How is my Newborn Covered by My Health Insurance in Colorado?
Under Colorado law, your child will automatically be covered by your (father or mother) insurance plan for the first 31 days of life, without notification or payment of premium.
If you do notify your plan of the child’s birth within the first 31 days, he or she will automatically be added to the plan going forward. As no new underwriting is required, this law is to assure coverage in the case that the child is born with problems.
Of course, you will be charged extra premium in the same manner you would for any new dependent.
Want to know more about it? Please give me a call at 303-541-9533
- Published in Colorado State Initiatives, Individual Health Insurance, Misc
Can’t understand your health insurance? Feds say insurers must give consumers a simple summary
Don’t have the slightest clue what your health insurance covers?
As part of the Affordable Care Act the government intends to take care of that. According to a recent article by the Associated Press “the Obama administration says that’s going to change, starting this year. Officials announced that private health plans will have to provide consumers with a user-friendly summary of what’s covered, along with key cost details such as copays and deductibles.”
“Just six pages long. And no fine print.”
“Officials are calling the summaries a “nutrition label for health care,” trying to capitalize on the name recognition of those information panels found on packaged foods at the supermarket. Consumer groups say the health care version isn’t perfect, but it’s a start.”
“These documents will allow consumers to compare plans on an apples-to-apples basis,” said Medicare chief Marilyn Tavenner, who is also overseeing implementation of President Barack Obama’s health care law. If an insurance plan offers substandard coverage in some respect, they won’t be able to hide it in dozens of pages of text, she added.”
Call me cynical, but judging by past “clarification” efforts by the government on wording to our tax code, federal laws and something called “Plan Descriptions” for present health insurance policies, I am doubtful of anything useful coming out of this venture.
How Long Will It Take For My Health Insurance Application To Be Approved?
I am often asked how long it takes to get an application for health insurance approved. The answer is always the same, “it depends on how long the insurance company takes to review or “underwrite” the information you submit. Underwriting is a term insurance companies use that basically means “background check.” Individual health insurance companies have the ability to pick and choose to whom they will offer coverage. So, they require that you fill out an application form, answering a comprehensive list of personal medical and life style questions.
Once they receive this information from you, the underwriting begins. In addition to reviewing the information you have provided, they may plug your Social Security number into something called the Medical Information Bureau (MIB). The MIB is a sort of clearing house that collects patient information from doctors, hospitals, pharmaceutical companies and other insurance companies.
The underwriters may also call the applicant for clarification of details and, if need be, request records from your doctor before they are ready to make a decision on the application. The more information they need, the longer it takes for them to make an offer.
So, the answer to the question of how long it will take to get your application approved is, “usually a week to 10 days if doctors’ records are not required. If doctors’ records are required, it will take as long as it takes for the doctors’ office to respond to this request.”
That is why it is important to work with a knowledgeable insurance broker to fill out an application properly to avoid misunderstandings and delays from the onset.
If you’d like to find out what a professional individual health insurance broker can do for you, please give me a call at 303-541-9533.
- Published in Applications, Individual Health Insurance, Underwriting
Age Related Wellness Benefits
Your non-grandfathered health insurance is required to cover wellness benefits at 100%. However, many of these benefits are “age related.” Please find below some of the more commonly used wellness services and the ages, if appropriate, when they begin being covered.
Well-woman visits 18-64
Pap testing 18
HPV Immunization 11-26
HPV DNA testing 30
Osteoporosis Screening 65 (60 if at high risk)
Prenatal visits and testing
STD’s Contraception counseling
Prostate exam 50
Preventative colonoscopy 50 (every 10 years)
Well child visits 0-13 Immunizations 0-18
If you’d like to know more, please give me a call at 303-541-9533
- Published in Individual Health Insurance, Wellness
Are Health Insurance Companies Leeches and Parasites?
I don’t believe so, but that is what I read in a recent comment section of an on-line article about health insurance.
Health insurance premiums have been going up at a much faster rate than inflation in general and many people attribute that to exorbitant heath insurance profits. But the truth of the matter is that 87% of every premium dollar goes to covering medical care and services.
What is driving up the cost of health care?
According to the Center for Medicare and Medicaid Services, Kaiser Family Foundation, BusinessWeek, Pricewaterhousecoopers and many other sources:
+ More expensive technology, used more often.
Are all those tests that add to your doctor’s income really necessary?
+ Doctors in the U.S. earn two to three times as much as other industrialized countries.
+ Medical price inflation
Expensive new tests, Rx and procedures drive 51% of the growth in health care spending.
+ Cost shifting
Underpayments of Medicare and Medicaid are picked up by private insurance companies.
+ High cost of complying with government regulations.
