Your Top Ten

Checklist
Checklist

• Buying Individual
Health Insurance

• Tracy McManamon
• One Source Benefits
• 877-549-1212
1. Cost is More Than Premiums

2 2
 1. Cost is More Than Premiums

Premiums based on many different factors

• Type of coverage
• Deductible and other cost-
sharing features
• Network
• Health status
• Age
• Gender (where permissible)
• Geographic location

3
 1. Cost is More Than Premiums

Deductibles
Amount you pay out
of your pocket

4
 1. Cost is More Than Premiums

How much are you comfortable paying?

Lower deductible = higher premium Higher premium = lower deductible

Higher Higher
Premium Deductible

Lower Lower
Deductible Premium

5 5
 2. How Coinsurance and Copays Work

Coinsurance

• Health insurance plan pays

percentage, you pay percentage
• Coinsurance may apply only to
certain items like hospitalization
• Use of “in-network provider”
services reduces your
coinsurance costs
• Look at your maximum
out-of-pocket expenses

6
 2. How Coinsurance and Copays Work

Copays
You pay fixed dollar amount for
doctor visit or prescription

7 7
3. Hospital Coverage

8 8
 3. Hospital Coverage

Review limits

• Length of hospital stays

• Outpatient treatments
• Tests
• Doctor or specialist visits,
medication while in hospital,
and any inpatient hospital
deductible

9
 4. Importance of Networks

Provider Networks

• Contracted doctors, hospitals,

pharmacies, etc.
• Health insurance plans distinguish
benefits and costs by networks
• “In network” often less expensive
than “out of network”

10
 5. Preventive Care

Look for:
Preventive care
• Blood pressure
• Certain cancer screenings,
Type 2 diabetes screenings
• Vaccinations
Annual physicals
Routine GYN exams
• 100% coverage
• No copay, no dollar maximum
• No deductible, no waiting period

11
 5. Preventive Care

Eyewear

Hearing aids
Look for: and services
Discounts
and savings Acupuncture, massage
therapy, vitamins

Gym memberships *

* At some clubs, participation in this program may be restricted to new club members. 1212
 6. Prescription Medication

• Work with a pharmacy that

is in your health insurer’s
network
• Generics usually cost less
than name brands
• Look for difference in price
from generic to name brand
• Lower copay for generics
• Check formulary for specific
medications

1313
 6. Prescription Medication

• Mail order Rx convenience

• Specialty drugs like insulin
delivered to your door

14
 7. Types of Health Insurance Plans

• Broader-based health insurance

plans have most coverage
• Available in lower and higher
deductibles
• Higher deductible =
lower premium
• Health Savings Account (HSA)-
compatible high deductible plans
– Out-of-pocket can go up
to $5,950 for individuals

15
 7. Types of Health Insurance Plans

Health Savings Accounts (HSAs)

• Deposit money into special

account at bank
• In 2010 up to $3,050 for single
and $6,150 family
• Pay no tax on amount
deposited, grows tax-free
• No tax on earnings for qualified
health care expenses
• Must use money for health
care expenses to qualify
for tax breaks

16
 7. Types of Health Insurance Plans

Health Savings Accounts (HSAs)

• Can roll over year

after year
• Must have annual
deductible of at
least $1,200 single,
$2,400 family

1717
 7. Types of Health Insurance Plans

Limited benefit plans

• Also referred to as “hospital plans”

• Less expensive than
broader-based coverage
• Might be right for people who:
– Want to save money
– Consider themselves
relatively healthy
– Want to protect themselves
from hospital stays

18
 7. Types of Health Insurance Plans

Limited benefit plans

• Do not usually cover doctor

visits or medications
• May cover generics
• Know what you’re buying

19
 7. Types of Health Insurance Plans

What to consider

• Overall health
• Need for doctor visits, tests,
hospitalization
• Medication now, in future

20
 8. Applying for Health Insurance Plans

• You’ll be asked for medical history

• May deny you or charge higher
premium based on history
• Agent should pre-qualify
before applying
• Consider your situation: job
transition, early retirement,
own business

21
 9. Health Care Reform

Most changes not until 2014

2010 changes include:

• Temporary government
program for those denied
due to pre-existing condition
• Lifetime limits to be lifted
• Companies cannot cancel
or discontinue your coverage retroactively
except for
non-payment, fraud, or
intentional misrepresentation
of material fact.
• No pre-existing coverage
exclusions for enrollees under
the age of 19

2222
 9. Health Care Reform

Most changes not until 2014

2010 changes include:

• No out-of-pocket max for
calendar year
• Will not have to share cost of
in-network “recommended”
preventive care
• Eligible dependent children
okay to stay on plan until
26th birthday

2323
 10. Who to Work With

Professionals
• Registered, licensed agent
• Reputable, stable company
Time and advice,
no extra charge Will help you
• Get the right health insurance
plan for what you need
• Analyze your situation

2424
Your Top Ten Checklist

1. Cost Is More 6. Prescription Medication

Than Premiums
7. Types of Health Insurance
2. How Coinsurance, Plans Available
Copays Work
8. Applying for Health
3. Hospital Coverage Insurance Plans

4. Importance of Networks 9. Health Care Reform

5. Preventive Care 10. Who to Work With

2525
Aetna Advantage Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company
(Aetna) directly and/or through an out-of-state blanket trust or Aetna Health Inc. In some states, individuals may qualify as a
business group of one and may be eligible for guaranteed issue, small group health plans. To the extent permitted by law,
these plans are medically underwritten and you may be declined coverage in accordance with your health condition.

This material is for information only. Plans may be subject to medical underwriting or other restrictions. Rates and benefits vary by
location. Plans not available in all states. Health insurance plans contain exclusions and limitations. Investment services are
independently offered by the HSA Administrator. Health information programs provide general health information and are not a
substitute for diagnosis or treatment by a physician or other health care professional. Providers are independent contractors and are
not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health
services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and
conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna Rx Home Delivery and
Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home
Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc. that operate through mail order. Discount
programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the
discounted services. Information is believed to be accurate as of the production date; however, it is subject to change.

2626
 Thank You.

13.25.300.1 (10/10) 27