Utah NetCare Basic Health Care Plan Passes the Senate

The Utah NetCare plan (House Bill 188) passed the Utah Senate on March 5th, 2009. 

The bill creates the Utah NetCare Basic Health Care Plan, a guaranteed issue plan that will be offered to Utah residents as an alternative to COBRA, to individuals, and to employees of Utah businesses. 

The NetCare plan will have high deductibles, less than state-mandated coverage, and will have fairly high premiums compared to individual and family health insurance plans.  

 The main attraction of the plan is that Utah residents who have previously been denied coverage will have an option besides the Comprehensive Utah Health Insurance Pool of Utah.  The NetCare plan will likely be offered as soon as January 1st, 2010. 

House Bill 188 also creates an online insurance exchange, or a website, where Utah residents can go to compare Utah health plans and prices side by side .  This technology is currently available in the independent market (see this Utah Health Insurance Instant Quoting System for an example).

To stay updated on the latest Utah NetCare happenings, please visit the Utah NetCare website.

by Jared Balis

Health Savings Accounts – Eligible Expenses

The following expenses are eligible to be paid for out of your Health Savings Account (if you have a qualified high deductible health plan):

  • Abortion
  • Acupuncture
  • Alcoholism Treatment
  • Ambulance
  • Annual Physical Exams
  • Artificial Limbs
  • Artificial Teeth
  • Bandages
  • Birth Control Pills
  • Chiropractor
  • Contact Lenses
  • Dental Treatment
  • Diagnostic Services
  • Drug Addiction
  • Drugs
  • Eyeglasses
  • Eye Surgery
  • Fertility Treatments
  • Guide Dog / Service Animal
  • Hearing Aids
  • Home Care
  • Hospital Services
  • Medical Equipment (Bandages, Crutches etc…)
  • Medicare Part A (Hospital) – Limited
  • Medicare Part B (Supplemental Medical) – Limited
  • Medicare Part D (Prescription Drug)
  • Laboratory Fees
  • Lead-Based Paint Removal
  • Learning Disability Expenses
  • Legal Fees (necessary to authorize treatment for mental illness only)
  • Lodging/Meals (if the primary reason is to receive medical care)
  • Long Term Care Insurance Premiums
  • Medical Conferences (dealing with a chronic illness you or a family member have)
  • Medicines
  • Non-prescription medicines (other than insulin)
  • Nursing Home
  • Nursing Services
  • Oxygen
  • Physical Exams
  • Pregnancy Test Kits
  • Prosthesis
  • Psychiatric Care
  • Psychoanalysis
  • Psychologist
  • Special Education Tuition (doctor recommended)
  • Sterilization
  • Stop-Smoking Programs
  • Surgery
  • Telephone (TTY/TDD – for the hearing impaired)
  • Television Equipment (for the health impaired)
  • Therapy
  • Transplants
  • Transportation (primarily for medical care)
  • Vision Correction Surgery
  • Weight Loss Program
  • Wheelchair
  • Wig
  • X-Ray

Here are some items that you cannot pay for with monies in your Health Savings Account:

  • Babysitting/Child Care
  • Controlled Substances (marijuana, laetrile, etc..)
  • Cosmetic Surgery (exceptions include breast reconstruction after breast cancer)
  • Dancing Lessons
  • Diaper Service
  • Electrolysis for Hair Removal
  • Flexible Spending Account
  • Funeral Expenses
  • Future Medical Care
  • Hair Transplant
  • Health Club Dues
  • Health Coverage Tax Credit
  • Household Help
  • Illegal Operations and Treatments
  • Insurance Premiums (with exceptions)
  • Maternity Clothes
  • Medicare Supplement Premiums
  • Medicines and Drugs from Other Countries
  • Swimming Lessons
  • Teeth Whitening
  • Veterinary Fees
  • Weight Loss Program (general purpose)

For a complete list (published by the IRS) with further explanation for each item, please see The IRS Guide to Eligible Medical Expenses.  Please know that the only exception to this list is that non-prescription medications are eligible to be paid for through your Health Savings Account.

For Wikipedia’s extended definition of Health Savings Accounts, please click here.

Health Savings Accounts – Here’s the Skinny

HSA Piggy BankA health savings account attached to a high deductible health plan just might be the prescription for increasing health insurance costs.

