Insurance Basics

Many survivors find that finances can be strained during cancer treatment. Financial security involves more than having an income to provide for basic needs. There is also a need to be financially protected in case of an unexpected crisis such as a major theft, natural disaster or a lawsuit. Such unexpected losses can be lessened or prevented if you have appropriate insurance coverage.

Insurance Basics: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Many survivors find that finances can be strained during cancer treatment. Financial security involves more than having an income to provide for basic needs. There is also a need to be financially protected in case of an unexpected crisis such as a major theft, natural disaster or a lawsuit. Such unexpected losses can be lessened or prevented if you have appropriate insurance coverage. There will be peace of mind knowing that you have made arrangements to provide coverage during a possible emergency.

If learning about and purchasing insurance seems overwhelming to you ask for assistance. There are professionals who should be able to help you, such as a cancer advocacy organization, insurance agent, attorney or certified financial planner. You may also have knowledgeable family members or friends.
This document reviews the basics of insurance including:
 

• Purchasing or renewing insurance policies
• Knowing about insurance professionals
• Reducing the cost of insurance coverage
• Knowing the impact of applying with too many companies
• Documenting your insurable assets
• Handling an insurance loss
• Dealing with insurance reimbursement and coverage denials

 

Purchasing or Renewing Insurance Coverage

Before purchasing or renewing insurance policies, check the financial reputation of the insurance companies. This includes reviewing their financial security and their record of paying claims. You can get this information through your state insurance commissioner. Various independent insurance rating services also provide this information online.

When purchasing or renewing insurance policies, remember to consider the need for any extra coverage that may be necessary for:
 

• All property and valuables (assets) you want to protect
• Liability risks, such as a lawsuit, in the event someone is injured on your property
• Specific risks such as wildfires, earthquakes, floods or hurricanes or wind and hail storms

Some insurance coverage may have to be purchased separately. For example, homeowners insurance does not cover flood damage from rising water so coverage must be bought through the National Flood Insurance Program (NFIP).

When it is time to renew your policy, you may be tempted to simply renew the coverage you have with the same insurance company. However, first consider the current value of your assets to be sure that you have enough coverage. You may need to increase your policy limits as property and other assets increase in value. It is also a good idea to check every few years to see if you can get the insurance coverage you need at a lower cost.

When insurance is purchased, you agree to make a periodic payment (premium) for the specific coverage that has been selected by you and written into your insurance policy contract. Depending on your contract, this premium is paid monthly, every few months, or once a year. In return, the insurance company agrees to reimburse (pay) on future claims for losses that are covered by the policy you purchased.

Each policy has a dollar “limit.” This is the maximum amount the insurance company will pay for a loss. When purchasing a policy, you need to be certain that the limit of each of your policies is high enough to cover your possible losses.

Knowing about Insurance Professionals

The following list defines the roles of professionals who typically assist people to determine the types and amounts of insurance coverage that are needed:

1.  Insurance agents
An insurance agent is an authorized representative sells insurance contracts and provides services on behalf of an insurance company. Insurance agents must have specific licenses to sell different types of insurance such as life, health, property and casualty insurance.

An independent insurance agent sells insurance policies from many different insurance companies and is able to offer a wide variety of insurance products with varying premiums. An advantage to using independent agents may be that they can help you get the product that meets your specific needs at the best price. An independent agent may also be able to let you know which insurance companies respond quickly and efficiently to loss claims.

Most states require that all insurance agents complete specified pre-licensing courses and pass state examinations that cover the fundamentals of insurance and state insurance laws. An insurance agent may represent one company or several companies and must be licensed in the states where he or she sells policies.

2.  Insurance brokers
An insurance broker is licensed to work with both the buyer and the insurer, usually for a fee (commission) that is paid by the insurance company from which the policy is purchased. Brokers assist buyers (often business owners) to define the insurance that is needed and to purchase the policy from a reputable company at a reasonable price.
Brokers are similar to agents, except that they are legally required to represent the buyer rather than the insurance company. Many brokers hold professional designations such as Chartered Property Casualty Underwriter (CPCU).

3.  Financial planners
A financial planner is able to offer advice about property and casualty insurance coverage. Some planners work only for a fee. Others do not charge the buyer because they are paid a commission by the insurance company. Many people prefer to work with a financial planner who only works for a fee rather than a commission, as this will eliminate any possible conflict of interest. Experienced and educated planners usually have a professional designation such as Certified Financial Planner (CFP).

