Meeting Your Family’s Health Needs With An HSA
Making sure that your family is able to stay healthy partly depends on having a good health insurance program for them. One of the more recent new additions to the health insurance industry is called the Health Savings Account (HSA). This new program enables you to have reduced insurance rates because of a higher deductible, and a tax deferred savings program with it. Here are some of the features of this program.
Reduced Rates
By getting a health insurance program with a high deductible, you are able to greatly reduce your monthly premiums. This is an especially good way to go, if you are younger and currently have pretty good health. The deductible amounts are pre-determined by the government, and you are required to have deductible amounts between $1,050 and $5,250 for singles, and it needs to be between $2,100 and $10,500 for families.
Savings Are Tax Exempt
One of the great benefits of this type of plan is that, like an IRA, you enjoy tax-free income, and interest on the amounts you have in the program. You can put into the plan money that comes off the top of your taxes. There are limits, though, and for singles it is up to $2,700, and for families it is $5,450. A little extra benefit is that you are able to take off of your taxes any money that is deposited into the account all the way up to April 15th. So, if you are coming up to tax time, and find you need to reduce your taxes some more, you can put it into your HSA, and find the tax break you need.
Better Coverage
The new HSA’s have an extra real nice feature - they cover more. Some things that you may not have been covered for under another type of policy, you may find that you are covered for with an HSA. This could actually allow you to get a better coverage for less. Things like dental coverage, therapy, even non-prescription medicines and some alternative treatments may also be covered, and even some mental illness treatments, too.
You Keep Control
Under an HSA, you are the one in control of the money. It is yours to use. You can take money out of the account when you want, but only the money that is used only for medical purposes is tax-exempt. Generally, you will be given a card, like a credit card, that gives you access to the account. Whenever you use money from the account, the insurance company automatically gets a receipt, and it is subtracted from your account, and your deductible - and it remains tax exempt.
Like any other insurance policy, once you have paid the deductible amounts, the rest is up to the insurer to pay. By having the high deductible you reduce the premiums considerably. The savings account can also provide a good hedge for your medical insurance program for the future, too, because any money not used toward the deductible remains your money – to use next year, if you need it. On the other hand, the money in your HSA might also be used to provide some money for retirement - assuming you maintain your good health.
Throw Away Your Pizza Delivery Refrigerator Magnet
Last time you opened your door to find food waiting for you what was it? Pizza, brownies from the neighbors, your sweetheart with a box of chocolates?
Instead imagine opening the door to a cooler packed with fresh, gourmet food. You might not notice until after you’ve enjoyed every bite of the delicious meals that on the lid of the box the word diet is staring at you in the face. Double take.
No, it is for real. And millions of people have already chosen to diet by getting healthy meals delivered right to them.
When you consider the time and knowledge required to prepare and cook just one meal and then add in time counting calories or carbohydrates and the research involved just to know how much you should take in… it’s dizzying just to think about. You’ll easily see why so many have switched to having their meals delivered when they are on a diet.
It is does work out great for some people but how do you know if it’s right for you?
First you’ll need to decide if you can afford it. Getting your meals delivered costs on average as much as eating at a fast food restaurant three times a day. If you compare prices you’ll find a very wide range. Cheaper plans, like the Medifast Diet tend to have less variety, smaller portions and don’t deliver as often, meaning the food won’t be as fresh and flavorful. If you spend a little more you can find meal plans that let you customize the menu and stretch your calories into larger portions to help you stay full.
You’ll also need to find a company that caters to your specific needs. There are plans out there designed for all types of diets and lifestyles so you don’t have to compromise: zone, low calorie, low carb, low sodium, diabetic, vegetarian, vegan, kosher and gender specific. If you prefer zone dieting but prefer not to eat meat there is a plan out there for you.
Then think about how it will work with your lifestyle. If you are a working bachelor and don’t have a lot of time to cook it may fit you to the tee. But if you like to cook dinner or have to cook something for the whole family anyway you may consider getting a family plan or just getting on a program that provides healthy recipes to you.
Getting the right kind of meals delivered to your home can be one of the best steps you take towards a healthier body. In this sense it is an investment that can’t be priced. That is why it’s important to find out what is right for you and run with it. Oh, and you can still get pizza delivered to your door and feel good about it, just stay away from chain store pizzas.
