New information has been released about health insurance exchange policies and premium payments. Under the new law, if you buy a policy from the health insurance exchange, you have a 90 day grace period to pay premiums. This is going to have a huge impact on how doctors treat exchange policyholders.

Doctor may be reluctant to treat exchange policy holders. If a doctor treats you while your policy is in the grace period, and then that policy lapses, the doctor may be force to try to collect from the patient. This will create major problems for the medical practice.

Let’s say the patient goes to have an outpatient surgery. The medical practice would file a predetermination of benefits. The insurance company comes back and states the policy is active. They perform the surgery and file the claim. Then let’s say that policy was at the end of the grace period and the insured loses the policy because of lack of payment. The insurance company is not going to pay that claim because the procedure happen during the grace period and the insured did not pay the back premium.  Now the medical provider is stuck trying to collect a $30,000 fee. The probability of them collecting this is very low.

This new information could have a big impact on how doctors treat patients that have an exchange policy.



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The Society of Actuaries released a study on the projected increases for health insurance premiums under the new health care laws.

It does not look good. Our health insurance premiums are projected to go up 67% under the new health care laws.  This is a huge jump because of health care reform.

We are one of the states getting the highest increase. The SOA believes these increased premiums will be on new policies purchased in 2014.

They state that self funded group plans should not be affected in this manner.


This study should be getting more attention.

With these kinds of rate increases projected, Hoosiers are going to be more dependent of Federal Subsidies through the health insurance exchange.


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Washington Post reported on the use of  Temp Employees to help keep companies below 50 employees.

This is very interesting article because is establishes a strategy of keeping a group from paying a penalty for not providing group health benefits. From the article, there looks to be a loop hole with providing coverage to Temporary employees. This could become a power full strategy for many Manuel labor industries.

A company could have 40 employees but need 60 to operate. If the group goes over 50 then they would either provide group health benefits, that follow the federal guideline, or a pay a penalty. That penalty would be $2,000 per full time employees. With many companies that have low paying jobs, group health benefits have always been a struggle.

Any company that is looking to game the new health care laws have had there problems providing health insurance in the past. The problems have be participation and underwriting. Many companies that have a lower pay scale can attract high utilization health conditions. The usually leads to higher premiums and unless the company is paying a large portion of the premium the employee will drop off.  At these lower pay scales, many of the employees can qualify for a subsidized plan through the state which leads to a lack of participation.

Many companies will have to take advantage of this loop hole to stay in business.


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Next year where will you get health insurance from?

Health Insurance will come from the same places that you are buying it from today. It may be delivered in a different platform. Currently you purchase health insurance from the individual market, employer sponsored group health plan, COBRA, HIP, Medicaid or Medicare.

In 2014, you purchase health insurance from the same places you get in now.

The individual market will be very different that what we have today. The big difference is going to be guaranteed issue. This mean there will no longer be medical underwriting to buy a individual health insurance policy. There is a segment of the population that is going to be very happy about this. We do predict that the cost of these plans are going to go up significantly. The cost of a Individual health insurance policy will resemble the cost of guaranteed issue group plan.  Premium could go up 200%-300%.  Now those policies are going to cover much more services like maternity and the essential health benefits.

Hoosiers will still have access to group health insurance on both small group and large.  If your small group employer (under 50 employees) continues a group health plan then not much will change. We do predict cost on those plan could go up. This has to do with the new health care reform laws. These plans will continue to have guaranteed issue but with no underwriting.  In Indianapolis we will have community rates. This could be a good thing for high risk groups. They could see their premium drop.  Large group will continue to cover their employees.  For a company to keep top talent they will be forced to continue to invest in health insurance. Some blue collar industries could entertain dropping coverage because the employees will GI in the Individual market.

Cobra coverage will continue to be an option for former employee. To this day people still don’t realize that COBRA is the coverage through the actual group health plan. The difference is that you no longer have the employer contribution.

HIP plans and other subsidized health plan may no longer be an option. Those Hoosiers would be have the option of buying health insurance through the Federal Health Insurance Exchange.  The exchange plans may very well turn out to have better access to Doctors than prior plans.

Medicaid and Medicare people will still have that option on the table. Now it does not look like Indianapolis is going to expand medicaid coverage. This will force a lot of people to look at the  Federal Health Insurance Exchange for coverage. They would have to pay something for that plan but it may only be 1.5% of household income.  Considering that plan could cost $20,000 a year that might be a good deal. There might also be tax credits available for medical claims. To the actuarial value of those plans could be in the 90% range.

If you would like to know more about options contact me.