Health savings account shift the cost of everyday health care to the insured, rather than the insurance company.  This is accomplished by the insured having a higher medical deductible (ranging from $1,150 to $5,000 for a single person & $2,300 to $10,000 for a family).  

The idea (formally recognized as Consumer Driven Health Care) is, that consumers paying for office visits and prescriptions out of their own pockets will create an awareness of how much those things cost.  The insured might be a little more cautious before they head off to the urgent care center for something that don’t necessarily need to go there for.  On top of that, the hope is, the insured will question and negotiate with the medical provider when the provider orders tests and prescribes name brand drugs.

Because deductibles are high and there is little coverage before you meet your deductible, premiums for these plans can be very attractive.  On top of that, health savings accounts allow the insured to contribute $3,000 of pre-tax money ($5,950 for a family), every year to the account.  This money can be used to pay for surgeries, doctors visits, accidents, prescriptions and much more.  Best of all, the money is tax free, the account is in the insureds control, and it’s not a “use it or lose it” account.  The money rolls over from year to year.

To illustrate how a high deductible health plan in conjunction with a health savings account can change your families health insurance situation, take a look at the example below.  The family in this example includes a 37 year old male, 33 year old female, and two kids, ages 7 and 5.

A Popular Health Insurance Plan -

  • A local and well known insurance company
  • $500 medical deductible
  • $0 prescription deductible
  • $15 & $25 office visits (no deductible payment required)
  • 80% coverage after the deductible
  • $3,500 stop loss (max out of pocket)
  • $2,500,000 lifetime maximum benefit
  • $596.00 monthly premium

A High Deductible Health Plan + a Health Savings Account -

  • A solid insurance company who focuses on high deductible health plans
  • $5,000 medical/prescription deductible
  • $35 preventive care (annual physical) visit (no deductible payment required)
  • 100% coverage after the deductible
  • $5,000 stop loss (max out of pocket)
  • $5,000,000 lifetime maximum benefit
  • $151.00 monthly premium

It’s true that a family of four might have quite a few doctors visits each year and may end up paying quite a bit of out-of-pocket costs during the year.  But, to make up for it, medical expenses are paid for with pre-tax monies and the family is saving $5,340 per year in annual premiums. 

What is attractive about this, is that the insured has an opportunity to save a large portion of their premiums.  With the $500 deductible plan, the family was paying out $7,152, guaranteed, whether they utilized the plan or not.   Now, they are only paying out $1,812 in annual premiums.  They have an opportunity to save a lot of money each year, as long as they don’t over-utilize their plan. 

Because the insured is on the hook for more medical costs, high deductible health plans usually make a lot of sense for individuals and families that are healthy, or don’t utilize their plan much, and don’t have a lot of expensive prescriptions. 

An individual or family that has prescription costs, multiple office visits, and other medical expenses throughout each year may want to consider staying on a plan with more benefits up front.

To learn more about Health Savings Accounts, visit the United States Department of the Treasury – Office of Public Affairs – HSA’s.

 *All dollar figures above (contributions, deductibles, and example plan premiums) are for the year 2009.

Generics -vs- Brand Name Prescriptions

The push for consumers to choose generic drugs over brand name drugs is stronger than ever.

I took my daughter to the urgent care center today, because she had an ear infection.  The doctor wrote us a prescription for an ear drop antibiotic that cost $137 (without insurance).  I asked her “Is there a generic version of these ear drops?”  The doctor said there wasn’t, but there was a very similar ear drop that was a generic.  The total cost (without insurance) was  $29.99. 

Prescription DrugsThe bottom line is that I saved $45 because my co-pay was only $15, instead of $60.  On top of that, my insurance company saved $62.01.  The significance of my insurance company saving money, is that consumers saving my insurer money on a large scale, by choosing generics instead of brand name drugs will keep my rates (and everone elses rates) lower when it comes time for my annual renewal.

Some doctors don’t care if consumers buy the generic.  In fact, they would rather you buy the brand name.  They have pharmaceutical reps in their office, day after day, offering them perks to sell their brand name drugs.  Although I have had first hand experiences with doctors that prescribe the generic whenever they can.

There is more than just the cost issue to consider when replacing brand name drugs with generics.  How do they stack up quality-wise?

