Dana's Insurance Agency

HMO (Health Maintenance Organization) is an organization that provides or arranges for coverage of certain health care services. Typical HMO coverages include access to a primary care physician, emergency care, and specialists/hospitalization when needed.

Kaiser Permanente is the largest HMO provider in North California. Many Kaiser Permanente hospitals bring physicians, emergency care, pharmacies, and medical labs under a same facility.

Comparing with ohter types of medical insurance plans, HMO normally has the lowest premium. However, some critics of HMOs address concerns as to a lack of selection of primary care physicians and making health care decisions based upon a pure profitability standpoint as opposed to decisions driven by providing the best level of care for its patients.

PPO (Preferred Provider Organization) is a form of managed care under which health care providers contract to provide medical services at pre-negotiated rates. Members who subscribe to a PPO are required to use the health care providers who participate in the PPO network – utilization of a health care provider outside the PPO network may result in the member paying more out-of-pocket for services which could have been provided within the network.

Blue Cross is the largest PPO provider in North California.

IPO (Independent Provider Organization) operates by having an HMO contract directly with independent physicians to provides services to HMO members.

POS (Point of Service) plans allow the individual policy holder or certificate holder to visit out-of-network, non-participating doctors for a fee. If the services of a non-participating health care provider are utilized, the individual often obtains restrictions of benefits or incurs more out-of-pocket costs.HMO: An HMO (Health Maintenance Organization) is an organization that provides or arranges for coverage of certain health care services required by members of the organization. Typical HMO coverages include access to a primary care physician, emergency care, and specialists/hospitalization when needed.

Q: I have not had any accidents or violations, So why do my auto insurance premiums continue to increase?
A: The costs of buying and repairing cars continue to climb. Insurance companies need to cover those costs. Even if your driving record is unblemished, your rates and those of other drivers will climb to compensate for more and costlier accidents involving others in your state or insured by your carrier.

Q I hear from time to time about people being seriously injured or killed when their vehicle has a head-on collision with another, usually driven by someone under the influence, going the wrong way. I have often wondered what I would do if confronted with such a situation. What avoidance tactics do your experts at the CHP recommend?

A I fired your e-mail to Hugo-the-CHP-Man, who suddenly faced a wrong-way driver while on patrol two years ago on Interstate 80 near American Canyon Road — just as he entered a blind curve. He swerved and missed the fast-approaching car, which a few moments later slammed head-on into another driver, putting that motorist into a coma for six months. Said Hugo:

“What I did to avoid the vehicle was to swerve to the right. It was more of an instinct rather than training, but I did manage to avoid the head-on collision. Many of the wrong-way drivers get on the freeways and immediately go all the way to the right side of the freeway, or the fast lane, because they think it is the slow lane. And because they are most likely impaired, they don’t want to get pulled over for speeding.

“So, at night, stay away from the fast lane, especially around blind curves. Stay away from the slow lane, too. It is much safer to travel in the middle lanes of the freeway at night because you never know

what you might encounter on the road, and by being in the middle lanes there is more room to maneuver around a problem.
“Another good tip is to have a vehicle always in front of you within the same lane, at a good distance, of course. The driver of the vehicle ahead of you is another set of eyes that is basically clearing your lane ahead of you. Keep a high visual horizon as you drive. Look up ahead and scan the freeway. You can easily look ahead at least a quarter of a mile during light traffic. People tend to look no further than a couple of hundred feet ahead of them. This can prove deadly sometimes.

“Another thing is to slow down. Reducing your speed will enhance your chances of avoiding and surviving a head-on collision. And always wear your seat belt.”

By Gary Richards, Mercury News

Coverage: Different coverages can be purchased depending on the needs and wants of the insured, e.g., the Liability coverages and Bodily Injury Liability, Property Damage Liability, and Medical Payments, and the Physical Damage coverages of Collision and Comprehensive.

Bodily Injury and Property Damage Liability: Pays when you are legally liable for injury, death, or property damage caused by your vehicle up to the policy limit selected. Legal fees, bail bonds and court costs are also covered.

Basic Reparations Benefits: Pays when reasonable medical, dental and hospital expenses, funeral expenses (up to $ 2,000) lost income, lost services and survivors, loss resulting from a motor vehicle accident.

Collision: Pays for loss or damage to your vehicle caused by collision with another object or by upset. Payments are made on an actual cash basis less the deductible which applies.

Comprehensive: Pays for loss or damage to your vehicle caused by fire, theft, vandalism, hail, windstorm, riot, falling objects, flood, etc. If selected, the deductible applies to all damage except by fire.

