This is a serious matter that has to be put to a stop. I receive calls more and more from clients looking for help. An agent sold them a policy that looked good from the outside, meaning premium was affordable, deductible was affordable, and covered doctors visits. On the inside the policy may not cover what was expected.
This a very common call I get. However when we look deeper into the policy I ask a few question's...
1. What is your actual liability ? The answer is normally, I'm not sure Brian.
As a buyer you need to be aware of this. If we purchase a policy and don't know the answer to this question, both parties in the transaction have failed. This the most important question to ask when purchasing a new insurance policy. How do we figure out an actual liability for health insurance? We need to add the deductible, the co-insurance, co-pay, and benefits caps.
Benefit caps ? Yes, there is such a thing as benefit caps and its more common then most people think. For instance, there is such a thing a maximum surgery benefit. I have seen them as low $3000. This means if you need to have a surgery, the total amount that will be paid by the insurance company is $3000. Do we know of a surgery that cost $3000. ? I can think of two off the top of my head. What this means as buyer, what ever amount over $3k is, you are liable for.
2. Is this a family policy ?
Buyers need to ask about the deductible maximum for a family. Most insurance policies will have a maximum deductible per insured family. Meaning four people are covered under the policy, but maybe the deductible will have to be hit at least twice for two separate insured. The deductible for the family now doubles due two that clause.
3. Is there a cap on your co-pay ? Usually I hear, I don't know.
This is another major mistake by both parties. If we have a 80/20 co-insurance and no cap, we are liable for 20% of all expenses unless stated.
example. Steve has a policy with a 1million lifetime maximum.
Steve in cures 1million in medical expenses and the bill must be paid. Due to the 80/20 co-insurance Steve will now have to pay a deductible, and 20% of the remaining $1million owed. Make sure there is a cap and more importantly the buyer can afford it.
Moral of the blog...
As a buyer ask questions! As an agent, answer the questions before they become an issue!
Thursday, May 20, 2010
Tuesday, May 18, 2010
A Dozen Disturbing Health Care Statistics
A Dozen Disturbing Health Care Statistics
Posted by Brad Tuttle Wednesday, September 30, 2009 at 9:03 am
21 Comments • Trackback (14) • Related Topics: budget, debt, families & children, health care, jobs & employers , COBRA, Medicare, public option, Remote Area Medical
Most people know the big number: 45 million. That's the generally accepted tally of Americans currently without health insurance. With the prospect of a public option all but gone, it appears that any change that does occur will pretty much bring more of the status quo—meaning more numbers like these.
10 Percentage increase that most workers will pay for health insurance premiums and out-of-pocket expenses in 2010. This means that since 2001, the share that workers pay for health care will have tripled.
More than 12 Number of states where lawmakers are currently trying to pass legislation outlawing any requirement that everyone must have health insurance or be subjected to fines.
38 Percentage of unemployed Americans who are eligible and who signed up for health insurance through COBRA after Congress began subsidizing 65 percent of COBRA premiums in 2009. Before the subsidy, only 19 percent of those eligible signed up.
131 Percent that health insurance premiums have increased in the last ten years.
$6,000 Amount that one journalist who used to cover the insurance business estimates he'll save this year by not buying health insurance.
$15,000 Amount that Medicare spent in 2006 per enrollee in McAllen, Texas, which is inexplicably nearly twice the national average.
$30,083 The estimated average that health insurance is expected to cost one family annually as soon as 2019, an increase of 166 percent from current averages.
$2,821,383 Dollar amount of health care provided free of charge recently at the Forum in Los Angeles by Remote Area Medical, a nonprofit operation that's based in Tennessee and staffed by volunteers. During the eight-day visit to L.A. over the summer, health care workers extracted 2,274 teeth, saved 5,438 teeth, made and gave out 1,984 pairs of eyeglasses for free, and took care of 8,775 general medical visits.
$4,000,000 Amount that a typical 22-year-old worker can assume he and his employer will spend for health care and insurance over his lifetime.
9,000,000 Estimated number of self-employed workers who essentially pay a tax on insurance premiums because they are not eligible for the kinds of deductions that workers employed by big corporations get on their health insurance policies.
13,000,000 Approximate number of Americans ages 19 to 29, or roughly one-third of all in this age bracket, who do not have health insurance. This group has the highest uninsured rate, by far.
$1.1 Trillion The high end of the estimated amount (one-third to one-half of $2.2 trillion) that is spent annually in the U.S. on unnecessary medical tests, treatments, and doctors' visits.
Read more: http://money.blogs.time.com/2009/09/30/a-dozen-disturbing-health-care-statistics/#ixzz0oJz8k4ji
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Posted by Brad Tuttle Wednesday, September 30, 2009 at 9:03 am
21 Comments • Trackback (14) • Related Topics: budget, debt, families & children, health care, jobs & employers , COBRA, Medicare, public option, Remote Area Medical
Most people know the big number: 45 million. That's the generally accepted tally of Americans currently without health insurance. With the prospect of a public option all but gone, it appears that any change that does occur will pretty much bring more of the status quo—meaning more numbers like these.
10 Percentage increase that most workers will pay for health insurance premiums and out-of-pocket expenses in 2010. This means that since 2001, the share that workers pay for health care will have tripled.
More than 12 Number of states where lawmakers are currently trying to pass legislation outlawing any requirement that everyone must have health insurance or be subjected to fines.
