Not qualified to be governor of California

This article discusses one of the dirty little secrets of health plans. They have future liabilities.

“[California] already owes another $48.2 billion in unpaid costs for retiree health and dental benefits.”

In the public sector, prime example California, these future liabilities tend not to be funded.

Suggestion from InsureBlog: if in this world of increasing pandemonium, you yearn for a brief respite of total silence - ask your town manager or mayor how much is the unfunded liability in your town employees' health plan.

Years ago, FASB decreed that all private companies disclose this unfunded health plan future liability and, in fact, reflect it as a cost on their financial statements. Not so for public entities like cities, counties, and states.

Or Medicare.

You don't think California is the only government entity with unfunded future liabilities, do you?

The unfunded future liability in Medicare is something like $60 trillion – give or take a trillion.

Just who do you think is going to pay these bills? Bernie Madoff? The tooth fairy? Your children and their children and their children?

Oh, and I can’t resist noting this additional gem:

“$11 billion in new borrowing”

See, that’s how states get out of debt these days. Ain’t it swell?

‘sfunny. It never occurred to me to borrow money to avoid indebtedness. Oh well.

All these things explain why I’m not qualified to be governor of California.

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Another twist in the new COBRA rules

[Welcome Industry Radar readers!]

Here's another interesting twist in the new COBRA rules...the 65% subsidy starts phasing out if an individual's income is above $125,000 ($250,000 for couples) and is completely gone at the $145K ($290K) income point.

Admittedly this won't affect too many people, but let's think about how this works in practice. You get laid off. You take COBRA and pay the 35% that the plan administrator bills you. Your government pays the other 65% via the payroll tax subsidy to your ex-employer. You think that this is a great deal and add Obama to your holiday gift list.

Then you get another highly paid position and end up, at year end, with taxable income above the threshold. Guess how the subsidy gets paid back to the government...

You got it. On your tax return. Not only will you face a surprise tax bill, can you say "Underpayment penalties ??"

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COBRA/Spendulus Update, Part 2

[ed: For background, click here and/or here]

FoIB and regular commenter Chad made this observation:

"As far as I can tell the subsidy applies to all group health plans subject to COBRA including dental, vision, HRAs, and [wait for it] health FSAs. Who wouldn't elect COBRA for their HFSA if the taxpayer is going to pick up 65% of the cost of the annual election. What a sweet deal!"

There was some discussion as to whether or not this was accurate, so I checked in with my Guru of All Things FSA/HSA/HRA, Pete Deist. He responded this morning that:

"It is but they still have to pay 35% AND have qualifying expenses to use up the money. I doubt many people will ... figure this one out."

So there you have it. For now.

And from co-blogger Bob Vineyard, this site has a plethora of up-to-date and helpful information on this complex and volatile issue.

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Bad News, Good News

■ Item the 1st, Bad News Dept: On the one hand, it's remotely possible that, over the years, I may have had occasion to, um, disappoint my wife and/or daughters. Thankfully, however, it's never gotten quite this far [ed: that you know of]:

"(A)uthorities told [Kenneth Hughes] his wife of 34 years, Shirley Hughes, and his oldest daughter, Tammy Lewis, had plotted a murder-for-hire scheme to collect on his $200,000 life insurance policy."

Ouch!

But wait, there's a twist:

"(H)e was shocked at the allegations made against his wife but not his daughter." [emphasis added]

Memo to self: No more chores for Junior.

Of course, even had the plan succeeded, it's likely that neither wife/mom nor daughter would have collected a cent on the policy: since it's illegal for someone to profit from their crimes, the benefits would have been paid to either a contingent beneficiary or Mr Hughes' estate.

■ Item the 2nd, Bad News Dept: I've never been a big fan of dental insurance (at best, it's swapping dollars with the insurer), but this seems like a good reason to stay in-network:

"The attorney for a Woodland dentist told jurors that his client massaged women's chests as part of a medical treatment."

The, um, unorthodox "procedure" was ostensibly to treat his patients' temporomandibular disorder; TMJ generally affects the jaw and some facial muscles, so this defense seems unlikely to prevail.

Memo to self: Always accompany the wife to her dentist appointment.

■ Item the 3rd, Good News Dept: It seems safe to say that we've all heard of CAT scans, but would you believe that the MVNHS© is now using DOG scans?

Okay, it's not really the British health care system's newest medical tech, but a 64 year old woman's collie who made the potentially life-saving discovery:

"After Max began sniffing Mrs Burns's breath and then gently nudging her right breast, the 64-year-old examined herself and discovered a small lump in the same breast."

One wonders if this new technique will gain wider acceptance, but there's no doubt that, in this case, "Max" really was her best friend. Oh, in case you're wondering, Mrs Burns has "since had the lump removed and her prognosis is excellent."

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Obama Doesn't Read InsureBlog

[Welcome FoxNews and Kaiser Network readers!]

Else he would know the difference between health insurance and health care. He would also understand that health care costs drive health insurance costs, and that simply extending insurance coverage to more people does nothing to cut the cost of health care.

So why is this important?

Because he's recommending that Congress spend an additional two-thirds of a trillion dollars to expand health insurance coverage.

Well, that's not quite right either: as we've pointed out many times here at IB, the gummint doesn't actually have any money: it simply takes funds from one group of people and redistributes them to another. This is called "taxes," and it's the primary means by which Congress can "pay for" such schemes.

The problem is that this is a well that can quickly dry up, especially as those folks targeted for additional taxation -- "the rich" -- stand by helplessly as their actual worth goes plummeting down the memory hole as the stock market continues its downward plunge. Then, too, there's the indisputable historical fact that higher taxes result in lower revenue for the gummint, thereby short-circuiting the process.

Historically, too, such programs inevitably outgrow their initially estimated size (cf: Medicare), and become cures which are worse than the underlying disease. Thus, a big problem becomes an even bigger one, with little hope of slowing down. Our political class has always been loathe to cut out programs which exhibit these traits (again, cf: Medicare), why would we believe that this one would somehow break that cycle?

The President is said to rely on "eight principles to guide his health reform effort," including freedom of choice as regards health care providers. But that flies in the face of experience: there are already two national health care schemes extant, Medicare and the VA. Both of these restrict that choice; why would any other program be any different? Indeed, how could another such system be any different?

The underlying problem is that the administration's “goal is still to bring down the cost of care and to get universal coverage." The problem is that it ignores the third leg: quality of care. As the saying goes, "you can have it fast, you can have it cheap, you can have it good. Pick any two."