4.  Direct writing companies 
A direct writing company is an insurance company that deals directly with the public and does not use brokers or agents. The buyer’s options are limited to one company. This type of insurer is also called a direct writer or direct insurer.

It is important to take the time to research insurance companies. You may also have knowledgeable family members or friends who can help you decide on an insurer and insurance coverage that meets your needs. Ask about their own experiences and any recommendations they might have.

Reducing the Cost of Insurance Coverage

A comparison of insurance rates for similar policies may help you reduce insurance costs. Compare quotes from a number of insurers to find the best price and coverage options. You do not have to agree to buy a policy to get a quote. Keep in mind that lower premiums are not always ideal if coverage is too limited or the insurance company has a history of not paying legitimate claims in a timely fashion.

The following are ways you may be able to reduce the cost of property and casualty insurance premiums:
 

• Think about increasing the deductible. Although some insurance companies have minimum deductibles (the amount you have to pay before insurance coverage begins to pay the health care provider), typically, the higher the deductible for the policy, the lower the premium. The amount of your deductible is selected by you at the time you purchase the policy.
   

• Consider whether insurance coverage is even needed. For example, if you have an older vehicle with little value, you may decide that it is no longer necessary to carry certain types of coverage. However, if you decide to reduce or eliminate insurance coverage, you must be certain that you will still meet any minimum requirements for coverage that are required by your state. In addition, if you still owe money on your car, your lender may require you to have collision and comprehensive coverage.
   

• Look for discounts. Some insurance companies offer discounts to customers for a variety of reasons such as:
   
  • Personal habits and merits such as good driving records or good grades
  • Anti-theft or safety features installed in vehicles or homes such as security and alarm systems
  • The purchase of multiple insurance policies through the same insurance company
     

• Find out if there are group discount rates available. Check to see if you belong to (or could join) any organizations that offer a group discount on certain insurance policies. For instance, some unions, fraternal organizations and various associations may offer insurance discounts as a benefit for their members. When you consider a purchase, keep in mind that it is not the discounts but the final cost that counts. For example, an insurance company that offers few or no discounts may still have the lowest premium rate and the best overall insurance package.
   

• Think carefully about filing claims. Consider the possible affects of filing claims and collecting insurance reimbursement for small incidents. Small claims can increase premiums and may cause the insurance company to decide not to renew your policy.

Some states have consumer protections regarding policy non-renewals due to claims. For example, a state may require that a written notice be sent by the insurance company to the policyholder advising that an additional claim within a certain period of time could result in a policy not being renewed. However, keep in mind that most states require insurance companies to follow a detailed process before they can decide not to renew policies.
 

• Keep your credit in good condition. People with poor credit records usually pay higher premiums than people with good credit records. Your state insurance commission may be able to provide information about how poor credit can be used by insurance companies to determine premiums. Some states allow you to appeal for lower rates if a poor credit rating is the result of medical expenses.

Knowing the impact of applying for insurance with too many companies
Online companies that do business by taking your application to shop for and compare insurance rates will send your application to each insurance agency with which they do business. In turn, each agency will then run your credit report. Although you have only submitted one initial application for insurance, your credit is subsequently checked by every company that is sent your application for a rate quote. This means that your credit is checked multiple times, and each check can reduce your credit score.

A better way to find the best insurance policy is to do your own research to learn about:
 

• The financial stability of the insurer
• The insurance company’s record of payment on insurance claims
• The costs for coverage
• The general reputation of the insurer with its customers

An independent broker who works with multiple insurance companies will be able to provide information and recommendations based on their previous experiences with customer claims. Also, consider reading the reports of independent insurance rating companies that are posted on the Internet to find an insurer that is rated “excellent” or “superior.” Knowledgeable family and friends also may be able to share information about their own insurance preferences.

Documenting Your Insurable Assets

When you purchase an insurance policy, the insurer will usually accept your listing of valuables and your estimate of what each asset is worth. However, if you submit a claim for a loss of a valuable, the insurer may require that you submit proof of the item’s value. Always keep proof of what you own such as receipts, written estimates of value, photographs or videos.

Keep in mind that insurance companies consider the age and condition of property when evaluating losses. For this reason, you should also keep evidence of upgrades and other changes to your assets that may affect the value. Proof of improvements and repairs to your property may increase the value of your assets and result in a higher claim settlement.