38 Percentage of unemployed Americans who are eligible and who signed up for health insurance through COBRA after Congress began subsidizing 65 percent of COBRA premiums in 2009. Before the subsidy, only 19 percent of those eligible signed up.
131 Percent that health insurance premiums have increased in the last ten years.
$6,000 Amount that one journalist who used to cover the insurance business estimates he'll save this year by not buying health insurance.
$15,000 Amount that Medicare spent in 2006 per enrollee in McAllen, Texas, which is inexplicably nearly twice the national average.
$30,083 The estimated average that health insurance is expected to cost one family annually as soon as 2019, an increase of 166 percent from current averages.
$2,821,383 Dollar amount of health care provided free of charge recently at the Forum in Los Angeles by Remote Area Medical, a nonprofit operation that's based in Tennessee and staffed by volunteers. During the eight-day visit to L.A. over the summer, health care workers extracted 2,274 teeth, saved 5,438 teeth, made and gave out 1,984 pairs of eyeglasses for free, and took care of 8,775 general medical visits.
$4,000,000 Amount that a typical 22-year-old worker can assume he and his employer will spend for health care and insurance over his lifetime.
9,000,000 Estimated number of self-employed workers who essentially pay a tax on insurance premiums because they are not eligible for the kinds of deductions that workers employed by big corporations get on their health insurance policies.
13,000,000 Approximate number of Americans ages 19 to 29, or roughly one-third of all in this age bracket, who do not have health insurance. This group has the highest uninsured rate, by far.
$1.1 Trillion The high end of the estimated amount (one-third to one-half of $2.2 trillion) that is spent annually in the U.S. on unnecessary medical tests, treatments, and doctors' visits.
Read more: http://money.blogs.time.com/2009/09/30/a-dozen-disturbing-health-care-statistics/#ixzz0oJz8k4ji
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Great news for Kids!!!
As of May 17, 2010, we implemented a new underwriting guideline for applicants who are under age 19 and covered on their parents' plan. We will no longer exclude coverage with medical riders so that these applicants will be able to take full advantage of all their policy benefits. Premiums will be adjusted instead of excluding coverage due to pre-existing conditions. This change is applicable for new business in 29 states, and the District of Columbia. See below for further state details.1
It is our hope that this change in our underwriting practice will help you place more business with us. Your clients seeking family health insurance coverage may benefit from this new underwriting guideline. Remember, we offer the preliminary evaluation form on E-Store for your convenience when you want to know of a family's potential underwriting outcome.
As we continue to prepare for the future, we remain committed to working with our brokers and customers, providing high quality health plans at competitive rates with outstanding service.
Thank you,
Golden Rule Insurance Company
1 States where the new underwriting guideline will be applied: AK, AL, AR, AZ, CO, CT, DE, FL, IA, IL, IN, LA, MD, MI, MO, MS, NC, NE, OH, OK, PA, SC, SD, TN, TX, VA, WI, WV, WY and the District of Columbia (D.C.).
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It is our hope that this change in our underwriting practice will help you place more business with us. Your clients seeking family health insurance coverage may benefit from this new underwriting guideline. Remember, we offer the preliminary evaluation form on E-Store for your convenience when you want to know of a family's potential underwriting outcome.
As we continue to prepare for the future, we remain committed to working with our brokers and customers, providing high quality health plans at competitive rates with outstanding service.
Thank you,
Golden Rule Insurance Company
1 States where the new underwriting guideline will be applied: AK, AL, AR, AZ, CO, CT, DE, FL, IA, IL, IN, LA, MD, MI, MO, MS, NC, NE, OH, OK, PA, SC, SD, TN, TX, VA, WI, WV, WY and the District of Columbia (D.C.).
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Monday, May 17, 2010
10 Reasons why to buy health insurance
People buy health insurance for different reasons. The following are ten of these reasons. Please look them over and consider which reasons apply to you and which do not. This will help you to evaluate what type of health insurance will best meet your personal needs.
1.Health insurance can protect you from the risk of uncertain bills for health care.
2.Without health insurance, you may not be able to afford expensive services.
3.Health insurance can pay for services that you use often.
4.Health insurance can help you to get better quality care as a member of a coordinated health plan than you would get on your own.
5.With health insurance, you do not have to worry about the cost of care when you are sick.
6.The additional money provided by health insurance when you are sick may be more valuable to you than money when you are well.
7.If you have more dependents than most people, then you may get more out of a family policy for health insurance.
8.If you or your dependents have more health care needs than most people and you only pay an average premium, then you get more from health insurance than most people.
9.You do not pay income tax on health insurance benefits so it is more valuable per dollar than the same amount in taxable pay.
10.Health insurance companies generally pay lower prices to doctors and hospitals than you would pay on your own.
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1.Health insurance can protect you from the risk of uncertain bills for health care.
2.Without health insurance, you may not be able to afford expensive services.
3.Health insurance can pay for services that you use often.
4.Health insurance can help you to get better quality care as a member of a coordinated health plan than you would get on your own.
5.With health insurance, you do not have to worry about the cost of care when you are sick.
6.The additional money provided by health insurance when you are sick may be more valuable to you than money when you are well.
7.If you have more dependents than most people, then you may get more out of a family policy for health insurance.
8.If you or your dependents have more health care needs than most people and you only pay an average premium, then you get more from health insurance than most people.
9.You do not pay income tax on health insurance benefits so it is more valuable per dollar than the same amount in taxable pay.
10.Health insurance companies generally pay lower prices to doctors and hospitals than you would pay on your own.
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