Smokers Cost Employers $12K More Per Year (each) than Non-smokers

by LAS

Studies show that each smoker costs a company an average of $12,000 a year more than non-smokers. Inspired by a California study that showed every dollar spent by the state on smoking-cessation programs saved $18 in health care costs – more employers are moving to start smoke-free policies or tobacco-cessation programs in the workplace.

Employers do have to skirt some smokers' rights laws in a few states to avoid discrimination lawsuits if they become too invasive.

In just 29 states, the employers are limited to prohibiting smoking in the workplace, and states may prohibit smoking in public places. They have what is called “lifestyle laws” that protect workers. Employers may not take smoking into account regarding promotions, hiring or firing.

These laws, one must admit, are pretty toothless. It is difficult to prove that an employer violated the law because they know enough to provide some other, innocuous reason for not hiring or promoting someone.

Some of the state laws are even weaker. The Virginia law apply only to state employees. Three states – Minnesota, Illinois, and Montana – protect smokers rights but allow employers to charge higher premiums for the smokers. Three states – Tennessee, Louisiana, and Colorado – apply their protection of smokers to future hires, not current employees (when the law was passed).

Smokers who try to quit generally have to make many attempts before it sticks. Statistically, it takes seven attempts for a smoker to quit smoking. So keeping trying, you never know what approach will finally help you reach your goal.

One Nagging Question About Qualifying for PPACA Exchanges

by LAS

One of the nagging questions that keeps bothering me about the states insurance exchanges is whether the people who need it will be be able to get coverage.

The PPACA law was intended to expand Medicaid coverage to all low-income adults under age 65 beginning in 2014. This would have brought 16 million uninsured under the Medicaid umbrella – assuming income of up to $15,415 for an individual and $26,344 for a family of three.

However, the Supreme Court ruled that the states can decline (opt out) of the expansion of Medicaid. About a dozen governors have said they will not expand Medicaid in their states, or are leaning in that direction. Now, since the Supreme Court ruled on this matter, I hear that the federals are trying the ol' carrot-and-stick approach with the recalcitrant states in question.

While I am on the subject of PPACA, here is what goes into effect in 2014:

by LAS

Several provisions of the PPACA law, aka Obama-Care, will go into effect in 2014. Let's review them now.

First, we should mention that the “employer mandate” has been pushed back to 2015. No word on what happens then.

Second, rules regarding waiting periods will go into effect. The most important provision is that waiting periods for health care coverage can no longer extend past 90 days. This may be a bit tricky for employees who work seasonal or variable hours. In that case, it may be that these employees might not be covered at all in 2014 if the employer requires its employees to work a minimum number of hours to be covered.

Third, pre-existing conditions cannot be used as a grounds for denying a policy nor for denying treatment for that condition. Plans cannot discriminate against persons for any of a range of health factors. Plans cannot impose restrictions on eligibility or charge more for coverage based on health history, etc. Women cannot be charged more than men. Also a part of this clause is that all employees must be given comparable healthcare plans; that is, high-income employees cannot get gold-plated plans and everyone else gets a tin version.

Fourth, starting in July 2013, employers start paying one dollar per employee into a fund for the Patient-Centered Outcomes Research Institute, which will collect and publish data relating to effectiveness of medical treatments. The assessment goes up to $2 per employee for years 2 thru seven, when it is designed to terminate.

Fifth, rewards for meeting requirements under wellness programs will increase from 20 percent of cost of coverage to 30 percent. Wellness incentives for quitting smoking will increase up to 50 percent.

Sixth, the so-called “donut hole” in Medicare Part D prescription coverage will shrink until it is eliminated in the year 2020.

Seventh, the individual mandate may (or may not) also be pushed back, but there was never any provision for sending people to jail for not buying insurance. People may lose all or part of a tax refund, or pay an annual tax for 2014 of one percent of income or $95, whichever is greater. 

Insurance Agents Don't Want to Scare Off Seniors with Too Much Information

by L.A.S.
I am going to assume that older readers out there will take offense at this. But financial advisors assume that seniors' decision-making skills will decline with age even if one does not have Alzheimer's or any other form of dementia.

Our brains temporarily store incoming streams of data -- numbers, words, phrases, pictures, and so forth -- while at the same trying to decide which of these data is important to us, to our own situation and values. We quickly go through processes of comparison and ranking of these bits of data. We also compare what is coming in to our own 'data banks', in other words what we have learned to be true about the world in general and about managing money in particular.

Brilliant people can juggle more bits of data than the rest of us. But all of us experience a bit of a slowdown in this process as we age. We can easily miss important facts because we are still trying to hold onto as many information bits as we can handle. We also tend, as ALL of us do, to look for the easy solution, which may not be in our best interests. As we get older, we also are more easily distracted or interrupted, so that we have to start over.

Seniors tend to compensate by taking more time to make a decision. This is perfectly all right. However, most sales people know that the decision delayed, is the decision NOT MADE. So give yourself a deadline to make a final decision. Write out what you feel you need to know to make an informed decision, then when you have gathered that information, sit down with your significant other and discuss what looks best for you.

My personal experience is that I can never find the absolute perfect choice, even when selecting so mundane an item as my apartment. I have to decide based on the best overall package of location, cost, space, and other amenities. I have made errors even after all that, but it is the best I know how to do.

Which features of a policy, annuity, or other financial package are MOST important to you? Weed out those options that do not offer them, but perhaps you might call the company rep to make sure that this is the case. The company might have another group of options that they did not even think you would be interested in.

I might mention that some features are not commonly advertised and you might not even know they are out there. For example, many insurance companies have policies with a return-of-premium rider. (This may be true of some term life insurance and of some 'dread disease' policies; the premiums are somewhat higher but the fact that it is virtually free after the return of your money, makes them very attractive.) A company may be allowed to offer certain riders in one state but not in another, but that is out of our control.

An example of a weeding-out process with annuities would first ask if you need it for an immediate payout, for the near future, or for 20-30 years from now. If tax considerations (for the beneficiaries) are paramount, then you might consider buying insurance instead. BTW if you cannot qualify for a long-term care policy, then maybe you could look into raising the value of your current life insurance if it has an accelerated benefit option.

To help you with the information-gathering phase, you might avail yourself of free lectures given by local banks or savings & loan offices. I went to one such lecture several years ago about the Roth IRA when that was a new option. I took notes and kept them for reference. Keep a notebook of notes taken at such lectures or seminars, so you can draw upon them when sorting through company offers.
Good luck!

Beneficial Will Stop Selling Life Insurance and Annuities

by L.A.S.
Another victim of the subprime debacle has hit the skids. Beneficial Financial Group, a Mormon-owned company, declared it will have to stop issuing new life insurance and annuities by Oct. 31 of this year. It will put 150 people out of work promptly, and concedes it cannot compete against bigger companies offering more products.
The cause of this turn of events is that Beneficial had about one-fourth of its assets in securities containing subprime mortgages.
Existing contracts will be honored, although the company is expected to expire in about 50 years.
To repeat, the current policies are good and will be honored. It is just not going to be able to sell new policies.