Private health insurance companies spend $339.2 billion in order to comply with government health regulations.
+ Poor patient lifestyles
+ Healthcare fraud and abuse
Conservatively estimated at 3% of total annual healthcare spending.
Someone is getting rich on your premium, but with health insurance companies averaging 3 cents profit for dollar they received, they may not be the villains may people think they are.
Next time you drive by one of those new marble palaces that passes for a hospital today, ask yourself “who’s paying for this?”
- Published in Individual Health Insurance, Misc
How do “Pre-Existing Conditions” Affect My Application for Individual Health Insurance?
When one applies for individual health insurance, the plans are “underwritten” to determine if the applicant qualifies for coverage. If “pre-existing” medical or lifestyle conditions exist, the applications might be “rated-up,” have a condition “excluded” or “denied.”
Issued Standard is the best outcome of an application. It means the policy has been issued, at the price you were quoted, with no modification to the coverage.
An Exclusion is when the health insurance company offers a client a policy but excludes something from coverage. Some common reasons for exclusions are on-going medical issues, such as a knee that needs surgery or a severe case of Asthma. Other reasons for an exclusion might be for the removal of any type of internal fixation (breast implants, screws or plates), certain types of activities like rock climbing and much more.
Rate-up is when a client is charged more than “standard” by the insurance company. Some typical reasons for this are high blood pressure, high cholesterol, body build, tobacco use, poor driving record, etc.
If the pre-existing condition is such that the insurance company feels they cannot issue a policy, the client is Denied.
This whole area of pre-existing conditions is where I spend a lot of my time in finding the right match for my clients. Different companies have different underwriting guidelines. I have actually gotten preferred ratings for many clients who have received a denial from another.
If you have concerns about pre-existing conditions, give me a call at 303-541-9533. I cannot find individual health insurance for every situation, but I promise that you will be better informed for having contacted me.
- Published in Individual Health Insurance, Underwriting
Why does Group Insurance Cost More in Colorado than Individual Insurance?
It doesn’t make sense, does it? Logic tells us that buying
in bulk is more cost-effective. So when you take the purchasing power of a
group of people, you would expect to negotiate a better premium price per
person for health insurance than that of an individual trying to purchase
coverage. But health insurance doesn’t work that way.
Group insurance is required to cover a wide range of
pre-existing conditions. The insurer of a group understands that,
statistically, a number of members will already suffer from ailments such as
heart disease, diabetes, and cancer, so they charge a premium that will cover
the treatment of these potential illnesses.
However, health insurance companies that cover individuals
can pick (and reject) whom they choose to cover.* Because individual health
insurance companies offer their plans to only the relatively healthy, premiums
can be substantially lower than group premiums.
It always comes down to the bottom line: health insurance
companies are just that—companies. Prices are set to not just cover costs, but
to ensure profits at the end of the year. But the silver lining is that every
health insurance company in the state of Colorado
is regulated by the Colorado Dept. of Regulatory Agencies, Dept. of Insurance.
For more information, you can visit their website or give me a call at 303-541-9533.
I’ll cut through all the jargon and get your questions answered quickly.
*With some exceptions: for example, during certain times of
the year, a child under the age of 19 cannot be denied coverage.
- Published in Individual Health Insurance, Premiums
Why Did My Colorado Health Insurance Go Up So Much This Year?
Unfortunately, premiums for individuals go up every year due to the fact you are a year older and thus more expensive to cover. Additionally, it increases for something called “medical inflation.” This is higher than the general inflation trends because medical inflation covers all the expensive new procedures and prescriptions that come on line each year. Your policy will cover most of these, but there is a cost associated with it.
In 2011 however, we are seeing some additional charges that have had to be added to your policy due to the passage last year of the federal Patient Protection and Affordable Care Act. Major changes are:
- No child under 19 may be denied for health coverage due to a pre-existing condition.
- There are no longer any annual or life-time limits on individual health insurance services.
- Children may remain on their parent’s plan until they are 26.
- There is no longer any “co-payments” associated with required wellness visits; they are covered at 100%.
- There are a whole list of additional tests and immunizations required to be covered at 100%, many of them age related.
The Department of Health and Humana Services will not allow health insurance companies to tell you that these new additions are increasing your premium, but simple logic will tell you this must be the case.
The big kicker here in Colorado is that all new policies now have to cover maternity. Since normal births cost $15,000 to $18,000, this has to have an additional big upward impact on premiums.
Insurance companies have had to figure how much these new requirements will affect their outlay for services. I believe some companies have overestimated how much these costs will be and have increased their premiums too much.
If you’d like to find out if your company’s latest increase is in line with the market, give me a call at 303-541-9533.
- Published in Individual Health Insurance, Premiums