What’s the best way to utilize my Accidental Injury plan in conjunction with my health insurance?

Posted on May 9, 2012 by stevew

Since health insurance rates have increased quite a bit due to healthcare reform, many of our clients have chosen to purchase a higher deductible health insurance policy (which comes with a lower monthly premium) in conjunction with an accidental injury plan and a critical illness plan.

If you have a covered accidental injury and need to visit a doctor or hospital, make sure to give them your health insurance ID card. The first step is for the provider to file a claim against your Texas health insurance policy. Request an Insurance QuoteIf you have a PPO plan, the health carrier will re-price the services as long as you use an “in-network” provider and normally pay their portion of the claim to the provider. At that point, you’ll begin to receive bills from the various service providers who treated you for the claim.

Here’s an example: Let’s say you have a broken leg and go straight to the ER. They will take a few x-rays, confirm the diagnosis and provide treatment. This normally consists of pain meds, a cast, etc.

Once you’re home recovering, the bills will begin to arrive for your portion of the charges that your health insurance policy did not pay for. You’ll normally receive one from the ER, one from the doctor on call who treated you, one from the x-ray technician and one for materials. Don’t pay these bills.

At that point, you would contact the accidental injury carrier and they will file a claim. They’ll just need some basic information such as how the injury occurred and they’ll also want you to send them the bills either by fax or via scan/email. You’ll be charged a $100, per incident, deductible and then they’ll pay all of the bills related to the injury that your health insurance didn’t pay for.

These policies are very cost effective and are well worth the price since they pay the first expenses of any injury up until your health insurance kicks in. In many cases, they actually pay more out of pocket than your health insurance will.

If you are a very active person or have children who are, I highly recommend these plans. For more information on these and our other products, please call us at 866.270.6209 or visit us at Health Insurance Texas.

By Steven Wendlandt

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Why is my employer group insurance so expensive for my family? I can barely afford it. Is there anything I can do? (Part 2)

Posted on May 3, 2012 by stevew

In addition, with group health insurance, an employer generally offers only 1-3 plan choices and that’s it. Take it or leave it. With Selected Benefits, we can place you with any type of plan you desire at any price point.

Here’s a recent example with one of our clients: Stanley Johnson is employed as a senior manager at a local chemical plant and he has access to excellent benefits which areRequest an Insurance Quote free of charge for him. These are offered as part of his compensation plan and it’s a $1,000 deductible plan with an additional $3,000 maximum out of pocket on major medical. The plan includes both doctor and prescription co pays.

Here’s the disconnect: Stanley has a wife and 2 kids (ages 46, 12 and 10 respectively in zip code 77027) and the rate for their portion on the group plan is $1046/month. It’s a great plan, mind you, but they don’t plan on having any more children, so maternity is unnecessary.

Stanley was primarily interested in saving money, so we told him to keep the group plan on himself (since it’s free) and we placed his wife/kids with the Cigna Open Access 2000 plan at $517/month. This plan carries $1,000 more risk than the group plan on major medical, so we also added a $5,000 accidental injury plan for $39.95/month (for the entire family) which all but eliminates any accidental injury risk. We also placed his family on a $10,000 critical illness policy for an extra $40/month, again, all but eliminating and critical illness risk (heart, cancer, etc).

The net result was better coverage for the family with much less overall risk and a much lower premium. His total savings were $449 per month (that’s over $5,300/year!) and he eliminated all but $100 of accidental injury and critical illness risk on his entire family (including himself).

If this sounds like it could work for your family, please don’t hesitate to call us at 866.270.6209 and we’ll be happy to analyze your situation completely free of charge with no obligation.

By Steven Wendlandt

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Why is my employer group insurance so expensive for my family? I can barely afford it. Is there anything I can do?

Posted on April 24, 2012 by stevew

Part 1.

We work with quite a few teachers, police officers, fireman, etc and this is a very common question. One would think that with such a large group of people, Request an Insurance Quoterates would be cheaper, but that’s not the case especially if you’re insuring a family.

The employer is required by law to pay for at least 50% of an employees’ group health insurance premiums, but is not required to pay anything toward the remainder of the family. In many instances, the employer will pay 100% of the employees’ premium as an incentive to attract competent employees.

This is generally a great deal if you’re a single person, but kind of a bad deal if you have a spouse/kids to support. Why is this?

Most group health insurance plans are required to offer more comprehensive coverage in certain areas, but many of those areas are unnecessary for thRequest an Insurance Quotee average person. For example, most large employers offer maternity coverage, severe mental health coverage and also alcohol and drug abuse coverage. These are items that are generally not available under most individual and family Texas health insurance policies, but for most people, that’s just fine.

