what is insurance

I just learned something new (to me). Recently, one of my small group clients had to let a long-time employee go. The plan itself is HSA-compliant, and the employer (very generously) funds each employee's account with $750 a year. He also covers the lion's share of the premium. The unfortunate employee reached out to me to see what his options were. The group wasn't large enough to be subject to COBRA, but here in Ohio we have a so-called " mini-COBRA " law that guarantees (in specific circumstances) that the employee can continue his group plan for up to a year (paying the full freight, of course). One can imagine that this gets, as my dear departed sister used to say, " spendy :" in this case, upwards of $1,000 a month for the employee and dependents, all while he's between jobs. Ouch. One option we explored was a short-term medical plan, which would be much less expensive (under $300 a month) but which has its own limitations. Here's where it ...

A few months back, we considered the case of the gentleman who had passed away after he'd let a policy lapse, and the implications thereof: " I asked for the policy number to which it referred, and advised him that when the policy lapsed last year it created a taxable event, and that the balance due is being treated as taxable income (which would have also been the case if my client was still with us) ." That is, letting a policy with a substantial loan against it lapse is a sure-fire way to trigger a potentially hefty tax bill. Flash forward to earlier this week, and I field a call from another agency client who had some questions about his life insurance policy. In this case, the policy was still in force, but also one he had bought from another agent long ago (and with a carrier we don't represent). So I of course offered to help as best I could (because he is an agency client) but that my answers would of necessity have to be pretty generic. The facts were thes...

Back in 'Aught 12, we noted that the Norwegian national health care scheme was starting to buckle: " [T]he E.R. is simply not open at this hour ... What? There�s not always a doctor at the E.R.? " That would be a ' no .' And even that model of competence Sweden had beg u n feeling the pain: " Swedes also complain about not being able to see their own regular general practitioner " Life under government-run health "care." But things are changing; co-blogger Mike alerts us to the newest developments: " It�s intriguing that while socialists in America would rush to nationalize the health care system, Norwegians, Swedes, and Danes are all gradually increasing their use of private health insurance ." Wait, what? How could this be? Well, the numbers tell a very interesting tale: " Between 2006 and 2016, the portion of the population covered by private insurance increased by 4% in Sweden, 7% in Norway, and 22% in Denmark ." Remem...

One of the bullet points in yesterday's order focused on the use of HSA's for Direct Primary Care and Health Sharing Ministries. To those in these types of arrangements, you might want to dial back your enthusiasm. Why do we say this? One first must remember the requirements to fund an actual Health Savings Account. Straight from the IRS website... To be an eligible individual and qualify for an  HSA , you must meet the following requirements. You are covered under a high deductible health plan (HDHP), described later, on the first day of the month. So, to fund an HSA to pay for DPC or HSM you must pay premiums and purchase an insurance plan. Nothing like paying premiums for insurance so that you can set up an account to draw funds from said account to pay for more "insurance."

Via FoIB Holly R, this latest from the rascals at the MVNHS�: " Coroner demands NHS 111 changes after six-year-old Sebastian Hibberd's death " And what, you may ask, is the context here? Well: " Sebastian Hibberd died after staff failed to spot warning signs that part of his bowel had collapsed ." After which he experienced cardiac arrest while, and sit down for this, he awaited medical attention. You don't say? But what could possibly have led to this tragic outcome? Would you believe ... math? " [C]all handlers were not being "adequately assisted" by the algorithm used to assess patients over the phone. " Those darned algorithms will get you every time. Cannot wait for us to implement that here. #Medicaid4All

Medicare Hospital benefit Part A covers medically necessary inpatient charges incurred and billed by the hospital. GA Medicare expert Bob Vineyard explains. Original Medicare has a PER ADMISSION deductible. In 2019 the amount is $1364. Charges incurred during the next 60 days are covered by Medicare. Most Medicare supplement plans, also known as Medigap, pay that deductible for you. You may also incur OUTPATIENT charges in the ER and treatment or consult by medical personnel who are not on staff. These charges are applied to your Medicare Part B coverage.

