Guaranteed Issue Defined Benefit Health Insurance for the Uninsurable.

Medical Health

health screening_6939

At the ‘Knowing Your Numbers‘ health screening in the Lavin-Bernick Center, Debbie Grant, left, vice president for university communications, gives a blood sample to be tested for cholesterol and glucose levels. The health awareness program for Tulane employees is sponsored by the Workforce Management Organization. (Photo by Paula Burch-Celentano)

Guaranteed Issue Defined Benefit Health Insurance for the Uninsurable.

I have been a multi state licensed health and life insurance broker for 13 years now. One of the biggest challenges I have had to deal with through the years has been trying to help the uninsurable. Unfortunately in most states if you have one of a host of “pre-existing” medical conditions you are labeled as uninsurable on an individual health insurance policy. In most states this uninsurable status lasts for many years and sometimes for life depending on the specific pre existing condition you have been diagnosed with. Some of the pre existing medical conditions that render an applicant uninsurable for ten years or more are:

Heart Attack
Stroke Diabetes (insulin or sugar pill dependant)
Cancer (Infiltrating Ductal Carcinoma only, Carcinoma in site ok after excision)
Lupus
Multiple Sclerosis
Muscular Dystrophy
Degenerative Arthritis

and a host of other pre existing conditions. In addition, there are applicants who have a combination of controlled pre existing conditions but because they have more than three “rate-able conditions” they are labeled uninsurable. For example, with many carriers an applicant who has Hypertension & Hyperlipidimia but is also overweight falls under the “3 strikes your out” rule and is labeled uninsurable. Or an applicant may have two of the aforementioned controlled conditions and is not overweight but is a smoker and is then labeled uninsurable also. Or an applicant who has asthma but also smokes falls in to the same uninsurable category with many carriers. 

This is just a small snippet of conditions or “combo conditions” that can render an applicant uninsurable. The question then becomes, what do I do now? Who will insure me against the catastrophic medical bills that I may face in the future? Who will help me pay for the medications I currently am taking to control the aforementioned conditions? For many years depending on the state you live in you only had two options. They are as follows: 

1.) If you have a corporate tax i.d. number you can purchase a small group health insurance policy from most insurance carriers. With this scenario a minimum of two people (often husband & wife) who work for the same corporation can apply for a small group health insurance policy. After a period of time, or in some cases immediately (depending on how many months you have had prior health insurance coverage without a lapse) pre-existing conditions will be covered provided that they are a covered expense on the policy.

2.) Enroll in your states insurance risk pool (if your state is fortunate enough to have one). In our home state of Illinois the risk pool is called the Illinois Comprehensive Health Insurance Plan (ICHIP). ICHIP is a state health benefits program and not an insurance company. Persons must qualify for coverage but in most cases if the applicant is coming off an exhausted qualified COBRA continuation plan from a prior employer sponsored group, their pre existing conditions will be covered from day one (provided again that those conditions are a covered expense on the ICHIP policy). However, ICHIP (and all insurance risk pools) are by no means entitlement programs. They are far from free! Premiums charged are established by law at from 125%-150% above the average rates charged individuals for comparable major medical coverage by five or more of the largest insurance companies in the individual health insurance market in that state. Suffice it to say, the premiums are far from affordable for many people. The rates for a person 50 years of age living in Chicago can range from 4 monthly for a ,200 deductible plan to 2 monthly for a 0 deductible plan. For those who do not have an insurance risk pool in their state (http://www.naschip.org/states_pools.htm) their options are then even more limited if they are labeled as uninsurable.

There is now another option. American Medical & Life Insurance Company of New York, New York is now offering Defined Benefit Health Insurance Policies to the uninsurable. There are only three restrictions to obtaining these quality Defined Benefit Health Insurance Policies. They are as follows:

1.) You may not be a Medicare recipient.
2.) You may not be receiving disability benefits.
3.) You may not be receiving workers’ compensation benefits.