Some good ways to document your assets and their value include:
 

• Having a current list of your assets including a description of valuable items, the date of purchase, and any model and serial numbers

• Keeping receipts, copies of warranties and owners’ manuals, as well as copies of credit card bills as documentation

• Using good quality copies of photographs or videos to document your assets

• Storing documentation kept at home in a fireproof box or safe

• Keeping any documentation that cannot be easily replaced in a safe place away from your home such as a safe deposit box.

Keep documentation of your assets in a safe place so it will not be destroyed if there is a loss to your home such as through a fire, flood or storm. If you do not have proof of the value of a loss item when filing a claim, some insurers may allow you to provide evidence of the current value of similar items that are of approximately the same age and condition.

Handling an Insurance Loss

The term “insurance loss” refers to a claim due to a reduction in the value of property or bodily injury. The insured person seeks a settlement through a claim under the terms of the policy.

Depending on the type of policy, proof of loss might be a claim form, written estimate, receipts, sworn statements, police reports, or other evidence. Documentation of proof of loss may include a list of the property involved, what caused the damage, the extent of the damage, and an estimate of the dollar amount of the damage.

If you have an insurance loss, call your insurance agent or broker to report the claim as soon as possible. Your insurance policy will specify exactly what you are supposed to do under the terms of your coverage. Proof of loss or damages will have to be provided within any time limits cited in the policy. Keep in mind that if you do not follow the policy terms, you may lose your right to recover damages through a claim.

The following are basic steps to follow at the time of an insurance-related loss:
 

• If a vandalism, theft or burglary has occurred, call the police immediately and file a formal report.

• Do not start permanent repairs before your insurance company’s adjuster has inspected the damage and documented how much coverage will be approved. Be certain to get a copy of the adjuster’s approval of coverage for your claim.

• Take photos or video of the damage for your claim records. Provide copies of these to the insurance company when you submit your claim.

• Always keep copies of claim forms, correspondence and notes about conversations with the insurer and agent, repair receipts and estimates, photos and videos for your own records as well.

• If your home or possessions have suffered damage, such as from a fire or storm, try to prevent more damage as soon as it is safe to do so. For example, have your possessions moved out of standing water and into a secured place.

• Talk with your claims agent to get approval if temporary repairs are needed to protect remaining possessions. For example, if a roof is damaged, there may be a need to provide a temporary covering to avoid further damage.

• After getting approval, see that temporary repairs are made as soon as possible to prevent further damage and that damaged areas in your roof or walls are covered to prevent additional rain or water from causing further damage.

• If you are involved in an auto accident, follow the specific instructions provided by your auto insurance company about what to do, how to report the claim and what timelines are required. Many insurers suggest that you write down identifying information about any other drivers and vehicles involved in the accident and take photos of the road conditions, skid marks and damage to any property. Auto insurance companies generally require that a police report be filed in cases of theft, vandalism or collision on a public street or highway.

• Depending on the amount of your insurance loss, you might decide to hire an attorney or a public insurance adjuster (who is a claims expert) to help you negotiate the amount of a claim award. Public insurance adjusters charge a fee for their services. The fee might be an hourly rate or a percentage of your claim settlement. Make sure you know how much the fee will be before you agree to services.

Dealing with Insurance Reimbursement and Coverage Denials

For those survivors with health insurance coverage, state-mandated external review offers them an important tool when it comes to insurance reimbursement and coverage denials. Forty- four states and the District of Columbia offer an independent external review option.  If the survivor is not satisfied with the health plan’s decision regarding a treatment, drug, or service decision and the survivor has exhausted the plan’s internal appeal process, they may be able to appeal the plan’s denial to their state’s external review program. 

These reviews are performed by Independent Review Organizations (IRO) that have no affiliation with the health plan. These IRO programs are designed to ensure that health plans make the correct coverage decisions and hold the health plans accountable for their decisions. Please note that these IRO programs are free to plan enrollees and are also overseen by State Departments of Insurance. Go online to www.nairo.org/patients-faq.php.

External review programs differ from state-to-state in the types of disputes that are eligible for appeal, the process used to resolve the appeal, and the time limits imposed at each step of the process. For more information about the states that offer external review and their appeal processes, go online to the Kaiser Family Foundation at www.kff.org. This website describes the variations found in states’ external review programs and provides a guide that outlines the specific requirements for a particular state and who to contact in that state for further information.

