If you are one of the 42,ooo insured through American Community in Michigan, good news!  Golden Rule, a unit of UnitedHealth Group Inc, has agreed to provide health coverage to those who had individual medical insurance plans.

What about pre-existing conditions?

The option of transferring your coverage to Golden Rule Insurance will be on a guaranteed basis.

Who will my doctors be?

Once enrolled in Golden Rule plans you will have access to the provider network managed by UnitedHealthcare, another unit of Golden Rules’s parent, UnitedHealth.

When would my plan start?

If you take advantage of the guaranteed issue offer, your new coverage with Golden Rule will take effect on August 15, 2010

What will my rates be?

You will have the option to purchase a guaranteed-issue plan with no waiting periods or preexisting condition exclusions or limitations at standard new business rates.

Questions?

Call us toll-free at 888.320.5388 or 248.246.6787

Frequently Asked Questions

If you have a health insurance plan that states office visit copay: 20% after deductible, what is the cost of your office visit?

Great question. If your plan does not include office visits prior to the deductible, you are responsible for the full cost of the office visit. That is, until you satisfy the deductible.

Once you satisfy your deductible you would be responsible for 20% of the cost of the office visit.

Example:

• You have satisfied your deductible
• Doctors Office charges you $100 for an office visit
• The insurance company would pay $80 dollars towards the office visit
• You would be responsible for the remaining $20 dollars.

With so many adult children graduating from college, Aetna saw the need and worry of families regarding their kids losing medical coverage.  Although healthcare reform addresses this issue nationwide later this year through regulation, Aetna is working with customers to extend coverage now.

This means current dependents under the age of 26 would not have to leave their Aetna Michigan plan when normally they would age out or are no longer full-time students.  This is also extended to adult children who would have lost eligibility effective May 31,2010.

An important note.  It does not include reinstatement of dependents who previously aged out of their plan.  It also does not affect dental, vision, standalone pharmacy or other benefits.

Aetna will continue coverage effective June 1, 2010 for dependents under age 26 who are currently covered on a parent’s medical plan.

Best news ever?  Aetna will not change the plan’s premium until renewal.

On the next renewal date on or after September 23, 2010 due to healthcare reform, all medical plans must cover dependents up to age 26.  This may include dependents who are not currently enrolled in the plan.

If you have questions about how this will affect you, please contact us at 888.320.5388.

Get a quote on Aetna Michigan health plans:

With Assurant Health Access plans you may use any doctor or facility, but when you use a doctor or facility that participates with the approved network, you get greater discounts and cost savings on the services provided.

To check if your Michigan doctor or facility participates with the Assurant Health Access plans, please call 888-304-9983.

Note: When you use a PHCS LBP preferred provider, you can save on average 40% for health care services.

If you are an existing Health Access Plan A customer, please visit www.multiplan.com/assurant

Assurant Health offers the following Health Access Plans

• Health Access Plan A
• Health Access Plan B
• Health Access Plan C

Get a quote on Assurant Health Access Plans now:

So the rate increase may or may not affect me.  Why the requested increase?

BCBS MI justified the request by claiming projected losses in the individual health insurance market would be close to $210 million.   Over three years up to $1 billion.  According to a report from BCBSM released, the loss on individual under-65 insurance plans was $94 million and $186 million on Medicare Supplemental (Medigap).  Thats a total underwriting loss of $257 million.  While overall BC/BS MI posted net income of $12 million in 2009, no company or non-profit can sustain itself long term posting large losses.

What does BCBSM have to say?

According to BCBS the reasons for the individual medical losses were familar:

The state’s broken regulatory system will continue to drag down financial performance in the individual market until a fair and balanced system is put in place. The current system allows out-of-state for-profit insurers and nonprofit HMOs to reject unhealthier and costlier-to-insure applicants in the individual insurance market. BCBSM accepts all applicants, regardless of their condition or cost. BCBSM had a $280 million underwriting loss in its individual lines of business in 2009, including $94 million in its individual under-age-65 products and $186 million in Medicare Supplemental (Medigap).