There are no other underwriting requirements. This means that regardless of your pre existing condition American Medical & Life insurance company will issue you a Defined Benefit Health Insurance policy.

What exactly is covered by their Defined Benefit Health Insurance policies? There are four different Defined Benefit Health Insurance Policies to choose from.
I will list the benefits covered on the best of the four different plan options. They are as follows:

All benefits are provided on a “first dollar” basis (no deductible or co pays required)
,000 per day covered for the first 100 days of hospital admission
,000 in additional coverage for the first day of hospital admission
,000 in additional coverage for the first 15 days of Intensive Care or Critical Care
Unlimited inpatient our outpatient Surgical Benefit provided on all plans
One Preventative Care Visit is covered per insured per calendar year with a 0 allowance for that visit
Up to 7 outpatient doctor office visits included with the with no co pay or deductible required
Mail order Generic & Brand name medications are discounted at up to 50%
Medically necessary diagnostic tests and x-rays performed in a doctor’s office or outpatient facility (e.g. MRI, CAT Scan, EKG, Mammography) are covered up to  0 per visit with a 5 visit allowance per year
There is a 12 month waiting period for Pre Existing conditions. However, because the plan is HIPAA compliant this waiting period will be waived if you have a Certificate of Creditable coverage from another health insurance plan showing 18 months of prior coverage with no lapse of more than 63 days
,000 of Critical Illness coverage provided for Primary Insured & Spouse (optional on other 3 plans) 
Nationwide P.P.O. network (www.multiplan.com)

Arguably these benefits rival the “first dollar” benefits provided on most major medical health insurance policies on the market today. The most attractive part about this kind of health insurance policy is that the premium required is well below half the premium required for the ICHIP state insurance risk pool. Also like the state insurance risk pool coverage these Defined Benefit Health Insurance policies are fully HIPAA compliant. This means that if you are coming off of an employer sponsored Cobra continuation plan and can produce a certificate of creditable coverage from this prior carrier showing 18 months of prior coverage with no lapse of more than 63 days your pre existing conditions will be covered from day one. If not, there is a 12 month waiting period for pre existing conditions.

Whilst a major medical health insurance policy is always the best way to insure oneself against the catastrophic medical bills one can experience throughout their lifetime, a Defined Benefit health insurance policy is most certainly a cost effective way to protect oneself if you are rendered uninsurable on the individual health insurance market.

Without a doubt, this is the finest Defined Benefit health insurance policy on the market today. Most especially since the majority of other offers to the uninsurable consist of discount P.P.O. network memberships that are by no means health insurance policies. We’ve all seen them advertised from company’s like “Care Entree” or “Ameriplan” that offer ”health coverage” (clever way to circumvent the words “health insurance”) that will “cover” the entire family for  monthly!

This “coverage” is so inexpensive because it provides nothing more than a P.P.O. repricing discount. This in itself is not a bad thing. However without a Major Medical or Defined Benefit health insurance policy in place one can experience catastrophic medical bills with these types of “health coverage” plans. This is the case because the average P.P.O. discount on medical procedures performed within a P.P.O. network is between 25% & 40%. For a 0 doctor office visit, this is a good deal. However, if the medical bill is 0,000 that can leave the “covered” person with as much as 0,000 in out of pocket expenses!

For more information about Guarantee Issue Defined Benefit Health Insurance Plans and or Major Medical Health insurance plans please visit click here: http://www.sbisvcs.com/guarantee_issue.htm

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Texas has top medical centers but provides poor health care: True of false?
medical health
So why does it matter if we mix up medical care and health care? It matters when we try to fix health care statistics by throwing more money at medical care. We already spend about twice as much per person on medical care as any other country. …

medical health question by Joe M: What jobs in the medical/health care have the least difficult schooling and pay good?
Im thinking about going to school in the medical/health field and have a full time family and job. Can anyone recommend jobs in these fields that are secure, pay decent and aren’t very insanely hard schooling? The quicker the schooling the better. The easier school, the better. Any help is appreciated!
preferrably one that doesnt involve nursing homes

medical health best answer:

Answer by Hubble
I did a nursing assistant class at a technical collage that only took about a month to complete and I started out at $ 11.00/hour. I’m a guy and I wasn’t afraid to go into the field….there’s alot of cute women at hospitals!

