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Saturday, June 30, 2012

Types Of Healthcare Plan


There is a lot said about health care these days. With costs rising and no end in sight there is a bigger need than ever for everyone to have the coverage of a health care plan. Health car plans are basically like insurance that helps you cover medical costs. Like any insurance they are sometimes difficult to understand.

There are many types of health care plans available. Each type breaks down into two basic groups: group or individual. Group plans are the least expensive option. They are provided through an employer. Individual plans are offered through private companies and can cost much more than group plans because there are no group discounts to the provider. Within each group there are a few different type of health care plans.

Fee for service plans are the most common and traditional forms of health care coverage. With a fee service the covered individual gets many choices of doctors and hospitals. The insurance provider pays for a portion of your costs while you pay a fee. You pay both a monthly fee for coverage and fees based on the care you receive. Many times there is a deductible that must be met before the insurance provider pays anything. Most plans also have a maximum amount you will pay out of pocket. Once this figure is reached your costs are covered 100%.

Health maintenance organizations or HMO’s are another type of health care plan. HMO’s charge a monthly fee. You are required to use certain doctors who are signed up with the HMO. You pay a fee for any costs you incur called a co-payment. The total costs of any medical care is negotiated between the doctor and the HMO so the costs are lower.

Preferred provider organizations or PPO’s are a combination of the fee based plan and an HMO. There are limits on the doctors and hospitals you can choose, you make a co-payment for each service and you may have a deductible. You can, however, use a doctor that is not part of the PPO. You will still get coverage but you may end up paying a larger fee.

There are other forms of health care plans. The government offer two plans: Medicare and Medicaid. Medicare is a plan for people over age 65 or disabled. The coverage provided by Medicare often changes and can be confusing. There are different types of Medicaid. There is a free type and a fee based type. Medicaid is another government offered plan. It is based on income. With Medicaid all of your expenses are covered. New changes have made it so some care requires a very small fee. There are also variations in Medicaid. To find out information a person should contact their local government human services agency.

Health care plans can be very confusing. Talking with your provider will help ensure you completely understand how your plan works and what coverage is provided.


Too good NOT to share


[Hat Tip: Bob and Bill]

Friday, June 29, 2012

Definition of whole life insurance

Whole life insurance, also known as "actual value" insurance is a type of permanent life insurance that remains in effect his entire life to a premium level basic and consistent. This life insurance is that you a good choice got you if not hoped that your life insurance should decrease over time. A portion of his cousin goes to a reserve fund known as "actual value" that accumulates over the years its policy is in effect. Its reserve fund is tax deferred and you can borrow against him, unless he retires.

Premiums must generally remain constant over the life of the policy and must be paid regularly according to the amount indicated in the policy. You can also have the option of a single premium - paying all premiums at the same time with a lump-sum. Cash values will grow to equal the amount of the death benefit when activated at age 100.

While whole life insurance is very expensive, and if you are on a limited budget, can not afford the luxury of all the insurance coverage you really need. But the point more than the death benefit is guaranteed provided that premiums are fulfilled. Also death benefit will never diminish if not borrow against it.

Returns the whole life insurance policy will fluctuate with the markets and will continue normally returns available from other investments as capital investment funds. However, if he decides to leave his policy, his cash value can pay in cash or paid insurance.

Whole life insurance is the most suitable for you, if you want to: • use it as a tax and estate planning vehicle • accumulate effective value to the education of the child or retirement, • pay final expenses, • provide money for a favorite charity work • finance a purchase/sale of business agreement, • provide protection of the key person.

Before buying the whole life insurance, should think carefully about how to choose your level of coverage. Too often people make the mistake of not sufficiently covering or worse still, shell financially to themselves. This would be a tragic mistake to whole life insurance policy because delinquent in the payment of premiums may mean the cancellation of the policy and the loss of its investment in everything. So be careful and make sure that: • choose a policy of life insurance that has a value of cash guaranteed since the first year, • choose the most effective value in the first year, • consider "participate" in insurance contracts that can pay dividends, increase the value of the policy to boost the total cash value and death benefits, • care with any insurance policy that levies "delivery charges" when it is cancelled.
• If you ever need to stop paying premiums, its policy allows you to use the accumulated effective value of the life insurance policy to pay the premiums, therefore keep your current coverage.


Speaking of fine messes

As the ObamaTax kicks into high gear heading into its full implementation in '14, it doesn't take a Nostradamus to foretell the consequences. Indeed, some are already making themselves rudely obvious:

"The next year is one massive scramble for employers to implement the [ObamaTax] now that it’s been upheld, and not all the regulations businesses need to follow have been written."

Most of these will affect businesses with 50 or more employees (ouch!), which means a lot of small to mid-sized firms have to be thinking "why do I need this headache?"

Here in the Buckeye State, the [Evil] Mandate ObamaTax may cost north of "$940 million in 2014 and 2015 based on the 400,000 people in the state who are eligible for Medicaid but are not enrolled"

Of course, Gov Kasich could just go all Walker/Jindal here. Good times, good times.

Finally (well, for now):

"The [Deloitte Center for Health Solutions] is set to release a study that says the number of businesses offering coverage – 130 million – could be cut in half during the next decade"

Told. You. So.

[Hat Tip: FoIB Holly R]

MedTech: VERY cool


That's the premise behind EmergencyLink, a free app and service accessible on your smartphone. You create a profile and contact list, and the service takes it from there.

Very cool.

But what if you just need some quick, helpful answers to a non-emergency qiestion? Well, that's where HealthTap comes in:


Like EmergencyLink, HealthTap can be accessed from your smartphone, but it also offers a web-portal for those of us with dumb ones. The service even lets you exchange files for more in-depth conversations with its 12,000+ physicians.

