Health Insurance

Individual Medical Quote – Assurant Health | Short Term Medical Link for Assurant Health | Supplemental Coverage for Assurant Health

to have one of our Qualified Insurance Specialists contact you.

Whether your needs for personal medical insurance are short-term or more of a permanent need, we offer many high-quality plans, and some even allow additional tax benefits.  We offer short-term plans that are affordable for when you are between jobs or waiting for group coverage to be effective.

Your employees may be your most valuable asset. One way of taking care of them is to offer appropriate group benefits, which might include medical, life, disability, or dental insurance programs. Because we are partnered with an assortment of reputable companies, we can provide a cost-effective medical & benefit program for your group.  Medical insurance costs have become a great concern for many employers. Let us review your program and make suggestions on how those costs might be brought under control.

The following are some of the products we offer:

• Individual Family Medical

• Individual Disability

• Individual Life

• Dental

• Short Term Medical

• Long Term Care

• Group Medical

• Group Disability

• Group Life Plans

• Group Dental

• Medicare Supplements

How Will Healthcare Reform Affect Your Health Insurance Premiums?

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Have you ever wondered how health care reform may affect you and your family’s health insurance?
 

• Will my rates go up or down? 
• When will everyone be able to get coverage? 
• How will I shop for my health insurance?
• Will I have to buy a certain type of policy or face a penalty?  
• Will I qualify for any subsidies on my premium? 

Here's what you need to know:
 

1. Individual Mandate Clause:
   The individual mandate clause of the law means all individuals must purchase health insurance or face a fine/penalty. The concept of this goes hand in hand with guaranteed issue because no one can be turned down for coverage, this prevents people from signing up only when they need it and canceling it when they don’t. Some argue, that it is unconstitutional to force business or individuals to buy insurance coverage. The individual mandate provision will be heard by the Supreme Court in June of this year.
2. Guaranteed Issue Clause:
   Guaranteed Issue, which means the insurance company cannot ask any medical questions to find pre-existing health conditions is a very hot topic these days. On one hand, this concept is great since an individual cannot be turned down if they have a pre-existing condition. On the other hand, this may cause insurance premiums to increase, perhaps even substantially. How? Currently insurance companies ask health questions to determine if there are any pre-existing health conditions.  If so, they can assign a premium increase to counter potential risk. Currently healthy people pay less and those with pre-existing conditions may pay more to help offset the financial risk the carrier is taking on. In 2014, if the law remains the same everyone will be guaranteed coverage and all premiums will be the same. This means that the carrier needs to build into the rate the financial risk they are taking on by accepting anyone with pre-existing conditions.  In addition, healthy individuals may be subsidizing individuals with pre-existing conditions.
    
3. Minimum Essential Coverage (MEC):
   In 2014, each individual must buy a health insurance plan that is considered credible coverage and this clause outlines what features must be included in a health insurance plan so you are exempt from fines/penalties. It is believed today that in 2014 the highest deducible medical plan you can purchase for an individual may be $2,000 and for a family may be $4,000. This means that if you currently have a $5,000 or $10,000 deductible medical plan, it may not qualify as credible coverage  and you could face a fine/penalty.  In addition, you may see significant increases in premium if you are required to switch from a $10,000 deductible medical plan to a $4,000 deductible plan. Your premium will more than likely double! 
    
4. Health Insurance Exchanges:
   Starting in 2014, each state is required to have a health insurance exchange available so individuals can shop for medical insurance from multiple insurance companies.  Each insurance company will be required to provide premium subsidies based on income.  As an example, families of four that earn under $80,000 per year will receive some subsidy.  If that family earns closer to $80,000 per year, the subsidy will be minimal.  This can be a good concept for those who currently cannot afford health insurance and will have their premium subsidized but if you make over this amount you will see very little benefit.
5. Minimum Loss Ratio (MLR) clause and how it affects your rates
   Starting in 2011, each insurance carrier is mandated by law to pay out 80-85% of premiums paid in claims. If the carriers do not pay out at least these amounts, they will be forced to refund money. In theory this will help reduce and control rates, however, if the insurance companies end up paying out more than the minimum required by law, they may ask for and will most likely receive any rate increase they request. Health Care costs, not insurance company profits will now primarily dictate what premiums will be in the future. If rates go up it’s more likely a health care cost issue. Each state was given Federal subsidies to police the insurance carriers and make sure they are compliant.

