your employer is generous enough to pay more than 50% of the premium for employee coverage, staying on your group coverage will probably be the logical choice. However, you still should compare your employee contribution under a group plan to the other non-group/personal options available. Rates under a group health plan can often be more expensive than those offered for individual health insurance. Many group plans are composite rated, meaning that the demographics, including ages, are blended to an average of the groups demographics or age and pricing is a reflection of the make up of the group. If your personal situation is under the average of your group and you’re in good healthy condition, you might find better rates or coverage on your own. You should also consider buying your own personal policy if you are self-employed, unemployed, a student, or if you are a non-smoker or don’t need maternity coverage any longer. Individual health insurance plans can be written on anyone age 19 through age 64.
As an example,
Blue Cross & Blue Shield of Illinois offers a unique range of health insurance plans that are now available to individual adults and families. Each plan is backed by the financial strength and stability of Blue Cross and Blue Shield of Illinois. Regardless of the plan you select, you will benefit from the experience, expertise and stability of the leading health insurer in Illinois.
At the present time, Blue Cross Blue Shield of Illinois offers only Preferred Provider Organization (PPO) programs for their personal individual/family policies. There are two different PPO hospital and doctor lists, many deductibles with varying out of pocket costs and HSA plans. Please review the Product Comparison Chart for all the differences in the plan designs.
The following are Blue Cross specific PDF documents for individuals, families and young adults:
I would recommend that you price up three different programs.
- Select Blue with a higher deductible, $1,000 or higher depending on you preference. The Select Blue Plan includes a $20 office visit co-pay and 100%/no deductible emergency coverage. I like this plan as normal doctor visits and emergencies are taken care of, but you still have better pricing because of the higher deductible.
- The second option is the Blue Value plan, everything is the same as above, but without the $20 office visit co-pay. Any office visit charge is still a covered expense, but is subject to the deductible and co-insurance. This plan is a little less expensive than the Select Blue.On both of these plans I would recommend going with the 80% co-insurance. The way this works is you have your deductible first, then the plan either pays A) 100%, or B) 80% BlueCross, 20% you, for the next $5,000 in bills, then 100%. The 20% you pay equals $1,000 plus your deductible. I think the premium savings well offsets the risk.
- Otherwise, the last plan you should look at is the $5,000 deductible 100%, H S A plan. If you can handle the $5,000 deductible, this plan is a lot less in premium and has deductibility options from a tax stand point. Please visit the H.S.A. page for more info.