We've written before about (so-called) Grandfathered Plans, most recently here: "... as frustrating as it is, their current policy is the least bad alternative (at least until the next Open Enrollment period) ." A good blog-friend of mine recently wrote about her experience with her own grandfathered plan. She's a long-time MS patient, and had this to say: " I finally received the hospital bill for my Feb 4th Rituxan infusion. That was my 36th infusion since Nov 2009. At first we tried stretching out the time between infusions, but I was still relapsing. After a relapse in Nov 2011, we went to the every-6-month schedule. I didn't relapse again until Feb 2016. That's amazing! So back to the bills. I'm a number cruncher and keep track of all sorts of things. For those 36 infusions, the hospitals have charged $539K in total. More than half a million dollars, folks! Insurance okayed charges of $458K of which $399K was for the Rituxan itself. Because of ha...

If you have an ACA plan and take prescription meds, you'll want to be careful about using those now ubiquitous manufacturers' coupons: New HHS Rule Regarding Manufacturer Drug Coupons Impacts ACA Cost Sharing Limits https://t.co/BUD5EGwSKQ � Healthcare Reform (@Health_Reforms) June 17, 2019 The key is whether there's a generic equivalent available. The problem here, it seems to me, is that this ruling doesn't seem to take into account folks for whom the generic just doesn't work. Caveat emptor.

Hard to believe but we first wrote about driver tracking and insurance over a decade ago: " A high-tech monitoring device makes it possible to reduce insurance premiums for drivers who avoid jackrabbit starts and slam-on-the-brakes stops...The catch? Bad drivers who take a chance on the program may wind up paying a surcharge instead ." So a reasonable, if potentially risky, trade-off. But that was then, and this is now (11 years on). Surely we've mined collected enough data to determine the efficacy of these programs and devices, no? Well, thanks to FoIB tsrlbke, the results are in, and they're (generally) positive: " [A] new business study involving Washington University in St. Louis provides analytical theories showing that such driver-monitoring technology can not only prove beneficial to the bottom lines of some consumers, but also to insurance companies by alleviating moral hazards that affect the risks of accidents ." Which makes sense: careful drivin...

So recently, had a client move to Orlando, and asked for a referral to a local health insurance agent (since I'm not licensed for Florida). I reached out to some folks who might be of help, including a couple relatives. One very helpful kin had this to say about the state of individual medical plans there: " We don't have an agent. About 2 yrs ago Florida Blue, the only insurance provider in our area, drastically cut commissions so independent agents are almost non existent. Do you know where he is moving? Basically the way I approach it is to find the insurance company with the best network (in Florida there are only two main cancer centers - Shands and Moffett). If you get in a narrow network you could end up in trouble if you have an unusual health problem since the local expertise may not be that good. I think Florida hospital is pretty good in Orlando but if you have something unusual you may need to go to Moffett in Tampa. I would just be sure the network includes M...

Regular readers may recall our post from last month on insurance and CBD oil: " I had an interesting conversation with a doc who specializes in pain management and is a big fan of CBD oil and its pain-reducing abilities. He also claimed that taken topically (ointment) or even orally, one would likely not get flagged on a drug test ." Well, I recently received this in email from one of my group clients: " Hi Hank! Brought to my attention and I didn't know: CBD oil/salves for anxiety/depression/pain management? Has anyone asked you about these for HSA write offs? " Which is a great question. I did some research, and thought I'd found the answer: " CBD products are probably not considered HSA- or FSA-eligible, though there hasn't been any formal guidance from the IRS on the matter. This is similar to medical marijuana, which is also not HSA or FSA-eligible even if you're taking it for a diagnosed disorder or to reduce the effects of chemotherapy ...

Regular readers may recall our post last year on the debacle that was Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs): " Their reaction, once learning about the caveats and limitations, has been a resounding /crickets ... the devil truly is in the details. " In other words: a dud. But that was then, and this is now: " The Health and Human Services, Labor and Treasury Departments joined forces on a new initiative intended to provide affordable health careOpens a New Window.  coverage ... The legislation will expand the use health reimbursement arrangements (HRAs), allowing employees use pre-tax health arrangements to buy insurance ." First impressions: This sounds great on paper (maybe), but what differentiates this new effort from last year's failed version? I reached out to our gurus of all thing FSA/HRA/HSA for their initial take, asking if this was just a QSEHRA re-hash. They graciously responded that it is not last year's iteratio...