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Health insurance companies continue to create online tools and apps to help insured have better control of their health care.

United Health Care has launched a new app call Smart Patient. This app is for either IPhone or Droid.

The app will hold of the patient medical information and more.

The application tracks 5 numbers that are essential to good health.

• Blood pressure
• Blood sugar
• Body mass index (BMI)
• Cholesterol
• Weight circumference

Smart patients are prepared with questions throughout their care.
• At a doctor visit
• Before a test
• After a diagnosis
• When filling prescriptions
• Before surgery
• When leaving the hospital
• If you need to go to the emergency room or urgent care

It also track Doctors Orders:

Once you have advice from your doctor, you’ll want to keep track of it. Store text notes or voice notes to refer to later, and delete them when you’re ready.

The app also has access to video that address certain health issues.

Get tips on when to have screenings, how to talk with your doctor, how to tell if it’s a cold or the flu, what to ask your pharmacist, and much more with short videos from UHC TV.

These types of tools are becoming more available to insureds. These tools come along with the policy so it does not cost you anything to use them. Why not take advantage of these tool to better control your health.

Smart Patient


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Under the new Health Care Reform laws, all breast pumps must be covered at no cost to the insured.

As you can imagine this has created some shortages.

If you find yourself in need of breast pump, look on the back of your insurance card for a phone number for member services.

This number will put you in contact with durable medical suppliers in the network. From there you should be able to find a breast pump.

You may want to ask your doctor if they have any in stock.

Be sure to utilize any online services that your insurance company provides. The online services can be a great source for information on durable medical equipment.


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Anytime you travel outside the United States, one should look at taking out a Travel policy. Most health insurance policies will have some level of coverage for travel but it is not enough. Most Indianapolis based health insurance policies will cover emergency room visits as in network. One issue that you will run into is reimbursement in a timely manner. Take all of the medical claims you incurred abroad and submit them to the insurance company. If they are emergency visit claims then they should be reimbursed with accordance to your plan design. This process can take some time. They have to translate the claims which create a delay. Then the claims will be processed.

Where this insurance policy lacks coverage is on medical evacuation. 9 times out of 10, you will not have coverage for this. If you need medical attention on the flight home, this can be very expensive. We are talking $10,000 and up. This is why you take out a travel policy.

The travel policy will cover the medical evacuation and most medical treatment abroad. These travel policies can also help in directing you to the best medical provider. The carriers have developed networks in other counties. This can be a key source of getting quality medical attention abroad.

The travel policy is relatively inexpensive. For a $50,000 benefit it can cost as low as $50.

When we go on vacation no one wants to think about medical claims, but if you have medical claims, the last thing you want to think about is the cost.

Travel Insurance Quotes


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Indianapolis Union Health Insurance Carve out


A lot of Union shops have a handful of non union employees in Indianapolis.  Owners have a option when it comes to health insurance for these employees.

Depending on the Union contract, the owner could choose to put these employees on their own group health plan. It just takes two W2 employees to form a group.

An owner will look at this option for a couple of reasons but the big one is a reduction cost.  Most union health plans are very rich and costly. A company could choose to design their own group health plan for the non union employees. The owner now has control over the health plan. They can choose plan design, contributions levels, waiting periods, wellness programs and employee education.

If you have 4 non union employees  and it costs $38K a year to insure them on the union plan, why not look to save $15K-$18K by forming a small group plan?

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The Essential Health Benefits have been released by the federal government. This dictates that Insurers must cover 10 broad categories of care. This includes maternity services, doctor and medical services, mental health and substance abuse, and prescription drugs.

Why is this important?

All individual and small group will be effected by this ruling. This document is 149 pages long.  Even Medicaid will have to cover the essential benefit.

Out of pocket max will be dictated to all health plan even self funded. For an individual the out of pocket max can not be more than $6,250 and for family $12,500. In 2014 you will not be able to get a policy that has a higher out of pocket. This could have a big impact on a lot o plans.

There has been a large amount of individual plans sold online, that have a higher out of pocket. Those plans will have to comply with the new rule or you could pay a penalty.

The benefits does allow people to get drugs that are needed but not on the drug formulary. So if you need a certain cancer drug then you should be able to obtain it. This is viewed as a positive thing.

The best news, is that insurance companies cannot charge for colonoscopy even if a polyp is found. This has been one of the most frustrating coverages for Hoosiers. You go in to have a colonoscopy and it is covered at 100% by the insurance plan, under preventive care. Then the doctor finds a polyp and now you have a diagnosis code and a bill for $1,200. So under the law the entire procedure is coverage at 100% with no cost to the insured.


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