Author Anthony Nefouse

If you are the controller or an owner of a small business there are  major decision you will have to make on an employee health insurance. The one that I will focus on here is age based vs composite premium calculations. These will impact your employees.

Age base premium is exactly what they sound like. The premium is calculated by your age. So the younger employee benefit with this because they pay less in premium. The older employee pays much more.

Composite rates are an average of the employee ages. So every employee pays the same amount.

There are pros and cons to both approaches. Composite is much easier to administer because everyone pays the same price. The age based makes it much cheaper for younger employees which can help with retaining young health people on the plan.

Each case is different but these are things to think about when establishing a plan or renewing a group health plan.

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It’s very important that we continue to talk about health care reform. Ask people that are in the health care equation. Speak to your Doctor, Nurse, Pharmacist, and Insurance broker.  It’s important for everyone to know what the people in the health care field think about the current reform laws. Right now there is a lot of debate going on with politicians using examples of both pro and con that might not really be truthful.  Speak to the people you receive health services from.

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I have read a lot of  blogs that are posted online about health insurance. There has been a really disturbing trend in most of these non broker sites. This trend is that the site is giving health insurance advice without having really any knowledge of health insurance.

These blog post are beautifully written and designed to be index by the search engines so that you may find them. The content of the blog is almost worthless in the realities of health insurance. Most of these blog writers have no experience in the health insurance field. They have not been either agents,underwriters,actuaries, services reps, sale reps, or any other position that is in the health insurance equation. These sites go on to talk about health insurance with the only intention of you clicking a link on their page so they can get paid.

What I can gather from these portals is most of them are selling your information. There is even a technique where they are using cookies to track your online behavior.

If you are in the market for health insurance you want to use a online resource that is accountable. The accountability comes from either a broker or Agents web site.  The problem that we have is we are not blog experts like these portal sites.

Obviously, I want you to choose me for your Indianapolis health insurance. I am willing to earn you as a customer. This means that not only will I educate you on plan design but will be here for you when a problem arises. Then add that I will be a trusted source for you. 

I really believe none of these portals can be trusted.

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The house is going to vote on repealing the health care reform.  Most news outlet are stating this is a symbolic gesture.  I think its a lot more than that. The healthcare reform bill is a huge gamble with 1/6th of the economy. The health care reform bill has done nothing to address the cost of care. The best way I can describe the reform is an attempt to increase benefits to reduce cost. The bill really fails to use math in calculating health coverages.

There are many states right now that are trying to figure out how they are going to pay for the reform. Most of this comes from an expansion of Medicaid. The carriers could pull out of certain markets because of restrictive laws regarding Medical Loss Ratio.  Some fear the law could keep companiesfrom hiring employees because they do not want to go over the 50 employee market. With50 employees that opens the doors to many penalties that come in the form of fines.  There is real concern with how the exchanges are going to be set up and if they can be set up on a state level.  There is so many issues that have not been clarified that it is many people are worried.

People that support the health care reform high light areas that sound good. No child under 19 can be declined a policy. This is a good thing but the carriers have pulled out of that market because the federal gov. would not put conditions so people don’t game the system.  Adults can stay on their parents group health plan until age 26 is being pressed as a very good thing.

There is huge discrepancies in what this bill is actually going to cost.

http://www.foxnews.com/topics/health-care-bill-gross-cost-of-coverage-provisions

The health care reform is a huge gamble with our economy. The law need to be looked at openly. There is also another 1000 pages of the law that could be viewed as nothing more than an expansion of government into private lives.

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Right now with all major health insurance companies there is a huge amount of online tools. These online tools have many functions. There are claims checker, Nurse Chat, Health Assessment, and even price shoppers that are available through your carriers website. If you are an employee  on a sponsored group health plan it’s your responsibility to get involved with tools.  These tools will educate, organize, and save you money when it comes to your health care.

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As the baby boomer generation get closer to 65 there are many challenges for them in both group and individual health insurance markets.

If you are an employee that is 60 on a small group health plan you could be paying a large sum for health insurance.  One of the calculations for group premiums is age. The older an employee is the higher the premium.  This is true for both composite and aged based groups.  If you are an employee on a group health plan that has aged based rates then the premiums could be very high for you. If you are with a company that is using composite then that could help you a great deal if the rest of the group is young.

A difficult decision for small groups (under 20 lives)  is if they should set the health plan with composite or aged based rates.  As it stands there is really no technique available that is going to reduce your premiums. Our current health insurance system is based on age.

The one technique that is available is to go out to market and pick up an individual plan. This is a great way to reduce premiums but you have to be able to get through underwriting. Genetics is tough enough but then if we add a unhealthy life style then it can be very difficult to find a policy.

