Utah Insurance Blog

Utah Health Insurance Market Update: 2012

Here's what happening in the Utah health insurance market:

Health Reform: Nationally, there aren't many changes that will be apparent on the surface. The reform bill is encouraging efficiency and an increase in the quality of care in 2012. The state of Utah continues to improve it's defined contribution system in the group health insurance market.

HumanaOne has a new rating structure that keeps health insurance affordable for single-parent families! Their Enhanced Copay plan with a $1,000 medical deductible has become more affordable in 2012. They also have a *Cancer Cash Plan that's only $8.99 per month for a family of 5 (parents, age 45) for a $5,000 cancer cash benefit. It's a way to protect yourself financially against devastating medical costs and lost income while you recover from a battle that many people win. Get a quote for this plan now.

SelectHealth seems to have some competitive pricing on lower deductible HSA-eligible plans. This is a great way to receive tax benefits and lower your health insurance premium! Get a quote for their HealthSave product now!

Altius Health Plans has a new product called Peak Preference. It's similar to an HMO product, but you don't need a referral to see a specialist. Rates are about 15% lower than their main product. Great way to save some money and still keep good coverage! Explore your options instantly online.

Hospital Cash Plan / Supplemental Health Insurance: Currently I know of one plan that pays a daily benefit when the insured is admitted to a hospital. Call me at 801-679-0405 to find out more!

Dental Insurance: Dental Select of Utah has some of the most competitive dental rates in the Utah market. Explore your plan options!

Term Life Insurance: It's been super-affordable for a while, and rates are still near an all time low. If you haven't explored term life insurance as part of your long term financial plan, get instant term life quotes with no obligation.

If you have questions on what's happening in the Utah health insurance market, or would like quotes for any type of insurance, please email or call me at 801-679-0405!

*Kanawha Policy Form 70620 UT.

What Does Preventive Care Mean?

I've run into a number of Utah residents who want to understand how preventive care is covered under the new law. I recently came across an article in a SelectHealth newsletter that gives a good explanation.

*This article is provided by SelectHealth. For more information about improving your health, visit www.selecthealth.org/newsletters.

What Does Preventive Care Mean?

The goal of preventive care, such as regular checkups and screenings, is to help you avoid illness and to detect problems when they are most treatable. Many preventive services are now available at no cost to you. Examples of preventive services include the following:

• Examinations and/or screenings (for example, a mammogram, colon and prostate cancer screening, etc.)
• Flu and pneumonia vaccinations
• Screening laboratory and X-ray tests (such as Pap smears or cholesterol tests)
• Routine immunizations

Checkups may include tests performed by your doctor to manage a known condition, such as treating high blood pressure to prevent a heart attack or a stroke. Services performed to maintain a known condition are not usually considered preventive. Your regular copay, coinsurance, or deductible will apply to these additional services.

SelectHealth has always been committed to covering preventive services. However, not every preventive service is appropriate every year, and recommended screening guidelines may vary. Discuss your specific health needs with your doctor. If you would like to learn more about preventive care, visit selecthealth.org/stayhealthy/proactivecare.

If you are interested in finding out more about SelectHealth's individual and family health plans, please visit our page about SelectHealth.

Health Insurance Options for People Who Have Been Denied for Pre-existing Conditions

If you've been denied for individual health insurance in Utah, there are several quality coverage options you can explore. Here are three of the most common:

High Risk Pools

High risk pools are designed to cover people who have ineligible pre-existing conditions and/or have been denied health insurance in the private market. They are typically state funded programs and eligibility is not based on income.

Although health insurance through high risk pools can be more costly than private insurance, the fact that you can't be denied for medical conditions carries a lot of value. The coverage, while often not as comprehensive as private plans, is still more than sufficient for most people's needs. Contact your agent for more information about Utah's high risk pool.

Temporary Health Insurance

Temporary health insurance plans can provide excellent short term protection for people who have been denied health insurance. While most short term plans don't cover pre-existing conditions, they can be used as a temporary protection against unpredictable catastrophic medical expenses. 

