Author Archives: Karla Rockwell

Once Upon a Time

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When we were going to spend the night in the hospital for something we knew about in advance, we had to call the insurance company and “Pre-Certify” the stay. And in an emergency, we had to notify them within 28-48 hours after admittance, depending on the carrier.

When we knew we needed certain kinds of medicine like Claritan,
Monistat, or Prilosec, we had to go to the doctor, and pay him to write out the prescription, and then take it to the pharmacy to have it filled.

As time went on, most of these drugs were available over-the-counter without a prescription, and the provider called the insurance
company on our behalf.

Guess what! Blue Cross has re-instituted the “call-it-in-yourself”
rule. You will be penalized up to $500.00 for non-compliance with their “reinstated” rules. In addition, if you have an HSA or health
savings account, you must get a doctors’ prescription to buy OTC
drugs and withdraw their cost from the HSA. Oh, and the penalty
for violating HSA contribution and deduction rules beginning this year will result in a 20% penalty instead of the prior 10%

Call me old fashioned, but I’d rather have the good old days.

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I’ll be over here when you need me.

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I was encouraged by the conversation between journalist Fareed Zakaria and Jamie Diamond, head of J.P. Morgan this morning on GPS.

Jamie said that although there are fewer big banks today, those which are left have lent more to corporations and mid-size business this year than previously. He said a lot of business has cash and doesn’t need it. The effort now should be to get them to spend it,
albeit wisely and get people back to work. He praised governments all over the world for having implemented programs which stopped the damage from getting even worse.

I realize this has not yet come to the consumer level. But what is wrong with having to have at least 20% down for a morgtage, and a stable credit history? Lenders cannot lend to those who have no stake in the home for which they are trying to purchase.

The country and people individually should begin to make more practical decisions again about when to buy, sell, retire, or go into business for themselves. When this happens, they will also want advisors in technology, purchasing, capital and financial investments who know what they are talking about. They will also want that in their insurance advisor. Whether discussing business overhead policies, replacement cost on property or COBRA and state continuation of benefits. They will want the quality they themselves are trying to deliver to their own clients.

When you want an experienced, qualified, thoughtful and thorough insurance advisor, let me know. I’ll be over here when you need me.

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Order in the Court!

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Last week federal judge Roger Vinson ruled PPACA unconstitutional in a response to a lawsuit by 26 states and the National Federation of Independent Businesses. The ruling specifically declared the individual mandate provisions in the new law unconstitutional, but Judge Vinson deemed the entire health care reform law unconstitutional, stating that it was too complicated to sever any part of it.

At the same time the houses of Congress are mopving to repeal the
1099 provision to report any expenses to one entity of more than $600.00. In additionthere are movements to modify benefits or repeal exchanges, LTC portions of the bill, the individual mandate, and whether or not to take away the business tax credit if the employers’ insurance plan covers abortion.

Most if not all of these items will end up as part of a decision of the
Supreme Court. In fact, 28 governors have already asked President Obama to ask the Court to expedite it’s decision on the Affordable Health Care Act. Meanwhile, as each date passes for implementation of another portion of the Act, we do.

If you want some help in sorting this out, let me know. That’s what I do.

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THE GREAT DIVIDE

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I was doing pretty much the same things everybody else was last
December. Working, shopping, getting ready for the holidays.
On December 16th things changed. I had a routine mammogram,
which by the way, is a very good thing to do. After that my world
seemed to be occupied by oncologists, surgeons, and radiologists.
I was lucky enough to have no chemotherapy and very little radiation.

But the day before I thought I was insurable. Now I am not for the
forseeable future. No long-term-care, disability income, life or health applications. If I have no re-occurance I may be able to purchase
at least some of those policies in 5 or 10 years.

Thorton Wilder asked in the play “Our Town”, “Does anyone ever realize life every every minute?” No, it’s humanly impossible.
But some moments must be recognized and seized upon, because
they may never ever come aground again.

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The Game’s Afoot

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There are so many provisions in the Health Care Reform Act (PPACA),
people are thoroughly confused about how, what, when, and why.
Besides the normal conversation on health care and reform itself,
I thought you all might benefit from knowing something which will affect you as business owners. Beginning in 2012, if the bill stands
as is, EVERY VENDOR from whom you purchase at least $600.00 during the year for goods or services, will require you to SEND THEM A 1099! This means your accountant, your office supplies, your IT
consultant, gas station, car dealer….; the list is endless.

