Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws. There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. Many critical details of this new insurance law will be clarified in the months and years to come.
These six major coverage options are:
(1) Individual or family coverage
(2) Employee/employer group option for small businesses (typically under 50 employees)
(3) Employee/employer group option for large businesses (typically larger than 50 employees)
(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)
(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards
(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.
Note: The US federal government high risk pool will morph into the Exchange plans through each state starting on 1-1-2014.
NAHU was invited by the Department of Health and Human Services (DHHS) to participate in a meeting yesterday about how to increase public awareness and participation in the federal high-risk pool program, the Preexisting Condition Insurance Plan (PCIP). Despite initial actuarial projections that hundreds of thousands of people would enroll right away and that an initial $5 billion appropriation would be insufficient program financing, DHHS is now reporting that after being open for business for two to three months in most states, the plans have enrolled only 8,011 people. In many states, the federal pools are operating at less than 10 percent capacity.
Some of the biggest barriers to PCIP participation include the requirement that an individual be uninsured for six months prior to enrolling, and the need for rejection notices from health insurance carriers that contain specific content. But another huge factor identified by DHHS and pool directors across the U.S. is agent involvement, and time was spent at the meeting discussing how to increase agent awareness of the new program.
Suggestions included more education through associations like NAHU and compensation for agents who help enroll individuals in the states where the federal government administers the program. All but two states operating their own federal PCIP programs provide compensation to participating agents and brokers already, as do all state-run high-risk pool programs.
Another suggestion that came out of the meeting was to use the PCIP as a means of filling a coverage void for child-only plans in some states. Since carriers have had to pull out of this market in many states due to lack of an open enrollment period and federal rules requiring guarantee issue of coverage, one state is already trying to make the PCIP plan work for these children. In New Mexico, the pool director is working with DHHS to get an exception to the rejection letter requirement, since children without coverage can’t get a rejection letter if there is no carrier serving their marketplace. Other states may follow suit.
Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care information with him at all times when he travels (check out his diving travels at www.douggulleson.com). Keep our blog close by you, www.gntravelinsurance.com , for continual updates on the changes with the US health care system.