Movement for Federal Controls of Insurance Industry Misguided

by L.A.S.
The federal government has seized on the problems with one segment of one company, AIG, as a pretext for more government control of the whole insurance industry. The truth is that the insurance division of AIG, American General, was doing just fine (and BTW was under state regulation). The problems were in the division that was already supposedly being supervised by the federals, the Financial Products Corp., which indulged in risky equities investment.
However, neither do I see any value in creating an optional federal charter, called an OFC. The OFC would give insurance companies the option of being regulated at the state or at the federal level. One must acknowledge that in some states, it is possible for the insurance commissioner's office to be much too cozy with the industry, and refrain from too close scrutiny of financial records or safety.
I have mixed feelings about this proposal, I admit. I have already opined on the frustration of not being able to buy certain riders or products in one state that are easily available in another state, simply because the insurance commissioner's office of one state decided to allow that product.
The Financial Regulatory Reform report strongly recommends the creation of an Office of National Insurance (ONI). One of the jobs proposed for this ONI is the identification of insurance companies that should be supervised as Tier 1 Financial Holding Companies (FHCs). A Tier 1 FHC is defined as a holding company “whose combination of size, leverage and interconnectedness could pose a threat to financial stability if [they] failed.” They would come under the supervision of the Federal Reserve who would supposedly hold them to a higher standard and do everything to prevent these companies from failing.
Insurers are expressing concern that the Fed would not be working in harness with an actual insurance regulator. This is in contrast with the rest of the financial services industry which has a federal regulator in the SEC. The Fed would not concern itself with solvency, but rather with the company's impact on the overall economy.
The Fed already has many critics of its authority. Does it really serve anyone's best interest to allow it to insert itself into another segment of the finance industry, when it already seems stretched to the limit in trying to monitor the banking industry?
Besides the creation of the ONI and an expansion of the Fed, the report is also spurring talk of creation of a Consumer Financial Protection Agency (CFPA). This agency is supposedly going to represent consumer interests at the administrative level regarding credit, mortgage and title insurance coverage. Whether it will also monitor the insurance industry in spite of intense lobbying against it, is anyone's guess at the moment.
Again, I have mixed feelings about this new agency. Much depends on exactly who will be appointed to serve in this agency and whether they will just be another shill for the industry. The devil is always in the details.
On the one hand, it has the potential to finally bring the credit industry to heel and cap interest rates on credit cards and other abuses. Have you never wondered why your credit card bills are always addressed to processing stations in Delaware and Dakota? That is because those states have no cap on credit card interest rates or any other meaningful regulation. It would also give consumers the option to buy new plain-vanilla insurance products and provide transparent pricing.
On the other hand, adding another layer of bureaucracy because the regulators we have, failed to do their job, is hardly cost-efficient. It is hardly an example of good government. Although if the Congress writes the bill so as to streamline (make that read 'fire') ineffective federal agencies like the SEC or FINRA (the SEC's enforcement arm) or the Federal Reserve itself, then that would be a net gain for consumer rights and for the bean-counters.
If any or all of the existing agencies had been doing their job, and regulating the finance and investment community, we might have averted the bloodbath of last summer and fall. How did earlier administrations allow the annulment of the Glass-Steagall rules? Rules that had prevented a recurrence of the errors and wild ways of the heady 1920's?
And then there is the really scary problem that is not addressed by any legislation anywhere, and that is that most of the people working for the federal government just cannot understand the complicated financial instruments now being used and marketed across the globe. What if Congress convened a hearing or an investigation into bank failures, and the crooks got off because our representatives really don't know a bundled mortgage from a certificate of deposit? Or an ARM from their leg??
Sorry to joke, but tragically, the American public does not generally have senators and representatives who can fathom the technical jargon of the industry. It is not that they are dumb; they are just in the dark. As are we all.

Texas Liquidating Memorial Life Insurance

by L.A.S.

Better check the name on that pre-need funeral policy of yours -- if you bought it from Memorial Life Insurance, it is now being liquidated by the state of Texas. Memorial Life Insurance sold funeral benefit contracts. After suffering a net loss of $2.3 million in 2008, the company was barred from accepting any more applications.
Fortunately your loss is protected under the Texas Life, Accident, Health and Hospital Service Insurance Guaranty Association Act. You must keep up the payments to maintain the policy in force, but check with the State of Texas insurance commissioner's office to see how to make out your checks.

Sorry to Dump So Much On You at One Time

by L.A.S.

I apologize for dumping so much in your laps all at once. I have been trying to catch up a bit on my backlog of stories I wanted to pass along to you -- and this has led to posting SEVEN articles all in one day on this blog. Sorry about that. But you at least have the luxury of clipping or bookmarking this site so you can come back and mull over all these tidbits at your convenience.

Have a wonderful -- and safe -- Fourth of July weekend!

Annuities Have Become 'The New Black'

by L.A.S.

In 2008, to no one's surprise, investors, suddenly shifted funds into plain old boring fixed annuities. How many investors did this? Just to quote some startling stats that came out earlier this year, sales of fixed annuities in 2008 jumped to $107 billion, up nearly 60 percent over 2007.

We are talking about the most snore-inducing sector of the financial investment field, the fixed or fixed index annuity here. Perhaps the only item that qualifies as duller is the savings bond. Now normally, we are told to have a portion of our investments in safe instruments such as bonds or insurance, vehicles like that. And some of us actually do that.

But traditional diversification did not work for most of us in 2008. So that explains the rush to the safety of the fixed annuity. It is very simple to understand: you just toss a lump sum into the kitty and draw upon it to suit your needs. There are variations in how long a waiting period before you begin drawing on the annuity, and there are also some that allow you to deposit small sums during your working life in order to draw upon it in your retirement, just like an IRA or 401K.

But the deferred accounts are nice because the interest they accrue is tax free. The longer the deferred period, the better, of course, so that they can swell into very nice nest eggs indeed. The downside has always been that you had to accept a rather low rate of return in exchange for this level of boring safety. The other downside is a rather steep penalty for dipping into your fund in case of emergency.

Deferred annuities generally produce a 5 percent rate of return, while immediate annuities may give only about 3.5 percent. And because you are locking into just one company, you want to know for sure that the company is very strong. Everyone thought that AIG was too big to fail, to coin a phrase, but we found out differently.

There are several reputable insurance companies that have avoided the flash and the sizzle, and as a result are in very good financial shape today, even after the stock market bloodbath. Northwestern Mutual Life, headquartered in Milwaukee, is one. (I am not an agent of NML nor am I reimbursed in any way for mentioning them; but I am rather proud that they are based in my birthplace.)

An Alphabetical List of Insurers Offering Supplemental Insurances

by L.A.S. --

The following is a list of the major insurers offering supplemental insurances which employers may choose to offer instead or as an alternative to standard group coverage. You may also wish to investigate other companies such as AdminiStaff, which offers supplemental insurance in addition to payroll services.

AEGIS ADMINISTRATIVE SERVICES INC.
888-881-2307
www.mini-meds.com
Offered as Limited Health Benefit Plans. Offered in ALL states. Issue ages 18-65. No deductible. Guaranteed issue. Details: defined benefits for inpatient hospital, surgery, outpatient, office visits, pharmacy, dental.

AIGILIS CORP.
407-324-3921
www.Rethink-Healthcare.com
Offered as eHealth Companion. Offered in ALL states. Issue ages not stated, but available to all employees. No deductible. Details: intended to be a personal health care management system to help you transition to a Consumer Directed Health Plan. Compatible with HSA, HRA.

AIGILIS CORP.
ALSO offers another plan called Way2SaveRx which is a discount pharmacy card. Minimum age 18. Available in all states. No deductible. Over 53K participating pharmacies. No enrollment or membership fees.

ALTERNET BENEFITS
877-815-2121
www.Alternetbenefits.com
Offered as Fusion. Offered in all states EXCEPT ID, MN, NY, VT, WA. Issue ages 18-70. Deductible $750 to $15,000 on catastrophic medical. Guaranteed issue. Details: Voluntary major medical.

