COBRA versus Subsidy for COBRA (18 vs 15 months)

This week I have been asked about this so many times that I wanted to address some confusion concerning federal COBRA.

Federal COBRA runs a standard 18 months, not 15 months. There are cases where it can be 29 months (disability extension) or 36 months (divorce, separation, death of the employee, state extension or dependent age-off of parent's plan). Generally it runs 18 months for most people.

The subsidy for COBRA (for those who qualify) runs 15 months. It was originally set up to run 9 months but was extended.

You do not exhaust or lose COBRA at 15 months. You only lose the subsidy at 15 months. You still have 3 more months of COBRA (or more if extended) after the subsidy goes away.

You are not eligible for HIPAA at 15 months. You have to complete the 18 months.

Bintang Leo dlm Ramalan tahun 2010

Ramalan Bintang Leo
Kesibukan membuat kalian jarang bertemu. Karena kedewasaan Anda berdua, hal itu tidak mempengaruhi hubungan. Anda berdua saling merindu. Karier Anda akan melejit dengan cepat. Anda mempunyai sifat yang aktif dan selalu berusaha untuk maju. Bagi Anda waktu merupakan sesuatu yang berharga. Kesehatan Anda berpengaruh pada perjalanan panjang yang akan dilakukan. Sebaiknya Anda mempersiapkan obat-obatan untuk mengantisipasi hal yang tidak diinginkan.

Asmara : Cinta sejati bisa bertahan
Keuangan: Kegigihan bisa mendapatkan lebih
Kesehatan: Cepat ngantuk, jangan dianggap remeh
Jodoh dan Keuangan untuk Bintang Virgo

Health Exchanges and Independent Agents

I am hearing and reading so much lately from the health insurance agent community about the future of agents under healthcare reform. Specifically as relates to the health insurance exchanges set for 2014. A minority believe that independent agents will have a place in the system while a majority, it seems, are suffering from "Chicken Little Syndrome". Truthfully, no one knows yet what place independent health agents will have in the new system. I do have some thoughts.

For those who know me and my business, I write a lot of HIPAA. HIPAA is guaranteed-issue health insurance, available kind of on an exchange (pick from available carriers and plans) and has no underwriting or medical screening component. Somewhat similar to the future exchanges (if you can get information which is generally only available on web sites like mine).

One would think that with the fairly small choice of guaranteed-issue plans (perhaps 25 at most in California) and fairly similar plan designs (HMO are similar and PPO/POS are similiar in deductible and general benefits) that choosing a HIPAA plan would be easy. Honestly, for every 10 people I help enroll under HIPAA, at least 9 of them need help in determining the most appropriate carrier and plan for their needs. And that is a good thing. Getting a coverage plan is important. Getting the best fit for coverage is more important.

There are a variety of factors that come into play during proper case development. Plan design and usage limitations are one area. Plan benefits and any exclusions or limitations is another. Then there is the network of participating providers and the prescription drug formulary to consider. All of these things before we really even look at the price of the plan. These services are easily and readily provided by independent agents who can compare multiple carriers and plans. The other option would be to call each carrier and then try to put it all together yourself. One of the problems with calling a carrier is...they only know their own plan. For example:

Blue Cross of California originated a plan in California called RightPlan PPO. It was the first no deductible non-maternity individuals-only PPO in California. It was subsequently copied by several other carriers and duplicated in their respective plan portfolios. Health Net has SimpleValue PPO (copy) and Blue Shield has ActiveStart PPO (copy).

Under the current market, you could call Anthem Blue Cross about the RightPlan PPO but they are not equipped to compare it against SimpleValue or ActiveStart. Each carrier only knows their own plans. You'd end up having to call three carriers, get whatever information you think is important, put it all together and try to decide which clone plan would work best. Or you could call an independent agent (for free by the way, there is no cost to have an agent) who can run that scenario for you.

Fast forward to the health insurance exchanges. Like HIPAA, the plans will all be similar but, like HIPAA, there will be differences between each insurance company's plans (network, formulary, benefits, tiers of drug coverage and so on).

Let's assume hypothetically that six companies in California offer plans to the exchange. The plans will be denoted as Gold, Silver, Bronze and Platinum. Benefit levels will be determined by mandates in the healthcare reform law. Seems simple enough, right?

Well, what if you take six medications and one of them is not in any drug formulary for the exchange plans? Which plans have tier 3 drug coverage and which don't. Are there restrictions on tier 3 benefits? How do I search their drug formulary? Are my doctors participating with this carrier's Gold plan? How about hospitals? Do the networks differ between Gold, Silver, Bronze and Platinum? Does this plan cover me locally only or can I use it in-network when I travel? Is this an HMO Gold, PPO Gold or POS Gold? What's the difference?

Needless to say, this list could go on forever.

Another factor that I believe may come into play are deviations from basic design. With Medicare Supplement plans, there are some carriers who offer the Medicare mandated benefits but also create enhanced plans with other options above the Medicare minimum standard. Could we see this in the exchange as well? I believe it is very possible. So instead of six carriers offer six Gold plans, you might see something like this:

Carrier A - Gold
Carrier B - Gold, Gold Preferred, Gold Plus, Gold Enhanced
Carrier C - Gold, Gold Preferred
Carrier D - Gold, Gold Select
Carrier E - Gold, Gold Select
Carrier F - Gold, Gold HMO

Gold = Standard Gold design based on reform rules for plan minimum standard
Gold Select = Gold plan benefits with a select network of providers (smaller)
Gold Preferred = Gold plan health benefits plus a long-term care rider
Gold Plus = Gold plan benefits with a dental HMO plan
Gold Enhanced = Gold Plus plan design (with dental) plus additional vision and chiropractic coverage
Gold HMO = HMO plan adhering to Gold plan design rules

Under this scenario, as many as 13 Gold plans could be available (or more, or less) from the six insurance companies. It could get really confusing really quickly. And what if they do the same with Silver and Bronze? Or Platinum?

The bottom line is that a person should not have to match their medical needs to a health plan. All of my case development for HIPAA plans is directed at matching the plan to meet the medical needs, not the other way around. While no plan is always absolutely perfect, good case development should find the one plan that, given overall medical needs, is the "best" fit for each client.

I would think, given these variables, that the role of the independent agent would be extremely important in matching people's medical needs with the appropriate health plan, whether through the exchange or privately outside of the exchange.

Certainly the states, or insurance companies, or federal government could set up "call centers" staffed by non-agents who would be available to review coverage options and answer questions. Would it be less expensive? Probably not. But more to the point, there comes a time in this business when experienced, veteran independent agents really get a feel for the way certain insurance companies operate with regard to networks, formulary and benefits. I have found that EOC (Evidence of Coverage) booklets are often sorely lacking in certain areas when it comes to benefit utilization or the way a claim is "really" processed. Just because something is written in a booklet or spreadsheet or benefit summary does not mean that is exactly how it works, or in all situations.

We learn from experience. I write mostly HIPAA. Claims for HIPAA tend to be much greater and much more varied than underwritten coverage. That is the nature of guaranteed-issue coverage. I have seen situations which absolutely contradict what was written in the benefit summary, spreadsheet or EOC. I have also learned over the years many of the little nuances of the plans and insurance carriers that can be very critical when a prospective client brings their medical needs to me.

I hope that our leadership understands the value that we independent health agents provide.

On a side note:

I was a bit saddened to read an article recently in an industry publication in which President Obama told a health agent who expressed concern about her career that she was "the one who has to tell her clients about the insurance company's rate increase". While that is part of our job, I'd like to think we do a bit more than just pass on rate increase information. I certainly hope this is not how our leadership sees us and perceives our value to our clients.

I don't always have time to tell people about rate increases since the carrier will tell them anyway. I am often quite busy running drug formularies, trying to find which network doctor X is actually in and trying to help my clients get the plan that will best cover their immediate needs like chemotherapy, heart surgery, infusion therapy, transplant surgery or self-injectible life saving medication.

MRMIP Clears Backlog (No Enrollment Waiting Period)

The California MRMIP (Major Risk Medical Insurance Program) has apparently received some additional funding and has cleared the backlog of applications.

As of today (5/19/10) there is no waiting list for MRMIP enrollments.

I am working on obtaining specific information regarding the federal temporary risk pool which is scheduled to open July 1. In the meantime eligible uninsurables may enroll in the MRMIP without an enrollment waiting period.

More MRMIP information here

Large Companies Contemplate Dropping Employee Health Coverage

The Dallas Morning News is reporting that several very large companies "have concluded that they might be financially better off canceling their health care coverage and moving their workers to government-subsidized exchanges that will be available in four years".

At least four companies have investigated to varying degrees the impact of dropping health care coverage and pushing their workers onto the new exchanges, where they will be able to buy their own insurance.

While doing this would subject companies to fines, the size of the fines would be substantially less than the cost of providing health insurance to their workers.

The four companies identified so far are:

*AT&T
*Verizon Communications, Inc.
*Caterpillar, Inc.
*Deere and Co.