Medical Health

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Consumer Driven Health Care. How can HSA Qualified HDHP’s Save You Money & Boost Your Retirement?

I have been a multi state licensed health and life insurance broker for 13 years now. One of the biggest challenges I have had to deal with through the years has been trying to help the uninsurable. Unfortunately in most states if you have one of a host of “pre-existing” medical conditions you are labeled as uninsurable on an individual health insurance policy. In most states this uninsurable status lasts for many years and sometimes for life depending on the specific pre existing condition you have been diagnosed with. Some of the pre existing medical conditions that render an applicant uninsurable for ten years or more are:

Heart Attack
Stroke Diabetes (insulin or sugar pill dependant)
Cancer (Infiltrating Ductal Carcinoma only, Carcinoma in site ok after excision)
Lupus
Multiple Sclerosis
Muscular Dystrophy
Degenerative Arthritis

and a host of other pre existing conditions. In addition, there are applicants who have a combination of controlled pre existing conditions but because they have more than three “rate-able conditions” they are labeled uninsurable. For example, with many carriers an applicant who has Hypertension & Hyperlipidimia but is also overweight falls under the “3 strikes your out” rule and is labeled uninsurable. Or an applicant may have two of the aforementioned controlled conditions and is not overweight but is a smoker and is then labeled uninsurable also. Or an applicant who has asthma but also smokes falls in to the same uninsurable category with many carriers. 

This is just a small snippet of conditions or “combo conditions” that can render an applicant uninsurable. The question then becomes, what do I do now? Who will insure me against the catastrophic medical bills that I may face in the future? Who will help me pay for the medications I currently am taking to control the aforementioned conditions? For many years depending on the state you live in you only had two options. They are as follows: 

1.) If you have a corporate tax i.d. number you can purchase a small group health insurance policy from most insurance carriers. With this scenario a minimum of two people (often husband & wife) who work for the same corporation can apply for a small group health insurance policy. After a period of time, or in some cases immediately (depending on how many months you have had prior health insurance coverage without a lapse) pre-existing conditions will be covered provided that they are a covered expense on the policy.

2.) Enroll in your states insurance risk pool (if your state is fortunate enough to have one). In our home state of Illinois the risk pool is called the Illinois Comprehensive Health Insurance Plan (ICHIP). ICHIP is a state health benefits program and not an insurance company. Persons must qualify for coverage but in most cases if the applicant is coming off an exhausted qualified COBRA continuation plan from a prior employer sponsored group, their pre existing conditions will be covered from day one (provided again that those conditions are a covered expense on the ICHIP policy). However, ICHIP (and all insurance risk pools) are by no means entitlement programs. They are far from free! Premiums charged are established by law at from 125%-150% above the average rates charged individuals for comparable major medical coverage by five or more of the largest insurance companies in the individual health insurance market in that state. Suffice it to say, the premiums are far from affordable for many people. The rates for a person 50 years of age living in Chicago can range from 4 monthly for a ,200 deductible plan to 2 monthly for a 0 deductible plan. For those who do not have an insurance risk pool in their state (http://www.naschip.org/states_pools.htm) their options are then even more limited if they are labeled as uninsurable.

There is now another option. American Medical & Life Insurance Company of New York, New York is now offering Defined Benefit Health Insurance Policies to the uninsurable. There are only three restrictions to obtaining these quality Defined Benefit Health Insurance Policies. They are as follows:

1.) You may not be a Medicare recipient.
2.) You may not be receiving disability benefits.
3.) You may not be receiving workers’ compensation benefits.

