Part 1: What are a few of the more popular types of term life insurance?

Posted on February 22, 2012 by stevew

Selected Benefits basically offers several types of term life insurance, but each one has different objectives and is applicable in different situations. On the plans we offer, the premiums are guaranteed to never increase over the term of the policy.

Term Life with Return of Premium (ROP): This type of coverage will give you life insurance coverage for a specified amount for a specific amount of time with one enhancement. If you outlive the term period, you’ll receive 100% of the premiums paid to the insurance carrier back in a lump sum check. These plans are available in 10, 15, 20, 25 and 30 year terms. If you decide to cancel the plan early, you will generally receive an increasing percentage portion of the premiums. In other words, if you cancel a 30 year term ROP policy after year 20, you will only receive back 60% of the premiums paid. This almost never happens since there is no downside to keeping the policy until the full term expires. You’re getting it all back anyway, so why would you cancel?

Term Life with Living Benefits: This is currently our most popular option for obvious reasons. This policy functions like any other term life plan in that if you pass away before the term is up, your beneficiary will receive 100% of the death benefit, but with one major enhancement.

If you have either a chronic, critical or terminal illness, the plan will pay up to 90% of the covered face amount upon the diagnosis. For example, if a person contracts a chronic illness which is defined as not being able to perform 2 of the 6 normal activities of daily living, you will receive 90% of the face amount of the policy paid out on a monthly basis. Activities of daily living include bathing, continence, dressing, eating, toileting and transferring. This is a wonderful benefit since that new monthly income can be used to pay for a assisted living facility or a nurse which will be necessary in this situation.

To be continued…..

By Steven Wendlandt

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How does my Accidental Injury Plan work in actual practice?

Posted on February 17, 2012 by stevew

Selected Benefits currently offers several accident plans, but our most popular is from NACD (National Association of Consumers Direct).

The plan is designed to pay for any expenses related to a covered accident (that your health insurance doesn’t pay for) up to the benefit amount you purchase. In order to activate the benefit, you must pay a $100 deductible. The plans are currently available in benefit amounts of $2,500, $5,000, $7,500 and $10,000.

What we normally recommend is to match the benefit amount of the accident plan as closely as possible to your health insurance total out of pocket. For example, in Texas, Cigna currently offers a $5,000 deductible Health Savings Account. This plan has 100% coverage after the deductible is met. If you have a covered accident, instead of paying Cigna $5,000, you would pay a $100 deductible and the accident plan would pay the first $5,000 of expenses for you up to the point where you health insurance policy takes over at 100%.

Most all accidental injuries are covered unless 1) you are drunk or under the influence of drugs when the injury occurs, 2) you are participating in a high risk activity such as bungee jumping, skydiving, motorcycle or boat racing, etc, or 3) you are over the age of 18 and are participating in an organized sports league. This last exception is because most all sports leagues are required to carry their own accidental injury plan and the expenses would fall to them (such as a college football team).

If you have a covered injury, when you arrive at the medical facility for treatment, give them the ID card from your health insurance company and ask them to file all claims with that company. Do not give them the accident plan ID card since they will not file a claim on your behalf for the accident plan. After you’re home for a week or so, several bills will start to arrive, Normally, you’ll have one from the medical facility, the doctor on staff who treated you, the x-ray department and possibly one for the materials used. At that point, just contact the membership department for your accident plan. They will require you to complete a short claim form describing how the accident occurred and charge you a $100 deductible. Then just fax them the related medical bills and let the accidental injury insurance company pay them for you.

Since Selected Benefits has begun offering accident plans about 2-3 years ago, the accident carriers have paid out and saved our clients several hundred thousand dollars in claims. If you feel this product would benefit you, please call us at 866.270.6209.

By Steven Wendlandt

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Am I insurable in the Texas individual health insurance market?

Posted on February 14, 2012 by stevew

Let’s review the general criteria.

There are quite a few factors that determine your insurability and they are always changing depending on how aggressive the health insurance carriers are at gaining market share.