Most everything I have read makes the argument that generics are “the same” as brand name drugs.  It’s true that the FDA requires the same amount of the active ingredient to be in the generic, as was in the brand name.  However, colors, flavors, and other active ingredients do make them slightly different. 

Some articles I have read, and people I have talked to, do leave a little room for concern with a few specific generic drugs.  In making a decision to replace a brand name drug with a generic, make sure you get your doctors and/or pharmacists opinion.

The takeaway?  Save money and lower your annual health insurance rate increases by buying generic drugs.

To learn more about generics, read Consumer Reports “Guide to Prescription Drugs – Generics.”

How Much Does it Cost to Have a Baby in Utah?

Utah is a unique state. 

Because there are so many babies born in Utah, it is nearly impossible for the individual/family health insurers to cover maternity charges.  If they did, they would be out of business, or everyone would be absorbing the costs in the premiums.

Individual/family health insurers in Utah have deductibles for maternity related charges ranging from $5,000 per pregnancy to $7,500 or even $10,000 per pregnancy.  It’s no wonder that the cost of having a baby in Utah is such a hot topic.  You will likely be paying most of the charges out-of-pocket.  Determining what the costs are going to be can help you plan for your next baby.

Normal Vaginal Delivery

In Utah, in 2007, the average cost for a vaginal delivery was $4,792.  In major or extreme normal vaginal delivery cases, the average cost jumped to $8,089.  This doesn’t include the physician’s professional fees throughout the pregnancy, just the hospital charges.

Cesarean Section Delivery

In Utah, in 2007, the average cost for a ceserean section was $8,243.  In major or extreme cesear section cases, the average cost jumped to $14,552.  Again, this doesn’t include the physician’s professional fees throughout the pregnancy, just the hospital charges.

The Least Expensive Hospitals (for normal vaginal deliveries)

  • Beaver Valley Hospital
  • Dixie Regional Hospital
  • Garfield Memorial Hospital
  • Gunnison Valley Hospital
  • Heber Valley Hospital
  • Kane County Hospital
  • Logan Regional Hospital
  • Sevier Valley Medical Center
  • Uintah Basin Medical Center
  • Valley View Memorial Hospital

The Most Expensive Hospitals (for normal vaginal deliveries)

  • Davis Hospital & Medical Center
  • Intermountain Medical Care
  • LDS Hospital
  • Mountain View Hospital
  • Mountain West Medical Center
  • Pioneer Valley Hospital
  • Jordan Valley
  • Saint Marks Hospital
  • Salt Lake Regional Medical Center
  • Timpanogos Regional Hospital
  • University Health Care

So what about quality?  Does going with a less expensive hospital mean that you sacrifice quality and safety? 

Not neccesarily.

While one of the least expensive hospitals, Beaver Valley Hospital, had a higher than average rate of vaginal tears (without tools) of 10%, Heber Valley Medical Center, Dixie Regional Medical Center, and Valley View Medical Center all had below average rates of vaginal tearing (with and without tools) and below average incidents of newborn injuries.

On the other hand, some of the most expensive hospitals had higher than average rates of tearing and newborn inujuries.

Although looking at the average maternity costs in Utah can provide a rule of thumb for how much you may end up spending out of pocket, doing some hospital-specific research could pay off in the end.

Download the full report “Maternity Charges and Safety in Utah 2007“, provided and written by the Utah Department of Health.  Find out how each hospital stacks up.  This is a great planning tool and an accurate way to predict costs and safety.

Auto Accident Worksheet

Download this worksheet as a pdf.  Keep one in your car(s) with your insurance information.  Print it out and give one to a friend, or email this article to a friend.

 

If you have an accident, you should do the following:.

1.      Ensure everyone is safe.

2.      Notify the local authorities (police, ambulance, fire department).  Call 911 if it’s an emergency.  Discuss the car accident with the police only, not the other driver(s).