What You Should Know about Health Insurance Claims
If you have been hurt or injured and have to receive medical services, and you have medical insurance, it might be beneficial to understand how a health insurance claim is processed.
Each health insurance company has its own set of policies and procedures. If you have a large claim, you will want to review the rules especially carefully. Many claims are denied over a simple technicality. Knowing the process is likely to help you make sure your claim does not get denied.
Most people assume that when they receive medical services all they have to do is present their insurance card and then never worry about it again. Oftentimes that is not the case. The first thing you want to check is if the medical services you are receiving are pre-approved by your insurance company. This differs greatly from company to company. An easy way to find out is by calling the customer service number provided with your insurance cards. If something is pre-approved, then generally filing a claim will be easy.
Remember, insurance companies are hoping that you will not need medical services. That is how they make their money. If you don’t use your insurance, the insurance company just gets to keep it. You will notice that the bigger the claim, the more paperwork you will need to fill out and the more red tape you will need to wade through.
If you receive medical services that should be covered by your insurance, make sure that the doctor or hospital file the appropriate forms. Make sure that you file any forms that you need to in a timely manner. If you have any questions, call the insurance company directly and find out the answer. Make notes of who you speak to and when.
Once your claim is received by the insurance company, they will try to determine if there is a reason they can get out of paying for your medical services. If your claim is justified, then you can expect payment to be made. Usually it is done directly to the hospital or doctor.
COBRA Insurance: Health Coverage for Terminated Employees
The Consolidated Omnibus Budget Reconciliation Act of 1985, more commonly know as COBRA, is a federal law that guarantees your heath insurance coverage will remain in effect for up to 18 months should you be terminated from your job. Most companies that provide groups insurance to their employees are mandated to abide COBRA. In some circumstances, the coverage period can be extended from 18 months to 29 months or even up to 36 months.
COBRA Insurance: Who Benefits from It?
If you have lost your job and you stand a chance of losing your health insurance benefits as a result, you are protected by COBRA. As a stand-by facility, COBRA can help you get through a tough time. However, COBRA insurance does not apply to every terminated employee. Employers need to know if the COBRA exclusion applies to their companies and employees.
If you have been recently terminated, the law allows you to get a health insurance for yourself (and your family, if you had family coverage while you were employed) at the group rate even though you are not employed anymore. Coverage is not cheap and you will have to pay the total cost each month along with a 2% surcharge.
If you are terminated, laid off or experience some kind of change in your employment status, such as reduced working hours, divorce from or death of the eligible employee), and you are qualified for COBRA, COBRA will continue to cover you for at least 18 months or until you get a new health insurance plan or a group health insurance plan.
The law mandates that employers notify eligible former employees of the available option to obtain health insurance through COBRA. Employees would also have to specify the price for this coverage. Employees who are notified of this option have up to 60 days to agree to COBRA coverage.
As COBRA essentially increases a terminated employee’s health insurance coverage by 18 months, you don’t have to be concerned about any changes in your benefits, should you choose COBRA coverage. Under COBRA, your health insurance coverage will not change; the only change is that you will be responsible for paying the monthly premium. If you have your family covered by your company’s group insurance, they will still be covered by COBRA. The only way that any changes will occur on your coverage is if your former employer makes modifications on the health insurance plan it is offering to employees.
COBRA Insurance: It’s only Temporary
COBRA is meant only as a temporary, but a very important, measure. COBRA ensures that you would have health insurance for 18 months. However, you will no longer have health insurance once the 18 months are up, unless you have not gotten an individual health insurance plan or a group insurance plan from your new employer.
And, hopefully you would never find yourself in a position where you discover for the first time that you have a severe medical condition, such as cancer, while you are under COBRA coverage. Should this happen, you would then become “uninsurable†because of a pre-existing condition.
Are Pregnancy Tests Always Accurate?
When you feel the first symptoms of pregnancy, you naturally head to the drug store to find a good pregnancy test. Have you ever wondered how they work?
Over-the-counter pregnancy tests look for the presence of the “pregnancy hormone” in your urine. The test you receive later in your doctor’s office looks for the same hormone in your blood. The hormone is called human chorionic gonadotropin, or hCG for short. This hormone begins to build up just a few days after the fertilized egg is implanted in your uterine wall. The hCG will cause your placenta to produce progesterone after the implantation of the embryo, which is necessary to prevent the embryo’s rejection.
