Federal Health Insurance High Risk Pool

We're finally starting to get some information about the temporary federal high-risk insurance pool created as the result of the health bill passed earlier this year. Below is an informational bulletin we received this morning. This pool is designed to help provide coverage for individuals who would otherwise have no access to health insurance - you'll note the three primary criteria below. Please note that this information should be confirmed with or corroborated by the government via the website and phone number listed. We're providing it here for informational purposes:

The federal government has created the Pre-Existing Condition Insurance Pool (PCIP) as part of the health care reform law. The PCIP program offers health insurance to people who have been denied coverage because of a pre-existing condition, have been uninsured for at least six months, and are U.S. citizens or are residing here legally.

To learn more about eligibility and see rates, please visit PCIP’s website, where you'll also find a link to download applications for the PCIP program. The ability to apply online directly will supposedly be available August 1.

According to its website, monthly PCIP premiums rates for South Carolina as are follows:

Ages 0 to 34: $301
Ages 35 to 44: $361
Ages 45 to 54: $462
Ages 55+: $642

The toll-free number for the PCIP program is (800) 220-7898.

Health Reform Changes

Health insurance companies are still coming to grips with all of the details involved in the health "reform" bill passsed earlier this year, and there are still definitions and regulations that are in the process of being developed. While most changes won't go into effect until 2014, there are a few changes that will take effect by October 1 of this year:

* Extension of dependent care coverage to young adults up to the age of 26
* Exclusions for pre-existing conditions no longer apply to individuals under the age of 19
* Preventive care, including routine physicals will be covered 100%, no deductible
* All lifetime dollar limits have been removed

One byproduct of this, of course, is that these items are not free (much as the government would have you believe they are! This will become readily apparent as there is a real threat of healthcare providers raising their rates on preventive care procedures, knowing that the bill is not going to be directly paid for or maybe even seen by the patient). So your premiums will probably go up somewhat the next time your policy renews.

If you have questions about healthcare reform and how it impacts your personal health insurance or that of your business, don't hesitate to contact AC Forrest Insurance Group. We'll be happy to help you find answers and to find cost-saving alternatives to your current coverage.

90 Day Probationary Period for Employer's Health Insurance

Employer-sponsored health insurance plans typically have some kind of probationary period before a new employee can become eligible to be covered. In most cases this period is 90 days. The question then, is what do you do for health insurance during these three months? You could roll the dice and hope you don't have a medical event, but the wise course is to find short-term health insurance coverage, which is designed for just this situation.

A short-term health insurance plan provides you with major medical protection for a defined period of time to bridge the gap between plans. Getting a short-term health plan for 3 months is generally very affordable. There is a little bit of underwriting, but not nearly as much as with a traditional individual health insurance plan. If you've not been declined coverage in the past for medical reasons, and don't have one of a few "deal-breaker" medical conditions (things like cancer, diabetes, and a few other "big-ticket" issues), you shouldn't have trouble getting approved for coverage to start tomorrow.

There are a number of short-term health plans out there. At AC Forrest we market plans through Assurant Health, Golden Rule Insurance, and HCC Life. The latter plan as the advantage of offering a copay for a visit to an urgent care center. To take a look at some quotes on short-term health, click here or contact AC Forrest.

Short Term Health Insurance as an Alternative

It is not uncommon to speak with someone who is having a hard time getting approved for individual major medical health insurance due to certain pre-existing conditions. While many states have high risk pools for these folks, the premium prices are typically very high. The new, temporary federal high risk pool is something of an unknown when it comes to premiums. One alternative to consider is short-term health insurance.

Short term health insurance is generally used for people who are in between group health policies, such as a new employee who has to wait 90 days to become eligible for a company health insurance plan. But they can also be used as an alternative for those who either cannot afford individual health insurance or are having trouble with pre-existing conditions. Most short-term health insurance applications are very short (often 5-6 questions).

Now this won't work for everyone. If you've already been declined coverage for a condition still present or if you're pregnant (or an expectant father) then this won't be an option. Similarly, there are a number of pre-existing conditions that will disqualify you (including cancer, diabetes, heart disease, and others). My point, however, is that the list of disqualifying conditions is not nearly as long as it is for a more permanent policy. This will be readily apparent in the short application.

To learn more about short-term health insurance and see quotes, follow this link or contact AC Forrest.

Will my insurance cover weight-loss surgery?

This question comes up from time to time. The quick answer, frankly, is "Probably not." The best you can do is make a request (or have your agent advocate for you) if you can document that you've tried other ways to lose weight including lifestyle changes, diet/exercise/ etc., and that your doctors believe that bariatric surgery is medically necessary as a last resort. It never hurts to ask, but don't be surprised if they decline.

What, then, are your options? My recommendation at that point would be to consider medical tourism. That sounds crazy to many people, but this is an industry that is growing rapidly and poised to get much bigger over the next several years. There are Western-style hospitals (actually they are often much nicer) with Western, board-certified doctors and surgeons that can perform these surgeries at a fraction of the cost you'd pay here in the States (even factoring in travel expenses).

For example, you could arrange lap-band surgery for $6-10k or gastric bypass surgery for $12-19k. This isn't cheap, but it's a whole lot less than you'd pay locally. Just a thought... feel free to contact us for more info.

What's the difference between term life insurance and whole life insurance?

Term life insurance and whole life insurance are definitely different. In many ways the question boils down to what you are trying to accomplish with life insurance.

Term life insurance is totally concerned with providing for your loved ones if you were to die unexpectedly. It is aimed at replacing the income you would have provided for them over the next 20-30 years. That is what most people are trying to accomplish with life insurance. A "level term" life policy takes the price of the coverage for each individual year and averages it out so that you pay one premium through the initial term period (usually 20 or 30 years). If you die, the policy amount (for example, $500,000) is paid out to your beneficiary.

It is generally recommended that you have 8-10 times your annual income in a term life insurance policy, potentially more to make allowance for remaining financial obligations (ie a mortgage or kids' college or that sort of thing). The basic idea, again, is that you don't want to leave your family in a stressful lurch if you pass unexpectedly. Thus, when you reach a certain age there's really no need to replace income.

Most term life policies (at least the ones we'd show you) allow you to keep the policy beyond the initial term period, but it would be rare to do that because the premium at, say, age 71 is very very high. Most term policies also have what's called a "conversion privilege," which allows you to convert the policy to a "permanent" life insurance plan (e.g. whole life insurance).

Whole life insurance is more of an investment product. This is life insurance that is designed to last until you die at whatever age, at which point it pays out the initial amount. Because the policy does accumulate cash value while you're alive, you have the ability to borrow against that amount in the future. (But the cash value is not included in the death benefit if you die.) That's the primary reason we call it an investment product. Dave Ramsey would tell you not to buy whole life because you can get a better return on investing that kind of money elsewhere (as in mutual funds). Whole life insurance is also a useful tax shelter for those trying to shield a large estate from estate taxes.

Where the rubber meets the road for most folks is in the price. Term life insurance is SIGNIFICANTLY less expensive than whole life insurance. Whole life is at least 5-10 times more expensive (a somewhat conservative estimate).

If you'd like to see personalized quotes on life insurance, please contact AC Forrest. 

What is a "dual option" health plan?

Many small businesses may not be aware that they can offer employees a choice in health insurance plans. Most insurance companies allow companies of a certain size (for Blue Cross of SC it's 7 or more) to establish a "dual option" plan. This allows you to choose two plans that you can offer your employees instead of just one. Perhaps the most common approach to a dual option plan is to offer an HSA-qualified plan alongside a more traditional plan that includes copays and the like.