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Community Living Assistance Services and Support (CLASS)

This act is a government sponsored long-term care plan that offers a basic level of guaranteed issue coverage to working Americans. It works like social security where you pay in advance for the benefit.

Many of the details are still in development. As of right now the plan:

  1. Can be offered by employers.
  2. Could allow automatically enrolling all actively at work employees or offering on a voluntary basis.

Premiums would be paid through a payroll deduction except for:

  • The Self-Employed.
  • Employees that want coverage but their employers do not offer it.

Additional Information

  • Class has a mandatory 5-year vesting period before any benefits can be paid.
  • Has no set premium yet. Estimates run from the mid $100-$200+ per month.
  • Will pay a daily benefit of $50 to covered individual if they lose at least two ADLs or have significant cognitive impairment.
  • May pay up to $75 a day or more on the level of ADL loss.
  • Includes a benefit that will be payable for life if the individual remains ADL disabled.
  • Has a benefit that will be adjusted for inflation.
  • The Class Act is not disability coverage. This act is designed to help cover cost associated with Activities of Daily Loss.

Cost of Care Estimates (Annually)

Home Care:                                    $25,000+

Assisted Living Facility:                    $41,000+

Nursing Home Semi Private:      $72,000+

Nursing home Private:                       $81,000+

With the cost of care so high one should look into a Long Term Care policy to go along with the Class act.

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There have been some huge jumps in technology when it comes to shopping for healthcare procedures. The large insurance companies have developed price shopping tools that resemble a menu. The ability to price shop an MRI on your lower joint within 20 miles from your zip code can make the difference of thousands of dollars. It’s truly amazing to see the price difference of the same procedure at different facilities. The interesting thing is the different locations are using the same equipment and processes. How can a hospital charge $1,800 more for an MRI than the clinic down the street?

This is why it is very important for people to starting looking at the cost of procedures.

Along with these price shopping tools there has been the development of “quality of care reports”. This is a very unique tool that can be informative for your future surgery. These reports contain information ranging from the percentage of complications, to the bed side manner of the attending physician. There are even reports on how clean the bathrooms are kept.  This type of reporting is extremely useful in deciding where you want to have a surgery.

These national health insurance companies put a lot of time and money into developing these tools and that is why it’s important you talk to us about where and how to access them.  Give me, Tony Nefouse, a call at (800) 846-8615 today.

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Every year Hoosiers experience increasing Health Insurance Premiums.  As Insurance Providers absorb the cost of claims premiums tend to go up.  Insurers increase premiums among the healthy to offset the cost of claims from the unhealthy.  As healthy people change jobs or switch insurance carriers the remaining people in the group are left to pick up the tab.  This is called the Death Spiral.  How can an individual or a group stay away from this?  The answer is simple…Control.  Taking control of your health care is the key.  Using a broker to find the health care plan that is the most economical while maintaining a necessary level of coverage is essential.  Weather you are  Self Employed or part of a large group there is relief.  Take control of your Health Care and get on track to lower your premiums.

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Timeline of Provisions

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As the explosion of health insurance sales online continues buyers need to be aware. Almost everyday I speak with a potential client that has received quotes online and thinks they are buying a certain type of plan. What they are actually buying is a plan that has limited benefits. This could be an honest mistake from the agent  or it could be something far more serious.
There has been a flood of new insurance agents to the industry that specializes in online sales. These agents do not or will not meet face to face with their clients. They just “churn and burn” personal policies. These types of outfits offer no customer service and have a lack of knowledge in product.
They might quote you plan for $140 a month and you think you are buying a plan that is valued at $300 a month. With online application many people are not looking at the plan they are applying for and over the phone they are being told they are buying another plan. So the plan that you think is such a great deal turns out to be a nightmare. Plans that have $3,000 max prescription drug benefit per year or only pays $25,000 a year on inpatient services.
These types of plans can be devastating should you end up need more than the benefit pays.
Its very important to choose an agent that has knowledge in the industry and is willing to meet with you. You want to buy a policy from an agent that is successful because they value what they sell and they value their reputation.

As the explosion of health insurance sales online continues buyers need to be aware. Almost everyday I speak with a potential client that has received quotes online and thinks they are buying a certain type of plan. What they are actually buying is a plan that has limited benefits. This could be an honest mistake from the agent  or it could be something far more serious.

There has been a flood of new insurance agents to the industry that specializes in online sales. These agents do not or will not meet face to face with their clients. They just “churn and burn” personal policies. These types of outfits offer no customer service and have a lack of knowledge in product.

