As of November 18th, 2009, Imerica has been placed in Rehabilitation, and is no longer issuing new policies.  During this process, the Arkansas Insurance Commission will be overseeing the day to day operations of Imerica, and for now, claims will continue to be paid.  If it is determined that Imerica can be rehabilitated, they will continue to do business under the rehabilitation plan.  If not, Imerica would be liquidated, and policyholder claims not paid by Imerica would become the responsibility of the life and health insurance guaranty funds in the states where Imerica was licensed.  In Colorado, this group is known as the Life and Health Insurance Protection Assocation (LHIPA).  LHIPA has a maximum benefit of $500,000 for major medical insurance, which is significantly lower than most of the benefit maximums offered on private health insurance policies in Colorado (including Imerica, which offered policies with lifetime maximums ranging from $2 million to $8 million).

If you currently have a policy with Imerica and are in reasonably good health, you may be able to qualify for a policy with another carrier.  This will involve medical underwriting, but we can help you determine whether there is a company that would work for you, based on your medical history.  If you are in very good health, changing to another carrier will be a relatively easy process.  Please contact us if you have questions about switching to a new carrier, or if you would like to compare other options that are available in Colorado.

1.  It’s important to know that each health insurance carrier has its own underwriting guidelines.  Just because you’ve been declined by one carrier, does not necessarily mean you’ll be declined by all of them.  We can give you an idea – based on your specific health history – of whether you might have better luck with a different carrier.

2.  Cover Colorado is available for most people who have been declined by a private health insurance carrier.  Cover Colorado is the state high risk pool, and has been providing health insurance for people with pre-existing conditions since 1991.   They offer premium discounts if your household income is below $50,000/year.  Applications must be received by the 15th of the month in order to qualify for a 1st of the following month effective date.

3.  Are you self-employed?  You may qualify as a business group of one.  You must have been in business for at least one year in order to qualify as a business group of one.  The state mandated Basic and Standard health insurance plans are guaranteed issue for a group of one during specific open enrollment periods, defined as 31 days from one of the following events:  the one year anniversary of the opening of your business, your birthday, or the loss of other coverage.  You can contact the Colorado Division of Insurance for more information about group of one regulations.  Like most group policies, group of one coverage is more expensive than most individual policies.  The notable exception is in the case of large families.  Individual health insurance premiums are calculated on a per-person basis, whereas group premiums have “family” rates that don’t vary with the number of children.  Group of one policies are offered by all carriers that offer group health insurance policies in Colorado.  The state mandated benefits in the Basic and Standard plans are the same regardless of what carrier you choose, but the price varies from one carrier to another.

4.  Have you recently left a job?  You may qualify to continue your coverage under COBRA or Colorado state continuation regulations.  COBRA applies to people who worked for a company with 20 or more employees, while state continuation applies to people who worked for a company with 2 – 19 employees.  In both cases, you’re allowed to continue your group coverage for up to 18 months (or more, depending on some specific circumstances), but you will be required to pay the entire premium, including the portion that your employer was paying on your behalf.  If you’re covered under COBRA regulations, you have 60 days to elect to continue your policy after you leave your job.  In the case of state continuation (if you were working for a company with fewer than 20 employees), you have 30 days to elect to continue your coverage.

5.  Depending on your income, and several other factors, you or your dependents may qualify for Medicaid.  In addition, children and pregnant women in Colorado may qualify for Child Health Plan Plus (CHP+) if their household income is less than 200% of the federal poverty level.

6.  Do you work for a small company that does not provide health insurance?  You could discuss the issue with your employer, and see if you can convince them to enroll in a small group plan.  Groups of 2 – 50 employees are guaranteed issue in Colorado, and with the passage of HB 1355, small group premiums cannot be adjusted either up or down during enrollment based on the medical history of the group members.

Thankfully, we live in a state where there are several options for people who are unable to qualify for private individual health insurance.  This is not the case in all states, although maybe the ongoing health care reform debate will eventually add options where there currently are none.