Last week, the senate reconsidered this portion of the bill. After failing in a move to repeal that part of the bill, and additional attempt by Republican Nebraska Senator Mike Johanns failed to raise the threshhold from $600.00 to $5,000.00. The vote failed 52 to 46 to
bring it to the floor for a final vote.

I don’t know about you, but it boggles my mind what kind of paperwork and expense this will generate. The possibilities are endless. Whatever happened to streamlining the IRS? Stay tuned
for the next chapter in the never-ending story.

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Buyer Beware

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According to Modern Healthcare, there has been a rise in fraudelent “medical discount plans”, typically targeting the uninsured with the promise of “cut-rate” coverage. In the article, three companies; The Consumer Benefits Association, United States Benefits, and Health Care One have been charged with deceptively marketing medical discount plans. “They took enrollment fees, “and then did not allow customers to disenroll”.

In another article The Oklahoman reports that Oklahoma “Insurance Department officials are warning of a health insurance scam similar to one a year ago that left more than 100 people without coverage and buried in medical bills.” In June, “an emergency cease and desist order was filed…barring as many as 40 individuals and companies from doing business in the state. Named in the order are plans marketed by the Association of Independent Managers, including AIM Health plans.” Oklahoma Insurance Commissioner Kim Holland estimates that “as many as 200 Oklahomans bought the bogus plans.”

The point is this, and always has been. Find a qualified health insurance advisor to prevent you from ending up with a plan you do not want, and paying an amount you may not be able to afford for coverage which doesn’t turn out to be what you thought it was.

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Change is the only constant

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PPACA, re-named the Affordable Care Act, has some fast-approaching effective dates.  September 23, 2010, all plans, including self-funded, fully-funded individual and group plans will no longer have lifetime limits.  This will apply only to policies renewing after 9/23/2010 until the full cycle is complete.

This means that if your renewal is not until next March, that will be when you will no longer have a lifetime limit.  The caveat is that up to January, 2014, the Dept of Health and Human Services may still define benefits it deems non-essential, and can prohibit them from being unlimited.  After that,  nothing will have a limit.

In addition, effective with renewals after 9/23, there will be no deductibles or co-pays for services which the DHHS lists as preventative.  The list is said to contain over 500 procedures, and is still growing.  Among them are colonoscopies, Pap tests, PSA tests, routine mammograms, bone density tests, immunizations, physicals, and tobacco cessation.  We’ll also be seeing further implementation of the 26 and under group, who can return to their parents’ policy, even if they are married and live elsewhere.

I have no idea how we are going to pay for all this without raising taxes and/or premiums.

Stay tuned.  There’s more to come.

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Blue Cross Awaits approval on new GI policy

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On July 16, 2010 Blue Cross filed with the Illinois DOI for a new child-only policy to comply with the guaranteed-issue regulations to take place September 23rd. The policy details of the new Blue Pathway have not been made public pending the approval of the policy. However, in filing for this plan, Blue Cross renews its committment to stay in the individual market. Contact me for more information on what’s happening now.

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Are you a grandfather?

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Over the last several days I have attended meetings, webinars, and spoken with people brighter than myself on the Afforable healthcare act.

There are so many changes, and so many dates of change that it concerns me that people will fend for themselves with their decision-making on their insurance without the counsel of someone like myself, who is making it a full-time profession. For example, if you have an insurance plan which was written or renewed prior to March 23rd of this year you have a grandfathered plan which will not change. However your renewal premiums could be going up and if you want to keep the same plan you have to pay them. If you change your c0-pays more than $5.00 or signifcantly change the contribution you make to your employee’s plan, you will no longer be grandfathered.

If you change plans, many new laws will affect you, which may include a higher cost. please don’t make these decisions on your own. It can be dangerous to your health.

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High-Riskpool or Dunk Tank?

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Sources at IDOI and IlCHIP tell me that there is still a great deal of uncertainty about how and when and if the high risk pool will be implemented in Illinois.  The funding for the plan hasn’t even been released yet.  Nor do they know who will actually administer it.

The AP (6/26) reported, “Illinois may be one of the first states to start providing health insurance in a new high-risk pool funded under national health overhaul, but enrollment will be limited, eligibility requirements tight and coverage may not begin until late summer.” Notably, “Illinois Department of Insurance Director Michael McRaith said the state will manage the program carefully to make sure there’s enough money to keep everyone who enrolls covered until Jan. 1, 2014, when the new health law will prohibit insurers from denying coverage to people with pre-existing conditions.”

I have two questions:

1.  How can they manage eligibility on total cost, and

2.  If they have trouble funding this plan, what are they going to do in 2014?

Stay tuned…..

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