Health Insurance A Necessity Of Life

Not everything in life goes smoothly or as we expect it to. That is why it is important that we should always be careful. Insurance of any kind is important to cover up for the uncertainties that may occur in future.

However the insurance that is most important to have is the health insurance as we can afford not to have the other insurances but the absence of health insurance can prove to be fatal not only for us but also for people around us as well.

There are different types of health insurance policies person who wants to get insured can choose the policy suits them the best. The two main types of policies are

1. Free – for – service insurance also known as indemnity insurance this is a traditional type of health insurance that pays the portion of each medical service you get like doctor’s visit and hospital stays while you pay the remaining costs. Premiums are higher than the other policies.

2. Managed care plans also known as HMO’s (health management organizations) or PPO’s (preferred provider organization). In this case the health insurance company has a contract with doctors and hospitals to provide you service. In this type of health insurance you pay monthly premiums and a small amount per visit called co pay. You can use the advice of other doctors as well by paying a higher amount of co pay.

The best way to go in for the health insurance is through a broker. You can choose your broker depending upon your requirements. A broker can get you a good health insurance policy as well as give you information on several key features of the policy in general. Like:

• What is the monthly premium?
• Is the policy guaranteed renewable/non cancelable or just guaranteed renewable?
• Are premium rates based on age of attaining the policy or using the features of policy?
• Does the plan pay for catastrophic medical costs?

You can answers to all the questions and more if you take the help of the brokers in your health insurance policies.

The health insurance organizations offer you different deductibles with larger the deductible the lower the monthly installments. You can choose a deductible of 50% to 80%. It all depends on your conditions.

Individuals with pre existing conditions for example, they have a health problem before going in for health insurance find it difficult to get health insurance coverage. However depending on your state you can choose any of the following policies. They are: open enrollment, health insurance provability and accountability act (HIPAA), high risk pools or temporary coverage.

The borrowers can choose from the myriad of resources that deal in health insurance.

Life is uncertain that’s why it is essential that we have insurances with us and every member of our family to live life with a reasonable amount of certainty. Also health insurance has plenty of features which help us in times that we feel a little vulnerable. So it is important that we go for a policy of health insurance.

Read More

Well, well, what have we here?

From Bloomberg (the news service, not hizzoner the mayor):

"Drugmakers led by Pfizer Inc. agreed to run a “very significant public campaign” bankrolling political support for the 2010 health-care law, including TV ads, while the Obama administration promised to block provisions opposed by drugmakers . . .

Whole lotta backscratchin goin on.  For whose benefit?  Yours?  Mine?  Well, not exactly:

 “President Obama’s efforts to enlist the support of private industry are exactly what presidents have always done to enact major legislation,” U.S. Representatives Henry Waxman of California and Diana DeGette of Colorado said in a joint statement"

Exactly. 

And isn't that absence of transparency exactly, precisely, and without doubt one of the principal problems that occurs so often in Washington? 

Read More

Small Employer Health Insurance Tax Credit

The Small Employer Health Insurance Tax Credit, part of the grand scheme of Obamacare to overhaul the current health care system and make health insurance affordable, is another money hole and dismal failure.

According to the Government Accounting Office:

Fewer small employers claimed the Small Employer Health Insurance Tax Credit in tax year 2010 than were estimated to be eligible. While 170,300 small employers claimed it, estimates of the eligible pool by government agencies and small business advocacy groups ranged from 1.4 million to 4 million.

That's fewer than 10% of the estimated eligible groups who said thanks, but no thanks, to a tax credit.

If the government can't even GIVE money away, what does that say about the way they are going to manage health insurance going forward?

One factor limiting the credit’s use is that most very small employers, 83 percent by one estimate, do not offer health insurance. According to employer representatives, tax preparers, and insurance brokers that GAO met with, the credit was not large enough to incentivize employers to begin offering insurance

Well yeah, that's a problem all right. You would think the brainiac's in DC would have considered that. But then these are the same folks that pass laws without ever bothering to read them before they vote on them.

The base of the credit is premiums paid or the average premium for an employer’s state if premiums paid were higher. In 2010, for small businesses, the credit was 35 percent of the base unless the business had more than 10 FTE employees or paid average annual wages over $25,000.

Even a 35% direct tax credit failed to provide enough incentive for businesses to provide health insurance if they did not do so already.

This won't improve in 2014 and there is no reason why it should. Of course, small businesses (those with fewer than 50 employees) are not penalized for failure to provide health insurance. In addition, most low wage employees will get their health insurance through the Medicaid expansion as ordered by Obamacrap.

Of course the states can't cover their current Medicaid costs so one wonders where the money will come in 2014.

Somehow this hope and change thing doesn't seem to be working too well. I hope those who voted for change the last time will have become a bit wiser and educated in the interim.

Read More

No-High Weed

From time to time, we've written about medical marijuana. One of the potential arguments against its use is that simply saying "it's for medicinal purposes" seems somewhat disingenuous.

Now comes word of a pot breakthrough:

"Israeli scientists have cultivated a cannabis plant that doesn't get people stoned in a development that may help those smoking marijuana for medical purposes ... the new cannabis looks, smells and even tastes the same, but does not induce any of the feelings normally associated with smoking marijuana"

Interesting development.

Read More

Travel Insurance – Is It Necessary For A UK-Based Holiday?

Just over a month ago, my boyfriend and I decided to visit the beautiful city of Edinburgh for our 5 year anniversary. We live in Dorset, so we didn’t want to spend the whole time travelling. To make the trip easier on ourselves, we decided to fly there, and used a travel agent to organise the week long holiday. Imagine my surprise when I saw an additional £27.50 on the quote for travel insurance! We were only going to Edinburgh, not Pittsburgh!

I was offended that they thought we would be so stupid as to get travel insurance for a trip within the UK. They have hospitals in Edinburgh, and it really isn’t very far away. But later on, over a cup of hot chocolate, I put some more thought into it.

Holiday disasters can happen anywhere, not just abroad - so I made a list of what could feasibly go wrong:

· One of us could fall ill before we depart, we’d have no choice but to cancel the trip. The flights and the hotel were non-refundable, so we’d have to pay anyway.

