Uninsured Americans Start to See Relief
The state of New Jersey has released pricing and plan information about their pre-existing conditions program for uninsured residents.
As you may recall from my original post about the new health insurance exchange, the Patient Protection and Affordable Care Act (PPACA) was started nationwide to provide subsidized insurance for American citizens that do not have insurance due to a pre-existing medical condition.
Each state has the choice to run their own plan or go under the federal plan. The New Jersey Department of Banking and Insurance has decided to run their own plan with Horizon Blue Cross Blue Shield as the sole provider of healthcare.
To be eligible for PPACA coverage an applicant must be a US citizen, a resident of New Jersey, been uninsured for at least six consecutive months, and have a pre-existing medical condition.
The plan in New Jersey will now be called, NJ Protect, and have premiums ranging from $212.63 to $767.95 for a single person depending on the age of the applicant and design of the policy.
Plans offered provide in and out of network benefits similar to a PPO plan. Treatments for pre-existing conditions are covered from the start of the policy and also offer preventive care with no additional cost to the policyholder.
Do you think healthcare reform will continue to provide affordable healthcare for un-insured Americans?
Post a comment or email me at blog@insureyourcompany.com.
Death Panel Accusation Haunts FDA
Avastin, a popular cancer treatment drug may have its approval revoked by the FDA after studies have found that the drug may not extend patients lives beyond a month, according to The Daily Telegraph. This about face has provoked fears that the FDA is starting a death panel as insurance carriers will likely drop coverage for the costly medication.
The FDA advisory panel has now voted 12-1 to drop the endorsement for breast cancer treatment. The panel unusually cited “effectiveness” grounds for the decision. But it has been claimed that “cost effectiveness” was the real reason ahead of reforms in which the government will extend health insurance to the poorest.
The New York Times has stated that the original trial showed that tumor progression halted for five months, but in new trials that used a combination of different chemotherapy drugs the tumor progression halted for less than a month to three months.
Britain’s National Institute for Health and Clinical Excellence, a pace-setter in evaluating medical advances, issued draft guidance this month against using Avastin for advanced breast cancer patients in the National Health Service. It called the clinical trial data “disappointing” and the cost “too high for the limited and uncertain benefit it may offer patients.”
I don’t believe that this results in Palin death panel rationing as some publications would have you believe.
If a drug does not work as intended, the FDA is within their rights to deny approval for the drug. If someone wants to use a drug that is not approved, then can do so and pay out of their pocket. If someone want to spend $8000 a month on Avastin, then they have every right to do so. I hope this issue is not used as a political weapon by politicians on either side of the aisle in the US.
What do you think? Is the FDA starting a death panel to ration healthcare? Do you think healthcare reform will make the country worse or better off?
Post some comments or email me at blog@insureyourcompany.com. I want to hear your opinion!
Health Insurance Premiums Tax NOT Coming!
I receive tons of spam email, and I’m sure you do too. You may even get email from friends who think they are being helpful and informing you about the current health insurance reform that is taking place.
Unfortunately, one email circulating lately is blatantly not true. The email that is going around claims that your employer’s contributions to your health insurance will be considered income and will become taxable to you. A health insurance premiums tax is not coming to the US. The Huffington Post debunks this email in a recent blog posting on their website.
The IRS will require employers to list their contribution amounts on your W-2 starting in 2012, but current law excludes health insurance premiums from taxable income. The reason for the new reporting, is due to the new individual mandates, requiring individuals to have health insurance coverage. There are also employer mandates to offer coverage and fines to individuals who have “Cadillac plans.” These are all reasons why your employer’s contributions will appear on your w-2.
Rest assured, there will be no taxes on the money your employer contributes to your health insurance premiums.
Why Health Insurance is Expensive
An explanation of why health insurance is expensive in America and an overview of current health care reform and other possible fixes that may alleviate high prices.
A Sample IT Consulting Insurance Quote
You may not know this, but a majority of our clients happen to be in the IT consulting industry. We are often asked what type of insurance a typical IT consulting company would need, so we came up with a fictional company, to show you the insurance that you would likely need and typical premiums for this coverage.
