BOAT INSURANCES

Boat insurance programs are normally designed to cover boats up to 26' in overall length. If the size of your vessel is greater than 26 feet, it's generally considered a "yacht", and therefore qualifies for yacht insurance.

Boat insurance provides physical damage coverage to repair your boat if it's accidentally damaged or destroyed by a covered peril such as collision, fire, theft, windstorm, lightning or vandalism. This coverage is broad, and provides coverage for the boat, including its machinery and auxiliary equipment, outboard motors, boat trailer and personal property.

A Boat Insurance policy can provide physical damage coverage on an Actual Cash Value (ACV) or an Agreed Amount Value basis. Both types of boat insurance policies offer important coverages for your boat but there are significant differences.

Actual Cash Value policies pay for Replacement Costs less depreciation at the time of the loss. In the event of a total loss, used boat pricing guides and other resources are used to determine the approximate market value of your vessel. A partial loss is settled by taking the total coast of the repair less a percentage for depreciation.

Agreed Amount Value policies mean you and the insurance company have agreed on the value of your vessel and in the event of a total loss you will be paid that amount. Agreed Amount Value policies also replace old items for new in the event of a partial loss without any deduction for depreciation. Most Agreed Amount Value policies require actual cash value on certain damaged property such as sails, protective covers, batteries, dinghies, trailers and aged outboard motors, lower drive units or outdrives.

Physical Damage coverage is usually subject to a deductible. The boat and motor usually have the same deductible with additional deductibles for the trailer and personal effects. The deductible is the amount you are willing to pay in case of a loss. The higher the deductible, the lower your insurance premium. Boat policy deductibles are usually calculated as a percentage of your coverage (1%, 2%, 3% of the vessel value) or can be on flat amounts of $250 or $500.

A good boat insurance policy should also offer Personal Effects coverage to provide protection for those items not intended for the normal operation of your boat, such as portable TVs, cellular or portable phones, stereos, radios and cameras.







Boat Liability

The Liability section of the policy provides protection if you are legally responsible for damages to property or injury to someone other than yourself or a family member. Boat Insurance liability provides protection if you are sued as a result of hitting another boat, or if someone is hurt onboard your vessel because of your negligence. This coverage is usually offered in increments of $100,000 up to $1 million.

Medical Payments

The Medical Payments section of the policy provides protection for reasonable medical, ambulance and hospital costs should someone be injured while in, upon, boarding or leaving your boat.

Uninsured Boat Owners Coverage

The Uninsured Boat Owners section of the policy provides coverage for injuries caused by an accident that you are entitled to recover from the owner or operator of an uninsured boat or "hit-and-run" boat.

Commercial Towing and Assistance enables you to be reimbursed for the reasonable costs incurred when you break down at sea and need a commercial tow to port.

These are some of the basic coverages you should look for when purchasing boat insurance. As a market leader in the boat insurance industry, United Marine Underwriters offers broad coverages at great rates for virtually any type of vessel.

SMALL BUSINESS INSURANCES

The Insurance Information Institute (III) in New York City estimates that about 40 percent of small business owners have no insurance at all, because many falsely believe they can't afford coverage. The truth is a small business can't afford not to have adequate insurance. Without insurance, you're unnecessarily putting your livelihood at risk. That's also why many landlords, suppliers, and other entities you work with will probably require you to have coverage.

If you're having difficulty determining which kind of insurance your business should have, you might want to check with the following agencies:

• The county or city clerk
• A local chapter of your industry association
• The state insurance office

DO I NEED SPECIAL INSURANCE FOR A CLASSIC CAR?

Do I need special insurance for a classic car?
You should always talk to your agent about coverage of rare and valuable property. Since a classic car usually cannot be replaced, you'll probably want ample compensation if it is lost. A classic car, because it is rare or unique, may indeed require a special insurance policy.

WHAT ACTUALLY HAPPENS WHEN I REPORT AN ACCIDENT?

What actually happens when I report an accident?
After an accident, you should call your agent as quickly as possible, to help you complete a claim form, determine what exactly happened and evaluate any damages or injuries. Your agent then will contact your insurer's claims adjuster--usually within an hour of your report --whose job is to work with you to fix the problem. While compensating you for auto repairs or medical expenses is easy and immediate, determining liability is more complicated. The adjuster will begin the settlement process, the length of which will depend on the cooperation of the other party.

The amount of compensation for your loss can vary according to the adjuster's analysis of the damage. You do not have to accept the first amount of money you are offered, if it is lower than the cost of your repair or recovery. While you may have to do some homework to prove your reported loss is valid, it's worth it to be certain your insurer lives up to the provisions of your policy.

Remember, negotiating with an adjuster is just business--insurers simply want to settle claims fairly in light of possible fraud. While it is your insurer's responsibility to root out false claims, you pay the price in the end. In fact, you spend nearly a dime on every dollar of your premium to cover the false claims of others. So, try to keep an open mind when working with your adjuster to settle on a price that's fair to both you and your insurer.

AM I COVERED FOR NATURAL DISASTERS OR 'ACTS OF GOD'?

Am I covered for natural disasters or 'Acts of God'?
Comprehensive insurance, which covers you for fire and theft, generally covers you against damage by flood, earthquake, hail and other natural perils, except when your car is overturned (which is technically considered a collision). If you have special concerns about the safety of your vehicle in the face of Mother Nature's wrath, contact your agent for information on catastrophic coverage.

WHAT HAPPENS WHEN I LOAN MY CAR TO SOMEONE?

What happens when I loan my car to someone? Is that person covered by my policy? Am I still covered?
Yes. Liability and coverage for physical damage (i.e., comprehensive and collision) always follow your car. So, if a friend borrows your car and has an accident, you're still protected against the cost of damages or injuries. Plus, if the driver of your car is insured, his or her policy will also be available to cover the cost of damages and injuries.

