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What kinds of health insurance are there?

There are essentially two kinds of health insurance:  Fee-for-Service and Managed Care.
Although these plans differ, they both cover an array of medical, surgical, and hospital

1. Fee-For-Service
These plans generally assume that the medical professional will be paid a fee for each service provided to the
patient.  Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the

2. Managed Care
More than half of all Americans have some kind of managed-care plan.  Various plans work differently and can
include:  health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point-of-service
(POS) plans.  These plans provide comprehensive health services to their members and offer financial incentives
to patients who use the providers in the plan.

What is "long-term" care?
Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating,
bathing, dressing, toileting or continence, and/or transferring (e.g. getting out of a chair or out of bed).  These six
actions are called Activities of Daily Living-sometimes referred to as ADLs.  In general, if you can't do two or more
of these activities, or if you have a cognitive impairment, you are said to need "long-term" care.

Long term care isn't a very helpful name for this type of situation because, for one time, it might not last for a long
time.  Some people who need ADL services might need them only for a few months or less.

Many people think that long-term care is provided exclusively in a nursing home.  It can be, but it can also be
provided in an adult day care center, an assisted living facility, or at home.

Assistance with ADLs, called "custodial care," may be provided in the same place as (and therefore is sometimes
confused with) "skilled care."  Skilled care means medical, nursing, or other similar services.  This distinction is
important because Medicare and most private health insurance pays only for skilled care-not custodial care.

What are the types of disability insurance?
There are two types of disability policies:  Short-term Disability (STD) and Long-Term Disability (LTD):
1.  Short-Term Disability (STD) policies have a waiting period of 0 to 14 day with a maximum benefit period of no
longer than two years.
2.  Long-Term Disability (LTD) policies have a waiting period of several weeks to several months with maximum
benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand.

1.  Non-cancel able means the policy cannot be canceled by the insurance company, except for nonpayment of
premiums.  This gives you the right to renew the policy every year without an increase in the premium or a
reduction in benefits.
2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy
canceled by the company.  However, your insurer has the right to increase your premiums as long as it does so
for all other policyholders in the same rating class as you.

In addition to the traditional disability policies, there are several options you should consider when
purchasing a policy:

  • Additional purchase options
                   Your insurance company gives you the right to buy additional insurance at a later time.

  • Coordination of benefits
                   The amount of benefits you receive from your insurance company is dependent on other
    benefits you receive because of your disability.  Your policy specifics a target amount you will receive from
    all policies combined, so this policy will make up the difference not paid by other policies.

  • Cost of Living Adjustment (COLA)
                   The COLA increases your disability benefits over time based on the increased cost of living
    measured by the Consumer Price Index.  You will pay a higher premium if you select the COLA.

  • Residual or Partial Disability Rider
                   This provision allows you to return to work part-time, collect part of your salary and receive a
    partial disability payment if you are still partially disabled.

  • Return of Premium
This provision requires the insurance company to refund part of your premium if no claims are made for a specific
period of time declared in the policy.

  • Waiver of Premium Provision
This clause means that you do not have to pay premiums on the policy after you're disabled for 90 days.
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Phone:        (337) 267-7979 or (337) 267-7910                Fax:        (337) 326-4761