Wednesday, July 15, 2020

Timing is Everything (Still!)

Working on an interesting case, and thought readers would be, um, interested:

Sally called yesterday about individual medical insurance. Her husband had retired and is on Medicare, she still has a couple years to go until she's 65. In the meantime, her COBRA plan is due to run out in November, and she's trying to figure out her options.

There are a bunch of issues here, and we discussed them at length (she's my favorite kind of client, interested and engaged, asking really good, helpful questions). I'll cover just a few of them in this post.

First is timing: if she rides out her COBRA until November she's going to end up squarely in "regular" Open Enrollment Season at the very same time that she's eligible for her own Special Enrollment opportunity. Which means she'll be shopping for a 2-month-long 2020 ACA plan (if she goes that route) and a 2021 version. Which also means that she's going to have 3 annual deductibles in about 60 days (2020 COBRA, 2020 ACA, and 2021 ACA). Not a great place to be, but as I explained to her, pretty common when we're looking at plans this late in the year.

It turns out that she's met very little of her 2020 COBRA deductible, so she might be better served cancelling that sooner rather than later; that way, any expenses that crop up would go towards the 2020 ACA (or other) plan. On the other hand, her COBRA plan is pretty decent, and is a PPO, unlike current ACA plans that are built on the HMO model with pretty much in-network coverage only.

Another option we're exploring is a Short Term Medical plan, which offers better coverage and lower rates than ACA plans, but are underwritten and don't cover pre-existing conditions. That latter isn't really a problem, she's in good health now, but some years ago she had a cancer scare, and we're looking to see if that's going to rule out the STM option.

This is the kind of case I most enjoy: challenging issues, an attentive, engaged client, and the opportunity to look at some outside-the-bun options.

Grateful!

Tuesday, July 14, 2020

Fighting For the Children

It seems the L.A. Teachers Union has issued a manifesto to create safe schools . . . for the children.

The UTLA has decreed that Los Angeles Unified District schools effectively cannot reopen unless certain conditions are met.

And those conditions are?

  • Charter schools should be closed
  • Medicare-For-All ("free health care) is to be legislated
  • Tax the rich with a state "wealth" tax
  • Fund housing for the homeless
  • "Financial support" for illegal aliens
Perhaps I missed it, but how does this benefit the children?

And here is an interesting tidbit.

Many private schools and charter schools didn’t miss a beat when Gov. Gavin Newsom ordered schools across the state to close down due to coronavirus. Within one week, most were already up and running with online learning programs, while public schools took as long as 6 weeks to even start to prepare online learning. And private and charter schools have been preparing to reopen for in-class teaching once again.

So how does CLOSING private and charter schools BENEFIT students?

All this begs the question.

Is Marxism taught in L.A. public schools?

Asking for a friend . . .


Monday, July 13, 2020

CV-19 Claims Another

If you've ever bought a life insurance policy, you've probably (although not necessarily) had what we in the biz call a paramed exam. These usually consist of a nurse (or NP, etc) who takes your pulse, height, weight and samples of various bodily fluids, and then transmits these to the carrier. It's not really a big deal, but on any given day thousands (hundreds of thousands?) of folks undergo this process.

One of the more successful such vendors is - was - EMSI. I say 'was' because, well:
"COVID-19 has disrupted families, communities and businesses ... As a result, all company operations ceased on Friday July 3, 2020."

Yikes.

So what does this mean to the average person? Well, unless you were an employee or recently applied for life insurance, not much. If the latter, then expect to see underwriting delays while the carriers sort this out. I understand that at least one major company expects this to add at least two more weeks to the underwriting process.

Co-blogger Bob wonders if this may lead to more carriers adopting some kind of simplified issue process,and I think that may be correct: one of our carriers recently (well, within the past couple of years) introduced a product, in conjunction with its sister P&C company, to offer auto/home clients plans which require no application, exams or even paperwork. Pretty cool. So, it can be done, will be interesting to see if it will be.

[Hat Tip: Co-blogger Bob V and FoIB Brian D]

Friday, July 10, 2020

Dodged a Bullet: A Close Call Non-Client Story

So got a call from Sam, inquiring about possible health insurance options.

Sam has a policy he bought from a company that doesn't, in fact, sell insurance, but is some kind of pre-paid, limited benefit type plan with a $2,000 deductible and $30 co-pays and costs about $300 a month (keep in mind that Sam's in his mid-50's and in good health). Problem is, no one accepts this insurance, and he's not satisfied.

