Mammography in Connecticut
Starting Jan 1 2012 a CT law kicked in requiring insurance companies to cover in the same way mammograms or the ultrasound type of mammograms used for women with denser tissues where regular mammograms don’t show up clearly. About 15% of women require this type of mammogram.
For anyone who has an Aetna plan in CT:
Client X (who has a grandfathered Aetna individual plan) got this second type of ultrasound/mammogram and was charged $180 after Aetna’s re-pricing. I advised her to call because there is this new law and it should be free. The Aetna rep told her that only mammograms were covered, not the procedure she had. When she mentioned that there was a new law the answer was unchanged. Most people would give up at that point.
Then the rep said …wait let me double check. She came back on the line and said it was covered 100% w/ no charge and the claim would be reprocessed.
Connecticut General Statutes 38a-530 – Mandatory coverage for mammography and breast ultrasound
a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state on or after October 1, 2001, shall provide benefits for mammographic examinations to any woman covered under the policy which are at least equal to the following minimum requirements: (1) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (2) a mammogram every year for any woman who is forty years of age or older. Such policy shall provide additional benefits for comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman’s physician or advanced practice registered nurse.
(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy.
Deciding if Group Term Life Insurance is a Good Deal or Not
Many people have access to life insurance through an employer or association, such as the AMA, American Dental Association, teachers association or local Union. When these plans are compared to commercially available individual term life insurance plans they often appear to be less expensive. These plans typically still require you to be in good health to get the best rates. They can turn you down or charge more if you smoke, are overweight or have other medical conditions.
What I would like to do is explain exactly what a group or association life insurance plan is. Since there is typically little or no commission being paid to an insurance agent you would think that it would be less expensive. It might very well come out less expensive, although you will not know until they finish the underwriting process and give you a final price. If you qualify, for instance, as preferred, they will honor that level for as long as you have the plan. Group life insurance usually is “age banded” , which means that once you qualify, most of these plans have a price rise when you enter a new age band . This could be at five year intervals , like age 45, 50, 55 or some other inverval. If you are planning to keep this for 20 years, for instance, you should find out the price increments along the way to get the total price. That is what you should compare to the individual 20 year term price. Sometimes the 20 year term is much better. You may also have to stay with the employer or association in order to keep the plan.
The other issue with group term is that if you need (or wish) to convert the policy to a permanent plan they have a conversion option, but usually to a permanent life with very high rates and poor cash accumulation.
The better individual term life plans have conversion options to better performing permanent plans. While you may not plan on converting it is important that this option remain in case your long term health changes for the worse and you become less (or un) insurable.
HIQS Group Speaks about the Anthem Rate Filing
The Anthem individual health plans are filed with a provision to pay NO commission to brokers for on exchange policies as well as policies during the year allowed through special enrollment. As a broker who has over 800 clients currently on the exchange this worries me a lot for two reasons. First having no commission for Anthem and full commission for Connecticare has the potential to compromise broker integrity. You are allowing a system where a broker can lose income potentially doing the right thing for his client. In addition if this allowed to stand you might lose brokers altogether.
The HIQS Group Response to Op-ed
I am replying to a June 28th op-ed by State Senators Kevin Kelly and Tony Hwang concerning health insurance rate increases for the next year. The article seems to be a thinly veiled polemic rather than an evenhanded way to address the issues and deal with the subject responsibly. As I have much experience, having helped thousands of people with health insurance through my agency, HIQS Group in Bethel, I would like to offer some perspective.
The senators are correct in their complaint that the rate increases are unpredictable and burdensome. Since the Affordable Care Act was passed, rates have risen as much as 300 percent. However, I take issue with the senators’ claim that if we only had public hearings, where average consumers could register their complaints, the insurance department could then force the insurance companies to lower their rates. The senators say that “massive increases must be explained and justified”. They ARE explained and justified in the State Insurance Department’s rate review process. This involves insurance companies submitting a proposed rate increase to the state insurance department with justifications-often hundreds of pages of documentation. Our state insurance department is then required to review the actuarial math behind every rate increase. This is not something the average consumer can even follow (or me for that matter). However, there is an opportunity for the public to protest the increase itself. Policyholders are sent letters telling them how and where to comment. The senators say this is a “rigged game” with no transparency. But the truth is, only after public input does the insurance department approve an increase. The process is transparent. I agree that rake hikes are frustrating, but the premium rate review process is not the problem.
