The Health Insurance Portability and Accountability Act of 1996, HIPAA, is a law that has a huge impact if you are looking for an individual health insurance policy, especially if you or someone in your family has a pre-existing condition. Knowing the laws and your rights will help you be better informed and more confident when searching for your own personal health insurance. Let’s take a look at what used to happen in the insurance industry and what was resolved by the HIPAA act.

The Past

An individual switched jobs and was denied coverage under the new employers health insurance plan because there was a pre-existing condition recorded under the previous employers health insurance plan. The new insurance company did not want to take on this liability. There was no law stopping the insurance company from denying coverage due to a pre-existing condition. Health insurance companies simply did not insure people with pre-existing health conditions even though they had insurance with their previous employers.

Insurance companies were looking out for their bottom line. They are in business to make money, so they saw this denial of coverage for individuals with pre-existing conditions as a way to protect their assets. This is where the portability comes in.

The Present

Today, insurance companies must honor the previous coverage for individuals, barring the individual did not have a lapse in health insurance coverage for longer than a set amount of time. This means that even a person with diabetes, diagnosed under their previous insurance plan, must still be covered under the new plan if all of the conditions defined in HIPAA are met.

The Future

In today’s world, there is also great concern about patient privacy. Words and numbers fly across cyberspace faster than we can imagine and private information can be compromised in an instant.

HIPAA is also on this curve, staying current with new technology. The HIPAA law requires companies to abide by certain safety criteria when it comes to handling personal information. HIPAA sets guidelines about what steps need to occur before information can be sent over the Internet.

Because of this safety net thrown out by the HIPAA law, there has been a reduction in health insurance fraud and abuse while also mandating standards throughout the industry for electronic billing and account updates.

The HIPAA laws are worth knowing and will provide you with the information you need when it comes to questioning health insurance companies about their HIPAA policies.
Before you begin looking for any individual health insurance coverage, read up on the HIPAA laws so you know the questions to ask to make sure your personal information will be protected.

There are several reasons why an individual will move from a group insurance policy to an individual insurance policy. These reasons may include job loss or retirement. Another reason may be finding your group plan is more expensive due to an unhealthy group. Whatever the reason is, there are ways to make the transition from group policy to individual policy a little smoother.

Job Loss

This is probably the number one reason people will switch from a company run group insurance policy to an individual health plan. Loss of a job also means loss of group health coverage, which just worsens a terrifying experience. This is made even more terrifying if a pre-existing condition exists for anyone on the group policy.

If you lose your job, the best thing to do is to take advantage of the COBRA insurance law. What this law states, is that, for a certain period of time, you are able to maintain health insurance under the same group plan you had with your previous job. Whereas the company you worked for used to cover some of the premium cost, you will be responsible for paying the entire premium with COBRA.

Electing to maintain your existing group policy under the COBRA insurance umbrella allows you more time to research and prepare for purchasing an individual health insurance plan. Signing up for continued insurance under COBRA is important for your family’s well-being during this stressful time. When everything else seems to be going wrong, health insurance is one thing you will not have to worry about for a while.

Retirement

Unlike the loss of a job, retirement is something that can be planned. Believe it or not, many people will spend more time planning their retirement party than planning their health insurance situation after retirement. Usually at this point, COBRA goes into effect, but with a little prior planning, the newly-retired individual could be paying much less with an individual health insurance plan.

Taking as little as two months to educate yourself before retirement can prove to be one of the best investments you make for your retirement. By doing the research ahead of time on different insurance plans and rates, you can save yourself time and money, and be able to fully enjoy that retirement you worked so hard for.

Unhealthy Group versus Healthy Individuals

Group rates are usually based on the average health of all the employees covered in a certain plan. For instance, if there is diabetes, hypertension, or even obesity in your office, your rates will probably be quite a bit higher than an office which is generally healthy. A few people who are healthy in an unhealthy office, may find it cheaper to switch to an individual health insurance plan. That way, they are only paying for the premiums and deductible they are using.