Interestingly enough, the al la carte insurance idea, written as a piece of satirical genius, reminded me of policies that are sold by some of the less scrupulous health insurance carriers in Colorado.  If your health insurance application is asking you to decide whether you’d like to have coverage for cancer and ambulance rides, you might want to keep shopping.  Health insurance isn’t like ordering a sandwich at Subway.  None of us know what might happen to us in the future.  I’m a big fan of keeping premiums down by choosing a high deductible, HSA qualified plan.  But if and when I meet my deductible, I want to know that I’ll be taken care of – even if I end up having a medical condition that I never imagined I’d have.

Health insurance is expensive.  And it only gets more so as time goes by.  People don’t like this.  And while every sector of the health care industry needs to be working to cut costs, health insurance carriers need to be working twice as hard at this as everybody else.  It doesn’t work anymore to say that we can’t bring down health insurance costs until health care costs come down too.  The health insurance industry needs to look at ways to lower costs regardless of what the rest of the health care world is doing.  The survival of the private health insurance industry is at stake, and business as usual isn’t going to cut it.

So I have a question for you.  How much money are you spending on postage, printing, and paper?  This may seem like a mundane issue.  It’s more along the lines of keeping your tires inflated than giving up the corporate jet.  But I’m curious anyway.  We’ve been selling health insurance in Colorado for nearly seven years, and we’ve seen a lot of technology advancements in that time.  When we started, all health insurance applications were done on paper.  We then faxed or mailed the originals to the underwriting departments at each company.  These days, just about every individual health insurance carrier has an online application.  All of the carriers that we work with have broker websites where we can log in and see the status of applications, current premiums for each client, renewal premiums, etc; we’ve been able to make our office pretty much paperless.

But although we rarely use our printer, our shredder gets plenty of use.  On any given day, we receive somewhere between five and thirty separate envelopes from health insurance companies.  The letters are to notify us when clients are approved, declined, behind on premium payments, or canceling a policy.  A few health insurance companies have started sending lists of client data on a single page or two, in one envelope.  But that is the exception to the rule.  Most of the health insurance companies we work with still send us separate letters for each client.  Obviously they have to send separate letters in their correspondence directly with the insureds (although I’m sure there are plenty of insureds out there who would love to get all their correspondence by email – just a thought).  But why do we need to be getting a stack of 20 letters notifying us that 20 clients have been approved or need to pay their premiums?  Especially when we already know the information in the letters because we visit the agent websites every day.  Even on the low end of what we get each day, ten letters means $4.20 in postage plus whatever the paper and printing cost.  Every day.  And we’re just one agency.

Talk of enhancing efficiency and making use of electronic information technology are all over the place right now in the health care sector.  Health insurance companies have absolutely come a long way from the days when everything was done on paper and applications routinely took weeks to underwrite.  But the amount of mail that we receive every day (all of which is redundant for agents who stay on top of the electronic communications from the health insurance companies) is astounding.  In addition to being cheaper and more eco-friendly, electronic communication of data is much more efficient – we find out immediately when an underwriting or administrative action has been taken, rather than waiting two or three days to get a letter in the mail.

I realize that not all health insurance agents utilize the internet the way we do.  They may appreciate the paper communications, although the volume of mail (and the cost of postage) could be dramatically reduced if health insurance companies sent out lists rather than separate letters regarding each individual client.

So if there are any health insurance carriers out there looking for ways to cut costs, I highly recommend that you review how you’re communicating with your agents and how much you’re spending on postage and paper.  Keeping agents informed about what is going on with their clients is essential.  But it doesn’t require stacks of paper mail every day.   Most of you have already made the information available to brokers online.  Now it’s time to phase out the multiple letters you send to us and all of your other agents every day.  Just make sure that the money you save goes directly towards keeping health insurance premiums in check.  Your agents and your insureds will thank you.