Because it takes time for the hormone to build up to detectable levels, most over-the-counter pregnancy tests work best when taken a few days or a week after your missed period. Some brands claim to be accurate sooner, but all women ovulate at different times of their cycles, so this may or may not be true for you.
The most accurate test is done in your doctor’s office. A blood test can detect much lower levels of the pregnancy hormone than urine tests. If you get a negative reading from your drug store pregnancy test, but you still “feel” pregnant, you’ll want to make an appointment with your doctor. Planned Parenthood offices also offer pregnancy tests and exams.
About 25 days after an egg is fertilized the fetus can be seen by transvaginal sonography.
What causes false negative test results?
A false positive result may occur if you take your test too early. The pregnancy hormone hCG does not begin to build up in your system until after the fertilized egg has attached to the uterine wall. This usually occurs within 14 days of fertilization, so a blood test is almost always accurate if it’s done after your next period was supposed to start. Some over-the-counter tests need higher levels of the hormone to be accurate, and so they say you’re not pregnant, even though you are. You can take another test a few days later to be sure.
Can you get a false positive result?
Yes, your test may say you’re pregnant even though you’re not. The most common cause is waiting too long to read the results of the test - the urine will evaporate from the test strip, and the color will change to show a positive result. If you get a positive result but you waited longer than suggested by the test’s instructions, you’ll want to take the test over.
If you’re taking fertility hormones, a home pregnancy test may show a false positive result. Ask your doctor if your injections include the hormone hCG. If so, the hormone will show up on the test, and the reading will be inaccurate.
In very rare instances, a false positive reading is caused by certain unusual forms of cancer.
What about the rabbit?
In your grandmother’s day, there were no over-the-counter pregnancy tests. The doctor would take a urine sample, and inject the urine into a female rabbit. If the rabbit was injected with humane urine that contained the pregnancy hormone, the rabbit’s ovaries would change. It usually took several days for the changes to take place, and the rabbit had to die before the lab technicians could look at her ovaries.
Your Pregnancy Diet - Can it Reduce High Blood Pressure Risk
During pregnancy, a nutritious diet may reduce the risk of preeclampsia, which is the early stage of pregnancy-induced hypertension (high blood pressure). This condition causes concern for your physician because it can lead to eclampsia, the full-blown form of severe high blood pressure during pregnancy.
In some women, severe high blood pressure may develop after the first 20 weeks of pregnancy. Additional problems that may occur at the same time are proteinuria (protein lost through the kidneys), and edema, or swelling from water retention in the hands and feet. In the worst cases, eclampsia can cause fetal damage, or expecting mothers may experience convulsions and coma. Fortunately, this condition is rare, with preeclampsia and eclampsia affecting only 7 to 8% of pregnant women. Younger women, women experiencing their first pregnancy, and obese women are most at risk.
Researchers have been trying to find a diet that will reduce the risk of high blood pressure for pregnant women, but studies are still inconclusive. It has been suggested that a higher protein intake for the expecting mother may help, but this has not been proven. Also, a lower salt intake, which is effective among the general population for reducing hypertension, has not been shown to reduce the risk of eclampsia for pregnant women.
Fortunately, calcium and antioxidant supplements during pregnancy do show some promise in preventing these conditions among women at risk.
Calcium
One study included 48 women with a family history of preeclampsia who were experiencing their first pregnancies. Some of the women in the study received supplements containing 600 mg of calcium and 450 mg of conjugated linoleic acid (CLA) during the 18th through 22nd weeks of pregnancy, and others received a placebo. The women who received the calcium and CLA supplements had a significant reduction in hypertension, and it is believed that these supplements may reduce the risk of pre- and full-blown eclampsia.
Antioxidants
Pregnancy is known to increase the need for antioxidants. When women lack antioxidants in their diet (vitamins C and E, zinc and selenium), the deficiency may worsen hypertension. Some women have low levels of these antioxidants due to poor eating habits, which is common among younger women and teens. Supplements of antioxidants may significantly reduce the risk of eclampsia, with vitamins C and E being considered the most important.
At this time it there is no fool-proof preventative measure to reduce the risk of pregnancy-induced high blood pressure, so good prenatal care is vital. Your doctor will monitor your blood pressure and do blood and urine tests. Be sure to ask your doctor which supplements she recommends for you. She may also recommend a good dietitian to make sure you eat right and maintain the most nutritious diet during your pregnancy.