No matter what the reason is for switching from a group plan to an individual health policy, make sure you take the time to research your options. Ask a lot of questions and make an informed decision that makes the most sense for you and your family.

Contrary to popular belief, COBRA is not a type of insurance company for former employees or retirees, but in fact, it is a federally mandated law. Passed in 1986, the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, gives certain individuals who qualify, the right to temporarily continue the group insurance policy they previously held. COBRA insurance allows past employees the ability to continue health coverage under the group discount rates.

Unfortunately, life insurance is not covered under the COBRA plan, but qualifying individuals may be entitled to dental and vision, prescriptions and even inpatient and outpatient hospital care.

While many companies pay for a portion of the group health care, one stipulation of COBRA insurance is that the individual covered must pay in full for their coverage. Usually this is more expensive than what they paid toward their employer sponsored group policy while they were employed. However, the policy will still at a better group rate than if the individual were to get insurance coverage on their own.

Family and dependents are also covered under the COBRA law. If your group insurance plan covered your family while you were employed, they will receive the same benefits if you continue coverage under COBRA.

One of the biggest benefits to COBRA insurance is that it provides much needed protection to those with pre-existing health conditions. When you take advantage of continuing coverage under COBRA, you are under the same policy you were with during your employment. If you choose not to continue your coverage under the COBRA plan, and are without insurance coverage for more than 63 days, you will not be covered for pre-existing conditions when you go to buy an individual policy. The COBRA plan ensures that you are continually covered until you switch to an individual plan, keeping out of the ‘pre-existing conditions’ nightmare.

COBRA benefits usually continue for eighteen months after initially signing up to use COBRA. There are options to extend this amount of time with certain qualifications, which must be met. Electing COBRA insurance also helps if you have a relationship with a specific doctor that you would like to continue. Nothing changes while you are under the COBRA plan.

Time is of the essence when leaving a group health plan and opting for individual coverage. COBRA has an eighteen-month time frame which should allow most people time to find an adequate individual plan. It’s wise to use this time to price multiple individual health insurance plans which provide access to the doctors and clinics that are preferable.

If you do choose to accept COBRA coverage, you have 60 days to file the notice. After you have accepted the COBRA insurance, you then have 45 days to make the first payment into the plan. Many previous employers will follow up by the 44th day to make sure you did not forget about the option to elect coverage under the COBRA law.

If you have recently lost your job or are concerned that your employer may be downsizing, COBRA insurance is definitely an important program to research. Signing on with COBRA will ensure that any pre-existing conditions are covered once you leave COBRA for an individual policy. Taking full advantage of COBRA is well worth the cost just to provide peace of mind for you and your family.

Looking for ways to reduce health insurance and health care costs is at the top of everyone’s list these days. Who wouldn’t want to pay less money for the same health care, or better? Here are ten ways to reduce health insurance premium costs.

1. Quit smoking or using nicotine of any kind - Smoking and chewing tobacco drives up insurance costs because there are associated health risks. When you quit your usage of nicotine products, you will not only feel better, but you will see your health insurance costs drop drastically.

2. Lose weight – Obesity is an ever-increasing concern with health insurance companies. Obesity can lead to health problems such as high cholesterol and diabetes, as well as back, hip, and knee problems. Many health insurance companies offer discounts if you are participating in a fitness program on a regular basis.

3. Higher deductible – The obvious way to lower personal health insurance costs is to assume a higher deductible. This will take more of the burden off the insurance company, which will mean they can charge less for your premiums.

4. Higher co-pay – Along with taking a higher deductible, assuming a higher co-payment amount will reduce the premium the insurance company will charge for your benefits. Instead of paying $20 per visit, see if there is a plan for $30 per visit, or more. Look at your past experience with office calls to see if you could save over the life of the policy in premiums charged using a higher co-pay.