Why Health Care Reform May Help

Michigan has been unique in that we had a preview of what guaranteed issue health insurance looks like.  As a non-profit.  Blue Cross of Michigan is required to insure those with pre-existing conditions.

Health care reform will level the playing field.  Out-of-state health insurance companies will eventually be required to accept all conditions as well.  With this requirement will bring rate increase adjustments.  The increases will bring rates in line with what some Michigan residents would say are uncompetitive rates from BCSBS.

Due to name recognition and their long history of insuring Michigan residents, BCBSM stands to benefit greatly from these changes.  As well they should, considering they have had to compete in a market with one hand tied behind their back.

Please comment, we would love your feedback.  You can find us on Twitter:  MichInsurance or ask us questions related to health insurance anonymously at Formspring:  MichInsurance

Assurant Health offers three health insurance plans in Michigan for small businesses.  They are:

• Real Choices I
• Real Choices II
• Real Choices Indemnity

Real Choice I plans are for employers who want extensive coverage for their employees.  They include multiple benefit choices, giving you, the employer an opportunity to creat a plan the satisfies the unique needs of employees.

Real Choices II offers the most choices of the 3 plans.  A great option if you are looking for maximum flexibility as an employer.

Real Choices Indemnity gives employees the freedom to choose doctors and hospitals.  The way to go if employees live and work outside a PPO network area.

All Real Choice plans have first-dollar benefits for preventive services from a network provider.  Depending on what plan you select, benefits range from $200-$1250 per year.  The deductible and copay are waived until the benefit maximum is reached.  Plan features do vary by state.

Plan Features

• Lifetime Maximum Choices – up to $10 million
• Annual Deductible Options – choose from $0 deductible up to $10,000
• Office Visit Copy Options – select from a large variety of choices
• Coinsurance Choices – choose the amount employees pay after the deductible as low as $0 or 100% coinsurance
• Prescription Drug Coverage – choose your options, including a $0 copay

Additional Benefits

• Life Insurance
• Accidental Death & Dismemberment
• Short Term Disability
• Dental Insurance
• Assurant Health Discount Card

To discuss options for your Michigan Small Business contact us today at 888.320.5388 or to get a quote on group health insurance fill out a company census here:  Small Group Health Insurance Quote

Frequently Asked Questions

What health care insurance covers lap band or gastric bypass surgery?  Depends.  Health care insurance covering the lap band surgical procedure is determined on a person-by-person basis.  Some policies only cover the procedure when/if medically necessary.  It may be covered if you meet the national guidelines for the care of morbid obesity.

Insurance Companies that cover Lap Band

These are companies that are known to partially cover or completely cover LAP Band surgery.  It does not guarantee that you will be covered.  Insurance companies cover surgery on a case-by-case basis.

• Cigna
• Aetna
• TriCare
• Blue Cross (some states)
• One Health
• Tufts Health Plan
• Medicaid
• American Family Insurance
• Humana
• Great West
• First Health
• Anthem BCBS

Verify Insurance

To determine if you insurance policy covers bariatric ( lap band ) surgery, refer to the insurance policy packet you would have received after paying your first premium.  For group coverage, it would have been provided by your employer.  If you don’t have a copy, contact your human resources department  or your insurance provider.  They will be able to provide a copy for you.

Most likely there are two sections that describe limits and the extent of your coverage.  Look for:

• Covered Expenses or What is covered (or similar) – This lists all the healthcare benefits for which the insurance company will pay.

• What is not covered” or “When the plan does not pay benefits”.  - cost that may not be covered by your plan

Look for statements  where the health insurance company excludes coverage for weith control, treatment for obesity, surgery for weith control, or exclude outright bariatric surgeries.

Look closely for statements such as “Surgery for the treatment of obesity is covered when deemed medically necessary”.   If bariatric or lap band surgery is excluded except when medically necessary, then if you meet the carriers guidelines, you may qualify.

