What is Medical Loss Ratio, and how does it hurt your agent in 2011.

The "Medical Loss Ratio" is the amount that an insurance company pays for claims divided by the premiums that people paid for insurance . A claim is a bill for medical items or services. For example, if an insurance company pays an average of 80 cents in claims for every dollar it collects in premiums, then its medical loss ratio is .80.

"Administrative Cost" is the flip side of the medical loss ratio. Administrative cost is the difference between what an insurance company collects in premiums and what it pays for claims. Administrative cost pays for claims processing, underwriting, marketing, utilization review, building up reserves, general management, and profit. Administrative cost is often shown as a percentage of the premium and ranges from 5% to 50% or more. For example, if an insurance company pays 20 cents for administrative cost for every dollar it collects in premiums, then its administrative cost is 20%.

A low administrative cost generally means that an insurance company is efficient. Consumers get more dollars of covered services for the premiums they pay. However, there is a bigger picture. A better measure of efficiency is how much health insurance contributes to people's health for the premiums they pay. This is not always the same as the most dollars of services paid per premium dollar. Some administrative costs can help you to get more for your money. For example, some administrative costs are used to help an insurance company negotiate lower prices for services or to develop programs to improve your health. Company "A" that pays $100 per x-ray may have lower administrative costs than company "B" that pays $60 per x-ray, but company "B" may provide more health for your premium dollar.

The Health Care Reform dictates that in 2011 the Medical Claim Loss Ratio in the individual market can not be higher than 0.80 and for large groups 0.85. As a result insurance companies have reduced the agent commission in half for the the individual market starting in 2011. This means we have to work twice as hard to earn the same amount of money.

This is a hardship for any agency and will cause us to reduce staff and not to hire employees. We will be able to survive but will reduce any expenditure we can avoid.

I wonder if we would tell any public employee, we are cutting your salary in half, what would happen. Although we agent are associated with NAHU, we were not able to help ourselves as we are to small a number to play any role.

It is a pity because we are the liaison to the consumer, who needs us more than ever to find an affordable health insurance coverage.

Health Insurance Affordability - What effect will the Gender Neutral rating have in California

Gender used to be a factor in determining accurate pricing in the California individual health insurance market.

Starting January 2011 accordingly to AB119 the gender rating will be eliminated for any health plan contract, and there are only gender neutral rates offered.

On maternity plans, which are very rare to find in the CA individual insurance market, there will be most likely a significant increase for male and a possible decrease for female insurance holders.

Furthermore in January all carriers have to offer individual insurance plans, which are in compliance to the health care reform. Advantages such as preventive care at no cost, no annual dollar limits for orthotics and medical equipment, will also come along with premium increases.

The only carrier who have approved rates for January is Blue Shield and Cigna.

Carriers such as Anthem Blue Cross, Healthnet, Kaiser Permanente are still not approved by the insurance commissioner.

So keep posted and visit my website and I will inform you about the newest updates in the health insurance industry

Brentwood Health Insurance Agent reports about insurance fines

Calif. regulator fines insurers for underpayment

Anthem Blue Cross and Blue Shield of California each have agreed to pay $900,000 fines. United/Pacificare is being fined $800,000; HealthNet and Kaiser Foundation Health Plan are being fined $750,000 each. Cigna is being fined $450,000; and Aetna is being fined $300,000.

Accordingly to Bloomberg Reports "California's seven largest health insurers face nearly $5 million in fines for failing to pay hospitals and physicians fairly and on time, following an 18-month audit by a state regulator, an official said Monday".

Improper claim payments are burdening health providers as they struggle to stay afloat in a bad economy, California Department of Managed Health Care Director Cindy Ehnes said.

"If providers are not paid, patient care and access suffers," Ehnes said. "The insurance companies in this state must pay their fair share of their claims promptly, fairly and on time."