If these four are looking at this option, it is a pretty safe bet that other large employers are doing the same.

HIPAA Enrollment Change (Yet Again) - Anthem

Anthem Blue Cross (CA) has made another enrollment change to the HIPAA plans.

Under the prior change, all enrollments in HIPAA were subject to approval followed by a premium notice. The notice would allow payments in two 15-day periods (1-15th, 16-31st paid or postmarked) to start on the first of the following month. Example:

*Premium paid or postmarked 1-15 June would start July 1 (30-day gap)
*Premium paid or postmarked 16-30 June would start August 1 (60-day gap)

Under the latest change, the premium payment period has changed as follows:

*Premium paid or postmarked 1-15 June would start June 1 (slightly retroactive)
*Premium paid or postmarked 16-30 June would start July 1

Also, Anthem Blue Cross CA has indicated that it will accept certain "substitute" documents in lieu of the Certificate of Creditable Coverage which is not issued until after the expiration of continuation coverage.

A Good Story (sadly not health insurance but life insurance)

Every day it seems the health insurance companies are making mistakes, denying claims, rescinding coverage and all of the rest. They pay claims grudgingly (if at all) and, according to many media sources, try to get out of paying as many as they can.

I asked my doctor during a recent checkup if it was true what 'Dr. Dean' says about doctor spending 1/2 their time working on patient files. He told me "not anymore", most of his time is spent fighting with health insurance companies. Sigh!

So, I wanted to share the following true story. It is not a health insurance story, but a life insurance story. I dream of the day even one California health insurance company could tell a story like this. I doubt any of them could..........

In 1999 I attended the annual agents meeting of Northwestern Mutual Life in Milwaukee, WI. This is an annual "must" for NML agents and it is both educational and a lot of fun.

Then-CEO Jim Ericson opened the first morning session with the following story (and yes it has stuck with me 11 years now).

In early 1999 an agent's client applied for a life insurance policy for his young teenage daughter. Something for the future I guess. Well, for some reason the case got hung up in underwriting and they didn't get what they wanted with medical records and never completed the underwriting.

The client called his agent in late spring to inquire as to whether or not the life insurance policy on his daughter was ever issued. The agent checked and told his client that it had not completed underwriting and was never issued.

The client told his agent, "well, I guess it doesn't matter anyway, my daughter has passed away".

The agent took the case to NML where it ended up on the desk of Mr. Ericson. He directed his underwriting department to complete the underwriting on the young girl's application and report to him whether or not the policy would have been issued at that time (given the missing information).

Underwriting reviewed the application, received the missing information and reported to Mr. Ericson that, indeed, a policy would have been issued at that time had they received all of the information they required.

Mr. Ericson directed Northwestern Mutual Life to issue the life insurance policy posthumously on the young girl, waive premium payments, and immediately pay the benefit to the beneficiary.


Northwestern Mutual did not have to do this. They could have simply said that the policy was never issued due to missing medical information. But they didn't.

This story never made the press, was never published in any newspaper. Quietly, as their nickname "The Quiet Company" suggests, they made a decision to do the right thing, or more to the point, to do the honorable thing.

It's about honor and being honorable. That's what it really means to be an insurance company!

Blue Shield CA Adds 5th HIPAA Policy

Effective May 1, 2010, Blue Shield of California has added a 5th policy to the HIPAA guaranteed-issue individual & family portfolio.

The new addition, Access+ Value HMO, is a lower-priced HMO option than the Access+ HMO that was made available 3/2/10.

This is the first time I have seen a carrier offer three plans under one plan registration for HIPAA.

MRMIP Will Not Be Used For Risk Pool

Today the CA Governor announced that California will not use the MRMIP program as the temporary high risk pool for uninsurable California residents.

Instead, MRMIP will continue to operate alongside the federal risk program to be established by HHS in the next few months.

Stay tuned for more details on the temporary risk pool and how to enroll. Remember, the federal risk pool is a temporary program to 2014 to help cover those who cannot obtain private health insurance and have been without insurance coverage for six months or longer.

MRMIP is a California state risk program for CA residents who are unable to obtain private health insurance. The current waiting list for MRMIP enrollment is 3-4 months from application submission.

Anthem CA Rate Increase Withdrawn

According to KGO Radio, Anthem Blue Cross CA has withdrawn the proposed 39% rate hike for California. Apparently they will be re-working the numbers for a more moderate change at some point in the future. Members will be given 30 days notice before any rate changes would go into effect.

KGO Article

Anthem Fights Back (Finally!)

On Thursday, a "reporter" at Reuters wrote a story about Anthem/Wellpoint deliberately rescinding health insurance policies on women who developed breast cancer. The article, which was then rebroadcast by other media, is full of factual errors (one of the women was not even insured by Anthem/Wellpoint and another's name was mispelled throughout the article). The media "report" even caused HHS Secretary Sebelius to fire off a nasty letter to Angela Braly (CEO Wellpoint/Anthem).

After getting beaten up over the last few months and being portrayed as an evil cross between Attila The Hun and Adolf Hitler, Anthem finally is fighting back against this kind of lazy and inaccurate "journalism".

Anthem Response to Reuters Article

Anthem Response to HHS Sebelius' Letter

It gets better, folks. The url for the original story is no longer active and the "corrected" story (minus the woman who was not even a Wellpoint/Anthem insured) is available here. Here's the top quote on the "revised" article:

Corrected: WellPoint routinely targets breast cancer patients(Removes all references to Robin Beaton in first paragraph and throughout to reflect that the insurance company that canceled her policy was not a WellPoint subsidiary)

Temporary Risk Pool (California)

Just a quick update on one of the provisions of healthcare reform that goes into effect in September--the temporary risk pools for the uninsurable who have 6 months or more uninsured (and are uninsurable).

Each state was given the option to use a federal risk pool (HHS) or, if that state has its own risk pool, to use the state program and receive federal $$ for it ($5 Billion earmarked for these temporary risk pools).

While I assume California will likely us the California MRMIP program for eligible California residents, a decision has still not been made by the MRMIB (Major Risk Medical Insurance Board) in Sacramento.

I called them this week for an update and was told that they are still meeting about it and working through the myriad of implications for using MRMIP.

I will provide updates as they become available and as we get closer to the initial changes under the new Healthcare Reform law.

For more information on California's MRMIP health insurance risk program (and other state programs), visit my CalHealth page.

The HIPAA Tango Continues (Anthem Blue Cross)

For those who may be looking at my HIPAA page and wondering what is going on with Anthem Blue Cross enrollments, I thought this might help (I hope!).

Effective 5/1/10, Anthem has a new enrollment process for HIPAA plans. The process works like this: application and supporting documents to get approval to enroll, premium notice sent out upon Anthem's "OK" to enroll (approval), then you pay future premium to get future start date. Gaps can run 30, 60, 90 days or more. Sounds crazy, huh?

I have spent the better part of this week tee-ing off Anthem trying to get clarification and work-arounds for enrollments for Californians in need of HIPAA coverage and don't want to gap coverage.

So, to answer the question of whether or not there would be a necessary gap in coverage from group to HIPAA, a firm "maybe". It is going to depend on how early on we can start the process.

It is possible to enroll under the new system at Anthem and have a seamless start date. But it is tricky. Here's what needs to happen to make it work.

60 days prior to the expiration of continuation (or loss of group is terminating active coverage), we will need to provide some or all of the following to help get you enrolled:

1. Completed HIPAA enrollment application.
2. Copy of Termination Notice (either COBRA, Cal-COBRA or from group. This is a letter you receive about 60 days prior to exhaustion indicating that your continuation coverage will expire on a certain date.
3. Records to reflect payments of premiums for the full period including the final month (bank online statements, letter from administrator, etc.). Something to show you've made 18 or 36 months of premium payments (if continuation coverage).
4. Copy of current health insurance ID card and name of employer (usually on the card)for those not eligible for the Cal-COBRA extension to 36 months.
5. If covered 1st 18 months federal COBRA and now on Cal-COBRA extension, a copy of your group health certificate issued after federal COBRA expiration (from the COBRA Administrator or Health Plan)

The purpose of such documentation is twofold. One, we need to help you get Anthem Blue Cross to generate a premium payment "approval letter" as soon as possible within the 60 days prior to eligibility date so that you can submit your HIPAA premium and receive your desired 1st of month start date. Two, your Group Health Certificate (Certificate of Creditable Coverage/Certificate of Prior Health Coverage, it goes by several names) will normally not be provided until 10 days AFTER the expiration of the group health plan. Anthem has stated that they will accept "substitute" proof of exhaustion in lieu of the CoCC to expedite the enrollment process.

This Is What Happens When You Don't Read The Bill!

I guess someone forgot to tell the administration and those who voted for health insurance reform to actually read the bill.

The current bill signed into law yesterday does not, in fact, provide guaranteed-issue health insurance coverage from children this year, sort of.

I assume this will be fixed but we will have to wait and see.