· My Grandfather has been ill lately, if he got suddenly worse then I wouldn’t be able to go on holiday. Again, the trip would have to be cancelled.

· Either of us could be called up for jury service at any time.

· Flights are delayed and cancelled all the time. On top of the inconvenience, we may need to arrange an overnight stay near the airport.

· Anything could happen to our luggage, airlines lose suitcases all the time.

· My boyfriend bought me a wonderful digital camera as a present, if I lost it, it would be very expensive to replace.

Hang on a minute, what about our Home & Contents insurance policy? I bet that would cover us for loss of luggage or my camera as long as I was in the UK. I found the policy and read the small print. No such luck, only ‘personal possessions’ that were listed on the policy counted, so everything in the luggage wouldn’t be covered, and I’d need to make a phone call to get the camera included on the policy.

I remembered something else – we had over 4 years of no claims discount on our Home & Contents policy. If we had to make a claim, we’d lose the no claims discount. Our premiums would go sky high after that, they were already high enough as it is, at £305 a year. I realised that I really should look for a cheaper Home & Contents policy at the time of renewal, and promised myself to do that in future.

After the investigations I had made so far, I realised that £27.50 for a travel policy wasn’t actually too bad.

I’ve never been one to rest on my laurels though. I might have decided that travel insurance was a good idea, but it didn’t mean I was willing to accept the price quoted by the travel agent.

I went online to get some more quotes. The first two or three sites I looked at couldn’t give me what I wanted, but 10 minutes later, I struck gold. I found a single trip travel policy for the UK, and it was a good £10 cheaper than the travel agent’s quote.

I read the small print, no point signing up without knowing all the facts. I was pleased to see all the points I had listed were covered.

Now the exclusions – was it all too good to be true after all? Phew – no need to worry. If the holiday was less than 25 miles from our home address, or for less than 2 nights, then we wouldn’t be covered. No problem there. Otherwise the only downside was that we’d have to pay the £30 if we needed to make a claim. Fair enough.

Happy with the policy I’d found and with the decision that we did need travel insurance after all, I bought the travel insurance policy there and then.

Read More

Yeah, about that 3000% Premium *Decrease*

"Curtis Johnson got the shock of his life yesterday when he opened a letter from Clearwater Christian College and discovered that his student health insurance fee was going to more than double – thanks to [ObamneyCare©]."

Ooops.

Read More

Alphabet Soup News

CongressCritters will be working on tweaking Health Savings Account (HSA) and Flexible Spending Account (FSA) rules tomorrow:

"One of the bills, for example, H.R. 5842, the Restoring Access to Medication Act bill, would restore health account holders' ability to use HSA and FSA cash to pay for over-the-counter medications not prescribed by physicians."

As we've pointed out before, this rule made no sense at all to begin with. Aren't we supposed to be using less health care?

"Other bills up for consideration could make it easier for FSA holders to get back or roll over unused balances at the end of the year."

Again, one of the major problems with FSA "use it or lose it" requirements is that it encourages profligate spending.

"A third bill up for consideration, H.R. 5858, would let early retirees over the age of 55 use HSA funds to pay for health insurance without paying income taxes on the distributions."

Currently, HSA funds can only be used to pay for (some) Long Term Care (LTCi) and COBRA premiums, and Medicare premiums once one hits the magic 65.

Read More

Nail number 27 in the Coffin

HHS recently released new guidelines outlining who can be a provider in a hospital setting.  The headline reads:
 

HHS FINALIZES NEW RULES TO CUT REGULATIONS FOR HOSPITALS AND HEALTH CARE PROVIDERS, SAVING MORE THAN $5 BILLION

“Today, Health and Human Services (HHS) SecretaryKathleen Sebelius announced significant steps to reduce unnecessary, obsolete,or burdensome regulations on American hospitals and health care providers.“

Four changes were announced, including this one:

“Require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members.”

With this change, an APRN (Advanced Practice Registered Nurse) or PA (Physician's Assistant) can do everything a doctor can do at an 85% reimbursement rate of a doctor.  The government will save significant monies if they are paying 15% less for the same service by virtue of the fact that a doctor is not performing the procedure.  One of the stated advantages is to free up doctors for more complex cases, but the real advantage is financial.  In addition to collecting less, these mid level providers also cost a hospital less with salaries being half that of a physician.  So, even though the hospital will get a reduced payment, they will not have the overhead associated with doctors.

If these rules are approved, then hospitals will be able to reduce their physician staff to the bare minimum to handle the more complex cases and hire on less expensive APRN’s and PA’s to do the work currently being done by Doctors.

Read More

Summer Travel Insurance

Travel insurance for summer vacation. Luxury or good idea? What to look for, and what to look out for.

The Georgia Dept. of Insurance issued a public service memo offering advice on what to consider in evaluating travel insurance.              

Some travel insurance can protect against the loss of non-refundable travel costs such as air fare or hotel costs. Other travel insurance plans offer protection against financial loss due to medical emergencies, damage to personal property and death.

• Trip Cancellation - Reimburses you for pre-paid travel expenses if you have to cancel your trip due to unforeseen situations such as illness, death or other conflicts.
• Travel Delay - Reimbursement for out of pocket expenses if you have to delay your flight due to circumstances beyond your control, such as flight delay or cancellation.
• Medical or Health - Reimburses out of pocket expenses for medical or dental emergencies, including those not covered by your major medical plan.
• Medical Evacuation - Transport to a hospital near your location or back home.

Air ambulance charges, even for local transport, can run $5,000 or more. If you have to be returned to your home country, a charge of $30,000+ is not out of the ordinary.

Another concern, especially when traveling to a foreign country, is the need for translation of medical records. If you have something serious enough that may require follow up treatment, your doctor(s) back home may not have the ability to read Mandarin. Translation of medical records can easily run in the thousands but is a common benefit included in travel insurance plans.

If you are on Medicare you should be aware that you have no coverage outside the U.S. borders in most cases. Some (but not all) Medigap plans have limited coverage up to $50,000 for travel outside the United States.

Travel insurance policies are written on a "stand alone" basis but are best used as an adjunct to major medical coverage. As Karl Malden used to say, "Don't leave home without it".

