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Are you looking for affordable high quality health insurance for yourself or your business?

Whether you're self-employed, in between jobs or seeking a group health insurance plan for your business, we have a health plan that's right for you.

Health Insurance

What You Should Know


If you have ever been sick or injured, you know how important it is to have health coverage, but if you’re confused about what kind is best for you, you’re not alone. Athens GA Health can help you make the best decision and answer your questions.

If you're looking for a disability insurance policy check out Pennington Disability Insurance. In addition to health insurance, we can also help you find the best policy for your disability insurance coverage.

What types of health coverage are available? What if you are too ill to work, or, if you are over 65 will Medicare pay for all your medical expenses?

These are questions that you may be asking, and these questions aren’t necessarily easy to answer.

Making Sense of Health Insurance

When people talk about health insurance, they usually mean the kind of insurance offered by employers to employees. You may have heard this kind of health insurance referred to as comprehensive or major medical insurance, alluding to the broad protection they offer. But the fact is, neither of these terms is particularly helpful to the consumer.

Today, when people talk about broad health care coverage, instead of using the term "major medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans.


This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service provided to the patient—either you or a family member—covered under your policy. With fee-for-service insurance, you go to the doctor that you choose and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for "covered" medical expenses listed in your benefits summary.

Managed Care

The three major types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.

Managed care plans usually provide comprehensive health services to their members, and offer financial incentives for patients to use the providers who belong to the plan. In managed care plans, instead of paying separately for each service that you receive, your coverage is paid in advance. This type of coverage is called prepaid care.

How Do I Get Health Coverage?

Group insurance is typically offered through employers, although unions, professional associations, and other organizations also offer it. As an employee benefit, group health insurance has many advantages. Much—although not all—of the cost may be borne by the employer. Premium costs are frequently lower because economies of scale in large groups make administration less expensive. With group insurance, if you enroll when you first become eligible for coverage, you generally will not be asked for evidence that you are insurable. Some employers offer employees a choice of fee-for-service and managed care plans.

Individual insurance is a good choice if you work for a small company that doesn't offer health insurance or if you are self-employed. Buying individual insurance allows you to create a plan to fit your needs from the insurance company of your choice. It requires careful shopping, because coverage and costs vary from with each company. While evaluating policies, consider what medical services are covered, what benefits are paid, and how much you must pay in deductibles and coinsurance. You may keep premiums down by accepting a higher deductible.

Pre-existing Conditions

Many people worry about coverage for preexisting conditions, especially when they change jobs. The Health Insurance Portability and Accountability Act (HIPAA) helps assure continued health insurance coverage for employees and their dependents. As of July 1, 1997, insurers could impose only one 12-month waiting period for any preexisting condition treated or diagnosed in the previous six months. Your prior health insurance coverage will be credited toward the preexisting condition exclusion period as long as you have maintained continuous coverage without a break of more than 62 days. Pregnancy is not considered a preexisting condition, and newborns and adopted children who are covered within 30 days are not subject to the 12-month waiting period.

If you have had group health coverage for two years, and you switch jobs and go to another plan, the new health plan cannot impose another preexisting condition exclusion period. If you have had prior coverage of only eight months, you may be subject to a four-month, preexisting condition exclusion period when you switch jobs. If you’ve never been covered by an employer’s group plan, and you get a job that offers such coverage, you may be subject to a 12-month, preexisting condition waiting period.

Federal law makes it easier for you to get individual insurance under certain situations, including if you have left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 62 days.

If you have not been covered under a group plan and have found it difficult to get insurance on your own, check with your state insurance department to see if your state has a risk pool. Similar to risk pools for automobile insurance, these can provide health insurance for people who cannot get it elsewhere.

What Is Not Covered?

While HMO benefits are generally more comprehensive than those of traditional fee-for-service plans, no health plan will cover every medical expense. Few plans cover eyeglasses and hearing aids because these are considered budgetable expenses. Very few cover elective cosmetic surgery, except to correct damage caused by a covered accidental injury. Some fee-for-service plans do not cover checkups. Procedures that are considered experimental may not be covered either and some plans cover complications arising from pregnancy, but do not cover normal pregnancy or childbirth.

Health insurance policies frequently exclude coverage for preexisting conditions, but, as explained, federal law now limits exclusions based on such conditions.

