Medical Insurance Blog

Four Ways to Protect Your Healthcare Information

Do you believe your healthcare information is always kept private? Unfortunately, it is not necessarily so.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) introduced some very significant privacy protections for your personal and healthcare information, which, in HIPAA vernacular, is called Protected Health Information, or PHI.

Among the protections that HIPAA covers is a set of requirements that allow your healthcare providers to share your PHI without authorization from you. They consist of all of the following situations:

1.)    Uses and disclosures that are mandatory by law
2.)    Uses and disclosures that are for public health activities
3.)    Disclosures that are related to victims of abuse, neglect, or domestic violence
4.)    Uses and disclosures that are for health supervision activities
5.)    Disclosures that are for law enforcement purposes
6.)    Uses and disclosures that are for medical examiners and coroners
7.)    Uses and disclosures that are for tissue, organ, or eye donation purposes
8.)    Uses and disclosures that are for research that involves minimal risk
9.)    Uses and disclosures that are made to prevent a serious threat to health or safety
10.)  Disclosures related to Workers Compensation

If your healthcare provider chooses to disclose your PHI for one of the above reasons, by law, they must document and account for the disclosure. Also, you have the right to receive that documentation so you will know to whom your healthcare provider has disclosed your PHI. By simply asking your healthcare provider for documentation of the disclosures, you can exercise that right any time you want. This information is very personal so you should take great care to know that your information is kept as confidential as possible.

However, compliance with proper documentation of disclosures can be spotty, at best. Oftentimes, healthcare staff and providers do not really understand how or why they should not disclose your PHI. So, some of them just do not properly account for such disclosures.

You may not necessarily know if your PHI has been disclosed as your authorization is not required for these disclosures, and health provider offices may not comply with the disclosure accounting rules.

You must also know that once your provider discloses your PHI, whether they account for the disclosure or not, whoever receives your PHI may or may not be required to comply with all HIPAA privacy rules.

For instance, Jackie Smith (named changed to protect the individual's privacy) suffered a death in her family. Due to those circumstances, her deceased family member's PHI was disclosed to law enforcement. Fortunately, the healthcare provider followed the HIPAA privacy rules and accounted for the disclosures. But then her family member's PHI was released to the press, including the Social Security Number, date of birth, and diagnoses.

The way the information was leaked to the press is a subject for the courts. The point is that the confidential information was not protected once it was disclosed through the healthcare provider.

And you too should know that your healthcare information may not be safe once disclosed by your provider.

What steps can you follow to help ensure that you and your family's protected healthcare information will really be protected and remain confidential?

First: if you or your family members are ever involved in any circumstance mentioned above, and your healthcare provider discloses your PHI, you must exercise your right for an account of the disclosure by your healthcare provider.

Next, if you do not receive any account in writing within 30 days, then file a complaint with your healthcare provider's HIPAA Privacy Officer (all healthcare providers are required to have one). If necessary, file a complaint through the Health and Human Services' Office of Civil Rights.

After that, check that you follow the chain of custody: who received the confidential information and what did they do with it. Ensure that each of your requests for this information are in writing and then follow-up with phone calls.

Finally, always remember to keep a log of your requests; one day you may need it.

The HIPAA privacy rules were created to maintain confidentiality of your protected health information whenever it is in your healthcare provider's custody. Once the information is disclosed to other organizations that are not healthcare-related, it is no longer protected by HIPAA regulation. It is your job to keep track of your PHI and to ensure that the information is kept as confidential as possible.

BestHealthcareRates.com provides medical insurance and major medical insurance quotes and information to help consumers find the best plans to meet their needs. Please call us if we can be of assistance to you.

Learn More About California Medical Insurance for the Self-Employed

Are you a California resident and self-employed? If so, it is likely that you are without California medical insurance, unless you are married to someone who has active medical insurance. Although a large number of self-employed workers receive California medical insurance through their spouse, there are a few who are unable to do so. If you fall into that category, you may be required to purchase your own California medical insurance.

When it comes to making a choice for your California medical insurance, it is likely that you already know that you must find a California medical insurance company or provider to receive insurance. What you may not know is that there are many different insurance companies that offer California medical insurance to anyone who lives in the state of California, like you. As well as numerous medical insurance companies, you will also discover that you have a number of California medical insurance plans available to choose from, and many of these plans are different from one other.