Read More

Cavalcade of Risk #158 at Nina's Place

 Nina Kallen hosts this week's round-up of interesting and insightful risk-related posts, including some interesting personal anecdotes.

Read More

The problem critical health insurance of non-disclosure

If you are in the unfortunate situation of having to make a claim on your critical illness insurance policy, the last thing you want is insensitive discomfort or not apparent cooperation of its insurer. But according to numerous newspaper articles, it is precisely what is happening. The basic problem is that before that you will have to pay, the insurer will want always to do thorough research about their health history. While we will have provided much similar information when you apply initially for the cover, insurers now insist that all the information is routine. And if at the time that you said that it wasn't a smoker, now they want this verified by your doctor.

The reasons are obvious. It is in front of a big demand, usually is about £ 100.00, and they want to be sure that you told the truth about his health when he applied for the first time. This means that it has now claimed, you crawl on your medical records in great detail checking had revealed all about its implementation. Every small and seemingly insignificant detail will be intense scrutiny. The problem is that their batteries of correspondence can be quite upsetting for you.

Insurers defend its procedures saying that they need to be sure when they accepted the business, revealed the truth about the factors that affect their health. They want to be sure to not cheat by omitting certain information in order to make the company to issue a policy when otherwise could not, or to help you to get a lower premium. Either way, not disclosure as they call it, deception and a valid reason for them rejects his claim. Even regardless of whether the information omitted ultimately had nothing to do with disease giving rise to the claim. The position of insurance is that each piece of information you provide was used to develop his cousin and any failure affects the calculation.

Insurers are particularly suspicious if the claim in the first five years of the policy. Any claim arising during this period is classified as a "claim of principle" and insurers are particularly vigilant to insured persons who took out critical illness insurance as suspecting that they were already sick.

The problem is that this intense scrutiny attracts a very bad press. If you are very sick and distressed, the last thing you want is many questions and arbitrary trouble to your insurer.

It is certainly a conflict here. If they are going to neutralize the bad press, insurance companies must work harder in softening the research process and must offer much more closely with their applicants. Insurers must submit a much softer Centre a more distressing moment for the claimants.

All this adverse PR has had two effects on the market of critical illness insurance. Applicants have apparently been favoring insurers that published lowest rejection rates and others have been removed from any application.

In practice, avoiding insurers who publish high rejection rates has few benefits. This is because the published figures can be misleading. The latest figures show that Scottish equitable protect has refused to pay 28% of critical illness claims followed closely by Friends Provident by 25%. If you compare these figures with Scottish Provident in 13.7%, many potential policyholders can be forgiven for favoring Scottish Provident. But that is not necessarily the best decision.

The problem with the interpretation of these figures is that the figures may Yes be distorted by how long the insurer has been active in the market of critical illness. As rejection rates are higher with policies that have executed only during a few years, and then, companies that are new in the market of critical illness will automatically have the highest rates of rejection. This leaves companies such as financial services Guardian looking good with a rate of rejection of only 10%. The truth is that the guardian has been on the market for more than 15 years and has a mature book of business.

And it is a pity that all this negative publicity has undermined confidence in critical illness insurance. In our opinion, this insurance plays an important role in the protection of family finances, but people are being deterred from buying it, leaving their family unit exposed if you get seriously sick. After all, if the supplier of the main source of income is taken seriously ill, they can falling family incomes. This means that the amount of taxes paid by these policies may be essential for the financial survival of the family.

Our advice is if you think you need critical illness cover press in. But keep in mind that these policies vary widely in coverage-, by what straight price comparisons are not really significant. Basic plans will cover one or more of the conditions more serious but comprehensive plans cover many more: for example: Alzheimer Aorta disease graft surgery anemia aplastic benign Bacterial Meningitis brain tumor blindness cancer cardiomyopathy CLD Coma Creutzfeldt - Jakob disease-coronary artery bypass surgery deafness dementia infarct replacement of heart valves or repair HIV or AIDS of an assault, transfusion of blood, labour duties or accident Keyhole heart surgery kidney failure loss of loss of limb loss of principal organ independent existence speech paralysis/paraplegia neural Motor Parkinson's disease progressive multiple sclerosis Supranulcear stroke paralysis third degree burning Total and permanent disability cover for children this complexity means that really need independent advice transplant. There are plenty of websites that can help you. Only seeks to "insurance critical illness" and make sure that you can speak with an adviser before you buy.

Read More

Jessco, Inc. v. Builders Mutual Insurance Co.: Part II - Appellate Attorney’s Fees and Costs

Here is Part II of our blog series regarding Jessco, Inc. v. Builders Mutual Insurance Co. 

Post by Logan Wells

You can read Part I here, which details a recent opinion of the United States Court of Appeals for the Fourth Circuit that addresses a multitude of issues presented in litigation involving commercial general liability policies – the “your work” exclusion, late notice, and the duty to indemnify.

On May 3, 2012, in Jessco, Inc. v. Builders Mutual Insurance Co., upon remand by the Fourth Circuit, the United States District Court for the District of South Carolina amended its previous Judgment and deducted $10,000.00 from the total amount previously awarded, $78,695.20, finding Jessco, Inc. (“Jessco”) was entitled to a judgment in the amount of $68,695.20 plus post-judgment interest. In the same order, upon Jessco’s Amended Motion for Award of Fees and Costs After Remand, addressing an issue of first impression, the court held that Builders Mutual Insurance Co. (“BMIC”) was obligated to pay Jessco’s attorney’s fees and costs incurred on appeal.

Citing Hegler v. Gulf Insurance Co., 270 S.C. 548, 550-51, 243 S.E.2d 443, 443 (1978), the court noted South Carolina courts have found an insured may be entitled to reasonable attorney fees and costs incurred in successfully defending a declaratory judgment action brought by the insurer in an effort to relieve itself of coverage under an insurance policy, reasoning that:

[A]n insured must employ counsel to defend — in the first instance in the damage action and in the second in the declaratory judgment action to force the insurer to provide the defense. In both, the counsel fees are incurred because of the insurer's disclaimer of any obligation to defend.