Gap in law for children's healthcare protection

HMO health insurance plans

Health Maintenance Organizations (also widely referred to as HMOs) is a variation of health benefits distribution, which provides coverage on a fee-for-service basis. Insurance companies that provide HMO coverage plans each have an agreement with certain medical facilities and professionals in order to offer reduced fees to those, who purchase such plans.

What HMO plans are all about?

HMO plans are based around primary care physicians (PCPs) that a person buying such a plan has to choose from the network of medical providers the company works with. The PCP is the person who will manage and coordinate all the actions and services provided to the customer, as well as offer consulting and basic care measures such as check ups and exams. Preventive medical services are usually free of copayments within HMO plans.

In case the health problem of a person exceeds the professional field of knowledge of the PCP, the doctor refers this patient to another physician specialized in that very domain. The said specialist will further investigate the problem and use his expertise to resolve it, but only after he or she receives the referral from the PCP. Otherwise, you won't be able to receive any medical attention with the exception of situations of critical emergency when the risk of complications is very high.

The coverage you receive through an HMO plan is provided only within the limits of the medical network specified by your provider. In case the member of an HMO plan chooses to receive any medical services in a facility that doesn't make part of the network, there won't be any coverage and the person will cover all the expenses in full out of own pocket. Besides, HMO plans will allow you to receive medical care from an additional specialist only when you have the corresponding referral provided by your PCP. Otherwise, this is regarded as using out of network services and your expenses won't be covered at all even if it's the same medical facility where your PCP is located.

Why would you want to choose an HMO health insurance plan?

HMOs represent the most affordable and cheap health insurance amongst managed care options. If comparing the rates of POS or PPO, HMOs offer lower premiums and fewer copayments. This is why many employees choose HMOs as the type of group insurance plans for their workers. This is especially useful for those, who rarely visit a doctor and don't need an extensive medical care with their plan or don't have pre-existing conditions that they want to cover. Employers find these plans useful because they can cut their costs and provide additional benefits to their workers rather than paying only for health insurance.

If you are worried by the constant trend of medical costs and insurance rates rising every year, it's highly recommended to see if an HMO plan meets your insurance requirements. Get health insurance quotes from multiple providers and you will definitely find a good plan for a reasonable and competitive price. However, if you have more specific insurance needs and can spend additional money on extensive coverage, it's better that you investigate other plan options outside HMOs.

Preferred Provider Organization health insurance possibilities

In case you are looking for a comprehensive type of health coverage with much room for flexibility that still has a reasonable price-tag, a PPO insurance plan may be just the thing you need to cover your health needs.

Preferred Provider Organizations represent a network of medical workers, facilities and other professionals that are contracted by the insurance company in order to get more competitive fees for their customers. So those who are getting their medical services within the specified network will be charged with lower rates than if looking for them outside. However, you can still receive medical coverage outside the network too, only that your rates will be higher compared to what you get within the network.

PPOs can be regarded as a mix of traditional indemnity health plans and later-developed managed care options. In what concerns the network organization of medical services, PPOs are quite similar to HMO insurance plans. However, when you get a PPO plan, you aren't required to choose a primary care provider (PCP). It's the main difference between these two quite similar health insurance plan types. And since there aren't any PCPs in PPO plans, you aren't required to provide a referral when addressing any given specialist within the network. And when you receive your medical care in a facility or with a specialist outside the specified network your copayments will be considerably higher, but you still will receive partial coverage.

The advantages of PPO plans:

• PPO plans help keeping out of pocket costs within certain annual limits.


• PPO plans let you consult with any medical service provider even if he or she doesn't make part of your network.


• PPO plans offer substantial money saving potential when receiving healthcare services within the specified network of doctors and facilities.

The disadvantages of PPO plans:

• PPO plans require you to pay the deductible before receiving any coverage.


• PPO plans make services you get outside the specified network a lot more expensive.


• PPO plans have higher copayment rates if compared to other managed plan types.

Flexibility has its price

As my may guess, when a plan provides more flexibility and options it will usually cost more than a cheap health insurance plan with greater restrictions. That's why PPOs are generally more expensive than HMOs.

Even in case you choose a lower amount of coverage with your PPO plan, there are additional fees and payments that will make your plan more expensive. So don't base your estimations on the amount of coverage alone.

For instance, besides the usual premiums you have to pay every month, there are also additional coinsurance fees, except for the cases when you use a preventive healthcare service. There is also a deductible to be paid before you can receive any benefits from your PPO plan.

How to get a good plan?

Sometimes it may be quite hard to get a good PPO plan that would provide increased flexibility for a reasonable price. If you feel that a PPO plan is just the thing you need to cover your medical costs, you first would want to get health insurance quotes from numerous providers or talk to your insurance agent about the options you have. Shopping around doesn't take much time but as a result you can expect substantial savings if you manage to select the right provider.

What does form the auto insurance rates?

Most of insurance buyers often forget that they are insuring a certain thing and it directly influences the final price of the policy. When speaking about auto insurance, the car you drive is the primary factor that affects your insurance costs and at certain moments the insurance company point of view of the car can be quite surprising to usual drivers. Insurance companies have internal charts and ratings, assessing how much it will cost you to insure any given car make or model. And the primary elements that set the car in this rating are the risk factor and the theft factor of this particular make and model. The risk factor relates to how the car will perform in an accident and how likely it is to end up in one, while the theft factor, eventually, deals with the likelihood of the vehicle to be stolen.

When a new car comes out, it is placed at a certain place within the rating as compared to other similar models and the insurance rates are set accordingly. And as experience with this particular model accumulates in the company's records, the model can be moved in either direction within the rating, making it cheaper or more expensive to insure. Of course, other things like your driving record and credit score also influence the cost of insuring your vehicle, but the car is actually the most important and crucial factor you will have to deal with.

In general, it will be more costly for you to insure sports cars, luxury cars and SUVs. Some companies rate SUVs differently because of their increased safety for the people inside, while others take in regard the fact that these vehicles are likely to cause more collision damage than others. Sports cars are much more likely to end up in a serious or even tragic accident due to their power and speed that is so tempting to be pushed to the limits. And luxury cars are usually the target of auto theft due to their price, and are more expensive to repair because of exclusive parts and costly service.

Car insurance experts state that the most attractive and non-expensive class of vehicles to insure are mid-class and middle sized cars. It is important that the car has good crash-test ratings and additional safety features installed, being safe in case of an accident. Small light-weight cars are cheaper to repair but they get damaged more easily and this may lead to serious injuries to those who are inside of it. The higher is the mass of your vehicle the less damage it will take in case of collision. That's why big SUVs are considered to be quite safe from this point of view.

It is good to see what car insurance rates you can get for different cars before you actually buy the auto. If the question of insurance price really concerns you then choose a vehicle that is cheaper to insure. And if the rates don't bother you much, just buy a car that you really like.

POS (Point of Service) health insurance benefits explained

When it comes to health coverage these days, we sure have a lot of various options to choose from. One of such options, which has become quite popular lately are Point Of Service (POS) plans that can be viewed as a mix of traditional indemnity and modern managed coverage options. And what such a combination provides you with are money saving potential and flexibility, all in a single package.

Health coverage on two levels at once

People familiar with HMO plans can easily see the similarity between HMOs and PPOs when it comes to organizing the services. Here you are also required to choose a PCP (Primary Care Physician), who will coordinate your services and provide referrals to other specialists within the network when required. But you are also free to choose any facility or physician that doesn't make a part of the specified network. And a POS plan will pay for such services out of the network, however to a narrower extent than with in-network services. So it will still cost you less to get your services within the POS network.

This is what is meant by two levels of insurance coverage, which are called "in plan" and "out of plan" health insurance. In plan coverage is usually more advantageous but it also has tighter restrictions imposed on the user. Like in case of HMO plans, in order to get full coverage at the "in plan" level you will have to provide a referral from your PCP and get your services within the network. You will also sometimes be required to get additional approval from your insurance administrator beforehand.

This all means that even sticking to the specialists and facilities of your POS network won't give you full coverage unless you provide a referral from your PCP. This is the so called "red tape", which is one of the biggest complaints about managed insurance plans and the formalities within them. However, when compared to indemnity plans, managed health care provides substantial money saving possibilities that can't be beaten.

The indemnity part of POS

POS plans provide the best of both worlds, that's why they are so popular. And when it comes to the indemnity part of POS plans, people find a lot of flexibility and freedom that just can't be obtained through typical managed care options. Just like in the case of PPO plans, you are still able to get insurance coverage even when addressing to a specialist outside of the POS provider network.

In other words, you can use "self-referrals" in order to get care from a specialist you choose. When treatment is required, you are free to choose any physician or facility without needing a special referral from your PCP, Still, you won't get much coverage when choosing this option, so flexibility still has its price.

However, this is a great way to avoid the restrictions typical for managed care plans. That will be very useful for those who have a long-term trusted physician outside the network. Still, in such a case you will have high co-insurance payments (up to 40%) that will make your visits a bit more costly if compared to a doctor from the POS network.