Whenever you are looking to buy California medical insurance for yourself, you must research a number of California medical insurance companies, and you must also research a number of different California medical insurance plans and policies. The easiest way to research this information is through the internet. When you use the internet, you will be able to quickly and effectively compare California medical insurance companies, as well as compare the different choices for medical insurance plans.

Once you find a California medical insurance plan that suits your needs, you have to request a California medical insurance quote. Just by answering a few personal questions about you and your health, you will be given an estimate on how much that particular insurance plan will be. If you have a specific budget to follow while shopping for medical insurance, you will find that requesting California medical insurance quotes is quite useful. Knowing insurance plan prices in advance will allow you to compare insurance quotes so you can find the best price for medical insurance coverage.

Now, if you are self-employed and do not have any employees, you should look in to purchasing an individual California medical insurance plan. If you have a family, such as a spouse or dependent children, you should also be able to purchase medical insurance for them as well. If that situation fits your needs then you must purchase California family health insurance, instead of individual insurance. On the other hand, if you are a small business owner and you have less than fifty employees, then you may be able to receive coverage for them as well. If you are a small business owner, health insurance is definitely something worth looking into.

As you can see, it is fairly easy to receive California medical insurance for yourself, your family, or even your small business employees. So get started looking online for California medical insurance so you can find the best health insurance plan to fit your medical needs.

Choosing The Right Medicare Plan For You

For many people that are eligible for Medicare, just beginning to look over all of the different types of healthcare coverage can be very confusing. As you know, having options is often a very good thing. But with all of the healthcare plans available, how do you make a decision that will be right for you?

Those that have reviewed the many options with Medicare know that it is simply nothing but choices. Depending upon your situation, you may decide to stay with traditional Medicare, known as Medicare Parts A and B. If you choose this plan, it is recommended to obtain a Medicare Part D (prescription drug) plan as well. Medicare Part D ensures that all of your medications are covered.

Or, you may take a look at a Medicare Advantage plan, which combines traditional Medicare coverage plus prescription coverage and many other benefits. You may also be interested in a Medigap (supplemental) plan that offers even more coverage than the Advantage plan.

With all the options that Medicare includes, many people just give up due to confusion. Fortunately, help is available. To get the most out of your healthcare insurance choices, you should be advised by a knowledgeable source. A Medicare advisor offers information and guidance on available Medicare programs, detailed action plans tailored to your situation, and answers all of your questions. And before you speak with an advisor, research the basics of Medicare.

Traditional Medicare

Medicare Parts A and B were part of the original Medicare Program. This traditional form has been around since 1965. For most people that have worked and paid Medicare taxes for a minimum of 10 years, Medicare Part A is free. Part A covers in-patient hospital care, and Part B, which cost an average of $96.40 in 2009, covers out-patient medical care.

Anyone that has the traditional form of Medicare can visit any doctor they choose in any hospital or office. They do not need a referral from another doctor as long as that doctor, hospital, or office accepts patients with Medicare. However, the benefits of traditional Medicare are very limited.

Traditional Medicare does not cover most out-patient prescription drugs. If a Medicare recipient needs prescription drug coverage often, then costs can become very high. This is why Medicare Advantage and Medicare Part D plans are available for purchase.

Medicare Advantage Plans

Medicare Part C, also known as Medicare Advantage, combines Parts A and B into one plan. This allows the Medicare recipient to get their Medicare Part A and Part B coverage all in one place. Medicare Advantage plans generally include prescription drug coverage and many other benefits that are not normally found under traditional Medicare, such as dental and vision services.

The Medicare Advantage option works just like private insurance - you choose from different types of plans depending upon what type of provider access you would like (for example, preferred provider organizations (PPO) and health management organizations (HMO). It also depends upon your health condition and any prescription drugs you are taking.

Medicare Advantage plans also offer many different levels of coverage, and they all offer as much coverage as the traditional Medicare plan. For instance, if the plan covers prescription drugs, that coverage must meet the minimum standards of Medicare Part D.

Medicare Part D

Medicare Part D has been put in place to cover prescription drug costs. Similar to Medicare Advantage, Part D is available through private companies who are reimbursed to provide healthcare coverage to those under Medicare Part D. There are many different plans offered in the United States, and some have many different levels of coverage. Also like Medicare Advantage, there is a minimum coverage amount required for a plan to qualify as a Medicare Part D plan. Those who take prescription drugs, but don't need to see their doctors regularly, are the best candidates for Medicare Part D

Medicare supplemental plans, or Medigap, are sold by private companies to fill the "gaps" that exist in traditional Medicare. In 2009, there are 12 different Medigap plans, labeled A through L. The cost of deductibles, co-payments and coinsurance are included in Medigap, and it may also cover services that Medicare does not insure.