No word yet on how many of them make housecalls.

Time to get to work

Now that ObamaCare is here to stay, for now, the real work begins. How do we make the best of the situation and minimize the damage?


Tens of Thousands if not hundreds of thousands of mostly small employers self fund under a high deductible that will be going away in 2 years or less. This model has been extremely effective, save 15% on your auto insurance in 15 minutes comes to mind. Employers can offer the same benefits just 10-20% cheaper. It also has brought the expertise of true professionals onto the issues of excessive provider reimbursement, inefficient care, and cost control. Ten thousand engaged brokers and TPAs will deliver far better results then 500 politicians and 100 Academic quacks any day. This model is counter to the principals of ACA which is looking for high premiums and top down cost control. It is going to take some major efforts and lots of luck for these plans to survive. Small employers need to be prepared for not only a 10-20% increase when high deductible plans go away but a 30-50% increase when their new low deductible plan is community rated. If your in Ohio and rated 1-36 in small group everyone under 20 better be prepared. If your under 10 I don't think a 3 digit rate increase is out of the realm of possibility.


The people that think professionally are strong believers that a $100 tax, penalty, tax is going to prevent adverse selection. 30+ years of reality says it will just make the issue worse. Employers are going to have to find an affordable plan they can pay 100% of the employee cost for to maintain participation. Prepaid plans sponsored by a local health system might be back in vogue pretty quickly. Choice will be the first casualty of ACA.


Tax rates will be the second, when this doesn't work, reform always fails to do what reform says it will, the logical thing to do would be to scrap it, just like Medicare they will borrow to cover it instead. Eventually we will hit our credit limit and when we do taxes will skyrocket. If you can't stomach health insurance as a career any longer accounting and financial planning are going to be very busy.


Finally the practice of medicine is about to get considerably more altruistic. You would think providers learned their lesson after getting suckered on Medicare. This time they are not getting flowers and dinner first. 80-85% of spending goes to providers, when the budget is busted that is going to stick out like a cancer for the scalpel.


The one positive I see is every time government has tried to fix healthcare they have made a complete mess of things and created entire new industries to address it. There is going to be a whole lot of fixing to be done and thus a whole lot of work for those that identify it.

The 50th Employee

Lost amid the shuffle of yesterday's ObamaTax ruling is the Employer Mandate. Way that works is, if you employ more than 49 people, you've either got to offer (and help pay for) a group plan or pay a penalty tax. For most employers this will be a no-brainer: the penalty tax will be much lower than the insurance premium.

Here's the problem: if you currently employ 49 people, you're not going to be hiring that 50th guy, because that would cancel your exemption. Which means your current workforce is either going to have to work harder (to make up for that missing 50th employee), or you're going to need to scale back even further.

And if you're the 50th employee right now, you'd best be updating your resume.

HWR Supplemental: SCOTUS rules edition [UPDATED]

Health Wonk Review co-founder Joe Paduda hosts a special edition highlighting blggers' reactions to yesterday's ObamaTax decision. Pro or con, there's some great analysis all conveniently available - check it out.

UPDATE (7/2/12): Joe's now posted a second part to this Special Edition. Kudos!

Thursday, June 28, 2012

Delta Dental Insurance 101

Delta Dental Plans Association, more commonly known as Delta Dental, is one of the insurers dental known in United States. Delta is a nonprofit that offers all kinds of companies dental plans through the United States. Its 39 member companies administer benefit plans dental whose main objective is to provide and improve access to dental care for all. Today, Delta Dental associates provide dental coverage to more than 46 million people through more than 80,000 employers and agencies.

Delta Dental Insurance offers three types of important plans to meet a wide range of needs. The benefits vary according to the plan, and costs vary depending on the region and the employer.

Delta Dental Premier (formerly DeltaPremierUSA) Delta Dental Premier is a traditional service fee insurance scheme. If you have a Delta Dental Premier, you can visit the dentist of their choice within or outside of the network of your provider. The dentist bills Delta Dental directly, and Delta Dental pays its portion of the invoice (most often a defined dollar amount), then sends an explanation of their portion of the Bill, which pay the dentist.

Former Delta Dental pays $45 for a filling. Your dentist charges $60 for a filling. The dentist to pay $15.

Plan Dental PPO (preferred provider option) as the Premier of Delta, Delta Dental PPO pays a fee for each service. You can also visit any dentist you choose, but will pay rates lower than dentists that are part of the network of preferred supplier of the Delta. The dentist responsible for all forms of claim and paperwork. Delta usually pays a percentage of the procedure rather than a fixed dollar amount.

Former Delta Dental pays 70% of the share of an extraction. Your dentist charges $210 for removal. Pay the dentist $63.

DeltaCare HMO DeltaCare focuses on prevention and maintenance of their dental health. When you register in DeltaCare, choose a primary care who shall be responsible for their dental care dentist. If you need specialty services: orthodontics or oral surgery, for example: your primary care dentist must be derived for services. You pay a low or no copayment for any dental services.

Former Depending on the plan, can pay a co-payment of $10 for the doctor's office visits, no matter what the procedure.

The cost and availability of each option is dependent on the company through which you register. As the largest of the nation's dental insurance provider, costs are significantly lower than most of the plans.


ObamaTax: A Silver Lining

Now that SCOTUS has affirmed that we must pay higher taxes, while placing our health care in the hands of unelected and unaccountable Death Panels, it's helpful to know that there are alternatives.