Since the private Texas based health policies aren’t required to offer those coverages, they are normally much less expensive. If your family planning is complete, have no need for severe mental health benefits (institutions, rehab, etc) and you have no alcohol or drug problems in your immediate family, why pay for it?

If your group health plan is very inexpensive or even free for you, why not drop your spouse and/or kids from the plan and place them with one of the many plans we offer. Selected Benefits, in almost all cases, can insure the remainder of the family for a fraction of what it would run on the group health insurance plan. We can normally save most families at least several hundred dollars per month.

By Steven Wendlandt

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I have a family member who is sick and needs treatment now. What are their options?

Posted on April 13, 2012 by stevew

There are plenty of options for your situation, but the private insurance market is probably not one of them.

Health insurance markets are, by design, constructed so that the monthly premiums that the younger, healthy people pay will go toward the expenses of those whoRequest an Insurance Quote contract illnesses or have accidents. Simple as that. That’s the reason why an insurance carrier can and will either place an exclusion waiver on the condition if you attempt to apply or they will just decline you altogether. These policies are generally much less expensive than the other alternatives for those who did not elect to participate in the health insurance marketplace.

If you need medical treatment and do not have coverage, you generally have three options in the great State of Texas:

1) The Texas High Risk Pool. This is a group insurance pool for higher risk individuals that currently do not have coverage. You must not have current coverage and must meet the general eligibility requirements to gain entry. Be careful though, if you have not had coverage elsewhere within the last 63 days, then you must wait one year before your pre-existing condition is covered.

2) The PCI Plan: This is a program created in Spring of 2010 from the Affordable Care Act and it stands for the Pre-Existing Health Insurance Plan. This plan is very cost effective and has no waiting periods on pre-existing conditions. The eligibility requirements are that you must not have been covered by another insurance carrier within the last 6 months and you must have a pre-existing condition.

3) Texas Medicaid: This program is designed to provide inexpensive coverage to those who are near or below the poverty level. Eligibility is based primarily on income and assets, so this will not work for the majority of Texans.

Overall, the best way to approach medical care is to stay continuously covered by health insurance. If you have a lapse in coverage of over 63 days, then you may have created a problem regarding a new medical condition or with your existing conditions.

Please feel free to call us at 866.270.6209 with any questions on this topic and we’ll be happy to place you with the best option for your needs. As always, our services are provided at no charge to our clients.

By Steven Wendlandt

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Since I’m self-employed, is there a better way to purchase disability coverage? It seems so expensive.

Posted on April 11, 2012 by stevew

You’re correct. The overwhelming majority of both accident and sickness disability policies are purchased through the workplace at a very reasonable rate for the insured. In fact, if you are self-employed, be prepared to pay about twice as much for comparable coverage if you do not purchase through your employer.

Selected Benefits – Texas Health Insurance has pioneered a better way to obtain the coverage you need at a much lower price. What we recommend is combining a short-term accidental disability policy with a high face amount critical illness policy.

Based on the numbers, most accidents do not result in a permanent disability and can therefore be insured on a shorter term basis. We normally recommend a two year benefit with a 30 elimination. Your payments will begin after the 30 day waiting period and will last for up to two years should you be unable to return to work (highly unlikely).

On the sickness side, we recommend a high face amount critical illness policy that will pay you an immediate lump sum benefit upon the verification of the diagnosis. There is no waiting period to receive your monies other than a few weeksRequest an Insurance Quote for the insurance carrier to verify to illness. The policy will then pay you the entire face amount of the plan ($50,000 up to $500,000 depending on what you purchase) to be used as you wish. Most people will use the monies to pay off any related medical expenses and pay their regular monthly living expenses. You’ll normally have a quite a bit left over once you’ve recovered from the sickness and are free to use those leftover monies any way you wish. Almost everyone will receive a higher payout over time than if they paid a similar premium for accident/sickness disability coverage. These critical illness policies generally cover about 22 conditions in the categories of cardiovascular, cancer and other miscellaneous illnesses.

The best part is that you will pay a much lower monthly premium than if you had bought the traditional accident/sickness disability combination. If you’re interested in receiving a quote for this type of coverage, feel free to call one of our agents at 866.270.6209.

By Steven Wendlandt

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Part 2 – What other type(s) of coverage should I think about when purchasing Texas health insurance?