Although Medigap may cover additional costs, if a person chooses to keep traditional Medicare, that person can't buy a Medigap plan if they have Medicare Advantage. Having both plans is unnecessary because most Medicare Advantage plans offer better coverage and benefits than the Medigap plan. It is simplest and cheapest to just purchase a Medicare Advantage plan instead of having both Medigap and Medicare Part D.

Choosing the Right Plan for You

As you can see, choosing the right plan on your own can be a very difficult task. There are thousands of plans offered in the United States, with an average of 40 Medicare Advantage and Medicare Part D plans in different regions. This is why using a Medicare advisor is so important. With so many options, choosing a plan is difficult when you do not understand what each one covers or doesn't cover. The use of a Medicare advisor can help you choose the right Medicare coverage plan choice for your situation.

Oklahoma Individual Health Insurance: What You Need to Know

Because the state of Oklahoma does not require health insurance plans to be guarantee issue, it is very important to have at least a basic understanding of the insurance regulations in Oklahoma.

At this time, health insurance companies in Oklahoma are not required to provide coverage on a guaranteed issue basis. So based on your medical history they will accept or decline an application for coverage. Applications go through the medical underwriting process, which reviews health history and medical claims to identify any pre-existing conditions. Once looking over the applicant's history, the insurer may decline coverage or offer a plan with an elimination rider-an amendment to a policy that exempts them from having to pay claims for certain pre-existing conditions.

Even Oklahomans with who have had prior creditable coverage are not exempt from exclusionary periods or elimination riders, unless the prior plan was an HMO. In Oklahoma, insurers are not allowed to impose exclusionary periods on individual HMO health plans, but it is nearly impossible to find insurers in Oklahoma who offer HMO plans. Regardless of the plan type, insurers do not have the right to cancel a policy based on an increase in claims or a medical diagnosis.

Read: Individual health insurance in Oklahoma for more information and plan quotes.

Pennsylvania Individual Health Insurance Regulations

People seeking insurance in Pennsylvania should know that their applications will be medically underwritten to determine whether the insurer will accept or decline the application. The process is also utilized to determine premium rates. During underwriting, the insurer may review the applicant's medical history and current medical condition; the insurer may review up to 60 months prior to the application date. Once the process is complete, the insurance provider has the right to either accept the application and provide medical coverage or decline the application.

Read the full article: Pennsylvania Individual Health Insurance

Finding the Right Virginia Individual Health Insurance

 

In order to protect your family's financial future and ensure they have access to the medical care they need, health insurance is a must-have. In Virginia, people seeking individual health insurance policies have a plethora of plans from which to choose. The state imposes laws that shape plan structure and benefits, and it is important to be aware of these regulations as you decide what plan is right for you and your family.

Are You Eligible for Virginia Individual Health Insurance?

First and foremost, insurers strive to determine whether you are eligible for their plans or not. Because there are no Virginia laws stating how an application must be processed, it is up to the insurance company to choose to provide medical underwriting or not. However, insurers in Virginia reserve the right to deny coverage to any applicant for any reason, and there are no laws to determine who must receive coverage, unless the consumer goes through two specific insurers: CareFirst BlueCross BlueShield and Anthem BlueCross BlueShield. Standardized plans through these two insurers are guaranteed issue, so any consumer can obtain them, even those with poor health or a history of medical problems.

If insurers have applicants who are HIPPA eligible, the state of Virginia requires that they provide health policies with guarantee issue. Still, applicants in this position will likely receive quotes for very high premium rates, as there are no restrictions in Virginia as to how high premiums can be.

Understanding Virginia Guaranteed Benefits & Pre-Existing Conditions

Insurers are not required to offer standardized policies to consumers in Virginia. But there is a list of benefits that each insurer is required to provide for all customers. Things like certain cancer screenings, immunizations and postpartum care are among the guaranteed benefits. The law in Virginia states that an insurance provider may not utilize exclusionary times or elimination riders to guaranteed issue policies for consumers who are HIPPA eligible. However, insurers may choose to incorporate elimination riders excluding the coverage of a particular pre-existing condition for the life of the plan when it comes to non-HIPPA eligible consumers.