You Can Save Money On Health Insurance
American consumers understand that one of the biggest costs of maintaining our high standard of living is ensuring that everyone has access to adequate healthcare. Unlike most of Europe and Canada, there is no national health insurance plan in place. For better or for worse, residents must find and negotiate for their own insurance apart from the help of a government agency. Your premium is determined by several factors including the number of people to be insured, health history, where you live, age, and more. Fortunately, there is a way that you can save hundreds perhaps thousands of dollars annually when shopping for health insurance. Read on and we’ll look at some ways to save.
Your Plan – The more coverage you seek, the more money you will pay. However, unless you are okay with a bare bones plan, then finding coverage that pays for most hospital stays, surgery, doctor’s visits and the like you will probably pay have to pay the full price for your insurance.
Deductibles – The higher the deductible, the lower your premium. If you choose a $1000 deductible, then you’ll pay a higher premium. Deductibles of $2500 or $5000 result in progressively lower premiums. Keep in mind that if you have a $40,000 hospital bill that you will be required to pay for the deductible amount.
CoPays – Ah, doctor visits! No plan will let you walk into a doctor’s office and walk out without contributing some money for the visit. Most doctors charge $125 to $250 per visit, more for specialists, but you’ll be expected to pay $10, $25, even $50 as your part of the payment, none as a copay.
In and Out of Network – Insurance companies line up physicians to join their “network†of service providers. Doctors who join are expected to adhere to certain rate structures and follow recommended insurance company guidelines. If you see a network doctor you’ll pay a smaller copay, if you see an out of network doctor you’ll pay more. In some cases you’ll still need an insurance company’s approval before you can see an out of network doctor.
You can also save money for health insurance by joining a plan through an association that allows members to group together for insurance such as a local chamber of commerce or civic organization.
Health insurance isn’t likely to ever be something we can afford with ease. By shopping around and comparing quotes you can save money and stay ahead of the game.
UB92 Forms Obsolete – Changing to UB-04 Forms in 2007
UB92’s are out – UB-04’s are in. Ever wonder where they come up with the names for these forms anyway?
Well I guess it doesn’t really matter what they are called, but that it is the format required if you want your services paid for.
UB92 and UB-04 forms are medical claim forms used by facilities such as hospitals, outpatient clinics and ambulatory surgery centers to bill insurance companies for services rendered.
The UB-04 forms come with a number of improvements and enhancements. They are more in line with the 837 format and they allow for the reporting of the NPI number, or National Provider Identifier number.
The new UB-04 forms will be available in the beginning of 2007 but they will not be accepted for billing until March 1, 2007. From March 1st to May 22, 2007 providers will be allowed to use either the old UB92 or the new UB-04. Starting on May 23, 2007 Health Plans will only accept the new UB-04 forms and format.
I would strongly recommend that you not wait until the last minute to make these changes. If you are submitting claims electronically you should contact your software vendor now to find out what changes need to be made to your system to allow for the new format.
If you are submitting your UB forms on paper, you need to make sure your software is capable of printing the new UB-04 format. Unless you recently upgraded your software, most likely it will need some changes.
In most cases, changes like this don’t go off without a few problems. If you wait until May 23rd to make your changes, you will end up disrupting your cash flow. To ensure a smooth transition, start looking into what needs to be done now so that you can work out all of the bugs in plenty of time for the cut off date.
Every Thing You Need to Know About Individual Health Insurance Plans
In “Every Thing You Need to Know about Individual Health Insurance Plans (Part I)â€Â, we began our discussion of individual health insurance plans by talking about indemnity plans. We then started a discussion about managed health care plans. We now continue that discussion…
A Health Maintenance Organization (HMO) plan is less expensive than a PPO and generally includes coverage for preventative care. Participants are required to pay a monthly premium, and a nominal co-payment each time they see a doctor. They must be seen by medical care providers that are part of the HMO network. These medical care providers have an agreement with the insurance company to perform various medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.
The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their ‘preferred’ doctor is not on the list. The HMO typically won’t cover the costs of medical care provided by professionals outside the HMO network. And because an HMO network is limited in size, it often takes a long time to get an appointment with the PCP.
