Archive for the ‘Individual’ Category
Thursday, July 8th, 2010
Startling news shows that one in five California residents (under the age of 65) have a “pre-existing” condition, which could render them ineligible for coverage, or offered premiums at inflated rates. Though health care reform promises all Americans coverage by 2014, this still leaves many without the coverage they need for years. What is considered a pre-existing condition? Pretty much anything you have been treated for, or are currently under treatment for prior to applying for coverage. While not all conditions will result in your denial for coverage, it can result in an increase in the monthly premiums from 20% – 100% higher. If you had a lapse in coverage, but are approved for coverage on a new plan, there may be a waiting period of 6 months before anything relating to your pre-existing condition will be covered by your insurance plan. The good news is as of September of this year, children under the age of 19 cannot be denied coverage due to their pre-existing conditions.
As your full service agency, we are happy to answer any of your questions relating to eligibility for a plan due to pre-existing conditions, what kind of rate increases you may be looking at due to your health history, as well as determining whether or not the six month waiting period applies to your situation.
Tags: health insurance, individual health, pre-existing, premiums, underwriting
Posted in Individual | No Comments »
Wednesday, May 12th, 2010
Health Care Reform promises to ensure that all Americans have access to medical coverage. The most pressing concern is the fact that many children are without coverage and the care they need now, so the bill states that by September 23rd, 2010, no child can be denied coverage due to pre-existing conditions. While this is well needed, it does bring to light the fact that there is an increasing shortage of Pediatric Specialists. With an influx of new patients entering the system, and the demand for both medically necessary and non-medically necessary treatments rising, will there be enough physicians to handle the load?
The problem lies in the way these specialists are compensated. Since the majority of their reimbursement comes from Medicaid, and is only covering about 67% of the cost, many new physicians decide to pursue alternate fields of specialty. With limited doctors, the average wait time to see a specialist can be as long as 114 days. This may cause parent’s to turn to the emergency room instead of waiting for a pediatric visit, putting the child at risk with inferior medical care. Hope lies in requiring Medicaid to pay Medicare rates, assisting new doctors with outstanding medical school loans, and funding for continued training. If we lose our pediatric specialists, we put our future at risk.
Tags: children's health, health insurance, pre-existing, Universal Health Care, wellness
Posted in Family, General, Individual, Resources, Tools | No Comments »
Tuesday, May 4th, 2010
As planned during six months following the signing of the health care reform bill, coverage will be extended for dependents up to the age of 26. This will allow parents to continue to offer health insurance coverage to their dependent children, even if those children do not live in the same household. This also holds true for young adults under 26 living out of state, and those that are married. Basically, unless they are offered employer sponsored health insurance, they can continue to remain on their parent’s coverage.
The deadline to implement this extension of coverage is September 23rd, 2010. However, numerous insurance carriers have decided to offer the coverage much sooner than that. CIGNA, Humana, United Healthcare, and Kaiser are a few that are increasing the dependent age limit as soon as June 1st. You can check with your carrier, or with us, to determine how your eligible dependents maintain coverage on your current plan. Regardless of whether a plan decides to implement this change ahead of schedule, health care reform will ultimately bring changes to all plans.
Tags: children's health, health care reform, heath insurance, individual health
Posted in Employees, Family, Federal, Individual, Laws, Resources | No Comments »
Thursday, April 15th, 2010
Important news for our Anthem Blue Cross clients in California who are on non-maternity plans! Prior to June 1st, 2010, if you became pregnant while on a plan with no maternity benefits, you would be offered their high deductible PPO Share 5000 plan. However, now that this is no longer the case, it is extremely important we evaluate your current situation to ensure coverage is in place when you need it.
Did you know that a C-section can cost around $30,000? Or that a premature baby can run up hospital bills in the $600,000 range? This only demonstrates the importance of making certain you are covered before becoming pregnant.
Please contact us today to go over your options, Phone us, or click on our Live Chat option and we will be happy to assist you.
Tags: health insurance, individual health, maternity
Posted in Family, Individual, Resources | No Comments »
Thursday, April 8th, 2010
Recent polls show an interesting correlation between age and health insurance coverage. Though many other factors, such as income, also play a major role in who obtains coverage, and who chooses to go without does depend greatly on the age group of that individual. According to a newly released
Gallup Poll:
• 84% of 18 year old children have coverage
• Once these individuals reach the age of 22, the percentage drops to 66%. Currently, as these older dependants reach this age, or graduate college, they no longer qualify to be covered under their parent’s coverage (note – with the implementation of health care reform, these numbers will be expected to drop as the eligible dependant age is extended to 26)
• This number rises only slightly through the remaining years, until Medicare age is reached. At this point, 95% of American’s are covered
These statistics are startling, as more and more young adults find it next to impossible to find a job with benefits, or feel that they are too healthy to need the burden of monthly premiums. These individuals risk financial ruin for themselves, and their families. Therefore, obtaining some sort of coverage, even if it is hospitalization only coverage, remains a vital priority.
These numbers also play an important role in the passing and implementation of the health care reform bill. Opponents state that even though coverage will be extended to all Americans, the cost will rise as much as 17% for younger individuals, while dropping slightly the cost for older Americans. Proponents find that the number of currently uninsured younger (healthier) clients is the reason that premium pricing is so skewed. By increasing the number of healthy individuals in the pool, the overall “risk” for everyone will be reduced.
