Anthem’s planned rate hike, which the state estimates would affect about 700,000 customers, averaged 25 percent and would have been as high as 39 percent for some.
Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company’s complex and detailed plan filing, including data on the medical costs it expects to incur.
The California Department of Insurance has been working with Anthem since mid-November to get more information about the increase, Insurance Commissioner Steve Poizner said. He wanted to have experts comb through the company’s figures to confirm the new rates comply with a 2006 state law that insurers spend 70 cents of every premium dollar on medical care.
“Medical cost inflation in California is in the 10 to 15 percent range, so I have a healthy skepticism how they can get to 39 percent” and comply with the law, Mr. Poizner said.
Anthem has stuck to its position that the individual insurance plan had lost money last year and the rate increases were justified. There is no evidence that health insurance rate hikes were used to pay costs related to the acquisition of Thousand Oaks-based WellPoint Health Networks Inc. by Indianapolis-based Anthem Inc., according to the report of an independent auditor issued by the state Department of Managed Health Care.
Anthem, a subsidiary of insurance giant WellPoint Inc. of Indianapolis, said its proposed rates reflect anticipated medical costs.
“They are actuarially sound and in full compliance with all requirements in the law,” said Brian Sassi, president of Anthem Blue Cross of California.
The company has blamed the increased rates on the recession, rising medical costs and more healthy people dropping out of the plan, leaving fewer premium dollars to cover costs. It has insisted that the situation shows the need for a health-care overhaul that requires everyone to have health insurance.
“We are seeing some significant price increases from other companies” filing new rates for individual insurance plans, which cover about 30 percent of Californians, Mr. Poizner noted. He said he did not have details.
Anthem however is responding to the national crisis of health care, offering two new health plans at affordable prices to residents of California. These two plans have a two year rate guarentee and providing low-cost alternatives to obtain insurance or many Californians who do not have insurance or have health insurance plans that are struggling to afford. Please call us to learn more
The year long, often ugly journey toward health care reform reached a historic milestone with the House approving legislation that would extend coverage to 32 million more Americans and impose new restrictions on the insurance industry.
Here are answers to some frequent questions about what reform will mean to consumers:
What provisions begin soon?
Starting this year, children up to age 26 would be allowed to remain on their parents’ health plan. People with pre-existing medical conditions would be eligible for a new federally funded “high-risk” insurance program. Small businesses could qualify for tax credits of up to 35% of the cost of premiums. Insurance plans would be barred from setting lifetime caps on coverage and would no longer be able to cancel policies when a patient gets sick. Health plans would also be prohibited from excluding pre-existing conditions from coverage for children.
When do the main reform changes kick in?
In 2014. That’s when insurance marketplaces, or exchanges, would be set up in states to offer competitive pricing on health policies for individuals and small businesses that don’t have coverage. People with a pre-existing condition would no longer be denied coverage, and all lifetime and annual limits on coverage would be eliminated. Medicaid would be expanded to cover more low-income Americans.
In addition, people in their 20s would have the option to buy a lower-cost “catastrophic” health plan.
How will small employers be affected by the changes?
Employers with 50 or more workers would face fines for not providing insurance coverage. Businesses with smaller workforces, though, would be exempt. Companies would get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000.
To learn more please call a qualified representative at 877-990-3808 or click the home at www.uinsureme.com to get a free quote now.
Most Americans who have health insurance receive it through their employer. Because employers pay a portion of the premiums, this is usually the most affordable way to get coverage.If your employer doesn’t offer health insurance, you can purchase a policy on your own. This allows you to pick a plan that provides you with the specific benefits you want.
If you can’t afford coverage, you may qualify for a state or federal safety net program. The federal Medicare program provides coverage for Americans over 65 or with certain disabilities, and the joint federal-state Medicaid program provides coverage for qualifying low-income individuals.
Buy It On Your Own
Buying individual health insurance allows you to choose a plan that fits your specific needs. Because coverage and costs vary from company to company, obtaining coverage on your own requires careful comparison shopping. When evaluating different policies, it is important to consider which medical services are covered, and the cost of deductibles, coinsurance and copayments.
The decision will usually come down to the tradeoff between flexibility and cost. If you don’t want any restrictions on the doctors or hospitals you can go to for care, an PPO plan or a plan that at least provides some out-of-network coverage is probably the way to go.
If you’re willing to sacrifice some choice in exchange for a plan that’s less costly, you might be better off with an HMO. You should also ask about Health Savings Account (HAS) tied to a high-deductible this would be a great way to get some great tax benefits.
You can determine the right policy for you by consulting with a health insurance agent or broker at ZIS insurance and ask to speak to Melika.
Agent
Advisors who work with you to assess your insurance needs and help plan for medical insurance security and stability.
Balance billing
A bill for the difference between what your insurer will pay and what the physician charges for a service.
Coinsurance
The amount you are required to pay for medical care in a fee-for-service plan and certain managed care plans after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.
Coordination of benefits
A system to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans are usually limited to no more than 100 percent of the claim.
Copayment
A way of sharing medical costs. You pay a flat fee every time you receive a medical service (for example, $10 for every visit to the doctor). The insurance company pays the rest.
Covered expenses
Most insurance plans, whether they are fee-for-service or managed care plans, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures the insurer agrees to pay for. They are listed in the policy.
Deductible
The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.
Exclusions
Specific conditions or circumstances for which the policy will not provide benefits.
Managed care
The way a health care system manages costs, use, and quality. All HMOs and PPOs, and even many fee-for-service plans, apply managed care techniques.
Maximum out-of-pocket
The maximum amount money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.
Noncancellable policy
A policy that guarantees that you will receive insurance as long as you pay the premium. This is also known as a guaranteed renewable policy.