Temporary health plans are ideal for someone who knows they'll have permanent health insurance in the near future (through an employer or other source). They are not meant to be used long term.

Employer Sponsored Plans

Group plans, or employer sponsored plans, are a great option for people with pre-existing conditions or people who have been denied health insurance in the private market. Employer sponsored plans are guaranteed issue, meaning that you can't be denied due to pre-existing conditions.

In order to qualify for an employer sponsored plan, you must work full time for an employer that offers health insurance, and make it through the company's health insurance waiting period. Group plans are an excellent way to get guaranteed issue coverage after being denied.

The three ideas above are only a few of the many options you can explore. Find out about more options for people who have been denied health insurance because of pre-existing conditions by visiting our webpage to learn about options for people who have been denied health insurance for pre-existing conditions.

Child Only Coverage in Utah - an Option That's Back on the Table!

Since fall of 2010, children have not been allowed to apply for health insurance unless they've applied with at least one adult. This has caused some serious problems for children caught in specific situations.

Emergency Rule Regarding Dependent Eligibility

The Utah Department of Insurance recently issued an emergency rule regarding dependent eligibility for health insurance plans. The rule states that a child under the age of 19 shall be issued a health insurance plan from any private insurance company in Utah, if that child has a certificate of insurability.

Certificate of Insurability

A certificate of insurability is a certificate issued by the Comprehensive Health Insurance Pool of Utah (HIPUtah) if they determine that someone who has applied for HIPUtah insurance is indeed insurable in the private market.

The Comprehensive Health Insurance Pool of Utah

The Comprehensive Health Insurance Pool of Utah (HIPUtah) is a state funded program that is administered by Selecthealth. The purpose of HIPUtah is to provide insurance to individuals who are uninsurable in the private health insurance market, or have been declined by one or more insurance companies. HIPUtah does not have income guidelines like Medicaid and CHIP, but does require that a person be uninsurable before they are approved for coverage.

What This Means for Utah's Children

Plainly said, if a child under the age of 19 years old needs to apply for health insurance as an individual in the state of Utah, they can now do so once they have applied for HIPUtah and obtained a certificate of insurability. It takes some paperwork, but it is possible to insure a child on a stand-along policy once again.

To get help insuring a child on a stand alone plan, please call me at 801-679-0405 or email me.

Selecthealth Releases Their New Online Application for Individuals & Families!

Today, Selecthealth released their online application.

They are the last major insurance company in the Utah market to offer the ability to apply online. From what I've seen, it looks like its been worth the wait.

Saving the Best for Last

Compared to other insurance companies' online applications, Selecthealth is definitely in the top two (the other being HumanaOne). Their online application system takes you step-by-step through the quoting, plan selection, and application process.

Out with the Old and In With the New

Paper applications slow down the application process in more ways than one. Using the new online application will;

• Help to ensure that each application is complete
• Make sure applications make it to the review process sooner
• Ensure that the correct supplemental application forms have been submitted

It's not a bullet-proof system, but it's bound to make things much easier for people who apply for a Selecthealth medical plan.

Get free instant quotes online and get access to the Selecthealth application now.

Check your doctors, download brochures and more at www.UtahInsurance.org, a Utah Insurance Advisors site.

What Healthcare Reform Means for You in 2011

Will health reform affect your situation? It might affect you and it might not. Here are a few things to be aware of through 2011:

Guaranteed-Issue Health Plans are Not Available Yet

A lot of people in Utah are under the impression that they can get guaranteed issue coverage already (meaning that the insurance companies won't deny them for a pre-existing health condition). In actuality, the date when that happens is January 1st, 2014. Anyone that's over age 18 must qualify medically for an individual or family health insurance policy. Children are now able to get guaranteed health coverage in Utah.

