About Private Health Insurance and UniCare

Like all insurance policies, health insurance is a risk-transfer mechanism. An insurance company agrees to protect the insured from the financial risk of high medical bills as a result of a severe injury or ailment that may occur sometime in the future, in exchange for a premium. In this way, the capital markets spread the risk of catastrophe among the entire risk pool, so that no one individual bears the entire financial risk. UniCare, a division of WellPoint is one such company, though it does not sell individual or family policies at this time.

Group Insurance Plans

• Millions of Americans have access to a health insurance plan via their employer's group plan. Employers sponsor these plans and subsidize their premiums. Typically, they cannot discriminate against workers with pre-existing conditions but must offer coverage to all qualified workers. In exchange, the insurance companies typically agree to take all enrollees without rejecting those with health problems. Companies can go through an insurer for this, or self-fund their own plan, creating their own internal risk pool. One of UniCare's lines of business is acting as an administrator, processing and verifying claims for businesses who are self-insuring their own employees. UniCare also provides workplace group medical insurance for businesses.

Individual Plans

• Insurance companies sell medical insurance to individuals and families, too. These plans are frequently comprehensive, and typically come with higher deductibles than workplace plans, which helps insurers to keep premiums affordable. Another variation is the family plan, which insures a spouse and one or more children, all with one common deductible for the year. You must medically qualify for coverage: A history of medical problems will make it more difficult or impossible to get a policy on the individual market. UniCare does not participate in this market.

Medicare

• Medicare is the federal health insurance program for those over age 65, and those with certain health conditions, such as end-stage renal disease. It consists of Part A, which covers hospitalization; Part B, which covers physicians charges, durable medical equipment and lab fees; Part C, which allows beneficiaries to access Medicare benefits through a private managed care company; and Part D, which covers prescription drugs. While Parts A, and B are government plans, Parts C and D are privatized. UniCare participates in the Part C market and competes with many other insurers across the country. You can also buy Medicare Supplement, or Medigap insurance, which is private insurance that covers a portion of your Medicare deductibles and certain other expenses not covered by regular Medicare.

Medicaid

• Medicaid is a federal program that funds health insurance for the very poor, elderly, handicapped and children. Congress funds the program, though state governments administer it. The states frequently contract with private companies to administer Medicaid benefits and monitor and verify claims and eligibility. UniCare does not participate directly in this market.