Finding the right plan

In order to get cheap health insurance with your POS plan you have to shop around first. Try getting as much health insurance quotes from different providers as you can, compare them and choose the right policy.

EPO (Exclusive Provider Organization) health insurance in-depth overview

Having an Exclusive Provider Organization (EPO) means that the medical service providers you will receive care from should have signed up an agreement with the insurance company to allow offering you these services. This way EPO plans are somewhat similar to PPO (Preferred Provider Organization) plans, meaning that the person having such a plan can obtain inexpensive medical services at a facility that makes part of the EPO network. Still, if you choose to receive your medical care at a facility outside the network, a PPO plan will still cover your costs, only to a smaller extent. With most EPO plans, you won't receive any insurance coverage when visiting a specialist outside the network.

When you choose an EPO plan, you will instantly notice that the fees you are charged with by the medical service providers that have accepted to join your insurance company's network are significantly lower than those normally charged. So when you receive your health benefits within the EPO network, you can rest assured that the rates you will be charged for the services will be very advantageous and your insurance provider will pay for all the services you receive.

However, if you have a condition that none of the specialists making part of the EPO network can help you with and you are forced to seek medical attention outside of the network, make sure you have enough money because you will pay for the service to the full extent. This is because EPO plans do not include any services provided outside the selection of facilities and specialists that have an agreement with the insurance carrier. Moreover, in contrast with PPO and HMO plans that have fairly large networks of health service providers, EPO plans usually have a much smaller number of specialists and facilities being part of their network. This means that you have fewer professionals to choose from when you need medical attention.

In what concerns health service providers, their advantage in joining an EPO network is in the increased number of patients they work with. So instead of charging higher rates to a smaller number of patients, they charge lower rates for a much higher number of people and get more revenue as a result. This is especially useful to those providers who target themselves at a certain geographical area and want to get more people through group health insurance coverage plans. The insurance companies, which choose to provide EPO plans charge their customers with monthly premiums and act as mediators between the customers and the medical service providers.

As a conclusion, EPO plans would definitely be appealing to those looking for cheap health insurance and having no special medical needs such as pre-existing conditions. The group of people who will probably benefit the most from such plans are young healthy workers with no serious health risks. And those who will find EPO plans quite uncomfortable are older people with complicated conditions that need regular and special care from certain specialist, who may be outside the network. Think well before you purchase such a plan and make sure to shop around to get the best rates. Use health insurance quotes online or contact your agent to see what local providers can offer and start from there.

Impact - MLRs (Medical Loss Ratios)

I am watching President Obama sign the new health insurance (care) reform bill on CNN. I wanted to share some things I have heard recently that may eventually impact the number of carriers in California selling individual and family plans either through exchanges or privately, or both.

While carriers (insurance companies) can boast an overall MLR (medical loss ratio) above 85%, this number is generally inclusive of all sectors of insurance (large group, small group, individual and senior). However, when small group and individual (especially individual) is segregated out, the MLR often falls well below 80% with an average running about 74% on individual and family health plans.

"MLR" is the ratio of premiums paid in to what is paid out for medical care and wellness. The current reform will require in 2011 that all carriers selling individual and family plans must meet 80% MLR in that market. That means every company selling health plans in California by 2011 must be spending at least 80 cents of every dollar received in premiums on healthcare and related expenses.

I will save the reduction in administrative costs necessary for another post. Needless to say it certainly is probable that reduction in those expenses, including agent commissions, will occur.

My concern is if and how some carriers will be able to meet the new MLR.

I suspect that some carriers may choose to exit the market in California instead of trying to achieve 80% MLR on individual & family health coverage.
I will be curious to see who is left standing between now and 2014.

Health Insurance Reform Has Passed

In a very close vote, HR 3590 was passed this evening 219-212.

Health Insurance Reform - What To Expect

Happy Sunday to you all. I am watching the House vote and waiting for the final determination on the Health Insurance (Health Care) Reform Bill.

Since I have received many questions concerning changes I thought I'd quickly summarize here what to expect initially if/when this Bill is passed and signed into law today.

During the first year you can expect:

Pre-Existing Conditions - The Bill includes $5 billion in immediate support to provide temporary coverage to uninsured Americans with pre-existing conditions. The money would help until the new health insurance exchanges are created in 2014.

Elimination of Benefit Caps - New policies sold will not have annual caps on benefits nor lifetime caps on benefits.

Children with Pre-Existing Conditions - Children with pre-existing health conditions will not be excluded from purchasing health insurance coverage.

Preventive Care - New insurance policies will be required to offer free preventive care benefits.

Small Business Tax Credit - A tax credit for small businesses up to 50% of premiums to help small businesses purchase health insurance.

Help for Seniors - $250 towards drug coverage in the "donut hole" to help pay for prescription drugs.

Appeals Process - An independent appeals process will be set up for those who feel that they were unfairly denied a claim by their insurance company.

Other changes take place in 2014 and beyond.

How To Get Make Quick Easy Money

Economic growth, an increasing number of employment opportunities, not easy to come and build their own business and being your own boss is an extension of ideas. Thank technology, we now have the Internet, it can make it possible on the Internet have their own business. If you have connected to the Internet, you can from the comfort of your home, almost no cost to all businesses in their own computer. Internet companies have tons of a choice, to make a lot of money, monthly, but I would like to talk about affiliate marketing business.

As an affiliate your task is simple. You will have to work with a company of your choice on any Internet market a few. Then, you need to send to their site visitors to achieve a percentage of sales each time one of their visitors through one of the products you buy them. It is important to know, when you start and the time and energy to the initial investment required for operation and management, but the time and effort required to bring a small amount compared to business management from today. In this first part of an online business is a matter of fact after installation can monitor the work of the unmanned aircraft, they produce huge long-term funding.

If you have at least 2 - 3 hours, you can click on a subsidiary to promote your business, you can begin to see results, as long as your commitment to your efforts. Is it possible to begin production, and even sleep in your money.

Medicare You Can Buy Into Act - Grayson (D-FL)

Congressman Alan Grayson of Florida has authored H.R. 4789. The Bill, titled "Medicare You Can Buy Into Act" or "Public Option Act", would open up Medicare enrollment to US residents of all ages 19 and above. The link below is for this bill, which is only four pages long.

Read The Bill Here

Tips to Increase page views on your blog

Work by some blogs recently, I tried to increase the user's blog page-per-view. I have found that user access, an average of only 2. It is strange that most of the next blog Dawson, care AOT views on the page, they are too busy to click on Adsense and concerns related to access, even make a profit! However, it can increase page views also lead to more users to your blog, and not by custom to leave. Increase the reader can increase the linkcount, and references, and also have a password of the network services of the mouth. I tried to launch a blog and can keep them in the blog are some tips for tourists. Deep-link on your site: If you have to read through the search engine, employment, and opportunities for you, and an initial interest in this specific problem. The link to open the same subject or topic is a great way to keep your blog and are displayed to the user. For you, Äôve link with the previous post written comments, and this is the way comedy will return to the previous joke, and the public is troubled.

Under the Tang, AOT participation of all of your content in RSS format: If you can help the blind to show your post feed, and excerpts from your RSS. Not the whole story. This will stop the reader from reading posts users and force them to return to your site.

Please refer to the user does not have its own: to capture the user's attention and impressed their feelings. Talk about things that may help in your office. If you find that your blog a bit with a lot of knowledge and information, Äôll easy to increase page views a useful resource.

Targeted traffic: access to topics of great importance, and your blog will increase your user's overall satisfaction of the blog engine traffic. In an attempt to target the blog your own tags in the title, then copy the specific keywords.

Related posts: If you are using Wordpress appears beginning, the Avenue of the Stars a nice little components, and allows you to prove to the position with the current. We hope that this will allow blog readers to find jobs old and have become deeper and navigation.

Good navigation and labeling: It is, Street Stars mark significant messages and put them in a good navigation system. You also can bring, such as the 10 most senior positions of the read or components feature in the function

To create a series of articles: a series of positions, it is almost certain that the return visit will attract visitors. A string can contain any number of functions, with the passage of time, to disclose more detailed information on each progress, kindof like the soap opera

Comment in response: When the views and functionality specific users, to spend some time and effort to answer any questions or comments. This will help you to get the link with your readers.

Additional features: readers like features, and opinion polls, gravatars, e-mail subscriptions, and games are all factors that help to increase your blog's overall user experience.

I agree that this man is not all hosted blog visitors views or increase the page. If you have any suggestions please go to these comments, and good luck, even Monyet Online

Can Make Money While You Sleep

Looking for a great way to start from the money home, and your working hours? You want to be your own boss? Who does not want to earn money while enjoying their lives? If you want to make money, and even in your sleep, can not be affiliate marketing a huge asset in their own way.

Of course, there are many ways to earn money at home, but not so simple. Prior notice, and will have a number of efforts, if you want to affiliate marketing, but only for the first time a lot of money. When you first start in the business, and this very important period of time before things started quickly.

