Posts Tagged ‘underwriting’

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.

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………

Blue Shield of California Cancellations for Non-Payment of Premiums

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.

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.


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