If the insurer can force [the insured] into a declaratory judgment proceeding and, even though it loses in such action, compel him to bear the expense of such litigation, the insured is actually no better off financially than if he had never had the contract right mentioned above.

(Alteration and emphasis in original). However, whether an insured is also entitled to recover attorney fees and costs incurred on appeal when (1) the insurer appeals the trial court’s ruling for the insured in a declaratory judgment action, and (2) the appellate court affirms the lower court’s judgment with regard to the insurer’s duty to defend, had never been addressed by the South Carolina courts.

In support of its motion for attorney fees and costs, Jessco argued that whether the fees and costs arose in the context of a declaratory judgment action or in its appeal makes no difference; because in either case, the insured is doing nothing more than attempting to protect its contractual right to a defense. Thus, Jessco argued, the rationale in Hegler for providing relief to an insured that is “forced” into a declaratory judgment action and wins should apply equally when the insured is forced to defend its rights in the appeal of that action and wins. In opposition, BMIC argued the reversal by the Fourth Circuit as to BMIC’s duty to indemnify Jessco for the re-grading allowance necessitated a finding in favor of BMIC on Jessco’s motion. The court rejected BMIC’s argument, noting that South Carolina courts have established the duty to defend is separate and distinct from the duty to indemnify, and Jessco’s motion sought payment for fees and costs as damages suffered by Jessco for BMIC’s breach of its duty to defend, not its duty to indemnify. See USAA Prop. & Cas. Ins. Co. v. Clegg, 377 S.C. 643, 654, 661 S.E.2d 791 (2008) (quoting Sloan Constr. Co. v. Cent. Nat’l Ins. Co. of Omaha, 269 S.C. 183, 186-87, 236 S.E.2d 818 (1977)).

BMIC also argued there was “simply no legal authority” supporting an award of appellate fees and costs. However, BMIC failed to produce any authority demonstrating that Hegler did not apply to support such an award. In response, Jessco acknowledged that the motion presented a novel legal issue, but argued there was no logical reason why Hegler did not apply to fees and costs incurred on appeal. The court agreed with Jessco’s reasoning, finding as follows:

When BMIC appealed the declaratory judgment action, it was still seeking to avoid its obligation to defend, just as it sought to avoid its' duty to defend at the trial level. Thus, after prevailing at the trial level, Jessco was forced into the appellate process by BMIC, thereby bearing the expense, just as it was forced to bring the initial declaratory action to protect and enforce its rights. Jessco prevailed at the trial level, and on appeal, the Fourth Circuit found BMIC had a duty to defend and affirmed this Court's judgment and damages award on that issue. Hegler held that an insured is entitled to recover attorney's fees and costs following a successful defense of a declaratory judgment action. See Hegler, 270 S.C. at 548 (emphasis added). The holding in Hegler necessarily encompasses fees and costs incurred at the appellate level of that action. The appellate expenses, like the trial level expenses, are damages arising directly out of the insurer's breach of its duty to defend. Therefore, the Court finds that Jessco is entitled to recover reasonable attorney fees and costs of defending this action on appeal from BMIC, just as it was at the trial level. See Hegler, 270 S.C. at 551 ("After all, the insurer had contracted to defend the insured, and it failed to do so. It guessed wrong as to its duty, and should be compelled to bear the consequences thereof.").

The court also found that Rule 222, SCACR did not prohibit an award pursuant to Hegler, and further, did not divest the court of authority to make such an award:

Sections (a) and (b) of Rule 222 state: "When an appeal is affirmed or reversed in part or is vacated, costs shall be allowed only as ordered by the appellate court." "In addition, the party shall be entitled to recover an attorney's fee in an amount which shall be set by order of the Supreme Court." Rule 222(b). However, the Rule "`does not preempt an award of attorney's fees to which one is otherwise entitled.'" Muller v. Myrtle Beach Golf & Yacht Club, 313 S.C. 412, 416, 438 S.E.2d 248 (1993) (citing McDowell v. S.C.D.S.S., 304 S.C. 539, 543, 405 S.E.2d 830 (1991)). Thus, the Court may grant an award pursuant to Hegler because the authority pursuant to Hegler and the authority vested in the court of appeals pursuant to Rule 222 are not mutually exclusive.

Noting that, upon remand, the district court had jurisdiction to enforce the judgment and take any actions consistent with the Fourth Circuit’s ruling, and the Hegler rule did not limit the collection of attorney fees to a specific court or level of courts, the court found it could properly award appellate attorney fees and costs to an insured as damages flowing from an insurer’s breach of its duty to defend. Accordingly, the court granted Jessco’s Motion for Award of Fees and Costs After Remand.

Read More

Pioneering MassCare, Part Deux

Last week, Kelley posted on the folly of taxing the "RichDoctor," including a video on that new MassCare scheme. Today, the Pioneer Institute presents the second video in that series.

In the video, Josh  Archambault (Pioneer's Health Care Policy Director) interviews Brian Rosman (Health Care for All's Research Director):

Read More

Medicare at Risk

Medicare is at risk and in desperate need of reform. With 48 million on Medicare and an aging baby boomer generation, Medicare must be overhauled before it goes bust.

Medicare at Risk: Visualizing the Need for Reform

View more presentations from The Heritage Foundation

Medicare became law in 1965 under President Johnson.

Since that time the number of people covered by Medicare has expanded while the number of workers paying Medicare taxes have shrunk. Roughly 88% of Medicare benefits are paid for through payroll taxes.

If Congress decides to cover the funding deficit through increased taxes, the amount a median family pays will jump from $1430 to almost double at $2630 per year.

Obamacare makes things even worse for seniors by cutting $421 in Medicare funding in order to pay for health insurance for the uninsured. Obamacare also dramatically cuts reimbursement to doctors and other medical personnel under the guise of saving money.

The next time you are with your doctor ask them how the feel about taking a 27% pay cut for treating Medicare patients. How would you feel if, in order to save Medicare, Congress decided to cut your Social Security benefits by 27%?

Currently the unfunded liability for Medicare and Social Security exceeds $40 trillion and the share of that burden for our children and grandchildren is roughly $200,000 each.

You can learn more about a Heritage proposal called Saving the American Dream at their website (just follow the link).