They might quote you plan for $140 a month and you think you are buying a plan that is valued at $300 a month. With online application many people are not looking at the plan they are applying for and over the phone they are being told they are buying another plan. So the plan that you think is such a great deal turns out to be a nightmare. Plans that have $3,000 max prescription drug benefit per year or only pays $25,000 a year on inpatient services.

These types of plans can be devastating should you end up need more than the benefit pays.

Its very important to choose an agent that has knowledge in the industry and is willing to meet with you. You want to buy a policy from an agent that is successful because they value what they sell and they value their reputation.

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The ever rising costs of employer sponsored group health insurance have driven more companies to elect high deductible health plans along with goal driven wellness programs. Under these types of wellness programs employee’s can reduce their out of pocket costs by meeting reasonable health goals.

Goal driven wellness programs work best when the program is to alter employee’s unhealthy lifestyle.  An example of this would be to help employee’s quit smoking. Where they can have great results is if an employee is suffering from multiple conditions. High Cholesterol, High blood pressure, and Obesity could be a direct result of a un healthy lifestyle depending on the individual. So to educate an employee how they can change their life style to help treat these conditions can have a huge impact on cost to the employee in the form of claims. The wellness programs can even address issues like stress management or how to buy and prepare health foods at a reasonable cost.

The first step is an employee/insured should complete a Health Assessment form. We are seeing these more and more in an online format. After completing the assessment form you will be given information on what you might be high risk for.  Some of these programs even address the issue if you drive too fast as it may be linked to stress. With that high risk information you could have access to a disease management program or health coach. In some programs the health coach will help you establish and work towards your health goals.

Once you have entered the disease management side of the program you will be educated on what conditions you are high risk for.  The education can include treatments and prevention. There might be 10 drugs out in the market place that can treat that condition and it’s important that you know about the different options. One of those options might cost you a lot less and treat the condition.

The best way to reduce your out of pocket expenses is to actively live a healthy life style and the wellness programs that are being developed today can help you meet those goals.

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SCHIP Expansion up to 250% Income Guidelines / Premiums

This is an interesting program that very few people are aware of. If your house hold income is below 250% of the federal poverty level then you may be eligible to put your children on this health plan.

Currently in Indiana the SCHIP program is being admin through Hoosier Health wise. So for a family of 4 to be eligible the house hold income cannot exceed the 250% of the federal poverty level ($53,000).

So if you are a business owner, controller, or a citizen of Indiana you should know about this program.

Being a business owner or controller it’s important to be able to advise newly hired employees and existing employee that they might be eligible to put their kids on this program.  Currently most group health plans could cost an employee or company much more than what it would cost on SCHIP. On SCHIP two children could cost up to $70 a month in premium. In the private sector those same kids could cost anywhere from $120 and up depending on the group and plan design.

This program could help out a lot of Hoosier families.

Now here are is one of the big obstacles of the plan. The child must be uninsured for 3 months before they are eligible.  This is a huge obstacle.

From an employer standpoint they should inform any new hires with children about this option.  With the current economic conditions we are seeing a lot of families that are going uninsured do to cost. So they might qualify for SCHIP which will reduce what they are spending on premiums.

This October 2009 we might see an increase from 250% to 300% of the federal poverty level to qualify.

This program has very little advertising to it.

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Anthem plans across the country are working to develop innovative products and programs that help address rising health care costs. Through pay for performance initiatives, consumer directed health plans and transparency initiatives; Anthem is providing access to the information needed to drive down health care costs.

While many people may believe that insurer profits are the driving force behind increasing health insurance premiums, research reveals very different reasons for the high cost of health insurance.

A May 2009 report titled “What’s Really Driving the Increase in Health Care Premiums?” addresses the issue. The report, issued by the WellPoint Institute of Health Care Knowledge, compiles research from sources such as PricewaterhouseCoopers, the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Bureau of Labor Statistics and the Congressional Budget Office.

According to the report, the “key drivers” of spiraling U.S. health care costs are:

  • Advances in medical technology and subsequent increases in utilization;
  • Price inflation for medical services that exceeds inflation in other sectors of the economy;
  • Cost-shifting from people who are uninsured and those receiving Medicare and Medicaid to the private sector;
  • High cost of regulatory compliance; and
  • Patient lifestyles, such as smoking, physical inactivity and obesity.

 

Citing PricewaterhouseCoopers research from 2008, the report found that only three cents of every health care premium dollar is spent on health insurer profit.

According to the Institute’s report, newer medical technologies tend to increase costs because they are generally more expensive than the older technologies they replace. While the availability of more advanced, superior technologies can yield better results for some patients, these technologies and diagnostic tests may be used inappropriately in some situations where existing, older technologies are more effective and accurate.

To view a copy of the full report, click here.

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