Height/weight: This is the most obvious factor and some carriers are more liberal than others in this department. Currently, Aetna and Cigna have the most liberal stipulations on a person’s build while Humana One, BCBS of Texas and United Health One seem to be the strictest.

Medications: Most insurance carriers have a general guideline that if a person were taking three or more medications to control a single condition, then they would be declined in the private market. This can vary, as the carriers are more forgiving if those medications are generic and thus less expensive than 3 brand name medications.

Medical Conditions: Each insurance carrier publishes an “Agent Underwriting Guidelines” book and those have a list of declinable conditions. While the list is too extensive to mention each condition, some common conditions would be Type I diabetes, invasive cancers which have yet to be eradicated, HIV/Aids and most other auto-immune disorders.

Tobacco use: Smoking and/or chewing tobacco are not an automatic decline, but can be in combination with other medical conditions. A perfect example would be a smoker who also has asthma and uses an inhaler. Any medical condition that tobacco use can exasperate would usually result in a decline.

Pending or very Recent Surgical Procedures: No insurance carrier will write a case on someone if they have a pending surgical procedure yet to be completed. This would be akin to asking your auto insurance company to fix the huge dent in your car that was caused by a recent accident before your policy was in force. Also, if your surgical procedure was less than 3 months ago or you have not have your surgical follow up consultation, the carrier will also decline.

If you’re unsure of your own insurability, please contact Selected Benefits and we’ll be happy to review your situation and recommend the best course of action.

By: Steven Wendlandt

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Is maternity coverage available on an individual or family health insurance policy in Texas?

Posted on February 10, 2012 by stevew

Unfortunately, as of this writing, maternity benefits are only available on group insurance through an employer in Texas. The individual/family private plans do not offer maternity coverage. Complications of pregnancy are covered as any other illness, but just not the routine pre natal, routine birth and post natal care.

Selected Benefits recommends that clients negotiate with their OBGYN for a cash price and also negotiate with the facility where they would like to give birth. If you do this, you’ll normally pay around $4-$5000 for a routine birth which is close to what your out of pocket would have been on a private plan anyway.

One more step you could take is to purchase a HSA (health savings account) policy which allows you to make tax-deductible contributions to an account that can be used to pay for ANY medical expense. The funds you deposit can be used to pay the “negotiated amounts” described above on a pre-tax basis. Since you’ve negotiated a lower price and are paying that lower price with pre-tax dollars, it’s like double coupon day at the grocery store. Other than a group plan through an employer, this is the best option in the private market.

We also offer an inexpensive hospital cash plan which will pay a lump sum cash benefit of $2,000 upon the birth of a baby. Once the plan becomes effective, you have a 10 month waiting period before the plan pays out for pregnancy related hospital stays. The trick is to purchase the plan and try to time the pregnancy for 3-4 months after the effective date to be safe. These monies should be used to pay the negotiated price(s) mentioned above.

If you have questions on the technique mentioned above or are interested in purchasing an HSA policy or our hospital cash plan, feel free to contact us at 866.270.6209.

By: Steven Wendlandt

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Should you use an agent when purchasing health insurance coverage?

Posted on February 8, 2012 by stevew

The question is, why would you not? A good agent can be invaluable in the process as he/she has access to information and processes that you do not.

For example, some insurance carriers will use exclusion waivers on certain pre-existing conditions and some will not. How would you which carrier would be best for your situation if you don’t have access to the Underwriting Guidelines?

Another example would pertain to problem solving during and after the underwriting process: Simply put, we have access to people at the insurance companies that you do not. As a top producer for every major health insurance carrier in Texas, we have specific broker support individuals who can quickly solve mistakes during the underwriting process, claims and billing issues and problems regarding pre-existing conditions, etc. Without them, many policies would never be issued in the first place or would be issued incorrectly and you would likely need to go through the process again to obtain the correct coverage.

