Office: 910-772-1599

Toll-Free: 800-429-5875

Two Health Insurance Clauses to Help Cut Down Your Premium Rates

Looking to lower your premium rates? These two clauses will help you do just that:

Under-Insurance – a clause wherein your insurer will pay a part but not all of your medical expenses in exchange for a lower premium rate. For example, you could negotiate a lower insurance premium rate in exchange for covering 20% of medical expenses out of your own pocket. Your insurer will then only pay $40,000 for a $50,000 medical procedure while you pay the remaining $10,000.

Excess – the value where the insurer will step in to pay for your medical expenses. Setting the excess at $5,000 means your insurer will pay for procedures costing more than $5,000 but you’ll end up paying if the total expenses amount to less than $5,000. This means that the higher the excess, the lower the premium rate.

Do remember that you will need to pay more money out of pocket if you have a higher excess and under-insurance rates. Prepare wisely though, and you’ll end up paying less each month in premiums!


Ask Your Doctor before Switching Plans

One thing some people forget is that switching health insurance plans could mean losing the coverage of the doctor who has been working with you for the past decade or so.

This might not be much of a problem for most folks but can be extremely problematic for those who have pre-existing conditions or who have formed special bonds with their doctors. Truth be told, it can be quite difficult to find a good doctor that you can literally trust your life with.

This brings us back to your doctor.

If you plan to change plans it is important to have to check whether or not your doctor is included in your new plan’s provider network. If not, you may end up having to pay extra out-of-pocket fees before your insurer assumes coverage. You can do this by first asking your doctor if he or she is included in your insurer’s network of providers.If yes, then you should be free to change providers as you desire. If no, then you have a choice to make: do you find an insurance provider with a network that includes your doctor or do you take a chance with a new network with more perks and cheaper premiums?

Priorities: Why They Matter in Insurance

Not everybody has the same health insurance needs. Some need extensive coverage that includes treatment for a pre-existing condition. Conversely some require a basic plan just in case they find themselves in an auto accident or developing an unexpected disease. Still others need a tailor-fit plan to cover the common occupational hazards within their field.

This is why it is important that you set your coverage priorities. The categories to consider are: money, occupational hazards, and genetic predisposition.

Money is obvious enough. If you are on a tight budget and are struggling with liabilities like mortgages or auto loans, a basic plan with a low premium rate can work for you.

Occupational hazards are the dangers you face daily preforming your job. For example, salesman have a much higher rate of auto accidents and mugging, while construction workers have a higher rate of physical injury.

Genetic predisposition is the tendency of people in your family to develop certain diseases. Cancer and diabetes are common hereditary diseases, so take a long hard look at your family tree and check for any genetic predispositions for diseases and other conditions.

Use this as a basis for prioritizing what is important for you and you’ll have an easier time deciding which insurance plan will work best for you!

Pre-Existing Conditions: How They Really Affect Your Current Health Insurance

If you are afflicted with an existing condition like diabetes or heart ailments, you may think you are no longer able to get insurance for yourself. Some dodgier insurance companies will a) outright refuse to take you on, b) exclude your condition from their coverage or c) charge you outrageous premiums.

The more established insurers, however, will offer you an option to help you out: condition-specific deductibles.

CSDs work by setting a ‘roof’ on how much out-of-pocket money you’ll spend for your condition. As an example, let’s go with a CSD of $7,500 for a condition involving your knees. You’ll basically pay up to $7,500 for medical procedures related to your heart. Anything more than that amount and your insurance company steps in to cover the excess.

This works pretty well for both parties. Agreeing to a higher CSD helps lower your premiums, while picking a lower CSD helps cushion the financial effects of a sudden medical emergency. On the side of the insurer, the CSD sets a decent buffer to help minimize its own expenses.

CSDs, however, are not perfect. They can only apply to conditions where the costs of your medical procedures can be decently predicted. They also don’t apply for conditions that deteriorate over time, like diabetes or high blood pressure.

But all this will be moot once 2014 comes rolling around the corner. That’s when a provision in the Affordable Car Act about prohibiting discrimination due to pre-existing conditions will take effect. That simply means insurance companies can’t deny you health coverage because of a pre-existing condition.

Health Savings Accounts: What They Are and Why They Matter

It is always a good idea to get health insurance, even if you have a modest income along with modest savings. It is an even better idea to get health insurance when the premiums you pay end up in a tax-advantaged savings account.

This is where health savings accounts (HSAs) come in.

An HSA is an option for those paying high deductibles on their health plans with significantly lower premium rates compared to ordinary health coverage. If you set your deductibles to about $1,100 for individual plans or $2,200 for family plans, you can basically deposit your yearly premium payments into an account with deferred taxes. You can then use this money to pay for medical expenses and can withdraw the whole thing for any purpose once you hit 65.

Think of it as an individual retirement account (IRA) except you fill up the cash reserves with insurance premium payments instead of your salary – making it an ideal choice for those nearing retirement.

Do note that HSAs are feasible only if you make enough money to cover your own medical expenses. You will end up spending more money out of your own pocket if you avail of an HSA, meaning you can only rely on your insurance company to cover dramatically expensive medical costs like a major surgery or emergency.

You must also be generally healthy as well. Remember that an HSA puts most of the financial burden on you, so you may want to put off availing of one if you are expecting to spend more on medicine and medical procedures in the coming years.

Contact Us




5725 Oleander Drive
Suite D4
Wilmington, NC

  • Family and Individual Insurance
  • Group Insurance
  • Student Health
  • Dental

Individual and Family health insurance plans provide long-term protection and comprehensive medical coverage for you and your family.

Group health insurance is employer-sponsored health coverage for business owners, employees and often for dependents.

Paragon Group in North Carolina provides health savings account plans. A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account are not subject to federal income tax at the time of deposit.

Read More

Paragon Group in North Carolina offers a variety of dental insurance plans. Some plans provide extensive coverage and will cost more at the time services are required. Other plans can be tailor made to cover specific types of coverage, including orthodontia, oral surgery, or dental implants. Family, individual or group polices are available.

A few things to consider when reviewing your dental insurance needs:

Read More