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Health Insurance Services

Disability Insurance
Family Medical
Long Term Care

Individual & Family Medical Insurance

Protecting that which Matters Most

We can help you find an individual or family medical insurance plan that fits your budget, from a plan that offers generous coverage to a high-deductible plan designed primarily to protect your family from the cost of catastrophic illness or injury. These plans meet the requirements of the Affordable Care Act health care reform law so you won’t have to pay a penalty.

When selecting a family medical insurance plan in Oregon, North Carolina, or any of the 26 states served by Ashland Insurance, it’s essential to consider the specific needs and preferences of all family members. A family medical insurance plan, which covers multiple individuals under one policy, can often provide cost savings compared to purchasing individual plans. Through group rates and family coverage options, a family plan can enhance overall health benefits while meeting diverse healthcare needs.

The Role of Qualifying Life Events

Several factors can trigger your eligibility to enroll in a new health insurance plan outside of the typical open enrollment period. These are known as a qualifying life event. Common examples include marriage, the birth of a child, or moving to a new state, like North Carolina. Understanding how these events affect your health insurance options allows you to make the necessary adjustments to ensure your family is adequately covered.

Open Enrollment: A Critical Time

Open enrollment is a designated period when individuals and families can enroll in or modify their medical plan. Outside of this timeframe, you may find it challenging to make changes unless you experience a qualifying life event. Therefore, it’s crucial to be prepared during open enrollment by reviewing plan documents carefully, as this is when you can explore various options that suit your family’s health needs.

Health Plans and Mental Health Services

An essential aspect of any comprehensive health insurance plan involves mental health coverage. Today, many medical plans include provisions for mental health and substance use disorder services as part of the overall health benefits. It is vital to review the specific products and services that are covered under your policy to ensure that they meet your family’s needs for mental well-being.

Understanding covered services, particularly those relating to mental health, can help address the needs of your family and provide necessary support when faced with challenges. Knowing how your plan handles these services can improve outcomes for family members seeking help.

Navigating Cost-Sharing

One area families need to understand when selecting family medical insurance is cost-sharing. This term refers to the way healthcare costs are distributed between the insurance provider and the insured. For example, while some benefits plans may cover the full expense of preventive care services, others might require co-payments or deductibles to be met first. Being informed about these arrangements can help families manage out-of-pocket expenses.

For instance, prescription drugs often involve varying levels of cost-sharing, depending on whether the medication is considered a covered service under your plan. Reviewing these details can prepare your family for any financial obligations they may face when accessing healthcare.

Supplemental Benefits Plans

You can also buy supplemental insurance plans that will pay some of the costs your health insurance plan won’t cover. These include hospitalization insurance (or hospital indemnity insurance), critical illness insurance, and long-term care insurance. These supplemental insurance plans will pay benefits if you are hospitalized, suffer from a covered illness, or require long-term care.

Families may also wish to consider supplemental benefits plans. These plans can cover expenses that primary family medical insurance policies may not address, providing an additional layer of security. Options can include critical illness insurance, accident insurance, and more, helping families navigate unexpected healthcare costs without facing financial strain.

Making Informed Decisions

Understanding the nuances of individual and family medical insurance plans is crucial when navigating the complex world of healthcare. Taking the time to consider your family’s unique needs and utilizing resources available in Oregon, North Carolina, or any of the 26 states served by Ashland Insurance will empower you to make informed choices. Key factors include recognizing a qualifying life event, reviewing plan documents during the open enrollment period, and analyzing all health benefits offered.

With the proper knowledge and resources, you can find a medical insurance plan that not only fits your budget but also provides comprehensive coverage for your family’s health needs.

Medical insurance plans with full coverage fall into four major categories:

PPOs are the most common type of health plan today. A PPO contracts with a network of doctors; plans typically reimburse a higher percentage of fees for in-network doctors. Members can use non-network providers but will have higher copayments. Plans usually include features to avoid unnecessary health expenditures, such as requiring pre-authorization for elective procedures or a primary care physician’s referral for visits to specialists. Most plans also include wellness or disease management benefits designed to keep your employees healthy and control your claim costs.

An HMO requires members to use physicians within the HMO’s network; HMOs typically do not pay anything for out-of-network treatment, except in cases of emergency. HMOs give your employees less flexibility in provider choice, but often cost less and involve lower out-of-pocket payments than other plans.

POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network agents with a referral from a primary care physician. Co-payments will be higher for out-of-network services.

If you want protection from catastrophic illness but you want to pay less in premiums, you can take advantage of a high-deductible health plan linked to a health savings account. These plans offer lower premiums than a plan with full coverage. You can use the savings to build funds in a health savings account, which you can use for any tax-qualified healthcare expense.
Only individuals with an eligible high-deductible health plans and no other health insurance can have an HSA. You use account balances to pay for qualified health expenses and funds can accumulate from year to year.

Some employers fund their employees’ HSAs–employer contributions to an HSA are not considered taxable income. Contributions you make, up to the annual maximum, are tax deductible. Withdrawals used for eligible medical expenses are not taxable, and interest on your funds is also not taxable.