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Uninsurable Residents of the United States
Declined for Health Insurance by an Insurance Company? Had Your Pre-existing Medican Condition "WAIVED", "RIDERED" or "EXCLUDED" for Coverage? Coverage Not Affordable? THESE ARE THE OPTIONS YOU MUST CONSIDER TO PROTECT YOUR FAMILY! If one of the above circumstances applies to you or a family member - do not feel alone. According to the U.S. Census Bureau 50.7 million, or nearly one in six Americans is without health insurance. An ever increasing number of individuals being declined due to pre-existing health conditions only contributes to this statistic. If not ultimately repealed, the Patient Protection and Affordable Care Act of 2009 will ensure that insurance companies will no longer be able do this. The portion of the law which prohibits such will not become effective until January 1, 2014. In the meantime - the individual and family faced with a need for medical treatment still needs a viable means of receiving and paying for such. Insuring for these things is necessary for most of us, but what can you do when your honest attempts to do so are rejected by an insurance company? Basically, you may have 5 options when this occurs: OPTION I SELF-INSURE You can elect to self-insure. This works fine if you are Bill Gates or - are at the other end of the spectrum - with no assets. However, if (like most of us) you are somewhere between the two - this could be disastrous. While medical providers have an obligation to render emergency care necessary to stabilize your situation - you will be billed afterwards. Beyond that point they are obligated to provide nothing until you demonstrate an ability to pay. Fund raisers and donation cups on convenience store counters are no accident. These exist because of someone's inability to pay for some critically necessary medical procedure. Will they die or suffer indefinitely without it? Quite possibly - but not the day the medical condition was diagnosed. Which is why treatment was not provided. Or - someone now owes a fortune. In other words if you are a responsible consumer, have a social security number and would like to maintain your good credit rating - you don't want to be in this position. Unpaid medical bills will follow you through the credit bureaus until such time as they are satisfied. So for those of us with anything going for us at all - this is not an option. OPTION II GROUP HEALTH You probably would not be in this position if you had "Group" health insurance available to you through an employer. Since the passage of the HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT) in 1997, employer sponsored group health plans have been obligated to approve an applicant in spite of pre-existing health conditions and must cover any and all pre-existing conditions from day one of coverage unless there has been a gap in coverage in excess of 62 days. In that case - you can be subject to a waiting period equal to your gap - not to exceed 12 months. However, if group insurance is available to you, you should enroll in it during your or the group's "open enrollment" period. If you do not have this option but are self-employed - you may be able to acquire group health insurance for your own business. Here are the requirements for an employer to qualify for group for health insurance in Texas: 1) Employer must have a minimum of two employees 2) Those employees must appear on a current "State Quarterly Wage & Tax Report" reflecting W-2 (wage earning) employees. 3) Employer must agree to cover 75% of all employees not covered under a spouse's group plan. 4) Employer must agree to pay a minimum of 50% of the employee's premium. If you (the employer) can meet these requirements - THIS CONSTITUTES YOUR SECOND OPTION. * IF YOU WOULD LIKE TO TAKE ADVANTAGE OF SUCH - *(Completion of the attached form will ensure we provide accurate quotes pursuant to your requirements. Click here to open the GROUP QUOTE REQUEST FORM. Should you have difficulty opening it - please go to our homepage and download it from there. Upon completion, you may fax the form to: (toll free) 800.848.4201. Once we receive the form, we will scan the entire TEXAS health insurance market to identify the very best value in group health insurance for your particular group. We will prepare your quotes as soon as possible and forward them for your review.) OPTION III THE
FEDERAL HEALTH INSURANCE RISK POOL In March of 2010, Congress passed and President Obama signed the Affordable Care Act—the new health insurance law. The law creates a new program – the Pre-Existing Condition Insurance Plan – a Federal Pool to make health insurance available to you if you have been denied coverage by private insurance companies because of a pre-existing condition. The Pre-Existing Condition Insurance Plan (PCIP), which is administered by either your state or the U.S. Department of Health and Human Services, provides a health coverage option if you have been without health coverage for at least six months, you have a pre-existing condition or have been denied health coverage because of your health condition, and are a U.S. citizen or reside here legally. An insured member of the Federal Pool is not subject to any pre-existing waiting period. The Program:
The U.S. Department of Health and Human Services, with the help of the U.S. Office of Personnel Management and the U.S. Department of Agriculture’s National Finance Center, runs Pre-Existing Condition Insurance Plan in 23 states and the District of Columbia. The federal government contracts with a national insurance plan to administer benefits in those states. In the other 27 states, there are state-based programs. The program may vary depending on what state you live in. Check with your states insurance department to learn more about how the Pre-Existing Condition Insurance Plan works in your state. The U.S. Department of Health and Human Services, with the help of the U.S. Office of Personnel Management and the U.S. Department of Agriculture’s National Finance Center, runs Pre-Existing Condition Insurance Plan in 23 states and the District of Columbia. The federal government contracts with a national insurance plan to administer benefits in those states. In the other 27 states, there are state-based programs. The program may vary depending on what state you live in. Check with your states insurance department to learn more about how the Pre-Existing Condition Insurance Plan works in your state. Eligibility for the Federal Pool Access Rates and a Benefits Summary below. To download an Application Form, go to www.allplaninsurance.com/pre-existingconditionhealthplanapplication. Your eligibility for the Pre-Existing Condition Insurance Plan will be determined by the National Finance Center after your application is received. To be eligible for the Pre-Existing Condition Insurance Plan:
*Email your state of residence, contact information, date you last had health insurance and the health history you feel qualifies you for the Federal Pool to: quote@allplaninsurance.com. We will contact you to discuss your eligibility and the potential of our providing the agent letter. We are currently licensed in and assisting (where the Federal Pool is operational) residents of Indiana and Texas. Residents of all other states, please contact your state department of insurance. State Information Pre-Existing Condition Insurance Plan Monthly Rates: Indiana
Pre-Existing Condition Insurance Plan Monthly Rates: Texas PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition - there are no waiting periods. PCIP offers a choice of plan options to fit your needs and provide more affordable premiums. Please note rates have changed in Texas as of July 1, 2011. The monthly premiums for your state are:
CLICK HERE TO DOWNLOAD THE 2012 BENEFITS SUMMARY CLICK HERE TO DOWNLOAD THE 2012 BROCHURE CLICK HERE TO DOWNLOAD THE APPLICATION OPTION IV TEXAS HEALTH INSURANCE RISK POOL
TEXAS IS ONE OF APPROXIMATELY 45 STATES WHICH DOES HAVE A HEALTH INSURANCE "RISK POOL” PLAN AVAILABLE TO RESIDENTS OF THE STATE WHO, AMONG OTHER THINGS, ARE UNINSURABLE BY PRIVATE PLANS (FROM COMMERCIAL INSURERS) OR HAVE HAD THEIR PRE-EXISTING CONDITIONS "WAIVED" FOR COVERAGE. The Texas Health Insurance Risk Pool was created by the Texas Legislature to provide health insurance to eligible Texas residents who, due to medical conditions are unable to obtain coverage from commercial insurers. The Pool also serves as the Texas alternative mechanism for individual health insurance coverage, guaranteeing portability of coverage to qualified individuals who lose coverage under an employer group plan, church plan or state plan, as mandated by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) Texas' risk pool is funded by premiums from the insured; contributions from insurance companies doing health insurance business in Texas and investment income. Even so the loss ratio (relationship of incurred claims to earned premiums) in 2006 was 145%. This in spite of an average monthly premium that same year of $510. The average incurred annual claim expense per member was $8,860. That being said, the Program continues to serve the State of Texas as an important "safety net" for individuals who have been denied health insurance coverage because of pre-existing conditions, can afford the Pool's premiums and do not have other coverage options. The mission of the Pool is to provide eligible Texans with cost effective health coverage that is consistent with major medical policies available in the commercial market. In perspective, during 2006, 83% of all survey respondents indicated they would recommend the Pool for coverage. As said, if you have no other options available to you for coverage of your pre-existing medical conditions, this represents your best opportunity for coverage. However, as an insurer of last resort, the application process is detailed, the completion process tedious and every attempt will be made to confirm no other options avail themselves to you. If your medical condition does not fall within one of 13 categories medical conditions determined to be a condition for "automatic eligibility" - you will have to provide documentation of "declination" for coverage by a private insurer and copies of all pertinent medical records. This process can be time consuming and expensive as many providers charge the patient a fee for providing a copy of their records. It is incumbent on the applicant to pay this fee - not the Pool. The alternative to these hurdles and the delay in negotiating them is to let a licensed insurance agent "Certify" that they (the agent) are unable to obtain "substantially similar" individual health insurance, as a result of a medical condition, based on the insurance carrier's underwriting guidelines. The agent must then provide the name and address of the insurance company. If you would like an agent to "certify" your application and potentially expedite the issue of your coverage - please complete the following steps.
**IF YOU WOULD LIKE TO DETERMINE WHETHER YOUR MEDICAL CONDITION WARRANTS APPLYING TO THE POOL PRIOR TO COMPLETION OF THE APPLICATION - PLEASE FAX YOUR CONTACT INFORMATION, DIAGNOSIS AND DATES OF TREATMENT AND WE WILL PROVIDE YOU OUR PROFESSIONAL OPINION VIA TELEPHONE OR EMAIL. * IF YOU PREFER TO MAIL YOUR APPLICATION TO US (FOR ALL THE ABOVE) PLEASE MAIL IT TO: ALL PLAN MED & LIFE
QUOTE OPTION V INDEMNITY PLAN ASSURANT HEALTH INSURANCE COMPANY EASY ISSUE INSURANCE FOR INDIVIDUALS (TRUE INSURANCE - NOT A "DISCOUNT" PLAN!) UNDERWRITTEN BY LARGE "A" RATED CARRIER INDIVIDUALS; FAMILIES AND GROUPS Assurant Health Access Having Access PaysSM Affordable – Plans that meet your financial and lifestyle needs.
Assurant Health Access is a fixed indemnity health plan designed to bring you access to health care and more for your money. It delivers real value by helping you save on health care expenses and paying cash benefits when you receive certain medical services.
Know the Difference Assurant Health Access plans pay fixed cash benefits to help pay for health care expenses, regardless of what your provider charges you. Be sure to review the limitations and exclusions listed in your contract. We have offered you 5 options if coverage for your existing medical condition(s) has been denied on an "individual or family" policy. Some options fit certain people's situations and provide the most comprehensive medical coverage available. If eligible, some will not be able to afford them. Other options will be affordable, but will not provide the level of coverage necessary to protect someone from all foreseeable and unforeseeable losses. There is no coverage that covers 100% of our risks 100% of the time. ALL PLAN MED & LIFE QUOTE is here to assist you along the way in whatever way possible. There is no charge for our advice and guidance. While we operate for profit, we are compensated if and only if you enroll in a product or insurance plan through us. And then - only by the entity providing your policy or contract. You are charged nothing more by going through us than if you were to acquire the product directly from the entity itself. We like to feel you receive the value of our experience in the insurance industry and our objective insight into the positives and negatives of each particular option. Please do not hesitate to call us to confirm these things. TOLL
FREE: 1-800-856-6556
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| A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and BlueShield Association | Copyright ©, All Rights Reserved |
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