Friday, May 25, 2018

What's the Big Deal?

Our friend and colleague David Fluker tipped us to this Sunshine State news:

I replied that this was, indeed, a big deal, and several folks asked me why.

It's actually kind of interesting (well, to me, anyway):

Carriers in the group market - and particularly in the small group space - are often subject to something called "adverse selection." This occurs when a company buys a group plan, but only those with health issues actually sign up (or mostly those). As one can imagine, this isn't good for he carrier or,m really, the employer. A significant wand effective way to mitigate against that is to require that a minimum number (and/or percentage) of the employees sign up.

But what if Joe is already has coverage through his wife's employer, or the VA? Well, then he has what's called a "valid waiver;" essentially a "hall pass" to opt out, and not affect the group's eligibility.

But what if he has an individual medical plan instead. This gets tricky: depending on the circumstances, some carriers don't consider this a valid waiver and it does count, potentially threatening the group's eligibility (and thus whether or not the carrier will issue a plan).

So this decision by Anthem California could be a big boost to small employers looking for a group plan.

Thursday, May 24, 2018

Under Pressure

Our house is on a slab, through which run the heating/air conditioning ducts. Several years ago, we experienced several days with substantial rainfall, and the ground became saturated. We were awakened one night to a series of horrific 'thumps,' which seemed to coincide with the cycling of the furnace. After groggily getting out of bed to determine the source, we determined that the groundwater had penetrated micro-cracks in the foundation and seeped into the ducts, almost filling them.

As the furnace cycled, it sent waves through the built-up water, which was the cause of the thumping. Eventually, we were able to bail out the ducts (thanks, Shopvac!) and return to normal.

Turns out, we had experienced the phenomenon known as "hydrostatic pressure." Thanks to our friends at the Cincinnati Insurance Company, here's a video explaining what that is, and its effects:

What is hydrostatic water pressure? from The Cincinnati Insurance Company on Vimeo.

Wednesday, May 23, 2018

PKD, Insurance, And You

Recently, I had the opportunity to speak with the local chapter of the PKD Foundation (PKD is Polycystic Kidney Disease, a genetically-based condition that causes cysts to grow uncontrollably on one's kidneys, to ill-effect). As one might imagine, this creates ...issues ... for folks who have the condition and would like to buy (more) insurance.

I was asked to speak to the challenges of procuring disability income and long term care insurance, so I came up with a short PowerPoint presentation

Take-away: Don't  assume - It costs nothing to ask!

[Special Thanks to FoIB Randy G]

Tuesday, May 22, 2018

Dental Insurance Basics

Recently, the dental insurance carrier we've linked to in our sidebar list of Product Links notified us that they're soon discontinuing new sales. Fortunately, we have a backup carrier with similar products, so no big deal. But it reminded me that we haven't talked about how individual dental insurance coverage works. Please keep in mind that this information is fairly generic, you should absolutely see your own plan documentation for specifics.

Dental insurance is a way to transfer some of the risk of tooth-related expenses to an insurance company. Be aware that this is often a dollar-for-dollar transfer, and may actually mean only a discount in actual dental fees.

Dental health often gets short shrift when discussing insurance. I once had a client that died of a toothache, so the subject is more serious than one might at first believe. There are generally two types of individual dental coverage: insurance plans and discount plans.

Full blown dental

Dental insurance plans are available from a number of carriers, all of which have their own plan design, network of providers (if applicable) and pricing strategy. But there are benefits that most (if not all) carriers cover, and we'll consider these.

Benefits tend to fall into one of three broad categories: preventive, basic, and major. Pricing is generally per person, with a maximum family premium.

■ Preventive services
These are generally covered at 100%, and include items such as semi-annual routine exams and cleanings, and fluoride treatments for juveniles. Sometimes, this category of benefits will include periodontal (gum health) exams, as well.

■ Diagnostic and Basic services
These services are often subject to a deductible, and are more intrusive than preventive care items. Fillings are generally considered in this category; one new technique is called "composite," which replaces older-fashioned metallic fillings with ones that more closely match actual tooth material and color.

X-rays are also often assigned to this category. Many practices have moved to digital versions of these cameras, meaning that results are available instantly.

Simple extractions can also fall under this definition of covered services.

■ Major services
In addition to a deductible, this level of services is usually subject to co-insurance (often 50%), which requires the patient to more directly share in the cost of care. Root canals are found in this category, as are dentures and crowns. Today, the latter may be fabricated in the dentist's office for immediate installation.

Onlays and space mantainers, surgical extractions and other dental surgeries would also fit in this category and are usually subject to an annual maximum benefit amount. They almost always require one to be insured for at least a year before these benefits are even available.

Discounts ahead

As one might imagine, dental plans such as those described above can be expensive, and may be off-putting to budget-conscious consumers who nonetheless acknowledge the value and importance of dental health. A dental discount plan may be the ideal product for people in that situation.

■ How they work
Dental discount plans generally have no waiting periods, deductibles or annual maximums. They are simple to understand because they're not truly insurance products, but offer access to dental care providers at a reduced cost.

Typically, one pays a fee for access to a network of dentists and other dental-related providers willing to provide service at a reduced rate. These services can range from simple cleanings to gum surgery and dentures. One thing to keep in mind is that, unlike a traditional dental plan, payment for services rendered is due at the time of the visit; there is generally no bill-me-later option (although payment plans may be available for major benefits).

One More Thing

Most of these plans don't cover orthodontia, but one may be able to use a Health Savings Account for those services. That means Uncle Sam is helping to pay for your son's or daughter's braces, which helps reduce your net cost.

Dental insurance isn't for everyone, but it can be a cost-effective way to shift at least some of the dental health burden to a third party. It's important to know, however, exactly what's covered, and at what level. Discount plans, while less comprehensive, may offer a value in reducing net out-of-pocket dental expenses.

Monday, May 21, 2018

Or Else ... What?

Our friend Jeff M sent us this intriguing (and, frankly, puzzling) item:

"Treasurer directs Blue Cross NC to cut state health plans’ rates by 15 percent"

As I mentioned in the title of this post, what possible stick could the Treasurer wield to enforce this edict? One supposes that he could direct his staff to simply not pay the premium - that'll show 'em! The problem there is that then the policy gets cancelled for non-payment, and suddenly there are a lot of newly uninsured  North Carolinians.

I reached out to FoIB Michael Bertaut, an economist with Louisiana Blue Cross, for his take:

"This is pretty fascinating....”oh every Doc and hospital is getting a 15% pay cut on the entire state group!, screw with us and we’ll pay you Medicaid rates!

I just don't see this ending well.

Friday, May 18, 2018

CAHU Comes Through

Lord knows I've had my issues with agents' associations, but sometimes they really do get things right.

Case in point: the California Association of Health Underwriters.

Seems that CAHU [gezundheit!] is sponsoring  "a Health Insurance Awareness and Agent Awareness Campaign" to explain to people the folly of government-run health "care."

From CAHU:

"As the experts in our industry we have an obligation to educate consumers and employers regarding health insurance. This includes helping to shed light on what all of these terms in relation to “Single Payer” actually mean. The general public are hearing very different terms used interchangeably."

Absolutely spot on.

The event is next Tuesday (May 22nd) in Sacramento (click here for details).

[Hat Tip: FoIB Shari G]

Thursday, May 17, 2018

May Health Wonk Review is up

Jason Shafrin, our favorite health care economist, hosts this month's compendium of health care polity, policy and wonkery.


Really, and quite well done!