AMERICAN FIDELITY ASSURANCE CO.
877-967-5748
www.afadvantage.com
Offered as Hospital GAP Plan. Offered in all states EXCEPT ID, MD, MN, NH, NJ, NY, ND, WA. . Issue ages 18-69. Details: supplemental coverage to cover your out-of-pocket costs. Not portable.

AMERICAN PUBLIC LIFE INSURANCE CO.
800-256-6736
www.ampublic.com
TWO PLANS: One is offered as Hospital Indemnity. Available in all states EXCEPT NJ, NY, VT. Issue ages 17-64. NO DEDUCTIBLE. Details: includes Rx discount, flexible plan designs, options for surgery, outpatient, emergency, wellness, etc.
The other is offered as MEDlink. Issue ages 18-69. No deductible on inpatient. This is not portable.

AMERICAN WORKER PLANS INC.
866-215-9300
www.theamericanworker.com
Offered as The American Worker Plan. Available in all states EXCEPT HI, MA, NY. Issue ages 18-70. Not portable. Limited benefit, critical illness, dental, disability, mini-med.

EQUITABLE LIFE & CASUALTY
800-352-5121
Offered as EquiChoice. Available in states EXCEPT AK, CA, CT, DE, DC, FL, GA, HI, ME, MD, MA, MN, NH, NJ, NY, RI, VT, WA, WI. Issue ages 65 and up. Guaranteed renewable. Designed as a Medicare Supplement.

GREAT AMERICAN SUPPLEMENTAL BENEFITS GROUP
866-459-4272
www.gasbinsurance.com
Offered as Medicare Supplement Plans. Offered in all states EXCEPT AK, DC, HI, MA, NJ, NY. Issue ages 65-99. Guaranteed issue, with pharmacy discount card.

HARBOR INSURANCE MARKETING
866-424-2167
THREE PLANS, first is Offered as the Gap Plan. Offered in all states EXCEPT CA, CT, FL, MN, MT, NJ, NY, ND, VT. Issue ages 18-70. No deductible. Not portable but can be continued under COBRA. Details: hospital benefit, fills gaps, flexible with several optional riders like surgery, outpatient surgical facility, office visits, diagnostics, wellness, ambulance, ER, accident, Rx card, etc.
Second plan is called Hospital Indemnity. Issue ages 18-64. No deductible. Covers expenses up to $1000 per day. Optional riders include AD&D, diagnostics, emergency, ICU, outpatient, private duty nursing, surgical, wellness, etc.
Third plan is called The Answer Plan. Issue ages 0-63. No deductible on inpatient. Covers medical expense inpatient and outpatient up to $250,000 per covered person per injury.

HEALTHPLAN SERVICES
800-545-6441
www.healthplan.com
Offered as Golden Rule Medicare Supplement. Available in AK, AR, CO, IL, IN, IA, LA, MD, MI, MS, MO, NE, OH, OK, SC, TN, TX, VA, WV. Issue ages 65 plus. Deductible varies.

KEY BENEFIT RESOURCES
877-907-5511
www.keybenefitresources.com
Offered as Keygap and KeySelect. Available in all states EXCEPT CA, CT, DE, FL, MA, NH, NY, WA. Issue ages 18-no limit. COBRA eligible. One is a group supplemental policy, the other is a limited benefit group plan.

MAGNA BENEFITS SOLUTIONS INC.
616-949-1199 or 800-278-2323
www.magnabenefits.com
Offered as Retiree Group Health and Prescription Drug Plans. Available in ALL states. Issue ages 65 unless already retired and Medicare eligible. Options include dental, vision, identity theft.

TRANSAMERICA WORKSITE MARKETING
800-400-3042
www.transamericaworksite.com or transchoiceplus.com
Offered as TransChoice Plus. Available in all states EXCEPT CA, CT, HI, NH, NJ, NY, VT, WA. No age restrictions for issue. No deductible. Limited group benefit for full or part-time employees. Options include diagnostics, surgical, inpatient, wellness, ambulance, hearing, pharmacy, etc.

UNUM
207-575-4942
www.unum.com
Offered as MedSupport. Available in all states EXCEPT CT, FL, KS, MA, MN, NJ, NY, WA. Issue ages 17-64 and spouse. No deductible. Inpatient confinement and outpatient surgery, diagnostics, ER.

Alphabetical List of Long-Term Care Insurance Carriers

Accurate as of January 2009. Most plans use as a trigger the inability to meet 2 of the 6 ADL's (activities of daily living which are bathing, continence, dressing, eating, toileting, and transferring), and many also accept Cognitive Impairment. No endorsement is implied or given by listing these insurance carriers. You must determine which plan is best for you.

Advanced Resources Marketing --
www.armltc.com 617-783-2622. Group and individual. Available in all states. Issue ages 18-85. Minimum group size 10. Trigger: TQ. Portable. Elimination periods zero to 100 days.

Aim Marketing & Ins. Services --
www.AimMarketing.com 600-245-2467. Available in all states. Issue ages 25-80. Minimum group size three. Portable. Elimination periods – all available.

AJF Consultants --
www.ajfconsultants.com 866-901-5323. Available in all states. Issue ages: any. Minimum group size: any. Portable. Elimination periods: none.

Allianz Life --
www.allianzlife.com 800-950-7372. Available in all states EXCEPT CA HI MA NY. Issue ages 18-84. Minimum group size 10. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – 7, 30, 60, 90, 180, 365.

American Financial --
www.afmus.com 800-880-3072. Available in all states. Issue ages 18-84. Minimum group size five. Trigger: Unable to meet 2 of 6 ADLs or cognitive. Portable. Elimination periods – zero to 365.

American Independent --
www.aimforltc.com 800-672-7202. Available in AK AZ AR CA CO HI ID KS LA ME MI MO MT NE NV NM NY OK OR TX UT VT WA WY. Issue ages 18-99. Minimum group size five. Portable. Elimination periods – many options. Many benefit triggers to choose from.

American Insurnet Agency --
www.AmericanInsurnet.com 800-333-4638. Available in all states. Issue ages 18-89. Minimum group size five. Trigger: Unable to meet 2 of 6 ADLs or cognitive. Portable. Elimination periods – zero day for home care; zero-30-90-180-354 for nursing home.

American Life & Health --
www.amlifegroup.com 800-992-1492. Available in all states EXCEPT CA CT KS ME MA NH NJ NY PA RI VT AND WA. Issue ages 18-84. Minimum group size: case by case. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – 90 days only.

Assurity Life Insurance Co. --
www.assurity.com 888-276-7619, x 3774. Available in all states EXCEPT FL NY AND VT. Issue ages 40-84. Minimum group size, none, but discount with 10 members. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 0, 30, 90, 180.

Berkshire Life Insurance --
www.TheBerkshire.com 888-505-8743. Available in all states. Issue ages 40-84. Minimum group size, none, but discount with 10 members. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 0, 30, 90, 180.

Equitable Life & Casualty --
www.Equilife.com 800-352-5121. Available in all states EXCEPT AK CA CT DE DC FL GA HI ME MD MA MN NH NJ NY PA RI VT WA WI. Issue ages 18-84. Minimum group size, none. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment (requires physician statement). Portable. Elimination periods – 0, 30, 60, 90, 120, 180, 365.

GamePlan Financial --
www.gameplanfinancial.com 770-517-2765. Available in all states. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 0, to 365.