You have to do? First of all, you should know a little about a great way to sales of products. When you engage in this business, will be the advertising companies or individuals who sell products or services. Will establish the links will take traffic directly to products and services online.

Basically, you will be there with ads are not true. You will pay through the sale of your link that is posted directly to the product. It is clear that this will help you wise for the company in the market because it will be converted into cash in your pocket. Now, you need to know that there are different companies, and can be adopted by you.

Also, you can with this will a certain percentage of your money with your help to complete the sale involves taking different actions. Sometimes all you need is to find someone to fill out the form on your website. This is the simplest of the Commission, you can get.

However, there are many different affiliate marketing program, and will sell products ranging from a few dollars to thousands of dollars. Percentage of the Commission, you may receive an increase over time you sell more.

The quickest way for you to get the commission is to make sure that you are using search engine optimization to get the public's right to your company website, so that the numbers game for you to achieve. We all know that sales is a numbers game. When you log on to the people, the right people, and sales will happen. Before you know it, the money will come flooding to you, or even in your sleep.

Credit Card Debt Management

Must focus on identifying the rights of the agreement, the company's process. Today, there is no real company to leave the market, you can rest assured that the government will ban all the work in the company of all settlements. In fact, it is not possible to take legal action against the company, while other companies are not very volatile means that a good company around. You first take a look, and for the company. How do you? Must take advantage of the network edge or must rely on other resources? How kind of yellow pages? These are silly questions, but a significant impact on the working methods. Will find hard to believe that your service provider, if you think you can do more to find a better company. Internet use is the main solution is not clear. However, no use of the Internet applications, and mind only when you click on the link first discovered the best debt settlement companies often will not work.

On the contrary, your search service provider to help you reduce to the chase immediately. Rather than contact with you to the service provider, you should choose on the Internet resources to make your job easier. You find?. The only thing you should know who to trust and to avoid. In addition to the rights of the company's solution should take into account use the Internet to obtain more information about the agreement, as a whole concept of information. There are many aspects related to the performance, but must rely on it to get the best information and debt relief.

California HIPAA Dance (Redux)

Another change for HIPAA in California.

Blue Shield of California, in response to Anthem's proposed premium payment arrangement (which is apparently not going to be fully implemented), has taken the following action with regard to HIPAA plan enrollments in California.

Effective 3/2/10, PPO enrollments from HIPAA plans will no longer offer any date of the month not before application receipt date. Now, 1st or 15th of the month following approval of the application.

From Wall Street Journal "The Wellpoint Mugging"

A very interesting article from the Wall Street Journal.

The Wellpoint Mugging

Some parts of the article are quite telling.

He ought to subpoena California's political class because Wellpoint's rate hikes are the direct result of the Golden State's insurance regulations—the kind that Democrats want to impose on all 50 states. Under federal Cobra rules, the unemployed are allowed to keep their job-related health benefits for 18 to 36 months. California then goes further and bars Anthem from dropping these customers even after they have exhausted Cobra. California also caps what Anthem can charge these post-Cobra customers.

This next one hits home for me as one of the leading Anthem HIPAA producers in California. While I know that Anthem is taking losses on the guaranteed-issue side, I also am confident that my book of Anthem HIPAA business (which apparently is #2 in the state of CA right behind e-healthinsurance)is not creating losses. Yes, the whole pool is losing money and Anthem has been covering almost 80% of it for several years (same with MRMIP). However, I always strive to do proper case development before I pick the appropriate HIPAA plan for a client and find I have a fairly even spread between my three California major medical carriers. And no, Anthem has not invited me to lunch for my high HIPAA production LOL!

This explains why Anthem lost $58 million in California on its post-Cobra customers in 2009. If WellPoint didn't raise premiums amid these losses, it would soon be under assault from its shareholders, if not out of business.

The company presented its findings to California insurance commissioner Steve Poizner last November, who had a month to review the proposed increases and never objected. But recently amid the White House campaign, Mr. Poizner has joined the chorus claiming to be "skeptical" of the increases and demanding that Anthem postpone them while he conducts a review. Anthem has done so.

More HIPAA Dancing

I have learned that Anthem Blue Cross California has again changed its position with regard to HIPAA enrollments.

Apparently they have backed off of the "no premium" with application design (which virtually guaranteed a 60-day minimum gap in coverage) and will allow premium submission with the application in the near future.

The current no premium program was only in effect on the HMO HIPAA plans, not the PPO HIPAA plans. Anthem had indicated a desire to have a unified HIPAA application with no premium pre-payment possible. Apparently this has been scrapped and HIPAA applicants will soon be able to pre-pay premiums for both HMO and PPO HIPAA plans with Anthem Blue Cross CA.

Get Top Rankings With SEO ULTIMATE

Perhaps one of the biggest misconceptions, perpetuated by industry SEO experts, is that a website must follow perfect SEO strategies to get top rankings. While adhering to simple common SEO standards does help the search engines both find and index your site more quickly, it doesn't guarantee by any stretch of the imagination, that following those SEO guidelines will propel your site to the top of the rankings.
If only search engine optimization was that easy!
No doubt, there are some SEO faux pases that will do harm to your site's rankings, especially in Google, the ultimate hall-monitor all puffed up and ready to pounce on any misbehaving webmaster. Things such as keyword stuffing, keyword spamming or linking out to bad neighborhoods such as link farms, pharmaceutical or gambling sites may get you blacklisted.
But how much SEO do you need? How much search engine optimization do you need to get top rankings? Do you need a whole lot or do you need very little SEO?
Actually, after 10 years of marketing online, the answer to that question varies depending upon what you're trying to accomplish with your SEO efforts? If you're operating an online business in a very competitive (read lucrative) market, SEO will be high on your agenda as you go about annihilating your competition.
Even if you're an ordinary webmaster or website owner you're probably fussing over your rankings in the search engines. The higher your rankings you achieve for your chosen keywords; the more traffic you will get. Good quality traffic that convert well into loyal subscribers and fans of your site.
Many webmasters and companies spend thousands of dollars each month in order to get their keywords and sites up to the top of the list. If you're into affiliate marketing, your daily income will rise and fall almost parallel to your rankings. Now, if my earnings increase, I know automatically my rankings have gone up, usually in Google. If my earnings go down, I know my rankings have gone south. Some times even a drop or rise of one place on the first page SERPs will affect how much you earn.
Obviously, because of this fact, SEO or how well I am optimized for the search engines is extremely important to me. I am constantly building quality links and quality content for my sites. Some keyword battles you win, some battles you lose. I have been fighting some keyword battles for over 3 or 4 years now!
But how much SEO is enough? How much SEO should you do with your sites? Many webmasters make sure all their on page set-up or lay-out is done exactly to what the SEO experts say you should do. This is not a bad idea. Make sure your Title, URL, Headlines, Keyword Density... are all laid out right. These are things we can control and adjust to meet the SEO standards.
Other SEO or ranking factors are much harder to predict, many of them are simply out of our control. How other sites link to us, what they put in the anchor text, what they say about us... simply things we can't control.
I believe the over-riding reason why your site is listed at the top of any rankings has to do with the number, the quality and the quantity of sites linking back to your page. The higher the number of related quality one-way links you have flowing back to your site, the higher it will perform in the rankings. Your anchor text is very important (underlined part of a link); it must contain your keywords or variations of it. The content on the linking page should also be related to your chosen keywords.
Get this part right and you will get high rankings.
Or at least this has been my experience -- all the other ranking factors do count but this is the over-riding factor in my opinion.
Another major ranking factor lately, has been the importance Google is placing on social media links. Get your content to the first page of Digg with lots of diggs and it will rank high in Google. This is not surprising when you consider the nature of these social bookmarking sites... it really is an actual "vote" for the quality of your content. Getting Delicious bookmarks has a similar positive effect.
Another prominent factor, from my observations, is having your major keyword in your Domain Name. Use hyphens if you want but having those keywords in there, does help rather than hinder your rankings.
Now if you're wondering about how Google ranks pages or your keywords.... Google has around 200 ranking factors (with filters and penalties thrown in to make all our lives interesting) which it uses to rank your keywords/pages. This is still the best online resource that lists all of Google's ranking factors.
Now the question still remains, how much SEO do you need? How much time should you spend at optimizing, building links, worrying your head off over the latest Google Itch?
The answer always comes back to quality content. Create a site that has quality content and the SEO will take care of itself. People will link to your site, you will get bookmarks in all the social media sites, Google will find your content and rank it. Your SEO will grow naturally as your site grows. Keep building more pages, keep targeting more and more related keywords in your niche or subject area and you will get higher rankings.
Now, of course, some webmasters are a little more aggressive in how quickly they want their rankings to rise to the top of the search engines. Here's something you can do if you want to go into the SEO battle full-force.
1. Download SEOquake and place this free SEO toolbar plug-in on your Firefox browser.
2. Go to Google and type in the keyword or keyword phrase you're targeting with your site or content.
3. Click on the number one ranking and observe how many pages it has indexed, PageRank, how many backlinks it has, age of the site... and so on.
4. Then click the page info button and study all the on-page factors this site has and notice what it's doing with its page and keyword density lay-out.
5. Check all the backlinks this site has in the different search engines. Copy or try to get the same backlinks for your site that your competitor has acquired. Then get more backlinks and/or higher quality backlinks than your competitor.
6. Watch your rankings rise...
Just a few more words of wisdom and we're done. Some battles will be too tough to fight, the competition will be so stiff you just can't compete. Other battles will take a long time; months, even years before you rise to the top. Your best bet is to choose long-tail (multi-worded) keywords that have little or no competition. You can rise to the top within days, even hours. The sweet thing is this: long-tail keywords are often the most lucrative and bring in the most sales. For in the final analysis, you just don't want SEO, you want smart SEO. And you will quickly learn, most times you can often out-smart your competition, even if you can't out-rank them.