Audits ordered by Ehnes in 2008 found seven health plans weren't meeting a legal threshold of paying 95 percent of claims correctly. On average, plans paid about 80 percent of claims correctly, Ehnes said.

Additionally, insurers will have to pay an uncapped amount of restitution to hospitals and health providers, which is expected to cost tens of millions of dollars, Ehnes said.

The fines and corrective actions have been negotiated and agreed upon with the insurers, officials said. Insurers also face a follow-up audit.

Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, said the lobbying group was preparing a response on behalf of insurers.

Hundreds of thousands of claims may have been affected, said Ehnes, but the state's audit relied on statistically significant samples of each insurer's claims, so an exact number is unknown.

Ehnes also criticized what she called the hollow provider dispute resolution process discovered at five of the seven plans -- all but Anthem and Blue Shield.

Providers with a claim dispute would often end up contacting the same department that had initially denied their claim, which rarely took a "real renewed interest in the claim," Ehnes said. Corrective plans are in place to prevent that in the future, she said.

Brentwood Health Insurance Agent wants to raise awareness for women to consider Long Term Care Insurance

Why is it so important to raise awareness about long-term care? Because it is an issue that touches so many aspects of our lives.

Women, especially, bear the burden of long-term care costs for three reasons: women live longer than men; they require care longer, and because women more often assume the responsibility for their family's welfare, they often become the primary caregivers for elderly family members or their partner.

Some 980,000 women over the age of 65 are currently nursing home residents compared to only 337,000 men. Nearly three-fourths (73.6%) of assisted living residents are women. Twice as many women age 65-plus are being cared for in a home setting than men (3.27 million versus 1.68 million). According to the AALTCI.

November is Long Term Care Awareness Month. The Premiums for a middle aged person are considerably lower than the one's for a 60 year and older person. Chronic diseases, such as hypertension, can make insurance more expensive.

So do not delay further, call me to learn more about long term care insurance choices.

November is Lung Cancer Awareness Month - Brentwood Health Insurance Agent alert stop smoking

Lung cancer is the leading cause of cancer deaths in both men and women. Smoking causes 80 to 90 percent of cases of lung cancer. Don’t smoke, and avoid secondhand smoke.

Each year, nearly 200,000 people in the United States are told they have lung cancer and more than 90,000 people die from this disease. Deaths from lung cancer represent about one out of every six deaths from cancer in the U.S.

Risk Factors
Research has found several causes and risk factors for lung cancer. A risk factor is anything that changes the chance of getting a disease. Lung cancer risk factors include—

• Smoking.

• Secondhand smoke from other people's cigarettes.

• Radon gas in the home.

• Things around home or work, including asbestos, ionizing radiation, and other cancer-causing substances.

• Medical exposure to radiation to the chest.

• Chronic lung disease such as emphysema or chronic bronchitis.

• Increased age.

Prevention
You can reduce your risk of developing lung cancer in several ways.
Don’t smoke. If you do smoke, quit now.
*Avoid secondhand smoke. There is no risk-free level of secondhand smoke exposure.
*Have your home tested for radon and take corrective actions if high levels are found.
* Avoid unnecessary medical tests that involve X-ray images of the chest.
*Follow health and safety guidelines in the workplace.
*CDC helps support a national network of quitlines that makes free "quit smoking" support available by telephone to smokers anywhere in the United States. The toll-free number is 1-800-QUITNOW (1-800-784-8669), or visit smokefree.gov.

Symptoms
Different people have different symptoms for lung cancer. Some people don't have any symptoms at all when first diagnosed with lung cancer. Lung cancer symptoms can be due to the direct effect of growth of cancer cells in the lung, or due to the effect of cancer cells that have spread to other parts of the body. Lung cancer symptoms due to growth of cancer cells in the lung may include—

*Shortness of breath.
*Coughing that doesn't go away.
*Wheezing.
*Coughing up blood.
*Chest pain.
*Repeated respiratory infections such as bronchitis or pneumonia.
These symptoms can happen with other illnesses, too. Talk to your doctor if you have symptoms that concern you.