This document was produced in collaboration with:
David S. Landay, Esq., author of Be Prepared: The Complete Financial, Legal and Practical Guide for Living with Cancer, HIV and Other Life-Challenging Conditions.

Works Cited

“A survival guide for the uninsured.” Weston, Liz Pulham. MSN Money. 31 January 2007.
http://articles.moneycentral.msn.com

“Health Insurance/Access to Care.” Agency for Healthcare Research and Quality. 26 January 2007.
www.ahrq.gov

“Choosing and Using a Health Plan.” WebMD Public Information from the Department of Health and Human Services. 26 January 2007.
www.webmd.com

“Consumer Guide to Group Health Insurance.” Consumer Information. National Association of Health Underwriters. 9 February 2007.
www.nahu.org

“Guide to Finding Health Insurance Coverage.” Prepared by Families USA for Cover the Uninsured Week: Let’s Get America Covered.  2 February 2007. www.CoverTheUninsured.org

“Guide to Long-Term Care (LTC) Insurance.” America’s Health Insurance Plans. 26 January 2007.
www.pueblo.gsa.gov

“Health insurance for medically-uninsurable individuals.” Health Insurance Resource Center. 31 January 2007.
www.healthinsurance.org

“HSA Primer for Employees/Individuals/Families.” Information Strategies, Inc.29 January 2007.
www.HSAfinder.com

“Insurance Questions and Programs Offered to Cancer Survivors.” Beyond the Cure. The National Cancer Society. 22 May 2006. 
http://beyondthecure.org.

Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New York: St. Martin’s Press, 1998.

“Medical Insurance and Financial Assistance for the Cancer Patient.” American Cancer Society. 22 May 2006.
www.cancer.org

“9 keys to choosing the right health plan.” MSN Money: Insure Your Health. 31 January 2007.
http://articles.moneycentral.msn.com

“16 ways to slash your insurance rates.” MSN Money: Insure Your Health. 31 January 2007.
http://articles.moneycentral.msn.com

“The Health Insurance Portability and Accountability Act (HIPAA).” Employee Benefits Security Administration Fact Sheet..” U.S. Department of Labor. 6 February 2007.
www.dol.gov/ebsa

“What is an HSA?” A complete guide to Health Savings Accounts for families, individuals and employers. 29 January 2007.
www.hsafinder.com

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Insurance Basics: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

Know what your insurance policies cover. Identify gaps in coverage so you can make an educated decision about the need for additional insurance.

Photograph, videotape and keep documentation (such as receipts) of your valuable possessions. Store the images in a safe place that is not on the premises where the possessions are located. Although not required by most insurance companies, this evidence will be helpful if you have a loss.

Pull together any receipts or bills you have for your possessions and store these in a safe location. This provides both proof of ownership and proof of value in the event of a loss.

When you renew a policy, check to see:
 

• Can you get a lower premium?
• Do you qualify for additional discounts?
• Has the value of your property increased or decreased?
• Have you obtained, given away or sold assets without updating the appropriate insurance policy?
• Should you continue to keep the same level of coverage for an asset that has decreased significantly in value?

Review the following see if you might qualify for a lower insurance premium:
 

• Check to see if there are discounts for which you can qualify.
• Compare insurance costs before you purchase a policy.
• Request higher deductibles (if you can afford them) to lower your premium costs.
• Consider the risks and benefits of reducing coverage.
• Find out if you can get a reduction by purchasing multiple policies from the same insurance company.
• Establish good credit and make certain your credit record is accurate.
• See if you qualify for discounts provided by your insurer.
• Find out if you can qualify for group insurance through your employer, groups or clubs.

Keep contact information for all of your insurance companies in a place where you can find it easily. Also, keep information from the insurance companies about what to do in the event of a loss.

Understand what your insurance policies say about what to do in the event of a loss. Follow the instructions provided by your policy and your insurance agent.

When it is time to renew or purchase insurance policies, remember to consider the current value of your assets to be certain you purchase the right amount of coverage.

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Life Insurance: Additional Resources

The resources listed below provide more detailed information and support services to help you with life insurance. Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG Navigation Services
LIVESTRONG.org/Get-Help

Online: Complete an intake form through the LIVESTRONG website.
Phone: 1.855.220.7777 (English and Spanish)
Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about fertility risks and preservation options, treatment choices, health literacy and matching to clinical trials. Emotional support services, peer-to-peer matching and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG has partnered with several organizations including Imerman Angels, Navigate Cancer Foundation, Patient Advocate Foundation and EmergingMed.