Part Deux: Is The California Individual & Family Health Insurance Market In Critical Condition?

Having recently watched the "bi-partisan" meeting in Washington and many videos on youtube, I wonder if the problem is "un"-fixable.

Speaker Pelosi, in a recent youtube video answering questions on the meeting, pointed out two things which are absolutely of concern. 1, our health insurance system is employer-based in design and function. 2, there are many more people not covered under the employer-based system who choose to remain on the sideline than those who participate in the non-employer health insurance market.

I won't go through the numbers again since they are covered under part one of this topic below. Suffice to say, nearly two-thirds of those who should participate in the health insurance market in California for individual & family coverage do not. No employer-sponsored health plan, whether fully insured or self-funded, could operate at a participation level of 33% or less. Employer plans require 75% of all eligible employees to participate. I have worked in the past for employers who made it mandatory to buy a health plan through their fsa/cafeteria plan unless one had a valid waiver (so as not to mess up participation).

With rare exception, most every vlog I have seen, including the grilling of Anthem/Wellpoint CEO Braly in Washington, have had a nasty, negative tone. While it is without doubt that people are upset by the rate changes and popular press, there are implications to this notwithstanding the fact that my study below shows that even with the "massive" rate increase, Anthem prices below most of the other California carriers for like coverage (including 2 not-for-profits).

Now here's your "inside scoop" for the day, dear readers. I have it on good authority that a very large health insurance company in California (which shall remain anonymous), in the last six months, approached the state regulatory agency/ies to review the option of cancelling the individual & family market product and bailing out. To be clear as to what is at stake....

IN THE LAST SIX MONTHS, ONE OF THE LARGEST HEALTH INSURANCE COMPANIES IN CALIFORNIA ADDRESSED TO A STATE REGULATORY DEPARTMENT THE POSSIBILITY OF NO LONGER SELLING HEALTH INSURANCE TO INDIVIDUALS & FAMILIES IN CALIFORNIA.

The writing is on the wall across the spectrum of carriers. Sales of new plans are flat. HIPAA plans have been reformated to high deductibles and expensive HMO plans to stem the bleeding in that pool. Programs like Tonik for individuals and BeneFits for small group have experienced less-than-stellar sales.

The only two PPO programs (non-HIPAA) that are selling at all right now are SmartSense by Anthem and VitalShield by Blue Shield. Even in those cases, the sales of new plans is not keeping up with the cancellation of existing subscribers.

Anthem has launched three new product portfolios for IFP in the last six months--Core Guard, Clear Protection, and coming April 1, Premier. I will be curious to see whether or not new enrollments in these plans (lower cost) will overtake defections off of coverage as is the current trend.

Until and unless this trend shifts, the IFP market is going to be chaotic at best. Continuous premium increases will become the norm, and this in turn will drive more people off of coverage which will create a repetitive cycle.

So, Dave, you ask, what is your solution to the problem?

Well, I see two choices.

One, like Speaker Pelosi mentioned, mandate coverage and penalize those who do not participate. Increase participation to as close to 100% as possible, guarantee-issue health insurance coverage with no pre-existing conditions problems and create an incentive (tax or othewise) for people to participate in addition to a penalty.

Two, and this is one I may favor over the first one, kill off all non-employer coverage plans and go to a single payer exchange for coverage (with a mandate or incentive). The exchange could offer compliant private plans from carriers that wish to offer them and/or public plans like Medicare/FEHB or other plans designed under federal mandates. Allow carriers to sell private plans outside of the exchange to those who can qualify and wish to purchase outside of the exchange.

Make the exchange available to those who cannot obtain employer-sponsored coverage and do not wish to or cannot purchase a private plan outside of the exchange. Also, provide that any employer under 20 employees (2-19) who chooses the exchange over the group plan must pay a penalty per employee to the exchange, and any company over 20 employees must either provider group coverage or pay a payroll tax penalty per employee to the exchange.

6 tips to take care of tattoos

So, you just get my first tattoo, or want to get a tattoo first, and a little bit ignorant to know how to take care of it. Tattoo care is very important. Must follow your tattoo artist tattoo care guidelines to you, to ensure that infected healing.

Take care of your tattoo me:
1. Order in the region, up to 24 hours of bandages. Make-up to keep dirt and harmful
bacteria from entering the skin cells, opening up and cause an infection.

2. Avoid contact with any possible formation of the region and the tattoo scab to
hunt, since it could also lead to the development of infection.

3. Do not use hydrogen peroxide wash tattoo. On the contrary, the use of
antibacterial soap and water ... with the tower of Pat dry. Hydrogen peroxide
(and alcohol) can lead to drying and fading tattoos.

4. If you see any redness or swelling, and in this region of the ice pack. If it
does not expand Not go down in a reasonable time, consult a doctor.

5. Try not to wet often tattoo completely healed.

6. To maintain, until the sun tattoo is completely healed. Tattoos are more
vulnerable to the sun. Because of this, it is very important to wear a tattoo of
the sun 30 or higher sunscreen to protect him.

In accordance with the above tips to keep your tattoo healthy, free of new bacteria, and give you a wonderful experience for your first tattoo!

Anthem Agrees To Delay Rate Increase in California

On Saturday (2/13) Anthem agreed to hold off on the March 1 rate increases until May 1 at the soonest. This will give time for independent actuaries and auditors to determine if the increase in rates is appropriate.

Anthem to delay insurance rate hike amid criticism

Anthem Answers Sebelius

Anthem President and CEO of Consumer Business, Brian Sassi, addressed his response to Ms. Sebelius regarding her inquiry concerning Anthem rate increases in California.

Click here to read Mr. Sassi's letter

Poizer Asks For Temporary Halt To Anthem Rate Increase

California Insurance Commissioner Steve Poizner has sent a strongly-worded communication to Wellpoint/Anthem requesting that they hold off on the proposed 3/1 rate increase until 5/1 so that an independent actuary retained by the DOI can review Anthem's payout ratios.

Additionally, the Obama Administration has expressed serious concerns about such a large rate increase in California.

A link to Mr. Poizner's letter here.

Is The California Individual & Family Health Insurance Market In Critical Condition?

With the recent LA Times article and notifications to approximately 800,000 CA residents by Anthem Blue Cross of California, the future of individual & family health insurance coverage is looking bleak. Anthem announced a rate increase for March 1, 2010 ranging between 30-39% on many private health plans.

I received information just yesterday that Aetna has now laid off the IFP staff support for northern California (and I supposed SoCal as well). The last time Aetna laid off people in these positions, they exited the market in California.

First a look at some "interesting" numbers and how they relate to this issue.

California population (2009) - 36,900,000 (probably 37,000,000 by now)

# California residents covered by private health plans - 2,100,000
# California residents on average uninsured - 6,000,000
# California residents covered under Group/Medicaid/Medicare - 28,800,000

Those numbers tell us a lot about what is going on. IFP (Individual & Family Plan) represents an average enrollment of 6% of the total population, and 7% of the total insured population of California. 76% of the total population is covered under an employer-sponsored health plan, Medicaid or Medicare and 93% of the total insured population is covered under an employer-sponsored health plan, Medicaid or Medicare.

Sadly, the uninsured population is nearly three times as large as those who have private health insurance.

Group plans (employer-sponsored) flourish in California. The plans are heavily mandated by benefit and also represent a true actuarial "pool" of risk. Carriers require 75% of all eligible employees to participate, thereby spreading the risk across a large and balanced company population. I have heard over the years that actuarily, group plans tend to run 20% using major benefits, 30% using some benefits and 50% using no benefits in any plan year.

While group plans will certainly experience rate increases due to health care costs, they are often minimized by mandated participation. So long as the actuaries do their job, group tends to be more stable.*

Individual plans have few if any mandates and there is no participation requirement. As such, plans react to utilization of benefits and increases in health care costs on a more radical scale than employer-sponsored group plans.

Also, plan benefit levels are continuously being adjusted to keep the utilization in check. Lower deductibles give way to higher deductibles, first-dollar benefits give way to services under deductibles first, co-insurance splits continue downward (Health Net has plans 50/50),and so on.