In addition HIPPA ineligible consumers may face a one year exclusionary period on pre-existing conditions, as the insurer may review the past 12 months of health history to search for these conditions. Claims made during the first two years of a health plan may be declined coverage if the insurer determines the condition was actually pre-existing. In this case, the insurer may again review the past 12 months prior to the date of application to identify the potential pre-existing conditions.

What is There to Know about Virginia Individual Health Insurance Premiums?

Premiums are important when it comes to health insurance plan selection. You need to understand the ins and outs of your Virginia individual health insurance plan, including the issues that determine premiums. Premium amounts are based on numerous factors, and it is possible for your premiums to increase significantly when your claims increase. While there are no limits regarding how much the insurer can raise your premiums, you always have the choice to seek out better rates if you believe your premiums are unaffordable.

Keep in mind the insurer may not cancel a plan due to an increase in claims or a change in health status. Consumers have the right to renew a policy even if medical claims increase. However, it is possible that premium rates will rise significantly.

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Maryland Individual Health Insurance Regulations Explained

Understanding the ins and outs of Maryland individual health insurance regulations can be confusing, but it is important to arm yourself with information when searching for right coverage to meet your needs. When you submit your application for health insurance, know that the insurer has certain rights in regards to your application that can significantly impact your coverage and premiums.

Below are some of the ways the health insurance provider may respond to your request for coverage:

• Any Maryland health insurance company may request information about the applicant's medical history, including any medical conditions.
• The insurer has the right to decline coverage based upon the personal information you provide in the application.
• The insurer may offer a plan with specific limitations or exclusions on certain medical conditions.
• Maryland law allows elimination riders, which allow the insurer to adjust any policy to exclude coverage for health conditions, or even body parts.
• When evaluating the applicant for all health plans, except when the selected plan is an HMO, insurers may review the applicant's health history up to 4 months prior to the application. An insurance carrier in Maryland may impose an exclusionary period for pre-existing conditions coverage for a maximum of 24 months. (HMO plans are not allowed to impose an exclusionary period for pre-existing conditions.)
• Insurers must provide credit to applicants who have had prior continuous coverage and are exercising their rights under the Group-to-Individual Portability Act through HIPPA.

Maryland Small Group Health Insurance Regulations

Any Maryland employer group with one to 50 employees qualifies for small group health insurance. Maryland law states that insurers must offer health coverage for small groups on a guarantee issue basis, meaning each eligible employee who is offered health insurance by the employer may not be declined coverage in the future.

An employer has the right to impose a waiting period beginning at the hire date before the employee becomes eligible for coverage under the small group plan, but the waiting period is required to be the same for all employees working for one company. Maryland state law states that insurers are not permitted to review medical history or impose an exclusion period for any pre-existing conditions.

Insurers determine the premium rates for Maryland small group health insurance based on geography and age and have a rate adjustment factor of 40%. Additionally, self-employed individuals can qualify as a "small group" and are eligible for small group coverage on the same guarantee basis; acceptance for self-employed individuals is reviewed annual during the period of enrollment.

Understanding Maryland COBRA and Continuation Coverage Issues

Federal law and Maryland state law require insurers to provide individuals, who have lost group health insurance due to a qualifying event, with continuation of health coverage. The COBRA plan states that one can remain under the employer-sponsored coverage, receiving all the benefits, for up to 18 months. The individual is responsible for paying all of the monthly premiums in addition to a 2% fee for administration.

Employees have 45 days from the time of termination to choose COBRA benefits, by requesting the coverage in writing. There are two different COBRA options available:

• Federal COBRA-companies with 20 or more employees qualify.
• Mini-COBRA-companies with fewer than 20 employees qualify. To apply for mini-COBRA, an employee must have received coverage under the small group health plan for a minimum of three months.

Conversion plans are also available to provide continuation coverage for people who surpass the 18 months on COBRA. People ineligible for a standard medical plan because of pre-existing medical conditions and who have run out of time with COBRA can qualify for the continuation coverage.

According to Maryland Continuation Law, the length of this continuation coverage varies depending on the reason why the employee left the small group health plan. An employee who was terminated without a reasonable cause is eligible for 18 months of coverage, while other terminated employees can receive 6 months of coverage, as long as they were covered for at least three months through the small group health plan.

