Tag Archives: healthcare updates

Employer Trends

October 1, 2012Healthcare updateshealthcare updatesDebbie Sears

If you are following my posts and e-newsletters on my site, you will see that I have a timeline of the Healthcare Reform for your reference. I want to continually make thoughts available to you.

I would like to mention that as I work with employers to position themselves in the market place best suited for their industry and their employees, I have always been a believer of high deductible plans paired with an HMO choice. This allows for the lowest to the highest compensated employee, as well as the healthiest and the greatest diagnosed employee to have affordable choices. This will allow the employee to choose a plan that best suits their personal needs from the financial aspect as well as the utilization of health care services.

This has proven to be a win-win for both the employer and the employees.

I’m your health care advocate

September 24, 2012Dental health, Estate planning, Group Health Insurance, Health Care Reform, Health Insurance, Healthcare updates, Medicaid, Medicare, premium increases, RX drug, tax advantages, Universal Life Insurancedental health, Healthcare Reform, healthcare updates, healthiest state, long term care, mandates, Medicaid, WellmarkDebbie Sears

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

September 3, 2012Health Care Reform, Health Insurance, Healthcare updates, MedicareHealthcare Reform, healthcare updatesDebbie Sears

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!

Doesn’t Everyone Want to Travel and Explore? – Part I

August 20, 2012Medicaid, TravelBoomer Magazine, healthcare updates, MedicaidDebbie Sears

Is it possible to listen to Proud Mary and not want to give up that “good job in the city” to “hitch a ride on a river boat queen”? Whether it’s by boat on the Mississippi, the Amazon, the Nile, the Ganges, or some smaller, quieter river, or by train, by plane, by foot, by car…the manner in which we travel plays a large role in the way in which we experience the world.

The manner in which we choose to be insured also makes a difference…and in some cases travel is necessary for the specialized care, known as Centers of Excellence, that we have been blessed enough to have access to. We may just take a vacation here in the states or abroad, we may choose to winter elsewhere, we may have children interested in studying abroad or on a spring break trip. You must not go anywhere without a thorough understanding of how your health insurance would work if you were to become ill or injured. Most illnesses and injuries are unscheduled as health care needs don’t surface only when you are near home. I always refresh my insured’s minds with some of the following information.

As a Wellmark Blue Cross and Blue Shield member, you have coverage through the BlueCard program wherever you travel. More than 90 percent of all hospitals and physicians throughout the United States contract with Blue Cross and Blue Shield Plans.

Your level of coverage depends on your plan:

Alliance SelectSM or Blue Select®: You pay the same cost share as you pay in-network when you use participating BlueCard providers.
Blue Choice® plans: If you receive care from an out-of-area provider without a referral, you have Level 3 benefits (your highest cost share) for services at a participating BlueCard practitioner’s offices or urgent care center. You also have coverage for emergency medical services.
Blue Access® and Blue Advantage® plans: You have coverage for emergency medical services only.

Read my next blog post as I discuss how to BlueCard and BlueCard Worldwide

Health Insurance Open Enrollment For Children up to Age 19

June 25, 2012Group Health Insurance, Health Insurance, Healthcare updatesHealthcare Reform, healthcare updatesDebbie Sears

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…

National Men’s Health Week – Men’s Health IS A Family Issue

June 11, 2012Healthcare updateshealthcare updates, healthiest stateDebbie Sears

The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for disease and injury. The response has been overwhelming with thousands of awareness activities in the USA and around the globe.

To quote Congressman Bill Richardson (Congressional Record, H3905-H3906, May 24, 1994): “Recognizing and preventing men’s health problems is not just a man’s issue. Because of its impact on wives, mothers, daughters, and sisters, men’s health is truly a family issue.”

We encourage all men and women to be aware of the screenings that are available and please schedule them regularly. What a great gift for Father’s Day…schedule the necessary routine screenings…prevention can save lives. Here’s a screening schedule for men of all ages from Wellmark.

What is the Big Deal About Centers of Excellence? Part I

May 7, 2012extended illness or injury, Health Insurancehealthcare updatesDebbie Sears

A government-defined Center of Excellence, beginning in the mid-1960s, is a facility or organization that creates healthcare value above the average found in a specific location. In the late 1990s, the US Health Care Financing Administration (HCFA) began to examine and compare treatment outcomes among hospitals paid by Medicare. Other divisions of government as well as the private sector have developed their own systems for rating and/or developing Healthcare Centers of Excellence.

As an example, The United States Federal Government established national centers of excellence in health care in the 1990s through their Department of Health and Human Services. Since that time, other new systems of Centers of Excellence have emerged, including a system of medical centers under the supervision of the US Veterans Administration and a system developed by insurance companies. Other systems exist as well and the healthcare consumer is wise to investigate the history, development, and certification rationale for any medical or healthcare “center of excellence.” They are not all the same.

By exploring this option, my husband, Dan is alive. I have a duty to share our story with each and every one of you. The lessons that we learned through his journey in 2008 have already made a difference not only to our family but several friends and clients. We learned the genetic patterns for family health history and the cutting edge of what may be in the future for our children and grandchildren. They also now have valuable resources that they may not have discovered on their own.

Stay tuned for Part II where I share our story.

It’s All About Prevention – Part 2

April 30, 2012Health Insurance, Healthcare updatesHealthcare Reform, healthcare updates, WellmarkDebbie Sears

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

April 23, 2012Dental health, Health Insurance, Healthcare updatesdental health, Healthcare Reform, healthcare updates, WellmarkDebbie Sears

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.