Full Glass: Pays for loss or damage to any item of glass without applying the deductible under comprehensive.

Medical Payments: Pays reasonable and medically necessary expenses incurred within three years of an accident.

Rental Reimbursement: Pays towards expense to rent a vehicle if you have a loss (covered under your Comprehensive or Collision coverage) and your car is disabled longer than 24 hours.

Towing & Labor: Pays for towing your vehicle and any labor cost at the place of disablement.

Uninsured Motorists / Underinsured Motorists: Pays for damages that you, household relatives and passengers in the insured auto are legally entitled to recover because of bodily injury or death caused by uninsured or hit-and-run autos.

The limits available are as low as $ 20,000 / $ 40,000 or as high as twice your policies bodily injury liability coverage. Also includes standard coverage which protects you where other parties insurance is not enough to pay your damages and is less than your coverage. You can purchase conversion coverage; this coverage is not reduced by payments from any source.

Actual Cash Value: Unlike the coverage provided for your home and other structures, coverage for your household contents and personal possessions is normally offered on an actual cash value basis. In other words, instead of being paid the replacement cost of an item, a deduction is made for depreciation due to normal wear and tear, obsolescence and use, usually less than you originally paid. For instance, you might recover only $200 for the refrigator/freezer that cost you $1,000 seven years ago.

There’s a popular alternative: insuring your personal property on a replacement cost basis at a somewhat higher premium. The choice is up to you. For a more complete explanation, see Replacement Cost Coverage.

Additions and Alterations: As a homeowner, you want to be sure any significant improvements to your home are adequately covered within the dwelling limit of your policy. A new family room, bath or remodeled kitchen could easily add $30,000 to the value of a home, pushing you well over your policy limit. Similarly, if you build a new detached three-car garage, you will almost certainly go over the coverage that applies collectively to your detached structures (10% of your dwelling coverage limit). In all cases like these, tell your agent about your new addition or alteration and ask whether you need to increase your coverage.

Business Property: Your homeowner policy restricts coverage to $2,500 for damage to items at home “used at any time or in any manner for any business purpose”. You have a mere $250 coverage for same when it’s away from your premises. Clearly, your homeowners policy was not intended to insure merchandise or property at home that is used for business purposes. If you offer professional services out of your home or conduct some home demonstration and regularly have a living room full of freezer ware, basketry or cosmetics, talk to your agent; your policy can easily be upgraded to provide a higher dollar limit for your business furnishings, equipment and supplies. What if you regularly bring work and equipment home from the office? Your dedication may get you a raise from the boss but it won’t necessarily pay off if your company’s word processor gets stolen…again. Tt wouldn’t hurt to seek a more clear-cut interpretation of coverage from your agent.

Computer Equipment: Insured within your personal property coverage limit for types of loss listed here. Caution: computers, monitors, disk drives, modems, scanners, other peripherals and software should be covered with a special endorsement that provides higher dollar limits and protection against additional kinds of loss. Your agent knows how to help. Portable and laptop computers are covered wherever you take them. However, if your computer equipment is used even partly for business, coverage under your homeowners policy is limited. See Business Property.

Debris Removal: If your property suffers damage that is covered by your homeowners policy, reasonable costs to remove any resulting debris are also covered. If the cost to both repair the damaged property and remove the debris exceeds your policy limit, an additional 5% of your policy limit is granted for the expense of the debris removal.

Dwelling/House: For insurance purposes, your “dwelling” means your house itself plus any attached structures like a garage, carport or shed. It also includes any materials/supplies located on or next to your residence premises (if occupied) for the purpose of repairing, altering or constructing the dwelling or other structures.

Electronic Data Processing Tapes: These tapes, wires, records, discs and other software media are not covered if they contain business data. Blank or unexposed records and media are insured within your personal property limit for types listed here.

Explosion: Damage to your dwelling or contents due to an explosion (of your heater, for example) that occurs on or off your premises is covered within policy limits–subject to your deductible. Off-premises examples: industrial accidents, blasting work, sonic boom.

Fair Rental Value (your own premises): If a covered loss makes your principal residence unfit to live in, your policy provides your choice of either Fair Rental Value or Additional Living Expenses. If you choose Fair Rental Value, you will receive the fair rental value of that part of your residence, minus expenses that do not continue while the premises are unfit to live in.

