Walter O. Rogers Insurance Services
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HEALTH INSURANCE

Individual and group plans

WE CAN HELP YOU WITH THE NEW HEALTH EXCHANGE FOR BOTH INDIVIDUAL AND SHOP (SMALL BUSINESS) COVERAGE.

AFFORDABLE HEALTH INSURANCE PLANS INCLUDING INDIVIDUAL, GROUP, DENTAL, EYE, AND DISABILITY INSURANCE.

2010 HEALTH CARE REFORM

Signed into law March 2010, the Affordable Care Act (ACA) is the most comprehensive health care legislation passed by Congress since the Medicare in the 1960's. The impact of ACA is still being shaped by new rules developed by federal agencies in support of the law. Portions of ACA such as increased access for dependents and prohibition of lifetime limits on coverage, have already been enacted. But, other provisions such as the requirement for all Americans to obtain health care and the creation of insurance exchanges, do not take effect until 2014 and beyond

The following is informational only, and should not be relied upon as legal or other advice.

FEDERAL REFORM OVERVIEW

  • Annual and lifetime limits - Annual dollar limts are prohibited, except for restricted annual dollar limits for essential benefits for plan years beginning prio to January 1, 2014. The new regulations allow gradually increasing annual limits until completely eliminated in 2014.
  • Choice of Provider - ACA provides that if a group health plan, or health insurer offering group or individual health insurance coverage, requires or provides for designation of a participating primary care provider, then the plan or issuer must permit the designation of any participation primary care provider.
  • Grandfathering - Health plans in existence on March 23, 2010 may be eligible for "grandfathered" status. A grandfathered plan will be exempt from some but not all of the ACA law's insurance market reform. However, change in benefits or other plan terms may result in the loss of the status.
  • Auto Enroll - ACA requires employers with more than 200 full time employees that offer health coverage to automatically enroll new full time employees in a coverage option. Employers must also automatically continue existing elections for current full time employees from year to year.
  • Preventive Care - Coverage of specified preventive care is required of non-grandfathered plans without cost sharing (deductibles, copayments, coinsurance, etc.), when provided in network. Preventive care is defined as items or services with an A or B rating by the U.S. Preventive Services Task Force, immunizations recommended by the CDC, preventive care and screenings for infants, children and adolescents supported by HRSA, and screenings for woman supported by HRSA.
  • For more information click to explore the Health Care Reform timeline. Read More

    THE RIGHT HEALTH INSURANCE

    Health plans can be a confusing search of difficult to understand benefits with a wide range of monthly costs. You CAN find a more cost effective plan that suits your health needs. But, knowing your options and choosing the right coverage is best done with a trusted family agent who listens to your concerns and explains each item carefully to you.  This includes quoting multiple plans at a cost that fits your budget. A few of the recommended health insurance companies:

    AETNA | AMERIHEALTH | HORIZON | OXFORD | UNITED HEALTHCARE | EMBLEM | EMPIRE | HEALTHPASS | HIP to name a few..

    Offering many different individual, family, self-employed and group health insurance plans:

    EPO | HSA | IND | HMO | POS | PPO

    DEFINITIONS

    The following is a partial definitions list of health insurance terms. For a more complete list visit: http://www.bls.gov/ncs/ebs/sp/healthterms.pdf

    Exclusive provider organization (EPO) -

    A more restrictive type of preferred provider organization plan under which employees must use providers from the
    specified network of physicians and hospitals to receive coverage; there is no coverage for care received from a non-network provider except in an emergency situation.

    Health Savings Account (HSA) -

    An account created for individuals who are covered by high deductible health plans, to save for medical expenses that their plan does not cover. Contributions are made to the account by either the individual or employer and are limited to a max amount each year. The contributionss are invested and can be used to pay for qualified medical, dental, vision and over the counter drug expenses. The account can provide major tax savings (ie. contributions tax deductible, grows tax free, qualified medical withdrawals tax free).

    Health Maintenance Organization (HMO) -

    A health care system that assumes both the financial risks associated with providing comprehensive medical services
    (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to HMO members, usually in return for a fixed, prepaid
    fee. Services are provided by physicians who are employed by, or under contract with, the HMO.

    Point of Service plan (POS) -

    A POS plan is an "HMO/PPO" hybrid; sometimes referred to as an "open-ended" HMO when offered by an HMO. POS plans resemble HMOs for in-network services. Services received outside of the network are usually reimbursed in a manner similar to conventional indemnity plans (e.g., provider reimbursement based on a fee schedule or usual, customary and reasonable charges).

    Preferred Provider Organization (PPO) -

    An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or nondiscounted charges from the providers..

    INDIVIDUAL HEALTH INSURANCE

    Individuals may find the newer EPO (Exclusive Provider Organization) health plans fit their needs and tighter budgets. Of course a variety of dental, disability, and longterm care programs are available as well.

    GROUP HEALTH INSURANCE

    Small businesses of 2 or more employees can benefit from group coverage offering a more cost effective approach to many health benefits including prescription copays. Also take advantage of tax savings for both employees and business using Premium Only Plans, Flexible Spending Accounts, Health Savings Account and more.

    DENTAL INSURANCE

    Select the plan that fits your needs and budget. Benefits can include 100% coverage for dental checkups, discounts or percentages for basic and major dental work. Whether your needs are fillings, crowns, or oral surgery, we will find the perfect plan for you

    VISION INSURANCE

    Basic services can include eye examination with dilation, an eyeglass frame, a pair of eyeglass lenses and, in some cases, contact lenses. Refractive surgery, such as LASIK and PRK, also might be included.

    Value added eyewear products that are covered in some plans include progressive lenses, high-index lenses, polarized lenses, polycarbonate lenses, plastic photosensitive lenses, scratch resistant coating and anti-reflective coatin.

    DISABILITY INSURANCE

    If you become ill or disabled and not able to work, disability insurance can replace a portion of your income to pay bills, rent, food, car payments, etc.

    TYPES OF DISABILITY INSURANCE

  • Group Short Term Disability (STD) - Pays percentage of salary (ie. 50%, 60% or 662/3%) if temporarily disabled (excluding injuries covered by workers compensation). Typically offering 13 to 52 weeks of benefits.
  • Group Long Term Disability (LTD) - Longer benefit terms (ie. 2yrs, 5yrs, age 65 or to retirement age) with monthly payments of 50% or 60%.
  • Individual Disability Income - Pays a monthly benefit, and uses your age, occupation, medical history and chosen benefit provisions to determine the cost of coverage.