Gelbwaks Insurance --
www.gelbwaks.cm 954-236-9999 x104. Available in all states. Issue ages 18-70. Minimum group size three. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 20 to 180 days.

Golden Benefits --
goldenbenefits.com 415-454-3359. Available in California. Issue ages 18-79. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – 0, 30, 60, 90.

Great American Life --
www.aimsltc.com 800-325-9876. Available in all states EXCEPT CA CT HI NJ NY. Issue ages 18-89. Minimum group size, five. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 30, 60, 100, 180, 365.

Guaranty Income Life --
www.gilico.com 800-535-8110 x292. Available in AL AZ AR CA CO FL GA IL IN IA KY LA MI MS MO MT NE NV NM NC ND OH OK OR SC TN TX UT WY. Issue ages to age 85. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment (requires physician statement). Portable. Elimination periods – 90.

Harbor Insurance --
www.HarborIns.com 866-424-2167. Available in all states EXCEPT NY. Issue ages varies by carrier. Minimum group size, any. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – varies by carrier.

Insurance Network America --
www.InsuranceNetwork.com 800-456-7999. Available in all states EXCEPT CA HI MA NY. Issue ages 18-84. Minimum group size, one. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 7, 30, 60, 90, 180, 365.

John Hancock --
www.JohnHancockLTC.com 800-330-4598, 800-330-4582. CareChoice plan available in AL AK AZ AR CT DC GA IL IN IA KS KY ME MA MS MO NV NH NM NY OH OK OR RI SC SD WV WI and WY. Corporate Choice plan available in all states EXCEPT CA FL TX WA. Corporate Solutions plan available in all states EXCEPT CA NY. Issue ages 18 to retirement. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 30, 60, 90.

LifeSecure Insurance Co. --
www.YourLifeSecure.com 810-220-4613. Available in AL AZ AR CO DE DC FL GA HI ID IL IN IA KS KY LA MD MI MN MS MO MT NE NV NM ND OH OK OR SC SD TN TX UT VA WV WI WY. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 90.

LTCi Decision Systems --
www.LTCia.com 800-360-9853 or 720-922-9060. No details were furnished to reporting group.

MedAmerica Insurance Co. --
www.medamericaltc.com 800-544-0327. Available in all states. Issue ages 18-85. Minimum group size ten. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – 30, 60, 90, 180 days.

Metropolitan Life Insurance --
www.metlife.com 888-776-3882. Available in all states. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 20, 45, 100 days.

Nationwide Financial --
www.nationwide.com 800-321-6064. Available in all states EXCEPT MN MT WA. Issue ages 21-80. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 90 days.

Pacific Advisors --
www.PacificAdvisors.com 877-455-9580. Available in all states. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 30 to 180.

Rampart America --
www.RampartAmerica.com 800-221-4623. Available in all states. Issue ages 18-85. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – 30, 60, 90.

Roster Financial --
www.RosterFinancial.com 800-933-6632. Available in all states. Issue ages 18-85. Minimum group size, five. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 30, 60, 90, 180 days.

Senior Market Sales --
www.SeniorMarketSales.com 800-786-5566 x4. Available in all states. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – zero to 730, depending on carrier.

The Prudential --
www.Prudential.com 800-732-0416. Available in all states. Issue ages 18-79. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 30, 60, 90, 120, 180 out of 365 days.

Transamerica --
www.TransamericaLTC.com 817-285-3604. Available in all states EXCEPT GA ID MT PA VT. Issue ages 18-79. Minimum group size, five. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – zero, 30, 60, 90, or 180.

Trustmark --
www.TrustmarkSolutions.com 800-840-4692. Available in all states. Issue ages 18-80. Minimum group size, 100. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 90 days.

Underwriters Marketing Service --
www.Callums.com 800-524-1774. Available in all states. Issue ages 18-84. Minimum group size, three. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – varies.

Unum --
Unum.com 800-421-0344. Two plans, GLTC Advantage and Group LTC. Available in all states. Issue ages 18-80. Minimum group size, ten or 15 depending on which plan is selected. Trigger: Unable to meet 2 of 6 ADLs or cognitive impairment. Portable. Elimination periods – 20 to 730 days.

Wachovia Insurance Services --
www.Wachovia.com 803-765-3520. Available in all states. Issue ages 18-75. Minimum group size, ten. Trigger: Unable to meet 2 of 6 ADLs. Portable. Elimination periods – most have 90-100 days.

Zenith Marketing Group --
www.ZenithMarketing.com 800-733-0054. Available in all states. Issue ages 18-79. Minimum group size, four. Trigger: Unable to meet 2 of 6 ADLs or severe cognitive impairment. Portable. Elimination periods – 30, 90, 180, 365.

Alphabetical List of Providers of 401k Plans

The following is a list of carriers and administrators that offer 401k plans. It is up to date as of Fall 2008, but we do not guarantee that it is an all-inclusive list. Please consult with your certified financial planner regarding specific features of plans that will best fit your needs. Providing this list does NOT imply endorsement, and none should be assumed. You must determine which company's plans best suit you. The data is accurate as of October 2008; my apologies for not getting this up sooner.

401kBrokers.com and 401kAdministrators.com --
www.401kBrokers.com. 800-474-3826. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: 0.25% and no extra charge for setup, loans, termination, tax returns, agency or placement fees. For COMPANY 401k plans, the charge is 0.25% plus $1000. Distributions upon request.

Advanced Benefits Consulting --
314-539-0836. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Varies with complexity of plan.

Alliance Benefit Group --
www.abgNational.com. 800-242-2356. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Quotes are per plan, and are based on average account balance. Distributions within 8 days of request.

Alliance Pension Consultants --
www.AlliancePension.com. 847-291-9440. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Quotes based on plan specs and parameters. Daily retirement distributions.

American United Life Insurance Co. --
www.OneAmerica.com. 866-313-7355. Available in all states except New York. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Varies by product. Daily retirement distributions.

Assurity Advisors Inc. --
www.AssurityAdvisors.com. 800-284-8576. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Varies. Daily retirement distributions.

Belanger and Co. Inc. --
www.BelangerandcCompany.com. 610-239-9750. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: $1850 plus an additional $10 per participant. Setup fees: $750 plus $150 per participant per year. Billed monthly.

Benefit Consultants --
www.bcionline.net. 888-968-2422 x22. Available in AL FL GA MS TN. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Vary based on assets. Distributions subject to plan designs.

BenefitStreet Inc. --
www.BenefitStreet.com. 925-328-4547. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: $450 setup, $500 conversion.

Century Benefits Consulting Inc. --
www.Benefits-shmenefits.com. 415-647-8144. Available in all states. Offers plan consolidation, and benefit statements. Annual administrative fee: Varies with plan structure.

Charles Schwab --
www.scrs.schwab.com. 877-456-0777. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Quotes on case-by-case basis.

CPI Qualified Plan Consultants Inc. --
www.cpiqpc.com 800-279-9916 x765. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Varies depending on plan selected.

Daily Access Corp. --
888-535-4322. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee:$85 loan set-up fee; $50 annual maintenance fee.

EBS Benefit Solutions, Inc. --
www.ebsbenefitsolutions.com. 585-421-4400. Available in all states. Strictly an administrator, does not offer rollovers etc. Fees depend on product plan, support or “open mutual fund architecture”.

Employee Benefit Systems Inc. --
www.ebspesnion.com. 570-223-8402. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: $1000 set-up; on-going $900 plus $30 eligible.