Since we'll now be seeing fewer medical innovations, what can folks do if (when?) they need health care and can no longer find it (or are denied outright)?




Of course, HSA-compliant plans will be phased out as ObamaTax is fully implemented, and it's unclear how the accounts themselves will fare down the road. But for now, it's up, up and away!

SCOTUS Postmortem

SCOTUS has spoken on Obamacare. What follows is a series of links and excerpts on today's news.  

First, the 193 page opinion from the Court.

It's not a mandate if it is a tax.

Potential impact on the fall elections.

What does this mean for you?

Erick Erickson's initial shot across the bow. If you are opposed to Obamacare, read this VERY carefully.

If you share Erick's views, today's SCOTUS opinion may have just opened the door for eliminating Obamacare this fall.

Fourth Circuit Rules in Favor of Insurer That Refused to Defend or Indemnify Trucker

Finds “Business Use” Exception to the Policy Applies to Bar Coverage for Accident While Under Dispatch

On June 27, 2012, in an unpublished opinion, the United States Court of Appeals for the Fourth Circuit ruled in favor of an insurer that refused to defend or indemnify a trucker based on the commercial auto insurance policy’s “business use” exception, affirming a decision of the United States District Court for the District of Maryland.  

Post by Logan Wells
In Forkwar v. Empire Fire and Marine Insurance Company, Hameed Mahdi was a contractor for J&J Logistics, Inc. (“J&J”), working under an independent contractor agreement. Madhi leased his tractor to J&J, which paid Mahdi for its exclusive use of the tractor. J&J’s ICC numbers and the name “J&J Logistics” were on Mahdi’s tractor. Pursuant to the contract, Mahdi called J&J’s office each morning to see if J&J had a job for him to do. On November 25, 2004, Mahdi called J&J and was instructed to pick up a load in Jessup, Maryland at midnight on November 26. Mahdi left his home on November 26 and began to drive to Jessup. On the way, Mahdi decided to stop to grab something to eat, but before he could exit the highway he was involved in a collision with Augustine Forkwar.

Mahdi had been issued a commercial auto insurance policy by Empire Fire & Marine Insurance Company (“Empire”). After receiving notice of the accident, Empire conducted an investigation and determined that the “business use” exception to the policy applied, relieving Empire of any obligation to defend or indemnify Mahdi for the accident. The business use exception provided as follows:

This Insurance does not apply to any of the following . . .
14. BUSINESS USE
“Bodily injury” or “property damage” while a covered “auto” is used to carry people or property in any business or while a covered “auto” is used in the business of anyone to whom the “auto” is leased or rented.
Forkwar filed the underlying suit against Mahdi and J&J in October of 2006, alleging Mahdi negligently caused injury to Forkwar and that J&J was liable under the doctrine of respondeat superior. Empire declined to defend Mahdi on the basis of the business use exception. During the trial, J&J moved for a judgment as a matter of law as to the claims against it, which Forkwar did not oppose. Later, the jury found that Mahdi was negligent in the operation of his vehicle and awarded Forkwar $180,756.67.

After securing judgment against Mahdi in state court, Forkwar filed the action against Empire. The action was removed to federal court, and the parties filed cross-motions for summary judgment. The district court denied Forkwar’s motion for summary judgment, granted Empire’s motion for summary judgment, and denied Forkwar’s counter motion for summary judgment. Forkwar appealed arguing (1) Empire was collaterally estopped by the judgment in the underlying action from arguing that the business use exception applied; and (2) the business use exception did not bar coverage.

Collateral Estoppel
Forkwar argued Empire was collaterally estopped from claiming the business use exception applied because the issue of J&J’s respondeat superior liability was litigated and decided in the underlying action. The court disagreed, finding Forkwar could not meet her burden because the issue in the underlying action was not identical to the one presented in the action in question:

Under Maryland law, the doctrine of respondeat superior permits “an employer to be held vicariously liable for the tortious conduct of its employee when that employee was acting within the scope of the employment relationship.” Oaks v. Connors, 660 A.2d 423, 426 (Md. 1995)....[T]here are four elements to establish respondeat superior in Maryland: (1) the existence of an employer-employee relationship; (2) the tortious act must have occurred “within the scope of the employment relationship;” (3) the employer consented, explicitly or implicitly to the use of the automobile; and (4) the employer had the right to control the employee in the operation of the automobile or the use of the automobile was vitally important in furthering the master’s business.
In contrast, the business use exception applies whenever “a covered ‘auto’ is used to carry people or property in any business or while a covered ‘auto’ is used in the business of anyone to whom the ‘auto’ is leased or rented.” Plainly, the respondeat superior doctrine and the business use exception are not identical issues. While respondeat superior requires the existence of an employer-employee relationship, the business use exception has no such element. Thus, an individual like Forkwar who was acting “in the business of” J&J but who is an independent contractor rather than employee would be subject to the Policy’s exclusion without falling under the doctrine of respondeat superior.
In so finding, the court specifically addressed the Court of Special Appeals of Maryland’s language in Empire Fire & Marine Ins. Co. v. Liberty Mutual Ins. Co., 699 A.2d 482 (Md. Ct. Sp. App. 1997), wherein the Court of Special Appeals stated in construing Empire’s business use exception that it would “follow the course of other courts that have sought guidance from the analogous common law doctrine of respondeat superior.” Acknowledging there were some similarities in the requirements for the business use exception and the elements of respondeat superior, the court rejected the notion that the elements were identical:

It is true that the requirement in the business use exception that bodily injury occur while an auto “is used in the business of anyone” is quite similar to the second element for respondeat superior, that the accident occur “within the scope of the employment.” However, that is not to say that all of the elements are identical. Respondeat superior requires that there be an employer-employee relationship, and Maryland -- like other states -- recognizes a distinction between an employee and an independent contractor. See, e.g., Greer Lines Co. v. Roberts, 139 A.2d 235 (Md. 1958) (“Whether the relation of the parties is that of master and servant, or employer and independent contractor, depends upon the facts . . . .”). In contrast, no language in the business use exception suggests there must be an employer-employee relationship; it requires only that the accident occur while the auto is used in someone’s business. Thus at best Appellant has proven that one of the four elements of respondeat superior are met, but cannot establish the remaining three.
Accordingly, the court rejected Forkwar’s collateral estoppel claim.