 5 Tips When Shopping for Health Insurance

It can be a challenge to find coverage that meets your healthcare needs and fits your budget. Health insurance that covers more tends to cost more.

• Do your best to balance the cost (monthly premium) of a policy with the protection it offers.

• Determine what you will have to pay yourself for covered services (deductible, coinsurance, copayments, and out-of-pocket limit).

• Estimate costs for non-covered care (services excluded or limited by the policy) and charges (fees above what the plan recognizes).

• Avoid policies that don’t have some kind of maximum out-of-pocket limit on covered charges.

• Don’t mistake insurance-like products for comprehensive coverage.

What’s the premium?

The premium is the amount you pay monthly to get and keep a health insurance plan. You must pay the premium even if you don’t use any services under the plan.

What’s a deductible?

This is the annual amount you must pay before the insurance plan will pay for any services you get.

• Usually, choosing a plan with a higher annual deductible will result in a lower monthly premium.

• The deductible might not apply to all covered services, such as preventive services.

• Some policies have separate deductibles for certain services, such as hospital care or prescription drugs.

What are copayments and coinsurance?

Insurance plans also typically require you to pay a fixed fee for the use of certain covered services under the policy. These costs are copayments (flat dollar fees, such as $25 per doctor’s visit) or coinsurance (a percentage of covered charges, such as 20%).

You’ll see all of these costs—deductibles, copayments, and coinsurance—referred to as “cost sharing” or your “out-of-pocket costs.”

What you pay for covered services may depend on whether you get care in or outside of the network. Increasingly, health insurance policies have multiple levels of cost sharing (also known as “tiered” cost sharing).

The deductible, copayments, and coinsurance that apply depend on the particular item or service you need or the type of provider you see.

For example, a policy might charge a $10 copayment for generic drugs, a $50 copayment for some brand-name drugs, and 50% coinsurance for very expensive injectible drugs (to treat diabetes or multiple sclerosis, for example).

Another example is that you may have to pay a copayment of $250 for care in community hospitals, while you pay 20% coinsurance in specialized medical centers.

What about other costs?

The policy probably won’t limit the amount you have to pay for doctor or hospital fees beyond a level recognized as reasonable by the health insurer.

Usually, providers in the insurer’s network aren’t allowed to charge more than the insurer’s recognized charge. But if you get care by out-of-network providers, you may have large out-of-pocket costs.

Some policies limit what they will pay for certain kinds of health care. For example, a policy that pays no more than $650 per day for hospital care could leave you owing thousands of dollars in hospital bills.

What’s an out-of-pocket maximum?

The annual out-of-pocket maximum is a limit on what you will pay each year for deductibles, copayments, and other cost sharing for health care you get under the plan.

It is important that a policy have an annual out-of-pocket maximum because it will cap how much you pay annually for these expenses. Without this cap, what you might have to pay for covered care could reach catastrophic amounts.

Keep in mind that even if there is an out-of-pocket maximum, not all costs may apply to this out-of-pocket maximum. Copayments for prescriptions, for example, often don’t count against the out-of pocket maximum. Check your policy document to see which costs apply to the out-of-pocket maximum.

Starting in 2014, all new health insurance plans sold to individuals, small businesses and Exchange plans will have an out-of-pocket maximum.  All co-payments, deductibles, and other cost sharing for covered in-network care will be limited by the out-of-pocket maximum.

Benefits and Services Covered

If you have a medical condition, look at the list of benefits and services the policy covers to see whether it includes the services that you need, such as:

• Hospital and doctor care

• Lab tests

• Medical equipment

• Prescription drugs

• Rehabilitation following illness or injury (for example, physical therapy)

• Preventive care

• Mental health care

If you don’t have a medical condition, ask your doctor or his/her office staff which insurance plans provide the most comprehensive services.

Limits on coverage

• In the past, many policies had a lifetime limit (the most an insurance company agrees to pay for covered services during your life)—for example, $1 million or higher.

Thanks to the Affordable Care Act starting as early as September 2010, private insurance policies can’t include lifetime dollar limits on the amount they will pay for covered benefits.

Some may have an annual limit on covered care (the most an insurance company agrees to pay for covered services in a year).

• Starting as early as September 2010, annual dollar limits on the amount that a new health insurance plan or existing job-based plan will pay for covered benefits will be restricted.

Limits on services

Look also for limits on individual covered services, especially those that will leave you without coverage for catastrophic health care costs.