Preexisting condition
A health problem that existed before the date your insurance coverage became effective.
Premium
The amount you or your employer pay, in addition to copayments, coinsurance and deductibles, in exchange for insurance coverage.
Primary care physician
A primary care physician monitors your health, diagnoses and treats minor health problems, and refers you to specialists if another level of care is needed. This is often a family physician or internist, but some women prefer to use their gynecologist.
Provider
Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.
Third-party payer
Any payer for health care services other than you. This can be an insurance company, an HMO, a PPO, or the Federal Government.
March 22, 2010 — The year long, often ugly journey toward health care reform reached a historic milestone late Sunday night, with the House approving legislation that would extend coverage to 32 million more Americans and impose new restrictions on the insurance industry.
Here are answers to some frequent questions about what reform will mean to consumers:
What provisions begin soon?
Starting this year, children up to age 26 would be allowed to remain on their parents’ health plan. People with pre-existing medical conditions would be eligible for a new federally funded “high-risk” insurance program. Small businesses could qualify for tax credits of up to 35% of the cost of premiums. Insurance plans would be barred from setting lifetime caps on coverage and would no longer be able to cancel policies when a patient gets sick. Health plans would also be prohibited from excluding pre-existing conditions from coverage for children.
When do the main reform changes kick in?
In 2014. That’s when insurance marketplaces, or exchanges, would be set up in states to offer competitive pricing on health policies for individuals and small businesses that don’t have coverage. People with a pre-existing condition would no longer be denied coverage, and all lifetime and annual limits on coverage would be eliminated. Medicaid would be expanded to cover more low-income Americans.
What are the requirements for individuals to buy insurance?
Starting in 2014, a person who did not obtain coverage would pay a penalty of $95 or 1% of income, whichever is greater. That penalty would rise to $695 or 2.5% of income by 2016. The bill would exempt the lowest-income people from that insurance requirement.
Medicaid would be expanded to cover those under age 65 with an income of up to 133% of the federal poverty level (below $29, 327 for a family of four).
To make coverage more affordable, the legislation would offer premium subsidies for people with incomes more than 133% but less than 400% of the federal poverty level ($29,327 to $88, 200 for a family of four).
In addition, people in their 20s would have the option to buy a lower-cost “catastrophic” health plan.
How will small employers be affected by the changes?
Employers with 50 or more workers would face fines for not providing insurance coverage. Businesses with smaller workforces, though, would be exempt. Companies would get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000.
I’m covered by a large employer. How will it affect me?
Large employers would run their health plans as they do now, so there won’t be much change. Even though they have more insurance-buying clout, large businesses have seen steadily rising insurance premiums over the past decade without reform, as medical costs have increased. That pattern isn’t likely to change much, at least immediately.
Most Americans who have health insurance receive it through their employer. Because employers pay a portion of the premiums, this is usually the most affordable way to get coverage.If your employer doesn’t offer health insurance, you can purchase a policy on your own. This allows you to pick a plan that provides you with the specific benefits you want.
If you can’t afford coverage, you may qualify for a state or federal safety net program. The federal Medicare program provides coverage for Americans over 65 or with certain disabilities, and the joint federal-state Medicaid program provides coverage for qualifying low-income individuals.
Buy It On Your Own
Buying individual health insurance allows you to choose a plan that fits your specific needs. Because coverage and costs vary from company to company, obtaining coverage on your own requires careful comparison shopping. When evaluating different policies, it is important to consider which medical services are covered, and the cost of deductibles, coinsurance and copayments.
The decision will usually come down to the tradeoff between flexibility and cost. If you don’t want any restrictions on the doctors or hospitals you can go to for care, an PPO plan or a plan that at least provides some out-of-network coverage is probably the way to go.
If you’re willing to sacrifice some choice in exchange for a plan that’s less costly, you might be better off with an HMO. You should also ask about Health Savings Account (HAS) tied to a high-deductible this would be a great way to get some great tax benefits.
You can determine the right policy for you by consulting with a health insurance agent or broker at ZIS insurance and ask to speak to Melika.
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Welcome to the uInsureMe.com Blog
0 Comments | Posted by admin in General, Health Insurance
These are historic times for the health care insurance industry—and every person who has or seeks health insurance. Pressure from consumers and lawmakers are driving changes to every part of the health care system. Unlike other issues considered by Congress, health insurance reform will touch every person in the United States. That is why it is vital to have good information about what is happening and what it means to you.
As health insurance experts, we will provide unbiased, practical analysis of each change to the health insurance system. We will offer advice on what to do and what not to do at each stage.
No one has all the answers, so we invite your participation as well. Give us your perspective on the issue of the day. Ask questions about each post, or even topics we do not address. The diversity of opinions will benefit all readers, and it will help us be a more agile, responsive health insurance agency.
To make the most of the changing health insurance marketplace, you need honesty, not spin. That is what we are dedicated to bringing you in the uInsureMe.com blog.
These are historic times for the health care insurance industry—and every person who has or seeks health insurance. Pressure from consumers and lawmakers are driving changes to every part of the health care system. Unlike other issues considered by Congress, health insurance reform will touch every person in the United States. That is why it is vital to have good information about what is happening and what it means to you.
As health insurance experts, we will provide unbiased, practical analysis of each change to the health insurance system. We will offer advice on what to do and what not to do at each stage.
No one has all the answers, so we invite your participation as well. Give us your perspective on the issue of the day. Ask questions about each post, or even topics we do not address. The diversity of opinions will benefit all readers, and it will help us be a more agile, responsive health insurance agency.
To make the most of the changing health insurance marketplace, you need honesty, not spin. That is what we are dedicated to bringing you in the uInsureMe.com blog.
