From our Free-Lance Correspondent

When we attempt to explain insurance, we are entering an area which remains illusive even to most Americans. One thing is clear: no one should live in this country without health insurance. The fact is that there are many who cannot afford it or who are willing to gamble with the risk of going without. The medical expenses for one serious accident or illness, however, can wipe out the assets and resources of an upper-middle class family. Don't take that chance. When considering bringing over parents, grandparents, or others for whom wish to care, you must remember that the U.S. does not have socialized medicine and that social security will not be available for your family members who spent their working years back home. If you cannot support them through a lengthy and expensive illness, make sure you have siblings or other family willing to share in the responsibility -- physical as well a financial.

If you already have a full time job in the U.S. you probably have health insurance options offered by your employer. Some employers (usually small companies with more limited funds) give you few, if any choices about your health insurance coverage. Larger employers can overwhelm you with the array of choices in "a cafeteria-style" benefits package which can include not only your health insurance but a pension plan, life insurance, educational allowances and more. Some options are paid fully or in part by your employer. The rest is deducted from your pay. Beware that it is sometimes very expensive to cover a spouse on insurance offered through employers. (Note that very few, but some employers do extend coverage options to "domestic partners" the same as to spouses.) The cost of covering children can, in extreme cases, leave you with next to nothing in your paycheck! If you and your spouse are employed, you should carefully consider whether it is most beneficial to be covered separately under your respective employers or if it makes more sense for one of you to waive your health insurance option and go under the other's coverage.

If you are a student you will have (probably minimal) health coverage through your school. While most of these policies cover emergency care to varying degrees, they usually do not cover any maintenance costs or any dental or vision needs.

Terms to understand :

• Comprehensive - Usually the most expensive coverage, a comprehensive plan gives you total freedom of choice regarding the physicians and specialists you see. When looking at these plans, you want to be certain you are covered for in-patient as well as out-patient costs and that there is one deductible to be met within a calendar year. Comprehensive care usually covers few or none of the costs incurred for health maintenance -- routine check-ups, children's immunizations, etc.
• HMO - Usually the least expensive coverage, an HMO has its own pool of physicians with your Primary Care Physician the gate-keeper to all visits to specialists. (Some states now allow women to visit their Ob/Gyn without a medical referral from the Primary Care Physician.) Health maintenance is encouraged - and covered under an HMO. There is usually a co-pay (the amount you pay) of $5-$10 for each visit to a doctor.
• Pre-existing Condition - Most insurance companies will not take on someone who already has a serious or chronic illness: cancer, heart disease, or diabetes or asthma. If you or a family member has such a condition, you want to carefully check before you drop an insurance policy you already have. You could find that no one will take you on!
• Prescription Plan - Many insurance plans offer prescription plans, which can be very beneficial, if it is a good one. With a prescription plan, you only pay a small amount, usually $5-$10 for a prescription. The pharmacy will fill the prescription with a generic brand, if available or if there is no specific request from the doctor not to do so. Some prescription plans, however, are beginning to cover only certain drugs.
• Co-pay - If you are in an HMO, the co-pay is the total amount you are required to pay out-of-pocket for a visit to a doctor.
• Deductible - This is the amount you are responsible for under the limitations of your insurance policy before they begin to cover your expenses.
• Reasonable & Customary - This is what many insurance companies use to determine how much of your cost they will cover. If an they believe you have incurred expenses at a rate which is not in line with their assessment of what is "reasonable and customary" for that procedure, they will only pay for the cost up to the limit of what they believe you should have spent. This is one way insurance companies try to keep health care costs in line. However, you want to be certain that your health insurance company readjusts their assessment of "reasonable and customary" to reflect the health care market. It may no longer be possible to have a procedure done for what they considered appropriate at the time "reasonable and customary" was determined.

What is COBRA?

April 7, 1986 the Federal government enacted Public Law 99-272, Title X. This law requires employers who sponsor group health plans to offer the option of extending their coverage to the employee and/or spouse and dependents in the event that the employee loses that benefit through a reduction in hours or termination of her/his position under certain circumstances or becomes no longer eligible for health care coverage. If you choose to extend your coverage under COBRA, it is available to you for 36 months unless your coverage was lost due to a reduction in hours or termination of your employment, in which case the limit is 18 months. Recognized as qualifications for continuation coverage to 36 months for spouse or dependents are: death of the employee, divorce, legal separation or Medicare entitlement. Under this law you are financially obligated to meet your premium payments plus an administrative fee. There are many subtleties and exceptions to the COBRA law as it effects employers and employees. If you think you may be eligible, you should speak with the health care administrator at your place of work.

For information on Visitors' Insurance.