Business Use Exception
Forkwar also argued the business use exception did not apply to the underlying action, arguing that Empire Fire & Marine Ins. Co. v. Liberty Mutual Ins. Co., 699 A.2d 482 (Md. Ct. Sp. App. 1997), was dispositive. The court disagreed, noting the timing of the accident in Liberty Mutual was different than the one involving Forkwar and Mahdi:

In ... Liberty Mutual ... the plaintiff, James Perry, was the owner and operator of a tractor that was contracted out to a shipping company, O.S.T.; the tractor’s I.C.C. license was in O.S.T.’s name. O.S.T. also had a similar method of assigning work: Perry contacted O.S.T. daily to obtain his next assignment. The timing of the accident, however, is different: Perry had completed his dispatch on January 16, dropped his tractor off at a service station that day, and returned four days later to pick it up. On his way home from the service station, he was involved in an accident. The Maryland court found that the business use exception did not apply, noting that Perry was driving to his home, not receiving any compensation from O.S.T., not operating under a bill of lading, not under dispatch, and not hauling a load at the time of the accident.
... While most of the facts parallel the instant case, in Liberty Mutual the accident occurred several days after the completion of Perry’s last dispatch, while he was driving home. Here, in contrast, Mahdi was under dispatch -- a fact expressly noted in Liberty Mutual.
(Internal citations omitted).

Lamenting the lack of additional case law on the applicability of the business use exception, the court sought guidance from outside the Fourth Circuit. Accordingly, the court followed the reasoning of the Seventh and Fifth Circuits, see Mahaffey v. Gen. Sec. Ins. Co., 543 F.3d 738 (5th Cir. 2008); Empire Fire & Marine Ins. Co. v. Brantley Trucking, Inc., 220 F.3d 679 (5th Cir. 2000); Hartford Ins. Co. v. Occidental Fire & Cas. Co., 908 F.2d 235 (7th Cir. 1990), and analyzed whether Mahdi’s conduct at the time of the accident “furthered the commercial interest” of J&J:

In applying the furthering-the-interests test to this case, we find that Mahdi’s conduct fell under the business use exception. The accident occurred while Mahdi was on his way to pick up a load for J&J; his driving to Jessup was a necessary step in completing his work. As the district court noted, Mahdi was not “pursuing leisurely engagement nor engaged in some frolic [or] detour.” Rather, he had received instructions from J&J to go to Jessup to pick up a load and was in the process of completing that task. Although Mahdi had decided just before the accident to stop for a meal before making his way to the warehouse, he was operating his vehicle at the time of the accident solely for the purpose of furthering J&J’s commercial interests.
The court therefore found that the business use exception applied to bar coverage, thereby affirming the decision of the district court.

Healthcare news: this week on the health pages

In the news this week - the Care Quality Commission (CQC) has found that nearly a quarter of NHS services were failing to meet 'essential standards' in England and Wales.


Areas of particular concern centred on things including staffing levels, 'compromised' management of medicines, and record keeping.


The chief executive of the Royal College of Nursing is quoted as saying: 


It is shocking that more than one in four locations inspected in this report have failed to meet even essential standards of quality and safety… this presents a long overdue wake-up call for the Government. Those locations in question must be brought up to standard as a matter of urgency



The news of this research will no doubt be seized upon by the opposition, while providing the coalition plenty to think about when it comes to making improvements to the service. The health minister has responded to the CQC report saying that the government is "determined to drive up standards for everyone".


There is a good précis of the report's main points here


In other healthcare news, this time from a private health insurance perspective, HI magazine reports that "waiting times, patient experience and availability of drugs and treatments all set to worsen". The article says that these factors could see an uptick in demand for PMI - while the majority of  NHS bosses surveyed believe that waiting times will increase as financial pressure on the system continue.













Words fail...

Wednesday, June 27, 2012

Travel Insurance – Insurance For The Over 65's


According to a survey published by Mintel, one in three pets needs an unexpected visit to the vet each year. This means that you are more likely to claim on your pet insurance than on a home & contents policy or even your car insurance.

The word “unexpected” is important here. If you are looking for pet insurance to provide cover for routine treatments such as vaccinations or worming, forget it – policies that do that are as rare as hens' teeth! And you won't find cover for elective treatments, such as neutering, either. This means that the most common reasons for visiting the vet are uninsurable.

But don't forget it's those unexpected visits that tend to be the expensive ones! Developments in animal care mean that more conditions can be effectively treated and costs of emergency care can be horrendous. A cat that argues with a car could cost £700, even more, to treat. After all, a series of X-rays could cost £400 and a MRI scan will put you back £1,000. If Buster the Bulldog tore a ligament that too can be treated – but the cost? Don't expect change from £1,500! This is serious money!

Having appreciated that most reasons for a visit to the vet are uninsurable, what do we get for our money?