Which ones would you choose?

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Insurance Person of the Year Awards

No, not us (heck, none of us is even eligible!). Our friends at the Lexis-Nexis Insurance Law Center (which has deemed us as one of the Top 50 Insurance Law Blogs) is debuting its First Annual Person of the Year Awards for 2008. Categories include:

■ Policyholder Attorney of the Year

■ Insurer Attorney of the Year

■ Insurance Regulator of the Year

and

■ Insurance Jurist of the Year

According to FoIB Karen Yotis, nominations are being taken through March 6, "comments will be taken through March 13, and the ILC Board will make its selections at its monthly meeting on March 16. Recipients of the award will be featured in ILC’s April “Meet Me” campaign."

You can submit your nomination(s) directly to Karen via email.

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Orphan Illness

The cost of health care in the U.S. is currently 16% of G.D.P. and projected to consume 25% of G.D.P. by 2025. Controlling the cost of health care is not just a U.S. concern, but worldwide.

To wage this war on health care inflation, the Spendulus Bill allocates $1.1 billion of the total $787 billion to compare the efficacy of drugs, medical devices, surgery and other ways of treating specific conditions. A total of $59 billion in the package is allocated for health care.

So what about the rest of the $59 billion? The bill allocates $20 billion to move us towards E.H.R. (electronic health records) which are supposed to save significant dollars in the big scheme of things, but even that is questionable.

So $787 billion distills down to $59 billion to tweak a portion of the economy that consumes 16% of the G.D.P.

Of that $59 billion they propose to use $1.1 billion to study the efficacy of health care treatment protocols.

Seems to be upside down in my opinion, but what do I know?

Already we are seeing fallout from the spending bill and it's impact on medications that may never reach the market. Drug giant Pfizer has pulled the plug on two drugs that are in the research stage.

The good news is, newer drugs usually cost more and may not be any more effective than current treatment protocol. Eliminating marginally effective drugs can be a good thing for your wallet.

The bad news is, if you have an orphan illness, one that afflicts only a small portion of the population, you may miss out on a new medication that might actually work.

Fibromyalgia is "a condition characterized by long-standing pain, has been the subject of controversy over its legitimacy, despite being recognized as a disease by the FDA and insurers." But fibromyalgia, once thought to be psychosomatic, only affects a relative handful of people.

There are two drugs on the market that have received F.D.A. approval for treatment of fibromyalgia . . . Lyrica and Cymbalta.

A 30 day supply of Lyrica runs $75 while a 30 day supply of Cymbalta is $125. Is one more effective than the other?

Like many illnesses, it varies by individual.

Would Esreboxetine, the Pfizer drug that is being shelved any better than Lyrica or Cymbalta?

We may never know.

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Cavalcade of Risk #72 online now

From The Land Down Under, Russell Hutchinson hosts this week's roundup of all that's risky in the blogosphere.

Do stop by!

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COBRA/Spendulus Update

[Updated - scroll down]

FoIB Bill Montgomery, CIC, points us to another "deal killer" in this bill. According to a memo from United Healthcare, "the subsidy provisions apply to state continuation coverage that is comparable to federal COBRA. That would include so-called "mini-COBRA" state laws that cover groups below the 20 employee threshold for COBRA."

Here in Ohio, groups with 2 (!) or more employees must indeed offer such an option; the key threshold is whether the (former) employee is eligible for unemployment compensation. If so, he or she may elect to continue the group coverage, at his/her own expense, for up to 6 months. Of course, this now means "at a substantial discount" for up to 6 months.

This does not bode well for small employers, who may have believed that they'd "dodged a bullet" when it appeared that these new reg's applied only to larger, COBRA compliant groups.

Of course, since "mini-COBRA" admin requirements are much less onerous than COBRA's, it's up to the (now former) employee to seek out this coverage. Still, if the extra costs are a problem for COBRA compliant groups, they could be disasterous for mom-and-pop shops.

Ooops.

Over on the Left Coast, co-blogger Bill Halper reports that California has CalCobra. He says that it "covers all group health plans (except those regulated by ERISA) with 2-19 eligible employees. The eligibility requirements are the same as Federal Cobra: as long as you are on the employer’s plan, pretty much anything short of walking in carrying an Uzi means you’re eligible. Voluntarily quitting your job, which would make you ineligible for unemployment, doesn’t affect your CalCobra eligibility. You can stay on CalCobra for 36 months; normally premiums are 110% of the employer’s premiums [ed: well, they were 110%. Now, not so much].

It’ll be amusing to see how this is implemented. Under CalCobra, the carriers are responsible for all of the administrative work. The employer notifies the carrier of a qualifying event, the carrier sends out the notice and then bills the participant and collects the premium. The employer is completely out of the loop. The Federal Law complicates things a bit.

OY! UPDATE: Just got this from one of our dental carriers: "Dental benefits are included in the health plan definitions of COBRA."

Exit question: If I didn't have dental before, will I be able to elect it at termination?

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More (Bad) AIG News

From the Throwing Good Money After Bad Department:

"American Insurance Group, the insurance giant that is 80-percent owned by the US government, is in discussions with the government to secure additional funds so it can keep operating after next Monday, when it will report the largest loss in U.S. corporate history." [ed: emphasis added]

As we averred when the political class began schushing down this slippery slope, "When the gummint is your reinsurer, you're pretty much bullet-proof as to claims, reserves, you name it." And thus we see the results of unfettered access to someone else's (i.e. taxpayer) money. We're already some $150 billion into the struggling, ertswhile insurance giant, with no "happy ending" in sight. In fact, the rocket surgeons in Washington are now looking at swapping "some of the debt held by the government for equity in AIG."

What part of "enough is enough" don't these people understand?

There should come a point where the market is left to correct itself (I hesitate to say "must" because, with the gummint, all bets regarding common sense are off); sometimes this correction is painful. But it's the nature of risk; that is, sometimes you lose. Based on what we've seen so far, it doesn't seem likely that another infusion of hard-earned taxpayer dollars will net a long-term positive effect.

In other words, why won't they let us cut our losses?

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Yummy! Grand Rounds is on the Table

The Blog That Ate Manhattan (burp!) hosts this week's roundup of medblog posts. From soup to nuts, you're sure to find some tasty food for thought.

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Start Spreading the News

I'm leaving today. I want to be part of it, New York, New York.

Apologies to ole blue eyes aside, why would one of the wealthiest men in the world come to New York for surgery?

Because he can.