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North Carolina Individual Health Insurance Regulations

The state of North Carolina requires all individual and family health insurance policies to go through the medical underwriting process, except for some plans provided by Blue Cross Blue Shield of North Carolina. Blue Cross Blue Shield (BCBS) in this state offers to provide a select number of their medical plans guarantee issue to any North Carolina resident. The insurance company reserves the right to impose elimination riders on plans that do not pay benefits on pre-existing conditions if the individual applying is ineligible for HIPAA.

Premium rates for BCBS guaranteed issue plans will likely be higher due to the fact that there are no caps on rates for the North Carolina individual medical insurance market. Other individual policies, including most of those offered through BCBS, will take into consideration current health and health history as well as other risk factors as they consider an application.

These insurers may decline an application or may decide to offer the applicant coverage with an elimination rider, excluding certain benefits for specific pre-existing health conditions. If the company does not impose an elimination rider, they may still choose to put a hold on paying benefits for a pre-existing condition for up to one year.

The insurer may only look back into one's medical history files as far as 12 months prior to the application date for pre-existing conditions, and prior creditable coverage must be applied to any exclusionary period. The state of North Carolina guarantees the renewal of individual medical insurance plans, meaning an insurer does not have the right to cancel coverage if one's health declines or claims increase.

North Carolina Small Group Health Insurance Regulations

North Carolina companies with one to 50 employees likely qualify for small group health insurance. Groups of two to 50 qualify for guaranteed issue coverage, meaning the group may not be turned down due to health history or current medical issues during the application process. On the flip side, self-employed individuals which are labeled a small group of one may be declined coverage on all insurance policies except for two standardized plans offered by every insurer that provides small group insurance.

These state-mandated plans have the same benefits from insurance company to insurance company. In North Carolina, all small group health policies are equal opportunity, so an individual employee will not be declined coverage under the group plan due to health issues. While insurers may put small group applicants though the medical underwriting process, it is only for the purpose of deciding the premium rate. Providers can adjust rates based on health history, lifestyle habits and demographics. The adjust factor is limited to a 1.2 rate. The highest risk groups may not be charged premiums in excess of 20% of the standard rate.

Understanding North Carolina and Continuation Coverage Issues

Small groups in North Caroline with more than 19 employees fall under federal COBRA regulations in the case of terminated employees. Groups with 19 or less employees fall under the state's mini-COBRA law. Continuation of coverage is available for 18 months from the termination date, with some qualified dependents being able to stay with the COBRA coverage for up to 3 years.

North Carolina's mini-COBRA law states that an employee must have been with the group plan for a minimum of three months. Furthermore, the employee must put the choice to go on COBRA in writing within 31 days of the employment termination.

When a person is using COBRA coverage, he or she is 100% responsible for premium payments as well as a 2% administration fee. If an individual has used all of the available time with COBRA and is unable to gain acceptance through private insurance, they can find guaranteed issue basis coverage through BCBS of North Carolina.

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Nevada Individual Health Insurance Regulations: What You Need to Know

Nevada requires all individual and family health insurance policies to go through medical underwriting process, which reviews the applicant's health history to determine if coverage will be offered and what the premiums will be. There are no limitations regarding the review-period, and the insurer may choose to look back as many years as desired to identify potential pre-existing conditions. The insurer may also choose to deny coverage or offer a health plan with specific exclusions on any condition that is labeled pre-existing. If the applicant received prior coverage through another insurance company, credit must be given for this previous coverage.

Insurers have the right to determine the monthly premium amounts when the application is approved and must keep any increase in rates to no more than 50% over the standard rate of the time. When the insurance provider approves an application, it may not change the rate level based on future claims for medical care. Nevada premium rates are based on factors such as age, sex, health status and geographical location.

Nevada Small Group Health Insurance Regulations

For Nevada companies with two to 50 employees, small group health insurance is available. The law states that small group health coverage is provided on a guarantee issue basis, which means that an employee who is part of the insurance group may not be declined coverage based on current medical conditions or health history. However, the employer may impose a waiting period after the hire date before the employee can be covered under the group plan, as long as the waiting period is the same time frame for all employees in the group.

Once the employee is eligible for the group plan, the insurer can impose a one-year exclusionary period on any pre-existing condition if the applicant is unable to present a proof of previous creditable coverage. Premium rates for a group in Nevada are medically underwritten and can fluctuate 25% plus or minus of the indexed rate.