Read More

Late to DIAM

That would be Disability Insurance Awareness Month, which is (or, was) May. Well, better late than never.

Do you know how much money you'll make over your lifetime? It may well be more than you've considered. And, of course, disability insurance helps protect those potential earnings, keeping food on the table and a roof over our heads.

But how to quantify that?

The folks at the Life and Health Insurance Foundation for Education (LIFE) have made available from helpful calculators to make that easier.

Just click here, and have at it.

And once you've figured out how much you'll make, and decided you want to protect it, contact your local, independent agent for recommendations.

Read More

Dental Insurance

Dental costs are becoming an increasingly significant health care expense and more and more people are making sure they are protected against these costs with a dental insurance policy. Dental insurance policies typically work in the same way as any other medical insurance policy. You will pay your monthly premium and this will entitle you to specific dental care procedures such as checkups, cleaning and x-rays. You will also be covered for other procedures that are deemed necessary to keep your teeth and gums in good health.

Comprehensive

As with all insurance policies, they will vary in what treatments they cover and how much they cost. While more expensive policies will give you greater benefits and allow you access to a greater range of services, cheaper ones will be restricted in what they cover and you will be required to contribute to the cost of procedures you require. If you think you will need dental surgery, oral implants, the services of an orthodontist and other more expensive forms of treatment, you will probably want to go for a more comprehensive policy.

One of the main differences between medical and dental health care is that children generally require far more treatment and expense than adults do. This is true right up through your child’s teen years when orthodontists’ bills can often be extremely expensive. You may therefore wish to cover only your children with dental insurance and you should check with your insurer to see if this is possible. While some insurance companies will allow children to have their own dental insurance policies, others will only insure them as part of an adult or family plan and if this is the case you will require to insure them with your own dental insurance provider and this may mean taking out dental insurance for yourself if you do not already have it.

Discounts

Another option offered by some insurance companies is to take a form of dental discount card. This is not dental insurance in the strict sense of the meaning but does provide you with discounts on dental treatment when you require using them. They can be a cheaper way of obtaining limited protection against dental costs and for this reason are growing in popularity. Not all insurers will provide them so shop around and see what’s on offer. As with all insurance, there can be great differences is what you will be offered for your money and considering that dental insurance can be a significant expense, it is wise to make sure you know what is available before you decide to opt for any policy.

Read More

Memorial Day - A Time to Remember

Memorial Day is the time when pundits and politicians alike stand and proclaim, "One life lost is one too many." Despite their best intentions, the statement is a hollow cliche that reflects a world as we want it to be versus the realities of the world as it is. It is an empty response that lacks  eloquence and true understanding. It falls desperately short in its attempt to honor those who have laid down their lives for their country or pay tribute to their families who have truly sacrificed for our nation. But what does it all mean in the context of sacrifice, commitment and dedication? A life lost impacts a family, their friends, comrades and the community they represent. One life represents so much more than a number; it is reflective of a community, a county, a state and our nation.


continue reading . . .

Read More

Private healthcare and hopitals

One of the main reasons people choose private healthcare is that it means more control over which geographical location you're seen in the event that you need medical treatment. And also of course it means that there's more flexibility when it comes to arranging treatment times as with most types of policy you can avoid the sometimes lengthy - and often complained about - waiting lists that are a reality for many types of treatment if you're not with a private medical insurance policy provider.

This week it was reported though, that there may be another benefit to private medicine, which is that the infection rates are lower. According to a report in the Independent, "private hospitals had a lower infection rate than the NHS". the picture looks positive overall with infection rates having fallen by a massive 22% since the previous survey in 2006.

In other news this week industry news website hi-mag.com reports that an interesting new clinic has opened up in the heart of London's financial district. Offering biochip technology services to test for up to 250 different symptoms - plus even a cutting edge 'diagnostic stress test' the clinic is sure to be popular with individuals and firms in the area. With big firm or small business health insurance providing employee cover it means that staff health can be managed more efficiently and have people back to work as soon as possible.

Read More

Travel Insurance - Insure Your Trip

You may think that travel insurance isn’t necessary, and that you have planned your vacation perfectly. Things like when to board the flight, where to stay, and when to come back would have been included in your plan; but what if you have to change your plan and get back early? Or what if you met with an accident or fell ill, which of course you were not prepared for? You would end up paying all the medical expenses that are not covered by your health insurance. This is when having travel insurance could save you. It is important that you purchase travel insurance to protect your travel investment.

Types of Travel Insurance:

Most travel insurance companies offer the same packages which include basic travel insurance, and comprehensive travel insurance. There are a few general types of travel insurance, however, depending on the insurance company, the coverage and limitations will be different. Given below are some of the common types:

Trip Cancellation: This is the most common and the most important type of travel insurance. Incase your trip gets cancelled because of any unforeseen circumstances, you don’t have to worry about your tickets not being refunded or bear the burden of the money spent, as this type of insurance will cover all these non-refundable payments or deposits.

Trip Delay: This type of insurance is also very helpful incase of any break in your travel plan, for example, say you have to take a connecting flight only to find that it has been cancelled or delayed for a few hours, what do you do? You take the next flight to get home. You don’t have to worry about the extra money spent by you on the ticket. In this case, if you have trip delay insurance, your money will be reimbursed.

Trip Interruption: If your trip gets interrupted due to any unexpected calamity, you don’t have to bear for the lost vacation. Your money will be reimbursed if you have trip interruption insurance.

Baggage/Personal Effects Loss or Delay: This is also a very common type of insurance. It will cover losses if your baggage is lost or delayed, or if any of your stuff gets damaged.

Travel Document Loss: Having this type of insurance will save you from situations such as a stolen or lost passport. Staying in a foreign country without your password would create problems, but you need not run places looking for emergency cash to get it replaced, as this insurance will take care of that.

Accident/Sickness Medical Expenses: If you fall ill anywhere during your travel, you don’t have to worry about the extra expense. This insurance will cover the cost for you.

Medical Evacuation/Emergency Transportation: In the case of a medical emergency during your travel, this insurance will cover expenses such as the transportation charge to the hospital.

Supplier Default: This insurance will cover any payments or deposits lost because of the bankruptcy of a travel supplier.