In order to waive enrollment in the health insurance policy that the university provides, students must complete this waiver form, showing that their own coverage is comparable to or better than CSU’s policy. CSU’s policy has a low deductible – only $250, and it covers maternity, which most individual health insurance policies in Colorado do not. In order for students to waive the CSU coverage, they must show that their own policy includes coverage for all of the benefits that are mandated for group plans in Colorado – including maternity care. This is tricky. Only three individual health insurance companies in Colorado still have the option to add maternity (United Healthcare, Assurant Health, and Rocky Mountain Health Plans). And the ones that do are very expensive and have very limited coverage (Rocky Mountain Health Plans currently charges an additional $538.11/month to add maternity to their individual plans). When we have clients who choose to add maternity coverage to a policy, it is because they’re planning on using it. Almost nobody adds it as a just-in-case provision – it’s just too expensive. It’s important to note that while routine maternity and delivery are covered on very few individual health insurance policies in Colorado, all policies are required to cover complications of pregnancy, and all policies are required to cover a newborn from day one (with no medical underwriting) who is added to a parent’s existing policy within 31 days of birth.

When we talked to Maria “Stella” Anderson, Manager of the Student Hartshorn Health Insurance Service at Colorado State University, she made a point that the requirement for routine maternity coverage also applies to men who are attending CSU as graduate students or international students. It is not possible for a man to add maternity coverage to an individual health insurance policy in Colorado, so even if they wanted to, they would have no options available that would allow them to waive the CSU coverage, unless they have access to a group policy elsewhere (ie, through a spouse’s employer, or their own employer if they are working and attending school at the same time).

Vickie Bajtelsmit, a finance professor at CSU, recently wrote an article about choosing a health insurance policy, and advised against getting a $250 deductible. Her recommendation was similar to what we tell our clients – go with a slightly higher deductible in order to lower your premiums, and budget for the small stuff. The point of health insurance isn’t to cover the small claims here and there. It’s there to CYA in case something serious happens. For that to work, you better have a policy that won’t cave under the weight of a large claim.

The requirement that “comparable” health plans cover maternity puts CSU grad students between a rock and a hard place. They can choose to spend several hundred dollars a month to get an individual health insurance policy that does cover maternity (whether they’re planning to use it or not), or they can go with the CSU health plan option and have an annual maximum benefit of $200,000. Neither one sounds very good to me. I have a friend who had a baby earlier this year, 9 weeks premature. The EOBs have started rolling in, and so far they’re up to $250,000. It’s a good thing my friend’s health insurance policy didn’t have a $200,000 annual limit.

I don’t mean any disrespect towards CSU with this post. It’s my alma mater afterall. And low annual and lifetime maximums are pretty standard with college health insurance plans. But grad students should have more choice in the matter. An individual health insurance policy that adheres to state mandates for individual policies should be acceptable coverage. This would give students a much wider array of choices, keep the prices affordable, and allow students to choose smart plans that have higher benefit maximums.

But Sweeney and Cerbo make some very good points. Our goal should be extending access to health care to everyone, rather than the wealthiest Americans who can afford to buy the best health insurance policies. They point out that McCain’s plan would call for the health insurance industry to regulate itself, which is asking the fox to guard the henhouse. There’s no way that a for-profit industry with a huge political lobby and a captive market is going to regulate itself to the degree necessary.