In the large group arena there is a real concern with the baby boomer generation and what kind of claims they are going to have. If a company is self funding the first $100,000 in claims you understand the worry.

Time will tell if this generation in the next 5-10 years makes life style changes to reduce claims.

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In the individual  health insurance there are many underwriting guidelines but none are more controllable than your weight. Weight can determine what premiums you pay.

For example a male that is 5’9″ if he ways 128-188lbs then he could qualify for Preferred 1. This would be the best risk factor you can get which mean your premium are the lowest for that plan design.  Now let’s take the same example 5’9″ and you weight 255 lbs now your are automatically in a standard 2 rate class which is the highest costing. The difference in cost from Preferred 1 and Standard 2 could be 100% more. Not only are you going to pay more in premium if you are over weight but now you could be declined. There is a good possibility if you are 60+ lbs over weight you could also suffer from High Cholesterol, High Blood Pressure, Hypertension, Sleep Apnea and so on. With the combination of being over weight and having health conditions you are an automatic decline for a Individual health policy from a private carrier. Now your options for coverage are a lot less and more expensive.

If you control your weight you could pay a great deal less in health insurance premium and pay a lot less for medical services.

The best way to get your individual health premiums low is t0 take care of yourself.

With todays technology there are all kinds of smart phone applications that can assist you with counting calories. Any Doctor in the country can point you in the right direction for a health diet.

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As health insurance prices continue to surge we are seeing a higher demand for Surgical and Hospitalization health plans.

This type of approach for health insurance is being entertained in both individualand small group health markets.  These plans show a change in how we view health insurance. People are willing to take out a plan that covers the most expensive aspect of health care and that is surgeries.

A typical hospitalization and surgical plan has a lot of craves out that in the past have been automatic with health coverages. A big carve out is coverage for diagnostic services. So if a customer is on one of these plans and needs a MRI on their knee then they half to pay for it out of pocket but could still get the network discount. We are seeing plan designs that carve out all prescription drugs.

Someone might look at this plan and think this is too much risk to take on. Not really! If you look for a plan that covers all the carve outs on an inpatient basis then the coverage can be satisfactory.

As we move along with health care reform there is no premium relief in site. These type of plans are going to continue to get serious looks from consumers because they usually are 50%-60% less in premium than a traditional.

Do not confuse these plans with limited liability policies! Hospitalization and Surgery plans are true forms of insurance.

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Most people that have an individual health policy has premium payments set with an electric fund transfer from a bank account. The health insurance industry like many others has really shifted to paperless. In fact if you want a monthly bill mailed it could cost you anywhere from $5-$25.

These EFT are good and bad. The good thing about it is your premium is always paid on time and you don’t really have to address the premium until renewal. The bad is if you switch to a new carrier and forget to inform the previous you wish to cancel you will have a very hard time getting your money back. The carriers have become notorious for keeping the money.

So remember if you switch your individual policy make sure your new effective give  you time to cancel the old one.

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As we enter in 2011 more aspects of  health care reform will have a direct impact on you.

All wellness and preventive care is now covered at 100% with not cost to the customer.   So there is no reason not to get your yearly check up. Technically speaking if you have diagnostic services done for wellness you would not pay anything.

 Guaranteed issue for children under 19 year of age:

This means a carrier can not deny a child coverage. Now we have a huge problem with aspect of reform because all of the carriers have pulled out of the stand alone child policy market. The other issue is the rate up that the carrier can charg for the child. We are seeing about 400% increase in premium for the child.

Medical Loss Ratio.

This states that at least 80% of your premium has to go to claims or you get a refund. This sounds like a great thing but in the long run it could prevent carriers from entering certain markets. The market where we could see carriers pull out of is Individual.

Individual Maternity Plans are no longer available

Health carriers have pulled out of these markets because of the negative impact of health care reform. It still is not 100% clear but I think if the carriers were to stay in the market the plan could not have a waiting period for the maternity benefit to kick in. In the past a policy had either a 1 year or 9 month waiting period.

Health insurance premium increases

The health care reform does nothing to reduce the premium increases. The premium increases are a direct response to the cost of care. The Reform does put in place a process of review if a carriers want to increase premiums more than 10%.  It is important to have these checks and balances in place so everyone sees the process.

Health Savings Accounts

For 2011 the contribution levels will stay the same for a H.S.A custodial account.  (Single $3,050, Family $6,150)  For members over 55 years of age there is an additional catch contribution of $1,000.  Over the Counter medicines are no longer qualified to use HSA accounts to pay for.

Waivers for Health Care Reform

There are a lot of waivers for health care reform because the reform would result in people losing coverage. There should be many states that ask for waivers in 2011.

These are just some aspects of health care reform that will impact you.

There are going to be positive things but we fear the negative could destroy certain markets.

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