That's typical of these types of plans, which sound really great, until you have to actually use them. But, lesson learned (maybe), one supposes, and I'm happy to offer an alternative.

Since we're out of Open Enrollment season, and he didn't appear to qualify for a Special Open Enrollment exemption, I turned to Short Term Medical plan options. One of my primary STM vendors recently got rid of their (obnoxious, but apparently industry-standard) application fee, and offers a $2 million lifetime maximum on their plan (unlike pretty much everyone else's $1 million max). I found several alternatives priced competitively with his (actual junk) plan, albeit with slightly higher deductibles.

I had also asked him if he was, perhaps, self-employed, and when he told me that he was, I began researching whether he might be eligible for one of those new-fangled Chamber Plans.

So, I called him back with my good news.

And, surprise, he told me that since my STM offerings weren't going to save him any premium dollars, his current deductible was so much lower, he wasn't interested. Okay, but...

And he further informed me that, after speaking with a local hospital admin, and his current carrier, he'd been assured that if he was hospitalized the facility would have to treat him and the insurance would have to cover that.

Of course, that's NOT how EMTALA works.

So he's told me at least one lie, and who knows how many others, and all I can see is "Red Flag Ahead." I immediately cut the conversation short, and thank him for the opportunity to have at least tried to help him. He replied that he understood but was only rejecting the Short Term plan ... No thank you, and best of luck!

(Whew!)

 This was definitely not the type of customer (let alone client) that I'd want to take on.

Thursday, July 09, 2020

Revisiting the MVNHS©

It's been a while since we last looked in on Britain's Much Vaunted National Health Service©:

"A doctor said pressures at a Bangor hospital in January left staff in a "very deep hole"

But that was then, and this is, well:

"NHS must apologise for dismissing pelvic mesh and anti-epilepsy drug patients' suffering."

How's that?

When we as patients raise concern about our treatment with those providing it, it's only right that they at least consider what we're telling them. But apparently that's not how it works in one of the world's pre-eminent government-run health "care" systems:

"Since the review launched in 2018, more than 700 families from across the UK have given "harrowing details of their damaged lives ... fought for decades to "achieve acknowledgement" of their suffering."

Turns out, they've actually lost count of how many.

But hey: Free.

#Medicaid4All

[Hat Tip: Holly R]

Wednesday, July 08, 2020

Who Was That (Un)Masked Man?

An un-named insurance agent has been fired after a COVID-related confrontation at Costco. A video of the dust up surfaced on social media and the termination followed shortly thereafter.

 In the video post on Twitter, the man screams an expletive-ridden tirade telling the woman and a man who appears to be defending her to back up and stop harassing him and his family after he was asked to put on a mask and stay 6 feet away.

"You're harassing me?" the man says as he clenches his fists, to which the other man replies, "I'm not harassing you, you're coming close to me."

The man continues to approach the pair, yelling, "I feel threatened, I feel threatened! Back up! Threaten me again! Back the f--- up, put your f---ing phone down." - Yahoo News

Some folks just aren't meant to be in the insurance business.

No word on whether Costco revoked his membership

#COVID19Mask #Costco

So here's something VERY different...

For RPG fans and 3D printing aficionados.

Our good friends at Fat Dragon Games have launched their latest KickStarter, and it's a doozy:

"VALLIS MORTIS, the valley of the dead, is the campaign world created by Fat Dragon Games founder Tom Tullis over 35 years ago. Starting with this Kickstarter, and continuing with future campaigns, locations in this setting will be brought to life as richly detailed 3D printable models, and an accompanying campaign setting pdf will feature information on each location as it is released."

There are some incredible stretch rewards, lighted terrain options, and even detailed miniatures that rival the most intricate store-bought models.

And the world of 3D printing keeps getting more and more affordable, with decent printers starting at about $220.

So what are you waiting for?

Tuesday, July 07, 2020

Double dipping and CV-19

It's not just George Costanza:



Nicely done!

Now, how to get the word out to even *more* folks?

Felonious Consumer Tricks

Or, more precisely, murderous consumer tricks:

"Florida woman had hitman kill stepfather to collect on life insurance"

Which is actually kind of refreshing after the ubiquitous "Florida Man" memes of late.