Covering Children in Utah

As of October 2010, children can get guaranteed issue health plans, but are being required to apply with at least one adult (some companies require the whole family to apply.) Children ages 18 and younger cannot get a policy on their own anymore. To find out more about this, please read my blog post "Insuring Children on a Utah Health Plan."

Group / Employer-Sponsored Health Plans & Defined Contribution

This year, Utah employers have the option of using a defined contribution model. This model allows employers to offer a defined contribution (a specified dollar amount) towards their employees' coverage, rather than paying a percentage of their employees' premiums. It also lets employees within the same company choose plans from different Utah insurance companies and choose from different plans within those companies. If you are interested in a group health insurance plan in the defined contribution market, please email us to work alongside a licensed agent.

Tax Benefits for Small Businesses

Some businesses qualify for a tax credit of up to 35%. To find out if your business qualifies, use this free tool from SelectHealth.

Changes will keep coming over the next few years. Sign up for blog-post email updates to keep up to date!

Catastrophic Health Insurance for Utah Residents

With prices continually on the rise, individuals and families are looking for less costly ways to insure their health. Catastrophic health insurance is a popular and effective way to provide quality major medical insurance at a price more affordable than traditional health plans.

Catastrophic health insurance is simply any health insurance plan that has the primary purpose to cover catastrophic medical expenses, and not so much the day-to-day expenses. Some plans that offer this type of coverage in Utah are; qualified high deductible health plans, The Utah Netcare plan, and deductible first plans with high deductibles.

Because most catastrophic plans don't cover office visits, prescriptions, or emergency room visits until after you've met your deductible, the monthly plan cost is often much lower than traditional health plans.

Most catastrophic plans in Utah do offer preventive care before you are required to meet your deductible (the deductible is waived). This means that you can take care of all of your/your family's annual physicals and preventive testing without much, if any, out-of-pocket cost. The main expenses you would normally pay toward are doctor's office visits, non-preventive diagnostic tests, accidents, surgeries, and hospital visits.

When considering catastrophic health plans, be sure they aren't "discount plans." Discount plans are not insurance plans. Many people I've talked to over the years are in serious financial trouble because they didn't understand what they had purchased until they needed their coverage.

Be conscious of the following plan components when choosing a catastrophic health plan:

The Out-of-Pocket Maximum:
This is the maximum dollar amount you would be responsible to pay, in a worst case scenario, each year. If you are shopping for a family plan, be sure you know the out-of-pocket maximum for the entire family.

Tax Advantages:
Does the plan you are considering offer any tax benefits? "Qualified high deductible health plans" offer the ability to be paired with a health savings account (HSA). This allows you to pay for most of your medical, dental, and vision expenses with pre-tax money. If you or your family could use another tax deduction, this is a benefit you'll want to explore.

Prescription Coverage:
Does the plan cover prescriptions? Some catastrophic plans don't. If it does cover prescriptions, is there a separate deductible, or are prescription expenditures combined with your medical deductible? How much does the plan cover once the prescription coverage kicks in?

Accident Coverage:
Does the plan have any special accident coverage? Most catastrophic plans don't. But, many companies/plans give you the option to add an accident rider, which can cover a specified dollar amount of accidents before you are required to pay toward your deductible each year.

Coinsurance:
This is the percentage your insurance company pays of your medical bills after you meet the deductible. Some common coinsurance percentages are 50%, 80%, and 100%. Of course, the most money you will pay in a year for covered services is equal to your out of pocket maximum.

In conclusion, catastrophic insurance can be an effective money saving tool for individuals or families that don't use their benefits often, are relatively healthy, and can benefit from a tax deduction.

Find out how a catastrophic insurance plan can improve your situation. Request a quote, or contact me for a custom proposal.

Jared J. Balis
Utah Health Insurance Agent
Utah Insurance Advisors

Utah Maternity Insurance - How to Afford Your Next Baby

If you don't have maternity insurance coverage through your employer, chances are you will pay a good amount of money to have your next baby.