Saudi Crown Prince Sultan bin Abdul-Aziz flew to New York for surgery.

"This operation is the completion of medical tests and treatment his Excellency had received recently and it was ... successful,"

Details were not released.

the prince had arrived in New York for follow-up medical checks and treatment after undergoing a "prescribed convalescence" in Morocco.

Prescribed convalescence in Morroco. My guess is he doesn't have an HMO.

So why come here?

One would presume because the standard of care here is the best in the world.

Try convincing Michael Moore of that . . .

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Knowledge is Power. Except when it's not...

[Welcome Industry Radar readers!]

Here at IB, an overarching theme is "empowerment." Generally, this means consumer driven health insurance plans (e.g. HSA's), but it also means taking a more pro-active role in learning about treatment options. Of course, the two are interrelated: when one has more "skin in the game," as in high deductible health plans, one has a greater financial stake in finding out as much as possible about what one's physician is recommending.

Which brings us to our first bit of news:

"Cancer patients who research treatment options are three times more likely to get the newest drugs than patients who don't spend extra time learning about their condition."

This makes sense, since it implies that those folks who take the time and put forth the effort to research their options are bound to know more about their possible choices than those who don't. These are folks who've scoured the 'net, read newspaper and magazine articles, and (presumably) talked to other folks with similar conditions.

And it gets better, since "those who pursued second opinions from doctors as part of their research were the most likely actually to be prescribed" one (or more) of the newer cancer med's, such as Erbitux, and Avastin. These are drugs which seem to slow the growth of tumors (although the article is quick to point out that they don't necessarily cure cancer).

On the other hand, those "first adopters" also face increased risk of developing negative side effects from these meds: "Avastin increases the risk of strokes, heart attacks and serious blood clots. Erbitux can cause a disfiguring rash."

Still, they show promise, especially for folks who face a death sentence.

On the other hand, just relying on the doc's, without doing one's own "due diligence," may backfire. The University of Michigan recently surveyed over 3,000 folks, all over 40, who had recently had office visits:

■ In "93% of talks about taking cholesterol or blood pressure drugs and in a majority of talks about cancer screening and elective surgery," the doc's initiated the conversation.

■ Doctors were much more likely to recommend taking action rather than adopt a "wait and see" posture.

That second may not seem like a big deal, but sometimes not taking action is the right course; at the very least, there's concern that, as researcher Brian Zikmund-Fisher oberves, "You need to have an opportunity to say yes or no."

Which is not to say that the doc's themselves are completely to blame here; after all, how many of us do make the time and effort to ask questions? Yet that's exactly what we should be doing, regardless of what kind of insurance we have. Or whether we're insured at all.

It really comes down to this: personal reponsibility and empowerment.

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Carnival of Personal Finance is up

The Broke Grad Student hosts this week's extravaganza, replete with (questionable) YouTube clips. It's a great way to see a lot of interesting finance-related posts.

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Shut Up, and Call Me in the Morning

It's as American as apple pie: the right to complain about poor service. But beware, you may have to give up that right if you want your doctor to continue treating you.

"Doctors across the country are forcing their patients to sign waivers giving up their right to post comments and reviews about them online."

Of course, just because you sign something doesn't automatically mean that you're bound by it. But there are usually consequences for ignoring the rules, especially ones to which you've explicitly agreed. In this case, the consequence is a boot out the door - of the doc's office, that is.

According to Laurence McCullough, a professor of medical ethics at Baylor College of Medicine, "(t)his is just the guild trying to protect itself from accountability to those it serves. That's not professional behavior — this is self-interested behavior." Of course, the medical profession has been under fire of late for other potential lapses in ethics, so this isn't necessarily breaking new ground.

But it is troubling:

Dr. Wendy Mariner, a law professor and director of the Patients' Rights Program at Boston University, opines that "the waivers create an adversarial relationship between doctors and patients, and could possibly limit options for patients seeking care. If this kind of thing gains any traction, medical licensing boards will, and I think should, prohibit it."

On the other hand, the reviews in question are often, well, questionable themselves. After all, how is one to know if the person posting an online complaint against Dr Smith was actually a patient of his, or simply a disgruntled employee, for example? Absent some kind of monitoring, who's to know. But that, of course, begs the question: who does the vetting? There doesn't seem to be any reasonable answer to that one.

And there's this:

"Under the terms of the agreements, patients promise they "will not denigrate, defame, disparage or cast aspersions upon" their doctors or post comments to any Web pages by name or anonymously."

Of course, if it's anonymous, how would the doc know whom to "fire?"

For now, both sides seem to be finding their way around these questions. It may be a while before we see any substantive answers.

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Cavalcade of Risk #72: Submissions Due

Next week's edition is hosted by Russell Hutchinson. Submissions are due by Monday, the 23rd, and should include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

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COBRA Subsidy? Maybe Not . . .

[BUMPED TO TOP: This is just too important. I highly recommend reading the comments for even more details. HGS]

Washington works in strange ways, if you can say it works at all. One part of the recent legislation, which no one read before voting on, provides subsidies for COBRA.

Or does it?

We found several resources that have their take on the subsidy. Of course, like anything else having to do with new rules, the devil is in the details.

Problem is, we don't have any details yet.

But here goes.

The folks at Fox Rothchild, Attorney's at law, offered this perspective.

the American Recovery and Reinvestment Act signed into law today. It is going to create some change to COBRA administration that require some attention very soon. It provides for a 65% employer paid subsidy for COBRA premiums for 9 months.

An employer paid subsidy. That's an interesting wrinkle, especially since the ex-employee normally makes the election and is responsible for paying the premium.

The subsidy applies to those who suffered an involuntary loss of coverage between September 1, 2008, through December 31, 2009. But the Act does not specify what it will consider an involuntary loss, and it also provides that all qualified beneficiaries, regardless of the reason for their qualifying event, must get the notice. Employers and plan sponsors should go back to September 1, 2008, and review records to determine everyone (including dependents) who had a qualifying event and confirm that these individuals will get notice. This can be for voluntary or involuntary termination or reduction of hours, but it also applies to those made eligible as a result of divorce, death or aging out of coverage. They may not get the subsidy, but you must be prepared to send them the notice.

This is like watching sausage being made.

You not only don't know what is going in, but what is coming out either.

The Act includes a retroactive provision that allows those who were eligible for COBRA and did not elect. It creates a window for them to now elect continuation coverage retroactive back to the first date of the qualifying event subsequent to September 1, 2008.

So what if someone bought coverage other than COBRA? Can they drop it and pick up COBRA going forward?