Tags: health care reform, health insurance, health plan, individual health, medicare
Posted in Family, General, Individual, Seniors | No Comments »
Tuesday, March 16th, 2010
Though no one knows where the health care reform bills are headed, it is of utmost importance that disease prevention and health promotion are at the top of the list. If we aim to “fix” a broken system, we need to ensure that the system is designed to “fix” us as well. This will be achieved by balancing the cost of providing medical care with providing services to help avoid the need for such services in the first place. Some concepts for prevention strategies are (notes from San Francisco Chronicle):
- a yearly personalized prevention plan for Medicare patients
- national assistance to wellness programs at the worksite
- a vast public-private partnership to teach everybody about prevention and health promotion, including Web site tools for self-assessment and personalized prevention
- educating patients how to reduce their risks for chronic disease
- support for community-based prevention and health promotion (i.e. no-smoking rules, seat belt mandates, calorie counts on restaurant menus)
The concern lies in the fact that if these strategies are not implemented, positive and healthy life choices will not occur. By encouraging such lifestyle changes, and providing resources to help people start and maintain healthier living, the return is invaluable – healthy people, fewer chronic conditions, and an enormous reduction in the need for medical intervention.
Tags: Chronic Condition, health insurance, preventative care, wellness
Posted in Employees, Family, Government Run Health Plan, Individual, Resources, Tools | 1 Comment »
Tuesday, March 2nd, 2010
A recent poll shows that 57% of Americans do not like any of the proposed health care bills, and agree that Congress should start fresh, rather than attempting to piecemeal a model from scrapped ideas. Trying to reach a bipartisan agreement as to what needs to be done is not an easy task, but it is vital to ensure that resolution is achieved. These polls shows interesting trend among voters as to how they feel now, as compared to a year ago in regards to health care reform:
• 53% said they strongly or somewhat oppose the legislation in both House and Senate plans
• 33% stated they were more supportive of reforming the health care system now
• 24% said they were just as supportive as they were a year ago
• 38% of voters now think it is at least somewhat likely that the plan proposed by the president and congressional Democrats will become law this year
• 51% believe passage of the plan this year is unlikely
• 24% of voters now say health care reform is the budget priority the president is most likely to achieve
Regardless of where this leads us, we will be there to guide you through and answer any questions you have.
Thanks for your continued support!
Tags: health care reform, health insurance, health plan
Posted in Employees, Employers, Family, General, Group, Individual, Resources, Tools | 1 Comment »
Sunday, February 14th, 2010
Recently, the California Department of Managed Care has released some new guidelines for HMO patients, in order to create a more efficient and comprehensive level of care for these patients. Among the new rules:
• A physician appointment within 10 business days of a request
• A specialist appointment within 15 business days of a request
• An urgent care visit within 48 hours of a request
• Telephone access to a health care professional at all times.
The state is giving health plans one year to comply with these new regulations. After the one year grace period, non-compliant carriers will face heavy fines. With the implementation of these new rules, it is hoped to reduce emergency room traffic, as more patients are able to obtain urgent care visits instead, as well as the overall reduction of appointment wait times (which benefit all patients – HMO and PPO alike).
Opponents to these new regulations feel that this adds to an already strained system of primary care physicans, who are already in shortage. Fears also lie in the fact that the doctor would now be forced to spend less time with each patient. However, with the average waiting time to see a general practitioner at 20 days, it does seem that the pros outweigh the cons with these timely-access rules.
Tags: health insurance, HMO plan, network provider
Posted in Employees, Employers, Family, General, Individual, Laws, Resources, State | No Comments »
Thursday, December 24th, 2009
Important news for our Blue Shield of California clients who are currently on individual and family plans. If you miss a payment, and exceed your grace period, they will no longer reinstate you after January 1, 2010. In these cases you will have to reapply for coverage and be subject to medical review once again. You are not guaranteed approval, even though you were a recent member.
We will make every effort to give you updates if you show late on payments. Not only will we send you email reminders, Blue Shield will also send you late payment notices via mail. Make sure to send in your premium, or contact us to set up monthly automatic payments via credit card or checking account to avoid cancellation.
Tags: health insurance, premiums, underwriting
Posted in Family, Individual, Resources, Tools | 1 Comment »
Thursday, December 17th, 2009
Is there a database out there with all of your medical information available to prospective and current insurers? No. However, there does exist a shared central database called the Medical Information Bureau that may contain some important medical information about you. This data base is used primarily by insurance companies when applying for individual or life insurance. These companies can use information in the MIB’s database to help make a decision as to whether or not you will be offered coverage.
However, based on HIPAA laws, this database does not include your entire medical history, doctor’s chart notes, etc. Instead, information in MIB reflects medical conditions (such as diabetes and high blood pressure) or lifestyle choices (i.e. skydiving or smoking) that are thought to be significant. While the decision to decline coverage is not solely based on reports in the MIB, it definitely plays a strong role.
It is very important that you monitor information in the MIB as you would with anything else, such as your credit report. If you note any incorrect information, you can work to have it corrected, and not hinder your chances of obtaining health or life insurance in the future.
Tags: individual health, pre-existing, underwriting
Posted in Family, Individual, Privacy, Resources | 1 Comment »