Posted on April 7, 2012 by stevew

Accidental Injury Plans: These supplemental policies will pay for all expenses related to any covered accidental injury after a $100 deductible up to the face amount of the policy. Our most popular accident plan is from NACD and is available in a $2,500, $5,000, $7,500 and $10,000 benefit levels. We recommend enough coverage to cover the total out of pocket (including deductible) of your Texas health insurance policy, but no more since the accident plan will never pay more than your total exposure. They only have a few exclusions except for injuries sustained while under the influence of drugs and or alcohol and injuries on those over the age of 18 who incurred the injury during an organized sporting activity. Most all adult, organized sports leagues are required to carry their own accident plans that will pay for any injuries sustained during the activity. These plans are a great idea if you are a very active person and/or have children who are. Adding an accident plan to a major medical policy will tend to mimic the type of coverage you will receive on a group plan through an employer since most accident related ER visits are covered with just a co pay.

Critical Illness Plans: These plans are designed to pay you a lump sum benefit of the face amount of the policy (after a $100 deductible) for any covered sickness. Our most popular plan is from Humana One and is available in coverage amounts from $5,000 up to $50,000. Most clients view this a viable alternative to a “sickness” disability policy in that if they contract cancer, for example, they can use the extra monies to pay for living expenses while they are taking time away from work to recover. At a minimum, we recommend enough to cover the maximum out of pocket of your health insurance plan, but many clients purchase more coverage since the payout on this plan is independent of your health policy (unlike the accident plan mentioned above). Covered illnesses include heart attack/angioplasty, invasive and non-invasive cancers, major organ failure, coma, stroke, blindness, paralysis and loss of speech.

Another feature of the Accident/Critical Illness plans is that they can be used in combination with a higher deductible health plan to actually reduce overall risk while also reducing premium. If you have an interest in adding any of these supplemental policies to your existing plan, please visit us at www.selectedbenefits.com or call us Toll Free at 866.270.6209.

By Steven Wendlandt

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Part 1 – What other type(s) of coverage should I think about when purchasing Texas health insurance?

Posted on April 5, 2012 by stevew

We have several options that will compliment your health care coverage; all of which are designed to reduce risk.

Dental Plans: Dental plans are available in two basic forms 1) Those that have free preventive care and normally a waiting period of at least 6 months for basic/major services. Once the waiting period has been satisfied, you’ll normally have a small deductible of $50 after which the plan will pay for 50-80% of basic/major services up to $1,000-$1,500 per calendar year, per person. This option is best for those who don’t need any major work done now and only have preventive care needs at this point. 2) Plans that have a “set fee’ schedule” – these policies have no waiting period and allow you to receive pre-negotiated rates on all services from day one. This would be best for someone who needs a significant amount of work done quickly.

Vision Plans: Vision coverage will normally allow for one free vision exam with dilation per person, per calendar year. Our most popular plan, from Humana One, has a $25 co pay for lenses, a $40 allowance for frames and a $110 allowance for contact lenses per person, per calendar year.

Hospital Cash Plans: These will pay you a lump sum benefit of up to $2,000 (after a $100 deductible) if you’re hospitalized for any reason. The cash is typically used to pay off any deductible and out of pocket on your health plan. Since individual/family plans in Texas typically do not cover maternity, we can use this plan to help with routine pregnancy expenses since that is a covered expense. You will have a 10 month wait before you can use the plan toward pregnancy expenses, so we suggest delaying family planning until you’ve been on the plan for at least 2-3 months. This plan will cover you for any hospitalization, but we most commonly use it to help with pregnancy related expenses.

If you have an interest in adding any of these supplemental policies to your existing plan, please visit us at www.selectedbenefits.com or call us Toll Free at 866.270.6209.

By Steven Wendlandt

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Why should I purchase traditional health insurance?

Posted on March 29, 2012 by stevew

I have found several limited benefit plans that cost less and appear to have no deductibles.

Limited benefit plans have become increasingly common on the individual market and may seem appealing to those who feel that a high deductible is cost-prohibitive.  Before turning to such a plan, however, there are some very important factors to consider.

First of all, most limited benefit plans only pay a flat amount for covered surgeries, often based on the schedule for Medicare Allowance.  The trouble is, the actual surgery is just a small part of the cost of a medical stay.

For example, appendectomy surgery typically costs about $2,500 for the actual surgery; however, the hospital bill can range from $25,000 to $40,000, because of all the auxiliary costs involved (overnight stay, anesthesia, surgical equipment, assistant surgeon, services of support staff, etc.)  This means that, at best, the limited benefit plan will pay a few thousand dollars towards the surgery, hospital stay, and anesthesia, leaving the patient with potentially tens of thousands of dollars in unpaid medical bills.