Understanding Nevada COBRA and Continuation Coverage Issues

When a Nevada employer has more that 20 employees, the group falls under federal COBRA regulations. There is also the Nevada mini-COBRA which applies to companies having fewer than 20 employees. Mini-COBRA states that if an employee experiences a qualifying event, he or she must have the opportunity to continue group health plan coverage.

Qualifications and guidelines for Nevada COBRA and mini-COBRA include:

• Employee received coverage under a group plan for a minimum of one year prior to the termination date.
• Employee verifies in writing the desire to utilize the COBRA option within 60 days of the termination date.
• Continued COBRA coverage is capped out at 18 months for employees, whereas and employee's spouse and dependent children have 36 months of the continued coverage.
• Employees who choose to continue coverage under COBRA are responsible for premium payments, which cannot exceed 125% of premiums charged to the employer for the small group.
• Employees who voluntarily leave the place of employment are ineligible for COBRA and mini-COBRA coverage.

After an employee has used all of the time available for COBRA coverage, they qualify for guarantee issue coverage through other private individual health insurance companies. In Nevada, these insurers are required to offer a minimum of two plans available to people who qualify through HIPPA.

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Finding the Right Kentucky Individual Health Insurance

When it comes to providing financial security and medical well-being for your family, health insurance is vital. One medical emergency can drain a family's finances quickly, which is why purchasing the right Kentucky individual health insurance plan is one of the wisest investments you can make. With a plethora of plans to choose from, it is important to understand the details regarding laws in Kentucky that regulate individual health plans.

As you consider the laws affecting your coverage, it is necessary first to understand your eligibility for certain insurance plans. In Kentucky, insurance applications are reviewed based on certain criteria determined by the insurer. It is typical for insurance companies to use determining factors including health, age, and lifestyle choices as they decide if they will accept a particular applicant.

The HIPPA Group-to-Individual Portability Coverage regulations that include the state of Kentucky guarantees issuance of health coverage. This coverage is provided through Kentucky access, which is the state's higher risk health insurance pool, to applicants who are HIPPA eligible and have been unable to secure an insurance plan through a private insurer.

Guaranteed Benefits & Pre-existing Condition Laws in Kentucky

The coverage one's policy provides is determined by the plan chosen. Insurers in Kentucky are required to carry at least one standard benefit plan in their products. These standardized plans like the HMO or PPO or indemnity plan provide uniform coverage, regardless of the insurance company offering it. The comprehensive coverage offered by these standard plans in Kentucky include:

• Hospital stays
• Preventative care
• Physician care
• Maternity services
• Immunizations
• Mental health services
• Prescription drug benefits

While the benefits are generally the same, the cost of these plans and the way they function vary. For example, the HMO plan allows the consumer to receive services only from in-network providers, but typically has no deductible and low co-payments. The PPO plan gives the consumer more options and the ability to select in-network or out-of-network providers. Out-of-network providers come with a higher out-of-pocket payment, but after the deductible is met, the consumer pays only 20 to 40% of the medical costs. On the other hand the indemnity plan requires a deductible before the claim payment kicks in and a 10 to 20% coinsurance after the deductible is met, but there is the freedom to choose any hospital or doctor. Additionally, the consumer is responsible for submitting all claims with the indemnity plan option.

As for pre-existing conditions for consumers in Kentucky, an insurer can enforce an exclusionary period on any identified pre-existing condition for up to a year, but elimination riders that exclude specific conditions indefinitely are prohibited.

What is There to Know about Kentucky Individual Health Insurance Premiums?

Premiums are determined based on the regulations and guidelines of the chosen insurance company. Kentucky does not have laws mandating how much one can or cannot be charged for individual health coverage. One benefit to Kentucky consumers is that health insurance policies have a guaranteed renewal policy, meaning an insurer cannot cancel a policy if health problems arise, although premiums may be increased to offset additional costs.

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Connecticut Individual Health Insurance Regulations

Connecticut Individual Medical Insurance Quotes

Individual health insurance plans in Connecticut do not have to be guarantee issue. In fact, insurers have the right to decline any applications. When individuals apply for coverage, the application goes through medical underwriting and the insurer reviews the health history of each individual applicant, identifying pre-existing medical conditions. Through this process, insurers may accept or decline coverage depending on the health history. The insurance company may also come up with an individualized plan with limitations based on these pre-existing conditions.