The same rules apply when you borrow someone else's vehicle-- your own insurance follows you no matter whose car you are driving. But the vehicle owner's policy is the key coverage if you have an accident.

DO I ALWAYS NEED TO BUY INSURANCE WHEN I RENT A CAR?

Do I always need to buy insurance when I rent a car?
If you have fully insured your own vehicle, including collision and comprehensive coverage, and rent a vehicle for pleasure only (while on vacation, for example), you do not need to buy extra insurance from the rental company. In fact, in most states your basic rental fee by law will include liability coverage for damage or injury to others. But different rules apply when you rent a car for business purposes, so check with your agent for details.

If you do not have your own insurance, be aware that many car rental liability policies cover you only at the state's required minimum. Also, you should buy the collision and comprehensive coverage offered by the rental company for your own protection. Plus, do not buy a collision damage waiver (CDW) from the rental company assuming it is insurance. A CDW simply releases you from financial responsibility if you damage the vehicle you are renting, provided you comply with the terms of the rental contract. But those terms can vary considerably, and CDWs are not state-regulated, which means they are technically not insurance.

It's always a good idea to review your policy before renting a vehicle and, if necessary, contact your agent for clarification.

WHO'S WATCHING THE INSURANCE COMPANIES?

Who's watching the insurance companies?
With few exceptions, your insurance company does not set its own rates (unless you live in Illinois). It request the right to charge appropriate rates from your state's insurance department, which responds with legal approval and authorization, provided the requested rates are fair.

Every state has some sort of department, administration or agency that regulates and monitors every insurer operating within the state's borders. In addition to approving rates, your state's insurance department is involved in all insurance matters on behalf of private citizens and businesses. It also issues operating licenses to insurance companies and agents, based on their ability to meet the state's requirements for conduct and knowledge about insurance issues.

Your insurance company works closely with your state's insurance department to make sure you are getting the best and fairest possible service within the state's guidelines. Contact your state's insurance department (listed at the end of this guide) if you wish to know more about how it serves your interests.

HOW DOES ADDING DRIVERS TO MY POLICY AFFECT MY RATES?

How does adding drivers to my policy affect my rates?
The more people you allow to drive your vehicle on a regular basis, the greater the chances of your vehicle being in an accident. Teenagers are especially expensive to insure because they are the least experienced drivers.

A driver's-ed course can help ease the burden of insurance costs since it teaches your teenager defensive driving techniques. If your child's high school does not offer driver's-ed, try to find one offered by another school or a private firm in the area. After all, the cost of driver's-ed could be cheaper than the extra cost of your insurance. (Many insurers offer "good student" discounts as well.)

An adult's driving experience can also affect your rates significantly. Don't assume that every adult you know has been driving since age 16 or is a competent driver with a clean record. Again, taking a defensive driving course is a good way for adults to prove they are responsible drivers, thus lowering their risk and their insurance rates. (This is a great solution for new couples who are jointly insured but unmatched in their driving skills or experience.)

WHAT STEPS CAN I TAKE TO REDUCE MY RATES?

What steps can I take to reduce my rates?
Insurers often discount their rates in order to encourage good driving practices and the use of safety and security precautions. Depending on the insurance company, you can often lower your rates from 5 to 35 percent.

Sometimes the investment you make in your vehicle is worth the discount, and sometimes it's simply worth some peace of mind. For example, the purchase of anti-lock brakes merits a discount from nearly every insurer, but the discount probably will not pay for the brakes (which cost several hundred dollars) during the normal life of your vehicle. Anti-lock brakes are touted, nonetheless, as a life-saving feature ó a serious consideration when safety is a top priority.

Insurers generally offer discounts for:

• Safety Features--Anti-lock brakes, air bags and passive restraint systems (i.e., automatic seat belts).
• Defensive Driving--Clean violation record, driver's-ed courses for teenagers and defensive driving or accident prevention courses for adults (insurance discounts for the latter are required in some states).
• Security Systems--Alarms, electronic locks and disabling devices.
• Changing Driving Habits--Commuting by public transit, using a company vehicle for work-related travel and car-pooling.
• Formal Agreements Not to Drink and Drive--The availability of a discount for signing such an agreement varies among insurers and states.
• Buying Home Owners and Auto Policies from the Same Company--If you own a home and an automobile and you are insured by two different companies, check into the cost of carrying both policies by one insurer. Your agent can give you guidance as to which insurers offer discounts.

You can also lower your auto insurance rates by requesting higher deductibles, or the amount of money you pay before you make a claim. Increasing your deductibles on collision and comprehensive coverage from $100 to $250, or even $500, will bring your rates down. Moreover, you may not need collision and comprehensive coverage if you drive an older car. Ask your agent which discounts are available to you.

HOW DO I KEEP MY INSURANCE COMPANY FROM CANCELING MY POLICY?

How do I keep my insurance company from canceling my policy?
The most obvious way to maintain your low-risk status is to keep a clean driving record. If you've been in an accident, consider taking a defensive driving course. Even those of us who have been driving for years rarely know the simple tricks to preventing accidents through defensive driving.

Also, look into purchasing special safety and security features for your car, such as anti-lock brakes and an alarm system. Your insurance agent can give you further tips on how to convince your insurer you're a safe driver

WHY WOULD MY INSURER CANCEL MY POLICY?

Why would my insurer cancel my policy?
Technically, in most states your insurer can cancel your policy only if:

• you fail to pay your premium;
• you lose your driver's license;
• you are guilty of material misrepresentation during the application process--i.e., you fail to notify your insurer of a recorded violation, such as a drunk-driving offense; or
• you fail to report a substantial change of risk, such as buying a high-powered sports car to replace a family sedan.