For example, some policies may only cover four doctor visits per year, only $5,000 for chemotherapy, or only $800 per year for prescription drugs. These policies could leave you facing tens of thousands of dollars in medical bills if you become seriously ill.

What’s not covered (“exclusions”)

There could also be exclusions that apply specifically to you. Many policies temporarily exclude services that the policy covers related to a medical condition you have now or had in the past.

Some policies add amendments (called “riders”) that permanently exclude services relating to your specific condition or the organ system or body part it affects.

Starting as early as September 2010 under the Affordable Care Act, job-based health plans and new individual plans won’t be allowed to deny or exclude coverage for children (under age 19) based on pre-existing conditions.

Starting in 2014, these same plans can’t exclude or charge anyone more for a pre-existing condition, including a disability.

Formulary (list of covered drugs)

Some coverage limits will be harder to judge. For example, most policies restrict coverage for prescription drugs to those on a list of covered drugs, called a “formulary.” Check to see if the drugs you take are on the formulary. The insurer should tell you whether exceptions can be made if you need a drug that isn’t on the formulary.

Other coverage rules

Prescriptions and other care, such as surgery, may require “prior authorization” to be covered.

• Prior authorization means plans may require you or your doctor to submit information to prove why you need certain drugs or medical procedures before the plan will cover them.

• A policy should state whether prior authorization is required, but generally you won’t know ahead of time whether prior authorization will be granted.

• You may want to contact your State Department of Insurance to find out how many complaints have been lodged against an insurer for refusing to authorize care.

Medicaid

Medicaid is a state-administered health insurance program for low-income people, families and children, the elderly and people with disabilities. It can also lower your costs or cover more benefits if your other coverage is limited.

The Federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States also have choices in how they design their program, so Medicaid varies state by state.

Currently, not everyone with low incomes is eligible for Medicaid. Children, pregnant women, people over age 65 and people with disabilities are most likely to qualify. In most cases, children in a family of four with an income of about $45,000 per year in 2010 are eligible for care through Medicaid or the Children’s Health Insurance Program (CHIP)

Even if your family income is higher than this level, you should check to see if your child may be eligible for Medicaid or CHIP since many states cover children at higher income levels.

Beginning in 2014, Medicaid rules will be simpler and more people will be eligible. Virtually all adults under age 65 with individual incomes up to about $15,000 per year will be eligible for coverage through Medicaid in every state.

Couples, pregnant women, and people with disabilities with somewhat higher incomes may also qualify. Children will qualify at much higher income levels.

The eligibility rules and benefits for Medicaid are different in each state.

Who should apply for Medicaid?

Medicaid offers health insurance for families and children, pregnant women, the elderly and people with disabilities. In some states, other people may also qualify.

The Medicaid program serves about 50 million Americans each year, many of whom are working but don’t have health insurance coverage through their jobs. And beginning in 2014, many more people will become eligible to enroll in the program.

Medicaid covers a comprehensive set of benefits and is also designed to meet the needs of people who have more significant health care needs, including:

• Pregnant women

• Children, especially those with special health care needs

• People with disabilities

• Elderly people, including those who need long-term care services and supports

Also, beginning in 2014, legal residents who aren’t eligible for Medicaid may be eligible for insurance through a health insurance

Exchange – What is it?

An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges and you will be able buy your insurance through Exchanges too.

What benefits are covered?

While Medicaid programs vary by state, there are benefits that all programs cover:

• Doctor’s services

• Laboratory and X-ray services

• Inpatient hospital services

• Outpatient hospital services

• Health screenings for children and treatment if medical problems are identified

• Comprehensive dental and vision services for children

• Family planning services and supplies

• Long-term care services and supports

• Medical and surgical dental services for adults

• Pediatric and family nurse practitioner services

• Services provided in health clinics

• Nurse-midwife services

• Nursing facility services for adults

• Home health care services for certain people

• Prescription drugs

There are other benefits that your state must cover for children and may also cover for adults:

• Physical, Occupational, or Speech Therapy

• Eye doctor visits, glasses

• Audiology, hearing aids

• Prosthetic devices

• Mental Health services

• Respite and other in-home long term care

• Case management

• Personal care services

• Hospice services

How much does Medicaid cost?

Medicaid coverage is designed to be affordable for everyone who is eligible. Most states don’t charge monthly premiums for coverage. The cost-sharing requirements for Medicaid vary by state, but co-payments are typically no more than $5 per visit.