Entrust New Direction IRA Inc. --
www.NewDirectionIRA.com 303-546-7930. ONLY in CO HI MT WY. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Varies depending on assets. Set-up fee: $350; Annual fee $300 plus investment costs.

Expert Plan --
www.ExpertPlan.com 866-929-2525. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Set-up fee: $75-$750; Annual recordkeeping fee: $75-$750; Annual participant fee: $0-$36 depending on assets.

Future Benefits of America –
www.fb401k.com 901-843-7799. Available in all states. Set-up fee: $1200; $1000 base fee; $35 per participant with balance.

Great West Retirement Services --
www.gwrs.com 877-630-4015. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: not specified here, but it does charge fees for loan origination and annual maintenance fee for each loan.

Guardian Ins. & Annuity Co Inc. --
www.GuardianRetirement.com 866-390-7268. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: Setup: $750; $1250 conversion; other fees depend on assets.

Harbor Insurance Marketing --
www.HarborIns.com 866-424-2167. Available in all states EXCEPT NY. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with size of plan.

ING --
www.ingretirementplans.com 888-238-6243. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with assets, number of participants, and/or if there is a TPA involved.

Insurance Designers of Houston, Elite Mktg. Gp. --
www.EliteMktg.com 800-477-3548. Available in all states EXCEPT AK, DC AND HI. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with size of account.

Iron Corporate Retirement Services --
888-396-4766. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with plan size and number of participants.

Lafayette Life Insurance Co. --
765-477-7411. Available in all states EXCEPT AK AND NY. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: if one participant $250; all others $1000.

Lincoln Financial Group --
www.lfg.com 877-533-9710. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies.

MassMutual Financial Group --
www.MassMutual.com 866-444-2601. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with plan size and complexity.

Mercer --
www.mercer.com 866-454-6477. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies by plan.

Milberg Consulting --
www.milbergconsulting.com 800-965-0988 x101. Available in all states. Offers no rollovers, but does offer plan consolidation, and benefit statements. Annual administrative fee: setup - $1750-$3,500; ongoing fee - $2,000-$5,000.

Mutual of Omaha Retirement Services --
www.GetRetirementRight.com 877-401-7253. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with plan size.

Newport Group --
www.Newportgroup.com 800-230-3907. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with plan participants and assets, funds, etc.

Ohio National Financial Services --
www.OhioNational.com 877-999-6637. Available in all states EXCEPT AK, HI, NY. Offers rollover plans, plan consolidation, and benefit statements. Administrative fee: setup $375; annual $675.

Online 401k --
www.TheOnline401k.com 877-775-4015. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Setup fee: from zero to $495.

Paychex Inc. --
www.Paychex.com 877-283-9520. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: starts at $95/month and $5 per participant.

Principal Financial Group --
www.principal.com 800-952-3343. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies with plan size.

Putnam Investments --
www.putnam.com 800-719-9914. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: setup starts at $250 and $500/year annual administrative fees.

Revzon Consulting Group --
www.RevzonConsulting.com 877-254-7085. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies.

Securian Financial Group Inc. --
www.SecurianRetirementCenter.com 877-876-4015. Available in all states EXCEPT NY. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies.

The Standard --
www.retirement.standard.com 877-805-1127. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: varies.

Sterling Trust --
www.Ster.lingTrustCompany.com 800-955-3434, option 5. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Administrative fee: base fee of $1250 for up to 20 participants; $1500 for 20+. Lots of features available.

Symetra Life Insurance Co. --
www.symetra.com/401k. 800-706-0700. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: None for the product. Symetra partners with Third Party Administrators to provide plan administration.

TGA, The Green Agency --
www.GreenAdvisory.com 508-224-9646. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Administrative fee: $900 bundled plan for less than 100 participants.

Transamerica Retirement Services --
www.TA-Retirement.com 888-401-5826. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: no setup fees, other plan fees vary with size.

Unified Trust Co. --
www.UnifiedTrust.com 859-296-4407 877-411-8781 Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Annual administrative fee: vary depending with services. Fees are online.

Wells Fargo Bank --
wwwWellsfargo.com/retirementsolutions 800-368-1225. Available in all states. Offers rollover plans, plan consolidation, and benefit statements. Administrative fee: setup is only $75.

Two Kinds of Long-Term Care Policies? Yes, Cash Model and Indemnity

While most people know that there are two basic forms of life insurance (term and whole life), they do not realize that long-term care insurance also has two basic forms, ie cash model and indemnity model.

It is hard enough to sort through the variables of setting up a long-term care plan. You have to select a coverage period, how much a month you think you might need for a nursing home, whether to include home health, whether to include an inflation protection rider.

First, the Cash Model: Once the policy-holder qualifies to become claim eligible, the insurer will mail out a check each month for the full amount of the monthly benefit. This money is his or hers to spend as they see fit to cover their bills. The cash model does not require the use of licensed care for the insured to be covered. The insured has complete freedom of choice of providers to tend to their needs. He can even buy a lift-equipped van if that what is needed to maintain independence.

These cash payments are tax-free up to $98,550 in 2008. It is an ideal plan for the insured, because he will know exactly how much money is coming in each month, and gives such complete freedom of choice in how one can spend it. Any excess funds can be stashed away in savings or investments for such time as the LTC policy coverage period expires. And if the insured does pass away, those funds will be in their accounts to cover any debts and be passed along to their estate's beneficiaries.

The second type is the Indemnity Model, which is what most of us have been exposed to. This model requires that in order for benefits to be paid, they must be performed by a licensed caregiver AND for eligible expenses. The insured typically has to receive at least one hour of licensed care per day to remain covered by the policy.

The insured under this plan has a daily amount allotted to him; at the end of the month, the insurer totals up the days in which the insured received at least one hour of care, multiplies by the daily coverage amount, and then issues the check to the insured.

Now think about this. This means that the insured could potentially receive wild variations in the level of benefits under this format. True, they are tied to actual services received. But the insured may have a real need for some type of adaptive equipment in the home so that they can remain in their own homes. This equipment is normally going to have a monthly bill no matter whether the insured has a lot of home visits or not – and MAY NOT be covered under your policy. That means the insured is paying out of his own pocket for whatever is needed to maintain independence.

The indemnity policy is generally 40-60 percent less expensive than the cash model, and I hope you readers can see why. People are scared of the cost of a LTC plan as it is, so insurers just show this model to their prospective clients. Your agent may not even be trained in the cash model plan because so few people know enough to ask for it.

You are wiser to save money by cutting down the coverage period rather than by going to the indemnity plan. Industry studies show that most long-term care plans have a claim history of only 2 to 3 years. And yet many clients select the lifetime option because they are terrified of outliving their money. This is one case where fear is costing people thousands of dollars in premiums unnecessarily.

I should also add that in case you do not qualify for coverage under a long term plan (in other words, you are rejected by their underwriting department), you still have other options. Many life insurance policies now have an accelerated benefits provision, where you can draw upon the value of your life insurance plan to pay your nursing home or other end-of-life expenses.

I hope this information is of benefit to you in planning your insurance coverages.

[Disclaimer: This article is not intended to sell the reader anything. But you must still consult with a financial planner (preferably certified) or your local insurance representatives to find a policy that fits your needs.]

What features should you look for in a Long-Term Care insurance policy?

You have finally decided to bite the bullet and check around for a long-term care policy for yourself or a loved one. But where do you begin? What features should be included in a plan?