So next time you plan a trip, do get travel insurance to ensure a safe trip and peace of mind.

Read More

Catastrophic health insurance coverage

A catastrophic insurance or major medical plan is a deductible form and relatively inexpensive health with an element of speculation that insurance. A deductible is the amount you pay out-of-pocket for medical expenses before that the insurer pays the balance. For example, if your deductible is $5,000 and the hospital bill is $12,000, the insurance company will pay only $7,000. The general rule is higher the deductible, the lower the premium. Opting for this plan, is betting that you will not face major medical problems in the near future.

It is a calculated risk. According to a survey, annual medical expenses of 90% of the U.S. population are less than $2000; 73% of the population is below $500.

Two groups that normally opt for catastrophic health insurance are young people in their twenties who are confident of their State of health and older men in their fifties and sixties and five who are still waiting for Medicare eligibility.

Catastrophic health insurance coverage only seeks to protect against hospital important positions and non-routine medical expenses. Normally does not cover maternity, visits to the doctor and prescription care. Certain pre-existing medical conditions and cases of mental health and substance abuse are normally excluded from coverage. You can purchase an insurance policy of health catastrophic as an individual plan or part of a group plan. In fact, it seems to be a tendency among employers to encourage employees to opt out of this type of medical coverage. The maximum limit of life could be as high as 3 million dollars.

Rates vary depending on where you live and your age. In some States, savings premiums could be two-thirds. For example, a 21-year-old woman, smoking can pay as little as $30 per month as a bonus.

It is advisable to seek professional guidance of agents or insurance companies and compare quotes before making a decision.

Read More

Question: Need Lower Costs? Answer: Higher Taxes !

 Kelley recently posted a thoughtful comment on what Massachusetts has been up to:

“Providers that charge prices deemed excessive and that they cannot prove are linked to above-average quality would pay a tax”

Additional taxes on physicians to reduce excessive medical cost? Yeah, that’s gonna work.

IMO, Physicians are getting a bum rap from people who blame them for rising medical insurance premiums. Yes, rising physician fees are among the reasons – but that cannot be the main reason.

First the big picture: physician charges, primary and specialists together, are + / - 30% of total national medical care spending.  (In the employer medical benefit plan I once managed, physicians’ charges amounted to 37% of our total yearly cost).  To blame rising premiums on a single component equal to 30% of the total medical spending is clearly wrong.

It’s true that insurance premiums rise because per capita medical costs rise.  So the right question is much broader: Why do medical costs rise?

I believe there are four main reasons:

1.  Aging population

Older populations have more chronic conditions that are more expensive to treat than conditions prevalent in a younger population.  (I assume everyone agrees that a “Soylent Green” strategy is no solution). 

2.  Impact of technology  

Modern innovations in medical care have generally been more expensive. (I assume everyone also agrees atorvastatin should remain on the market, along with MRI’s, laser surgery, and the multitude of examples of modern medical care that have value - not simply cost).

3.  Consumption of a more expensive mix of services year by year

A more expensive mix of services each year means the overall cost of medical care rises, even if not one physician raised her fees.  I almost never see this factor mentioned. 

It appears this change in mix results mainly from

(a) growth in the ratio of specialists to total physicians 

(b) evolution of more costly medical specialties (e.g., diagnostic radiology), driven by technology 

(c)  “downstream” impact on hospitals that must support the new kinds of treatments including necessary equipment/devices.   

4.  Overinsurance - insurance that reimburses medical expenses virtually in full. 

Medical professionals and institutions whose patients have their fees paid virtually in full have no incentive to find ways to reduce them.  And patients have no reason to care, or ask, if there may be perfectly adequate treatment alternatives that are less costly.

Are American policy decisions based on correct diagnosis of the problems we face?  For example, can anyone demonstrate whether Americans consumed too much care in 2009 or whether we consumed too little in 1980?  Why has the emergence of newer, super-specialty treatment not reduced the trend in total cost?  What is the evidence that the growth in specialist care is producing better outcomes - even for the same cost? How can medical care be delivered in many other nations with arguably comparable outcomes to the U.S. but at much less cost?   And by the way, if services are paid essentially in full by a third party - private or government, doesn’t matter – does it make sense to blame physicians for filling in numbers on what amounts to a blank check provided by the third-party payers?  The answers carry enormous policy implications.   IMO, the fees that physicians charge for their services are much less significant than these answers.  

Yet America has now been committed to specific “reforms” that don’t appear to consider, much less answer these questions.  Our health policy leaders and pundits have done a remarkably poor job explaining why.  In any case, I suspect that the answers aren’t to be found in any legislative body that behaves as though higher taxes are the right answer to every problem.

Read More

Health Insurance And High Deductibles

When most people learn that their family's health insurance coverage is going to cost more, they shop for a more affordable policy. Often the solution is a combination of an insurance plan and a tax-sheltered Health Savings Account.

More than 1 million Americans have made a similar choice, signing up for high-deductible health insurance policies and associated HSAs since the program was introduced in late 2003 according to the Washington-based industry group, America's Health Insurance Plans.

The new plans are a bit complex, but a growing number of insurers offer them.

Under federal law, the policy must have a minimum deductible of $1000 a year for an individual and $2000 for a family; maximum out of pocket expenses; for example, copayments required for surgical procedures, cannot exceed $5100 for individuals and $10,200 for families.

People Help With Their Own Health Insurance

Policyholders, meanwhile, can set up HSAs that they fund with their own money. Employers also can contribute to their workers' HSAs. HSA contributions, generally set an amount equal to the policy's deductible, can best be used to cover health care costs, and unused money can be carried over at year's end. This differs from company sponsored Flexible Spending Accounts, health care savings plans in which unused money is forfeited after Dec 31 of each year.

Some companies are replacing existing catastrophic health coverage plans with the new plans because they see HSAs as a good way for workers to handle the higher deductibles. Others see them as a way of making workers more mindful of health care spending.

Health Insurance For The Young And Uninsured

The new policies are especially attractive to young singles, people in relatively good health and higher income people who can afford to cover higher out of pocket costs.