The real blame lies on the underlying laws. The federal and state governments have mandated the coverage which must be included in each health insurance policy. It is these mandates that drive prices. There are two types of policies in CT, employer based and individual. Employer based plans currently require many benefits to be included in order to protect employees. There are good reasons for that. Unfortunately, the same laws apply to insurance purchased by individuals, supposedly “protecting” them by forcing them to purchase coverage they may not need or want. Requiring that policies cover all pre-existing conditions and include an ever increasing laundry list of benefits result in consumers paying a lot more for their insurance.
People often ask me how we could make health insurance more affordable. I would eliminate all insurance exchanges. They are expensive to maintain. They impose an extra layer of bureaucracy. I would leave the employer based plans alone and focus on changing non-employer based plans purchased by individuals. I would allow insurance providers to sell policies tailored to the benefits which are needed by that policyholder. This would result in lower prices. Subsidies would not be needed for these plans if insurance was affordable. Uninsurable people could have help subsidizing their premiums. The money for these subsidies could come from the savings realized by doing away with the exchanges as well as not having to subsidize plans for the healthy and insurable. Protesting the rate increases is not realistic. Changing the laws that drive insurances rates higher makes more sense, however it will not be easy.
R. Joseph Knudsen
HIQS Group, Bethel, Ct.
The Best Insurance Options available without Open Enrollment
Our office has received several calls from people who have fallen through the cracks and for one reason or another, failed to procure health insurance prior to the February 15th, 2015 deadline. The CT Exchange is allowing for a Special Enrollment Period for those who can prove that they would face the fine from the IRS for not enrolling. This period runs from April 1st through April 30th, 2015, and is being offered for plans sold only through the Access Health CT Exchange.
If after this period one is still not covered, there is a strategy that would neither exempt one from the fine, nor would cover pre-existing conditions, but would be a much “better than nothing” strategy.
The first is Short Term Medical insurance, this can be purchased for up to 6 months and up to two policies a year. It neither covers pre-existing conditions, nor preventative care. It would cover any new illness or injury.
The second is Accident Expense plus, with a small deductible it gives you $15,000 worth of immediate coverage for claims resulting from accidents. This means you will have coverage for almost any accident from day 1 of the policy.
The Third is ProVantage Plus, featuring Teledoc. This product allows you to speak to a doctor over the phone with no waiting. These physicians can prescribe medications as needed. It also provides discounts for prescriptions, dentists and many other services. This is a flat rate of $29.50 regardless of the number of family members that use the plan.
Short Term Medical Highlights include:
•Inpatient and outpatient charges made by a hospital, including inpatient prescription drugs
•Charges incurred at an urgent care center after a $50 copay
•Charges made by a physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the physician has referred the case
•Charges made for dressings, sutures, casts or other supplies prescribed by the attending physician or specialist, but excluding nebulizers, oxygen tanks,
diabetic supplies and all devices for repeat use at home
•Charges for diagnostic testing using radiology, ultrasonography or laboratory services
•Charges made by a licensed extended care facility upon direct transfer from an acute care hospital
•Emergency local ambulance transport in connection with injury or sickness resulting in inpatient hospitalization
•Helps cover deductibles, co-pays and other expenses not covered by your primary major medical plan.
•Pays medical benefits to you regardless of other coverage you have.
•Rapidly reimburses you for a wide variety of covered medical expenses related to accidents.
•Telehealth help save time and money with 24/7 access to a doctor by phone or online video consult.
•Medical Bill Saver, Expert negotiators help save on uncovered medical and dental bills over $400.
•Pharmacy our members save an average of 42% on their prescriptions, reducing their out-of-pocket costs by over $94 million in 2013.
•Dental smile brighter with big savings on dental services at thousands of locations nationwide.
