The netcare plan was originally designed as an alternative to the COBRA and State Continuation (Mini-COBRA) options.  Since its inception it has become a much broader solution than that.

Here’s what the netcare plan can be used for:

Utah Individuals and Families

Individuals and families can use the netcare plan as their main health insurance solution.

Utah Employer-Sponsored Group Plans

Utah’s small employers will be able to use netcare as a group plan.  By offering the netcare plan option instead of traditional insurance plans employers can save on employee healthcare costs and still provide a health insurance solution to their employees.

Alternative to COBRA and Mini-COBRA

COBRA and Mini-COBRA offer a former employee, who had a group plan through their employer, the ability to continue their group coverage for between 12 and 18 months.  This is a great solution, but can be very costly.  Many people can’t afford this option when they have recently lost their job.  The netcare Plan is a lower-cost alternative to COBRA and Mini-COBRA and be accepted in lieu of either.

You can learn more about the netcare plan by calling independent Utah health insurance agent Jared Balis (license #192152) at 801-679-0405.

This leaves only a few decent options when looking for insurance plans to help cover the costs of maternity.

Regence Blue Cross Blue Shield of Utah

As of now, Regence Blue Cross Blue Shield of Utah still offers a $5,000 deductible for maternity along with their individual and family plans.  This can prove to be a good option for a family that is planning on a pregnancy in the future.  It still remains to be seen whether or not Blue Cross will follow suit and raise their maternity deductible in 2010.

Assurant Health

Assurant Health has offered a variety of maternity deductibles with their plans in the past.  They still continue to offer maternity deductible options of $2,500, $5,000, and $10,000.  Although going with a lower maternity deductible can cost you, it’s a good option Assurant has on the table.

Altius & SelectHealth

Both Altius and SelectHealth have their maternity deductible set at $7,500 for individuals and families and it looks like it’s going to stay that way through 2010 and very possibly beyond.

HumanaOne

HumanaOne has a unique way of covering maternity charges for Utah individuals and families.  Their plans don’t cover any normal maternity charges.  However, complications of pregnancy are covered under your deductible and coinsurance specified by the plan you choose.

You can also look at supplemental plans to help you cover maternity expenses.  For more information visit www.UtahMaternityInsurance.org.

Answer:   They’re all more profitable than the health insurance industry.”  - The Daily Herald October 26th 2009

I wanted to share an article on Utah health insurance companies and the profits they actually make.

http://www.heraldextra.com/news/national/govt-and-politics/article_8e5cc179-4140-5473-b914-14ae667d4f77.html

Tip 1

Raise Your Deductible

By raising your deductible, you can lower your monthly premium.  On most plans, your office visits and prescriptions are covered with a copay before you are required to pay your deductible.  If this is the case with the plan you are on, raising your deductible may only change the amount you are willing to pay before your coverage kicks in, and the maximum you will pay toward your co-insurance once it does.  It’s a great way to lower your plan cost.

Tip 2

Reapply

Depending on how long you have been with your insurance company, you may be eligible to reapply for the exact same plan, with a lower monthly rate.  When you apply and are accepted as an individual or family, you are grouped with a number of other individuals and families.  As time goes on, that group has claims.  Those claims are paid by raising the rate a little extra at renewal.  So, on renewal, you may be paying for inflation plus other peoples claims.  After a couple of years, it makes sense to reapply, especially if you or your family have remained healthy.

Another option is to reapply for a different insurance company.  Each companies rates change on a yearly basis.  Besides that, there are a lot of changes happening all of the time that can make looking at a different insurance company beneficial.

Tip 3

Move to a Qualified High Deductible Health Plan

Moving to a high deductible, catastrophic health plan is an excellent way to drastically lower your monthly premium, and still keep major medical coverage for you or your family.   It’s true your risk increases, but the good thing is, most insurance companies still cover some preventive care before the deductible.  Some also have an accident rider you can add, so minor accidents are covered before you are required to pay your deductible.

Best of all, if the plan is a “Qualified High Deductible Health Plan” you can open up and use a health savings account to pay for your medical expenses pre-tax.

Take some time each year to review your plan and make sure you get the best coverage at the most affordable price.

Sincerely,

Jared Balis

The Medical Information Bureau (MIB)

It’s not quite as comprehensive as a credit report, but it does contain medical information, possibly about you that you should know about.  The Medical Information Bureau (MIB) is a membership corporation that is owned by Member life insurance companies.  They house medical histories and information on people that have applied for health or life insurance in the last seven years.

How Does This Affect Me?

When you apply for individual or family health, or life insurance, policies, the insurance company has access to the MIB.  Some of the time your MIB record is requested by the insurance company you have applied to and compared to the medical information on your application.  The information in your MIB file can help an insurance company determine whether or not they are going to offer you a policy.

