Posts Tagged ‘individual health’

Pre-existing Conditions and California Residents

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.

Insurers to Offer Overage Dependents Coverage Earlier Than Anticipated

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.

Maternity Coverage – Important Notice

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.

The Balance Between Age and Health Insurance Coverage

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.

Health Care Reform is here! What does this mean for you?

Monday, March 22nd, 2010

No one really knows! It seems that revisions are made by the hour, and nothing is quite set in stone as of yet. Also (as of this hour) 11 states have filed lawsuits stating that the bill is unconstitutional, in that it forces people to pay for coverage or face financial penalties. Does it promise to cover all Americans? Supposedly, by 2014, after spending the next few years inching towards this goal by means of guaranteed issue policies, no lifetime maximum amounts, the cessation of policy rescission’s, etc. Once this is in place, individual policies would be purchased via an exchange:

 Health Benefit Exchanges. Effective in 2014, state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges are established, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. States are permitted to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015)

 We will see some changes right away, such as offering coverage to all children regardless of pre-existing conditions, and the creation of high risk health pools. Others will take more time, such as the adult pre-existing conditions being a non-issue when it comes to obtaining medical coverage.

 Proponents of the bill claim this will save us trillions over the years, while opponents can’t see how that is possible. Guaranteeing and requiring that all obtain health insurance coverage cannot be without a hefty price tag, can it?

 Stay tuned………

Brown’s Victory & What it Means for Health Care Reform

Tuesday, February 2nd, 2010

Health Care reform faced yet another setback as Massachusetts State Senator Scott Brown received 51.9% of the vote needed to fill late Senator Kennedy’s seat in the US Senate. This now makes the Republican head count 41, thereby bringing the 60-count Democrats were relying on to pass the health care reform legislation to an end. Brown’s strong statements regarding the negative portions of the bill, such as higher taxes and the destruction of jobs, played a major role in his political success. However, ironic that he fills the seat of a major proponent of universal health care, many are breathing a sigh of relief as the thought is while health care reform is much needed, it is something that needs to be dealt with carefully – not a “fix it later” attitude.  

While Brown’s win does not mean this legislation is dead in the water, it will mean that it goes back to the drawing board, where hopefully a system that works for all will come to light.

The Medical Information Bureau and You

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.

Insurance Policy Rescissions versus AB 1945

Wednesday, June 3rd, 2009

AB 1945 (amendment to Section 10384 of the Insurance Code) recently passed in the State of California in light of all the recent publicity from insurance policy rescission’s. This Bill “prohibits a health care service plan or health insurer from engaging in post claims underwriting, defined to mean the rescinding, canceling, or limiting of a plan contract or policy due to the plan’s or insurer’s failure to complete medical underwriting and resolve all reasonable questions relative to an application for health care coverage before issuing the plan contract or policy“.

Insurance companies are still able to retro-review policies for omission of pertinent health information. However, in order to follow through and rescind a policy, the insurance carriers must first seek approval from the Department of Managed Health Care or the Commissioner of the California Department of Insurance. This bill is intended to protect the individual in question from a biased review of their case.

There are, of course, pros and cons to this bill. Those in favor state that this bill will provide protection to patients by means of regulators who will independently scrutinize policy rescission’s, and ultimately develop a standardized application that health plans and health insurers must use. Those against state, amongst other things, that uniform applications do not guarantee success and that the rescission rate is only at about 1/10th of all individual policies.

Help for Uninsured Californians!

Wednesday, May 20th, 2009

Many Californians don’t have medical coverage, and are unable to qualify for health coverage due to pre-existing conditions. However, it is important to know that there are options you may qualify for:

Medi-Cal
 
Medi-Cal is California’s version of the federal Medicaid program.  This program will pay for health services for California residents that qualify based on income and assets.  Eligibility is determined by the Department of Health Services through its sub-agency Department of Public Social Services.

Access for Infants and Mothers (AIM)


The program is designed primarily for uninsured low income pregnant women and their infants who do not qualify for Medi-Cal.  Since individual health plans will not approve you for coverage if you are currently pregnant, this provides an excellent opportunity for coverage.

Healthy Families Program

 
This program provides low-cost comprehensive health, dental and vision coverage for children and teens up to age 19 that do not have access to insurance and cannot qualify for Medi-Cal. If the mother qualifies for AIM, the baby is automatically eligible for enrollment in Healthy Families.  

Major Risk Medical Insurance Program (MRMIP)

This program provides comprehensive health insurance for Californians who are unable to obtain coverage within the individual health market.  You are able to enroll in the MRMIP program after you’ve been declined coverage by an insurance company or health plan due to a pre-existing condition. 


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