A Preferred Provider Organizations (PPO) is similar to a HMO, except that there is no need to first be seen by a PCP. Participants are advised to choose a medical professional from the PPO’s approved ‘network’ but they don’t have to and they don’t need a referral to see a specialist. Should a participant choose to go outside the network, their co-payment will generally be higher, the percentage that the PPO pays for the medical care will be lower, and they will likely have to satisfy a deductible. PPO plans have become the most popular individual health insurance plan in the U.S. today. Although PPOs offer more freedom of choice, there are generally more costs involved in this type of managed care plan. These costs can be significant when participants go outside the network.
A POS or Point of Service managed care plan can be described as a cross between a HMO and PPO. It offers more freedom of choice like a PPO, and a lower cost like an HMO. Participants must designate a PCP, but even then it is difficult to get a referral to a specialist. When participants stay within the network, paperwork is minimal, and so are co-pays. Plus, there are no deductibles. Although they might sound like the best of both worlds, POS individual health insurance plans aren’t very popular.
When considering a managed care plan, be sure to look closely at the list of in-network doctors. If you don’t see your doctor listed, you may want to forego this option. Of course, if your health care is primarily yearly check-ups and the occasional antibiotics, and you do not have a physician preference, then this is an individual health insurance plan that could work for you. It will cover health emergencies, as well; there are just more hoops you have to jump through.
Five Things You May Not Know About Small Group Health Insurance
This past September (2006), America’s Health Insurance Plans (AHIP) Center for Policy and Research published a survey about the state of small group health insurance in the U.S. as of January 2006. The study was very comprehensive with many interesting results. Of the many findings, this article will touch on five that are most likely to shed some light on this subject for those in the small group health insurance market.
First, of the 650,000 small groups surveyed, it was found that for small group plans, premiums decreased as group size increased. On average, companies with between 26 and 50 employees paid about 13% less for single coverage than companies with 10 or fewer employees.
For those familiar with health insurance in general, this disparity probably does not come as a surprise. As group size increases, underwriters are able to spread risk more effectively. So, unfortunately, if you are looking for small group health insurance with say 10 employees, be prepared to pay more per employee than if you had say 30 employees.
Second, the amount of cost sharing by the employee typically is higher with small group health insurance plans. The average deductible for small groups (50 or fewer employees) was $849 while a survey by The Kaiser Family Foundation and Health Research and Educational Trust showed an average deductible of $469 for mostly medium size companies (up to 199 employees), a nearly 45% difference.
This disparity is most likely related to the higher cost for small group health insurance. Couple this with the fact that small firms may not have the resources of their larger counterparts, and you can more clearly understand this higher level of cost sharing for small group employee plans.
Third, among the companies surveyed with small group coverage, PPO plans enjoyed the most popularity. Fifty-seven per cent of employees with small group coverage chose a PPO plan, followed by HMO coverage with 39%. It’s interesting to note that the oldest type of health insurance, indemnity health insurance, was barely a blip in the survey with less than 0.5%.
The recent popularity of PPO’s is reflective of the changes in the health insurance market, changes brought on mostly by spiraling costs. Indeed, PPO’s allow for the cost savings of an HMO, with the freedom to go out of your network if necessary and still have coverage, albeit at a reduced rate.
Fourth, just over 10% of small group employees had a choice of two or more insurance plans. This number seemed low until it was viewed in light of the popularity of PPO plans. That is, one PPO plan is more likely to offer coverage that addresses the needs of a larger number of individuals.
More significantly, perhaps, is the fact that more than 80% of the small groups surveyed had 10 or fewer employees. With such small groups to begin with, it would be very difficult to offer affordable group health insurance to any subset of such groups.
Fifth and last, is an issue that is mentioned in the survey results but was not a finding of the survey. That is, while small group health insurance is mostly regulated by the states, it is federal law that requires small group health insurance be offered as “guaranteed issueâ€Â. This means that small businesses cannot be denied coverage due the health problems of its employees or dependents. However, even though the health status of a company’s employees and dependents cannot be used to deny coverage, it can be used to determine rates. This varies by state, but will typically result in higher premiums.
The small group health insurance market can be a frustrating place for many. By gaining a greater understanding of the current state of this market, one can approach the subject in a more realistic manner. For those in the small group health insurance market, there are many factors to consider that can affect cost. These include, but are not limited to, the size of your small group, the state in which the company is located, and the level of benefits offered to employees.