However, your insurer can choose not to renew your policy for a variety of reasons. Do you have a bad driving record? Have you received a lot of speeding tickets? Have you ever been caught driving drunk? Not only are these scenarios considered unsafe and illegal, they are justifiable cause for your insurer to label you a bad risk and refuse to renew your policy. (Some underwriters may feel compelled to cancel policies after only one accident.) Where do you live? Has the neighborhood changed in the last few years? Have the accident or crime rates risen noticeably? As regions are reassessed periodically, their status could change and you could suddenly find yourself living in a high-risk area, where your insurer's rates may not be adequate to cover losses.

DO ALL STATES REQUIRE SOME KIND OF LIABILITY INSURANCE?

Do all states require some kind of liability insurance?
No. Some states, while not mandating auto insurance, have "financial responsibility laws" that require all drivers to be able to pay for any damage or injury they may cause. However, carrying liability insurance is still the best way for you to meet your state's financial responsibility requirements.

UM and UIM policies are offered by law in all states, including no-fault states. In fact, some states require all motorists to carry this coverage in order to gain protection from inadequate insurance coverage of other drivers.

WHAT IS 'NO-FAULT' INSURANCE?

What is 'no-fault' insurance?
No-fault insurance is a system adopted in some states that essentially bypasses the conventional legal procedure which finds fault in an accident. (This is the procedure by which you hire a lawyer, file suit and possibly go to court to prove the accident was the other guy's fault.) No-fault simply does away with the concept of one party or the other being at fault--no lawyers, no court, no judge, no jury, no lengthy lawsuits against the other party. This is considered beneficial to taxpayers, because it eliminates costly legal proceedings that the state must manage, and to insurance policyholders, because it helps keep rates down.

If you are insured in a no-fault state and have an accident, you don't go after the other driver. You contact your own insurer and file a claim. Your own insurance policy guarantees you immediate compensation for damages, medical expenses, lost wages, etc.

The type and range of no-fault coverage varies from state to state. What defines the limitations of no-fault policies can differ in two critical areas:

• Threshold--The type of damage/injury or the cost of repair/recovery that triggers the need for legal action.
• Mandated--Benefit Level--The package of benefits (medical, wage loss, replacement services and other expenses) your state requires you to carry.

The details of no-fault insurance can be complicated. Contact your agent or state's insurance department for further information.

HOW DOES WHERE I LIVE AFFECT MY PREMIUM?

How does where I live affect my premium?
Where you live (or, more precisely, where you keep your car) has a bearing on your chances of having an accident or becoming a victim of theft or vandalism. That's why a vehicle owner in Brooklyn, New York, pays a higher rate than the owner of an identical vehicle in Dallas, Texas.

Other factors affecting regional insurance rates include time and efficiency of police response and law enforcement, local road and traffic conditions and the quality of local medical services. Insurers even factor in the litigation rates in a given area--that is, how many lawsuits are filed, go to trial, are settled out of court and for how much.

WHY AND HOW ARE POLICIES PRICED FOR DIFFERENT DRIVERS?

Why and how are policies priced for different drivers?
Drivers are grouped according to the level of risk each one poses--i.e., the amount of loss incurred by insurers within various categories of policy holders. For various reasons, drivers are categorized by:

• Sex--Men have more accidents on the road than women.
• Age--Drivers under 25 (and, for some insurers, under 30) are considered at higher risk of having an accident.
• Marital Status--Married drivers tend to have fewer accidents than single drivers.
• Personal Driving Record--Years of driving experience, accidents, speeding tickets and drunk-driving offenses are all factors in determining how much of a risk you pose as a motorist.
• How You Use Your Vehicle--If you commute by car during rush hours, you're at greater risk of having an accident than if you only drive for errands and recreation on the weekends. Drivers who use their own vehicles for business also are considered to be at greater risk.
• Type of Vehicle--The value, size, weight, age of your vehicle--even the cost of replacement parts--are essential to determining the price of your insurance. Larger, heavier vehicles are considered at lower risk than smaller, lighter ones. Plus, more expensive cars are costlier to have repaired than economy models.

The cost of your insurance policy is based on the average cost of covering actual losses, spread out over your particular "rating group" as a whole. Of course, you may never have an accident or have your car stolen, and therefore will never need to be compensated. But others in your category may not be so lucky. Your premium will help to pay for their losses, just as their premiums would help to pay for yours. In other words, you are investing a little today in case you need a lot tomorrow; your investment is pooled with others, and the pool pays for your loss.

For example, if you are a 23-year-old man and you park your new sports car on a downtown street in a large city, you will likely pay more for insurance than a 37-year-old woman who parks her four-wheel-drive in the suburbs, simply because--based on average losses--you have a greater chance of having an accident or being the victim of auto theft.

WHAT ARE THE DIFFERENT TYPES OF POLICIES & WHAT COVER?

What are the different types of policies & what cover?
Auto insurance is divided into several different types of coverage:

• General liability covers damage you may cause to other people's property and injuries to the people themselves.
• Collision covers damage to your own vehicle in an accident.
• Comprehensive (i.e., fire, theft and other non-collision damage) covers fire damage to your vehicle, break-ins, vandalism or theft, as well as natural disasters (earthquake, hail, hurricane, flood, etc.--unless the vehicle is overturned, then it is considered a collision).
• Medical payments insurance, usually in the range of $5,000 to $10,000, covers medical expenses for injuries. This "good-faith" coverage guarantees immediate medical payments for you, your passengers and other parties, regardless of who is at fault. It also covers you and members of your household in any accident involving an automobile, whether you are on foot, on a bicycle, in a friend's car, etc.
• Uninsured motorist (UM) and underinsured motorist (UIM) coverage protects you if you are injured in an accident with others who themselves carry insufficient or no liability insurance.
• Extra coverages include expenses for towing, labor, temporary replacement vehicles, etc. These are generally defined as add-ons or endorsements to your policy.

CAR INSURANCE

What is a Car Insurance?
This is insurance which protects the insured against losses involving the use of automobiles. Various coverages may be bought depending on the desires of the insured. Such coverages include the liability coverages of bodily injury, property damage, and medical payments, and the physical damage coverages of collision and comprehensive.