The new policies also are attractive to small businesses and the uninsured. Of the new policies purchased through eHealthInsurance, more than 40% were purchased by people with annual incomes below $50,000, almost half were families and more than one-third had been uninsured.

Affordable Health Insurance

It's the affordability. Participants get a lower cost premium and the money they probably would have been spending can be run through a savings account to buy day to day medical services.

More companies will adopt the plans because the trend is that more of the burden for health benefits is going to be moved to the employee.

On the other hand, people who can afford to fund the HSAs and don't need to draw them down entirely to cover annual medical expenses will be able to let them grow tax-free. In retirement, the excess savings can be used to purchase long-term care insurance and to pay for other qualified medical expenses.

That means that they're more popular for those approaching retirement age, especially if they don't have company plans available to them.

There are many health insurance alternatives, so it's important that people asses their individual needs.

Read More

Memorial Day Tribute

Luke AFB is west of Phoenix and is rapidly being surrounded by civilization that complains about the noise from the base and its planes, forgetting that   it was there long before they were...  A certain lieutenant colonel at Luke AFB deserves a big pat on the back.  Apparently, an individual who lives somewhere  near Luke AFB wrote the local paper complaining about a group of F-16s that disturbed his/her day at the mall. 

When that individual read the response from a Luke AFB officer, it must have stung quite a bit. 

The complaint: 

'Question of the day for Luke Air Force Base: 

Whom do we thank for the morning air show?  Last Wednesday, at precisely 9:11 A.M, a tight formation of four F-16 jets made a low pass over Arrowhead Mall, continuing  west over Bell Road at approximately 500 feet.  Imagine our good fortune!  Do the Tom Cruise-wannabes feel we need this wake-up call, or were they trying to impress the cashiers at Mervyn’s early bird special? 

Any response would be appreciated. 

The response: 

Regarding ’A wake-up call from Luke's jets' On June 15, at precisely 9:12  a.m .  , a  perfectly timed four- ship fly by of F-1 6s from the 63rd Fighter Squadron at Luke Air Force Base flew over the grave of Capt. Jeremy Fresques.  Capt Fresques was an Air Force officer who was previously stationed at Luke Air Force Base and was killed in Iraq on May 30, Memorial Day.  

At 9 a. m. on June 15, his family and friends gathered at Sunland Memorial Park in Sun City to mourn the loss of a husband, son and friend.  Based on the letter writer's recount of the fly by, and because of the jet noise, I'm sure you didn't hear the 21-gun salute, the playing of taps, or my words to the widow and parents of Capt. Fresques as I gave them their son's flag on behalf of the President of the United States and all those veterans and servicemen and women who understand the sacrifices they have endured ..  

A four-ship fly by is a display of respect the Air Force gives to those who give their lives in defense of freedom.  We are professional aviators and take our jobs seriously, and on June 15 what the letter writer witnessed was four officers lining up to pay their ultimate respects. 

The letter writer asks, ’Whom do we thank for the morning air show'?  The 56th Fighter Wing will make the call for you, and forward your thanks to the widow and parents of Capt Fresques, and thank them for you, for it  was in their honor that my pilots flew the most honorable formation of their  lives. 

Only 2 defining forces have ever offered to die for you....Jesus Christ and the American Soldier.  One died for your soul, the other for your freedom. 

Lt.  Col. Grant L. Rosensteel, Jr. 

USAF 

Read More

Dental health and time off work

Before the days of the ATM, people had to queue up at the bank to get money. It might not seem like much, but think about the logistics involved if you needed a tenner. You had to find a branch of your banking provider, then go into the building and wait until there was a bank teller free to deal with your request. 

And given that the banks were only open during business hours, ie the hours of the day most people were at work, it was even more of a challenge. The only thing that saved many people from mega-frustration would have been shops that accepted cheques.

A similar situation happens when we need to see the dentist. It means straying away from the office - sometimes quite far, as well - in order to get that filling done and get your mouth back to full dental health status. Of course, there are dental practices that open late one night a week or maybe more. But in the main, our dental appointments are generally booked in for some point during the working day.

So it's all the more surprising to read this week that fewer than half of UK workers get paid time off to see their dental health practitioner. Quoted in a report on the dentistry.co.uk site,  the Chief Exec of the British dental health Foundation said that the findings highlight a general "low level of importance" of maintaining "good oral health".

As anyone knows, toothache is no fun. And as the article points out, poor dental health can lead to a host of other ailments, some serious. So don't put off that dental treatment.

Read More

Tax the Rich{Doctors} to Lower the cost of Healthcare [VIDEO ADDED]

In the ongoing drum beat against the doctor in terms of income earned, Massachusetts lawmakers are trying to lower the cost of healthcare and have decided that doctors simply charge too much.  I spoke about this perception of the richdoctor previously as more of an attitude, but Massachusetts has taken it to a practical level with monetary penalties for the richdoctor.

“Massachusetts House leaders released amajor proposal to curb health care costs Friday, calling for new limits on thefees charged by hospitals and doctors and for creation of an independent agencyto monitor medical spending….Providers that charge prices deemed excessive andthat they cannot prove are linked to above-average quality would pay a tax,similar to the luxury tax Major League Baseball imposes on the big-spending NewYork Yankees and Boston Red Sox”

Of course the doctors and hospital groups are fighting this:

“Lynn Nicholas, president of the state hospital group, said, “To expect the health care industry to perform at less than the economy overall is unreasonable and will impinge on our ability to deliver care at the level people expect. . . . That may damage the economy more than it helps it, and, because of that, jobs may be lost.’’

The bill will not only lower what a physician can charge for an appointment or procedure, but a tax will be levied on the provider if he/she cannot prove that the care was more exceptional than the care down the street.  Medicine is a service and we all have different definitions of quality service.  Thus, an immeasurable item cannot be proved or disproved.  The only measurable component in healthcare is if you are still alive after the appointment or procedure.  If you are, then the quality was excellent.

Physicians today are being squeezed financially, with increasing overhead and stagnant reimbursement due to a frozen Medicare fee schedule for approximately 10 years, now Massachusetts not only wants to lower reimbursement rates, but tax providers for simply trying to stay viable in business.  Ms. Nichols states this rather well, one cannot expect a business person to perform their skill or sell a product at less than is needed to keep one’s business profitable.