Well, insurance plans largely fall into three types. The first restricts the value of the claim for each condition or event; the second limits the total annual payout and the third and cheapest option, limits the payout per condition and ceases cover after 12 months of treatment. Most will make a payout if you pet dies. And with all policies you will have to pay an excess on any claim, usually between £50 and £100.

And the cost? That depends on which type of policy you want, the excess you want to pay, the sort of pet you have, its breed, its age and even your post-code (vets charge more in Chelsea). But as a guide, an industry estimate suggests costs between £30 and £200 per year for a cat and between £50 to £500 for Buster.

The best advice is start the insurance when your pet is young. Most pets can be insured after they're 8 weeks old and you can then maintain the insurance over the course of its life. If your pet is in it's middle age when you want to start the insurance, say eight or nine for a dog, then it may be difficult to get worthwhile cover. This is because treatments for existing health conditions will be excluded from the cover and in any case, a new policy at that age gets expensive.

So how can you lower the premiums? Sometime insurers will give you a discount if you pet has been identity chipped and quantity discounts do prevail! Discounts are widely available for your second and subsequent insured pet.

Then there's always the Internet. The Internet is taking an increasing share of the insurance market and no wonder – its simple, quick and easy. What's more it's probably the cheapest avenue for all your insurance whether it be for your home, your car or pet.


Read My Lips

PLENTY of new taxes.

The folks at American's for Tax Reform have this to say about Obamacare and SCOTUS.
On the eve of the Supreme Court’s decision on Obamacare, taxpayers are reminded that the President’s healthcare law is one of the largest tax increases in American history.
Obamacare contains 20 new or higher taxes on American families and small businesses. On Thursday, Americans for Tax Reform will do a full analysis of the tax implications of the Court’s decision.
Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today
Click here for the rest of the story...

So the question is, if Obamacare is repealed, either by SCOTUS or next year's president/congress, what happens to ALL THOSE TAXES?

Something else to ponder...

Although we've had an unofficial moratorium on predicting tomorrow's SCOTUS decision re: ObamneyCare©, it's worth noting that the [Evil] Individual Mandate and the Exchanges aren't the only issues to be decided:

" [T]here are some major health-insurance regulations besides community rating and guaranteed issue ... Medicaid expansion"

Although the CornHusker "dodge" was withdrawn, the very real financial (and legal) issues that accrue to the expansion (at state cost!) to Medicaid are very real.

Money is money.

The Height of Ineptitude

On the eve of the Obamacare decision from the Supreme Court, it is both interesting and disturbing, to read some of the chatter both from the health care and health insurance industry and from the outside. What is remarkable to me is how many people that SHOULD understand the ramifications of Obamacare clearly illustrate how inept they are at their own game.

This just in from Life Health Pro where state insurance regulators offered their view at a press conference.
how states can muscle past a possible rejection by the Supreme Court of the individual mandate under health care reform, yet still have state health exchanges remain viable. What no one at the event could figure out was how to contain health insurance costs without more Congressional fixes if the exchange ever came to be.
You would think by now they would have figured out there really is no way for anyone to control health care costs short of nationalizing the industry and setting the value of health care by fiat.

Price controls don't work. We don't have to look too far back in our history to see what happened when the federal government imposed controls on gasoline. The long lines and rationing of gasoline didn't go over very well.

The same will be true with the government controlling the cost of health care, or health insurance for that matter.

So how about a voucher system, where the government issues chits that can be used (by some) to purchase health insurance?

All you need do is look at the food stamp program where 44 million people use taxpayer dollars to pay for their food, and in some cases, alcohol, tobacco, lottery tickets . . .

Health care costs rise primarily because of excessive demand and little financial pain to those with insurance. Something on the order of 88% of health care bills are paid for by third parties (health insurance, Medicare, Medicaid) leaving only a very small portion to be paid by the consumer.

If consumers paid more for the direct cost of health care they might assume healthier lifestyles rather than seeking a drug to alleviate the symptoms of an illness.

The insurance exchanges, a kind of Amazon for health insurance, is one of the precepts of Obamacare. States are required to establish their own exchange, and if they don't, the feds will do it for them.

Oh, and here is a clue.

Although Amazon has grown to be much more than just a book store you need to be reminded that there are still some folks that like to stroll through Barnes and Noble and leisurely read a book while sipping a latte and really don't care for buying online.

Health insurance isn't any different.
If the federal government takes over the exchanges, which must be self-sustaining after a period of time, other questions remain. Among them: Where will the money will come from? Who will collect the funds? And by what method?
Obamacare was a law that was not only pieced together like sausage with parts from head to tail of the pig, but was conceived and sold to the public on the promise that it would not only make health care (and health insurance) more affordable but would actually reign in the federal deficit.

Whatever those folks were smoking, I want some of it.

Obamacare is built on a foundation of fantasy and lies.
Adam Hamm, vice present of the National Association of Insurance Commissioners (NAIC), told reporters at the press conference that while NAIC Health Insurance (B) Committee Chairperson Sandy Praeger took a glass half-full approach to a mandate-less health reform law, there were a “number of us with grave concerns” related to enormous pressure to increase rates starting as soon as 2013.