Or say they did nothing, but had a major claim in the interim. Can they elect COBRA retroactively and expect COBRA (and the taxpayer subsidy of course) to cover the claim?

Recognizing that now there is an added cost to reductions in force that equates to paying 65% of COBRA premiums, employers must consider this added expense when considering the cost benefit of a reduction in payroll. Not all eligible employees will elect COBRA because of the subsidy, but it can reasonably be anticipated that more will than would without the subsidy. If you are in the process of reducing the workforce, affected employees should be advised that the subsidy is available, but application of the subsidy will not be finalized until the close of the transition period.

OK, so the employer is laying off employees to save money. After the RIF, say half decide to opt for COBRA. Since this is an employer subsidy, the employer must pay their share, collect the balance from the ex-employee, and then ask the government for a refund of their share.

Or something like that.

Regardless of the mechanics, the RIF was to save money, but the COBRA SNAFU might create cash flow issues for the employer, leading to more lay offs, creating more COBRA elections, which creates more cash flow issues, leading to more . . . .

Confused?

I know I am.

UPDATE (HGS): New details on this issue have come to light, including news that this may apply to smaller groups, as well. Click here.

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Health Wonk Review: The Anti-Spam Edition

In honor of all the "spamblog" submissions I received for this outing, I thought it appropriate to include some useful spam tidbits. And so, each post this week is accompanied by a relevant, and yet tasty, Spam© concoction.

Enjoy!

(Oh, and if that doesn't work, try this)

■ We start off with a Singapore Salad, in honor of Pizaazz blogger Glenn Laffel's post reminding us that not all talk of health care reform is taking place here in the US: China's system is undergoing some changes, as well.

Careful though, about an hour after you read this post, you'll want to re-read it.

■ Moving on to the appetizer course, Sarah Axeen of the New Health Dialogue blog argues that we can both save the economy and reform our health care system, all in one fell swoop.

■ For those interested in lighter fare, we present Fiona Gathright's post at the Employee Wellness blog. She contends that folks are more likely to lose weight if they are paid for it, and that this weight loss would then translate to lower health care costs.

■ Sometimes, Puffs are a great idea. But David Williams, proprietor of the Health Business Blog, warns that looking for bargains in healthcare can lead to puffed up claims, particularly for uninsured and underinsured patients.

■ In a nod to our new president's heritage, we have a Hawaiian Spamburger, courtesy of Musings of a Distractible Mind's Dr Rob Lamberts.

The good doctor is thoroughly unimpressed with the state of Medicare, and in an Open Letter to the President, he explains why.

■ For a south of the border taste, we look to Nursing Degree blog. Looking to mix travel with surgery? Erika Collins has an indispensible guide to what she considers the Top 50 (and then some!) resources for Medical Tourism.

■ Interested in something that may sound good on paper, but might just be overreaching? Our own Bill Halper gives us his take on the "Stimulus" package (known around these parts as "The Spendulus"). Bill takes a look at all the health care provisions, and worries about their impact.

■ Like this recipe for incomparable corn chowder pot pies, Health Care Renewal guru Roy Poses has his own take on the comparative effectiveness research imperative in the recently passed "Stimulus" bill: if done right, he's all for it.

■ Sometimes, it's important to remember the basics, like a classic baked Spam loaf. Jason Shafrin, the Healthcare Economist, reviews some important healthcare statistics. These are classic, too, like health care spending that is expected to grow to almost 20% of GDP in 2017.

■ Remember when Egg McMuffins were first introduced, and folks wondered what they were? Well, just what is the Certification Commission for Healthcare Information Technology, and why should we care? Healthcare journalist Neil Versel explains both, including what they have in common with Bernie Madoff.

■ Is the Kaiser Family Foundation's recent report a bit cheesy? Disease Management blogger Jaan Sidorov thinks so, and gives the KFF a thorough fisking for its disingenuous criticism of insurance coverage for cancer patients. The good news, Jaan assures us, is that his own "pic is Obama-esque."

■ When grilling kabobs, managing heat is critical. So, too, is managing patient care, as Dr Rich reminds us in this "meditation" on why patients who receive stents are so poorly informed, and how policy decisions (i.e, how doctors are "managed") may play a role.

■ Talk about heartburn in a bowl: Blogger Merrill Goozner takes aim at the Atlantic Magazine's apparent misrepresentation of comparative effectiveness. Ouch!

■ This Mexican Extravaganza is sure to cause some gastric pain. And while we're thinking of it, does the level of pain you experience while recovering from surgery have any relationship to the type of coverage you have? Jon Coppelman of Workers' Comp Insider makes the case that it sometimes does.

■ If you're on a budget, these BLT Bites might be just the ticket. But, as Medicaid Front Page's Brady Augustine reports, the new SCHIP legislation may leave states scrambling to stay within their own budgets.

■ Bet you never expected to see the words 'Spam' and 'cupcake' together, did you? Canadian Medicine blog's Sam Solomon reports on a similar surprise: the Canadian Medical Association is lobbying to reform the country's healthcare system to make it look more like one of the mixed public-private European systems.

■ These Tuscan Spam Bites aren't the only things with (metaphorical) fangs; Anthony Wright opines that the benefits of COBRA shows the complete disaster that is the individual insurance market.

■ Just as this Seven Layer Dip has many levels, Louise at Colorado Health Insurance Insider reports that the Stimulus Package [ed: referred to as "The Spendulus" here at IB] includes some not so obvious ingredients, including some that she hopes will help to ameliorate the problem of so many uninsured.

■ And for dessert, something both sweet and tart. THCB's Brian Klepper reports on a recent appeals court decision that held against the advocacy organization Consumers' Checkbook, and with the AMA and HHS. The latter two are looking to keep Medicare physician data secret, but this may conflict with increased efforts at transparency in health care.

Be sure to check out the comments for some great fireworks, um, debate.

Thanks for stopping by; be sure to catch the next edition when Brady Augustine hosts at MedicaidFrontPage.

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2009 Health Insurance Behaviour

In these difficult economic times, individuals and businesses have to prioritise where they going to invest their hard earned cash. Obviously, within these circumstances there are implications for private healthcare insurance. With increasing food and energy bills, does private healthcare retain its status as an important cornerstone of a family or businesses life?

Our question for our readers is simple - are you planning to either increase or open a comnpletely new private healthcare insurance policy in 2009? Any comments are welcomed.

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Taxes and Top 10 Lists

Our good friend Joe Kristan has been named one of the Top 10 Tax Bloggers.