You do not have to re-invent the wheel when seeking a LTC policy. The folks at the National Association of Insurance Commissioners (NAIC, found online at NAIC.org) have kindly provided a mini checklist for your benefit. The list includes:

• 
  At least one year of nursing home or custodial care, and should also include intermediate care.
  You probably want home health care included, too. Home health should not be limited to skilled care (meaning a registered nurse). You will probably need to call in unskilled help to assist with household chores, to help bathe and feed your loved one, or any of the myriad things that need to be done.
• 
  Coverage for Alzheimer's disease, if the policyholder develops the illness after the policy is issued.
• 
  Inflation protection option. No one knows just how expensive it will be ten years from now to keep someone in a decent nursing home; prices have risen sharply over the past ten years for all health care. It will cost you more to have this rider or option.
  The insurance carrier is obligated to provide you with a free copy of the “long-term care insurance shopper's guide”. They prefer to hand this out after you have signed on the dotted line for an application, but you are NOT obligated to buy or express an interest in buying, in order to get this booklet.
• 
  A guarantee that the policy cannot be canceled, nonrenewed, or otherwise terminated because you get older or develop a chronic illness/serious disease.
• 
  You have the right to a 30-day period – known as a 'free look' – in which to examine the policy and return it if it does not seem to be what you wanted. The insurer will return your check. This is a standard provision, not a gift from each insurer, but do mention it anyway.
• 
  There should not be any requirement such as the following: that the policyholder first be hospitalized before admission to a nursing home in order to be covered; that the policyholder first receive skilled nursing home care before entering an intermediate or custodial nursing home; or that the policyholder first receive nursing home care before receiving benefits for home health care. Why are these important? Because most people prefer to keep a loved one at home for as long as possible before finally transferring him or her into a nursing home. These provisions we have listed all are intended to keep someone in a healthcare facility of some kind rather than at home.
• 
  In addition, you might see a 'waiver of premium' rider. This allows you to stop paying premiums during the time you are receiving benefits. Read closely to find what restrictions there are on this rider. Commonly, you will have to be in a nursing home for 90 days before the waiver goes into effect.
• 
  Pre-existing conditions. Insurers usually say in the policy that pre-existing conditions are excluded for 6 months or a year. However, often they will simply not write a policy for someone with certain diagnoses. For example, I once tried to get a long-term care policy for a lady who was 72, in great shape – but underwriting turned her down because she had diabetes. Even though her condition was controlled and her weight was in the normal range, they felt her disease was progressing enough so that they did not want the risk. Also, some diseases may be quite common in your state and some insurers will not cover it. In Minnesota, multiple sclerosis is quite common (statistically speaking) and so it is excluded from dread disease policies. (In other words, if you have a family history of this disease, move to another state if you want to buy a dread disease policy.)
• 
  What exclusions are in the policy? It is common that injuries or illnesses that result from self-inflicted causes are excluded. But you may be surprised that those who have a history of drug or alcohol abuse will also be excluded from coverage if their condition is deemed related to that history. (Example: liver disease, brain damage from a drug overdose, etc.)
• 
  Possible return of premium. Some policies allow you to get a healthy refund of premiums paid if you do not use the insurance provisions or decide to cancel. You will not get 100 percent of your premiums back. You will however pay more for this rider. Why would you want this rider? If at some point you can no longer afford the premiums, or some other option opens up for you that will replace the coverages of this policy, you could decide to cash it in, so to speak, and use the cash to buy into another coverage.

People generally buy far too much long-term care insurance. From the statistics that I have seen, most people only spend one, two, or three years in a nursing home. And yet people are terrified of the possible expenses of spending twenty years in such a facility.

Although I personally know of a classmate's father, an Alzheimer's patient, spending six years in a nice facility, he was not the norm. He was a big, strong guy before he came down with the disease, and he died as result of complications of pneumonia.

On the other hand, my own grandmother only spent about six months in a skilled care facility before she died. But you have to play the odds here, the reasonable odds. And most likely, three years of nursing home care is all that one can reasonably be expected to afford premiums for.

My other recommendation, as a past professional in the area of senior products, is that IF you cannot get a long-term care policy due to health history or whatever, then increase your life insurance coverage to the most you can reasonably afford. Most life insurance policies are 1) cheaper than LTC policies, 2) easier to get than a LTC policy, and 3) have acceleration of benefit provisions so that if you are diagnosed with a terminal illness or have to go into a nursing home, you can draw upon the policy limits. At the very least, you can put up the life insurance policy as a form of collateral on the final bill from the nursing home.

SEE ALSO:
America's Health Insurance Plans (AHIP) – online at AHIP.org; they have an office in Washington, DC.
American Health Care Assn. -- 1201 I (as in Illinois) Street NW, Washington, DC 20005, 202-842-4444, or online at ahca.org.
National Assn. Of Insurance Commissioners (NAIC) – 2301 McGee Street, Suite 800, Kansas City, MO 64108, 816-842-3600, or online at NAIC.org.
National Council on the Aging – 300 D Street SW, Suite 801, Washington, DC 20024, 202-479-1200, or online at NCOA.org.
Area Agency on Aging – 1-800-677-1116 to find a local office.

In Honor of the Upcoming Veterans Day – How To Make Claims on Your Military Life Insurance

In honor of Veterans Day this year, I want to help the families of military veterans get their proper benefit checks for life insurance policies held by service persons. IF you have kept up your military group life insurance policy during service (if still in uniform) or after discharge, you (or rather your beneficiaries) should be able to get the VA to accept your claim. Just read this article and go to the link given below to find the claim form.

Several years ago a scandal broke out about the Veterans Administration denying all phone inquiries inre making claims on veterans group life insurance policies. It seemed that the staff was using the funds to pay for department parties and other nonsense.

I was also surprised to hear of one widow of a WWII veteran making a successful claim on her late husband's policy not long before this scandal broke out (about ten years ago). Fortunately for her, she had an adult child who sent in a request for a claim form instead of just accepting the erroneous information that had been received by phone. The veteran had kept policy status updates on file, and so they had a policy number and an address to send the request to.

So to make a long story short, they received the claim form – a mere half-page long – and filled in the necessary information. The only difficult section asked for the veteran's discharge date, an item they luckily had on the discharge papers.

Do you want to guess how much money the widow wound up with? The policy had been paid up some time before and was accruing interest. The final valuation was for over $6200. That was a very welcome hunk of change to help make up for the loss of her husband's pension check from work.

Below is the link to the VA insurance page. There are several forms available but to make a claim, click on the one that says: SGLV 8283, Claim for Death Benefits. There is also a related form to make claims for the death of a spouse (or other covered family member) of a military service person.
http://www.insurance.va.gov/sgliSite/forms/forms.htm

It does not matter how long ago your military service person or veteran died; the policy still accrues value until the claim is made. Just dig up your insurance policy and discharge papers, and you will have enough information to fill out the claim form.

Good luck to all of you, and thank you to all our United States veterans out there (and their families). Have a good day.

[The erroneous information given by phone was possibly a mixup; the VA continually has to deny inquiries about a mythical veterans insurance dividend payout. You can read a full article explaining that confusing urban myth at http://urbanlegends.about.com/library/weekly/aa050698.htm .]

Wall Street Journal Has Story on Fighting Insurance Denials

Pushing Back When Insurers Deny Coverage for Treatment --
By Anna Wilde Mathews, The Wall Street Journal
http://www.marketwatch.com/News/Story/Story.aspx?guid=b6e08398424d449bb8ac46fc3c8a2565&siteid=nwtpf&sguid=LlOmLCZmMkSOlLZa0_8Pmw
Battling a health insurer when it refuses to cover certain treatments can be aggravating and time-consuming. But if you choose to join the growing number of people who are appealing coverage denials, there are several strategies that can bolster your case.