Still, beyond the actual tragedy lies a fascinating, if horrifying, detail:

"Stepdad was killed two weeks after the insurance policy was changed from $25[thousand] to $750[thousand]." [emphasis added]

There's a lot to unpack here, starting with the obvious question of how,exactly, one might go about increasing one's life insurance (let alone someone else's)  by 30-fold without some kind of underwriting?

But of course, the MSM can't be bothered to report that little piece of info; too much trouble, one supposes. So I reached out to three reporters who covered the story, and Eli Witek of The West Volusia Beacon was kind enough to share the charging document with me (Thanks, Eli!). It's a bit confusing, but it appears that the the policy was, in fact, an accidental  death plan with a $750,000 face amount. My favorite part, though, is when Ms Williams says to the Mutual of Omaha rep "life insurance is not trying to kill somebody."

What's that word?

Oh, yeah.


In the meantime, we have other questions.

The investigation revealed that Williams’ motive was an insurance policy, which she recently had increased the value in the event of Mr. Gibson’s death."

Well, yeah, three quarters of a million dollars would be classified as a decent motive for murder (even by Angela Lansbury's criteria).

As we've noted previously, it's generally considered illegal (and, of course, poor sportspersonship) to profit from ones' crime, but we also know that this isn't always the case:

"Judge rules Denver man who 'killed his wife' can use up to $500,000 from her life insurance to pay for his defense"

Be interesting to see if Ms Williams can tap that $750,000 policy's proceeds for her legal fees.

Monday, July 06, 2020

Let's talk about those "Non-Existent" Death Panels

Our friend Holly R tipped us to this post at Hot Air:

"Disabled man with COVID-19 left to die of starvation in Texas over “quality of life” judgment?"

Michael Hickson, a 46 year old Lone Star State citizen, was diagnosed with COVID.

He was also paralyzed with a brain injury.

Certainly not a likely candidate for a long, healthy life.

But: he seemed to be recovering, kinda:

"[H]e was moved out of the ICU, was stable and breathing on his own, and that hospice care would be calling her. "

Why hospice?

Well, because shut up, explained the doc and "the state."

And that's where it gets, well, fuzzy:



Pay special attention to the doc at 3:21, where he explicitly says "at this point, we are going to do what we feel is best for him, along with the state." [emphasis added]

So first, who is this we you're referring to, Doc, and what do you mean by "the state?"

The closest explanation of the latter that I could find was that the patient victim had been appointed a guardian 'ad litem' as the result of an intra-family dispute. But it seems a stretch to go from guardian "only for the duration of a legal action" to agent of the state, replete with the power of life and death (but mostly death).

And let's circle back to that initial statement, itself particularly chilling:

"This is a calculated decision, we feel like this is what is going to be best for him."

Who thinks this is best for him? Hickson certainly didn't seem to think that:

"He was still responsive, puckering his lips when she said “Can I get a kiss?” and answering that he would like her to pray with him."

Well, now we know.

And there's this: there is perhaps an argument to be made for withholding life support for someone in, say, an irreversible coma (although even that presents challenges). But Mr Hickson was certainly awake and cognizant of what what was happening, and from what we can tell was not asking for a referral to Dr Kevorkian.

This case has an overwhelming stench to it.

Friday, July 03, 2020

Happy (And Safe!) 4th of July

Our friends at the Cincinnati Insurance Company's blog have some tips for enjoying the holiday weekend, especially in this modern era of social distancing:
• Read your grill's/smoker's instructions and owner’s manual.

• Place the grill well away from the home, deck railings and out from under eaves and overhanging branches.

• Keep the grill clean and check for grease and fat in the drip pans before firing up the grill [ed: especially important when using gas grills/smokers]

• Use only charcoal starter fluid to start a charcoal fire – never gasoline [ed: better yet, use lump hardwood and a chimney]

And more at the link.

Enjoy!

Thursday, July 02, 2020

Off Topic: Unemployment Comp

While this isn't really in our wheelhouse, the Fed's have provided us with this helpful video, "to better assist you help consumers impacted by COVID-19."

On second thought, it is, after all, unemployment insurance, the "premium" for which every employee pays.



Oookay:


Wednesday, July 01, 2020

Medicare (Re-)Certification: Are you kidding me?

Got this in email:

"Things to pay attention to when doing your recertification:

New Kids- plan to do one section a day over a course of days cause it’s REALLY boring! It will take you about 12-14 hours to complete including the exam.

Recerts- it will take you 4-6 hours approx. You will need to click into EACH section to download the slides and then you are required to take the quizzes at the end of each section."

