Archive for May, 2010

Fallon Health Insurance Individual Plans

Friday, May 28th, 2010

pie chartThe Patient Protection and Affordable Care Act contains a provision that may force smaller insurance companies like Fallon Health Insurance out of the individual insurance market completely.  According to “Actuary: Act Fast, Or Individual Health Insurers Will Flee,” Allison Bell of Life and Health National Underwriter summarizes the dilemma.  The minimum medical loss ratio requires health providers to spend 80% or more of their premium revenue on paying the medical claims of their insureds.  Experts recommend regulators come up with a way for companies to make this transition.  They worry that smaller companies will opt out of providing individual health insurance because of this new provision.  If that is the case, they would most likely have to let insureds know by June to give them a 6 month warning that they won’t offer individual coverage next year.

Those hoping for some transitions to be spelled out would like to see them immediately so companies know before making the decision to leave the individual market.  The idea behind the 80% medical loss ratio is that insurance companies like UPMC would just reduce administrative costs and other costs they have not related to claims.  It might be hard for insurers to reduce those costs so quickly, not to mention the fact that it will likely hurt smaller insurers much more.  In order to stay competitive, smaller insurance companies offer lower rates for the same coverage as larger companies and have higher marketing and administrative costs.  One suggested solution is to make the minimum medical loss ratio smaller for insurance companies with less market share or for those who sell low-cost plans like high deductible insurance.  Without any changes it is very possible that more smaller insurers will stop selling individual health plans.

Will Mercy Health Plans Extend Coverage?

Thursday, May 27th, 2010

All health insurance companies are required to extend coverage to many young adults on their parents’ policies starting September 23rd of this year.  According to “Three insurers won’t drop adult children on parents’ policies” by Duke Helfand of The LA Times, some insurance companies are enacting the policy starting immediately.  WellPoint, Humana, and UnitedHealthCare have made the decision to start following the new federal regulations early so that college students nearing graduation and some other young adults will not lose their health coverage.  It remains to be seen whether other insurers like Mercy Health Plans will follow suit or if they’ll wait until the regulation deadline in September.

Young adults will now be able to remain on their parents health plans until they are age 26, along with some other additions to young adult coverage.  Minneapolis based UnitedHealthCare and Louisville, Kentucky based Humana have already begun their continuity of coverage for young adults.  UnitedHealthCare says that they will be positively affecting 150,000 people by implementing President Obama’s regulation early.  Indianapolis based Wellpoint will begin extending their coverage on June 1.  They’ll automatically continue the coverage of the young adults included on their parents’ plans whether they have employer-sponsored coverage or individual plans.  Since many young adults can’t afford their own health insurance, the government is pleased that so many insurers are offering this extension before the deadline.

Fallon Health Plans & Pregnancy

Wednesday, May 19th, 2010

mom and babyThere is a lot of planning to do for having a baby before you even become pregnant, according to the article “Pregnancy,” from Health Key.  While most potential moms are thinking about what they’ll need to buy for baby and how to decorate the nursery, there are physical steps you should take before even becoming pregnant.  Make sure that you have health insurance from a company like Fallon Health Plans.  Have an exam with a doctor to discuss medications you take and any immunizations you may need.  Don’t take medicine like ibuprofen or aspirin, but do start taking a prenatal or multivitamin.  Take care of any dental work you need done.  Keep track of your menstrual cycle because it will help you get pregnant and help your doctor figure out your due date.  Live a healthy lifestyle through your diet and regular exercise, along with avoiding caffeine, alcohol, tobacco, illegal drugs and unnecessary medications.

Once you become pregnant, continue with all of the healthy lifestyle changes you’ve already made.  Also, get regular checkups from a doctor or midwife.  Your first exam will probably be the longest and include blood work, a pelvic exam and urine test, weight and blood pressure check and a listen for the baby’s heartbeat.  At your following appointments, your belly and weight will be measured and your blood pressure and urine tested.  It is important to go to all recommended prenatal visits because doctor’s are working to make sure nothing is wrong with you or your baby.  There are optional screenings you can do to test for Down Syndrome and other birth defects.  Near the end of your second trimester, you will be tested for gestational diabetes.  Some of the warning signs that should immediately lead you to call your doctor include bleeding, cramping, stomach or back pain that doesn’t go away, painful urination, bad headaches, a fever, blurred vision, or sudden swelling in your extremities.

Doctors Get Pay for Performance: Will UPMC Health Insurance Be Next On Board?

Monday, May 17th, 2010

philadelphiaThere’s an interesting concept coming out of Philadelphia where doctors are being rewarded for helping to improve your health.  In “Philadelphia Insurer To Implement Pay-for-Performance Model” from The Philadelphia Inquirer, the plan is detailed.  Independence Blue Cross is Philadelphia’s biggest health insurer.   Their newest program is a pay-for-performance model where doctors will get paid more as their patients’ health improves.  They want to reward those primary care physicians who are offering higher quality care at a lower cost.  These are the doctors who use “patient-centered medical homes” which give patients better access, follow guidelines for treatment, educate people to manage their own health, and easily prescribe needed medications.

With Philadelphia’s largest health insurer implementing this new plan, maybe other Pennsylvania insurers like UPMC health insurance will follow with similar programs.  Doctors are happy with this new plan because their primary and preventative medical care will be strengthened as will the way they finance it.  Many doctors are worried that the increased administrative burden will be high though and they hope the plan will help to pay for that.  According to Independence, patients’ health has already improved.  The diabetics seeing doctors in the program improved their blood sugar levels and even their blood pressure by nearly twenty-five percent.