State, insurers, doctors in battle over billing

-- from the Ventura County Star, Sept. 12, 2008
A person injured in a car crash is treated in the emergency room. The insurance company pays the out-of-network doctors involved in the care less than they think they're owed.
So a doctor or the hospital sends a bill for the remainder directly to the patient।

It's called "balance billing" and has spawned a turf battle among state officials who are trying to outlaw the practice, insurers who support the ban and doctors who fight it and see themselves as victims।

"Legislate, regulate and litigate। We'll do whatever it takes," said California Medical Association President Richard Frankenstein, before a meeting with Ventura County doctors this week. He laid responsibility for balance billing on insurers trying to protect their profits by underpaying doctors.

"It's a very clever ploy of multimillion-dollar companies to avoid their responsibilities," he said.
But some patient advocates say there's enough blame to share। They say the fight over compensation for emergency care ends up wounding patients who worry that if they don't pay the doctor's bill, their account will end up with a collection agency.

"We're caught between these two institutional providers," said Beth Capell, an advocate with Health Access California. "It's a temptation to say a plague on both your houses."
Many of the problems occur in emergency rooms where neither patients nor doctors control who they see। People may be treated by providers who don't contract with their insurance company. The doctors are paid a lesser, out-of-network rate.

According to the California Association of Health Plans, 1।76 million Californians who went to emergency rooms over a two-year period were billed by doctors or hospitals for money not paid by insurers.

The total bill was about $528 million.
The California Department of Managed Health Care plans to roll out a regulation next month that labels balance billing for emergency care as an unfair practice, opening the door to enforcement action against doctors or hospitals।

A bill by Sen। Don Perata, D-Oakland, would ban ER doctors from balance billing and would set up a process to mediate insurance disputes as well as an interim rate of payment. The bill was approved by the Legislature two weeks ago and awaits Gov. Arnold Schwarzenegger's signature. It would supersede the managed care regulation.

The doctors' association will sue the day after the state implements its new rules, said Frankenstein, in Camarillo for a meeting of the Ventura County Medical Association. The state group also opposes Perata's bill, though a group of emergency physicians supports the measure.
Frankenstein said insurance companies need to expand their networks to include more emergency room and on-call doctors। They also need to pay more, he said.

"It's up to the health plan to either serve up the doctor or pay the bill," Frankenstein said, suggesting insurers maximize profit by saying, "This is what we feel like paying today."
Nicole Kasabian Evans of the California Association of Health Plans fired back।

"Health plans are not the ones that are sending the bill to the consumer," she said। "We don't think it's appropriate strategy to hold patients hostage."

Evans said the insurance group supports a ban on balance billing and an independent process to deal with disputes with doctors। But the group opposes Perata's bill because the rate of payment may be too high. Doctors who currently contract with insurance companies might drop out to get the out-of-network rate, she said.

Eliminating balance billing is great if it comes with reform that transforms the healthcare system and provides insurance coverage to everyone, said Jim Lott, executive vice president of the Hospital Association of Southern California। But hospitals aren't happy about measures that eliminate the bills but not the underlying causes, he said.

"Balance billing is a tool hospitals use to force health plans into negotiating fair rates," he said. "Consumers need to know. If their health plan is screwing up, they need to know that."
Patients shouldn't be seen as a tool, said Cindy Ehnes, director of the state Department of Managed Health Care।

"It's inappropriate to put a vulnerable, potential sick patient in the middle of a billing dispute just to provide leverage," said Ehnes, calling on doctors to take their disputes to her department.
Local doctors say balance billing isn't about getting rich but about staying in business। Some predict that eliminating the mechanism will amplify other healthcare problems such as getting doctors to serve on call.

"I think that will be the death knell to taking call in the emergency room," said Dr। Mark Ghilarducci of Oxnard.

Jerry Flanagan of the Consumer Watchdog group in Santa Monica feels sympathy for doctors who can't break what he called the stranglehold of insurance। But he also blames the medical association for holding up years of efforts to end balance billing.

"As sympathetic as we are for the physician, we think there is no excuse for billing the patient because of disputes between the doctor and the insurance company," he said। Referring to strategies that would solve the problem, he said: "That's what we've been waiting five years for."

Ventura County Star, Sept. 12, 2008, http://www.venturacountystar.com/news/2008/sep/12/state-insurers-doctors-in-battle-over-balance/

NEW Autism Center Opens in Minnetonka, MN But Insurance Limits Treatment

Great news on the autism front as a new treatment center opened in Minnetonka, MN with Governor Pawlenty doing the honors. The new ABA approach to treating autism has showm remarkable promise in a short time.
It is a very intensive therapy, however, with upwards of 40 hours a day of therapy. The insurance company – in this case the high-risk pool for Minnesotans – has capped coverage at 40 hours a week. The children receive more than that, so providers are forced to limit treatment.
ABA is an acronym for Applied Behavioral Analysis, a new technique that has been remarkably successful in turning non-verbal youngsters into normal expressive children who can express their wants and needs.
From a story in WCCO.com on Aug. 20 --
On Tuesday, Gov. Tim Pawlenty appeared at the Grand Opening of the Minnesota Autism Center's new facility in Minnetonka. The center focuses on applied behavioral analysis, or ABA therapy, in which children with autism work intensively with therapists on speech, language and daily living skills. "This center is a modern, capable, wonderful place that's going to provide these services and provide hope and improvement in the lives of these families and the children it serves," said Pawlenty. However, the governor's appearance comes as some parents are questioning the likelihood their insurance will continue to cover as much ABA as their children need. For Amy Dawson, the value of the ABA therapy her son Mac receives is without question. "He was non-verbal a year ago and now he scores in the gifted range for spoken vocabulary," said Dawson. [http://wcco.com/local/ABA.therapy.insurance.2.799665.html]
The Cambridge Center has an excellent source of information about the ABA approach to autism and explains what Applied Behavioral Analysis is. See this link for more information about it. [http://www.behavior.org/autism/]