There are no other underwriting requirements. This means that regardless of your pre existing condition American Medical & Life insurance company will issue you a Defined Benefit Health Insurance policy.

What exactly is covered by their Defined Benefit Health Insurance policies? There are four different Defined Benefit Health Insurance Policies to choose from.
I will list the benefits covered on the best of the four different plan options. They are as follows:

All benefits are provided on a “first dollar” basis (no deductible or co pays required)
,000 per day covered for the first 100 days of hospital admission
,000 in additional coverage for the first day of hospital admission
,000 in additional coverage for the first 15 days of Intensive Care or Critical Care
Unlimited inpatient our outpatient Surgical Benefit provided on all plans
One Preventative Care Visit is covered per insured per calendar year with a 0 allowance for that visit
Up to 7 outpatient doctor office visits included with the with no co pay or deductible required
Mail order Generic & Brand name medications are discounted at up to 50%
Medically necessary diagnostic tests and x-rays performed in a doctor’s office or outpatient facility (e.g. MRI, CAT Scan, EKG, Mammography) are covered up to  0 per visit with a 5 visit allowance per year
There is a 12 month waiting period for Pre Existing conditions. However, because the plan is HIPAA compliant this waiting period will be waived if you have a Certificate of Creditable coverage from another health insurance plan showing 18 months of prior coverage with no lapse of more than 63 days
,000 of Critical Illness coverage provided for Primary Insured & Spouse (optional on other 3 plans) 
Nationwide P.P.O. network (www.multiplan.com)

Arguably these benefits rival the “first dollar” benefits provided on most major medical health insurance policies on the market today. The most attractive part about this kind of health insurance policy is that the premium required is well below half the premium required for the ICHIP state insurance risk pool. Also like the state insurance risk pool coverage these Defined Benefit Health Insurance policies are fully HIPAA compliant. This means that if you are coming off of an employer sponsored Cobra continuation plan and can produce a certificate of creditable coverage from this prior carrier showing 18 months of prior coverage with no lapse of more than 63 days your pre existing conditions will be covered from day one. If not, there is a 12 month waiting period for pre existing conditions.

Whilst a major medical health insurance policy is always the best way to insure oneself against the catastrophic medical bills one can experience throughout their lifetime, a Defined Benefit health insurance policy is most certainly a cost effective way to protect oneself if you are rendered uninsurable on the individual health insurance market.

Without a doubt, this is the finest Defined Benefit health insurance policy on the market today. Most especially since the majority of other offers to the uninsurable consist of discount P.P.O. network memberships that are by no means health insurance policies. We’ve all seen them advertised from company’s like “Care Entree” or “Ameriplan” that offer ”health coverage” (clever way to circumvent the words “health insurance”) that will “cover” the entire family for  monthly!

This “coverage” is so inexpensive because it provides nothing more than a P.P.O. repricing discount. This in itself is not a bad thing. However without a Major Medical or Defined Benefit health insurance policy in place one can experience catastrophic medical bills with these types of “health coverage” plans. This is the case because the average P.P.O. discount on medical procedures performed within a P.P.O. network is between 25% & 40%. For a 0 doctor office visit, this is a good deal. However, if the medical bill is 0,000 that can leave the “covered” person with as much as 0,000 in out of pocket expenses!

For more information about Guarantee Issue Defined Benefit Health Insurance Plans and or Major Medical Health insurance plans please visit click here: http://www.sbisvcs.com/guarantee_issue.htm

The acronym HSA is being tossed around quite a bit nowadays especially since the tax advantages of owning an HSA and a corresponding qualified HDHP (Deductible Health Plan) have been significantly increased under the former Bush administration. Effective December 20, 2006 President George W. Bush signed the Health Opportunity Patient Empowerment Act of 2006, enhancing Americans’ access to tax-advantaged health care savings. The law, part of the Tax Relief and Health Care Act of 2006, provides new opportunities for health savings account (HSA) participants’ to build their funds. To read about the new adjustments Click here: http://www.treas.gov/press/releases/hp209.htm For the 2009
IRS H.S.A. COLA Adjustments click: http://www.treasury.gov/press/releases/hp975.htm

