Pre-existing | Health Insurance

Posts Tagged ‘pre-existing’

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.

Tags: health insurance, individual health, pre-existing, premiums, underwriting
Posted in Individual | No Comments »

Lack of Pediatric Specialists a Growing Concern

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 »

The First Year for Health Care Reform – Step One

Thursday, March 25th, 2010

Though some fine tuning will be taking place, the plan for implementing the Health Care Reform Bill during the first year will (most likely) look something like this:

Dependent children will be eligible to stay covered under their parent’s plan until their 26^th birthday. The House is still pushing to make this coverage last through their 26^th birthday.
Insurers can no longer impose exclusions on pre-existing conditions in children. Children are considered exempt from this until their 19^th birthday
Lifetime maximums on benefits and annual limits on coverage will be discontinued
A “high risk pool” will be created for people who cannot otherwise obtain individual coverage due to pre-existing conditions
Seniors will receive a $250 rebate for help them cover the costs of their medication while in the “doughnut hole” (between $2700.00 and $6154.00)
The implementation of covered preventative care services requiring no co pays

Though the final outcome is still yet to be known, these are some of the highlights of the plan of action for health care reform in 2010. Though changes will be made, and battles will be fought, we can expect some of these changes to take shape in less than 6 months from now. From then on? No one knows for sure. We do know, however, that every American will be watching and waiting to see what happens next.

Tags: doughnut hole, health care reform, health insurance, pre-existing, preventative care, Universal Health Care
Posted in Federal, General, Government Run Health Plan, Laws | No Comments »

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………

Tags: health insurance, individual health, pre-existing, underwriting, Universal Health Care
Posted in Federal, Government Run Health Plan, Laws, Resources, Tools | No Comments »

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.

Tags: individual health, pre-existing, underwriting
Posted in Family, Individual, Privacy, Resources | 1 Comment »

SB 810 (LENO) The California Universal Healthcare Act

Wednesday, July 1st, 2009

Senate Bill 810, the Universal Health Care Act, proposes methods to provide affordable and attainable healthcare to all Californians. In a time where there are more uninsured individuals than ever before, and more stringent medical underwriting requirements (leaving those with pre-existing conditions ineligible for coverage), this bill could bring some much needed relief to our strained economy.

Under SB 810, eligibility would be based on residency. All residents would be covered, regardless of health status, employment status, or income level. Would this mean an increase in taxes? Well, theory states that over $200 billion dollars were spent in California on healthcare last year. By utilizing this enormous cash flow already being spent on healthcare by Federal, State, and County funds, such a plan is possible. By changing the way the funds are directed, such as purchasing prescription medication and durable medical equipment in bulk, California can save billions in the first year alone.

Ensuring fair reimbursements to providers, allowing consumers to choose their own doctors, and relying on a shared source of financial support, may be the answer to one of the biggest issues facing our State and Nation as whole.

Tags: health insurance, pre-existing, Universal Health Care
Posted in General, Laws, Resources, State | No Comments »

Gender Based Rating and Health Care Reform

Tuesday, June 16th, 2009

These days, everyone seems to be ready for change. The idea of national health care, coverage for all people (regardless of pre-existing conditions), and the end of gender based rating, is top priority.

One of the biggest issues these days is the fact that men and women are charged different amount for the same plans, at the same age, regardless of health history. Insurance companies defend this disparity by the fact that women tend to utilize health services more frequently than men, especially during their child bearing years. Therefore, instead of being rewarded for taking on a proactive role with their health care, they are penalized by 25% to 50% higher rates than their male counterparts.

With greater government regulation, it is thought that gender differentiation will be a thing of the past. As an effort to keep health insurance out of the hands of the government, and become more user friendly, insurance carriers will need to find ways to be easier on those seeking their own plans, or the millions of currently uninsured individuals nationwide.

Tags: heath insurance, pre-existing, premiums
Posted in Individual | No Comments »

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.

Tags: individual health, pre-existing
Posted in Federal, General, Laws, State | No Comments »