Choosing Health Insurance Plans

Contact Info

Ms. Mary Patricia Watson, FNP 
Director
Student Health Service
Falcon Center, 3rd Floor
Phone: 304.367.4719
FAX: 304.367.4710
E-Mail: trish.watson@pierpont.edu

Ms. Patrice Anderson, RN
Student Health Nurse
Falcon Center, 3rd Floor
Phone: 304.367.4155
FAX: 304.367.4710
Email: panderson@pierpont.edu

Ms. Sally Britton, LPN
Falcon Center, 3rd Floor
Phone: 304.367.4155
FAX:  304.367.4710
Email: sbritton3@pierpont.edu

 

Nurses and Nurse Practitioner 
Monday through Friday
8:00 AM - 4:00 PM

 

Fairmont State University and Pierpont Community & Technical College do not currently have insurance plans that are available through the institutions.  However, some individual health insurance information from outside sources is available in the Student Health Service waiting area.  Of course currently enrolled students are free to access the Student Health service office for healthcare needs.

The following items are given as an aid in helping students determine the correct policy and company that will meet their individual needs. 

Items for Consideration when Choosing Health Insurance Plans

1. Duration of time the policy will be needed. 
Short-term policies are ideal for students in that they are generally less expensive, but if you will need the policy for longer than one term (this varies from company to company) you must make sure that you are able to renew the policy.  Also, make sure of the conditions for renewal.

Example:  One company offers short-term coverage for any period between 30 – 185 days.  The policy is non-renewable, but you may purchase one additional policy if certain conditions are met: 

  1. No claims were incurred under your previous short-term plan,
  2. No significant change in health has occurred, and
  3. Total days of coverage for both policies does not exceed 365 days.

2. Types of coverage needed. 
Consider whether coverage includes such things are prescription coverage, office visits, lab testing, x-rays, hospitalization, ER visits, and limitations regarding facilities where services may be sought.

3. Policy Cost, Deductible, Co-Insurance and Stop-Loss Amounts. 
Out of necessity people consider the cost of the insurance policy on a monthly basis.  Usually this is what determines whether or not a policy is purchased.  If the payments are too high, it doesn’t matter what the policy covers.  But there is more to consider than just a monthly premium cost.

Example:  In addition to policy cost, the Co-Insurance amount needs to be considered.  This is the amount of coverage provided; i.e. 100% of covered expenses paid; 80% of covered expenses paid with the policyholder being responsible for the other 20%; etc.  Also, the Stop-Loss Amount needs to be checked.  This is the total out of pocket expense the insured will be required to pay in a calendar year; i.e. for an 80/20 policy with a $2000 Stop-Loss Amount, the total out of pocket expense of the deductible + the 20% co-insurance amount cannot exceed $ 2000 for that calendar year.  The deductible must also be taken into consideration.  It is the amount the policyholder will be required to pay before any reimbursement for expenses will occur.  This amount is paid at the beginning of the policy period until the total is paid, then the policy co-insurance kicks in.  If the deductible is $ 250, 100% of expenses will be paid by the policyholder until that $250 amount is reached.

4. AM Best Rating
The AM Best Rating does not, per se, rate the “quality” of the insurance company.  Rather it is an indicator of financial stability.  For the policyholder, this translates into company soundness and the financial ability of the company to pay claims.  The highest possible rating is A+++, the lowest is D.  Actual claim payment and procedures are separate areas altogether.

5. Limitations and Exclusions. 
It is imperative that these areas be explored.  It defines what is or is not covered under the policy.  Check this closely.  Also in this category to be considered are waivers for pre-existing conditions.  Discuss this carefully with the company agent.  Although temporary coverage policies are a little more forgiving in this area, it still must be considered.

6. Claim Payment. 
How the policyholder places a claim and how the company pays claims needs to be addressed. 
Example:  Does the company reimburse the policyholder after they pay the service provider, or does the company pay the provider directly?  How does the policyholder place a claim?  Does it have to be online or are there paper forms?  If paper forms, where does the policyholder acquire them?


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