One of the most impactful regulations of the Affordable Care Act (Obamacare) that has already gone into effect is the requirement that no child under 19 may be turned down for health coverage. For the family with a child with a significant ”pre-existing condition” this is a godsend. For the insurance companies it is a headache.
The reason that this is difficult for the insurance companies, is that although they can “rate-up” the child’s portion of the premium up to 200%, some of these kids have conditions that may cost $100,000′s to treat
Another concern is that parents, knowing the insurance companies must cover their child, will not be willing to purchase and pay for coverage until the child is “literally in the ambulance on the way to the hospital.”
While a parent and child may apply anytime for insurance, to ameliorate this situation somewhat, the feds have allowed the insurance companies to only offer child-only policies during ”open enrollment” periods, except in the case of a “qualifying event.” In Colorado those open enrollment periods are January 1-31 and July 1-31 with coverage starting 30 days after the enrollment period.
Outside these periods, the only other times insurance companies are required to offer child-only coverage is in the case of a qualifying event. A qualifying event is defined in the new Colorado law as within 30 days of birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of eligibility for Medicaid or Child Health Plan Plus (CHP+), entry of a valid court or administrative order mandating the child have coverage, or involuntary loss of existing coverage other than because of fraud, misrepresentation or failure to pay premium.
A carrier may deny coverage if the child has access to other creditable coverage such as a parent’s plan through an employer.
Most health insurance carriers will offer only one of their plans to child-only applicants. These plans are usually bare-boned and are difficult to apply for, i.e. paper applications, no agent involvement, etc. The only company we work with in Colorado that offers their full array of plans, and no additional barriers in applying, is Rocky Mountain Health Plans.
Of course, we expect this will all change on January 1, 2014 with the full implementation of the Affordable Care Act and the exchanges that go with it.
If you’d like to know more about child-only policies, please call me at 303-541-9533.
Clients are often concerned that they will get “locked into” a long-term commitment when they purchase individual health insurance. The truth is that you may cancel your plan whenever you choose, and most companies will reimburse you for any time you have paid for, but not used.
However, your insurance company is required to continue to offer you coverage as long as you continue to pay the premium and have told the truth, to “the best of your knowledge and belief” on the application. Once your health insurance policy is in place, you cannot be singled out for premium increase or termination no matter how many claims you make. You must be treated like everyone else in you age group and Zip Code.
If you would care to know more about this, please give me a call at 303-541-9533.
Colorado Continuation/Conversion is a state law that assures an employee who leaves a company with less than 20 full time employees and has been covered by the firm’s health insurance plan for 6 continuous months, a continuation of their health insurance coverage for up to 18 months, except in cases of “gross misconduct.” For an employee leaving a Colorado based company with more than 20 employees, the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies.
The ex-employee will be responsible for the full premium (the combination of that which the employer and the employee were previously paying) plus a small administrative cost.
Within 10 days of termination, the employer must sent written notice to the employee of the right to continue. The employee then has an “Election Period” of 30 days from termination to notify the employer of acceptance.
If after this period the employee decides they do not want to accept Continuation coverage, they owe nothing. However, if they do decide they want to accept the coverage, they will owe premium back to their last day of employment.
One concern with smaller companies is that if the firm goes out of business and/or cancels their health insurance plan, this whole option disappears for the ex-employee.
Colorado Continuation/Conversion is a form of “group health insurance” and generally cannot exclude coverage for pre-existing conditions. However, because of this, the premiums are much higher than a relatively healthy person or family could obtain with an individual policy.
If you would like to know more about your options, please give me a call at 303-541-9533.
If your in-box is anything like mine, you are receiving an endless stream of offers for on-line health insurance quotes. If you are perfectly healthy and know enough about health insurance to be able to select a plan that is well suited for your situation, then this system will work well for you.
However, if you are dealing with some, even minor, pre-existing conditions, or you have not been keeping up on all the changes in the health insurance industry, it might behoove you to speak to an experienced health insurance broker like, modestly, me.
Pre-existing conditions? I promise you that different health insurance companies look very differently at certain pre-existing conditions like; depression, asthma, recent operations, gout, build (height vs. weight), DUI’s and many others. An experienced broker can steer you towards the company who will give your application the best chance of being accepted.
The “right” plan? Low priced health insurance plans often have hidden “gotchas.” These might include excessive co-insurance charges, limited or no doctors’ office visits, no “branded” prescription coverage, additional “access fees” for hospital/ER visits, no mental health coverage, etc. Unless you know what you are doing or have someone to point these “holes in coverage” out to you, you may end up buying a policy that excludes the very things you most want covered.
And, best of all, it costs you nothing to work with a broker; the insurance companies pay our commissions. The cost to you is the same either way.
So, give me a call at 303-541-9533, if you want to make sure you are getting the health insurance coverage you are paying for.
If the health risks associated with the use of tobacco are not enough to get a person to consider stopping, perhaps the monetary penalties will tip the scale. Not only does a tobacco consumer (cigarettes, cigars, pipe, chew, dip, etc.) have to pay for the cost of the product and all the punitive taxes attached to it, but their premiums are significantly “rated-up” when they apply for health insurance.
Because the actuaries that work for health insurance companies well understand that tobacco users are much more likely to require expensive medical treatments than non-users, smokers/chewers are charged more for coverage. Typically a 25 year old tobacco user pays 20% more and at 50 it can be 30% or higher.