What is the Children’s Health Insurance Program (CHIP)?

The Children's Health Insurance Program (CHIP) provides low-cost health insurance coverage for children in families who earn too much income to qualify for regular coverage but cannot afford to purchase private health insurance.

Who qualifies for CHIP?

Children up to age 19 in families with incomes up to $45,000 per year (for a family of four in 2010) are likely to be eligible for coverage.  In many states, children in families with higher incomes can also qualify.

• Pregnant women may be eligible for CHIP. Coverage for expectant mothers generally includes care while you’re pregnant for lab testing and labor and delivery costs, and at least 60 days of care after delivery.

• CHIP covers U.S. citizens and certain legal immigrants. States have the option of covering children and pregnant women who are lawfully residing in the United States. Undocumented immigrants aren’t eligible for CHIP.

To find information about children’s coverage programs in your state and other options available to you, use the insurance and coverage finder.

What services does CHIP cover?

The benefits that are covered through CHIP are different in each state, but all states are required to cover these important services:

• Routine check-ups

• Immunizations

• Dental and vision care

• Inpatient and outpatient hospital care

• Laboratory and X-ray services

How much does CHIP cost?

Health insurance through CHIP is designed to be affordable for families.

Routine (“well child”) doctor visits are provided free of charge, but there may be co-payments for certain other services, and many states also charge a monthly premium for coverage.

The costs you’ll be responsible for under CHIP are different in each state, but cannot be more than 5% of your family’s income each month.

Affordable Care Act Update

In March 2010, Congress passed and the President signed into law the Affordable Care Act. The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.

Which puts in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

Whether you get health benefits through work, buy insurance yourself, have a small business and desire to provide health coverage to your employees, are on MedicareMedicare A Federal health insurance program for people who are age 65 or older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). or don’t currently have insurance, the Affordable Care Act gives you better control of your own decisions about your health coverage. It makes insurance more affordable right away by providing small businesses with a tax credit to provide coverage, and in 2014, by providing tax credits to those who need help in buying insurance -- representing the largest middle class tax cut for health care in history.

The Affordable Care Act is projected to reduce premium costs for millions of families and small business owners who are priced out of coverage today.  This could help as many as 32 million Americans who have no health care today receive coverage.

Once the Affordable Care Act is fully implemented, Americans will have access to affordable health coverage.

To help lower costs, the Affordable Care Act:

• sets up a new competitive private health insurance market – through state Exchanges -- giving millions of Americans and small businesses access to affordable coverage, and the same choices of insurance that members of Congress will have.

• holds insurance companies accountable by keeping premiums down and preventing many types of insurance industry abuses and denials of care, and ending discrimination against Americans with pre-existing conditions.

• puts our budget and economy on a more stable path, since it is expected to reduce the deficit by more than $100 billion over the next ten years – and by more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Starting this year and continuing through 2014, the Affordable Care Act will be implemented, increasing access to affordable health care for individuals, families, seniors, and businesses.

Many important benefits begin as early as this year, including bans on the worst insurance company abuses; cost savings for seniors, families and small and large businesses; and coverage options for many Americans who have been locked out of the insurance market because of a preexisting condition.

The source for this is www.healthcare.gov.

Short Term Medical Insurance

Short-term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. If you think you'll need coverage for a longer period of time, you may want to look at a standard, longer-term health insurance option like our individual and family health insurance plans.  Short term health insurance is a low-cost option for your temporary health insurance need and is also a low cost alternative to COBRA.

The application process for short-term health insurance is usually simpler than standard, longer-term health insurance. Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care.

Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise. If you wish to maintain your eligibility for HIPAA plans, you should not purchase a short-term plan. Please consult us to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.

Short-term health insurance plans typically do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA, which you should seriously consider if you have an existing medical condition.

Short-term medical insurance can bridge the gaps in health insurance coverage if:

• You’ve lost coverage through recent job or life changes,

• You’re a student or graduate no longer eligible for coverage under your parent’s plan,

• You’re a seasonal worker,

• You’ve retired and are waiting for Medicare eligibility.

NOTE: Short-term medical is issued for a specific period of time.  If your needs for coverage extend beyond this plan, you may apply for additional short term plans. This may require a new application and would not be an extension of your current plan.  Any illness or condition you develop while covered by your current plan would be considered “preexisting” when you apply for a new short term plan and, as such, will not be a covered expense.