“The bill also encourages providers to form so-called accountable care organizations to care for patients in a more efficient coordinated fashion, and pushes insurers to shift toward global payments, which pay providers a lump sum to care for a group of patients, and away from paying separate fees for every service.”

If this bill passes and implemented, then doctors will have to consider if they are willing to take pay cuts, live at a lower standard of living than doctors a generation ago, and continue to work the same number of hours they work now, in Massachusetts at least.

UPDATE: This video, from the Pioneer Institute, offers five ways that payment reform legislation on Beacon Hill misses the mark on true health care reform:

Read More

Cavalcade of Risk #158: Call for submissions

Nina Kallen hosts next week's CavRisk. Entries are due by Monday (the 28th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

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

Thanks!

Read More

Health Insurance 101 Explained

We all understand the importance of health insurance; however, as the types of health insurance continue to increase it is becoming more and more difficult to select the type of coverage that is best for you and your family. To help you find out which type of policy might benefit you the most, let’s take a look at the most common types of policies.

There is usually a lot of hype regarding HMOs so let’s look at that one first. A HMO is a health maintenance organization plan that works with a specified group of doctors and hospitals within the network. A primary healthcare physician is selected and you must obtain referrals for care that cannot be provided by that physician. The benefits of this type of plan are lower office visit costs and prescription drug co-pays. In addition, there will typically be either no or limited deductible costs for hospital stays. Depending on your coverage, there may also be no pre-existing condition cause limitations. It is also important to understand that your choice of doctors and hospitals will be limited with a HMO and you won’t be able to have out of network services covered.

A PPO or Preferred Provider Organization works similar to a HMO; however, the major difference is that you are not required to select a primary care physician. In addition to the benefit of being free to choose your own physician without worrying about a referral you also gain the benefit of limited or no deductible costs for hospital stays as well as a possible larger selection of physicians that might be available with a HMO. Out of network services may also be covered; however, for a higher charge than in network services.

A POS, or Point of Service, is also similar to a HMO in that you select a primary care physician. The difference is that you are free to choose out of network treatment if you’re willing to pay a higher out of pocket cost.  
Another option is what is known as a traditional coverage policy. This type of policy will have a higher monthly premium as well as deductibles. In addition, you will generally be required to pay for services out of your own pocket up front and then submit claim reimbursement forms.

You may also wish to consider various types of disability plans, which cover a percentage of your income in the event that you experience an illness or accident that prevents you from working for a period of time. A short term disability plan will provide benefits from the first day of an accident or the eighth day of an illness up to 26 weeks. Generally, this type of plan will cover 66% of your weekly income.

Long term disability will begin after short term coverage has expired and will provide coverage for a variable term, depending on the policy you select. Some policies are limited to providing coverage up to two years while others will cover you up to the age of 65.

Read More

Ezra K finally finds a nut!

As we've repeatedly knocked Ezra Klein's less-than-stellar grasp of insurance issues, it seems only fair to point out when he actually gets it right. An on-going IB meme has been consumer-centric health care, the goal of which is to educate and empower insureds to make more efficient health care choices.

Ezra reports that Blue Cross of Massachusetts (BXM) is attempting to do just that. He may actually be a closet IB reader, acknowledging early on that "Massachusetts has had, for years now  ... some of the highest health insurance premiums in the country."

BXM has introduced a new "tiered" co-pay system to incent its insureds to choose less expensive, but equally effective providers. It's not really new - Golden Rule flirted with this a few years ago, as did other carriers - but it's notable for the particular market, and its scope.

And it seems to be working. CEO Andrew Dreyfus reports that:

"[We] haven’t heard much in the way of complaints from the employers ... however, heard from one of Boston’s more expensive hospitals.

They were starting to lose referrals because of the new payment model... ‘can I lower my prices?’ I said, ‘absolutely.’”

Qualified kudos to Klein.

[Hat Tip: FoIB Holly R]

Read More

The Tutu Project

Nothing to do with Desmond Tutu. Pink tutu's. A grown, hairy man. In a pink tutu. And little else.

The Tutu Project is a love story.


Nothing kinky. True love of a man, Bob Carey and his wife Linda.


Linda has been battling breast cancer since 2003. Initially it seemed she had won the battle but then the cancer returned in 2006.


Bob started The Tutu Project as a way to raise money for breast cancer awareness. The self portrait pictures he has taken have brought joy to many individuals and families dealing with cancer. In Bob's own words:


During these past nine years, I’ve been in awe of her power, her beauty, and her spirit. Oddly enough, her cancer has taught us that life is good, dealing with it can be hard, and sometimes the very best thing—no, theonly thing—we can do to face another day is to laugh at ourselves, and share a laugh with others.


Read the story of Bob and Linda Carey. "Like" them on Facebook. Revel in their story. Make a contribution.

Read More

Monday Lagniappe

■ We haven't really addressed the new ObamneyCare© CO-OP program, and now's a good time to start. Scheduled to launch in 2014, these are essentially "mini-insurers" designed to compete with the big boys. CO-OP's (the misnomered Consumer Operated and Oriented Plan) would be state-licensed, and available both inside and outside of the Exchanges, targeting the small group and individual medical markets.

I remain skeptical of their viability, but "[t]he organizers ... are facing plenty of competition and strict scrutiny."

We'll see.

■ As we've repeatedly pointed out, MLR's (Medical Loss Ratios) are a dumb idea. Nevertheless, they're real (and not so spectacular); UHC has a new report out predicting that the total payout will be "less than 1% of total premium for 2011."

Be still my beating heart.

■ Frequent IB tipster Holly R dropped a dime on this interesting item:

"While UCLA Health System has long prided itself on being at the forefront of treating patients ... it is now trying to lower sharply the cost of providing that care. By enrolling young patients with complex and expensive diseases in a program called a medical home, the system tries to ensure that doctors spend more time with patients ... to coordinate care."

The "medical home" concept is relatively new, but seems promising. By communicating and coordinating care, it's hoped that the cost of that care can be reined in. And as we all know, the cost of care drives the cost of insurance.

Potential win-win.

Read More