CAR RENTAL INSURANCE

In most states, car rental companies are prohibited from refusing to rent you a car unless you purchase the additional insurance, but many companies still try to do it. The coverage's that you can get are all optional. Combined, they can add up to $30 per day to the rental bill. Each coverage protects against a different risk, but your car, home, life, or health insurance policies, or your credit card, may provide all or part of the protection you need, particularly when they are combined with the minimum insurance the car rental company is required by law to provide as a part of every rental.

There are four different types of insurance and insurance-like coverage's the companies try to sell to consumers at the rental counters: Collision Damage Waiver (CDW), Supplemental Liability Protection (SLP), Personal Accident Insurance (PAI), and Personal Effects Coverage (PEC). While this coverage may make sense for some renters, in most states you already have this coverage for a rental vehicle as part of your primary auto insurance, unless you declined to accept it when you purchased that policy.

SLP usually provides $1 million of liability protection, considerably more coverage than most consumers have under their own automobile insurance policies. So if there is a reason that you want more coverage for the rental than you ordinarily carries for your own car or you do not have an automobile insurance policy, buying the SLP may make sense. However PAI coverage, usually costing about $3 per day, provides medical, ambulance and death benefits for the renter and passengers of the rental car in the event of an accident. The medical coverage is usually around $3,500 and the ambulance benefit $150 and REC coverage typically costs $2 per day, usually provides $500 per person of insurance coverage, with a $1,500 maximum, for theft of personal effects of the renter and his or her family. The motto here is that before you buy into rental car insurance, you should check to see if your own car policy covers you already.

ANNUAL MEDICAL

Global Insurance Benefits cover individual expatriates and their families, as well as employees working abroad on assignment, international organizations, missionaries, and others living or traveling internationally who need annually renewable insurance.

Three types of annually renewable insurance are included in this category:

• International Major Medical Insurance
• International Life Insurance
• International Accident Insurance (AD&D)

EMERGENCY EVACUATION

Not all medical facilities were created equal. Depending on the plan, Emergency Medical Evacuation insurance covers the cost of transporting a seriously injured or ill person to one of the following locations:

• The nearest adequate medical facility
• A hospital near home
• Or the hospital of his/her choice

Emergency Medical Evacuation insurance is usually included with both Travel Medical insurance plans and Trip Protection plans. However, unlike baggage insurance and trip cancellation insurance, it is also sold separately. Sufficient Emergency Medical Evacuation coverage is recommended, especially for long-distance trips abroad.

FLIGHT ACCIDENT

Accidental death and dismemberment insurance, known as AD&D insurance, pays you, or your beneficiary (or your estate if you do not name a beneficiary) a lump sum benefit (e.g., $500,000) when an accident results in your death or the loss of a limb or the loss of your eyesight. There are 3 major types of Travel AD&D insurance:

• Flight Accident AD&D insurance pays a benefit only for accidents involving an airplane during the coverage period.
• Common Carrier AD&D insurance pays a benefit only for accidents involving a common carrier during the coverage period.
• 24-Hour AD&D pays a benefit for accidents that occur for any reason during the coverage period.

AD&D is often included with Travel Medical insurance and Trip Protection plans, but unlike baggage insurance and trip cancellation insurance, it is also sold separately.

"Common Carrier" means any licensed land, water, or air conveyance operated by those whose occupation or business is the transportation of persons without discrimination and for hire (e.g., airplane, train, bus, subway, tram, ferry, cruise ship, taxi, limo, etc.).

AD&D insurance usually covers Terrorism, but some plans require the payment of additional premium for a Terrorism Rider. War is usually excluded, but War Risk AD&D insurance is available at a high cost, and you must complete a special application with details about your trip itinerary and activities.

TRIP PROTECTION

Trip Protection plans typically reimburse your non-refundable travel expenses if an unexpected crises (e.g., death, sickness, airline strike, travel company bankruptcy, among other crises) occurs before or during your trip causing it to be cancelled, interrupted or delayed. Plans often provide reimbursement for:

• Trip cancellation, interruption & delay
• Baggage loss and delay
• Emergency medical expenses
• Emergency medical evacuation
• Accidental death and dismemberment (AD&D)
• Repatriation of remains
• Travel assistance services

Although the maximum benefit limits for medical expenses are not as high as in Travel Medical Insurance, there is usually no deductible or co-pay.

Most plans exclude Pre-existing Conditions but will waive the exclusion if the insurance is purchased within a certain amount of time (7 - 21 days depending on plan) after payment of the initial trip deposit.

The cost of insurance or "premium" for Trip Protection plans is based on a percentage of Trip Cost, which is the amount of money that a traveler has pre-paid or is otherwise obligated to pay to a travel supplier (e.g., airline, travel agent, tour operator, hotel, cruiseline, Internet booking service) that might not be refunded if a trip is cancelled, according to the given circumstances and wording of the cancellation terms and conditions indicated in the travel purchase agreement between a traveler and travel supplier.

Rental car insurance, also known as collision damage waiver (CDW), may be included, or purchased as an upgrade, or purchased separately as a stand-alone plan.

TRAVEL MEDICAL

Travel Medical Insurance reimburses you for emergency medical expenses incurred when you are traveling or living in a foreign country.

Maximum coverage levels can be substantial enough (up to US$5 million) to cover major medical expenses such as emergency surgery and extended hospital stays.

The "American-style" of international medical insurance coverage requires you to pay the specified deductible (excess in the UK) and co-insurance also known as co-pay before the insurer pays any expenses.

Plans often require pre-certification by the insurer prior to hospital admission abroad.

When hospitalization is necessary, many insurers provide a guarantee of hospital admission, and some insurers provide direct payments to hospitals.

When hospitalization is not necessary, most insurers require a claim form to be submitted for reimbursement of covered expenses for basic treatment by a physician and outpatient medical services.