Well first, up to 14 hours? That's ridiculous. And keep in mind that, unless one pays an additional fee, they don't count toward one's Continuing Education requirements (TBF: Same with ACA certification/re-certification).

If this does nothing else, it should definitely discourage lay people from trying to DIY their supplemental Medicare coverage.

Finally, because we so value the 1st Amendment:

"Section 4 has more and better examples plus clarification on what you can do/not do on social media."

Or else, what?

#Overreach

[Hat Tip: Amanda B]

Tuesday, June 30, 2020

This word, "accident"....

I must admit, this story (courtesy of FoIB Jeff M) surprised me:

"The family of the first known South Florida first responder to die from COVID-19 was crushed by his loss. Now, they feel like they’ve been dealt another blow, after the AIG insurance company twice denied their claim for an accidental death in the line of duty."

They were paid the face amount for his death, but for some reason think that dying of what is essentially the flu is the same as, say, getting shot or hit by a car.

Who thinks that?

Well, Deputy Shannon Bennett's brother does:

"He says the family was stunned that COVID-19 did not fall under the category of an injury or accident."

Why is this "stunning?" Would they have expected this if he'd had a heart attack or cancer?

And of course, this somehow makes AIG a villain:

"We want to make sure that any other agency that is partnering with AIG would potentially completely dismantle their relationship."

Dude, you're going to find that no carrier is going to classify such a death as "accidental."

Except, as Jeff M also notes, "How long before AIG caves to the mob?"

#CromulentPoint

Saturday, June 27, 2020

Bad Boys, Bad Boys [Updated]

[Scroll down for update]

Brian Bartz, 38, of Rochester, NY, was arrested and charged by criminal complaint with wire fraud, attempted wire fraud, and aggravated identity theft. The charges carry a maximum penalty of 20 years in prison. Justice.gov

Comment: Charged but not (yet) convicted . . .

Still . . . 


over the past five years, the defendant has been employed as an insurance broker by several different life insurance companies including: the Benjamin Hollamby Agency, which sold life insurance policies on behalf of Nationwide Life Insurance Company; the Banker's Conseco Life Insurance Company; Mass Mutual Life Insurance Company; and the Lavoro Group via Mass Mutual, located in Rochester.

Five years and just now catching up with him.

Just what did this rascal allegedly do?

Bartz would submit false applications for life insurance policies to the insurance companies on behalf of individuals who were not aware of these applications. The applications included individuals' means of identification without their knowledge or consent. In order to avoid detection, the defendant used various victims' bank accounts to pay the premiums for the unauthorized policies. Between 2015 and 2020, Bartz defrauded or attempted to defraud a number of life insurance companies and dozens of investors out of more than $950,000.

Quite a busy guy.

Stay tuned for more.

UPDATE [From HGS]: The scope of this fraud is simply astounding and, as was pointed out in the comments, it's unclear how the perp agent actually profited from it. I think I might have at least a partial answer:

Depending on his level of production with the carriers, he may have been eligible for significant commission "overrides" (kind of like production bonuses). Many years ago, a friend of mine told me about a scheme that he had learned about where the agent's compensation for a case was 125% (and please forgive me if I'm fuzzy on the details, this was a long time ago). The deal was that he'd go to his clients and say "here, buy this policy an I'll give you back the entire premium, and you'll have a year's free insurance." Yes, this was illegal, unethical, immoral and likely fattening, but at least his clients knew about it.

The article also notes that at least a few of his victims made "premium payments to him directly instead of to the life insurance company with which they had or believed they had a policy."

We've seen how well that works out.

Friday, June 26, 2020

The Latest Case for Health Care Transparency

Well, health care cost transparency, anyway.

We've long been advocates of this concept; all the way back in '05, we had an exclusive interview with one of its earliest architects:

"Recently, I had the opportunity to interview Dr Dexter Campinha-Bacote, Aetna Medical Director ... this is a great example of consumer driven health care (CDHC) ... These employers asked Aetna to develop tools that their employees could use to make “better informed decisions.” One of these tools is the pilot transparency program."

Over time, I became enamored of what I named "The McDonald's Model," which was eventually manifested most explicitly by a clinic in Southern California. Again, the emphasis was on providers giving consumers the price of their services up front, just as Ronald McDonald or Burger King tell us how much that burger and fries is going to cost.