Congratulations, Joe!!

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Medical Transparency Update

Boy, do we get results!

Regular readers may recall that we recently reported on regulations regarding physician rewards for recommending certain regimens [ed: okay, enough already with the alliteration!]. Specifically, "the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies...that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs."

First out of the box, it would appear, is Big Pharma Behemoth Pfizer, which has just announced that "will begin disclosing all sizable payments it makes to doctors, including those who test experimental drugs in people, a first for the industry." Now, that's not quite the same as, you know, actually ending said payments, but it certainly adds an element of transparency to a hitherto murky underworld of quid-pro-quo.

As Pfizer's Chief Executive Jeffrey Kindler noted, "It's very important that we earn the trust of patients and the public."

No kidding.

And it looks like Pfizer's move has sparked an interest in others, as well: "A handful of drugmakers, including Merck & Co. and Eli Lilly & Co., have recently announced plans to disclose payments for consulting, giving speeches and the like."

Another "freebie" sore point has gone unremarked; the underwriting of CME (Continuing Medical Education) credits by Big Pharma isn't mentioned. It would appear that this potentially valuable "gimme" will remain untouched by these new efforts. Actually, that doesn't really bother me: presuming that CME courses undergo at least as much scrutiny as insurance ones do, I don't think there's much danger of "contamination."

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Condo Unit Owner? Here's the Insurance You Need!

Read through the article and your HOA "secret" is indicated with ***** below.

Your condominium or Condo as we affectionately call it is a very important investment. Protecting it properly is critical to your financial security. If you’ve only been guessing until now, then guess no longer.

Insurance for your condo need not be a shot in the dark. There are simple ways to determine EXACTLY how much insurance you should have.

Even though insurance has been part of our culture for over 100 years, to most people – It’s still a just a mystery. And because they don’t understand it, a lot of people think they’re being “ripped off” by the Insurance Industry; aka “The Club”

I want to end that for you.

I'm an industry "insider": A licensed member of “The Club”
I’ve been inside the insurance business for over 30 years and I know it like the back of my hand: From policy to claims and back again.
I've sold insurance.
I've studied it.
I've discovered what makes "good insurance" -- and what makes "bad insurance".

I know that not all insurance is "created equal".

If you’re not properly insuring your condo you could be either wasting needless premium money on excess coverage or you could be setting yourself up for a severely UNDERINSURED loss that could cost you tens of THOUSANDS of dollars or even MORE!

I’ve been around the insurance business for a long time and I’ve seen it all.

• I’ve seen people standing next to smoldering ashes that just hours before was their home and everything they own.
• I’ve comforted those who have just received a 50-page lawsuit because their sprinkler flooded their neighbor’s yard or their dog bit a friend’s child.
• I’ve reassured clients that they have coverage after their toilet flooded their house over an entire 3-day weekend.
• I’ve seen clean-up bills for just water damage in excess of $100,000.

And I’ve been able to pay all these losses for these very frightened people because we made sure that their insurance was right for them – That it would be there to “write the check” should these shattering losses happen to them!

Condo insurance, when purchased properly, can give you the security of continuing life as you know it in the event of a catastrophic casualty or liability loss.

Condo insurance is POWERFUL and very comprehensive in the scope of coverage it offers.

Here’s a little overview….

• It protects your condo (more on that later)
  
• It protects your stuff at home
• It protects your stuff on vacation
• It protects your stuff in the USA
• It protects stuff you may have in a storage facility
• It protects your stuff all over the world !
• Yes, that’s right… you lose your stuff ANYWHERE on the planet…you’re covered just as you are in your own backyard.
• It protects your CHECKS & CREDIT CARDS if they’re stolen
• It gives you Liability protection....that’s when you get sued
• It gives you protection for stuff you’d never imagine.
• Here’s just a few examples
  
• Money, Bank Notes, Coins (including collections) up to $200
• Property used or intended to be used in business
• On premises up to $1,000
• Off premises up to $250
• Watercraft and equipment up to $1,000
• Securities, Checks, Traveler’s Checks up to $1,000
• Trailers (not used with watercraft) up to $1,000· Stamps, trading cards, comic books (including collections) up to $2,500
• Theft loss of:
  
• Jewelry and Furs up to $1,000
• Firearms up to $2,500
• Silverware and Goldware up to $2,500
• Rugs, tapestry, wall hangings
• Per Item up to $5,000
• Aggregate up to $10,000
• Home Computers up to $5,000

WOW, you say!
That’s quite a list.
Yes it is…and there’s MORE…
Yes, there’s a LOT more…
But before we get to that … the WHAT and HOW TO BUY Condo Insurance,
let’s talk about the WHY!!
Why would anyone need or want Condo Insurance?

Most Homeowners Associations (HOA's) purchase insurance for the buildings in the condo complex. That cost is paid from a portion of your monthly HOA fees.

*****And here's the IMPORTANT PART:

Generally (and I say that because every HOA is different) but GENERALLY, the HOA covers only the outer portion of the buildings and the roof and common areas. YOU are responsible to insure the interior walls, cabinets and fixtures. And you are responsible to cover your personal property: your clothes, bed, furniture, TV, iPod, dishes.... All your "stuff".

Properly structured Condo Insurance provides protection for your interior structure, your personal property,
AND Protection in case of a liability lawsuit.

“WHAT?!?!” you say. “Lawsuit ! !”
Yep, lawsuit. Could it happen to you? The answer is…
Of course it could ! !

But we’ll talk about that in a minute. So….

Let’s talk about the nitty-gritty of Condo Insurance. There’s certainly not room here in this report to cover all of it, but I promise, that when you’re done you’ll know more about condo insurance than 95% of the planet. Having a good handle on your insurance decisions is the only way to best prevent problems and surprises at claim time.
There’s three main parts to your condo coverage: 1. Coverage for the interior structure 2. Coverage for your stuff 3. Liability coverage

Let’s take these on one at a time.

COVERAGE FOR YOUR Interior Structure

Remember that the interior structure includes all the interior walls, cabinets, built-ins, carpet, tile, bathroom sinks, toilets, showers, closets - EVERYTHING inside the outer perimeter of your unit.

This is probably the least understood of the three. And the biggest question is HOW MUCH? How much coverage to I REALLY NEED to properly and reasonably cover my interior?

It’s really a simple answer. This is probably worth the entire time you’d spend reading 10 of these POSTS.

You need just enough coverage to rebuild your condo.