When I first started in health insurance in California, then Blue Cross of California (now Anthem) had a very impressive set of PPO plans. $10, $20, $30 and $40 co-pay plans with no deductible, low out-of-pockets and 80%-90% coinsurance levels. They also covered all normal benefits including maternity. The $40 co-pay plan was so inexpensive that it became a loss-leader. The plans were retired around 2000 to make room for plans with lower co-insurance levels, deductibles and higher out-of-pockets. This trend has continued since.

The bottom line is that slowly but surely IFP will become undesireable to consumers and carriers. Carriers will bleed money on accelerating health care costs and consumers will hate the plan designs. Every year the IFP carriers introduce "new" plans, all of which are stripped-down from the preceeding plan designs. Carriers will continue to retire plans that are no longer profitable (see Anthem Share PPO plans and Blue Shield Spectrum PPO plans). At the rate things are going, IFP plans in a few years will be completely catastrophic coverage with little or no preventive care, generic only drug benefits and deductibles in the 10-20,000 range. Oh, and you can pretty much forget about maternity on PPO plans in a few years, too.

HMOs will continue to offer richer and stronger benefits (with access restrictions), however, they will eventually price so high as to be unaffordable for many consumers.

* the exception was the major rate increase in the Lumenos HSA plans a couple of years ago for group. This was due to an actuarial error in terms of anticipated benefit utilization. Lumenos group HSA plans offer free no-cost preventive medicine. The utilization by the traditional 50% who normally don't use benefits in a plan year as almost 100% which totally blew the curve. Rates were increase between 25-39% at the first Lumenos plan anniversary to compensate.

Cal-COBRA under ARRA

I have just received information from multiple sources that the ARRA extension through 2/28 for subsidy to 15 months does now apply to Cal-COBRA as well as federal COBRA.

Firefox Mobile just to Linux and Windows

After a long process, the Mozilla Foundation finally released Firefox as your web browser for mobile devices. First version officially released January 29, 2010. "He built a desktop machine Firefox 3.6 browser with a few modifications in order to optimally on mobile devices," the statement on the Mozilla site. For easy browsing many pages, it is the tab feature. The browser also has features no less than 40 add-on like AdBlock Plus, Twitter Bar, language translator, and YouTube enabler. The software is free to download and use. However, this product is temporarily available for Nokia N900 tablet devices that use the platform or operating system Linux Maemo 5.0. In addition, Firefox for Maemo can also be used on the Nokia N810 and N800, although not recommended Mozilla.

Firefox for Windows Mobile is already available but the new version of Alpha 3 for Samsung Omnia II, AT & T Fuze Touch, and HTC Touch Pro. To reach the final version still has to go through stages of beta and release candidate (RC) a few times. No explanation when Firefox for Windows Mobile will be completed. In addition to the two platforms, Firefox is also planning to release a Google-made Android platform. In its website, Mozilla states only immediate, but did not specify when.

However, other handheld device users platform Linux and Windows Mobile do not expect to feel the Firefox Mobile. So far, Mozilla is not planning to develop for the BlackBerry, iPhone, and Symbian. Cheap mobile phones will also not be subject to Firefox. But if you just want to try out Firefox Mobile is made with the code name Fennec, then it can be done on the PC.

Business to make online money in home

o believe, that storm is now with the Internet social media. But if you have a home business and I think until this situation as a search engine as you next Twitter or Facebook cozying followers for a friend or can be made.
Why do some more in this article I should be search engine friendly reasons, if you own a home based business are making.
1. Organic search engine results to bring you long-term out of pocket can zero traffic. The long term traffic for your website or blog is an incredible amount term solution. Now this does not mean that the hard work you're not going to gain membership system.
Case did not know what that means when you page down on top of groups and the right hand column to see the links are sponsored. Group for advertisers to pay more to be in that place.
If you walk on the left you will see the light see the results - called organic results. These sites are the right has gained high rank because it is targeted keywords.
There are many things that fall into this category, but the traffic that comes from it's free. I do not characterized by groups when someone clicks on your site.
The hard work seems a lot different words for these words earn rankings. With less competition, it's easy to start with longer phrases and create a background for him.
But if you work hard enough you can end your high office as you might want to target phrases are willing to. For this you give your home business on the Internet traffic will be an incredible amount.
2. Some people are not ready, put in this type of work and choice buy sponsored links. With other groups or you can pay per click search engine and the bill is only when someone clicks on your ad.
The fact that there are some really good buy less known PPC search engine. , Marketing, Yahoo, and Ping, and others give you excellent traffic at a lower price than you will pay groups. You can find more information payperclicksearchengines.com.
If you work hard and a ranking member, or use pay per click search engine making system and quickly select visible. The traffic coming from this type of work is worth doing. Search engines are your friend!

100-day performance of the President

Good morning. Today, January 28, 2010, some elements of society, including the students will hold a demonstration in Jakarta. Well, for those who have and are on their way to work may be a little disturbed. This demo was held for 100 days criticizing the government of SBY-Boediono. I, as well as elements of society, which of course this lay, secretly wondering; 100-day if enough to evaluate the success of a government? Are we not in a hurry? While campaigning period before the future leaders promised to solve the nation's problems for time in 100 days.

While see, hey .... There are many problems of this nation. Not only the Bank Century, not only law enforcement people are getting hurt, not only the national exam dilemma, not only corruption .... There are so many problems. And we are in such a hurry to all resolved within 100 days. We're not cooking instant noodles loh .... Okay, I know, elementary school children know, that the country does not only consist of the President alone. There are state agencies that should be able to resolve each problem quickly and appropriately.

I know, these days it SBY impressed doubters in making decisions. People need a calming statement, not sentences. That style of leadership that has chosen SBY people of Indonesia at the election last year. As a nation which he said democrats, let us appreciate the results of yesterday's election was not an option though SBY heart. It means let's give him a chance to solve the nation's problems are very complex,. Not just a problem today, but also the public relations of the past that have not been resolved.

All people need a quick, everyone needs satisfied, all people need certainty, all the people talking, everyone demanding, criticizing everyone. And, of all people is more than 200 million people are compartmentalized in a variety of political interests. SBY and his staff are trying hard on these issues. Maybe when I'm sleeping soundly last night, SBY was looking for a solution to all problems of this nation. Frankly, I'm not a big fan of SBY, nor close the connection. I'm just a people who try to appreciate the performance leader. Although not always my desire sated by the policy.

Please demo, please aspirations your voice, please criticize the officials. Fine, just do not disturb public order. Demos is the right of each citizen, guaranteed by the 1945 Constitution. But, do not always tell our government failed. We, I, you, may not know for certain problems this nation as a whole. I mean, we do not really know the root cause, onset, cause, the factors, impact, and ABCD her.

I remember a book by William Dunn who said that, lest we do not really know what is called the root of the problem, lest we call the root of the problem is a problem situation. That is, when we do not really know the root cause, how can we determine the solution. It means more, not easy to trace a problem from the root, and find a solution in the blink of an eye. So do not rush our government's failure rate. If you assess the government has failed, what form of failure, what starting, what is the solution, what is the impact to the overall solution of this nation? Students interviewed demonstrators TV One this morning did not have. Do you have? Maybe SBY will gladly invite you to come to court.

The California HIPAA Dance

For those who have been following the near-hourly updates on my HIPAA insurance page, the one word I would use to describe the recent activity is--CHAOS.

Anthem Blue Cross initiated what has essentially become a "you-know-what contest" between the two Blues concerning their respective HIPAA portfolios.

The chronology is as follows:

Fall, 2009 - Anthem retires the Share PPO portfolio (retired plans do not need to be offered in the HIPAA mirror of plans)

Jan 11,2010 - Anthem Blue Cross announces a complete HIPAA portfolio overhaul, replacing the 1500 and 2500 Share plans with HMO plan. DOI-registered PPO plans remain the same (5000 and Basic 1000)

Jan 15, 2010 - Anthem closes new enrollments on the 1500/2500 at end of business day

Jan 18, 2010 - Blue Shield CA advises an impending change to the HIPAA products, but cannot comment until 1/22

Jan 22, 2010 - In response to the Anthem HIPAA portfolio change, Blue Shield closes the Spectrum PPO portfolio and eliminates the Spectrum PPO 1500 and 2000 from the HIPAA portfolio. New plans will be available effective Mar 2, 2010 and include an HMO plan, 5500 PPO, 5000 PPO and 4000 HSA-compatible PPO

Jan 25, 2010 - Anthem indicates that a new enrollment requirement applied to the HMO plans will go into effect on Feb 8 in regard to the PPO plans as well (DOI plans). This new requirement will, in effect, guarantee that all Anthem Blue Cross HIPAA enrollees will experience a minimum 30- to 60-day gap in coverage between expiration of group (COBRA/Cal-COBRA) and enrollment in the HIPAA plan.

Please stay tuned to my blog and HIPAA page for further updates as information becomes available.