While you may be able to negotiate the bill down somewhat, the fact is that even relatively minor surgeries and conditions will prove to be a considerable financial burden.  The rhetorical question thus becomes: would you rather have to pay a deductible up front and be liable for a few thousand of the initial costs?  Or have first dollar coverage with no deductible, but risk severe financial hardship once you receive bills for all of the items you didn’t consider in the first place?

If your main concern is a severe illness such as cancer, heart attack or a serious accident, the answer is obvious.  Limited benefit plans are not insurance, nor do they purport to be acceptable substitutes.  They give the illusion of coverage, but that mirage will quickly disappear in the hour of need.

If you have unknowingly purchased one of these plans and want actual major medical coverage instead, please visit our website at Selected Benefits Health Insurance Texas or call us Toll Free at 866.270.6209. We’ll be happy to review your current plan and point out the pitfalls so you know exactly what you have at all times.

By Steven Wendlandt

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Does my policy cover lab work and x-rays?

Posted on March 24, 2012 by stevew

Most Texas health insurance policies do include routine lab work as part of your preventive care.  For example, women over the age of 16 will receive and annual, routine pap smear and women over the age of 35 will receive a routine, annual mammogram. Men age 50 and over are entitled to a colonoscopy.  In addition, both men and women can receive an annual physical with routine blood work as part of preventive care.  These benefits are part of every health insurance policy in the U.S. per the Affordable Care Act.

It is important to note that preventive care only includes the initial testing. If follow up treatment is required, then it will be subject to the deductible as any other illness.

Currently, only Humana and Blue Cross offer further assistance for lab work and x-rays.  Humana pays the first $300-$500 (depending on the policy), per person, per year.  BlueCross covers lab work and x-rays on their Select Blue Advantage program, provided it is done on the same day as the doctor visit.

So, other than HumanaOne and Blue Cross Blue Shield of Texas, I can’t get any help with these expenses until I meet my deductible? You’ll still receive the PPO contracted rate for the services rendered, which can be substantially (30-50%) less than the retail price.  A popular option is our NACD accident program, which will pay for x-rays if they are needed due to an accident.  In addition, NACD offers substantial discounts on lab tests through iNeedLabs.com, which can save you 50% off the retail price.  If you have an HSA insurance policy, you can also use the funds in your HSA bank account to pay for these expenses with pre-tax dollars.

What if I opt for a lower insurance deductible instead? This is one way to get coverage faster for lab work and x-rays.  However, most people will find that the higher premium for a low-deductible policy essentially cancels out this benefit.  For the vast majority, it is better to save on the premium and self-insure for smaller items such as lab tests.  Call our office at (866)270-6209 to discuss your options.

By Steven Wendlandt

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What is a Pre-existing Condition and How Will it Affect my Individual Insurance Policy?

Posted on March 21, 2012 by stevew

Here at Selected Benefits, we deal with this question on a daily basis and the answer is quite simple.  A pre-existing condition is defined as any medical condition for which you have been diagnosed or treated within 12 months of the effective date of your policy.  An example of a pre-existing condition would be going to your doctor for a swollen knee 7 months before the your policy started.  Even if you had no physical treatment or rehabilitation suggested by the doctor, the diagnosis alone would be considered a pre-existing condition.

The insurance carrier determines the net result of a pre-existing condition on your policy.  One of the ways the providers will handle the condition is by adding an “exclusion waiver” for the condition and/or the medication taken.  An example of this would be the diagnosis of High Cholesterol.   The provider will cover you for a heart attack or illness due to the diagnosis, but “exclude” the medication you take daily to control your cholesterol.  A competent agent (see Selected Benefits above) should know that some providers will handle the diagnosis in this fashion and some will not.  The alternative is going with a Texas health insurance carrier that does not use exclusion wavers.  These carriers will cover the issue in question as long as it’s been noted on the insurance application.

The final and most important part of the equation is the 63 day gap in coverage clause. This situation is where it gets tricky.  The clause states that you have a 63 day grace period between the ending point of your last policy and the beginning of the new policy. If you do not gain coverage within that period, all of your pre-existing illnesses will be subject to a 12 month waiting period.

It is vital to not exceed the 63 day gap between policies. Depending on the severity of the condition, you could save hundreds to thousands of dollars per year in medical bills by avoiding the gap.  When canceling a policy and moving to another, you must forward the “certificate of credible coverage” on to the next insurance carrier.  This insures that your pre-existing conditions are covered from day one of the new policy.  Since it generally takes 10 days or so to receive the Certificate, any claims adversely affected will be automatically reprocessed once the certificate is received by the new insurance carrier.

By Steven Wendlandt

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