Hamm, the Republican North Dakota insurance commissioner (who is up for re-election this year) compared a striking down of the mandate, to pulling a pin on a hand grenade and putting the grenade in the lap of the American people. Hamm also echoed the Administration’s argument that the mandate and requiring insurers to take all comers are interconnected. He noted also that a dangling guaranteed issue, unmoored from the individual mandate, would not work due to skyrocketing costs.
I've got news for you. Even WITH the mandate in place the cost of health insurance will skyrocket. It will only get worse when you can wait until you are really sick to purchase health insurance.
Actuaries will be crunching the numbers as soon as the High Court delivers its opinion—expected Thursday—and rate insurance requests will pour in, Hamm said. He added he is seeing rate increases in the individual market spike by 75% to 100% from one provider, and by 15% to 20% in the group market, both spikes on top of normal rate increases under current law. These numbers are going to be “much more if the individual mandate goes,” Hamm said.
Beyond what happens tomorrow, and the ensuing impact on health insurance, there are other things tied to Obamacare that impact most of us.

As the economy has struggled to recover (in spite of the meddling by DC rocket surgeons) there is one common thread that is perplexing to those who do not understand commerce.

While some businesses have failed, and others have downsized, most every business that has survived has remained profitable. Some are even investing in new equipment . . . . but few are hiring. When they do hire, the jobs go to part time employees, independent contractors or workers outside of the country.

The combination of excessive government oversight, possibility of higher taxes and the unknown costs associated with Obamacare have caused the job market to languish.

Will employers start to hire if Obamacare is de-fanged or gutted and hung on a tree to die?

Some will, some won't.

No doubt the total elimination of Obamacare will be a shot in the arm for employment and the economy, but to return to REAL growth there needs to be a new mindset in Washington with regard to private industry.
As scary as that is, I think 75% is a very conservative number.

Health costs and obesity

Given the amount of space devoted to obesity as a topic within the health and wellness media, you'd maybe think that obesity was a major strain on NHS resources.

But according to the findings of a recent study, it looks as though this may not be the case. Research was carried out by the UK's Institute of Economic Affairs (IEA), who believe that ...


argument in favour of fat taxes could be on the grounds of the obese imposing a disproportionate burden on the British National Health Service. However, against this there is some evidence that the obese have shorter life expectancies and therefore are less likely to require the even greater long term costs of geriatric care.

You can read this very interesting (and thought provoking) article in full here.

It's difficult to say whether a fat tax would have much efficacy - especially in light of the fact that we're not in a situation of talking from experience - only informed conjecture as to what might happen. 

And while it may be the case that obese people have shorter life expectancies - it would still be a reflection on the nation's health as a whole if the status quo were to go unchanged and people die younger due to being overweight to this degree.

So, though there may be a link between obesity and the NHS - the onus will still be on government to ensure as many as possible live as healthy as possible regardless of whether that means the individual require geriatric care later on.

the question is whether a 'fat tax' would have a slimming effect on the nation. What do you think?


Cavalcade of Risk #160: Wildfire Edition

Louise Norris hosts this week's smokin' hot edition of the Cavalcade of Risk. Come for Money Mustaches, stay for the Financial Cents. But do stop by.

24 Hours and Counting

Intrade puts chance of SCOTUS overturning the evil Obamacare mandate at 75%.

Link to Intrade site.



Tuesday, June 26, 2012

Definition of health of Point of Service (POS) insurance

A POS plan or point of service is something like an HMO and PPO combined type health plan. You have more flexibility than a regular HMO, but they pay a deductible and lower rate than a PPO. It is perfect for those people who need more flexibility but want to pay less. You will be asked to select a general provider that is out of the list of acceptable medical. This will be your primary care physician and he or she will be that manage what attention it receives. Will he or she direct you to specialist and hospitals if necessary that they also participate in the plan. Usually there are many suppliers of each specialization to choose and which normally covers a wide geographical area. With this type of policy, you won't have a large deductible if any and they still have a minimum copayment visits and prescriptions. This is of course, if we stick to the list of preferred suppliers. You may also want to be sure of which medications are covered under this plan and if you have to pay more for the more recent not generics. Some doctors do not think about what kind of insurance you have to write a prescription and need reminding him or her if you can only buy generic to cover.

You will also have an option to see providers outside the network when you need a specialist and they are not on the list. Most POS plans require that you get a physician referral before seeing another doctor or specialist. Once refers to a specialist within the network, you must be willing to pay more. If you do so, you will be billed directly and must submit the claim to his car insurance company. Your insurance company will pay your rate flat for everything that you have done and you will be responsible for the rest. It may also be responsible at the time of the service to pay the whole amount and wait to be reimbursed to your car from your insurance. If you decide to see a specialist in their own, the cost will be higher and about 50% if you made no reference. You will be asked to pay a higher amount if you go outside the network. So in essence, you have the right to see who choose, but at his own expense. The POS plan will only pay your rate flat for specific medical issues and not above it, unless that is an emergency situation. Many people like the idea of having more say in their health care options, while others worry more for saving money and not care that are to be used. What you choose will depend on what want personally and what is most important.

The emphasis of this plan is the prevention of disease or illness to reduce the cost to the individual and the insurer. Most PPO and HMO plans has the same basic importance. It is recommended to take an active role in their health and do what it takes to not stay patient and disease free as long as possible. The idea is to see the doctor less what both you as your carrier together spend less money. The idea with this plan is that if you have to put more money in your health think twice on whether or not really need to go. If you want to waist the money from insurance companies have to waist too to do so. Medical insurance companies are in the business to make money, wish to maintain healthy so they can pick up his cousin and don't have to pay for the health care provider. Therefore, for those people that don't want to pay as high as a monthly premium tend to opt for this type of health insurance plan. This will ensure a low rate with having to worry about huge deductible or copayment if used more as an HMO. So, if you think this sound like something you are interested in, please contact several companies and get some political to look at. Be sure to check what is covered, as well as the price. Do a little research in the various policies of insurance are available. You need to choose will depend on your priorities.