Plans usually include coverage for emergency medical evacuation, reunion, repatriation of remains, accidental death and dismemberment (AD&D), and various other 24/7 travel assistance services.

TRAVEL MEDICAL

Travel Medical Insurance reimburses you for emergency medical expenses incurred when you are traveling or living in a foreign country.

Maximum coverage levels can be substantial enough (up to US$5 million) to cover major medical expenses such as emergency surgery and extended hospital stays.

The "American-style" of international medical insurance coverage requires you to pay the specified deductible (excess in the UK) and co-insurance also known as co-pay before the insurer pays any expenses.

Plans often require pre-certification by the insurer prior to hospital admission abroad.

When hospitalization is necessary, many insurers provide a guarantee of hospital admission, and some insurers provide direct payments to hospitals.

When hospitalization is not necessary, most insurers require a claim form to be submitted for reimbursement of covered expenses for basic treatment by a physician and outpatient medical services.

Plans usually include coverage for emergency medical evacuation, reunion, repatriation of remains, accidental death and dismemberment (AD&D), and various other 24/7 travel assistance services.

TRAVEL INSURANCE

Why you need a Travel Insurance? Travel insurance covers a number of possible mishaps that can occur on the road. Peace of mind comes from knowing that if one experiences terrorism, a need for medical attention, emergency evacuation, or bankruptcy of a trip organizer, there will be recourse. Travel should be about wonder and delight, not anxiety and lost funds.

Travel insurance is much more affordable than people think, whether they buy it for one trip or for unlimited annual use. Some of the travel insurance types available include flight accident insurance, trip cancellation insurance, travel medical insurance, and even custom insurance products. Nearly every conceivable mishap can be insured against, to ensure against financial loss

WHAT IF I AM NOT SATISFIED WITH MY CARE?

What if I Am Not Satisfied with My Care?

Getting the best care and services means understanding how your health plan works, what your rights are, and how to complain if you need to. You have the right to get copies of test results as well as medical information about yourself. If you are in a managed care plan, you can ask to change your primary care doctor if you are unhappy with the relationship. You may also be able to switch plans during open enrollment.

Most plans have an appeals process that both you and your doctor may use if you disagree with the plan's decisions. If your plan refuses to provide or pay for services, you can complain or file a grievance about any decision you feel is unfair–or you can appeal it.

You can contact the member services division of your plan for more information or to complain. Use your plan's complaint process fully before taking other action.

Be sure to keep written records of:

• All correspondence with the plan.
• Claims forms and copies of bills.
• Phone conversations–the date and time, the people you speak with, and the nature of each call.

If the plan does not satisfy you, you may decide to bring the matter to the attention of your employee benefits manager, your State insurance commissioner, your State department of health, or the legal system. If you are a Medicare or Medicaid beneficiary, you have additional ways through those programs to file a grievance about the care received from a plan or provider. For information, contact your State's medical Peer Review Organization or State Medicaid Program.

WHAT IF I HAVE TO GO TO THE HOSPITAL?

What if I Have to Go to the Hospital?

The time to find out what rules your plan has on hospital care is before you need it.

Planned Hospitalizations

Unless it is a medical emergency, your health plan or primary care doctor will probably have to give advance approval (preadmission certification) for you to go to the hospital. Otherwise, the cost of your hospital care may not be covered. Ask these questions:

• What hospitals are part of the plan network?
• Is there a limit on how long I can stay in the hospital?
• Who decides when I am to be discharged?
• Will needed followup care, such as nursing home or home health care, be covered by the plan?
• If I have a serious medical problem, will the plan provide someone to oversee care and make sure my needs are met?

Ask how your plan handles getting a second doctor's opinion on whether surgery or another treatment is needed. Are second opinions encouraged or required? Who pays?

Emergency or Urgent Care

If you have a true medical emergency, you should go to the nearest hospital as fast as possible. It is important for you to know what kind of medical problems are defined as emergencies and how to arrange for ambulance service, if needed. Most plans must be told within a certain time after emergency admission to a hospital. If the hospital is not part of the plan network, you may be transferred to a network hospital when your condition is stable. Ask these questions:

• How does the plan define "emergency care?" What conditions or injuries are considered emergencies?
• How does the plan handle "urgent care" after normal business hours? Urgent care is for problems that are not true emergencies but still need quick medical attention. Check with your plan to find out what it considers to be urgent care. Examples may include sore throats with fever, ear infections, and serious sprains. Call your primary care doctor or the plan's hotline for advice about what to do. The plan may also have urgent care centers for members.
• How do I get urgent care or hospital care if I am out of the area? How must I tell the plan and how soon after I get the care?

HOW DO I OBTAIN CARE?

How Do I Obtain Care?

Learning what you can expect from your health plan and how it works are key steps to getting the care you need. Ask these questions:

• When are the offices open? What if I need care after hours?
• How do I make appointments? How quickly can I expect to be seen for illness or for routine care?
• If I need lab tests, are they done in the doctor's office or will I be sent to a laboratory?
• Will most of my appointments be with the primary care doctor? Will nurse practitioners or physician's assistants sometimes give care as well?
• Is there an advice hotline? Some plans have toll–free phone services that help members decide how to handle a problem that may not require a doctor's visit.

Find out how your plan provides care outside the service area and what you must do to get care. This is especially important if you travel often, are away from home for long periods, or have family members away at school.

HOW CAN I GET THE MOST FROM MY PLAN?

How Can I Get the Most from My Plan?

You will get the best care if you:

Stay Informed

• Read your health insurance policy and member handbook. Make sure you understand them, especially the information on benefits, coverage, and limits. Sales materials or plan summaries cannot give you the full picture.
• See if your plan has a magazine or newsletter. It can be a good source of information on how the plan works and on important policies that affect your care.
• Talk to your health benefits officer at work to learn more about your policy.
• Ask how the plan will notify you of changes in the network of providers or covered services while you are part of the plan.