Treatment
Lung cancer is treated in several ways, depending on the type of lung cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with lung cancer often get more than one kind of treatment.

People with lung cancer may want to take part in a clinical trial. Clinical trials study new potential treatment options. Learn more about clinical trials at the National Cancer Institute.

Survivors
People who have been treated for lung cancer may continue to have symptoms caused by the cancer or by cancer treatments (side effects). People who want information about symptoms and side effects should talk to their doctors. Doctors can help answer questions and make a plan to control symptoms.
For more information about symptoms and side effects, visit the National Cancer Institute's Coping with Cancer.
For information about finding or providing support for people with lung cancer and their caregivers, visit CDC's Cancer Survivorship.

Santa Monica Insurance Agent hopes that Anthem learns out of their mistake in 2010

Anthem rate increase has not only hurt their reputation and made millions of clients, non-clients including the CA Insurance Commissioner very angry. Finally the rate increases have been approved for October 1st. (a 6 month delay). To be compliant to the healthcare reform Anthem decided to switch all new enrollments after 9/23/2010 to the new compliant plans. These plans have been submitted to the insurance commissioner at the End of June but only 5 out of 43 plans are approved. And most popular plans, like the Smart Sense Plan, Premier Plan, Core Guard plan are not approved. What does it mean for you the consumer.

Since 9/23/2009 Anthem can only offer 5 plans, so in reality almost no product. Anthem's new individual insurance business is since 6 weeks at a stand still.
We agent are forced to sell other carriers such as Blue Shield, Healthnet, Kaiser Permanente or Aetna.
Aetna is the only carrier who has plans which are compliant to the Health Care reform.Unfortunately most of their plans offer only high deductibles and are not feasible for many families.
Blue Shield , Healhtnet, Kaiser Permanente are currently only selling "old- grandfathered plan".
Blue Shield just announced that any individual subscriber who enrolled after October 1st has no rate guarantee, that means the consumer can experience anytime a rate increase. Is that really what we want!!
I understand that the insurance commissioner has been angry at Anthem, as we all have. But the
current situation, with so many limited product and so few carriers does really hurt at the end the consumer.
I do not understand that anyone allowed a transition time where some carrier comply to the rules of the health care reform and other carriers do not. It is confusing to the consumer.

Their are many advantages to the new plan, such as preventive care at zero cost, free choice for females to go to their in network gynecologist, and to choose an in network pediatrician.

I hope that the Insurance commissioner will release the plans, or if the submitted rates are to high, request corrections.
But to be in the California Insurance market without Anthem really does not serve the consumer and allows carriers such as Blue Shield to offer "non rate guarantees", which are unacceptable. Even Healthnet who still offers a 6 months gurantee, is saying to the consumer that due the implementation of the Health Care Reform a rate increase for January will be most likely!
These are turbulent times and we the agents and consumer need rate clarification at once.

Although Anthem did make bad decision, we need their product! The competition in the individual insurance is very little. Having the main insurance carrier not being able to offer product, does really hurt in end effect the consumer!


Soemhow he must be so upset that the Anthem's rate, w

Brentwood Agent will help you to find the right plan for your Medicare Needs

The AEP ( Annual Enrollment Period ) will start November 15th and Ends December 31st.

In this time period Seniors are able to to review and switch from their current medicare plan , into a new Medicare Advantage or Supplemental Plan, or Drug Prescription Plan.

Understanding all the choices can be very confusing. Let me guide you through the process, and show you what Medicare Supplemental Plan changes happened in 2010.

West Los Angeles Health Insurance Agent suggest to review your Health Insurance

With all the changes in the Health Insurance Industry there has been never a more important time than now to review with me, your agent in West Los Angeles, your current health insurance.