Howard Consulting, Manalapan, NJ 07726
Owner works from home and placed 4 consultants at client sites in New Jersey.
- 5 employees including one sole proprietor
- $1,000,000 estimated revenue for year 2010
First of all, you will need general liability insurance. General liability insurance covers liability claims of bodily injury, other physical injury or property damage. This means you are covered for accidents at your business or at your clients’ place of business. It also covers the cost to defend or settle claims whether they are fraudulent or not.
General Liability Insurance
- $1,000,000 liability per occurrence
- $2,000,000 liability aggregate
- $10,000 medical claims
- $1,000,000 hired and non owned auto
- $10,000 business property
Estimated annual premium:
$350-$750
*liability only would be $350
Umbrella insurance extends your coverage beyond the limits of your basic business insurance. Also referred to as excess liability insurance, umbrella insurance is important because it covers unexpected events. It’s generally not expensive and in certain instances, it could literally save your business.
Umbrella liability
$1,000,000 per occurrence
Estimated annual premium:
$400
Workers compensation insurance coverage represents a compromise between employers and employees regarding employment related injuries or illnesses. Here’s how workers compensation works:
Your employees relinquish their right to sue you if they suffer an on-the-job injury or illness. In return, you, the employer, agree to provide state-mandated benefits as a result of that on-the-job injury or illness.
Workers compensation insurance
$1,000,000 bodily injury
Average rate across U.S. with fees is .27-.35 per $100 of payroll
Estimated annual premium based on $360,000 of payroll
$972-$1260
Professional liability insurance is appropriate for any information technology company that provides advice, makes educated recommendations, designs solutions or represents the needs of others and protects your company from errors or omissions that damage your clients.
Professional liability
- $1,000,000 per occurrence
Typical annual premium:
$750-1250
A fidelity bond covers against loss due to employee dishonesty.
Fidelity bond
- $1,000,000 coverage
Typical annual premium:
$1,250-$1,750
Health insurance provides re-reimbursement for illness and provides preventive care.
Health insurance
Small group health insurance in New Jersey is based on the census of your employees and where your office is located. The average age, gender makeup, and the coverage status of your employees all factor into the price.
Here is the information used for this sample quote.
07726, effective date of 8/1
Census:
- Employee 1-male-family-32 years old
- Employee 2-female-single-40 years old
- Employee 3- male-parent/child-35 years old
- Employee 4-male-single-26 years old
- Employee 5-female-family-45 years old
Health Insurance quotes:
1. Aetna HSA compatible HMO, deductible funded under 50%
$1650/$3300 deductibles
- Office co-pay is $20 after the deductible
- Specialist co-pay is $40 after the deductible
- Hospital in-patient is $300/day for 5 day maximum after the deductible
- RX benefit is 15/35/60
Monthly cost is $2,961
2. Amerihealth Cost Sharing HMO
- $1000/$2000 deductible
- 70% co-insurance
- Office co-pay is $20
- Specialist co-pay is $40
- Hospital in-patient is 70% after deductible
- RX Benefit is 7/50% $125max/rx
Monthly cost is $3441.47
3. Horizon BCBS of NJ HMO
- Office co-pay is $20
- Specialist co-pay is $40
- Hospital in-patient is $250/day for a 5 day max per admission
- RX benefit is 10/25/50
Monthly cost is $4401.90
Introduction to Health Savings Accounts
This is the first in a series of audio education articles that CG Benefits Group and Technology Insurance Associates has produced. Recorded by insurance broker, Paul Kaplan, the proceeding audio file introduces health savings accounts and contains information about how the underlying medical plan works, how contributions work, and advantages and disadvantages to HSA plans. Health Savings Accounts can be a great way for you to save money pre-tax to dedicate to medical related expenses. Many employers are starting to offer this as part of their employee benefits packages. I hope you enjoy listening as much as I did putting this together,
Paul Kaplan
Government Healthcare Website Launches
Last week Healthcare.gov launched as a portal for U.S. citizens to explore the American health insurance market in an easily navigated and concise website. The website includes ways to find insurance coverage options, learn about preventive care, compare quality care, and ways to understand the new insurance laws.