Schwartz makes an excellent point when he says “We consume medical care like a business traveler dining on the company’s expense account: Since someone else pays the bill (insurance companies), patients need not shop around, so providers don’t compete on price.” Very true. When a health insurance policy covers everything (more likely in the case of employer sponsored plans than individual plans), there’s no incentive for the patient to avoid over-utilization of health care. But on the other hand, when people switch to high deductible policies, more of them are likely to discontinue maintenance medications for chronic conditions, citing cost of the medication as a major factor. So there’s not a simple answer. Schwartz would have us rely on the “market” for health insurance, with each person free to “choose what’s best for you and peacefully trade with others doing the same.” But what about the person with a child who has cystic fibrosis? Or Type 1 diabetes? Or the mother with MS? How are these people going to get health insurance through the “free market”? In some states, they will have no options at all without employer-sponsored health insurance, as they would be ineligible for individual coverage. I don’t think that health insurance needs to be tied to employment, but pushing everyone into the individual health insurance market won’t work either. Without a public, tax-funded, guaranteed-issue health insurance plan in place, the people with pre-existing conditions who earn too much money to qualify for Medicaid are going to be left with very few options for coverage. This is the major flaw in the idea of utilizing individual health insurance for everyone, and letting everyone choose what policy they prefer – there are too many people who don’t have a choice at all.

Overall, I have to agree with Sweeney and Cerbo – we need more government regulation and intervention in health care, not less.

The products listed on the Caregivers Marketplace website are aimed at improving health, but they are the sort of things that aren’t covered by health insurance. Since health care is already expensive enough, we thought we’d pass this information on to our Colorado Health Insurance Insider readers. We’re not affiliated in any way with the Caregivers Marketplace – just thought the information might be helpful.

If your health insurance company paid you to follow a healthy lifestyle, would you do it? How much money would it take? Health insurance carriers could give their policy holders an annual credit towards their premium just for getting their blood sugar level checked. Then insureds could get further credits for working with their doctor to set up some basic lifestyle changes and following through with them (with documentation on improvement provided by the doctor). And since the goal would be to take away excuses for not following through, it would make sense if the insurance companies waived any applicable deductibles and copays for the blood sugar tests and follow up appointments with a doctor. People who already lead healthy lifestyles and have normal blood sugar levels could qualify for an additional premium discount if they maintain their health as the years go by.

In the individual health insurance market, insurers are quick to offer increased premiums to applicants with various pre-existing conditions (and in Colorado, applicants who have been diagnosed with diabetes are not eligible for individual health insurance at all). But the idea of giving money back to current policy holders as an incentive to remain healthy hasn’t caught on yet. I know that insurers are loathe to lower premiums, but given the amount of money that an insurance company stands to save if an insured does not end up with diabetes, it seems that it would be worth their while.

In January of 2007, my parents were able to join a pilot program at the University of Colorado Hospital that was working to get patients set up on a home hemodialysis system. They took a three week training course where they learned all the ins and outs of the machine and my mother learned how to insert the needles and prepare for possible problems that could arise during treatment. They plumbed the dialysis machine into their house, and have been using it six days a week for the last 13 months. My father has felt better in the last year than he ever felt in the previous six years. His blood pressure is normal again. He hasn’t vomited since last May (before switching to home dialysis, it wasn’t uncommon for him to vomit daily). He and my mother are remodeling an old house they bought last summer, and he has the energy to work on it several days each week. When I’m around him now, I often forget that he’s sick, whereas before he started the daily home dialysis, it was pretty hard to miss.

Once a month my parents go to the University of Colorado Hospital for testing to make sure that my father’s treatment is working. The doctors also run additional tests for the study that my father is part of, to determine whether daily home dialysis results in better patient outcome than trice-weekly clinic dialysis. Medicare is the primary health insurance for the vast majority of dialysis patients, and they are very interested in large-scale studies to determine whether daily home dialysis should be the recommended treatment for more patients.

From my family’s experience, we would absolutely say that the daily dialysis is dramatically superior. But it does require a caregiver – in this case my mother – who can operate the system and assist with the dialysis process. So it might not work for everyone. But for the majority of patients with kidney failure, daily dialysis can make life seem much more normal than the standard protocol of going to a clinic three times a week and then riding the roller coaster of peaks and troughs in toxin and fluid levels that accumulate over two days. I’m very thankful that my parents were able to enroll in the University of Colorado Hospital program, and that the home dialysis is working so well for my father. I hope that this option will become available for more kidney patients, and will be reimbursed by Medicare for anyone who wants to participate.