What is your yearly deductible and out-of-pocket maximum, which will renew in January? Does it make sense for you to move into a plan which follows the new health care reform, or should you stay on your "grandfathered plan "? Though the premiums of these new plans are slightly higher, but they also come with great incentives, such as preventive care at zero cost to you.

Take the time to review your plan for the next year. Changing plans or companies might increase your benefits and save money!

The advantages of the new plans "non-grandfathered Plan"versus the old "grandfathered plans" are:

• No cost sharing for Immunization or Preventive Care
• No discrimination in favor of highly compensated individuals
• Allow individuals to choose OB-GYN without referral
• Allow individuals to choose pediatricians for child's primary care provider
• Allow Emergency Services without pre-authorization and treat as In-Network-Provider

Brentwood Insurance Agent inform of Estate Tax Law changes in 2011. - Death and Taxes: 2011 Estate Tax Laws

Brentwood one of the most beloved areas on the Westside of Los Angeles, will be hard hit with the 2011 Estate Tax Laws.

Many of us own home in the 1Mio- 2 Mio range and have 401k savings and other investments. Read this interesting article and see your possible tax implications.

Senior Market Sales, Inc. - Death and Taxes: 2011 Estate Tax Laws

Do you know that universal life insurance and annuities are great vehicles of tax-exempt investments.

What does "grandfathered status" in the health care reform law mean ?

Wondering what "grandfather" or "grandfathered plan " means in the health care reform law.

If an employer keeps the same coverage it had on March 23, 2010 – the date the law took effect – the plan may be considered a “grandfathered” plan.

This means the plan may be exempt from some of the requirements of the health care reform law. However, certain changes must be made to all plans, whether they’re grandfathered or not.

The following changes must be made to all plans:

* No lifetime benefit maximum limits

* Dependent coverage for adult children up to age 26

* No annual limits on certain types of benefits

* No pre-existing conditions exclusions for children under age 19

If certain changes in coverage are made after the law’s effective date, the plan will not be a grandfathered plan.

This means the plan will also see the following changes:

* 100% coverage for preventive care in network.

* No prior authorization for emergency services or higher cost-sharing for out-of-network emergency services

* Coverage of routine patient costs for clinical trials of life-threatening diseases, starting in 2014

How do you loose your grandfather status ?

The following changes to a

plan will result in the loss of a grandfathered status:

* Eliminating all (or substantially all) benefits to diagnose

or treat a particular condition

*

Increasing coinsurance by any amount above the level set

on March 23, 2010

* Increasing fixed amount cost sharing (other than

copays) more than the sum of medical inflation plus

15 percentage points from the level of March 23, 2010

* Increasing copays by an amount that exceeds the greater

of (1) a total percentage (measured from March 23, 2010)

that is more than the sum of medical inflation plus

15 percentage points, or (2) $5 times medical inflation,

* Reducing employer or employee organization

contributions based on the cost of coverage or a formula

by more than 5 percentage points below the contribution

rate on March 23, 2010

* Reducing an overall annual dollar limit or adding a new

overall annual dollar limit, compared with what was in

effect on March 23, 2010

* Ensuring that consumers switch to a grandfathered plan

that, compared with the current plan, has fewer benefits

or higher cost sharing as a means of avoiding new

consumer protections.

* Buying or merging with another plan to avoid complying

with the health care reform law

September 23 - Big Changes in the Health Insurance Industry

September 23 was crucial because that’s when the biggest changes (so far) took effect in the Patient Protection and Affordable Care Act (PPACA).

Here’s a summary from the government’s website on healthcare reform.

After September 23, 2010 on any new group insurance plans, insurer’s can’t:
* Deny coverage to kids with pre-existing conditions
* Put lifetime limits on benefits
* Cancel your policy without proving fraud
* Deny your claim without a chance for appeal


And consumers can:
* Receive cost-free preventive services
* Keep young adults on a parent’s plan until age 26
* Choose a primary care doctor, ob/gyn and pediatrician
* Use the nearest emergency room without penalty

These changes take place for any policy issued or renewed after September 23 for group insurance.

