Tag Archives: Healthcare Reform

I’m your health care advocate

Dental health, Estate planning, Group Health Insurance, Health Care Reform, Health Insurance, Healthcare updates, Medicaid, Medicare, premium increases, RX drug, tax advantages, Universal Life Insurance, , , , , , ,

I was invited to a meeting with Representative Kraig Paulsen, Speaker of the House, Iowa House of Representatives, to discuss your future health care costs and how to develop a strategy to try to contain the ever-rising premium increases.

I’m not only working with the carriers in your best interest, but also with the leadership in the State of Iowa to combat the increasing health care costs we’re all confronted with. After a meeting a few weeks ago with Representative Kraig Paulsen,we are trying to develop strategies that would be a win-win for individuals and families, employers and insurance carriers, while at the same time, aligning ourselves with the visions Governor Branstad has asked us to focus on: the Healthiest State Initiative and the Wellmark Blue Zones Project.

As the nuts and bolts of this attempt become realities, you will be informed accordingly. In the meantime, please know that I am your go-to resource for anything to do with health, life, disability, long-term care and estate planning issues.

Time for an Honest Debate on Medicare

Health Care Reform, Health Insurance, Healthcare updates, Medicare,

I feel that allowing the private sector to mange their healthcare and the insurance is he best way for the taxpayers to deal with their medical expenses.

The folks on Medicare have paid into the system for many years, since its beginning in some cases. I feel that some patients decisions will be based on advise from the doctors of their choice and their moral beliefs. I do not feel that the government should have the right to tell any one person how they should make decisions pertaining to their health.

We have the greatest standards of health care, delivered 24 hours a day by very dedicated doctors. They have devoted their lives to their education and expenses necessary to be of the greatest expertise in the world. Now comes their time for the profession and the patients. The thought of reducing their compensation seems unconscionable.

The government has failed at the postal system, medicaid, social security, national security, etc…now are we to trust them with our health??? Please do your homework – it is your future!

What Is Fair?

Health Care Reform, , , , , ,

As we all have our feelings on this matter (and my position is to respect all views) our elected Governor is operating on an “elected by the people” position and what we may not realize is that if he would have gone the other way, we would have a federal subsidy that would be entitlement (starting with 150,000 people and going rapidly) lasting for four years. Then the federal subsidy would end and we would have all of the financial burden to pay…raising our taxes…where does this end??? Other states share his sentiment.

Also, he is asking for volunteers on the State payroll to pay for 20% of their premium. Presently the State employees’ premium is provided 100%. Polk County Board of Supervisors recently approved a contribution to their cost of an approximate $25 per month. The true cost is around $1100 per month for family plans. The employer is mandated to pay 50% of the employee premium for any business. How could the employer pay 50% of the premium, increased taxes for the uninsured to have more entitlement and still stay in business?

Governor Branstad is trying to bring our jobs back. He is trying to make us healthier (Blue Zones and Healthiest State Initiative). Somewhere in this struggle we all have to come to the table and be fair. There must certainly be a balance between free and 100%.

 

Health Insurance Open Enrollment For Children up to Age 19

Group Health Insurance, Health Insurance, Healthcare updates,

From July 1 through August 14, 2012, children under the age of 19 can apply for child-only policies or be added as dependents to existing family policies as long as they are not enrolled in or eligible for other coverage. Other coverage does not include HIPIOWA, HIPIOWA-FED, Medicaid, or hawk-i.

When applying during this open enrollment period, qualifying children cannot be turned down or have coverage for certain conditions limited or excluded because of any pre-existing medical conditions.

Learn More…

It’s All About Prevention – Part 2

Health Insurance, Healthcare updates, ,

Click here to read Part 1.

What is the difference between a health maintenance exam and a well-female exam?

A health maintenance exam is a complete physical, including:

  • Health history
  • A review of all health and lifestyle risk factors
  • An exam of all systems including cardiovascular, respiratory, neurological, musculoskeletal, reproductive and behavioral
  • Laboratory studies appropriate for age, risk and sex
  • Discussion of recommended lifestyle changes.

These exams are recommended every five years from ages 18-39, every 2-3 years from ages 40-49, and every 1-2 years for ages 50 and over.

Well-female exams are far less extensive, limited essentially to pelvic and Pap tests, as well as your clinical breast exam. Well-female exams can be performed by your primary care provider or selected Plan OB/GYN provider.

How often should I have a well-female exam?

Well-female exams are recommended for women 18 and over. Sexually active women should have well female exams every 1-3 years. Discuss the interval that’s appropriate for you with your physician.

What if my child has already had his or her health maintenance exam this year, but is now required to have a sports physical for school?

Since your child already had a health maintenance exam, it is usually not necessary to also have a separate sports physical. In this case, have your provider complete the school’s physical form, and use the date of the previous physical examination. This should be acceptable documentation for the school’s purposes.

If there is a range recommended for an exam, how often should I schedule the exam?

Where there is a range, such as 1-2 years, talk to your physician about how often you need to have the exam.

What if my provider recommends that I have these exams more frequently?

In most cases, your benefits provide coverage for an exam to be performed once per benefit period.

If the reason for a more frequent exam schedule is due to an underlying chronic disease, benefits would apply. However, if your physician just wants you to have health maintenance exams at a more frequent rate than once per benefit period, the additional exams are not a covered benefit.

Click here to read Part 1.

It’s All About Prevention – Part 1

Dental health, Health Insurance, Healthcare updates, , ,

What are the Preventative care guidelines?

The guidelines list the types of care screenings and exams needed for your particular age and gender.

  • For infants and young children, the guidelines focus on physical and mental development, immunizations, nutrition, and safety.
  • For children and young adults, the focus is on maintaining or developing healthy lifestyle habits and eliminating high-risk behaviors.
  • For adults, the focus continues to be on eliminating high-risk behaviors, however, screening for chronic and/or life-threatening disease becomes more important.

Does my health insurance cover these preventive care exams?

The health care reform Affordable Care Act (ACA) requires that plans begin providing benefits for preventive services with no member cost share, such as co-payments, deductibles, and coinsurance, when services are performed by in-network providers. However, some plans are not required to comply with this mandate.

If your contract is affected by this change, Wellmark will provide first-dollar coverage for covered preventive services performed by in network providers. Claims for preventive services from out-of-network providers will process using the benefits specified in your benefits policy or coverage manual, and will continue to apply member cost-sharing amounts.

The change will become effective in stages over the next several months, depending on your health plan. For more details about your preventive benefits, contact Customer Service at the number on your identification card.

What is a health maintenance exam (HME)?

A health maintenance exam is what was commonly known as a “routine” or “annual” physical. You might have heard of an “annual physical.” Your health benefits, however, do not necessarily cover “annual” physicals. Instead, your benefits cover periodic health maintenance exams.

How is the frequency of health maintenance exams determined?

Our guidelines are based on recommendations from the American Academy of Pediatrics, The American Academy of Family Practice, the American College of Obstetrics and Gynecology, and the Center for Disease Control, among others. Wellmark’s guidelines are reviewed annually. We provide benefits for health maintenance exams at time frames that are considered most appropriate given your age and gender.

Read Part 2 about female exams.

Let’s Look at 2012 and Health Care

Group Health Insurance, Healthcare updates

You may be wondering what is in store for you or your business as far as the Healthcare Reform Act and exactly how is that going to affect you.  Like anything else there are some that will gain and some that will feel that they didn’t. One of the references that I trust is the Henry J. Kaiser Family Foundation. They have provided a very user friendly timeline of the scheduled events, detailed explanations of each and their intended purpose and which ones are implemented and which ones have not yet been achieved.

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