Here’s another example: A few years back, the State of Massachusetts started using health insurance exchanges as the entire will begin doing by 2014. It turns out, this was a pilot program for the federal exchange(s) soon to begin. Something unexpected happened though! Even though a person can enroll in a health insurance program without using an agent, 92% of all policies written during the test period were done so by an agent. This shows us that even though an agent is not required to purchase health insurance, most people people prefer to use one for guidance. This is a complicated topic and simply not common knowledge, so an agent can be invaluable to obtaining the correct policy for your needs with the least amount of hassle.

Are you ready for the best reason to use a health insurance agent? It’s free! Whether or not you buy from Selected Benefits (Member of the Better Business Bureau Greater Houston), you’ll pay the same monthly premium for the same plan as all health insurance rates are pre-set and filed with the Texas Department of Insurance. All services offered by Selected Benefits are provided at no cost to you.

I can’t think of a better time to give you our phone number of 866.270.6209 or you can always visit our Houston Health Insurance website for a free no obligation quote.

By: Steven Wendlandt

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What are my options if I’ve been declined for a Texas health insurance policy?

Posted on February 3, 2012 by stevew

1) COBRA coverage: If you or your spouse has recently lost their job, COBRA may be an option. COBRA is simply an extension of the health insurance you had before, but with a 2% surcharge tacked on. Many people are shocked at the cost of COBRA, but remember, the plan costs the same as it always has, it’s just that now you will be paying the entire monthly premium and your former employer will not be contributing anything toward the monthly bill. There are no medical questions to elect this coverage and you can generally keep it for up to 18 months if you choose.

2) The Texas High Risk Pool at www.txhealthpool.org. Again, this can be an expensive option especially if you are over the age of 50, but you cannot be turned down due to medical reasons. There are a few eligibility requirements to meet in order to qualify, so make sure to check their website.

3) Our most popular option: We call this the PCI flip. When healthcare reform was passed in 2010, this lead to the creation of the Pre-Existing Condition Health Plan (www.pciplan.com). The PCI Plan is a federal program and is generally much less expensive than the Texas Risk Pool or COBRA, but there is a catch. There are two eligibility requirements in order to gain entry. A health insurance carrier must have declined you AND you must be uninsured for at least 6 months.

How do you protect yourself if you need to be uninsured for 6 months? At Selected Benefits, we offer a benefit plan that will not jeopardize your eligibility for the PCI plan and will give you protection against unforeseen medical issues. This program has excellent benefits for doctor visits, well care, lab/x-ray, prescriptions, surgeries and accidents.

How does it work? Let’s say you have your gallbladder taken out and the charges total $30,000. If you have this “benefit plan”, here’s how the charges will pan out. You’ll be a member of a PPO, so that will generally knock about 1/3 off the cost. Now we’re down to $20,000. The plan will also pay 100% of whatever the Medicare surgical pays on that surgery. As an example, let’s say that’s another $8,000. Now we’re down to $12,000. The plan pays another 25% of the surgical amount toward anesthesiology, so that’s another $2,000, which brings us down to an even $10,000. The final component is the Karis Patient Advocacy program that comes with the plan for no extra charge. They will take the remaining charges and negotiate with the physician/hospital on your behalf for a lower price. This program can save as much as 80-90% of the original charges. The final result is just a small fraction of the original $30,000.

We recommend staying on this benefit plan for at least 6 months after which time you can hop into the PCI plan with no restrictions. If you would like to take advantage of this strategy or know of someone who could, please feel free to contact us at 866.270.6209.

By: Steven Wendlandt

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Can I go to any doctor or hospital I choose on my PPO plan?

Posted on January 28, 2012 by stevew

The short answer is you can, but you’ll be sorry unless you take a few steps first.

The basic idea with a PPO is that you have a “network” of physicians, hospitals, imaging centers, pharmacies and many other ancillary medical facilities that have banded together. They have each contracted with the various Texas health insurance carriers as a simple business arrangement: this medical network agrees to give members of the PPO (you) contracted rates in exchange for the insurance carrier sending them patients by placing those practitioners in the network.

