With Two, You Get Group Health
By: Paul Davis
paul@biznetonline.com
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With Two, You Get Group Health |
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WHAT’S NEW IN SMALL GROUP AND INDIVIDUAL HEALTH INSURANCE?
Did you know that with Two you get Group Health?
BizNet Magazine has asked Paul Davis to help bring our readers up to date on some changes in the laws regulating health insurance.
Paul Davis is licensed in California, Nevada and Oregon. However, his expertise is primarily in the California marketplace. If you are outside of California please consult with a local broker to determine how your states’ laws may impact on your health insurance options.
HIPAA: THE HEALTH INSURANCE PORTABILITY ACT OF 1996BRINGS NEW MANDATES
1. Guaranteed Issue and renewal for group health plans from 2 to 50 lives. Pre-existing conditions are limited to 6 months prior, 12 months forward. There are no pre-existing conditions if you had prior coverage for 12 or more months.
2. If you were a member of a group plan, and you have exhausted COBRA, and you have had "creditable" coverage for 18 months you are eligible for guaranteed issued individual coverage. Implementation varies from state to state. In California this will be implemented 1/1/98.
3. If you chose not to enroll in a group health plan and you get married, have a baby or adopt a child you can add the child, yourself and your spouse onto that group health plan within 30 days of the event.
4. If you are an employer, you need to make sure that your insurance carrier is issuing certificates of coverage to anyone who loses health coverage. There is a $100 per day per participant penalty for failure to comply.
5. Medical Savings Account eligible plans. Available for the self-employed and small groups. These are high deductible ($3000 - $4500 family) health plans. Once you have one of these plans you can establish a Medical Savings Account into which you can make tax-deductible contributions. You can then use this account to pay for your medical expenses. If you don’t spend money in your account it accumulates much like an IRA. Also, if you have need for benefits that are limited by health insurance companies you may be able to pay for those expenses with tax-deductible dollars (if they’re on the Government MSA-eligible list). If the physician(s) you wish to see are not on any PPO or HMO plan this will at least allow you to pay for their services with tax-deductible dollars.
CALIFORNIA ONLY!
1. Guaranteed Issue group health insurance 2-50 lives. Guaranteed renewal. Maximum rate surcharge 10% for the group. Several carriers have eliminated the surcharge, either by policy or practice. Most HMO plans have no pre-existing condition limitations. So, on a group with 2 people, you can have guaranteed issue, guaranteed rates, no pre-existing conditions and guaranteed renew-ability.
2. Blue Cross of California has introduced "newer" individual co-pay plans. If you have one of the old co-pay plans, or an older Blue Cross plan you should request a transfer into the newer plan. The $40 co-pay is especially attractive. If you have any other individual policy and you don’t want an HMO plan you need to look at this plan. Blue Cross also offers group co-pay plans. 3. Kaiser Permanente has reduced their small group rates twice in the past 3 years. Kaiser rates start at $69/month. Kaiser offers guaranteed rates and no medical underwriting 2-50 lives.
3. The key to a successful small group HMO health plan is allowing everyone to see the doctors they want to see on a favorable basis. It’s hard to find 1 plan that has every doctor! In California, we now have 2 health insurance purchasing cooperatives for small groups. HIPC (The Health Insurance Plan of California) and California Choice. HIPC offers 19 carriers in the LA area, California Choice offers 15. Each employee can choose their own carrier. An employer can easily budget how much they want to spend on coverage and still offer employees a variety of plans and networks.
Still Confused ?
At the request of BizNet Magazine, Paul has agreed to answer any questions you may have. He will be happy to discuss your individual or small group health insurance needs. Feel free to call him at (818) 888-0880 e-mail to pdinsure@earthlink.net. California License # 0669770. If you have a Heath Insurance specialist your now working with, Please contact them to discuss your needs.