Here’s what you DON’T NEED! You DON’T NEED to insure it for its market value (what you could sell it for). You also DON’T NEED to insure it up to the LOAN AMOUNT. Both of these numbers have NOTHING TO DO with the cost to rebuild your condo.

If you determine that you need $80,000 to rebuild your condo and your lender tells you that you have to insure it for $200,000 because that’s the amount of your loan. You tell them that you know different! If you can’t get this through their thick heads, call me. I’ll take care of it for you. There’s a law I can cite to them that will cool their jets in a hurry. (And I’ve done it many times in my 3 decades of helping my policyholders)

So how much do I need to rebuild my condo?

That’s the magic question, for sure! The answer is that you calculate it by using cost per square foot. You’ll need to know how many square feet of living space you have.

Ideally you’d like to get a licensed contractor to your house to estimate that for you. Get one who is currently building houses in your area. Believe me, he knows the cost.

Remember though, EVERY HOUSE IS DIFFERENT! The range in San Diego is usually $60-$75 per square foot. Where you fall in that range is dependent in the quality of your interior. Average is probably $65-$70. So, if you have 1200 square feet and your think $60 per foot is sufficient, you need $72,000 of BUILDING coverage on your policy.

I have several contractors insured and I keep up with them on the current cost of construction in my area. I hesitate to just give you a number here as it changes all the time and you need to tweak it a little based on the configuration of your house. For example, if your house is a track house, (one that was built among a bunch of others that are about the same) your cost of construction will probably be less than if you lived in a custom house. You have to ask questions like these:

• Do I have carpet or marble tile?
• Do I have a central vacuum system?
• Do you have Upgraded Counter tops? Granite?
  
• 
• Are my kitchen cabinets standard or custom?
• Do I have central air conditioning, ceiling fans, custom wood stair rails, etc?

With just a quick phone call to my office, we’ll be happy to help you determine your cost per square foot.

Another common point of confusion is that people think they need to insure their condo for it’s market value. NOT SO! Your house is (almost) always going to be worth more than it takes to build it. Remember there’s value in your land, neighborhood, schools, view, etc. All that is unaffected by the loss of your home. And remember this….

NO MATTER HOW MUCH COVERAGE YOU PUT ON YOUR CONDO, THE INSURANCE COMPANY WILL ONLY PAY YOU WHAT IT COSTS TO REBUILD IT.

So here’s how a typical house can look. Remember there’s 3 key numbers associated with your house: Market Value, Amount of your Mortgage, and Rebuilding Cost.

If your 2500 square foot condo has a market value of $650,000 and your local building costs are $70/square foot, your rebuilding cost would be $175,000 (2500 x 70). Your mortgage could be $120,000, $400,000 or $0. Regardless of the loan amount or the market value, you’d want to have approximately $150,000 of insurance on the interior building coverage for your condo. There’s some tricky thinking here that you need to consider.
The cost of construction isn’t static, it’s always changing. Lumber cost changes almost daily, as an area builds more and less through changes in economy, the cost of subcontractors will fluctuate. At the end of this report you’ll see a special feature that my office offers you to help you be sure that you don’t get caught short as construction costs rise and fall. Look for this picture. -->

Usually your condo has what’s called ALL RISK coverage on the structure. That means that, except for a few exclusions, anything that happens to your condo is covered. If there’s a loss to your condo, the adjuster looks at the list of exclusions and if what happened isn’t there… it’s probably going to be covered. Remember that all insurance companies are different and it’s the policy contract that decides, not what I say here!

Some common exclusions include flood (the natural kind, not water from a broken pipe which IS COVERED), earthquake, riot, freezing of pipes in an unoccupied, vacant, or under-construction building, vandalism and malicious mischief if the building has been vacant for more than 30 days, normal wear and tear, intentional damage, damage from animals, birds, or fish, and war. These are just a sampling of exclusions. See your policy for your actual exclusions.

Equally as important as the coverage for your home is your coverage for your stuff – Your Personal Property.


COVERAGE FOR YOUR STUFF

If your stuff is stolen from your car,
IT’S COVERED under your Condo Unitowners Insurance!!!
There might be damage to your car though. THAT’S covered under your auto insurance. I’m sure you have car insurance ! ! ! (see 10 Ways to Beat the High Cost of Auto Insurance (Part 1) & (Part 2) )

This is the coverage that insures your personal property: Your sofa, dishes, clothes, television, stereo, art work, silver, china, watches, jewelry, blender and your socks. How much do you need? That's the important question. Start thinking at a minimum of $30,000. I insured a condo once with personal property coverage of $250,000! Yes, he was a doctor and she a surgical nurse. Lots of money there!

Again... just a quick phone call to my office and we can help you decide the right amount for you.

Here’s an important distinction on the actual coverages for your personal property as compared to the coverage for your structure. You’ll remember that your structure is covered for all losses EXCEPT for those specifically excluded. Your personal property is only covered for a specific list of losses. Here’s a typical list:

• Fire or lightning
• Weight of ice, snow or sleet
• Explosion
• Aircraft & vehicles
• Smoke
• Sudden and accidental tearing or bulging of heating or cooling systems
• Windstorm or hail
• Theft
• Riot or civil commotion
• Falling objects
• Vandalism or malicious mischief
• Sudden and accidental water discharge from plumbing or appliances
• Freezing of plumbing systems

Once again it’s important to check your own policy language for the specific coverages for your personal property. If you’re not sure, just give us a call. 619-670-1000

Now before we talk a little about the most important portion of your condo policy -- Your Liability Coverage, let me mention one VERY COMMON MISCONCEPTION.

Condo insurance DOES NOT cover the mortgage if one of the owners should die. You’ll need MORTGAGE INSURANCE to cover that.

Mortgage Insurance is simply life insurance that’s designed to pay off the mortgage at the death of one of the owners.

Life insurance can be somewhat overwhelming to purchase. You’re so afraid of making a mistake.

It’s easy to incorporate your mortgage insurance TOGETHER with your regular Life Insurance and SAVE TONS OF MONEY in the process. Learn how with this:

7 Things You Need To Know BEFORE You Buy Life Insurance

If you own a home and anyone depends on your income to keep the home then mortgage insurance is a must for you! You have far too much invested in your home to allow those you love and provide for to risk having to lose the house if one of the bread winners dies.

It’s simple and easy and probably NOT AS EXPENSIVE AS YOU MIGHT THINK.

You can usually get mortgage insurance for your home for about the price of a DVD a month!

Think about it. Safety, security and peace of mind for about the cost of a DVD a month!