So that is the good news, but here are the bad news:

In the individual insurance world in CA only few carriers are implementing the health care reform on September 23. Only Aetna and Anthem have updated their plans to comply with the reform. Kaiser Permanente, Blue Shield and Healthnet will implement the reform at a later time, most likely by January 2011. Unfortunately Anthem rates have not been approved yet by the insurance commissioner, so that their currently only few Anthem individual plans available.

Increased coverage could lead to increased premiums. According to this report by the Kaiser Family Foundation, average health insurance premiums have increased 114 percent just since 2000 – healthcare reform isn’t going to immediately reverse that trend. One new report claims that American families are paying 14 percent more for their health insurance coverage this year than last year – an average increase of $482. Most of that jump isn’t because of higher insurance rates – it’s because employers are paying less of the cost. And that’s another trend that will probably continue – yet another study says that next year, 63 percent of employers will hike the percentage their employees contribute and 46 percent will increase employee out-of-pocket costs.
Some health insurance providers would rather drop than switch. Anthem, Aetna, Cigna have announced they won’t offer any more health insurance policies solely covering children, because of the pre-existing condition provisions of the new law.

The “full force” of healthcare reform doesn’t happen until 2014. This is just the appetizer – and very likely a catalyst for increased debate over health care and our government’s role in it. Stay tuned.
In the meantime, if you’re looking for health insurance right nowcontact info@solidhealthinsurance,com

Preexisting Condition Insurance Plan in California (PCIP)

Effective September will be a new "Preexisting condition insurance Plan' (PCIP) in California available.

It is for Individuals, who are legal citizen or legal resident alien, who were denied by private insurance carrier due to pre existing condition and are without health coverage at least 6 months. People who are on Cobra or MRMIP or any insurance plans are not eligible, they need to be at least 6 months without coverage.

This insurance plan is substituted by the Federal Government and managed in California by the State.

In contrast to the existing MRMIP program the rates are lower and there should be no lifetime limits. As of now the plan has as of copayment of $ 30.00 per doctor visits , $ 1500 deductible and a maximum out of pocket limit of $ 2500.-. It should become effective September 1st, however as of now the application are not available. The final plan outline has not been published. Anyone interested can sent me an email at info@solidhealthinsurance.com and I will provide the application as soon as I receive it or you can also request an application directly from pcip@mrmib.ca.gov.

The current MRMIP program does not have the mandatory 6 months waiting period of no health insurance coverage, but it is very restricted regarding yearly limits and life time limits.

Here are the rates of the new PCIP Plans ! They are higher but more competitive than any current existing preexisting condition plans . We are expecting daily up dates of the new plan details. Follow my blog, to get the newest info on the Health Care Reform.

Preexisting Condition Insurance Plan in California

Monthly Premium Rates*

Effective through December 31, 2011

Age Band Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

15-29 $199 $195 $201 $180 $200 $181

30–34 $286 $282 $292 $258 $288 $260

35–39 $319 $314 $325 $288 $321 $289

40–44 $337 $332 $344 $304 $339 $306

45–49 $369 $364 $377 $334 $371 $335

50–54 $494 $481 $499 $445 $495 $448

55–59 $627 $608 $624 $564 $625 $567

60–64 $796 $780 $802 $720 $799 $723

65-69 $891 $873 $899 $806 $895 $810

70-74 $939 $920 $947 $849 $943 $853

over 74 $995 $975 $1,003 $899 $999 $904

* August 5, 2010

Region 1: Northern 31 counties

Region 2: Valley 14 counties

Region 3: Bay Area 6 counties

Region 4: South Coast 3 counties

Region 5: Los Angeles County

Region 6: South 3 counties

The Seven Wonders of Life Insurance

Many young people avoid the topic of life insurance, as the topic of death is making everyone uncomfortable and it is far away. We all hope to live a long life but statistically some of us won't have the opportunity. Each year, roughly 465,000 Americans will die prematurely leaving behind loved ones who will have to manage financially in their absence. Learn about seven amazing things life insurance can do for families:

1) Buy time

Allows loved ones to focus on their grief by helping to pay funeral and other final expenses.