3.       Document information about the other vehicles involved in the accident:

  • Driver’s Name
  • Phone Number
  • Address
  • Insurance Co. Name
  • Insurance Policy #
  • Driver’s License #
  • Vehicle’s License Plate #
  • Vehicles Identification # (VIN)
  • Vehicle Year
  • Make
  • Model

4.      Leave the following with the other driver(s):

  • Driver’s Name
  • Phone Number
  • Address
  • Insurance Co. Name
  • Insurance Policy #
  • Driver’s License #
  • Vehicle’s License Plate #
  • Vehicles Identification # (VIN)
  • Vehicle Year
  • Make
  • Model

5.      If necessary, stay with your vehicle until it is towed.

6.      Contact your insurance agent or insurance company to report the accident and start the claims process.

Published in:  on March 3, 2009 at 6:13 pm Leave a Comment
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What Does a Funeral Cost?

How much the average funeral costs can be a big help in determining the amount of life insurance to purchase.

It’s been common for years for people to expect a funeral to cost $6,000, but that estimate is from around the year 2000 and it’s more expensive than that now.

 A local mortuary in Salt Lake City, UT publishes their price list on their website.  I picked their mortuary because they had an online price list.  As of October 1st, 2008, the below is what you can expect to pay for a funeral living in Salt Lake City.

  • Services of Funeral Directors and Staff – $2,495
  • Embalming – $695
  • Other Preparation of the Body – $405
  • Use of the facility (average of day/night use) – $280
  • Equipment and Staff for Graveside Services – $150
  • Transfer of Remains to Funeral Home (local) - $430
  • Hearse (local) – $270
  • Service Vehicle – $160
  • Casket – $895 – $21,595
  • Outer Burial Container – $365 – $2,595
  • Extras/Miscellaneous (Register Books, Music, Memorial DVD etc…) - $1,000

Assuming the casket was $2,500 and the outer burial container was another $700, the total price of this funeral would have been $9,085.  This doesn’t include the cemetery and burial costs, which can easily exceed $2,500.  It’s not unreasonable to assume that a funeral in Utah will be around $11,000.

Orrin Hatch’s website says that in 2005-2006, the average full funeral and burial in Utah was $12,685.

When looking to purchase a Utah life insurance policy, it’s safe to estimate between $10,000 and $15,000.

Your Funeral Guy

Your Funeral Guy

If you are looking for some ideas on how to lower a loved one’s funeral cost, please consider R. Brian Burkhardt’s book, “Rest in Peace: Insider’s Tips to the Low Cost Less Stress Funeral.”

 

 

 

 

 

 

 

 

 

 

This article will include new, updated, and more detailed information toward the end of March 2009.

How Much Life Insurance is Enough?

No one wants to pay for coverage they don’t need.  But figuring out how much life insurance you really need can be an eye-opening task. 

People ask me to quote a life insurance policy for between $100,000 and $250,000 all the time.  In the 1970’s this may have been enough.  But the example below might give you a different perspective on how far $250,000 will really go.

The Story of Bob and Andrea (a very possible scenario…)

Bob works as a manager at a local warehouse in Salt Lake City, Utah.  He makes $56,000 a year, before taxes.  Bob has a wife, who stays home with their three kids. 

Bob is tragically killed in an accident when his kids are 4, 5, and 7 years old.  Bob had just purchased a $250,000 term life insurance policy.  His final expenses are $8,000, which is conservative.  The $8,000 is paid for out of the life insurance benefit.  Now Andrea, Bob’s wife has $242,000 left.  She hasn’t had a job in over 7 years, and needs to pay the bills and take care of herself and her three children.  This family has lost their entire income.  Let’s assume that the kids plan to be in the house another 14 years.  So, the youngest will move out when they are 18, the next oldest, 19, and the oldest when she is 21.  Andrea plans on using the life insurance benefit to stay at home and raise her kids.  So, is that a realistic expectation?

Andrea has $242,000 left.  Without investing any of this money, She will have an annual income of $17,285.71 for the next 14 years.  This is about 31% of Bob’s income.  Andrea has $3,000 in monthly bills (house, car, food, gas, electric and other basic expenses).  $17,285.71 gives her $1,440.48 each month; not even enough money to pay half of her bills. 

Andrea is forced to get a job and put all three kids in daycare all day, or after school.  Daycare, at $15 per child (a conservative estimate) for three kids each work day of the month, costs Andrea $990 per month.  Andrea new job pays her an entry level $30,000 per year, because she hasn’t worked in 7 years.  Nearly $12,000 of her annual income is eaten up in daycare costs.  This leaves her and her three children with and $18,000 a year income, plus the annual life insurance benefit of $17,285.71; totalling $35,285.71 each year.  Not bad, but only 63% of what the kids and her are used to living on.  The worst part is that she is working 40 hours a week, robbing her of the opportunity to raise her kids as a stay-at-home-mom.