Liability Coverage

Remember we were talking about that LAWSUIT!?!?! Yes, it could happen to you! There’s ALSO coverage in your CONDO INSURANCE for THAT !

Liability is the portion of your condo insurance that protects your home, your assets, your retirement savings and your future income!

Someone slips and falls in your place,
Breaks their leg, or cuts their hand.
(Bummer if it’s a Plastic Surgeon)
Your policy will pay whatever you’re legally liable to pay. (up to the limit of the policy, of course) That’s why at least a $1,000,000 limit is important there (especially if you live in California). Many offices will let you walk away with the standard $100,000. For just an extra $7/month, you get TEN TIMES the coverage -- Almost a crime not to take that.

If you own your condo you should probably consider a Liability Umbrella. It gives you $1,000,000 coverage on your house and all your personal vehicles. You have just too much equity in your house and too much of your net worth tied up there to risk it by saving a few dollars a month.

Let me tell you a story….

Just this year a policyholder called me and told me that they were being sued because their son’s girlfriend accidentally let their dog out of the back yard. The dog made a beeline across the street and kicked the stuffing out of the neighbor’s dog. The homeowner was being sued by the neighbor for veterinarian bills that exceeded $3000 and for mental anguish, stress, and… well, you know the drill. Fortunately the homeowner had not only their homeowners insurance but also a Liability Umbrella standing between this crazy neighbor and everything they owned. Without that, this could have been their problem…

They could have been paying off this “little problem” for years. They could have risked everything they own in addition to their FUTURE EARNINGS by not having the foresight to get (in this case) HOMEOWNERS INSURANCE and a LIABILITY UMBRELLA policy.

You can insure your home, your personal property and your liability exposure in one simple policy.

BUT WAIT ! ! ! ! THERE’S EVEN MORE ! ! !
Condo insurance also includes Medical Payment coverage. That pays for MEDICAL EXPENSES up to the limits of the policy for people who are on your premises with your permission and accidentally injured. And ALSO for people injured by your activities. Coverage doesn’t pay for medical expenses for you or members of your family that live with you.

BUT WAIT ! ! ! ! THERE’S MORE!!!!!!
You also get what’s called LOSS OF USE or ADDITIONAL LIVING EXPENSES coverage. Whenever your place is rendered UNINHABITABLE because of a covered loss, we’ll pay the cost to put you up someplace else while your place is being repaired. I’ve actually written checks to people sitting outside their burned residence to pay for a hotel. VERY COOL!!!!
This pays up to 24 MONTHS! ! Hopefully you won’t be out that long,
but it’s THERE IF YOU NEED IT ! ! ! !


BUT WAIT ! ! ! ! THERE’S SOME MORE!!!!!!
You know how things just get more expensive every year. We’ll automatically increase the amount of your coverage every month FOR FREE until your next renewal to keep pace with inflation. When you renew you policy each year, it will be for the newer IMPROVED amount of coverage.


BUT WAIT ! ! ! ! THERE’S STILL MORE!!!!!! (starting to sound like one of those Ginsu Knife Commercials..?)
I mentioned this up above but you might have missed it. If someone steals your checks or credit cards and you suffer loss cuz they’re out there spending YOUR MONEY, you’ll have coverage for that up to $1000.
“WOW”, you say!
And all that’s included in the Condo Insurance we provide in our office.

Hey, Let’s talk about Deductibles for a second….
The deductible is the portion of a covered loss that is your responsibility. They are typically available in amounts such as $250, $500, $750, or $1000.For example, if you had a $500 deductible, you would need to pay the first $500 of the covered loss and we’d pay the rest.Generally speaking, higher deductibles lower your premium, but increase the amount you must pay out of your own pocket if a covered loss occurs. Ask yourself how much you are willing to pay in order to save on premium. ... you know what, just ask us when you're in the office and we'll show you how simple it is to calculate.

SO what’s the best way to buy CONDO INSURANCE ?


RULE #1 – Don’t over-insure and don’t under-insure. Get the right amount of coverage. Yes, you’ll have to estimate how much stuff you have.

We have convenient calculators in our office to estimate this for you.

RULE #2 – Take the biggest deductible you can afford. (within reason). Increasing your deductible from just $500 to $1000 will usually save you about $75 per year. Let us help you do the math to see how long it takes you to absorb the difference in the two deductibles.

We can help you walk thru those numbers and find the best blend of deductible and price... Takes about 3 minutes.

RULE #3 – Get at least $500,000 of liability coverage (especially if you live in CALIFORNIA!) People just love to sue in good old CaliforNyeYay.

You need someone who explains and helps you with this. It’s just what we do...

RULE #4 – Only get policies with REPLACEMENT COST coverage for your contents. (all of the policies we offer in our agency have this provision.) This is a cool one. Provision sez that if you suffer loss to your stuff, and you replace it, we’ll pay you what it costs to get a brand new one rather than what your old one was worth.

We automatically add this to all your policies unless (for some reason) you tell us not to.Looks like this. Someone steals your 8 year old TV set that’s worth $75 and a new one is $350, we’ll pay you based on the $350 rather than the $75! VERY COOL!

RULE #5 – Take the PERSONAL LIABILITY option in the LIABILITY SECTION of your policy. That gives you coverage for things like slander and libel. Californian’s, for some crazy reason, get all bent out of shape if you talk to them or about them the wrong way.

We automatically add this one too. Unless you don’t want it...

RULE #6 – Don’t forget to check out things like Special insurance for your baseball card or Precious Moments collections. There’s limits on those kinds of things. You might also need to look into waterbed liability, or business liability (if you run any kind of business out of your home.) And don’t forget EARTHQUAKE coverage.

We’ll walk you thru a checklist of all those things just to make sure we don’t forget anything. You may not need any of them, but we just want to be sure.

RULE #7 – Only get a condo policy with GUARANTEED EXTRA REPLACEMENT COST (GERC) coverage for your structure. This is SO IMPORTANT. We offer policies that will pay you up to an EXTRA 20% above the actual amount of coverage. For example, let’s say you’ve lost your 2500 square foot home to a fire and it was insured for $200 a foot -- $250,000. But there’s a recent spike in the cost of materials and the real cost comes to $285,000. OUCH! Looks like you’re going to have to dig into your pocket for $35,000! Not so with the policies we write in our office. Our company offers you, AT NO EXTRA CHARGE the GUARANTEED EXTRA REPLACEMENT COVERAGE at an additional 20%. Your $250,000 will actually pay you up to $300,000 to rebuild your home.