Now, FoIB Steve Downey alerts us to the latest development:

"Trump White House wins court ruling upholding plan to require insurers and hospitals to disclose prices"

Well first, good on them - it's been a slog.

Second, it will ... interesting ... to see how (if?) this is actually implemented. As it is, the ruling seems to apply only to "the actual prices for common tests and procedures," the idea being that this will encourage competition and thus lower costs. Obviously, we're all for that latter, but I remain skeptical that this will actually be the end result.

For once, I hope to be proven wrong.

[Hat Tip: FoIB Shari G]

Thursday, June 25, 2020

Up, up and away (Finally!) [UPDATED]

[Scroll to bottom for update]

Our friends at Global Underwriters have some hopeful news about short-term travel trends:
1. Airlines are enacting policies to make travelers feel safe again, as well as outline security measures (I.E. testing or certification to board flights) that are being taken, in order to allow passengers back on planes.
2. There are still hundreds of thousands U.S. Citizens and Foreign Nationals stranded outside their home country.
3. Some Domestic meetings that were postponed might be moved to the fall, hopefully creating a strong fourth quarter for hotels and restaurants that were able to reopen.
4. International Travel will resume at a moderate pace depending on the country, but it will probably take 3-6 months minimum before things start to look normal again.

So it looks like, although few folks are currently traveling, that may soon change as the country continues to "open up." And it's not just the obvious things, like camping or vacations, but other, less-obvious situations:

"[V]olunteers, part-time staff and participants working at food banks, shelters, or on natural disaster response teams, etc. that are rarely covered by workers compensation policies."

These folks (or rather, their employers/sponsors) can obtain coverage via "domestic Special Risk Accident coverage to help fill in the gaps and mitigate financial exposure for the organization that they work for."

Nice!

UPDATE: Click here for even more helpful info, including Business Travel and International Travel insurance trends.

Wednesday, June 24, 2020

*Another* oustanding customer service experience

Here's a tip: if you're going to use your cell phone to time the burgers on your grill, best practices dictate that you remember to bring it back into the house with you when they're done.

Especially if there's rain in the forecast.

So I awoke Monday morning, bright eyed and bushy tailed, and reached for my cell phone.

Which was not where it was supposed to be.

I eventually found it next to (you guessed it) the still-open grill. Hit it with the compressed air and threw it in rice, and hoped for the best. Twenty-four hours later it turned on, and I could access notes, calendar and contacts, but couldn't charge (and thus couldn't back up) [ed: and please don't get me started on The Cloud]. My better half suggested that I call the folks at Batteries+ (which also does some cell phone repair work). After asking me some questions, they referred me to Gem City Digital (a few miles up the road). I called Gem City, described the issues, and they said "bring it on in, we have a $30 service where we take it apart, dry it out, repair any water damage and try to fix the problem. And if we can't, well, it's only $30 [which is a fair cop], And no, you don't need an appointment."

Nice!

So I headed on over, they took the phone to their workshop, and a few minutes later told me that they couldn't find any water or water damage. but that the charging port seemed to be the culprit. They hooked up a new one to check that theory, and a short time later reported that the phone was indeed charging. I asked about the cost and they said $45, which seemed more than reasonable to me.

So, a few minutes later they were ringing me up, and said the charge was $48.

Wait, what? Shouldn't that be $78 ($30 service charge plus $45 for the new charging port and tax)? "Nope, $48 is what we think is fair."

And they didn't even have a tip jar!

Highly recommended.

Tuesday, June 23, 2020

An interesting conundrum

Offered without comment:



Well?

Monday, June 22, 2020

Fees, fees and more more fees....

Our friends at FlexBank remind us that the "requirement to file and pay the annual PCORI fee is just around the corner."

And just what is this PCORI fee, you wonder?

Well, it's an acronym for the Patient-Centered Outcomes Research Institute, which "funds studies that can help patients and those who care for them make better-informed healthcare choices."

Oh goody.

Anyway, the ACA requires health plans, including employers with Health Reimbursement Arrangements (HRAs) to pony up these fees each year. And they can add up, too; as FlexBank notes:

"The IRS has announced the applicable PCORI fee is $2.54 for HRA plan years ending on or after October 1, 2019 and before October 1, 2020."

While that may not seem like a lot, it adds up: the Feds estimate that upwards of 11 million folks are covered by these plans, so we're really talking about almost $28 million.

Not too shabby.

Anyway, the fee is due no later than July 31 of the calendar year immediately following the last day of your HRA plan year.

