Posts Tagged ‘Health Insurers’

Highmark stops subsidies for uninsured children

August 2nd, 2010

Highmark Blue Cross Blue Shield has stopped subsidizing premiums for some families in the Pennsylvania Children’s Health Insurance Program (CHIP). The insurance company said it will no longer subsidize care for children in families whose incomes fall between 200 percent and 300 percent of federal poverty guidelines.

As a result, families have seen their premiums skyrocket 78 percent since the change went into effect in October.

Highmark is one of four health insurers that administer the state’s program for uninsured children.

In an email to area legislators and others, Highmark offered the following explanation:

“I am writing to inform you of a recent decision made by Highmark regarding the Children’s Health Insurance Program (CHIP), which may affect some of your constituents. As you know, CHIP offers free and low-cost health insurance for eligible uninsured children from birth to age 19. The program, for which we serve » Read more: Highmark stops subsidies for uninsured children

The Diabetic And Health Insurance

March 20th, 2010



There are two prevalent problems in the world of healthcare that causes hardship to many of the American Populace today. The first is diabetes and the second is insuring people with diabetes. I want you to keep reading, because in a few sentences I will outline what you can do to get health coverage for someone who has diabetes.

First, let us address the condition known as diabetes. According to the American Diabetes Association (ADA), there are 20.8 million children and adults that have diabetes. That is 7% of the population. There were 1.5 million new cases of diabetes diagnosed in people aged 20 years or older in 2005. Of those 20.8 million, 6.2 million are undiagnosed and the ADA speculates that there could be as many as 54 million pre-diabetics, which is to say that they have not been diagnosed as a diabetic, but show the tendencies of a diabetic. These figures are overwhelming.

Diabetes also attributes to other health problems. Diabetes can lead to heart disease and stroke, high blood pressure, blindness, kidney disease and failure, damage to the nervous system, amputations, dental problems, pregnancy complications, sexual dysfunction, and diabetes can even cause you to have trouble getting over a cold.

It is because of these associated health problems many health insurance companies are not willing to take on the potential risks attached with insuring a diabetic.

So what is a diabetic or the family of a diabetic supposed to do for insurance? The following is a list of options that a diabetic can follow in their pursuit to find health insurance:

1. Look at your employer. Many group health insurers will take people that cannot find health insurance elsewhere. Why is that? Many group health insurers understand and calculate the potential for having a percentage of the employees in a company who are not able to obtain health insurance on their own. This is the primary reason that most group health insurance policies are costly for employers.

2. Do your homework. Shop around. There are plans out there, but you really need to look. If your employer does not offer health insurance there are additional avenues that you can explore. This leads us to number three.

3. Be upfront when talking to an insurance agent. Many times a good agent will have a program for people that are hard to cover due to health complications. For instance I currently have two carriers that I use to help people get coverage.

Additionally, when you sign a health insurance application for coverage you are attesting that the answers that you gave are true and correct. Please understand that if you intentionally misrepresent yourself on an application you can, in the very least, be denied coverage for falsifying an application. I have even seen insurance companies revoke a policy because someone was untruthful on an application.

4. Realize that there is going to be a pre-existing waiting period. I have yet to find one insurance company that will waive the pre-existing waiting period for a diabetic. Please understand that most health insurance companies treat diabetes as an uninsurable condition, and because of that, most insurance companies will deny coverage to new applicants who have been diagnosed as a diabetic.

Therefore, if you have been diagnosed with diabetes and you have found a health insurance company that will insure diabetics, then please recognize that there will, most likely, be a pre-existing condition clause or rider attached.

5. Understand that insurance will be expensive. In all my years as a health insurance professional, I have found that the people with the lowest premiums are the younger healthier people. The converse is equally true. The premiums that are the highest are paid by the people with pre-existing conditions.

I have family members that have been diagnosed as diabetics, and I have friends and clients that have diabetes. I know the attention that is required on a day to day basis. I know the costs involved. I know the difficulty in obtaining good quality health insurance coverage for a diabetic.

