DECLINED FOR HEALTH INSURANCE BY AN INSURANCE COMPANY?

HAD YOUR PRE-EXISTING MEDICAL CONDITION "WAIVED", "RIDERED" OR "EXCLUDED" FOR COVERAGE?

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. Texas leads the nation in terms of those uninsured for health insurance and the ever increasing number of individuals declined due to pre-existing health conditions only contributes to this statistic. One problem is obesity. It is a national epidemic, not just a regional one, but this alone cannot explain the problem. While legislators and industry analysts attempt to identify the cause and solution - 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)

You can elect to self-insure. This works fine if you are Bill Gates or - are at the other end with of the spectrum - with no assets. However, if (like most of us) you are somewhere between the two - this could be disastrous. 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 - if it was - someone now owes a fortune. In other words if you are a responsible consumer 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)

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 "Texas 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)

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.

1) MAKE CERTAIN PAYMENT OF THE POOL RATES IS FEASIBLE FOR YOU IN THE FIRST PLACE. CLICK HERE TO OPEN; DOWNLOAD AND PRINT THE RATES: RISK POOL RATES

2) IF THE RATES ARE AFFORDABLE, CLICK HERE TO OPEN; DOWNLOAD AND PRINT THE OUTLINE OF COVERAGE (BENEFITS) AND APPLICATION: RISK POOL APPLICATION

3) PULL THE "CHECKLIST" FROM THE BACK OF THE APPLICATION AND PUT IT NEXT TO THE APPLICATION ITSELF AS YOU BEGIN THE PROCESS OF COMPLETION. ADHERE TO IT STRICTLY. ANY DEVIATION OR ADMISSION WILL DELAY PROCESSING YOUR APPLICATION AND CERTAIN OMISSIONS OR INCORRECT ENTRIES COULD RESULT IN IT BEING RETURNED TO YOU OR DENIED. CALL US AT: 800-856-6556 IF YOU HAVE ANY QUESTIONS REGARDING PROPER COMPLETION.

4) UPON COMPLETION - FAX YOUR APPLICATION TO: 800-848-4201*. WE WILL CHECK YOUR MEDICAL CONDITION**, AS INDICATED, AND IF WE BELIEVE IT HAS THE POTENTIAL TO BE COVERED BY A COMMERCIAL INSURER, WE WILL ADVISE YOU OF SUCH AND OFFER ASSISTANCE. IF WE KNOW IT CANNOT BE - WE WILL APPLY OUR "CERTIFICATION" AND RETURN IT TO YOU TO BE MADE A PART OF YOUR APPLICATION. IN ADDITION, WE WILL REVIEW YOUR APPLICATION FOR ANY ERRORS OR OMISSIONS WHICH MIGHT DELAY ITS APPROVAL AND ADVISE YOU OF SUCH. ONCE ANY NECESSARY CORRECTIONS ARE MADE, THE APPLICATION CAN BE FORWARDED DIRECTLY TO THE POOL FOR UNDERWRITING. WE WILL BE YOUR AGENT; MONITOR THE RECEIPT AND STATUS OF YOUR APPLICATION; INFORM YOU OF OUTSTANDING REQUIREMENTS AND NOTIFY YOU WHEN YOUR APPLICATION IS APPROVED.

**IF YOU WOULD LIKE TO DETERMINE WHETHER YOUR MEDICAL CONDITION WARRANTS APPLYING TO THE POOL PRIOR TO COMPLETION OF THE APPLICATION - PLEASE FAX THE 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
ATTN: TEXAS RISK POOL APPLICATION
7 SWITCHBUD PLACE, STE. 250
THE WOODLANDS, TX 77380

OPTION IV)

While the Pool option is ideal for those not eligible for other options - no option is meaningful if one cannot afford it. Therefore, we offer option four. While not ideal, as it is not insurance, it basically takes the burden off you of having to explain your lack of coverage to medical providers and to pre-negotiate your own medical expenses. Presentation of your card to a network provider automatically determines the "discounted" price you will be charged for each medical procedure - resulting in 20%-60% discount (depending on the procedure). Further advantages include:

1) NO DEDUCTIBLES TO BE MET

2) NO WAITING PERIODS APPLY

3) NO ANNUAL PLAN MAXIMUMS

4) GOOD AT THE DOCTOR'S OFFICE AND HOSPITAL

5) THE PPO NETWORK IS ONE OF THE BEST AND LARGEST IN THE NATION (BASICALLY MIRRORS THE PHCS NETWORK)

6) PRE-EXISTING CONDITIONS ARE NOT AN ISSUE - EVERYONE IS APPROVED!

7) IT'S AFFORDABLE - $29.95 PER MONTH TO COVER AN ENTIRE FAMILY

TO OBTAIN RATES; CHECK THE PREFERRED PROVIDER NETWORK IN YOUR AREA AND TO APPLY - CLICK HERE:

OPTION V)

EASY ISSUE INSURANCE FOR INDIVIDUALS (TRUE INSURANCE - NOT A "DISCOUNT" PLAN!) UNDERWRITTEN BY LARGE "A" RATED CARRIER

INDIVIDUALS; FAMILIES AND GROUPS

1. Value Health Plan (AIG) Choice of options with up to $1,000 per day IN-hospital, up to $4,000 per day for ICU, up to $20,000 per surgery, up to $4,000 for anesthesia and up to $500 ambulance

2. Value Med Plan (GTL) Benefits for Dr's office visits, IN-hospital $100 or $500 per day, OP-hospital xray & lab and ambulance - QUOTE & APPLY ONLINE:

3. Value Hospital Plan (AIG) Benefits for IN-hospital $1,000 per day or ICU care $,4,000 per day

4. Value Emergency Room Sickness or Injury benefits up to $1,000 per Hospital ER visit - up to 2 times per year - QUOTE & APPLY ONLINE:

5. VBA Accident Medical Expense 24 hour coverage for medical expenses from a covered injury - up to $2,500, $5,000, $7,500 or $10,000; AD&D and Air Ambulance included - QUOTE & APPLY ONLINE:

6. Truckers Occupational Accident (AIG) Provides up to $1,000,000 medical expenses from covered injury, AD&D,
paralysis, temporary & continuous total disability & more . . .

7. Individual and List Bill available

8. GUARANTEED ISSUE for qualified employers

9. Strong & affordable alone or as a supplement to a high deductible or HSA

10. Prior health declines accepted

*IF YOU WOULD LIKE TO APPLY FOR PLAN 1; 3 or 6 ABOVE - PLEASE CALL: 800-856-6556

We have offered you 5 options if coverage for your existing medical condition(s) has been denied on an "individual and 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. And - in the end - 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
MONDAY - FRIDAY 9:00 - 5:00 PM C.S.T.
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