And now you know.

Friday, June 19, 2020

Queen City Trifecta

Our friends at Cincinnati Insurance also have a blog, and there are currently several noteworthy posts that  may be helpful to our readers:

First up, something that a lot of folks don't seem to understand about their home and the insurance thereon: the market value is not (necessarily, or even generally) the same as the replacement cost. That is, the home's value in the eyes of the realtor is going to be very different that what an insurance underwriter sees:

"Market value is the selling price on the open market — how much someone will pay for the property ... Replacement cost is the price to rebuild the house in the event of a total loss."

A distinction lost on more than a few, sometimes to their detriment come claim time.

■ Second, Spring and Summer tend to bring big-time storms, often accompanied by copious amounts of lightning. Matt Hunter brings us the latest preparation (and prevention) tips from the Insurance Information Institute.

For example:

"Before the storm:• Plan ahead when going outside, so you can get to a safe place quickly if thunderstorms develop• Know the weather patterns in your area and listen to the weather forecast for any outdoor area you plan to visit."

And lots more.

■ Finally, if you're a business owner (or key employee), there are insurance-related steps you can take to mitigate some of the risks associated with severe weather in the age of COVID:

"[P]lanning for natural disasters is an inevitable and necessary part of every disaster preparation or business continuity plan. But how effective will these plans be in the midst of the current COVID-19 pandemic?"

There's no doubt that these uncertain (but not unprecedented) times offer some unique challenges, and this post from a pair of loss control specialists has some very helpful suggestions, and some areas of concern that folks may not have considered:

"Shelters – Shelters may need to be reconfigured to accommodate social distance guidelines. Decreased occupancy rates at hotels may present a viable shelter option to maintain social distancing."

More at the link.

Thursday, June 18, 2020

And speaking of Long Term Care

Yesterday we discussed the value of information gathering and the Long Term Care insurance buying process:

"While I certainly encourage my clients to be informed consumers, there's a point where that becomes "information overload," and one simply shuts down, unable to make an actual decision."

That was really about product design (and budget, of course) before actually needing care.

But a key piece that did not, in fact come up, is the cost of the care itself. And of course, that information would be quite helpful in evaluating insurance solutions, no?

Well, our friends at Mutual of Omaha have updated their Cost of Care Calculator, and are once again making it available to the general public. With it, one can search for long-term care costs by state, and even see what those costs might look like five, ten, up to twenty years in the future. Wouldn't that be nice to know?

The calculator is *here - I really encourage you to take it for a spin.

Wednesday, June 17, 2020

Analysis Paralysis*

Back in April, an agency client (we'll call him Mark) inquired about Long Term Care insurance (LTCi). As usual, I forwarded the link to FoIB Herman Bruns' evergreen primer on purchasing this valuable coverage.

Yesterday, I received this in email:

"Hi,

Just wanted you to know I am still here, just sidetracked with other responsibilities.

I am back to reading about LTC. 

Also I am curious about the combination policies that link together LTC and universal life [ie hybrid plans]; not sure I understand the death benefit. If I don't use the LTCi funds my heirs would receive a death benefit i.e. life insurance?  But you put a lot of money in upfront? Not sure how that compares with annual premiums.

Lots of questions. and apparently one can decide on certain components of traditional LTC.

I am almost at the time where we need to talk
."

So, rather than try to answer all that via email, I called him.

The conversation ran for almost an hour, but I took away a few key points that I thought would be helpful to our readers.

First, I told Mark that, while I certainly encourage my clients to be informed consumers, there's a point where that becomes "information overload," and one simply shuts down, unable to make an actual decision.

And that would be bad.

Why?

Well, to paraphrase a dear friend:

The best LTCi plan is the one that is in force on the day you enter the nursing home.

The worst plan is the one that you never bought, and so wasn't in force when you needed it.


So ultimately, it doesn't really matter which plan you buy, as long as you make the conscious decision to either pull the trigger or self-insure.

Now, one may quibble as to which plan design represents the "best bang for the buck," and I'm happy to have that convo, as well. But the bottom lime is that a well-designed plan, that fits one's budget (both current and projected) is the goal.

It really is that simple.

(* Thanks, Jeff M!)

Tuesday, June 16, 2020

OffBeat BluesNews

First up, this item from our friends at GeoBlue (one of our travel medical plan vendors):

"The last thing you want is for one of your clients to be surprised by their coverage, or lack thereof, while living abroad ... it is important to understand options available and how pre-existing coverage may vary between competitors. Preexisting conditions may be covered from day one, pending proof of credible coverage."