Make Sure Your File is Correct

Sometimes your MIB file contains information you disagree with.  It’s good to order a free copy and make sure everything is accurate, because it can affect your ability to get a policy in the future.  You can request a free copy of your file by calling 866-692-6901.  More information is available at the MIB website’s “Request Your File” page.  Click here for their main page.

Making sure your medical file is correct is the first step in protecting your insurability.  It doesn’t stop there.  Make sure your doctor’s records contain accurate information.  If you were diagnosed with a condition and it is now resolved, make sure your doctor notes it in your records.  If you have stopped taking prescriptions, make sure that is noted as well.   You can usually order a copy of your medical records by calling each doctor’s office and asking to speak to the medical records department.

by Jared Balis

Taking a brand name medication, as opposed the generic equivalent can cost you more than just your increased co-pay amount.   It can cripple, or completely destroy your eligibility to apply for a new health insurance plan in the future.

Here’s why it’s so important to consider taking generic medications, instead of brand name drugs:

Today, my wife went to a dermatologist to find an effective treatment for a mild acne condition she has.

She first met with the medical assistant, and told him that she was concerned about the effects that an expensive prescription would have on her health insurability and rates.  She explained that she wanted a generic, or inexpensive medication.

She also made it a point to tell the doctor the same thing.  He looked at her file, asked her if she had “good insurance?” and told her that she should be “fine.” He offered to give her samples and a prescription discount card that would “help.” He also mentioned that if the medication was too expensive, he could prescribe something else. This was an indication to my wife that the prescription was very expensive.

She called the doctor back and explained how she had been clear about only wanting a generic, or inexpensive prescription. It turns out there isn’t a generic of this medication, but a very second close.

In the End

Instead of my wife having to pay $60 each month for her prescription, and her insurance company having to pay $120, she will now have to pay $10, and her insurance company will only pay $23.42.

Because my wife didn’t just “go with” what the doctor suggested, and sought out a generic alternative, she protected her insurability and will be able to apply to a new company in the future. She will likely be approved, rather than completely denied, or forced to take a large prescription deductible and pay for her medications on her own.

It may sounds odd, but I make it a point to be aware of what my insurance company is paying toward my family’s medical care. I know if I have multiple claims throughout the year, my annual renewal increase will be more than it would if we had no claims. On top of that, telling your doctor you will pass on unnecessary diagnostic tests, taking generic alternatives, and questioning why the doctor is doing what  they are doing can protect your insurability for the future.

Protecting You Insurability is Your Responsibility

Duration 8 min 53 sec

Download the audio Podcast

Assurant Health – Offers a $2,500 maternity deductible, the lowest in Utah, (with the exceptions of HIPUtah, Medicaid, and employer sponsored insurance with a maternity rider).  Assurant is also the only company in Utah to offer a 24 and 36 month rate guarantee, so you can rely on your rate staying the same for longer than 12 months.   On top of those, Assurant is the first company to offer a decreasing deductible on their high deductible plans.  For each six month period that you don’t meet your deductible, it goes down by 10% (the amount it goes down is limited, but it can be nearly cut in half after around 3 years).

HumanaOne – Allows you to carry over the amount you paid toward your deductible during the last quarter of the year, crediting that amount to your deductible for the next year.

Regence Blue Cross Blue Shield of Utah – Offers their members a high quality website account where members can view  claims information and research average costs for specific procedures at different facilities.

SelectHealth – Just rolled out  a dental insurance plan for individuals and families and changed their maternity insurance deductible from $5,000 to $6,500.

The Health Insurance Pool of Utah – HIPUtah (state funded insurance for uninsurable Utah residents) – is offering a premium subsidy program with lenient income requirements.  The subsidy pays up to 50% of your monthly premium for a limited number of months, if you qualify.

Sometimes you can call your health insurance company to start the appeal.   However, it’s often best to file a written, formal appeal.  In your appeal, include you group and individual ID number, your name, address, phone number, specific dates and dollar amounts.  Explain exactly why you believe your claim was paid incorrectly and attach supporting documents such as bills etc…

Here is the address and phone number for appealing claims for each major health insurance company that offer plans in Utah. 

• Aetna- Attn: Appeal Dept., 151 Farmington Avenue, Hartford, CT 06156.  Phone: (860) 273-0123.
• Altius Health Plans – Attn: Claims Appeals, P.O. Box 7147, London, KY 40742.  Phone: 800-377-4161.
• Assurant Health – Appeals Dept., One Chase Manhattan Plaza
  New York, NY 10005.  Phone: 800-553-7654.
• HumanaOne (Individual) – Attn: Claims Appeals, 500 West Main Street, Louisville, KY 40202.  Phone: 800-448-6262.
• Humana (Group) – Attn: Claims Appeals, 500 West Main Street, Louisville, KY 40202.  Phone: 800-448-6262.
• Regence Blue Cross Blue Shield of Utah – Attn: Appeals Dept, 2890 E Cottonwood Parkway, Salt Lake City, UT 84125-0956.  Phone: 801-333-2100.
• SelectHealth – Attn: Appeals Dept, PO BOX 30192, Salt Lake City, UT 84130-0192.  Phone:  801-442-4684.
• United HealthCare – Attn: Appeals Dept, 2525 Lake Park Blvd , Salt Lake City , UT 84120 . Phone: 800-624-2942.

