Reader Requested Topics - Version 1

On Last month's article I asked the readers for suggestions on topics. Here are three.

With healthcare reform law passed, can a person with a pre-existing condition get insurance without being denied?

First, let me define pre-existing condition. Simply put, it means that a person has received, been tested, hospitalized, had surgery, taken medication or should have received treatment for a condition for the past certain number of years.

The law has a couple of provisions that allows a person to obtain insurance if they have pre-existing conditions.

The first one is a bit difficult to obtain as the person has to be uninsured for at least six months because of a pre-existing condition or have been denied coverage because of their health condition. For more info, go this link: http://www.healthcare.gov/law/provisions/preexisting/index.html

The second one is not available until January 1, 2014 where the law prohibits insurance companies from refusing to sell coverage or renew policies because of an individual's pre-existing conditions.

I read somewhere that with the new law makes provisions for me to get free colonoscopies and mammograms, is that true?

Yes it is but you must check with your plan. The benefit is for preventive services only and restrictions do apply. Did I say, check with your plan? Plans effective on or after September 23, 2010 and plans that renewed after that date who were non- grandfathered. In other words, plans that are law compliant or non grandfathered. If a plan kept that did not make any changes prior to the law (as in deductibles, coinsurance, etc) it is considered grandfathered or exempt from some provisions of the law.  Go to www.healthcare.gov for details.

My group is comprised of Franchise Owners /non employee representatives in many different states; it seems that there is no way to form a group for them.  Is that right?

At least in Georgia, plans like these have been tried in the past and failed. While many proponents see the potential of a large number of members being insured, they do fail that in order for those to work; the pricing has to be competitive. Historically, these plans have been tough to maintain Rates are determined on the number of units that are insured plus conditions at risk. At first rates may look good but as claims and demographics change, those rates tend to go up drastically causing the healthier members to drop off the plan leaving only those who most likely need it.  A plan comprised with those who most likely will use it will have higher rates. . Insurance is easy, you pay premiums and they pay claims. The higher the claims, the higher the premiums.

Please send me questions that you may have and I will try to publish the answer in future articles. Have more questions or are you looking to buy health, life, and long term care, disability, dental for yourself or for your company? Contact Al Schiebel at 404-256-2171 or al@shopbenefits.com

Phone: 404.256.2171 Fax: 404.256.2161 www.ShopBenefits.com