More Stupidity from Ezra [UPDATED]

Alleged health blogger Ezra Klein, noted rocket surgeon extraordinaire, continues to double down on the stupid. Today he opines that even the Father of Our Country liked him some mandates. As reported on Twitter:

"In 1798, Congress mandated that sailors buy health insurance. John Adams signed it into law."

The twit (tweet?) directs the unwitting to Ezra's latest contrivance, wherein he demonstrates profound difficulty discerning the difference between forcing all citizens to purchase a product as a condition of citizenship and specifying that certain individuals must buy a product in order to serve in the military.

Seems pretty clear to me.

In order to show that he really doesn't get it, Ezzie doubles down by citing a 1790 Congressional mandate that "ship owners buy medical insurance for their seamen." Perhaps noticing that there's a pretty glaring logical fallacy here [ed: is there any other kind with this guy?], he observes that "in 1798, Congress ... enacted a federal law requiring the seamen to buy hospital insurance for themselves."

Again, one can choose whether or not to be a sailor. But the [Evil] Individual Mandate applies to all citizens (well, almost all). How come you don't talk about those exceptions, Ezra?

[Hat Tip: FoIB Holly R]

UPDATE/IRONY ALERT: I can't believe I missed this before posting. Ezra Klein relies on legislation from the 18th Century to make his "point?" Is this the same Ezra Klein that pooh-poohs the Constitution because it's "not a clear document. Written 100 years ago, when America had thirteen states and very different problems, it rarely speaks directly to the questions we ask it?"

Why yes, yes it is.

The stupid burns strong in that one.

PCIP Abuse

PCIP is one of the few things in Obamacare that I support, even AFTER the government decided they would stop paying insurance agents a finders fee.

I seriously doubt the bozo's in DC considered how easily their plan could be manipulated. Consider this posting by an insurance agent in an industry forum.

I recently spoke with a friend that doesn't have any coverage. She needs major back surgery quick. They met with the hospital and projected charges are 150,000. The billing department suggested buying the PCIP plan, paying a few months premium, and then if they can't afford the premium to drop the coverage, everything gets paid for pennies on the dollar. Seems the hospital is encouraging this ploy. Wonder how often this is being done?

Every day, Ned.


Every day.

There are also agents that field calls from women who are pregnant and need health insurance. Care to guess where they are referred?

Yup.

God bless Obama.

So, are you a Hep Cat?

FoIB Jeff M alerts us to this disturbing news for the Boomers among us:

"A government proposal that all baby boomers get tested for hepatitis C may be drawing high praise for its potential health benefits, but it’s also raising questions about the unintended consequences of screening for those seeking insurance."

We see this a lot: doc's prescribing tests and/or med's for conditions that may (or, you know, may not) exist, which then show up in the medical records of folks seeking insurance. I recently spoke with a Long Term Care insurance prospect whose physician had prescribed a particular med for her anxiety; this has caused her some grief in the application process.

The Hep C issue is, I must admit, news to me. On the one hand, it was a routine blood exam for a life insurance policy that turned up HIV in a famous professinal athlete. On the other, well:

"Even treatment for hepatitis C might not guarantee acceptance since current protocols may not be 100 percent effective."

I do have a problem with this:

"I would never, ever tell anybody to delay getting any kind of medical exam ... But you have an advantage over the insurance company if you apply for insurance before undergoing any kind of medical checkups.”

Ooops.

Here's the problem: life and health applications ask not just whether you've seen a doc recently, but whether or not you've experienced any "issues" which might be a clue that you do so. Long Term Care apps are especially stringent on these points. And although carriers routinely act stupidly, they're not run by stupid people.

Monday, June 25, 2012

Car insurance rates - find them cheap

The most important thing when you are looking for a cheap insurance car is probably a ride. Need to look at competing products and the companies that you are trying to let with know that you are looking for as well. Many companies have flexibility with packages that are willing to offer you, and this goes double if you're an insurance broker, who makes his life making agreements between private citizens and insurance companies.

There are some factors that can work on their behalf in obtaining lower costs for your car insurance. Are women? You are more than 25 years? Are you in good health? Do you have a record of driving completely clear? All these things can work in your favor. Less than a risk for yourself, you can test below, chances are better that you can get lower premiums.

Other ways you can get reductions in your car insurance are package to ensure your car with camera, content and or life insurance. All together insurance means that it is possible that you can get a relatively low premium, rather than having to pay premiums individually for every insurance need.

You can also search for offers of reward. Some companies will lower your premiums for you if you've been with them for some time without having an altercation car and need to use your insurance to cover it. These can work really be much cheaper over time.

Another thing you can do to save some money is safe limited, which means that ensure the car only for you, or maybe for you and your partner. This will get reduced rates with insurance that covers anyone driving your car, or insurance to cover their wild teenage driving his car.

The best way to get cheap car insurance is simply being a safe driver.


Hoosier Healthcare Hijinx

We last discussed the Healthy Indiana program almost 4 years go. At the time, we noted that low income Hoosiers were eligible for Health Savings Account (HSA) plans. Even then, preventive benefits were available with little or no out-of-pocket. The major downside seemed to be the $300k lifetime cap on all covered expenses.

Well, a few years later and along comes ObamneyCare©, and the most vulnerable of Hoosiers can kiss their Healthy Indiana coverage goodbye:



[Hat Tip: FoIB Bob D]

Ill-advised Citizen Tricks

FoIB Patrick P sent us this item:

"I canceled my very expensive individual health insurance coverage through California's state-run high-risk plan and became insurance-free ... no one will insure me on the individual market ... I have made do with the state's high-risk insurance plan. California ... The federal high-risk plan would cost me just $265 a month"

It's hard not to feel some compassion for Randy Dotinga (Mr D): his health issues don't seem to be self-inflicted. But I have a number of issues with what he proposes. Of course, I completely respect his right to make this choice, even if ill-advised.