Take Charge

• Ask your doctor about regular screenings to check your health. Discuss your risk of getting certain conditions. What lifestyle choices and changes might you need to make to lower your risks or prevent illness?
• Ask questions and insist on clear answers.
• Ask about the risks and benefits of tests and treatments. Tell your doctor what you like and dislike about your choices for care.
• Make sure you understand and can follow the doctor's instructions. You may want to bring another person along or take notes to help you remember things.

Keep Track

• Write down your concerns. Start a health log of symptoms to help you better explain any health problems when you meet with your doctor.
• Set up health files for family members at home. This will help you to monitor care. Include health histories of shots, illnesses, treatments, and hospital visits. Ask for copies of lab results. Keep a list of your medicines, noting side effects and other problems (such as other drugs and foods that should not be taken at the same time).

QUALITY OF PLANS

How Do I Find Out About Quality?

Quality is hard to measure, but more and more information is becoming available. There are certain things you can look for and questions you can ask. Whatever kind of plan you are considering, you can check out individual doctors and hospitals.

Many managed care plans are regulated by Federal and State agencies. Indemnity plans are regulated by State insurance commissions. Your State Department of Health or insurance commission can tell you about any plan you are interested in.

You can also find out if the managed care plan you are interested in has been "accredited," meaning that it meets certain standards of independent organizations. Some States require accreditation if plans serve special groups, such as people in Medicaid. Some employers will only contract with plans that are accredited.

Several national organizations review and accredit plans and institutions. You can contact these organizations to see if a plan you are considering, or an institution in the plan, is accredited.

Another approach is to ask the plan how it ensures good medical care. Does the plan review the qualifications of doctors before they are added to the plan? Plans are supposed to review the care that is given by their doctors and hospitals. How does the plan review its own services, and has it made changes to correct problems? How does the plan resolve member complaints?

Some managed care plans survey members about their health care experiences. Ask the plan for a report of the survey results.

Some plans and independent organizations are also beginning to produce "report cards." These reports often include satisfaction survey results and other information on quality, such as if a plan provides preventive care (for example, shots for children and Pap smears for women) or if the plan follows up on test results. Report cards may also include information on how many members stay in or leave the plan, how many of the plan's doctors are board certified, or how long you may have to wait for an appointment.

Report cards can only give you an idea of how a plan works and may not give a full picture of a plan's quality. Ask plans if their activities have been reported in report cards developed by outside groups (business or consumer organizations).

Also keep any eye out for magazine articles that rate health plans.

Finally, you can talk to current members of the plan. Ask how they feel about their experiences, such as waiting times for appointments, the helpfulness of medical staff, the services offered, and the care received. If there are programs for your particular condition, how are the patients in it doing?

COMPARING PLANS

How Do I Compare Health Plans?

After you review what benefits are available and decide what is important to you, you can compare plans. Many things should be considered. These include services offered, choice of providers, location, and costs. The quality of care is also a factor to think about.

Services

Look at the services offered by each plan. What services are limited or not covered? Is there a good match between what is provided and what you think you will need? For example, if you have a chronic disease, is there a special program for that illness? Will the plan provide the medicines and equipment you may need?

Find out what types of care or services the plan won't pay for. These usually are called exclusions.

Few indemnity and managed care plans cover treatments that are experimental. Ask how the plan decides what is or is not experimental. Find out what you can do if you disagree with a plan's decision on medical care or coverage.

Choice

What doctors, hospitals, and other medical providers are part of the plan? Are there enough of the kinds of doctors you want to see? Do you need to choose a primary care doctor? If you want to see a specialist, can you refer yourself or must your primary care doctor refer you? Do you need approval from the plan before going into the hospital or getting specialty care?

Location

Where will you go for care? Are these places near where you work or live? How does the plan handle care when you are away from home?

Costs

No health insurance plan will cover every expense. To get a true idea of what your costs will be under each plan, you need to look at how much you will pay for your premium and other costs.

• Are there deductibles you must pay before the insurance begins to help cover your costs?
• After you have met your deductible, what part of your costs are paid by the plan?
• Does this amount vary by the type of service, doctor, or health facility used?
• Are there copayments you must pay for certain services, such as doctor visits?
• If you use doctors outside a plan's network, how much more will you pay to get care?
• If a plan does not cover certain services or care that you think you will need, how much will you have to pay?
• Are there any limits to how much you must pay in case of major illness?
• Is there a limit on how much the plan will pay for your care in a year or over a lifetime? A single hospital stay for a serious condition could cost hundreds of thousands of dollars.

You can't know in advance what your health care needs for the coming year will be. But you can guess what services you and your family might need. Figure out what the total costs to your family would be for these services under each plan.

IMPORTANT COMPONENTS

What Is Most Important to Me in a Plan?

In choosing a plan, you have to decide what is most important to you. All plans have tradeoffs. Ask yourself these questions:

• How comprehensive do I want coverage of health care services to be?
• How do I feel about limits on my choice of doctors or hospitals?
• How do I feel about a primary care doctor referring me to specialists for additional care?
• How convenient does my care need to be?
• How important is the cost of services?
• How much am I willing to spend on premiums and other health care costs?
• How do I feel about keeping receipts and filing claims?

You might also want to think about whether the services a plan offers meet your needs. Call the plan for details about coverage if you have questions. Consider:

• Life changes you may be thinking about, such as starting a family or retiring.
• Chronic health conditions or disabilities that you or family members have.
• If you or anyone in your family will need care for the elderly.
• Care for family members who travel a lot, attend college, or spend time at two homes.

WHAT BENEFITS ARE OFFERED?

What Plan Benefits Are Offered?

Most plans provide basic medical coverage, but the details are what counts. The best plan for someone else may not be the best plan for you. For each plan you are considering, find out how it handles:

• Physical exams and health screenings.
• Care by specialists.
• Hospitalization and emergency care.
• Prescription drugs.
• Vision care.
• Dental services.