First of all, finding insurance coverage options is a very easy process of selecting options that apply to your unique situation. Whether you are a small employer, an individual with an illness, unable to get health insurance, or a young adult under 26, the website directs to state specific resources for finding coverage.
For example, for a small IT consulting firm in New Jersey, I was informed that New Jersey is a guaranteed issue state for health insurance. An insurance carrier cannot turn a small business down for coverage if it meets the qualifications of small employer. I was then directed to Department of Banking And Insurance where I could read their online New Jersey small employer’s buyers guide to health insurance.
The preventive care section of the website partners with healthfinder.gov where you can enter your age and gender and recommended tests, immunizations, and other health tips tailored to your information is presented. This is a great feature to include in the website and I found it very helpful.
Next, the U.S. Department of Health and Human Services’ hospital compare tool allows users to search hospitals by zip code and offers the ability to compare hospitals in your area by patient care surveys, care outcomes, medical imaging statistics, their Medicare coverage, and volume. This tool is an excellent addition to healthcare.gov and provides an easy way to compare hospitals.
Lastly, the website includes information about the Patient Protection and Affordable Care Act in an easy to understand format. A timeline for establishment of reform changes is included to easily reference when certain provisions of the bill will go into effect.
Pre-Existing Condition Insurance Plan Begins
Many Americans without health insurance coverage due to pre-existing conditions may find themselves with health insurance coverage due to the newly established Pre-Existing Condition Insurance Plan (PCIP.)
Starting today, July 1st, 2010 many states will start accepting applications for the new plan with coverage likely beginning on August 1st. You can check to see if your state is running their own program at the following website.
This temporary high risk pool of coverage for Americans with pre-existing conditions will expire on 2014 when denying individuals insurance based on pre-existing conditions will be outlawed.
The congress has already allocated $5 billion to the program, so if you fit the description, you are urged to apply immediately, just in case the program runs out of money if a higher number of people than anticipated enroll in the plan.
In New Jersey, for example, the department of banking and insurance has decided to run their own program under guidance from the Department of Health and Human Services.
General rules for the program are as follows:
- You must be un-insured for over 6 months
- You must be unable to get insurance due to a pre-existing medical condition
- You must be a United States citizen or a national
Premiums will vary from state to state, but the coverage cannot be higher due to your medical conditions or age.
According to healthcare.gov typical premium for the federally run program for a 50 year old will be between $320-$570. To get an estimate of premiums, check out the details at the website for the PCIP.
The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a pre-existing condition.
Most plans will have a deductible for major medical services such as hospital visits and surgery and a maximum out pocket to limit the patient’s liability.
COBRA Subsidy Expires
In February of 2009, President Obama created a 787 Billion Dollar stimulus program intended to help Americans during our present recession. As part of the stimulus bill a 65 percent subsidy was started for Americans who were involuntary terminated from their jobs. The subsidy was extended in April, but expired May 31st.
Americans that lose their job after June 1st will have to pay the entire premium for COBRA coverage. According to Families USA, a consumer advocacy group, the monthly premium alone can eat up to 84 percent of a person’s unemployment check.
The extension of the COBRA subsidy was rejected by House Democrats to reduce the costs of a new jobs and tax bill that proposed extending the subsidy through December 31st. The extension would cost 7.8 Billion Dollars according to a report by CNN.
NJ Individual Health Insurance Becomes More Affordable
Here at CG Benefits we noticed a very interesting trend. For some employers that may have one or two employees enrolled, the individual health insurance marketplace may offer less expensive health insurance coverage as an alternative.
This happened recently but, one carrier for example, Horizon Blue Cross Blue Shield has lowered their rates to be very competitive with the employer based market. Their EPO and EPO Plus product is a viable method to insure yourself and your family, even if you are eligible for group coverage.
Now I’m not saying that every employer should run out and drop their group coverage and let the employees cover themselves in the individual marketplace. You will lose some of the benefits of the employer based group marker such as expanded support services such as billing, claims, and administration assistance provided to employers.
To check to see if you can benefit from new low rates for individual health insurance, get a quote now.