National Association of Health Underwriters
www.nahu.org

Email:  info@nahu.org 
Phone: 1.703.276.0220

The National Association of Health Underwriters is an organization that provides consumers with free information about how to assess, review and obtain health insurance coverage that will meet individual needs.  On their website you can review a glossary of terms, search for an insurance agent and use their state-based database to review health insurance coverage options that are available in your state. They provide many consumer guides related to different aspects of health care coverage.

National Committee for Quality Assurance
www.reportcard.ncqa.org/plan

Email:  customersupport@ncqa.org
Phone:  1.888.275.7585 or 209.955.3500

The National Committee for Quality Assurance (NCQA) is a private, independent non-profit organization dedicated to improving health care quality.  NCQA’s Health Plan Report Card can help you choose a health plan that is right for you and your family. You can use this online tool to learn more about how well health plans offered in your area perform.

Health Insurance Resource Center
www.healthinsurance.org

Email: Send email through the website.

The Health Insurance Resource Center (HIRC) may be helpful if insurers tell you that you are "not medically insurable." The HIRC website can help you learn about and identify whether your state has sponsored a "risk pool" to provide health insurance coverage for people to whom private insurance companies will not sell individual policies.  HIRC will also provide tips on purchasing insurance as well as advice on how to reduce health care costs.

U.S. Department of Health Resources and Services Administration
www.hrsa.gov

Email: Send email through the website.

The Health Resources and Services Administration is a service of the U.S. Department of Health and Human Services. Through this website, you can find community health centers that provide health care services regardless of a patient's ability to pay, and hospitals, nursing homes and other facilities that provide free or reduced cost care under the Hill-Burton Program. Links are provided to sites that offer information about Medicare, Medicaid, State Children’s Health Insurance and other government programs.

Cancer Legal Resource Center (CLRC)
www.disabilityrightslegalcenter.org

Email:  clrc@lls.edu
Phone: 1.866.843.2572 or 213.736.1455
TTY for deaf and hard of hearing callers: 1.213.736.8310

The Cancer Legal Resource Center (CLRC) provides information about cancer-related legal issues to survivors, loved ones, friends, employers, health care professionals and others coping with cancer.  CLRC information covers health insurance, employment, government benefits, estate planning, advanced health care directives, family law and consumer assistance. Through the CLRC national toll-free Telephone Assistance Line callers can receive information about laws and resources for their particular situation. The CLRC volunteer panel of attorneys and other professionals can provide more in-depth information and counsel to CLRC callers. All CLRC services are free and confidential. Services are available in both English and Spanish.

National Coalition for Cancer Survivorship (NCCS)
www.canceradvocacy.org

Email: info@canceradvocacy.org 
Phone: 1.877.622.7937 
An information specialist is available from 8:30 a.m. to 5:30 p.m. (EST). 

The NCCS website provides comprehensive information on a wide range of cancer topics. These include managing the side effects of cancer treatment, controlling pain, understanding clinical trials, maintaining good nutrition and exercise habits, getting the most out of your health insurance coverage and addressing employment issues. The NCCS also offers the Cancer Survival Toolbox, a free audio program created to help people develop skills to help with communicating, decision making, problem solving, finding information, negotiating, and standing up for your rights. They also offer a variety of publications that can be ordered free of charge. Information on the NCCS website is available in Spanish, and the Cancer Survival Toolbox is available in both Spanish and Chinese.

America's Health Insurance Plans
www.ahip.org

Email: ahip@ahip.org
Phone: 1.202.778.3200 

America's Health Insurance Plans is a national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.  Their consumer information section includes guides on health insurance and managed care as well as links to health insurance providers. Because AHIP is an insurance trade association, the other links on the website do not necessarily provide consumer-related information.

MIB Group, Inc.
www.mib.com

Email: Info@mib.com
Phone: 1.866.692.6901
TTY for deaf and hard of hearing callers: 1-866-346-3642

MIB Group is a not-for-profit membership corporation that collects and shares underwriting information among its 450 member life insurance companies. If you have applied for an individual insurance policy within the last 7 years and the insurance company reviewed your medical history and records, some of that information may be available to other life insurance companies through MIB. The website provides information about what records MIB has and how those records are used by insurance companies. You can contact the MIB to find out what information they have about your medical records and what is available to life insurance companies. You can also correct information that is not accurate. Consumers are entitled to one free report from the MIB each year. You must request this report by phone.

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