Related Posts:

Cost of Lap-Band in Michigan

Financing Lap Band Surgery

Frequently Asked Questions

Yes.  Group insurance is medically underwritten. The entire gr0up, including the individual are reviewed by underwriting for group health insurance.

Let’s take a look at why one might ask this question.  Most often we hear this due to a concern about being denied for coverage.

The good news for those concerned is this.  Health Insurance companies in Michigan underwrite individuals to determine your rate.  The amount you pay monthly for health insurance.

When small group plans are medically underwritten, employees are asked to provide health information about themselves and their covered family members when they apply for coverage. When determining rates, insurance companies use the medical information on these applications. Sometimes they will request additional information from an applicant’s physician or ask the applicants for clarification. If a company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively, meaning that the assumption relative to the missing information will be negative rather than positive.

Example: A person has a history of diabetes but it is controlled with medication and he is not overweight. If the company is unable to determine if that individual smokes or if he has normal cholesterol, it will assume that the missing information is negative and rate accordingly.

In most states the amount a company can vary a group’s premium rates based on medical underwriting factors is limited to a certain percentage of the average small group insurance rate. This is known as a rating band requirement, and the specifics vary by state.

If you have a pre-existing condition, a new insurance company can review your medical records for the last six months only and apply an exclusion of that condition from coverage for varying times according to the type of group plan you have. If you have maintained coverage of your pre-existing condition, without a break of more than 63 days, you are entitled to creditable coverage.

Please contact us at 888.320.5388 to answer specific questions not addressed here.  Or ask anonymously at http://www.formspring.me/michiganhealth

Make it a great day!

Billy

Find Me: 

Frequently Asked Questions

If you have a $0 copay for office visits after your deductible, how much does your office visit cost? That depends.

At first glance, without knowing what your copay before the deductible, all indications would be that you would pay nothing for your office visit. Of course assuming you have satisfied your deductible.

If you haven’t hit your deductible and you aren’t sure what your copay is before the deductible, a quick way to figure that out would be to look at your health insurance card.

Here is an example:

A quick review of the left side of the card shows your office visit copay is $25.  $35 for a specialist.  It also lists your X-Ray, Lab, and prescription benefits.  Your card may be different.

If you have questions please comment or feel free to ask us anonymously at http://www.formspring.me/michiganhealth

Make it a great day!

Billy

Image Courtesy of bgcr.org

Unknown to many a Michigan sole proprietor, BCBS of Michigan offers One Subscriber Group health insurance (OSG).  That’s right if you are a solopreneur, you can get individual group health insurance coverage for one.

To qualify for individual coverage you must be either a sole proprietorship (One Subscriber Group) or as an employee of a company who is the only person (Group of One) that needs health insurance coverage.

What the heck is a One Subscriber Group (OSG)?

Best defined as an individual who is a sole proprietor or owner (shareholder) of a Michigan based business.  You must be a Michigan resident.  You do not have any eligible employees who work on a full time basis with a normal work week of 30 or more hours, who do not contribute towards any heath insurance coverage.

That’s fine, How about Group of One?

A GOO or group of one is an employee of a Michigan based company who works on a full time basis with a work week consisting of 30 or more hours and is the only person in the company who is seeking employer paid health insurance coverage.

What kind of stuff do I need to qualify?

Great question.  If you are a OSG / One-Subscriber Group – Sole Proprietor with only one eligible subscriber / owner you need the following:

• Group Enrollment & Coverage Agreement
• Enrollment Application
• Group Underwriting Roster
• Tax Documentation
• Copy of Proprosal
• Check for first month’s premium

For a Group of One ( GOO )

• Group Enrollment & Coverage Agreement
• Enrollment Application
• Group Underwriting Roster
• Federal Tax ID Number proof (must be printed)
• Copy of Proposal
• Check for first month’s premium
• MESC Wage Detail Report for most recent quarter (must be signed by owner)
  • If business is new – a detailed payroll is required
  • If business is new and has no payroll – W4 (s) required for everyone (including waivers)

If you have questions or require a copy of the required forms please contact us at broker[at]mymichiganhealth.com or toll free 888.320.5388