5. Keep diabetes in check – Having regular blood work done to check for diabetes is essential to save on insurance costs. Having these routine check-ups can also offer the added benefit of getting proper medical attention if something does happen to surface. Keeping diabetes in check by maintaining a proper diet and fitness program can also help lower your rate. If you can keep your diabetes in check without medication, the insurance company does not have to pay for supplies, which means lower premium costs to you.

6. Improve your credit score – Many insurance companies actually pull your FICO score in order to determine what your premiums will be. Improving your credit scores will show the insurance companies you are a good investment.

7. Open an FSA or HAS – These medical savings accounts are money pools you create by depositing ‘before tax’ income. You can then withdraw funds from the account for medically necessary items. This can include anything from office calls to prescriptions to over-the-counter allergy medicines. This is a ‘before taxes’ account, which saves you money right up front. These accounts give you a place to keep money, tax free, to pay for your deductible and co-payments, as well as medical and health related supplies.

8. Buy generic – Generic medications cost much less to produce and to distribute, and the savings are passed on to you. Also, some insurance policies no longer cover name brand drugs, so if you want the well-known ‘label’ you’ll pay the extra cost right out of your pocket.

9. Use walk in clinics – Walk in health clinics, or ‘retail clinics’ are popping up all over. You’ll find clinics in malls, drug stores and even in large retail outlets. These clinics offer simple services like vaccines, routine checkups and even blood work, all without an appointment. Check their rates and compare to your primary physicians office. You may be surprised what you can save.

10. Use urgent care clinics – Urgent care clinics are similar to an emergency room, but without much of the specialized equipment. These clinics are more suited to everyday emergencies, like issues requiring x-rays, bandages and stitches, but not for surgeries. Many times, these smaller clinics are much cheaper than going to a full fledged emergency room and have a lower co-payment because they bill as a clinic instead of an emergency care facility.

When you’re looking for ways to cut health care costs, put these ten ideas to work. Trim your budget and continue to get the care you need!

Life insurance companies do not always require a physical exam. Let’s look at the options.

1. No exam, no tests- These are called “Guaranteed Issue” policies and often are purchased by people uninsurable by any other means. In almost every case the face amount is limited (typically 25-35k) and the policy does not pay a claim except for a return of premium in the first two years. Also, the premium is expensive in the long haul relative to the death benefit. Most of these policies the total premium over more than 8-10 years will exceed the face value. This is why most of them are cash value policies- the death benefit at that point will begin to grow with the total premium paid into them. They are a good deal if you die in the third to 7th or 8th year, but unless you are completely uninsurable for anything else, they don’t make much financial sense.

2. No exam, blood or urine test only- These are called “non-medical policies” and are common in face amounts under 250k. Typically there is no medical exam except for a brief interview on your health and blood or urine test to check for nicotine, HIV, narcotics and serious disorders (such as diabetes or medications for cancer etc). These are very common in the industry and the easiest to purchase. Insurance companies can do these over the phone with you and will pay for the blood test. You can get very good rates and most low face amount term policies are sold this way.

3. Para-med Exam- These are used where face amounts exceed the blood test only exam but usually not in excess of one million or more. A physician’s assistant or nurse weighs and interviews you and copies of your medical records are sent to the insurance company. Blood and/or urine is tested but the exam is simple and breif (blood pressure, heart and lungs listened to). It is typically non invasive and takes less than 20-30 minutes in your home. It is the most common form of life insurance underwriting method

4. Full medical exam- Typically performed in a doctor’s office and involves a full medical exam. If you are a smoker, a treadmill or lung efficiency exam is also requested. An EKG is often done as well. These are used in large policies, typically in excess of one million or more.

Bottom line, is that the best rates and largest policies will involve some sort of exam. Before an insurance company is going to accept the risk of paying a claim, they have to have a reasonable assurance of a return of monies paid. The healthier you are and the better you maintain yourself, the more likely this will occur and therefore a lower rate. The highest risk factors in underwriting an individual come from nicotine use (smoking, chew etc), weight and blood content (medications, cholesterol etc).