•Medical Health Advisor, Time is money. Members get one-on one support from professionals for medical or insurance related-issues.
•Nurseline, Rest assured—highly trained registered nurses are on-call 24/7 to answer your questions.
•Vision, 10% to 60% off glasses, contacts, laser surgery, exams and more.
•Chiropractic you save 30% to 50% on X-rays, diagnostic services and treatments at chiropractors nationwide.
•Legal Care Direct, Access to free and discounted rates on services from experienced lawyers.
•Safe Identity, keep one step ahead of identity theft. They are protected and alerted if their identity is compromised.
•Roadside Assistance, don’t leave yourself stranded! 24/7 help with a flat tire, lock-out, battery, collision and towing.
•All for $29.95 a month for the whole family.
Please note that these supplemental products do not meet the minimum coverage guidelines set forth by the Affordable Care Act and tax penalties could apply. Please consult a tax professional in regards to these penalties.
Call our office today to discuss! 203-730-8304
How to Purchase On & Off Exchanges
Any health insurance plan that is available ON the exchange for January 1, 2014 will also be available OFF the exchange at the same price. The State Insurance Department is encouraging people to take advantage of the fact that you can purchase On and Off the exchange using brokers. There will be no difference in your price. Brokers are paid commission by the carriers and commissions are built in to all prices. There is no good reason to purchase on the exchange if you don’t qualify for a subsidy. There are also 4 additional carriers, for a total of 7 carriers, available OFF the exchange for January 1, 2014. Companies are still filing plans and rates with the state. Although all EXCHANGE plans need to be finalized by October 1, 2013, near the end of October will be the best time to review ALL available options off of the exchange. These plans do not have the same filing deadline.
The Perfect Marriage between C-Corporations and LTC Insurance
Portions of Long Term Care premiums are tax deductible for individuals and businesses based upon age. However, for C-Corporations 100% of LTC premiums are tax deductible. This provides a unique strategy to reduce gross income, and provide a permanent benefit to company employees and/or their family members. Here is a following case study:
Our office recently placed an indemnity (cash benefit) LTC policy with a C-Corporation with the first class problem of being successful. Always looking for legal ways to reduce gross profit, the two principles purchased LTC for themselves, 2 employees (one with a spouse) , and a policy for their mother for a total of 5 contracts. The plan purchased featured a monthly benefit of $12,000 and $1,000,000 of LTC Benefit. It should be noted that this benefit is not considered taxable gross income to the employees. As yearly premiums are not guaranteed, they chose to utilize the 10-pay option so that all contracts would be paid for in 10 years with pre-tax dollars. 10 year premiums spent will be approx. $300,000, for a total permanent benefit of 5 Million. It gets better. The clients chose to include a return of premium option in the contract. This benefit triggers if the member dies. All premiums spent (either full or less claims) will be returned to the individual owners’ beneficiary tax free. The IRS classifies Return of Premium as a non-taxable event. This is one of the few scenarios where a company can implement a benefit, and receive a double dip tax benefit.
While defined as a long term care contract, our office also utilizes this product as a Catastrophic Disability plan. In Connecticut, the largest % increase of Medicaid Long Term Care expense demographic is males in their 20′s. Most people think of LTC as a nursing home benefit, and few think of becoming permanently disabled at any age. Having a plan in place to assist with the devastating results of either scenario is sound fiscal advice.
News on Senator Cassidy's Suggestions
It is not clear whether the Republican Freedom Caucus in the House, which is fiscally conservative, will embrace the Patient Freedom Act. Senator Cassidy suggested in a press conference yesterday that his bill would initially cost the federal government about the same as Obamacare, but is expected to bend the cost curve over time by obtaining greater consumer engagement in the cost of their care through HSAs and by demanding greater provider cost transparency. More proposals will be forthcoming, with Sen Rand Paul of Kentucky expected to release his proposal soon. Senate Finance Chairman Orin Hatch and HELP Committee Chair Senator Lamar Alexander are important figures to watch, as, of course, is House Speaker Paul Ryan.