Individual Health Insurance In Texas May Change

Texas insurance consumer advocate is looking to get rid of the blanket authority of health insurance companies to decide what their policies will cover according to the article “Texas Consumer Advocate Wants Ban on Health Insurers’ Blanket Clauses” by Terrence Stutz on DallasNews.com. This would cause a big impact on individual health insurance in Texas.

Deeia Beck, the Public Insurance Counsel, asked the state’s insurance commissioner to stop provisions present in many health insurance policies, called discretionary clauses. This gives health insurance companies the freedom to decide what benefits will get paid. The health insurance industry strongly opposes this type of change being made.

There are currently 22 states who have banned this clause, and Texas may be next. Insurance Commissioner, Mike Geesline, has held a hearing to consider whether or not to move forward with this proposal. The National Association of Insurance Commissioners has urged its members to stop this practice.

Individual Health Insurance Affected By Reform

The Senate voted for health care reform last week and changes are just around the corner. According to the article “Senate Approves Health Care Bill” by Robert Pear on nytimes.com, the passing of the bill will guaranteeindividual health insurance to millions of Americans and also keep health care costs down.

The new bill has many parts to it but one of the main points is that it would require most Americans to carry health insurance and it would add 15 million people to Medicaid to subsidize private coverage for low and middle income residents. The budget office believes the bill would offer coverage to about 31 million uninsured Americans but still leave an unsettling 23 million uninsured by 2019.

If this bill does end up becoming a law it will be a major milestone in US history. This initiative does not carry full support from both sides of Congress which makes it even more complicated. Only one Republican voted for the House bill last month and in regards to the Senate version, no Republicans voted for that. This my end up being counterproductive as government tries to improve our health care system.

Health Insurance Tips

Review your health insurance policy and make sure you know coverage limits and exclusions. For example, health insurance typically excludes most dental profit. Understand that if you have a medical condition that result in damage to your teeth, while the medical condition may be covered, dentistry to restore your injured teeth may not be.


Understand your responsibilities under your health plan. Have you chosen a primary care provider (PCP)? Do you need a transfer from your primary care supplier for services and events your PCP cannot provide? Have you received written confirmation that a requested referral has been accepted, or, if you need authorization before a written notice has time to get to you, have you called your insurer to make sure they have certified the referral? Have you recognized with your insurer that the services your PCP has made a referral for are services covered by your health plan?

Keep your insurance ID card handy. Don't hesitate to pick up the phone and call the number on your insurance ID card for support in understanding any part of your policy you don't understand. Call your insurer if you get a bill, a referral, an explanation of benefits form or other document you don’t understand. Other sources of assistance include your insurance agent and your human resources department if your employer provides your health insurance


Keep good files. Know where to find your policy or benefits booklet. Keep copies of any health insurance linked documents you receive from your insurer, agent, human resources department or health care provider in a file you can easily locate. If you call your insurer, agent, human resources department or health care provider regarding an insurance issue, keep a pad of paper handy. Ask for the name of the person you are talking to and make a note of what you discussed, being sure to indicate the date and time of your call.


Know your rights. You have a right to receive a response to a request for authorization of services within two working days. If your insurer denies a request service on the grounds that the requested service is not medically necessary, your insurer must send both you and your supplier a written notice explaining why it believes the requested service is not medically necessary. The notice must advise you of your right to obtain any clinical criteria or information relied upon by the insurer in reaching its decision. The notice must also advise you of your right to appeal the decision. By law you are entitled to appeal any health insurer decision you disagree with. If you lose your appeal, your insurer must sent you a written notice identify the names and credentials of the persons who made the decision and explaining the reasons for the decision. You have the right to the information relied upon by your insurer in arriving at their decision. You have the right to a second level appeal. You have a right to attend and be represented at any second level appeal. If you are not content, you have the right to complain to the Bureau of Insurance.

Health Insurance Companies Easing Burden of High COBRA Costs

Senate Health Committee Chairman, Senator Kemp Hannon, announced a part of the recently adopted a new budget, which enables health insurance companies to carry individuals under their parent's policy to age 25, instead of age 19 for those who do not go to college and 23 for those who do.

The part of the bill, announced at a University Student Center during a June 1 press conference, will be a relief to many parents and young people facing extremely high COBRA costs when their child reaches the age of ineligibility under their plan, but is either still in school or searching for employment. The legislation also assists those young 20-somethings who are bearing the brunt of their own health insurance costs by enabling them to obtain health insurance coverage through their parents.

"We have to be realistic," Senator Hannon said. "With double and triple majors and five-year master's programs, many of our young people are not graduating college when they are 21 anymore. Burdening them and their families with COBRA costs is unfair."

Health Insurance Q&A for Small Business

This health insurance question came to me recently and I thought it worth sharing:

We are meeting with our health insurance broker tomorrow to review and select options in providing our employees HMO/PPO health insurance benefits. We have many options, and many rates in front of us between two insurers. Would you be able to suggest a few key critical review questions we should be asking our broker both from the perspectives of 1) lowest cost options to the company and 2) acceptable employee options? We have under 50 employees now, and are going to contribute 50% to the plan for the employees. None of us are experts in benefits, so we want to be sure we are making the choices in both the best interest of the company and to our employees which range in age from 22 to 75, half of which are over 50.

From a benefits perspective, you certainly know more about what it takes to attract and retain employees in your industry. My recommendation is to make sure you get all the numbers to make your health insurance spreadsheet for comparison and know how high a health insurance deductible your group will be able to tolerate (the higher the health insurance deductible, the lower the monthly health insurance rate). Depending on the group of employees and creative strategies allowed in your state, some companies are able to create reimbursement packages for employees such that they buy their own health insurance and/or receive HSA contributions from the employer.