With GERC, your policy for $250,000 will actually pay you up to $300,000 to rebuild your condo. And OH BY THE WAY... This is included automatically at no additional premium on ALL of our condo policies!

And don’t forget EARTHQUAKE coverage. I know there’s a lot to think about. So let us help you remember all of it. One step at a time.

This can be so simple and easy to do.

We do all the work for you and in less than 30 minutes, you’ll have protected your condo, your personal property, your current assets and your future earnings.

Why somebody wouldn’t buy CONDO INSURANCE this way is simply beyond me.
BUT LET ME MAKE A LITTLE EASIER FOR YOU…

In our agency we offer you 5 different ways to pay for this. You have your choice of Annual, Quarterly, Semi-annual, monthly and SPECIAL MONTHLY…
“So what’s so special about SPECIAL MONTHLY,” you might ask.
It’s special cuz it’s just so insanely easy.

We set it up for you and your monthly payment comes right out of your checking account: Same day; Every month.

(of course of your insurance is already part of your house payment, we’ll set things up so that continues just as it’s always been for you)

So, here’s what you get…

• Coverage for your condo: The right amount so you sleep well.
• GUARANTEED EXTRA REPLACEMENT COST for your condo. AN ADDITIONAL 20%
• Coverage for your stuff: TV, stereo, blender, dishes, clothes, etc.
• This coverage at REPLACEMENT COST (as I explained above)
• Liability Protection. (assets AND your future earnings)
• A place to live while we put your place back together
• We’ll walk you thru the whole process (probably will take less than 30 minutes)
• Confidence that you’re buying the insurance you need: NOTHING MORE, NOTHING LESS

It Just doesn’t get any better -
OR EASIER - than that…

You’ve got everything to gain and NOTHING to lose.
I look forward to talking with you soon!

It's a Good Life !

Dennis Volz Insurance Agency
10783 Jamacha Bl, Suite 1, Spring Valley, CA 91978
OFFICE: (619) 670-1000 - FAX: (619) 670-1121

eMail:Dennis@DennisVolzInsurance.com

Websites: Company Site: DennisVolzInsurance.com

Client Convenience Site: 6701000.com

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Word Problems

No, not that kind of word problems. More like this kind:

When is a rate reduction not a rate reduction?

When it's tied to buying another product. As in this lovely little offer that I recently received from our UHC service rep: "My UW [ed: underwriter] has provided 3% rate relief, off your groups medical rates, if you add any of our ancillary lines...dental...vision...or life."

A few simple words, and I blew my stack.

Why is that, you ask? Let's rephrase this, and perhaps it will become more apparent:

"We're offering a one-time, multi-policy discount on your group health rates if you also purchase dental, vision or life coverage. In fact, this discount could pay for itself."

(NB: I had to add the "one-time" bit because they already offer an on-going "package" discount)

So why would one phrase give me the warm fuzzies, and a simple re-wording send me through the roof?

Call me old-school, but when a carrier rep says "underwriter" and "rate relief" in the same sentence, it implies a whole series of specific processes and decisions, the results of which should be completely independent of whether or not we buy an additional line of coverage.

In fact, wording it in such a way strikes me as just shy of extortion ("(t)aking money by force, threats or deception or by excessive overcharging"). After all, if we're healthy, why not just offer the lower rates? In fact, if the underwriter has determined that we qualify for lower rates, isn't the carrier obligated to just put them in place?

Why not?

But recasting this as a completely separate business decision (which, after speaking with the rep, I came to understand it to be) makes it an attractive offer, not a thinly veiled attempt at squeezing even more premium.

As they say, "words mean things." And sometimes, they mean things we don't intend.

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Grand Rounds is up!

Nurse Kim hosts this week's 'Rounds, and it's Dynamite! (Napolean Dynamite, that is). Kim does a great job of weaving together snippets from the film with great medblog posts.

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Eraser

"Who are these children and why are they calling me Mom?"

Wouldn't it be nice to be able to forget bad memories? What if there were a pill you could take to wipe out the memory of bad things that happen in your life.

According to my wife, I don't need such a pill. She claims I already have selective memory.

And a hearing problem.

But I digress.

Dutch researchers have discovered that taking a generic beta-blocker "significantly weakened people's fearful memories of spiders."

So much for a fear of spiders, but what about other things?

The findings published in the journal Nature Neuroscience are important because the drug may offer another way to help people suffering from post-traumatic stress disorder and other problems related to bad memories.

That sounds promising.

And here is some good news as well.

Propanolol is not some new miracle drug. It is generic and available for $4 at many pharmacies.

That's cheaper than getting drunk to forget.

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Asking the Wrong Questions

If you ask the wrong question, you will never get a right answer.

Roland Burris, newly appointed to the U. S. Senate to fill the vacancy of Barack Obama was repeatedly asked if Governor Rod Blagojevich had solicited donations or any form of remuneration in exchange for the appointment.

According to testimony, and news conferences, the answer was emphatically "no".

Now comes word that, while it is apparently true that Gov. Rod Blagojevich did not ask for money, his brother, Rob Blagojevich DID ask for money in the form of campaign contributions.

So if you ask the wrong questions, you will never get the answer you really want.

Same is true when shopping for insurance.

If you ask the wrong questions, you will never get the right answer.

"Are prescription drugs included in this plan?"

"You will receive a discount on medications equal to the lowest price negotiated by the carrier."

Note: Receiving a discount is not the same as covering the drugs as part of the major medical. Your discounted price for Abilify will be $450 but the carrier will never actually pay for the drug.

"Is my blood pressure medication covered under this plan?"

"There is a rider for blood pressure medication but you may still receive the discounted price"

Note: Many people will dismiss this as insignificant since many BP meds are available in generic form for $4. Most, but not all, riders exclude coverage not only for the named medical condition but anything that could be related to high blood pressure. This means, no coverage for heart attack, stroke, renal failure. However there are some riders that are not as broad and will only restrict coverage to outpatient treatment of the high blood pressure.

"Is maternity covered?"

"Yes."

Note: Most major medical plans issued in Georgia are required to cover complications of maternity but may not cover normal delivery. Most, but not all, plans covering females of child-bearing age require an extra premium to cover normal delivery. Most, but not all plans have waiting periods of up to 12 months before maternity is covered. And just what are complications? It varies by carrier. Even if you have maternity coverage, once the pregnancy becomes "complicated" you start a new deductible and most people do not know that.

Why?

Because they asked the wrong questions.

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