Once you submit your appeal, be sure to call and follow up on a regular basis until your appeal has been processed and a decision has been made.

• HB 165 (House Bill 165) – Health Reform – Administrative Simplification
• HB 178 (House Bill 178) – Health Insurance and Program Amendments
• HB 188 (House Bill 188) – Health System Reform – Insurance Market
• HB 331 (House Bill 331) – Health Insurance Coverage in State Contracts

Highlighted below are the three bills that will have largest impact on Utah residents.  Click HB 331 to learn more about this bill.

House Bill 165 – Administration Simplification.  This bill…

-Amends the timing of the requirement that a hospital sends an itemized bill to a patient.

-Creates a system-wide, broad based demonstration project between health care payers and health care providers for innovating the payment and delivery of health care in the state.

-Establishes a committee to study and develop a more efficient coordination of benefits process.

-Requires health benefit plans to issue to enrollees a printed card containing health plan information.

-Requires an insurer to provide access to information sufficient for a health care provider to determine the compensation or payment terms for health care services.

-Requires the Insurance Department to convene a group of providers and payers to establish standards for the electronic exchange of health plan information using card swipe technology which is compatible with national electronic standards.

-Prohibits an insurer from requiring less than one business day’s notice of an emergency in-patient hospital admission and amends the period of time in which an insurer can recover an amount paid to a health care provider when the insurer determines the payment was incorrect.

-Requires hospitals sending bills to patients to include the following words in bold “THIS IS THE BALANCE DUE AFTER PAYMENT FROM YOUR HEALTH INSURER,” or other appropriate language.

House Bill 178 – Health Insurance and Program Amendments. This bill…

-Clarifies that the Children’s Health Insurance Program should have access to at least two different provider networks.

-Extends the COBRA premium assistance provided under Section 3001 of the American Recovery and Reinvestment Act of 2009 (Pub. S. 111-5) to state mini-COBRA benefits; and

-Makes technical amendments to the health benefit plan broker disclosure

House Bill 188 – Health System Reform – Insurance Market.  This bill…

-Prohibits balanced billing by certain health care providers in certain circumstances.

-Revises the basic benefit plan used for consumer comparison of health benefit products.

-Requires the Insurance Department to include in its annual market report a summary of the types of plans sold through the Internet portal, including market penetration of mandate lite products.

-Allows insurers to offer lower cost health insurance products that do not include certain state mandates in the individual market, the small employer group market, and in the conversion market;

-Creates the Utah NetCare Plan, a low cost health benefit plan as an alternative to current federal COBRA, state mini-COBRA, and conversion products.

-Requires health insurance brokers and producers to disclose their commissions and compensation to their customers prior to selling a health benefit plan.payment reform demonstration projects.

-Modifies the number and type of products an insurer must offer in the small employer group market and the individual market.

-Establishes a defined contribution arrangement market available on the Internet portal, which;  1.  Beginning January 1, 2010, is available to small employer groups.  2.  Offers a range of health benefit plan choices to an employer’s eligible employees.  3.  Beginning January 1, 2012, is available to eligible large employer groups.  4.  Beginning January 1, 2012, will offer a wider range of choices of health benefit plans to employees.

-Establishes a board within the Insurance Department that is given the responsibility to develop a risk adjustment mechanism that will apportion risk among the insurers participating in the Internet portal defined contribution market to protect insurers from adverse risk selection.

-Requires insurers who offer health benefit plans on the Internet portal to provide greater transparency and disclose information about the plan benefits, provider networks, wellness programs, claim payment practices, and solvency ratings.

-Establishes a process for a consumer to compare health plan features on the Internet portal and to enroll in a health benefit plan from the Internet portal.

-Requires the Office of Consumer Health Services to convene insurers and health care providers to monitor and report to the Health Reform Task Force and to the Business and Labor Interim Committee regarding progress towards expanding access to the defined contribution market, greater choice in the market, and

-Establishes limited rule making authority for the Office of Consumer Health Services to assist employers and insurance carriers with interacting with the Internet portal and facilitate the receipt and payment of health plan premium payments from multiple sources.

-Authorizes the Office of Consumer Health Services to establish a fee to cover the transaction cost associated with the Internet portal functions such as sending and processing an application or processing multiple premium payment sources; and

-Re-authorizes the Health Reform Task Force for one year.