Buying health insurance will be an annual exercise for your company, and of course there are other options such as employee leasing companies that can handle all of these details for you. Be sure to check out news stories (such as those from the LA Times and the Wall Street Journal) on these health insurers as well as to check them out via the free online databases in the health insurance resources center. You may also wish to make sure you are considering all of your options by looking at the insurers rated best at in the health insurance resource center and ensuring that you have health insurance quotes from them.

California Children at Risk of Losing Health Insurance Coverage

Thousands of California children could lose health insurance coverage in the coming months as a result of changes in Medi-Cal rules and decreased funding for local efforts that have provided coverage to children, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.

State lawmakers will require parents of children enrolled in Medi-Cal to renew their enrollment every six months.

The administration of Gov. Arnold Schwarzenegger (R) projects that the requirement will contribute to a drop in Medi-Cal enrollment over the next two years of about 196,000 children.

State lawmakers also have increased monthly premiums for Healthy Families, California's version of the StateChildren's Health Insurance Program, by $2 to $3 per child.

As a result, the state estimates that the parents of 19,000 children no longer will receive coverage through the program by July 2009.

The changes to Medi-Cal and Healthy Families were approved as part of a larger effort to address the state budget deficit.
Local Efforts.

Beyond changes to Medi-Cal and Healthy Families rules, children also could lose coverage because of funding challenges faced by local initiatives operating in 30 counties. The efforts target children who are ineligible for Medi-Cal or Healthy Families because of income or citizenship requirements.

The initiatives are funded largely by private philanthropies and local First 5 commissions, which disburse funds from a state tobacco tax for early childhood health care and education efforts.

Wendy Lazarus, co-president of the advocacy group Children's Partnership, estimates that enrollment in the efforts has dropped by 8,000 over the past two years.

Public Health Insurance Would Be Too Good and We'd Like It Too Much

A common thread is emerging in the right wing response to healthcare reform. Its opponents aren't claiming that public healthcare will be bad. Rather, they are terrified that the new system will be so good that no citizen would buy expensive private insurance--or vote for politicians who wanted to take public insurance away.

The Obama team is sending clear signals that healthcare reform is a core economic issue, and the health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare costs under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation, if they have insurance at all. Healthcare reform is a pocketbook issue for all of us, according to the Obama team.

In tough economic times it might be tempting to postpone healthcare reforms, but Obama is adamant that delay would be a false economy.

In the American Prospect, Joanne Kenen and Sarah Axeen support claims about the high cost of doing nothing:

A recent report by the New America Foundation's health-policy program estimates that the cost of doing nothing about health care, including poor health and shorter lifespan of the uninsured, is well above $200 billion a year and rising. That's enough to cover the uninsured and still have some left over for other public-health needs.

If healthcare costs continue to rise at their current rates, it will cost $24,000/yr to insure a family of four by 2016, an 84% increase from today. At these rates, half of American households would have to spend at least 45% percent of their income to be insured.

In the Nation, Willa Thompson describes how a bicycle crash made her appreciate the connection between healthcare and politics. Thompson was 21 years old when she suffered major injuries after a collision with a truck. Luckily, she was covered by her parents' medical insurance until she turned 22. She later realized that if she had been just a few months older when the accident happened, she wouldn't have been able to pay for her medical care.

We all agree that something needs to be done. Let's briefly review the options that have been proposed so far. Obama wants to provide healthcare for all by requiring private insurance companies to cover everyone and creating a public health insurance plan to compete with private insurers. The second part of his plan is the public option that Republican opponents are so scared of.

The Truth on Health Care Reform and Taxes

First, the health insurance reform bill being considered in the Senate does not raise taxes on families making less than $250,000 – in fact it is a substantial net tax cut for American families. The bill being considered represents a substantial net tax cut for middle income families. According to the independent Joint Committee on Taxation, the bill will provide nearly $450 billion in individual income tax cuts over the next 10 years.

Second, the excise tax levied on insurance companies for high-premium plans, the so-called "Cadillac tax," will affect only a small portion of the very highest cost health plans – a total of 3% of premiums in 2013. The vast majority of health plans fall below the thresholds set in the Senate plan and would be completely unaffected by the provision. And those that are above the threshold would only face an excise tax on the generally small portion of the plan that exceeds the threshold. As a result, based on analyses by the Joint Committee on Taxation, only about 3% of premiums will be affected by this provision in 2013. In addition, the Senate plan provides special protections to plans held by workers in high-risk professions – like police and firefighters – as well as by those over 55.

Third, for the small sub-set of plans that are affected, the primary impact of this provision will be to increase workers' wages. Getting a pay raise is not what most people would call a tax increase. Economists agree by taxing the highest cost plans this provision will lead insurance companies to be more efficient and provide quality care to consumers at lower Even a report commissioned by the insurance industry's trade association acknowledged that: "[w]e expect employers to respond to the tax by restructuring their benefits to avoid it." As a result, employers will be in a position to increase workers' take home pay.

Finally, supporters of the status quo are supporters of continuing the hidden tax of $1,000 that the millions of Americans who get insurance through their job or buy it on their own are already paying each year to cover the costs of caring for those without insurance. Even if you believe that some of the tax on insurance companies is passed along, it would be more than outweighed by the benefits middle-class families would get from not only hundreds of billions of dollars in health care tax credits but from reducing the hidden tax they currently pay for the uninsured. Supporters of the status quo would not only deny middle-class families the tax cuts proposed in the Senate legislation, they would also continue this unfair hidden tax.