Numerous individual health insurance policies are available in the state of Connecticut with benefits varying from plan to plan, depending on the insurance company and policy type. The state does require that any insurance company serving consumers in Connecticut offer standardized health plans including HMO, PPO and indemnity plans.

Connecticut insurers are allowed to utilize a 12-month period to exclude pre-existing condition coverage. They may conduct a review of the applicant's health history for the previous 6 months. An applicant who has received coverage from another credible health plan prior to the request for new coverage will receive credit with the new insurance company. Still, applicants who have a history of prior health problems should expect higher premium rates. Laws state that these increased rates may not be more than 35% of the standard.

Connecticut Small Group Health Insurance Regulations and Guarantee Issue

An employee group in Connecticut that has two to 50 people in the group qualifies for small group health insurance. Law mandates that small groups must receive guarantee issue coverage, which means a group may not be denied coverage based on current or previous medical conditions.

Each employer must determine whether or not he or she wants to apply a waiting period for new hires joining the employer-sponsored group plan. Connecticut law mandates that the insurance carriers for the group plans may review the new employee's health history in the previous six months and may utilize a one-year exclusionary period for new employees who possess pre-existing conditions and did not have prior health coverage.

If there was not a break in coverage for more than 63 days, the new employee must receive credit. Once the insurer and employer determine the new employee is eligible to join the group plan, coverage must be guaranteed. Declining coverage due to health issues is no longer an option once the employee has become part of the group plan. Still, the employee's application will go through medical underwriting and the employee can have premium rates that are 35% higher or lower than the indexed rate based on the group's health status.

Understanding Connecticut COBRA and Continuation Coverage

Connecticut small groups fall under COBRA benefits, regardless of the group's size. There are two categories for COBRA:

1.      Mini-COBRA-covers employer groups with less than 20 employees. Providing coverage for an individual who has had at least three months of prior credible plan coverage, a mini-COBRA applicant must choose the coverage within 31 days from the time the insurer sends a notice of eligibility. If the insurer does not provide the required notice in a timely fashion, the applicant has an additional 60 days to choose coverage, as well as up to 90 days after the employment termination.

COBRA-covers employer groups with 20 or more employees. This coverage offers an additional 18 months of coverage under the employer-sponsored plan. An employee also has the option to choose a conversion plan, which allows him or her to convert a group health plan into a personal coverage policy.

Aetna health insurance now covers administration of H1N1 flu vaccine

Aetna has made the decision to cover administration of the H1N1 flu vaccine for all fully insured medical plan members and all members of self-funded plans unless directed otherwise by the plan sponsor. Aetna will provide this coverage even in instances where members' have major medical insurance plans or specific health plans that do not provide coverage for preventive care or have limits on such coverage. Aetna will cover the full cost cost of the administration of the vaccine with no member copay, co-insurance or deductible applied.

Aetna is reaching out to all members in many ways. Educational mailings to members have begun, and messages will be included in the Member Essentials e.newsletter. In addition, professionals staffing Aetna's member services call centers have received special materials on the H1N1 flu so they are well prepared to answer questions.

They will also use information available in their CareEngine® to proactively identify members who fall into three of the five categories of "priority individuals" as defined by the Centers for Disease Control and Prevention (CDC). Aetna will reach out to these members and urge them to be vaccinated.
These three categories are:

* Members who are younger than 65 years of age who have health conditions associated with higher risk of medical complications from influenza
* Persons 6 months to 24 years of age
* Pregnant women

Members in these high-risk groups will receive Care Considerations sent to their personal health records with information on H1N1 flu, their specific risk factors and suggestions they consider vaccination. We will include information about all of the priority groups, including those we cannot readily identify through our records - health care workers/emergency personnel and caregivers of children six months and younger - in messages sent to all members' Aetna Personal Health Records.

In a similar effort to reach high-risk members, Aetna is providing H1N1 training to nurse case managers who work with members enrolled in Aetna's disease management, case management, and Beginning Right® maternity programs. Members in these programs may also be among those the CDC has targeted for prioritization when the vaccine is first available.

Resources are available to all members on Aetna's public website include fact sheets and Question & Answer documents, with up-to-date information on the H1N1 flu along with tips on preventing infection. We have posters and flyers for download with tips on how to avoid the flu. Aetna is one the nations top insurers offering individual health insurance, family health insurance and group health insurance.