This is indeed a critical point, and one that may get short shrift, especially when dealing with folks not just on a cruise or vacation, but especially those who have decided to move to a different country. Regular readers may recall the strange case of Courtney Wilson, for example.

The GeoBlue folks explain that their ex-pat plans "strive to cover as many pre-existing conditions as possible" (at a price, of course).

So, something to consider when contemplating that move abroad.

"Hey Alexa, what does 'co-insurance' mean?"

Yup, the hi-tech folks at Anthem are now offering a direct line from your Alexa device to a number of online services, including:
• Access to their health savings account (HSA) or health reimbursement account (HRA) balance
• Ability to check how close they are to their health plan’s deductible or out-of-pocket amounts
• Help finding definitions for more than 200 insurance terms

And more.

This can even include access to dental plan info (where applicable).

Caveat: Might want to avoid calling out "Hey Alexa, it hurts when I do this."

Just sayin'.

Monday, June 15, 2020

Clickbait Uber Alles

I am often amused by the lengths to which clickbait sites will go to generate traffic. Recently, FoIB Holly R tagged me in a Facebook post with the scary tite:

"Coronavirus survival comes with a $1.1 million, 181-page price tag"

Oh noes!

Of course, the article itself eventually belies the headline (we'll circle back to that).

Regular readers may recall the 2018 story of the "the young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue,"and whose parents were ostensibly sued for $132,000.Of course, that tuned out to be clickbait, too:

"All the city did was file an insurance claim," Overland Park communications manager Sean Reilly told CNET ... We are NOT seeking payment from the family"

And so it is with the Coronavirus patent mentioned aboive:

"The bill is technically an explanation of charges, and because Flor has insurance including Medicare, he won’t have to pay the vast majority of it."

Oh. So not a bill.

The reason I am so amused by these is the credulity demonstrated by my fellow citizens who immediately condemn these episodes as some sort of indictment of the American health care system (which, to be sure, is far from perfect). This is because we're reluctant to have the real discussion: how much should this treatment cost? And who decides whether that patient is actually worth it?

And, of course, the post generated the usual "oh, you poor Americans, the Canadian government-run model is so much better and more efficient."

The cognitive dissonance is truly a sight to behold:

The article explicitly (if belatedly) explains that this actually ocuured under a government-run system, and one which certain policitcos have expressly advocated that we should apply to every American: Medicare.

Sheesh.

Friday, June 12, 2020

Alphabet Soup & CV-19: The Latest

From our friends at FlexBank:

"The COVID-19 relief measures and benefit plan compliance changes keep coming at a rapid pace. Recently, the IRS issued additional notices (beyond the provisions of the CARES Act and the DOL guidance released on April 29th) that further relax rules related to group health coverage and Section 125/FSA benefits."

Specifically, this news applies to an employer's POP (Premium Only Plan), also frequently (and not quite accurately) called a Section 125 Pan.

Briefly, a POP plan is what enables an employer to deduct the employees' portion of the group health insurance premium pre-tax, which generally result in decent savings for both the employer and the emnployee. The plan document is the magic wand that allows this to be considered legit by the IRS.

Oh, and what are those changes?

For example:

"Employees may make a new election to enroll in employer-sponsored health coverage on a prospective basis if the employee initially declined to elect employer-sponsored health coverage."

And there's more - click here for the whole picture.

Thursday, June 11, 2020

Outstanding Vendor Service

My better half has a rather long commute to and from work, most of which is highway miles. As one might imagine, this has resulted in quite a few little chips and dings on her car's hood; last year some gravel really did quite the number on it, and we finally got around this year to having that fixed.

(We went the self-pay route on this, since it was fairly minor and it didn't seem prudent to file an insurance claim)

After getting a couple estimates from local body shops, we selected the Collision Center of Dayton.

Why them?

Well, primarily because Marty (the manager, who also did the estimate) just struck me as a genuinely honest and helpful person. He stressed how important it was that the newly-painted hood match up with the fenders (which were *not* being re-painted), and he spoke about how his "paint guy" was one of the best in the business at this sort of thing.

It also didn't hurt that his estimate was about 20% lower than the other fellows (for the same exact job).

And I also liked that he made a point at the initial appointment that, no matter who did the work, we should follow up in a month or so with a plastic shield (from another vendor altogether) to prevent this sort of thing from happening again.