2) Provide a fresh start

Let loves ones start with a clean slate by helping to pay off credit card bills, outstanding loans and even mortgages.

3) Generate Income

Helps replace lost income for years to come so that surviving family members can continue to pay for life's necessities.

4) Offer Flexibility

Give s surviving spouse the chance to take time off from work or to switch a job that offers a more flexible work schedule.

5) Create Opportunities

Give a surviving spouse the chance to start a business or pay for schooling so surviving families can rain for a new career.

6) Fund the Future

Offers a way to fund longer-range goals like college education for the kids or a retirement for a surviving spouse.

7 Tips for a Smooth & Healthy Transition 'Back to School"

Back to school can be a time of mixed feeling. Happy for getting back to a routine for your family, sad as time just flew by and you can't believe that Summer is almost over.

Now it is time for parents and children alike to start preparing for a new adventure and reduce the pressures and stresses that come with school schedules and activities.

Here are 7 Helpful Tips for a smooth and healthy transition back to school.

1) Schedule a check-up with your child's pediatrician

Does your child have all the necessary booster vaccines? Even Teenagers need still booster shots for Tetanus and Meningitis. Make sure that your child gets also his vision and hearing checked. Go to visit your child's dentist and orthodontist.

2) Start two weeks before school to establish a routine.

Start with a bedtime, earlier wake up and dinner routine which is close to your school schedule

3) Start to talk with your kids to speak positively with enthusiasm about the new school year

Set goals together on what the child wants to achieve and by when.Brake the large goals into mini goals . Put the goals onto index cards or in your child's day planner.

Ask what activities the child wants to learn.

4) Get Organized
Organize your child's room, clean your child's work area of all clutter. Create a To-Do List . Examples are what to pack in back pack or up coming assignments. Crossing things off together will give the child extra sense of accomplishment and you a sense of calmness that things are under control.

5) Relax
It is important to balance work with play so be sure to incorporate down time after school and on the weekends.

6) Regroup
The school year can be hectic so make a point to step back from the chaos, clean out folders and notebooks, revisit goals and set new ones on a monthly basis.

7) Reward your family
When your monthly goals have been accomplished and you have been able to be calm and collected. Celebrate your accomplishment with a great family treat, something you all enjoy.

Remember good times, laughter and love are the best medicine for you and your family.

Can excessive Hospital Charges have anything to do with excessive building cost of Hospitals in California ?

The Ronal Reagan UCLA Hospital has cost over 1 Billion US-Dollar to built, this is a building for 525 beds. If you do the math each bed cost $ 1.904,762 Million Dollar. How come that no one is questioning the cost! Maybe now it makes more sense why a 2 hour outpatient hospital procedure can cost easily $ 10,000,- somehow hospitals have to collect their money.

In 2014 we will be able to offer an additional 47 million people insurance, so there will be a greater need for hospitals. Look around your neighborhood and see how many hospitals are built. Who is in control to make sure that building cost are not excessive, we need control and sharp budgets now.

Part of Health Care Reform should be also an oversight on reasonable building cost of hospitals, so that we might be able to get a handle on the medical cost.

Read more about the UCLA Ronal Reagan Hospital Building expense.

http://www.stonebusiness.us/index.php?option=com_content&view=article&id=625&Itemid=67

Allianz Study examines babyboomers preparation for retirement

Reclaiming the Future

At 76 million strong, the “baby boom” generation represents the largest, wealthiest, and most influential segment of the U.S. population. Yet, this “power generation” will face one of the most pronounced retirement income challenges in history.