In Utah, if your employer doesn't provide insurance, or you are self employed, you may find yourself looking for a health plan in the private market. The problem with Utah is, most of the plans sold to individuals and families in the private market cover maternity expenses, but only after a large deductible (often between $5,000 and $10,000 per pregnancy). Young families have an especially hard time coming up with that amount of cash, and if they can't, they end up paying off their medical bills for years. Here are some tools and ideas you can use to help pay for your next baby.

1. Supplemental Health Insurance Plans - Also referred to as hospital indemnity plans, these plans pay you a benefit when you are admitted to a hospital. Some even pay benefits for every day you are in the hospital, have surgery, and go to the doctor. Many supplemental health plans pay hospital benefits for maternity related hospital stays. These plans can help pay for a good portion of your maternity related expenses. Get a quote and information on supplemental plans that pay benefits for maternity related hospital stays.
2. Pre-paying the Hospital - Talk to the billing department at the hospital you plan to use. Ask them if they offer a discount if you pay your maternity bill before the baby is born. Some hospitals offer discounts up to 50% if you pay in advance.
3. Review Your Health Insurance - Find out how your current health insurance plan covers maternity and research different plans, comparing the maternity benefits to what you currently have. Having catastrophic health/maternity insurance in place (in case of problems or complications) is the most important thing you can do to prevent serious financial heartache.
4. Explore Baby Your Baby and Medicaid. If you have a low income, these can be excellent resources for paying for your next baby.
5. Research Hospital Charges and Quality - Every hospital in Utah charges a different amount to have a baby. Research a few hospitals that are near you. Ask them what their average maternity charge is for both a normal and c-section delivery. Ask them about quality. There's even a report that compares hospital charges and quality between Utah hospitals. You can find it by clicking here.

Taking the above steps will help you afford the expenses associated with having your next baby.

Learn more about supplemental health plans and more about having a baby in Utah by visiting my Utah maternity insurance website.

by Jared J. Balis

SelectHealth Raises Their Utah Maternity Deductible in 2010

SelectHealth announced that, starting January 1st, 2010, they will be raising their maternity deductible from $6,500 to $7,500.  Although this applies to employer sponsored group plans, groups may or may not choose to add better maternity coverage.  This will primarily affect Utah’s individuals and families.  The good news is, if you are already pregnant in 2009, SelectHealth will only hold you to the $6,500 deductible for this pregnancy.

This leaves only a few decent options when looking for insurance plans to help cover the costs of maternity.

Regence Blue Cross Blue Shield of Utah

As of now, Regence Blue Cross Blue Shield of Utah still offers a $5,000 deductible for maternity along with their individual and family plans.  This can prove to be a good option for a family that is planning on a pregnancy in the future.  It still remains to be seen whether or not Blue Cross will follow suit and raise their maternity deductible in 2010.

Assurant Health

Assurant Health has offered a variety of maternity deductibles with their plans in the past.  They still continue to offer maternity deductible options of $2,500, $5,000, and $10,000.  Although going with a lower maternity deductible can cost you, it’s a good option Assurant has on the table.

Altius & SelectHealth

Both Altius and SelectHealth have their maternity deductible set at $7,500 for individuals and families and it looks like it’s going to stay that way through 2010 and very possibly beyond.

HumanaOne

HumanaOne has a unique way of covering maternity charges for Utah individuals and families.  Their plans don’t cover any normal maternity charges.  However, complications of pregnancy are covered under your deductible and coinsurance specified by the plan you choose.

You can also look at supplemental plans to help you cover maternity expenses.  For more information visit www.UtahMaternityInsurance.org.

Utah Health Insurance Company Profit Margins

“Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo?

Answer:   They’re all more profitable than the health insurance industry.”  - The Daily Herald October 26th 2009

I wanted to share an article on Utah health insurance companies and the profits they actually make.

http://www.heraldextra.com/news/national/govt-and-politics/article_8e5cc179-4140-5473-b914-14ae667d4f77.html