For example, when you visit a physician that is “in-network”, you will generally just pay a co pay for the visit (if your plan has doctor co pays) or the PPO contracted rate. If you have a co pay, the amount you spend will generally not count toward your deductible. If you plan doesn’t have co pays, the allowed amount by the insurance carrier that you spend on the visit will generally count toward your major medical deductible. The idea here is that if you stay in network, you’re receiving a rate (either through a co pay or through the PPO contracted rate) that would generally be lower than what you would pay if you didn’t have your Texas health insurance policy.

If you do visit a doctor or hospital that is “out of network” on your plan, make sure to do this very sparingly. You’ll end up paying whatever they want to charge and the amount you spend will count toward your “out of network” deductible.

Here in lies the problem: Out of network deductibles are generally double what the in network deductible is. Also, your out of pocket costs beyond the out of network deductible will generally be higher as well.

For example, if you have a surgery and use an out of network hospital, but an in network surgeon and anesthesiologist, you end up paying much more than if the hospital was in network.

Let’s say you have a $5,000 in network deductible with 100% coverage thereafter (i.e. the Texas BCBS HSA Plan VIII). The out of network deductible on this plan is $10,000. If your surgical and anesthesiology costs total $4,800, but your hospital costs total $3,500, you’re going to pay the entire amount of $8,300. If the hospital were in network, your total out of pocket would only be $5,000. Why? The $3,500 hospital cost counts toward the $10,000 out of network deductible and does not go against the $5,000 in network deductible.

The bottom line is that if you have a PPO plan, make sure to stay in network with everyone who lays a hand on you. Demand that your surgeon uses only in-network assistants, anesthesiologists, imaging centers and of course, that the surgical center or hospital is also in network. You’ll be sorry if you don’t.

If you have questions about who is and is not in your network, please visit us at www.selectedbenefits.com or call 866.270.6209.

By: Steven Wendlandt

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I pay all this money each month for health insurance and I don’t get anything for it!

Posted on January 26, 2012 by stevew

Texas health insurance agent, I hear this comment all the time and it always makes me laugh because nothing could be further from the truth.

I would love it if my auto insurance carrier would pay for an annual tune up on my car each year. I would be over the moon if my homeowners carrier would pay to have an inspector visit my home once a year and let me know of any repairs that need to be made before they become very expensive problems.

I’ll even go even further and say that if I totaled my car, I’d love it if my auto insurance carrier replaced my old car with a nicer, more expensive vehicle of my choice. If my home burned down, I’d love if if they built me a new home with twice the square footage of my old home. Throw in an Olympic pool and a home gym while you’re at it!

Those sound like pipe dreams, but with Texas health insurance, that’s exactly what you receive.

Based on recent health care reform (the Affordable Care Act), two major changes have made policies even more attractive than they were before: 1) All health insurance policies must now pay for an annual physical for all adults with routine blood work, a routine, annual pap smear for all women over the age of 16, a routine, annual mammogram for all women over the age of 35, a routine colonoscopy for everyone over the age of 55 and all children now receive their well child check ups including immunizations for no charge. 2) All health insurance policies now have no more lifetime maximums meaning you’ll never run out of coverage no matter how much care you need.

This allows you to maintain your health with free preventive care each and every year and if you do need extensive medical care, you will never run out of coverage. Try asking your car insurance carrier to pay for your tune up and see what happens. While you’re at it, ask your homeowners insurance company to pay for that annual maintenance inspection.

The next time someone says they never receive anything from their health insurance policy, please forward them a copy of this article.

If you have questions about your current Texas health insurance coverage or would like us to send you a no obligation quote, please visit us at www.selectedbenefits.com or call 866.270.6209.

By: Steven Wendlandt

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How does recent healthcare reform affect my Texas health insurance policy?

Posted on January 24, 2012 by stevew

There are some major changes to the industry as a whole on the horizon, but not all of them have been implemented as of the writing of this article.