What if Bob’s life insurance benefit had been one million dollars?

Using the same example, let’s say that Bob had purchased a $1,000,000 term life insurance policy.  After he was gone, and the final expenses were paid, Andrea was left with $992,000.  This gave her an annual income of $71,428.27, or $5,952.38 per month.  Andrea was able to pay the bills of $3,000 easily each month and stay home with her kids. 

What if Bob’s life insurance benefit had been one hundred thousand dollars?

Just for kicks, let’s find out what would have happened if Andrea would have only received $100,000.  After Bob’s final expenses were paid, she would be left with $92,000.  Over 14 years, that leaves her with $6,571.43 per year, or $547.62 per month, barely enough to pay for groceries for the four of them.

The point?  Andrea was able to continue a similar lifestyle with Bob having $1,000,000 in life insurance benefits.  Anything much less, and her lifestyle was drastically changed.  The difference in monthly premium for Bob to have $1,000,000 instead of $250,000?  $35 per month.

To calculate how much insurance you may need, please use this Quick Life Insurance Estimator.

Or, for a really quick way to get an idea of how much life insurance you need, read How Much Life Insurance is Enough?.

*The example above doesn’t take into consideration Andrea investing her money, the kids college expenses, or some taxes.  However, it illustrates a point that a quarter million may not be as much as it sounds like, when put into a family’s real scenario. 

Utah NetCare – Utah’s Basic Health Care Plan

Jon Huntsman Jr.

Jon Huntsman Jr.

Jon Huntsman and the legislature’s Health System Reform Task Force have been working on implementing a new plan called NetCare to capture some of Utah’s uninsured. It’s all part of a 10 year plan to reform health care in Utah.

NetCare is the first step in the 10 year plan. It’s going to allow small businesses, individuals, and Utah residents who have lost their jobs to access a plan that is “mandate light” or doesn’t meet the state of Utah’s requirements for a basic health care plan. I guess in order to lower costs, some sacrifices need to be made.

The NetCare plan will be available to Utah residents starting January 1st, 2010, with no unexpected snags.

The bad news:
The deductibles will be quite high, for medical and prescriptions. It’s possible that diabetes management, adoption benefits, and specialists as primary care physicians won’t be covered under the NetCare plan.

The good news:
The plan will be guaranteed issue. So, no matter what your health history, you will qualify. This is great news for Utah residents who haven’t been able to find coverage due to their medical history or current medical status.

If you want to learn more about the Utah NetCare plan, and keep up to date on the latest news, articles, and advancements, check out my informative, always updated, and comprehensive website dedicated to the NetCare plan. Click on the Utah NetCare Website link.  You can add the page to your favorites once you get there.

Read an interesting article about Utah healthcare reform.

Minimum Auto Insurance Limits – Are They Enough?

Utah requires auto liability insurance limits of $25,000 per person and $65,000 per accident.

This isn’t enough coverage.  Plain and simple.

If someone gets in a car accident and causes damage to a passenger in the other car, it’s very likely that passenger will have more than $25,000 in medical bills. Once your auto insurance company pays the $25,000 and exhausts your benefit, you are opened up to a lawsuit, so the injured person can collect on the rest of the damages.

An old friend of mine was injured in an accident and settled for around $100,000. The driver who hit him would have been exposed to $75,000 worth of damages if he had $25,000/$65,000 limits.

There are some situations where it makes sense to have the state minimum limits. Teenagers just coming off of their parents policies, or young couples and families getting started sometimes need the extra money in their budget and don’t have many assets to protect. However, if you have assets to protect (money in the bank, equity in your home, cars, boats, retirement accounts etc…) you most likely need more protection than minimum coverage provides.

Some auto insurance agencies in Utah won’t even write Utah auto insurance with the state’s minimum limits. In fact, the agency I work with, SentryWest Insurance Services, is one of them.  The lowest the agency will write is $50,000 per person, $100,000 per accident. It’s just too risky to have anything less.