University of Chicago professor Harold Pollack nails it:

"[Randy's] responding in an understandable way ... Any program that requires people to be actively uninsured creates a very paradoxical and painful set of incentives and encourages people to do what you're doing."

As we've noted before, PCIP requirements are not only counter-intuitive, they actually punish folks who've played by the rules (as Mr D appears to have done). In this case, he's taking a calculated risk that he'll make it through that half-year wait without a major setback (ie "claim"). Given that he's already acknowledged his precarious (if not imminently threatened) heart health, this is either really gutsy, or really stupid.

And to be frank, I'm not sure which way I lean here.

I do respect that he at least touched base with the government agency overseeing the program. They were less than enthused that he might encourage others to follow his example, which I suppose is justified, but I think unfair. After all, it was the rocket surgeons who dreamed up the train-wreck ObamneyCare© that insisted on making folks "go bare" for six months. What did they suppose was going to happen?

I have two particular problems with this strategy, both of which Mr D acknowledges: first, there's no guarantee that there'll be space for him once he's eligible; and second, the program has limited funding (and a sunset provision) that could leave him in the middle of a claim with no coverage.

 Mr D's claim that he was uninsurable through the individual market gave me pause, so I reached out to California health insurance gurus David Fluker and our own Bill Halper. Turns out, this claim is likely valid; as Bill notes "any cardiac condition that requires ongoing treatment is pretty much death in the individual market." David expanded on this, explaining that "California individual health plans do not provide for any waivers, exclusions or riders. It’s all or nothing whatever the plan covers.  As such our decline rates are much higher here and any condition of the heart is too risky for an insurer to cover."

Which is good to know.

The real problem, though, is the timing. As noted in the article, one must be uninsured for (at least) six months to be eligible. But (at least in California), one can't even apply for coverage prior to that six month "waiting period." David went above and beyond, and caught a disturbing flaw on Mr D's part:

"With the enrollment process for PCIP, a person would likely be uninsured 7-8 months by the time they were enrolled in PCIP, which is very risky for those with serious health conditions.  PCIP enrolls 10th of the month for 1st of the following month and since you have to be uninsured 6 or more months before you apply, the 10th of month 7 is the earliest one can apply.   If a person submits the application prior to the 6 months having elapsed, the app is deemed ineligible for PCIP and sent over to MRMIP.

It can be done but it’s a bit complicated
."

Talk about understatement.


I've had more than one client (or potential client) in the same boat as Mr Dotinga, and I must admit that I am torn about what to advise. I am not comfortable telling folks they should "roll the dice," but the alternatives are difficult, as well.

On the other hand, there are any number of programs available to folks in his position to access health care for nominal or no cost. In fact, we've linked to some of these in the sidebar for many years. Of course, one must take the initiative and at least contact these folks, but help is available.

For now, anyway.

Will SCOTUS striking down ACA cause for reflection?

It amazes me how often I see comments like this from Jodi Kantor of the NY Times:


 The article in whole is about SCOTUS striking down all or part of Obama's Affordable Care Act, something these same people said was impossible. To question the constitutionality of ACA was dismissed and ridiculed; yet here we are today widely expecting just that to happen.

When will people like Jodi realize they are idiots, the problem is not the aggressive courts or divisive politics? They just don't understand healthcare or the law and thus tend to get analysis wrong. Just as the ACA was always unconstitutional, Death Panels were always a legitimate concern, Jodi just isn't intelligent enough to understand why.

We can only hope that people like Jodi Kantor take some time after the court ruling and reflect on why, once again, they got it wrong and make the connection to their lack of talent. Jodi could have had a perfectly accurate article if she had left that partial sentence out, yet for some reason they always feel compelled to over reach and show just how little they know.

Sunday, June 24, 2012

Health Insurance – A Necessity of Todays Life

Health Insurance is the only solution for increasing health care cost in todays world. It is an absolute necessity to have a good health insurance as it will help keep you and your family safe and insure that you do not get engulfed with health care bills if one of you should have an accident or have grave health issues.



Many people do not get insured because they think that it is a waste of money and consider health insurances to be very costly. But the fact is that it is not that costly and you can get health insurance for a fair amount of money.



The simplest and cheapest way of getting a good health care insurance is through your employer. But you must understand that when you leave that job you may lose the coverage. Other way of getting health care insurance is through a personal plan. Entrepreneurs & people whose employers do no offer coverage, acquire this kind of insurance. This kind of insurance policy will come out of your pocket, but the cost of insurance is much cheaper than bearing your own medical costs.



If you have to go with a personalhealth insurance then be sure to shop around to ensure you get the best coverage for the really best price. There are numerous insurance companies offering different health/medical insurance plans but before you choose one, you need to think of few important things like general state of your health, your age, any medical problem history, your boozing and smoking habit etc. If you are going for family cover, then your will need to find these details for each member and then think carefully what kind of coverage you want. Do not conceal any medical problem from insurance company as bearing a claim denied later because you had failed to disclose medical truth to the insurance company would be far more displeasing - and very expensive.



A careful study of above mentioned factors will help you decide the kind of coverage you need and where you can cut the expenses of premium. This might appear like a boring process, but it will assist you considerably in ascertaining appropriate and affordable health insurance and making sure your healthcare needs can be met by the medical insurance you select.

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