The Allianz Reclaiming the Future Study was conceived to be one of the most comprehensive examination of baby boomers’ preparation for and expectations of retirement.

Our study looked at the unique needs, perceptions, and strategies that define this generation’s need to rethink retirement. We also looked into consumer and financial professional attitudes toward annuities, and their role in providing retirement income.

> Download the White Paper (pdf)
> Download the Executive Summary (pdf)

CA implements Web Portal to assist Individual & Small business to identify insurance options

Fact Sheet on Establishing the Web Portal

The Affordable Care Act establishes an internet portal to help individuals and small businesses identify insurance options in their state.

The web portal will help consumers navigate their options in the individual and

small business private market and help them determine if they may be eligible

for a variety of existing public programs, including existing state high risk

pools, new high risk pools, Medicaid, Medicare and the Children’s Health

Insurance Program (CHIP). The new web portal will provide information on: the small business tax credits available for 2010 and beyond; and the Early Retiree Reinsurance Program including instructions on how businesses that provide coverage to non-Medicare retirees age 55 and older can enroll to receive reinsurance payments to stabilize coverage for this at-risk population.

Small Business Tax Credit and Related Tax Information

http://www.irs.gov/newsroom/article/0,,id=223666,00.html

Eligibility Rules

• Providing health care coverage. A qualifying employer must cover at least 50 percent of the cost of health care coverage for some of its workers based on the single rate.
• Firm size. A qualifying employer must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
• Average annual wage. A qualifying employer must pay average annual wages below $50,000.
• Both taxable (for profit) and tax-exempt firms qualify.

Amount of Credit

• Maximum Amount. The credit is worth up to 35 percent of a small business' premium costs in 2010. On Jan. 1, 2014, this rate increases to 50 percent (35 percent for tax-exempt employers).
• Phase-out. The credit phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.

Related taxes and tax credits:

http://www.irs.gov/newsroom/article/0,,id=220809,00.html?portlet=6

Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26; Interim Final Rule and Proposed Rule

2.37 million young adults might be affected by this provision, or approximately 8% of the 29.5 million young adults in the age group. Approximately 1.83 million are currently uninsured, and 0.55 million are currently covered by their own nongroup coverage. Mid-range estimate: 1.24 million will enroll in 2011, at a cost of $3380 a year.

Federal Register: http://edocket.access.gpo.gov/2010/pdf/2010-11391.pdf

The First Reforms that Will Take Effect

from Families USA: http://www.familiesusa.org/health-reform-central/implementing-the-new-law/implementation-advocates-to.html

Temporary Coverage for Uninsured People with Pre-Existing Conditions
(Section 1101 of the Patient Protection and Affordable Care Act)

Grants for Consumer Assistance Offices or Health Insurance Ombudsman Programs
(Section 1002 of the Patient Protection and Affordable Care Act; Creates Part C, Section 2793 of the Public Health Services Act)

Grants for Rate Review
(Section 1003, as amended by section 10101, of the Patient Protection and Affordable Care Act; Creates Section 2794 of the Public Health Services Act)

Small Business Tax Credit
(Section 1421, as amended by section 10105, of the Patient Protection and Affordable Care Act; Creates Section 45R(d)(3) of the IRS Code of 1986)

Medicaid and CHIP Maintenance of Effort (MOE) Requirements
(Section 2001(b) of the Patient Protection and Affordable Care Act; Amends Section 1902 of the Social Security Act)

Option to Expand Medicaid Before 2014
(Section 2001(a)(4), as amended by Section 10201(b), of the Patient Protection and Affordable Care Act; Amends Section 1902 of the Social Security Act)

Changes to Community Benefit Requirements for Nonprofit Hospitals
(Section 9007, as amended by Section 10903 of the Patient Protection and Affordable Care Act; Amends Section 501(r)(5) of the Internal Revenue Code of 1986)

Other Reforms That Go into Effect Later This Year:

http://www.familiesusa.org/health-reform-central/implementing-the-new-law/implementation-to-do-other.html

Rescissions (Section 1001 of the Patient Protection and Affordable Care Act, Section 2301 of the Health Care and Education Reconciliation Act of 2010; Creates Section 2712 of the Public Health Services Act): The federal health reform law protects against unfair rescissions of health plans, which typically occur only after an enrollee submits expensive claims for care. The law states that rescissions may occur only in cases of fraud or intentional misrepresentation and that insurers must provide advance notice to policyholders if they intend to rescind their plans.