Frequently Asked Questions

Q What is the first thing I should know about buying health coverage?

A Your aim should be to insure yourself and your family against the most serious and financially disastrous losses that can result from an illness or accident. If you are offered health benefits at work, carefully review the plans’ literature to make sure the one you select fits your needs. If you purchase individual coverage, buy a policy that will cover major expenses and pay them to the highest maximum level. Save money on premiums, if necessary, by taking large deductibles and paying smaller costs out-of-pocket.

Q I’m planning to keep working after age 65. Will I be covered by Medicare or by my company’s health insurance?

A If you work for a company with 20 or more employees, your employer must offer you (through age 69) the same health insurance coverage offered to younger employees. After you reach age 65, you may choose between Medicare and your company’s plan as your primary insurer. If you elect to remain in the company plan, it will pay first—for all benefits covered under the plan—before Medicare is billed. In most instances, it is to your advantage to accept continued employer coverage.

But be sure to enroll in Medicare Part A, which covers hospitalization and can supplement your group coverage at no additional cost to you. You can save on Medicare premiums by not enrolling in Medicare Part B until you finally retire. Bear in mind, though, that delayed enrollment is more expensive and entails a waiting period for coverage.

Q Can I buy a single health insurance policy that will provide all the benefits I’m likely to need?

A No. Although you can select a plan or buy a policy that should cover most medical, hospital, surgical, and pharmaceutical bills, no single policy covers everything. Moreover, you may want to consider additional single-purpose policies like long-term care or disability income insurance. If you are over 65, you may want a Medicare supplement policy to fill in the gaps in Medicare coverage.

Q I’ve had a serious health condition that appears to be stabilized. Can I buy individual health coverage?

A Depending on what your condition is and when it was diagnosed and treated, you can probably buy health coverage. However, the insurer may do one of three things:

Comparing Plans

Whether you end up choosing a fee-for-service plan or a form of managed care, you must examine a benefits summary or an outline of coverage—the description of policy benefits, exclusions, and provisions that makes it easier to understand a particular policy and compare it with others.

Think about your personal situation. Do you want coverage for your whole family or just yourself? Are you concerned with preventive care and checkups, or would you be comfortable in a managed care setting that might restrict your choice somewhat but give you broad coverage and convenience?

Here are some of the things to look at when choosing and comparing health insurance plans.

Health Insurance Checklist

Covered medical services

Are there any medical service limits, exclusions, or preexisting conditions that will affect you or your family?

What types of utilization review, pre authorization, or certification procedures are included?

A Final Word

If you are buying individual health insurance, or any form of insurance that you purchase directly, read and compare the policies you are considering before you buy, and make sure you understand all of the provisions. Marketing or sales literature is no substitute for the actual policy; read the policy itself before you buy.

Ask for a summary of each policy’s benefits or an outline of coverage. Good agents and good insurance companies want you to know what you are buying. Don’t be afraid to ask your benefits manager or insurance agent to explain anything that is not clear.

It is also a good idea to ask for the insurance company’s rating. The A.M. Best Company, Standard & Poor’s Corporation, and Moody’s all rate insurance companies after analyzing their financial records. These publications that list ratings usually can be found in the business section of libraries or online.

Long-Term Health Insurance
Understanding The Coverage

This type of coverage can be renewable for multiple years and can provide continuous claims coverage over a long period of time. Most plans of this type cover both major medical expenses (e.g., hospitalization and surgeries) and routine medical expenses (e.g., office visits and annual exams), subject to deductibles and co-payments or co-insurance.

Family Members To Be Insured

You can apply for any one of the following combinations of family members:

The gender and age/date of birth of each person is also required.

When entering a child and/or children only, enter the age/date of birth in the child boxes. Enter any additional children in the appropriate child blocks. Rate computations for child/children only plans vary by carrier. Some insurance companies have specific rates for youth plans and other insurance companies base rates for children on the age of either the youngest or oldest child.

Age/Date of Birth - The age or date of birth for each family member that is to be insured.

Tobacco Usage - For each adult that is to be insured, please check the box if they are a tobacco user. By default, all adults are assumed to NOT be tobacco users.

About Athens GA Group

Athens GA Health is a member of the Pennington Brokerage, LLC in Atlanta, GA.

To learn more about the Pennington Brokerage you can visit

Pennington Brokerage, LLC
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