Aultcare: Is LeBron James’ Elbow or Ego to Blame?

Wednesday, May 12th, 2010

As the Cleveland Cavaliers faced their worst playoff loss in franchise history, the disappointing performance from their star Lebron James has fans wondering if he really did injure his elbow or if his ego has already taken him out of Cleveland.  From sports blog Fear the Sword, we get the article “RUMOR: LeBron James Has Torn Elbow Ligament.”  They say that although it’s just a rumor, LeBron has a torn elbow ligament causing him tremendous pain.  Whether LeBron has health insurance from Aultcare of Ohio or another insurer, chances are they aren’t happy to have him playing professional basketball with such an injury.  The article also states that he received a shot before game 4 to numb the pain but was not able to get the same shot before game 5 because it can only be given every ten days.

That rumor being stated, Adrian Wojnarowski of Yahoo Sports seems to worry that LeBron’s ego has more to do with his poorer play than this elbow controversy.  In “LeBron’s moment of truth awaits,” he states that he simply doesn’t think this championship is important enough to James.  Since things in the NBA have come pretty easily to LeBron, the author doesn’t see the fire or maniacal desire needed to win championships.  He worries that LeBron is more concerned with his endorsements, his own companies, and his free agency status than winning in Cleveland.  Other playoff greats in the prime of their careers would have shouldered the burden for last night’s loss and that of winning the next two games.  LeBron, on the other hand, acted spoiled and selfish and brushed off his terrible performance as one of three bad games in his seven year career.  We’ll see if he pulls it together in a game 6 and a game 7 to save his legacy in Cleveland.

Travel Health Insurance Essential: Golden Rule Insurance

Monday, May 10th, 2010

airplaneThere probably aren’t that many travelers who worry about medical evacuation insurance.  You should, according to “Experts Say Travel Health Insurance Can Be Crucial,” by Lindsay Tanner of the Associated Press.  Most health insurance policies do not include transportation home for critically ill patients requiring medical equipment and staff.  And while most people think that they will never need those services, accidents happen.  Car crashes and heart attacks are the main injuries sustained on vacation and those can happen to just about anyone.  If you have Golden Rule Insurance or medical coverage from another insurer, you should inquire about their coverage in advance.  If it is not under your plan, you can usually purchase supplemental insurance just for traveling.

It is also possible to get a stand-alone policy from an insurer like Assurant Health that will only cover you when you are traveling.  With the busy summer travel season fast approaching, no one wants to come home with hundreds of thousands of dollars in medical bills or worse yet, not come home at all.  The cost for most supplemental plans is around 4 to 8 percent of the cost of your trip.  A vacation costing $2000 would make for about $120 in supplemental travel insurance.  Those who have needed the services say that it is well worth the cost.  The State Department has information on where you can obtain travel insurance and what type you may want to get, including medical evacuation insurance.

Anthem Blue Cross Blue Shield: Insuring Adult Children Longer

Friday, May 7th, 2010

Under President Obama’s new health care plan, health insurance companies will be required to insure adult children for a longer time period come September of this year.  Anthem Blue Cross Blue Shield has implemented that practice ahead of the deadline, according to “Blue Cross Blue Shield Does the Right Thing” on Fav Stocks. This information comes from White House Communications Director Dan Pfieffer.  With May and June being the top months for college graduation, many parents and young adults are thrilled with this health insurance development.  Young adults were traditionally kicked off of their parents health insurance plans upon graduation or age 23 if they were still in college.

The age has been increased as well as the college stipulation modified with President Obama’s new plan.  Since many recent college graduates and young adults get starting jobs that don’t include health insurance, staying on their parents’ insurance a bit longer keeps them from going without coverage.  Secretary Sebelius sent letters to major health insurers asking them to implement this policy before the deadline and the White House is pleased with the response.  They are proud of how many insurance companies have chosen to “do the right thing” for eligible customers.  Kaiser Permanente, United Health, Wellpoint, and Humana are some of the others who have implemented the changes ahead of September’s deadline.

High-Risk Pools: Compare Health Insurance Options

Wednesday, May 5th, 2010

All 50 states had to decide by April 30 whether they would run their own high-risk health insurance pools or have the government run them.  Florida has opted out of running their own high-risk pools, according to “Crist wants federal government to run high-risk health insurance pool,” by Fred Tasker of The Miami Herald. The Obama administration’s health care reform created these high-risk pools to compare health insurance options for those who cannot get insurance in the private market.  Americans with preexisting conditions such as cancer or diabetes will now be able to obtain health insurance from these high-risk pools, whether run by individual states or the federal government.

The Department of Health and Human Services will be in charge of all of the government run programs.  With 29 states opting to run their own high-risk health insurance pools, they’ll use a one-time government subsidy to help establish the programs.  Although Florida will receive $5 million of the total $351 million subsidy, Governor Crist says that he cannot commit any of Florida’s own resources to run this temporary high-risk pool.  Companies like Aultcare health insurance will work hard with their individual consumers to offer health insurance to everyone they can.  Those who still don’t qualify can look to the government pools.  Of course, politics seems to be working its way into which states opt to run their own programs and which do not.  Regardless of what the states decided, more Americans with preexisting conditions will be able to obtain health coverage.