Educate your employees about what group health insurance is and how premiums and coverage work. [Benefits 101: Introduction to Group Health Insurance]
When I consider purchasing an individual health insurance plan for myself or my family, do I have any financial obligations beyond the monthly premium and annual deductible?
Answers: It depends on the plan, but some plans have the following cost-sharing elements that you should be aware of.
Co-Payments: Some plans include a co-payment, which is typically a specific flat fee you pay for each medical service, such as for an office visit. After the co-payment is made, the insurance company typically pays the remainder of the covered medical charges.
Deductibles: Some plans include a deductible, which typically refers to the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.
Coinsurance: Some plans include coinsurance. Coinsurance is a cost sharing requirement that makes you responsible for paying a certain percentage of any costs. The insurance company pays the remaining percentage of the covered medical expenses after your insurance deductible is met.
Out-of-pocket limit: Some plans include an out-of-pocket limit. Typically, the out-of-pocket limit is the maximum amount you will pay out of your own pocket for covered medical expenses in a given year. The out-of-pocket limit typically includes deductibles and coinsurance. But, out-of-pocket limits don’t typically apply to co-payments.
Lifetime maximum: Most plans include a lifetime maximum. Typically the lifetime maximum is the amount your insurance plan will pay for covered medical expenses in the course of your lifetime.
Exclusions & Limitations: Most health insurance carriers disclose exclusions & limitations of their plans. It is always a good idea to know what benefits are limited and which services are excluded on your plan. You will be obligated to pay for 100% of services that are excluded on your policy.
Beginning September 23, 2010, the Patient Protection and Affordable Care Act (health care reform) begins to phase out annual dollar limits. Starting on September 23, 2012, annual limits on health insurance plans must be at least million. By 2014 no new health insurance plan will be permitted to have an annual dollar limit on most covered benefits.
Some health insurance plans purchased before March 23, 2010 have what is called “grandfathered status.” Health Insurance Plans with Grandfathered status are exempt from several changes required by health care reform including this phase out of annual limits on health coverage.
If you purchased your health insurance policy after March 23, 2010 and you’re due for a routine preventive care screening like a mammogram or colonoscopy, you may be able to receive that preventive care screening without making a co-payment. You can talk to your insurer or your licensed eHealthInsurance agent if you need help determining whether or not you qualify for a screening without a co-payment.
There are five important changes that occurred with individual and family health insurance policies on September 23, 2010.
Those changes are:
1. Added protection from rate increases: Insurance companies will need to publically disclose any rate increases and provide justification before raising your monthly premiums.
2. Added protection from having insurance canceled: An insurance company cannot cancel your policy except in cases of intentional misrepresentations or fraud.
3. Coverage for preventive care: Certain recommended preventive services, immunizations, and screenings will be covered with no cost sharing requirement.
4. No lifetime maximums on health coverage: No lifetime limits on the dollar value of those health benefits deemed to be essential by the Department of Health and Human Services.
5. No pre-existing condition exclusions for children: If you have children under the age of 19 with pre-existing medical conditions, their application for health insurance cannot be declined due to a pre-existing medical condition. In some states a child may need to wait for the state’s open-enrollment period before their application will be approved.
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Life insurance benefits and annuities are associated with some very important income tax rules that you’re going to want to know. Find out about income tax on life insurance benefits and annuities with help from a longtime financial planner in this free video clip.
Expert: Karen Lee
Filmmaker: Edward Castner
Series Description: It’s never too early to start thinking about life insurance, retirement and other types of financial-related plans that are an absolute necessity in today’s world. Learn how to get the most for your dollar and plan for your future in the proper way with help from a longtime financial planner in this free video series.
In this video Marc Whitehead, Board Certified Disability Insurance Attorney, discusses how to prove diabetic neuropathy qualifies you for Disability Insurance benefits.
Almost 26 million children and adults have Type II Diabetics according to the American Diabetes Association and many of these people also suffer from peripheral neuropathy as a result of diabetes related nerve damage. Neuropathy may become increasingly more server over time causing pain, numbness and weakness in the hands, feet and other parts of the body and eventually compromise an individuals ability to work and complete normal daily activities. If neuropathy makes it impossible for you to continue completing your normal functions of your job, you will likely need to apply for Disability Benefits and prove that this disability is legitimately preventing you from working.
The following forms of documentation will help you prove your case
and receive the benefits that you need to support yourself.
1- Medical Records: The most obvious evidence that you will need is your complete medical history including a neurologist diagnosis or your peripheral neuropathy based on nerve testings such as MRI’s, nerve biopsies, Blood tests, nerve conduction tests or spinal tap.
2- Documentation of Treatment: Presenting an initial diagnosis of Peripheral Neuropathy is generally not enough in a long term Disability Case. You need to prove that you have continued the recommended treatment. If you can’t prove that you’ve received regular treatment from a neurologist or other medical provider, your claim may be denied.
In order to prove that you can no longer work in the capacity that you used to you need to prove that your Neuropathy hinders your completion of basic day to day activities. The most straight forward way to do this is by tracking how long it takes you to do certain tasks and what type of pain and other symptoms you experience while completing these daily activities. Things such as showering, dressing and completing household chores. If you write all of this down in an activity log, you can use that log as evidence.
Finally get a written statement from a Neurologist. To make your claim even stronger you should have your Neurologist write and sign a detailed statement stating the symptoms you experience, how those symptoms are disabling you and what they recommend for your course of treatment.
For more information download a free copy of Marc Whiteheads eBook:
Disability Insurance Policies: How to Unravel the Mystery and Prove your Claim
Or contact our office to discuss your own claim
5300 Memorial Dr. Ste. 725
Houston, Texas 77007
LTD Video Blog Post
Sarah Friend, Employee Benefits Consultant at The Partners Group, explores the advantages of self-funded health plans (vs. fully insured health plans) as a cost-saving option and how more companies are able to seriously consider it as an option.
The Partners Group, with offices in Bellevue, WA; Bozeman, MT; Portland and Bend, OR; is an independent financial services, risk management, commercial insurance and employee benefit consulting firm. The Partners Group is locally owned with national strength due to being a founding member of Collaboration Centric Solutions (C2), the nation’s 5th largest privately held commercial insurance broker serving more than 1 million households in the United States. For more information, visit http://www.tpgrp.com . 503-241-9550 or 425-455-5640.