We dropped her car off on Tuesday morning, assuming it'd be available for pickup this afternoon. But they actually called yesterday about noon to let me know that the car was done. Wow!

So we drove over, and the car looked beautiful, there was literally no indication that it had ever been damaged. Which was what we were promised, and they delivered. But what really stood out was something very small, but tells you everything you need to know about the pride they take in making their customers feel special: they had also cleaned the inside of her car.

We would never have expected that, and it just underscores the value they place in providing excellent customer service.

Recommended!

Wednesday, June 10, 2020

Can I Have Medicare Advantage AND a Medicare Supplement?

Yes, but why would you want both?

If you have an MA plan and apply for a Medigap, one of the caveats on the app states "You don't need both an MA and Medigap plan".

Of course no one ever reads those things.

That includes some agents . . .



If you have an MA plan and enroll in a PDP (Prescription Drug Plan), you are automatically disenrolled from your MA plan. But if you only buy the Medigap and forgo the drug plan, your MA plan will continue without missing a beat until YOU cancel the plan.

If you keep the MA plan your Medigap carrier will never see or pay a claim.

Essentially you are paying for worthless coverage.

Tuesday, June 09, 2020

Riddle Me This: A Health Insurance Premium Update

So, a few weeks ago, we noted this challenge:

"I’ve gotten $100 back from my auto insurance company because of the decrease in traffic. With health care utilization down as much as 70%, where’s my check from my health insurance company?"

At the time, we posited a few answers, and were even provided a credible rebuttal:

"Only 3% of our April claims were COVID related. And no guarantee the avoided elective procedures won’t skyrocket now. Not the same thing."

But that was then, and this is now.

A small group client just received this from Anthem:
"We continue to look for ways to provide support and financial relief to you and your employees during the COVID-19 emergency.
Shelter-in-place orders across the country have caused significant disruptions to traditional patterns of care. As a response to these challenges, we are supporting our customers by issuing you a premium credit based on your April 2020 invoice."
That is, a credit on their August premium representing 10% of what they paid in April. Is this too little too late, or simply a nice gesture acknowledging the pain we've all been experiencing? I'm in the "don't look gift horses in the mouth camp," and grateful.

#YouMakeTheCall

Monday, June 08, 2020

Clickbait or Fact: Riots and Your Health (and maybe life)

So here's a pretty relevant question:

Does your health insurance cover your expenses if you're injured in a riot?

And what, precisely, does "in" mean here?

As we learned from last week's post on homeowner's insurance, the definition of a word is often (usually? always?) relevant when we're speaking of what's covered and what's not.

Okay Henry, what's your point?

Well, FoIB Bill M sent along a link to this little item:


And indeed, this appears to be very much the case.

In researching this post, I learned a few things, myself:

First, as usual, consulting the exclusions of a policy is generally pretty helpful in determining whether or not you have a valid claim (we'll circle back to this).

Second,the type of plan you have matters: individual versus group plans, even from the same company, may treat the issue differently (and indeed, one such carrier's individual plan has no exclusion for riot-related claims, while their group plans do).

Third, and I think this may the be the most important distinction of all: among those plans which exclude riots (and/or civil unrest), some exclude only those injuries resulting while an active participant, while others just exclude any and all riot-related expenses. This is important, as we've seen innocent folks pulled from their cars and others hit in the head by bricks thrown at them from yards away.

Oh, and what about other kinds of insurance? Well, turns out that, in general:


·         Life insurance (no longer) has no such exclusion, but Accidental Death riders may
·         Some individual disability plans do exclude riots/civil unrest, and some don't
·         Group plans seem to ...


And what about the Big Daddy, Medicare? Well, that also kinda depends. According to Kaiser Health News, "Medicare, the insurance program for people age 65 and older and people with disabilities, doesn’t have these exclusions."

BUT: Medigap policies (Supplements) typically follow Medicare's lead on what's covered or not, but that doesn't seem to be universal. For example, Viva Medicare Select Plus says:

"... the following items and services are not covered by ViVa Medicare Plus Select:47. Services required as a result of participation in a riot"


Hunh.

As usual, check with your own agent or carrier (or simply look up the exclusions in your policy itself). In this case, it really does pay to be informed.

[Special IB thanks to Brian D, Tana H, Beth D, Fred W, Michael B, Roger D, and co-blogger Bob V]