CARRIERS OF CRITICAL ILLNESS INSURANCE POLICIES

NAME OF CO. NAME OF POLICY STATES AMT
AFLAC.com -- Specified Health Event -- All except MA NY VT WA; $5K 1st occurrence with other amts. for specific bills; only issue age restrictions; 10 question application
AIG.com -- Group Critical Illness -- All except CT MT NY VT WA; $10K and up; issue ages 18-64; terminates age 70; simplified underwriting
AIGebs.com -- AIG Group Critical Care Ins. -- All except CT MN NY WA -- amt varies; issue ages 18-69; terminates age 75;
ALLSTATEatWork.com -- New Lifeline Critical Illness -- All except CT MD NH NY VT WA; issue ages 18+ payroll only; three levels of underwriting depending on benefit level
CAICworkSite.com -- Critical Illness -- All except CO CT MN NH ND RI WA; issue ages 18-69; benefits levels $5 to $50K; benefits reduce age 70; three underwriting questions
Century Benefits (TodaysMedicare.com) -- Medicare Plans -- In CA CT FL ME MA NH NJ NY PA SC TN TX; issue ages 64 and up; no health restrictions
ColonialLife.com -- Critical Illness -- All except CT; issue ages 16-69; choice of $5K to $50K indemnity or lump sum; benefits reduce at age 75; underwriting depends on benefit level (2-7 questions)
CBL-Life.com -- Timber Ridge Series of Critical Illness Ins. Plans -- All except CT NY VT; issue ages 18-64; benefits $10K to $250K; no age restrictions; underwriting restrictions on history of cancer, heart disease, insulin dependent, diabetes.
CONSECO.com -- C. worksite Critical Illness -- All except CA CT FL GA ID IL MD MA MN MS NH NJ NY NC ND SD TN VT WA; issue ages 18-69; lump sum up to $70K; no coverage for pre-existing conditions first year of policy
EMCnationalLife.com -- Worksite Critical Illness 3.0 -- All except CT DE MD MA NH NJ NY PA VT; issue ages 18-65; lump sum; policy expires age 70; simplified issue
EquiLife.com -- Life Guard -- All except AK CA CT DE DC FL GA HI ID LA ME MD MA MN NH NJ NY PA RI SD VT VA WA WI; issue ages 20-70; lump sum; reduces at age 65; underwriting restrictions
FDL-Life.com -- Critical Illness -- All except CA CT GA ID IA KY MN NH NY SC WA; issue ages 20-90; one-time payment, $5K to $50K; benefits reduce age 70; health restrictions
GUARDIANlife.com -- Critical Illness -- In AL AK AZ AR CO DE DC GA IL IN IA KS KY MI MO NE NM OH OK OR PA RI SC TX WI WY; attained age rating; lump sum from $5K to $50K; benefit reductions with age; simplified underwriting
HARBORins.com -- Simplified Critical Illness -- All except CT MD NH NJ VA WA; issue ages 18-59; policy guaranteed to age 75;
HARBORins.com -- Simplified Critical Illness Plus -- All except FL MA MN NY VT; issue ages 18-69; lump sum; pre-existing conditions not covered in first year of policy
HEALTHplan.com -- Group and Indiv. Critical Illness -- All except CT MA NJ NY; issue ages 18-69 (may vary by state); benefits reduced age 70; health restrictions vary per state
HUMANA.com -- Critical Advantage -- In AL AZ AR CO DE DC GA HI IL IA KS LA MA MI MS MO ME NC OH OK RI SC TX VA WV WI WY; issue ages 18-69; lump sum up to $50K; one year waiting period for pre-existing conditions
SETTLEMENTS101.com -- Viatical Settlements or Life Settlements -- All States; any age; must have short life expectancy (24 months)
MetLife.com -- Critical Illness -- All except CT FL WA; groups of 1000 or more; all ages; lump sum $1K to $100K; NO age restrictions; underwriting varies by plan
MHN.com -- EAP and Managed Behavioral Healthcare -- groups of 50 or more; any age; no age or health restrictions
CRITICALillnessCoach.com -- Critical Illness Plus -- All States; issue ages 18-64; individual product requires underwriting but only 3 questions
TRANSAMERICAworksite.com -- Critical Assistance Plus -- All except CT FL GA IN MD MA MN MT NJ NY TN UT VT; issue age 18 and up; must be actively at work; one year waiting period for pre-existing condition
TRUSTMARKsolutions.com -- Critical Illness -- All except CT; groups of 100 or more; issue ages 18-70; lump sum on diagnosis; no benefit reduction with age
UNITEDamerican.com -- Health Guard -- All except CT KY MA MN MT NH NJ NY SD; issue ages 18-64; one-time lump sum on diagnosis $10K $20K $30K $40K or $50K; benefits halved at age 65; ONLY COVERS heart attack, stroke, TIA, Migraine, Vertebrobasilar ischemia, Cerebral Injury due to trauma or hypoxia, vascular disease affecting eye or optic nerve.
UNUM.com -- Specified Critical Illness -- All except CT; issue ages 17-69; full payout except for coronary bypass surgery and carcinoma in situ (skin cancer) which are paid at 25 percent; only 3 questions in application

Big emphasis on HSAs and high-deductible plans

Many employers want to take a more active role in enticing workers to form the habits and get the recommended screenings that can protect their long-term health. To encourage employees to stick with preventive-care maintenance medications such as drugs to control high blood pressure, next year Guardian hopes to be able to waive the copay on such drugs, Mansberg said.

A growing number of employers are embracing incentive programs that reward workers who take health risk assessments, attend onsite health fairs or participate in biometric screenings, where they're measured for height, weight, blood pressure and other health-risk indicators, she said. "The vendors we work with make the information available to your primary-care physician so [he or she is] kept in the loop of what's going on."

A break on premiums or a small cash incentive can persuade busy workers to make their health a priority, Mansberg said. "A lot of times people will take care of their kids but they don't take care of themselves the way they should. It's another way to make it top of mind."

Full story from Market Watch -- www.marketwatch.com/News/Story/Story.aspx?guid=38e267addf124ae18d6733a44a95895a&siteid=nwtpf&sguid=-ELWpQNc4kyEAAp-GHdHfQ

Some employers are dropping formal group insurance coverage completely or just sign up with administrative services like AdminiStaff. The advantage of these outside administrators is that it saves the company hours of processing time for check deductions, while allowing employees to pick and choose insurance plans that fit their needs.
Not selling you anything -- just acknowledging that there are other options out there that are catching on.

Americans Finding They Can No Longer Afford Insurance

QUOTE: ‘What we're seeing is a market that's gotten so mature and beyond its customer[s] that people can literally no longer afford to buy the product,’ said Sheryl Skolnick, an analyst with CRT Capital Group. ‘The number of uninsured is growing faster than any player in the game, and it's getting bigger.’

That was from a Wall Street Journal story about the insurance industry. --

When our country decided back in 1919 that it was not going to go the same route as several European nations and embrace national health care, we never imagined that the private health insurance industry could price itself out of the market.

Health care bills have been rising even though doctor bills have been pretty steady. The reason is that more services are ordered -- the X-ray or MRI, the technician to take the X-ray or MRI, the physician specialist to read the X-ray or MRI, the drugs needed for the MRI, the nurse assistant to administer the drugs so that they can take the MRI, etc. You get the idea.

Even managed care has been unable to keep the cost of medical care down. The insurer may arbitrarily decide on a fee for a mammogram, usually $100. The provider may actually bill $300 to cover costs, etc. A mastectomy really costs $5000, but the insurance may only pay $800 or so. Where is the difference going to be made up?
The patient cannot afford to pay both the insurance premiums AND the balance of his medical bill. All too often, he or she may decide, hey, I am not getting my money’s worth out of this deal so I am foregoing the insurance. And this is the decision being reached by employers, too.

Stop and digest this figure -- 6.4 million fewer workers had employer-sponsored health insurance in 2006 than in 2000, according to the Economic Policy Institute. By the way, there are a total of roughly 47 million Americans without health insurance at all, and about 9 million kids with no coverage. How did we come to this state of affairs, and what do we do about it?

Part of the problem is that a nice system, the HMO, was twisted around to serve as a profit-generating mechanism. In the process, premiums rose from 1993 to 2003 by over 7%, but administrative costs rose by 500%. No one can stay in business for long with those kinds of statistics.

I can attest that insurers are under big pressure to reduce their costs. I used to work behind the scenes and saw the cuts in staffing, the reliance on faster computers and software to process mountains of claims (about 4,000 to 6,000 claims a day were received by that company), and the many small cost-cutting measures that affected worker morale.
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PS --
I found a blog about health matters that was very interesting. Here is that writer’s take on “The Managed Health Care Roller Coaster” at http://www.healthbeatblog.org/2008/07/the-managed-car.html.