CURRENT-DAY MORTGAGES

Having a home that will serve as the shelter of your growing family is one of the major concerns of any person, is it not? How much could you stretch money in these days? How would money be involved for your future?

Under a roof, one may build a home out of a house. A place where you can just sit relaxed on your comfy couch, your wife serving you that favorite pasta for ten years now, your kids rushing by your side bathing you with affection…

In a blink, you receive a piece of paper telling you that you have to pay loads o cash or else you have to lose your home. It is because of the wrong mortgage loan you have chosen 5 years ago.

Will you allow this nightmare to strike and topple down your dream home for your family?

We know that life may be worth taking the risk sometimes but I decision-making involving a long-term consequence, think again.

These are the kids off mortgage loans that entail the scariest risks in your entire life. If you are gutsy enough to venture, then consider all sides. These may be so easy to apply for but it may give you the most difficult times in the future.
40-year Fixed Mortgage
It is said to be the least risky among these risky mortgages. What happens is that one has a fixed-rate mortgage but he or she has to pay it off over 40 years instead of the traditional 30 years. The payments will be lower, so one qualifies for a higher mortgage. The danger is: you are going to end up paying a lot more of the house and there is going to be a long time to build equity.
Piggy-Back Mortgage.
This type is less risky than the other mortgages. It involves taking out two other mortgages. These are the home-equity loan or line credit for 20% of the house’s price which is used as the down payment. The other 80% serves as the primary mortgage of the house’s price. The danger is that the house’s price may drop and one may be pushed to the act of selling the house for less than one owes.
Low-Doc Mortgage
It is one of the two second most risky mortgages. This scene happens: one borrows without proving that he or she qualifies for the loan. One may not have to even provide proof of your income because they do not ask for financial information. The danger of this mortgage lies in the fact that it may give you a loan you could not even afford.
Interest Only Mortgage
This is considered to be a type of loan which needs you to be a risk-taker. If you are not too determined to take risks, this is not an option. Your aim is to be able to manage your finances, not to push your self to pitfalls of financial problems.
Option-Payment Mortgage
It is tagged as the riskiest mortgage around us. This brings you to a situation where one chooses what to pay every month, including the principal and the interest. If not, a minimum required by the lender but may be less than the interest you owe. The difference is being added to the balance of the loan. The risk is that one could end up carrying an owe more than what one’s home is really worth.
Be not a loser. Choose a home that is right for your family. Choose a mortgage that is right for your budget. Feel what real security and comfort mean… for good.

Tinnitus sufferers and music therapy

You never have tinnitus? Namely, the perception of sound "arrested" ear when actually there is no sound from the outside. Thus, the patient's complaints always feel the noise. However, researchers in Germany have designed a special therapy to address these complaints. "Although the cause of tinnitus is unknown, studies have shown that the brain is processing the sound most often disrupted in this condition," said Dr. Christo Pantev of the Westphalian Wilhelms University in Munster, as reported by the BBC. "The research specifically targeted at areas of the brain responsible for tinnitus."

The researchers also set for 39 people with tinnitus are divided into three groups and given the music that has been modified to therapy. Patients who had suffered for five years of complaints that are required to listen to music on average 12 hours per week. A year later, they reported the results of therapy generally experience a significant reduction in noise. Technical therapies mentioned are cheap and making your favorite music frekuasi patients with a particular ring in his ears, for to remove the previous record had been recorded in the brain. According to the researchers, this technique can be combined with other therapies.

"About three percent of one of tinnitus sufferers tend to reduce the quality of life," added the researchers.

Cal-COBRA Subsidy Change?

I have the current word on the applicability of ARRA extension in regards to Cal-COBRA.

As it stands currently, the state of California has not amended the applicable law nor signed off on this change. If you remember, when the first ARRA came out, California had to amend existing law to allow for subsidy on Cal-COBRA.

Until such time as the state agrees to amend and sign off, there is NO extension of subsidy for Cal-COBRA to 15 months and no eligibility for subsidy for any beneficiaries going onto state continuation after 12/31/09.

I will update the blog if there are any changes forthcoming. In the meantime, it is 9 months subsidy with a sunset of Dec 31 2009.

Thinking about the Business and Make Money Online

Too many people have the wrong idea about internet business, they thought that by contributing part of their internet business would be successful and quickly feel the results of an Internet business. wrong thinking about the internet business I conclude this because many people who ask me about the internet business, I thought she had a reliable internet business, in view of my age in the Internet business this virtual world.

More than ten people who had a dialogue with me through IM services (yahoo messenger) that is deliberately display at the bottom of this blog, they expressed difficulty in getting results from their business to follow. their average entry in the Internet business as tempted by talk of friends and all keyword " make money from internet" that spread in many beginner bloggers blog. even worse is when they are in dreams to buy the product will get money without working hard.

From the stories above I feel a lot of people were jumping into the virtual world and take part in the Internet business because they have the wrong idea about internet business. they initially tempted to fancy where they will get a lot of money from internet business without having to work hard. so I was finally few things as follows:

1. Internet business is considered by many business people are the easiest and most profitable.

2. Internet business is a business that can change one's financial life quickly without having to sweat and racked his brains.

3. Internet business is a business that can be run automatically and will generate money by itself after we buy the product at a moneymaker said.

Three points above are just a few examples of thinking about a successful internet business my capacity of dialogue between me and a few new people into the Internet business. we should be able to learn from the 3 points so we are not wrong in judging what the internet business and how we can get results from Internet business.

Is Organic Worth It?

When you head to the grocery store, shopping for products like eggs, meat, fish, milk, and produce can be very tricky. Signs are posted everywhere labeling food as natural, organic, and a number of other things—but what’s the difference, really? Learning what specific names mean can help you decide if you should shell out extra money on a product of it is simply a marketing ploy.

Natural is a turn associated with a number of fruit and vegetable product. Typically, this is simple a marketing ploy to convince you to buy the product. After all, all fruits and vegetables are natural, right? Unless it’s a new kind of food that has been developed and processed, the product is natural. What you really probably want is organic. Organic foods are grown without chemical pesticides and fertilizers. There are two main benefits to organic foods. First, you are helping the environment because those chemicals are not being introduced into nature. Secondly, you are avoiding ingesting chemicals and are therefore healthy more healthy foods. However, organic products are usually more expensive. If you’re on a budget, skip over organic fruits and vegetables that you can peel, like oranges and bananas. After all, once you’ve discarded the peel, you’ve also discarded the chemicals. Instead, opt for organic items like apples, where you eat the peel. No matter what you buy, however, make sure that you rinse off the food when you get home.

Another tricky label you will see is “no hormones.” This is usually in regards to milk or meat products and is false, since all animals naturally produce hormones. Hormones are what helps an animal (even a human) regulate body organs, have young, and otherwise function. All meat products have hormones. What the labels really mean is that no hormones were unnaturally given to the animal, which is sometimes done to increase milk production. Regardless of hormones, however, the milk and meat is safe for a person and not a violation of an animal’s rights.

Lastly, a label on eggs and meat can indicate if the animal was caged or penned. This does not make a difference in the quality or nutritional value of the meat, but is simply a matter of animal rights. These products may be a bit more expensive, but if you want to make human decisions, that is the way to go. Reading the label and making healthy choices can sometimes be difficult, but learning how to do so can help you make the best choices for you diet.

Just Say No

If you are on a diet or simply enjoying a healthy lifestyle, than you probably know that peer pressure to eat foods that are not good for you is a major part of your life. If you are worried about the food that goes into your mouth, don’t worry—there are ways to overcome peer pressure. It simply takes a little know-how to get people off your back!

Parties are a major source of peer pressure, especially with alcohol. However, remember that alcohol contains hundreds of empties calories in just one drink. When you go to a part, people might be pressuring you to have a drink and relax, and it can be difficult to say no when they are constantly trying to convince you. Instead, offer to drive to a bar instead. This way, you re the designated driver, so people won’t want you to drink and, in fact, they will probably be purchasing you waters and maybe even helping to pay for your gas. It’s a win-win situation for everyone.

Another time when you may feel pressured to eat is at work when the boss orders lunch for everyone at a meeting or when you have to visit a client. Instead of giving in to temptation, simply politely decline the food by letting your boss know in advance or order a meal that is healthy and split the portion in half so you have a meal for tomorrow’s lunch as well.

Baby showers, weddings, birthday parties, and other special events can also wreak havoc on your diet, even if you are good at resisting temptation on your own. When someone hands you a piece of cake and won’t take no for an answer, it can be difficult to know what to say! Here, little white lies might be appropriate. For instance, saying that your stomach was upset earlier in the day will convince a person that you don’t want to eat at the moment or pretending to have a chocolate allergy will get people to allow you to enjoy the party without a hassle surrounding food.

Remember, however, that while refusing bad foods is fine, you should be eating good foods. If you do not, dangerous eating habits and disorders can develop, which will give you, your friends, and your doctor a real reason to worry. It’s ok to say no to peer pressure, but don’t say no to food in general!