Also ask about:

• Care and counseling for mental health.
• Services for drug and alcohol abuse.
• Obstetrical-gynecological care and family planning services.
• Ongoing care for chronic (long-term) diseases, conditions, or disabilities.
• Physical therapy and other rehabilitative care.
• Home health, nursing home, and hospice care.
• Chiropractic or alternative health care, such as acupuncture.
• Experimental treatments.

Some plans offer members health education and preventive care, but services differ. Ask questions such as:

• What preventive care is offered, such as shots for children?
• What health screenings are given, such as breast exams and Pap smears for women?
• Does the plan help people who want to quit smoking?

WHERE TO GET A PLAN

Where Do I Get These Health Plans?

Group Policies

You may be able to get group health coverage–either indemnity or managed care–through your job or the job of a family member.

Many employers allow you to join or change health plans once a year during open enrollment. But once you choose a plan, you must keep it for a year. Discuss choices and limits with your employee benefits office.

Individual Policies

If you are self–employed or if your company does not offer group policies, you may need to buy individual health insurance. Individual policies cost more than group policies.

Some organizations–such as unions, professional associations, or social or civic groups–offer health plans for members. You may want to talk to an insurance broker, who can tell you more about the indemnity and managed care plans that are available for individuals. Some States also provide insurance for very small groups or the self–employed.

Medicare

Americans age 65 or older and people with certain disabilities can be covered under Medicare, a Federal health insurance program.

In many parts of the country, people covered under Medicare now have a choice between managed care and indemnity plans. They also can switch their plans for any reason. However, they must officially tell the plan or the local Social Security Office, and the change may not take effect for up to 30 days. Call your local Social Security office or the State office on aging to find out what is available in your area.

Medicaid

Medicaid covers some low–income people (especially children and pregnant women), and disabled people. Medicaid is a joint Federal–State health insurance program that is run by the States.

In some cases, States require people covered under Medicaid to join managed care plans. Insurance plans and State regulations differ, so check with your State Medicaid office to learn more.

Pre–Existing Conditions

A pre–existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre–existing condition often has not been covered for someone who joins a new plan until after a waiting period. However, a new law–called the Health Insurance Portability and Accountability Act–changes the rules.

Under the law, most of which goes into effect on July 1, 1997, a pre–existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre–existing condition will be covered–without additional waiting periods–even if you have a chronic illness.

If you have a pre–existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months.

To find out how this new law affects you, check with either your employer benefits office or your health plan.

WHAT ARE MY HEALTH PLAN CHOICES?

What Are My Health Plan Choices?

Choosing between health plans is not as easy as it once was. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ, both in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others. Almost all plans today have ways to reduce unnecessary use of health care–and keep down the costs of health care, too. This may affect how easily you get the care you want, but should not affect how easily you get the care you need.

Plans change from year to year, so you should carefully consider each plan, using the questions outlined in this booklet. If you get health insurance where you work, you should start with your employee benefits office. Its staff should be able to tell you what is covered under the plans available. You can also call plans directly to ask questions.

Health insurance plans are usually described as either indemnity (fee–for–service) or managed care. These types of plans differ in important ways that are described below. With any health plan, however, there is a basic premium, which is how much you or your employer pay, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by plan. In considering any plan, you should try to figure out its total cost to you and your family, especially if someone in the family has a chronic or serious health condition.

Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out–of–pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans. Indemnity plans pay their share of the costs of a service only after they receive a bill.

Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out–of–pocket costs if you select a managed care type plan and a broader choice of health care providers if you select an indemnity–type plan.

Over time, the distinctions between these kinds of plans have begun to blur as health plans compete for your business. Some indemnity plans offer managed care–type options, and some managed care plans offer members the opportunity to use providers who are "outside" the plan. This makes it even more important for you to understand how your health plan works.

Besides indemnity plans, there are basically three types of managed care plans: PPOs, HMOs, and POS plans.

HEALTH INSURANCE

What is a Health Insurance?
It's a fact of life — you need health insurance — and the time to get it is before you have an accident, suffer a serious illness, or discover you're pregnant. Insurance doesn't cover health care for medical problems or conditions that start before the moment you have your policy. Finding adequate coverage may seem overwhelming, but knowing the basics can help make your search less stressful.

HEALTH INSURANCE

What is a Health Insurance?
It's a fact of life — you need health insurance — and the time to get it is before you have an accident, suffer a serious illness, or discover you're pregnant. Insurance doesn't cover health care for medical problems or conditions that start before the moment you have your policy. Finding adequate coverage may seem overwhelming, but knowing the basics can help make your search less stressful.

THE VALUE OF YOUR HOME

How to determine your homeowner's coverage

Your first step in determining the right homeowners coverage is estimating the replacement cost of your home. The second step is selecting the coverage amount that best fits your needs. We recommend that you purchase an amount of coverage equal to the estimated replacement cost. But the choice is yours. Determining your home’s estimated replacement cost is important because this will ultimately determine which policy options are available to you. Since it is impossible to predict today what the exact cost will be to replace your home in the future, it’s important to have enough coverage to account for unforeseen circumstances.

Understand the difference between market value and replacement cost

“Replacement cost” is the amount needed to repair the damage or to rebuild the home to its pre-loss condition. The replacement cost of a home is NOT the market value of the home, its purchase price or the outstanding amount of any mortgage loan. It does not include the value of the land, but is the cost of rebuilding your home. New improvements or required upgrades are also not accounted for in the replacement cost.

You've worked hard to get your home. We’ll work hard to help you protect it

Before you purchase a new home, make sure that you determine the appropriate amount of coverage needed. When you have the home appraised, ask if a replacement cost estimate is available. Or consult with your local builder association or a reputable builder for an estimate.