One of the main changes is on preventive care. All Texas health insurance policies must now have provisions for free preventive care which do not even require a co pay to be paid. The preventive care is quite extensive and includes the following services: A free, annual physical for all adults to include “routine blood work”, a routine, annual pap smear for all women over the age of 16, a free, annual mammogram for all women over the age of 35, all routine well baby/child visits including all required immunizations and a free colonoscopy for those over the age of 50. These preventive benefits are automatically included on all Texas health insurance policies written after March 23, 2010.

Another benefit of recent healthcare reform is that all dependent children (age 18 and under) are now “guarantee issue” on all fully underwritten medical plans. Before healthcare reform was passed, everyone, including children, had to qualify medically for a individual or family health insurance policy in Texas.

At first glance, this sounds like a great addition, but there is a catch. When this legislation was passed, our government did not realize that a health insurance carrier still has the right to insure some groups of people at the exclusion of others. Specifically, they are not required to write “child only” just because an application is received.

To date, I’m not aware of a single Texas health insurance carrier that will write a “child only” policy. The only way to insure a child on a fully underwritten individual or family plan (one that includes the free preventive care mentioned above) is if at least one of the parents is on the plan with the child. This at least allows the insurance carrier to collect additional premium in the event the child is very unhealthy and requires extensive medical treatment.

To summarize, if you are attempting to obtain coverage for a child in the individual/family market (not group health insurance), you can either purchase a policy for at least one of the parents and the child together -or- you can purchase a temporary health insurance policy for the child alone (which does not include the free preventive care).

If you have questions on insuring your child, please call us at 866.270.6209 or visit us at www.selectedbenefits.com

By Steven Wendlandt

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How will my prescriptions be treated under my current health insurance policy?

Posted on January 22, 2012 by stevew

Prescription coverage will differ a great deal depending on type of coverage you have in place. For purposes of this discussion, we are only describing the coverage under a an individual or family Texas health insurance policy.

If you have a Health Savings Account (HSA policy), then your plan can cover prescriptions in several ways. The deductible on an HSA is generally for both medical and prescription expenses. Since most all HSA plans are also PPO plans, you will receive the PPO contracted rate on all prescriptions (this will generally give you about 30-50% off on generic medications and 10-40% off on brand name medications) and whatever you spend on the medication will count toward the deductible of your Health Savings Account plan. Once you hit that deductible (remember that it’s a combination medical/prescription deductible) on your HSA, the medications will either be covered at 100% or covered by a co pay applicable to whether it’s a generic drug or a brand name drug.

For example, on the BCBS of Texas HSA Plan VIII for individuals, this plan covers all prescriptions at 100% after the $5,000 deductible has been satisfied. However, on the BCBS of Texas HSA plan VI for families, once you hit the 5,000 deductible, you’ll have a $10 co pay for generic drugs, a $50 co pay for brand name formulary drugs and a $65 co pay for brand name non-formulary drugs.

If you have a more traditional PPO policy (one that is not HSA eligible), you will generally have prescription coverage that is separate and distinct from your medical coverage. On most Texas health insurance plans, you’ll see three styles of prescription coverage as follows:

1) A co pay on all prescriptions without having to satisfy an RX deductible first. For example, on the BCBS of Texas Select Blue Advantage plan, you have $10/$30/$45 co pays for generic drugs, brand name formulary and brand name non-formulary drugs respectively.

2) A co pay on your prescriptions only after a small deductible has been satisfied first. For example, on the BCBS of Texas Select Choice plans, you must first satisfy a $200 deductible first and then it’s $10/$30/$45 (again for generic/brand name formulary/brand name non-formulary respectively) or

3) some plans have a co pay for generic prescriptions from the very first day without having to satisfy a deductible first. However, on the brand name drugs, you’ll have a small deductible (typically $250-$500) first before the co pays begin. For example, on the Texas CIGNA Open Access 2000 policy, you have a $10 co pay on generic medications with no deductible, but on the brand name medications, you must satisfy a $250 deductible first and it’s a $35 co pay for brand name formulary and a 60 co pay for brand name non-formulary.

Feel free to call us at 866.270.6209 if you have questions on your policy or visit us at www.selectedbenefits.com

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