In order to qualify as a non-tobacco user you must have gone the previous 12 months without its use. You will also want to be truthful about tobacco use on a health insurance application, because if you are not, your policy may be cancelled just when you need it.
If you are presently insured with a plan that rates you as tobacco user, you can request that this be changed once you have abstained from its use for a minimum of 12 months. You will probably be asked to submit a blood test to prove you have no nicotine in your system.
So, the choice is quit or pay up.
If you’d like to know more about this, please give me a call at 303-541-9533.
I meet in person with the vast majority of my clients, most often in my home-office, but occasionally in their homes as well.
Most health insurance agents never see their clients in person, but rather deal with them over the internet or on the telephone. This has never worked for me for a number of reasons.
* There are some complex concepts involved with health insurance and I have found it difficult making them understood when I am not physically with a person.
* I find most clients prefer having an in-person relationship with their agent; it is a matter of building trust.
* The part about my job that I enjoy most is meeting with clients. One certainly gets to know someone quickly when you are talking about their health insurance.
* Since I am a poor typist, and anything to do with health insurance involves filling out forms, I am able to enter the information by hand on forms when the client is sitting right their next to me.
I am fortunate that my home-office is located in an easy-to-get-to location in downtown Boulder.
Additionally, working with clients out of my home gives me an additional incentive to do a good job for them, THEY ALL KNOW WHERE I LIVE.
Accidents happen. And, too often, they are the reason you are using your health insurance.
With clients choosing ever-higher deductibles and co-insurance for their health insurance plans, this means they are paying the medical costs for these accidents out of their own pockets.
But, there is a clever way of avoiding this and possibly saving some premium monies as well.
I often recommend that my clients go with as high a deductible on their health insurance that “they can sleep well at night with.” This keeps the premium as low as possible and, as a deductible is statistically rarely reached, “it is better to keep the money in your pocket each month, than to automatically send it to an insurance company.”
However, to play it safe, I recommend that they buy a separate Accident Only Policy to cover the deductible and co-insurance so that, if the reason they are using the health insurance is for an accident, all the bills they get stuck with, they will send to the accident company for reimbursement and they end paying virtually nothing.
Here is a link to an accident plan offered by WBA (Wholesale Benefits Association) that I often use.
Or, if you’d like to talk to a human about this type of protection, give me a call at 303-541-9533.
Most clients originally call me to help them sort through their options for health insurance and come up with some recommendation for the best combination of price and value for them.
However, once this is done, I believe the greatest service I can provide is to help a client fill out an application. It can save you a lot of brain damage. Each year these forms carry more and more obscure legal clauses and terminology, supposedly included to protect the consumer, but mostly it just confuses everyone.
The parts of an application that many people stumble on are the federally mandated form:
THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA)
and the State of Colorado required:
DETERMINATION OF SELF-EMPLOYED BUSINESS GROUP OF ONE.
In ten years of doing this, with thousands of applications filled out, not once did these parts of an application help a single person obtain health insurance, but the confusing nature of the questions surely have stopped many of them from finishing the paperwork.
These requirements are prime examples of your government creating road blocks to something that could be easily achieved, all in name of “protecting you from yourself.”
If you need new health insurance and want to avoid the agony or filling out the forms yourself, give me a call at 303-541-9533. It costs no more to work with a broker and, as I said, it saves a lot of brain damage.
Most insurance companies consider health insurance “credible” if it is a group or medically underwritten individual medical insurance policy.
Why is this important?
*If you are moving from one group (usually employer sponsored insurance) to another, and have had previous “credible coverage” that was not interrupted for a period of 63 or more days, most pre-exiting conditions must be cover by the new plan.
*Although individual health insurance companies are not required to cover pre-existing conditions, even with prior credible coverage, they often offer better premium prices and eliminate “wait times” for those with this type of prior coverage.
I believe the reason for this is individual health insurance companies would prefer to offer plans to people who have had continuous coverage because the client will have a greater likelihood of having taken care of medical problems along the way, instead of waiting until they obtain a new policy to get issues attended to.
Many individual health insurance companies do not consider travelers insurance, student insurance and short term insurance credible.
And, you do not want to fib on a new application for health insurance about prior coverage, because if this is found out future claims may be denied.
If you would like to know more about how this might affect you, please give me a call at 303-541-9533.
Well, to start off, you are a year older each birthday and thus statistically more expensive to cover. Now, the increase for a 25 year old that turns 26 is relatively small. But, for a 55 year old, with growing health care needs that turns 56, the increase can be significantly higher.
So, the older you are, the greater your increase will be each year.
Additionally, there is something called “medical inflation” that is different from your run-of-the mill cost of living increases. Medical inflation takes into account all the expensive new tests, prescriptions, procedures, etc. that come along each year. Your present plan will cover these, but there is a cost involved.
Then of course there are the new federal and state mandates larded on as requirements to health insurance plans. In the past few years the Affordable Care Act has added no co-pays for wellness visits, a provision that no child under 19 can be denied coverage for a pre-existing condition and eliminated any annual and life-time dollar limits to coverage as just a few of the new, expensive add-ons. In Colorado, the recent requirement that all new policies must cover maternity has also significantly increased costs.
These are the basics, but if you need a more detailed explanation go here.
Or you can just call me at 303-541-9533 and we can talk about some ways to trim your premium costs.