Be aware of any architectural details or unique building materials that may affect your estimated replacement cost, such as:

• Upgraded bathrooms or kitchens (including cabinets)
• Additional rooms
• Custom molding or arched windows
• Other unique features

A contractor or appraiser can help estimate your home's replacement cost

Building contractors or professional replacement cost appraisers are a good source for obtaining an estimated replacement cost of your home. Estimates from these sources should reflect your home’s features, like those mentioned above. If you are unable to obtain a detailed estimate from these sources, your State Farm agent can help provide one for you.

Review your policy annually to make sure that your coverage meets your needs

• Have you recently remodeled or improved your home? When you upgrade or improve your home, you may increase your home’s estimated replacement cost.
• Has the rate of inflation risen since your last appraisal? Your agent provides coverage that automatically adjusts each year in an effort to compensate for increases in construction costs in your area. However, certain conditions such as severe weather can increase the demand for labor and materials, and raise costs beyond normal inflation. It is important to update your coverage amount each year to keep up with the changing economy.
• What influences the building costs in your area? Market conditions in your area may impact the amount it will cost to rebuild your home if you experience a loss. Replacement cost estimates are influenced by supply of labor, demand for labor, and cost of construction materials. Staying abreast of the current market conditions in your area, and changing your coverage amount accordingly, will help you maintain 100% estimated replacement cost coverage for your home.

Some important things to consider when determining your coverage amount: Your home’s estimated replacement cost is different than its market value (real estate cost)

• Each time you remodel or improve your home, you should adjust your coverage amount accordingly.
• If your home is made of unique building materials, make sure they are reflected in your replacement cost estimate.
• Stay abreast of the fluctuating building costs in your area and update your coverage amount accordingly. Make sure that you maintain coverage at 100% of your home's estimated replacement cost at all times.
• It is important to review your coverage annually and inform your agent of any changes you’d like to make.

BASIC COVERAGE IN HOMEOWNER'S INSURANCE

Basic Coverage included in Homeowner's insurance

The homeowner’s insurance policy is a package policy that combines more than one type of insurance coverage in a single policy. There are four types of coverages that are contained in the homeowner’s policy: dwelling and personal property, personal liability, medical payments, and additional living expenses.

Property Damage Coverage

Property damage coverage helps pay for damage to your home and personal property. Other structures such as a detached garage, a tool shed, or any other building on your property are usually covered for 10% of the amount of coverage on your house.

Personal property coverage will pay for personal property including household furniture, clothing, and other personal belongings. The amount of insurance coverage is usually 50% of the policy limit on your dwelling. The coverage is also limited by the types of loss listed in the policy. The coverage only pays the current cash value of the item destroyed, unless you purchased replacement cost coverage.

Your homeowner’s policy also provides off-premises coverage. This means that the policy covers your belongings against theft even when they are not inside your home. Your insurer will reimburse you for the cost of replacing your suitcase and its contents if it were lost or stolen while you were on vacation, but only for replacing them with items of like kind and quality.

Personal Property Floater

Your homeowner's insurance policy may provide only limited coverage for furs, jewelry, silver, and other valuables. It may be necessary to insure these valuables with a special addition to your homeowner's policy, such as a personal property floater. A personal property floater itemizes each article, gives a description of the article insured, and lists excluded perils. It often provides coverage that is broader than the coverage granted in the home insurance policy. You should discuss this with your insurance company or agent to determine the availability and cost of this additional coverage.

Your homeowner’s insurance policy does not cover your pets, your car, and any aircraft. Although your policy does not cover your pet or damage it does to your possessions, it will cover damage your pet does to others or their possessions.

Personal Liability Coverage

Homeowner’s policies provide personal liability coverage that applies to nonauto accidents on and off your property if the injury or damage is caused by you, a member of your family, or your pet. The liability coverage in your policy pays both for the cost of defending you and paying for any damages the court rules you must pay. And unlike the other coverage in your policy, liability insurance does not have a deductible that you must meet before the insurer begins to pay losses. The basic limit for liability coverage is usually $100,000 for each occurrence. You can request higher limits that are available for an additional cost.

Medical Payments Coverage

Medical payments coverage pays if someone outside your family is injured at your home regardless of fault. This includes payment for reasonable medical expenses incurred within one year from the date of loss for a person who is injured in an accident in your home. The coverage does not apply to you and members of your household. The medical payments portion of your homeowner’s policy will also pay if you are involved in the injury of another person away from your home in some limited circumstances. Medical payments coverage limits are generally $1,000 for each person. Higher limits of medical payments coverage are available at additional cost.

Additional Living Expenses

If it is necessary for you to move into a motel or apartment temporarily because of damage caused by a peril covered by your policy, your insurance company will pay reasonable and necessary additional living expenses. The typical policy will pay an amount up to 20% of the policy limit on your dwelling for these expenses. If you move in temporarily with a friend or relative and do not have any extra expenses, you will not be paid any additional living expenses by your insurance company.

WHY YOU NEED A HOMEOWNER INSURANCE

Why you need a Homeowner Insurance?

The largest single investment most consumers make is in their home. The consumer can protect his or her home, possessions, and liability with a homeowner’s insurance policy.

In addition to its availability to homeowners, similar coverage is available to those who rent homes or apartments. These policies are referred to as tenants’ or renters’ homeowner’s policies. If you are a renter, you do not need protection against damage to the building itself, but you do need protection against damage to or theft of your personal property and liability in the event someone falls or gets hurt on the part of the premises you rent.

A condominium owner may purchase a condominium homeowner’s policy to insure personal property. Some policies may also include any additions or alterations not insured by the condominium association. It is important to check with your condominium association and your agent before buying a policy to make sure you are adequately covered.

HOMEOWNERS INSURANCE

What is homeowner insurance?

Homeowners is one of the most popular forms of personal insurance on the market. The typical homeowners policy has two main sections: Section I covers your property, and Section II provides personal liability coverage (to cover you in case of lawsuits arising from things that happen on your property). Almost anyone who owns or leases property should have this type of insurance. Often, homeowners insurance is required by lenders as a requirement to obtain a mortgage.