Flood: Flood damage is never covered under a homeowners policy including a rain-flooded basement. If your property is located in an area that requires this coverage, you can obtain coverage for most properties through the National Flood Insurance Program. Any licensed property insurance agent or broker can help you get this coverage. Overflow or accidental discharge of water from within your residence may be covered.

Freezing: Damage to your residence, household contents and/or personal possessions from freezing is covered if you maintain heat in the building or shut off and drain the water system and appliances when the building is under construction, vacant or unoccupied.

Garages: A garage attached to your house is insured within your dwelling coverage limit. Detached garages are insured with other structures on your property, up to 10% collectively of the amount of coverage on your house. You can increase your coverage limit for an additional cost. Click here for types of loss covered.

Hurricanes: Damage to your house and detached structures from violent winds, such as hurricanes, cyclones and tornadoes, is covered. Damage to the contents of a building is not covered unless the storm causes an opening that allows damaging wind or water to enter; in that case, it is.

Injury to Others: You are insured under your policy’s personal liability section for bodily injuries you or residents of your household or your pets accidentally cause to others. This coverage applies on or off your premises, anywhere in the world–provided you are legally liable for the injury and the resulting loss. If your misdirected golf shot injures another person or breaks a window, your homeowners policy would most likely pay for the injury or any property damage.

Legal Defense: Your homeowners policy pays for legal expenses to defend a lawsuit brought against you for a covered loss (even if the suit is fraudulent or groundless). The cost of your defense does not come out of your coverage dollars.

Living Expenses: If severe damage to your house from fire, windstorm or another type of covered loss makes your primary residence unfit to live in, your policy compensates you for either Additional Living Expenses or Fair Rental Value reimbursement. If you choose Additional Living Expenses, you will be reimbursed for any increase in expenses over and above your usual expenses so that your household can maintain its usual standard of living until you move back into your house. Extra costs for staying in a hotel/motel, use of a Laundromat and telephone expenses are some examples of what would be covered.

Malicious Mischief/Vandalism: Coverage is provided for your personal property, your home and other structures unless the damage occurs in a building that has been vacant (empty and unfurnished) for more than 30 consecutive days before the loss. If your home is under construction at the time of the malicious mischief or vandalism, this is not considered “vacant” and your loss is covered.

Medical Payments to Others: Your homeowners policy provides this coverage, which differs from personal liability coverage in two ways:

If someone is injured on your property, coverage is available to pay that person’s necessary medical expenses–under the medical payments to others limit (usually $1,000)–whether or not you are responsible for the injury. These expenses may include medical, surgical, x-ray, dental, ambulance, hospital, professional nursing, prosthetic devices and even funeral expenses. Your policy also pays for injuries occurring off your premises if you, a family member living with you, a residence employee in the course of their employment (while on the job), or a pet causes the injury.
Medical Payments applies only to injury and not to property damage.
This coverage does not apply to you or residents of your household except residence employees.

Pipes (Water): Damage from burst water pipes is covered within your dwelling coverage limit. Damage to pipes themselves is also covered.

Power Failure: If a power failure occurs on your premises, any resulting damage to your property is covered. If a loss is caused by a power failure off your premises, the loss is not covered. For example, if a storm knocks out power from your local electric company and your freezer-full of filet mignon is endangered, better have an immediate barbecue feast. (Special coverage can be purchased to insure your refrigerated goods against spoilage in this case.)

Power Surges: Your are covered for damage caused to domestic electric appliances, except to a tube, transistor or similar electronic component.

Replacement Cost Coverage: On your household contents, this popular alternative to Actual Cash Value reimbursement pays you at today’s cost to replace or repair lost or damaged property–subject to your policy limits and your chosen deductible (and provided actual repairs are made). This coverage must be specifically requested.

Water Heater: If your water heater suddenly and accidentally tears apart, cracks, burns or bulges, any resulting damage to your personal property is covered. If water drips or seeps from your heater over a period of time and gradually ruins your carpeting or flooring, this “slow loss” is not covered. If you notice dampness around a water heater, you’ll save money by calling the plumber before serious damage occurs. Damage to your water heater itself is not covered, unless the damage results from fire or another type of covered loss listed here. Damage from freezing of your water heater is not covered.

Windstorm/Hail: Damage to your house and other structures from violent winds and hails–including hurricanes, cyclones, tornadoes and typhoons–is covered up to policy limits. Loss to property inside a building is not covered unless the storm causes an opening that allows damaging wind, rain, snow or sleet to enter. If you leave a window open and the rain blows in — grab a mop; insurance does not cover you.)