Many diabetics might feel that health insurance coverage is just a dream. Coverage for the diabetic is out there. Look at the list, check your resources, and see what your search turns up. You can find it.

By: J Timothy Clark

Barack Obama’s Health Care Plan

February 22nd, 2010



Barack Obama’s ambitious health care plan is fairly simple and straightforward. His plan seeks to dramatically and swiftly increase the number of people that have health insurance. He insists that this plan will save the typical American family approximately $2500 in annual costs. Since the average Ohio premium is less than most other states, savings to Ohio residents may average less than $2500.

The plan is designed to give the federal government more control over medical decisions and dollars, a major difference from the current decentralized system of employer-based insurance and state-based insurance regulation. Here in Ohio, health insurers have been effectively held in check by the Ohio Department of Insurance. This, however, is not the case in many other states.

The Obama Plan

Many parts of the Obama plan resemble initiatives from the Clinton health plan of 1994 and the Kerry Health plan of 2004.
Essentially, Obama’s health care plan is divided into three sections:

1. Modernizing the US health care system to lower costs and improve quality
2. Promoting prevention and strengthening public health
3. Quality, portable and affordable health coverage for every person

The “Savings”

The $2500 in savings will come from health care reform, using some of the following initiatives:

*Making medical insurance universal, which may reduce spending on uncompensated care.
*Improving management and prevention of chronic conditions.
*Increasing insurance industry competition and reducing underwriting costs and profits.
*Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.

Shifting Cost Burden

While all of these ideas are feasible, the underlying theme seems to be simply shifting some of the cost burden from the private sector to the government. And of course, much more control of our health dollars and decisions would come from Washington D.C and not Anthem or UnitedHealthCare.

The plan will actually compete directly with Ohio private insurance companies in a “National Health Insurance Exchange.” The federal government (not health insurance carriers) would determine the quality of benefits that Americans would receive. And these new rules would apply to both the new national health plan and all participating private health plans.

Preventative Coverage Would Be Emphasized

Obama’s health care plan will encourage “healthy lifestyles” with specific emphasis on wellness. Employer wellness programs will be increased, and cafeterias and vending machines in the workplace may see healthier food.

School-based health screening programs may increase along with increased support for physical education.

For Ohio individuals and families, the Obama plan would require preventative services on many federally-supported programs such as Medicare, Medicaid and SCHIP. One benefit may be possible discounts to on health insurance premiums for enrollment in wellness and prevention programs.

Currently, some Ohio individual health insurance policies offer a similar discount, such as Anthem’s Lumenos Health Incentive Account (HIA).

Ohio Group Health Insurance

Employer-based health insurance would radically change under the Obama plan. Here in Ohio, both small and large employers are able to choose among many different plans for their employees. The Obama plan would force employers to offer a specific level of health benefits to their employees or pay a tax to finance a national health program. Currently, the amount of provided health benefits and the size of the tax have not been specifically discussed.

Perhaps the best and most economical health insurance plan for Ohio residents would be a concept already in place…HSAs (Health Savings Accounts). Thus, instead of imposing a top-down change on the health care system, it would seem to be prudent to transfer direct control of medical dollars to individuals and families. This would allow Americans to choose their own health plans and benefits, while making health insurance companies compete directly for consumer’s dollars by providing a real value to patients.

All of this could be accomplished by specific tax and regulatory changes designed to utilize the power of free-market competition. Health care spending could be reduced, preventative treatment could be emphasized and portability could be promoted. Reforming the tax treatment of health insurance and aiding employers that help their employees buy health insurance would help quite a bit.

For now, Ohio health insurance rates are remarkably low compared to many other states. There are many reputable insurance companies that offer a wide array of policies, including Health Savings Accounts. That shouldn’t change much for the next two years. In 2011, things might change…hopefully, for the better.

By: Ed Harris