Internal and External Appeal Rights (Section 1001, as amended by section 10101, of the Patient Protection and Affordable Care Act; Creates Section 2719 of the Public Health Services Act)

Whopping cough (Pertuussis) is now an epidemic in California since 50 years

Dr. Mark Horton, director of the California Department of Public Health (CDPH) is urging Californians to get vaccinated now.He warned that the state is on pace to suffer the most illnesses and deaths due to pertussis, also known as whooping cough, in 50 years.

“Whooping cough is now an epidemic in California,” Horton said. “Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot.”

As of June 15, California had recorded 910 cases of pertussis, a four-fold increase from the same period last year when 219 cases were recorded. Five infants — all under three months of age — have died from the disease this year. In addition, 600 more possible cases of pertussis are being investigated by local health departments.

Pertussis is cyclical. Cases tend to peak every two to five years. In 2005, California recorded 3,182 cases and eight deaths.

Pertussis is a highly contagious disease. Unimmunized or incompletely immunized young infants are particularly vulnerable. Since 1998, more than 80 percent of the infants in California who have died from pertussis have been Hispanic.

The pertussis vaccine is safe for children and adults. Pertussis vaccination begins at two months of age, but young infants are not adequately protected until the initial series of three shots is complete at 6 months of age. The series of shots that most children receive wears off by the time they finish middle school. Neither vaccination nor illness from pertussis provides lifetime immunity.

Pregnant women may be vaccinated against pertussis before pregnancy, during pregnancy or after giving birth. Fathers may be vaccinated at any time, but preferably before the birth of their baby. CDPH encourages birthing hospitals to implement policies to vaccinate new mothers and fathers before sending newborns home. CDPH is providing vaccine free of charge to hospitals.

Others who may have contact with infants, including family members, healthcare workers, and childcare workers, should also be vaccinated. Individuals should contact their regular health care provider or local health department to inquire about pertussis vaccination.

A typical case of pertussis in children and adults starts with a cough and runny nose for one-to-two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare.

How Much Money Does The United States Spend on Health Care?

Health care cost predictions are doubling in the next 10 years.

According to the Centers for Medicare and Medicaid Services Office of the Actuary, spending on health care reached $2.2 trillion in 2007. National health care spending has been predicted to reach $2.6 trillion by 2010 and could exceed $4 trillion by 2018.

Health care costs and premiums go hand-in-hand. If costs go up, so do your premiums.

Do You Know Where Your Health Insurance Premium Goes?

Every months you spending money on your health insurance. Here is a quick overview where your money goes and how much the profit of health insurance is.

On average, 87 cents of every premium dollar you pay is spent covering medical care and services that members receive like doctor visits, hospital costs, prescription drugs and more according to a PriceWaterhouseCoopers medical cost trend report for 2009. Another 10 cents funds services we provide like claims processing, enrollment and billing and provider credentialing. That leaves 3 cents of every premium dollar for profits. Kaiser Health news has reported that the combined annual profits of the top 10 health insurers are equal to just two days work of national health care expenditures or just 0.5% of the estimated $2.5 trillion the nation spent on health care in 2009.

Health Insurance Agent in Los Angeles Explains Impact of New Health Care Program

The Health Care Plan is in place and while there are many regulations yet to be written, there are certain things that we do know for sure about the future of group and individual health insurance packages.