HSA stands for Health Savings Account, more commonly referred to as a “Medical IRA”. HSA qualified HDHP’s are one of several relatively new Health Insurance concepts that fall under the heading of “Consumer Driven Health Insurance”. Health Savings Accounts are a unique way to attractively manage your health insurance costs. They were originally named MSA’s or Medical Savings Accounts designed by Senator Bill Archer (R) of Texas. Bill’s project was to find a way to reduce the cost of health insurance for the self employed without sacrificing quality coverage for a major medical illness. Bill’s brilliant idea was to eliminate the parts of a Traditional Health Insurance Plan that cost the consumer the most money. These expensive benefits include outpatient doctor “co pays” and outpatient prescription “co pays”. Bill approached Congress with a proposal that stated in essence that if you remove those two features and keep the major medical coverage in place you could conceivably cut the cost of your health insurance premium considerably. He was absolutely right!

To illustrate how Bill’s idea works in the real world. We will use a real world example. Tony & his wife are currently paying ,134 a month for Cobra continuation coverage from a previous group plan. In comparison, the monthly premium for an HSA qualified HDHP (High Deductible Health Plan) which covers each insured family member up to million dollars is less than half of the premium that they are paying now (1.64 monthly to be exact). This is a yearly savings of ,828.32 or a monthly savings of 2.36. This is a significant difference. However the insured has to give up all of their outpatient co pays. Is this worth it? This was the question posed to Senator Bill Archer (R) when he approached Congress back in the late 1990′s. His answer to Congress was simply “make it worth it”.

In other words, he asked Congress to make it worth it to the insured. Their response was two fold. And it is these two primary reasons that make HSA’s a “no-brainer” for every self employed prospective insured and for their corresponding employees. The first thing Congress did was to state that if a policy holder buys a major medical health insurance policy (HDHP) with a yearly family deductible between ,200 per family (not per person) or as high as ,800 per family we will call that an HSA qualified health insurance plan (HDHP).

They further said that in order to make giving up outpatient co pays more attractive to the insured we will allow anyone who has an HSA qualified health insurance plan (HDHP) the option to open a tax favored HSA (Health Savings Account) with their local bank or financial brokerage house. Since the insured is saving a considerable amount of money each month by giving up their out patient co pays, we will allow them to take that extra premium that they would have normally given the insurance company for the “privilege” of a co pay and put it into a 100% tax deductible account that will grow tax deferred at an interest rate adjusted by the Fed.

In addition to depositing the amount you save in insurance premiums, you may also deposit in your HSA an amount equal to what the IRS allows for that given year. For the year 2009 the maximum contribution a family can make to their HSA account is ,950. In addition, any family member who is 55 years of age or older can deposit an additional ,000 annually (more on the age 55 allowance below). This means that the total amount that Tony and his wife (in our example above) can deposit per calendar year is ,950 and they can take a 100% tax deduction for that contribution similar to an IRA.

Furthermore, if they do incur medical expenses that arise throughout the course of the year that are subject to the deductible (i.e. prescriptions, doctor’s office visit charges, etc.) the IRS will allow them to pull out that money that they put into their optional tax deductible, tax deferred HSA savings account to pay for those expenses. When they use their HSA money to pay for those expenses the IRS will allow them to write those expenses off at a 100% tax deduction. The list that the IRS allows them to spend their HSA money on is very liberal and includes things like dental, orthodontics, eyeglasses, radiokeratonomy (Lasik corrective eye surgery), alternative medicines etc. Click the hyperlink to see the list of allowable expenses and disallowed expenses on the HSA section of the IRS web site here: http://www.irs.gov/publications/p502/index.html

Arguably the most attractive tax advantage to owning an HSA is the fact that the money left over in the HSA account that was not used on medical expenses at the end of the year is “rolled over” into the next year and awarded a higher rate of tax deferred interest. The insured also has the option to roll those unused funds into no load mutual funds, thereby building an extra tax deferred retirement account with money they would have normally given to the insurance company each and every year whether or not they had any claims that year!

It should also be noted that with not having a “co pay” with your plan does not mean that your outpatient doctor visits and outpatient prescription drugs will not be a covered expense. With most HSA qualified HDHP’s these charges are a fully covered expense just as they would be with a Traditional Health Insurance Plan. The only difference is these charges will be subject to the “aggregate” family deductible.

Being “subject to deductible” does not mean that you will pay full price for these charges either. If you stay within the vast PPO network that most reputable carriers offer (www.phcs.com) your outpatient doctor office visit charges will be discounted by as much as 40%. Your prescriptions will also be discounted significantly as well by staying within the Rx prescription network.

Let’s break that down in plain english. Let’s say your doctor’s office charges you 0 for a “sick visit”. If you use a PPO provider (typically PHCS or MultiPlan) those office charges will be “re-priced” down to roughly . Now compare that to a Traditional plan which provides you with a “co pay”. The difference to you is out of pocket for that doctor’s office visit. But is that all you are really saving?

Not if you add in the monthly premium savings between the two plans. The typical monthly premium savings between a Traditional plan and an HSA qualified plan for a family is 0 to 0 monthly or more. Let’s split the difference at 0 less monthly. This equates to an annual savings of ,000.

Now let’s take that ,000 annual savings and deposit it into a tax deferred, tax deductible interest bearing account. Let’s go a step further and imagine you find an HSA account that bears you NO interest AT ALL (which is not that hard to imagine in this economy). You’re still saving ,000 annually and your deducting that amount from your adjusted gross income. This means less reportable income which means less taxes.

Now lets imagine you have no major medical claims in year two and you deposit the same amount. Now in year three you have a worse case scenario occur. Now you have ,000 to help pay your “aggregate” family deductible. Moreover, since deductibles with HSA qualified HDHP’s include only one “aggregate” deductible for the entire family there will be no other risk to any other family member for the rest of that year. Unlike Traditional Health Insurance Plans which typically require each of three separate family members to pay their own calendar year deductible if they end up in the hospital (or need an MRI, CT, Nuclear Medicine Scan etc.)

The longer you look at HSA qualified HDHP’s the more sense they make. This is why they have caught on like wildfire and will continue to do so. The only inhibitor to the spread of HSA’s is lack of education (as is the case with any other financial vehicle).

To learn more about HSA’s and the recent federal legislation that has made them even more attractive to people over the age of 55 click: http://www.treas.gov/offices/public-affairs/hsa/about.shtml to read all about them on the Federal Governments HSA educational web site. To learn more about H.S.A.’s in a power point presentation format please click here: http://www.hsacenter.com/

If you are an employer and are considering HSA qualified plans for your employees consider this. An individual’s employer can make contributions that are not taxed to either the employer or the employee. The combined income and payroll tax deductibility leads to discounts for health insurance of over 40 % in some cases relative to other forms of insurance. For more details for the employer http://www.treas.gov/offices/public-affairs/hsa/faq_employer-participation.shtml

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Watson gets a job in medical field
medical health
players on TV, is being tapped by one of the nation's largest health insurers to help diagnose medical problems and authorize treatments. WellPoint Inc., which has 34.2 million members, will integrate Watson's lightning speed and deep health care …

medical health question by M.E.: What does the new medical health plan mean for me?
I am in my early 30′s, working as a freelance consultant (meaning buying private health coverage).
Can I and my wife choose the new Gov Medical health plan that are in the works — and what will that mean for covering her and kids when we start a family?

medical health best answer:

Answer by Tyeleisha
idk