A few weeks ago, we blogged on active shooter insurance cover: " Beyond the obvious (wrongful death and medical and funeral expenses), there's counseling, biohazard cleanup, and destruction of property; in some cases, relocation and rebuilding expenses might also come into play ." And of course the list went on. An active shooter in the workplace is obviously a deadly physical threat, but there are other attacks that can wreak significant damage (and also threaten lives). I recently received an email from an outfit called JGS Insurance , which offers what looks to be pretty comprehensive cybercrime coverage. Um, what the heck is "cybercrime," Henry? Well, Techopedia defines it as: " [A] crime in which a computer is the object of the crime (hacking, phishing, spamming) or is used as a tool to commit an offense (child pornography, hate crimes). Cybercriminals may use computer technology to access personal information, business trade secrets or use the interne...

Yesterday, we wrote about the unfortunate case of the college versus the bakery: " A jury has awarded Gibson�s Bakery and its owners $11 million in compensatory damages against Oberlin College, for libel, intentional interference with business, and intentional infliction of emotional distress ." We noted that the trial to determine whether (and for how much) punitive damages had started, and that these could amount to a tripling of the original amount. We noted at the time that it's unlikely that these would be covered, should it come about. Well, we're about to find out: " Oberlin College hit with maximum PUNITIVE DAMAGES (capped at $22 million by law) in Gibson�s Bakery case " That's gonna leave a mark. Click the link for details.

Saw this on Twitter: The next installment of the https://t.co/GzlcjJFLl5 mag is taking shape, with new perspectives from @LiisShea on #Estonia 's open source system + @BrennenHodge on the need for an OS health operating system. Here's our working cover (by Patricia Nguyen)... pic.twitter.com/j1oYpxvn4X � Juhan Sonin (@jsonin) June 11, 2019 Hunh: " What if, instead of focusing on "consumer driven" or "people powered" health care, we turned our efforts instead to "Open Source Health Care? " [ ed: note the date ]   What if, indeed?

#GAMedicareExpert #CommonMedicareQuestions

As you may have seen, Oberlin College (a private liberal arts school in northeast Ohio) was recently successfully sued for trying very hard to put a local bakery out of business: " A jury has awarded Gibson�s Bakery and its owners $11 million in compensatory damages against Oberlin College, for libel, intentional interference with business, and intentional infliction of emotional distress ." So how did this come about? Well, a couple years ago some yutes ... er ... underage Oberlin students tried to buy adult beverages, and when they failed to produce proper ID, decided to just help themselves. Even though they were arrested and eventually pled guilty, the college bureauweenies decided that this was obviously racially motivated by the shop's owners, and proceeded to act accordingly: By passing out fliers accusing the business of racism, and urging customers to take their business elsewhere (the flyers helpfully included suggestions as to alternate merchants, aka competit...

Shot: California will now be taxing it's citizens who choose to not purchase health insurance in order to pay to insure others who are in the US illegally. This is the individual mandate reinstated at the State level. https://t.co/qeqNi5b6SU � Dutch Rojas (@DutchRojas) June 10, 2019 Chaser (from 2012): " Many of those who refuse, or are unable, to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens ." Heh.

So, saw this the other day: Skin cancer can affect sales of life insurance by making some otherwise healthy applicants difficult or impossible to get through underwriting. https://t.co/QE7kUxJDa7 � ThinkAdv Life/Health (@TA_LifeHealth) June 7, 2019 I've had a few cases over the years where there was either current or a history of skin cancers (usually benign), but wanted to confirm this claim. So I reached out to the ever-helpful folks at Issue Insurance (our local experts on difficult cases), and FoIB Tana H replied: " Certain types of skin cancers can be an issue, especially, malignant melanoma. There are definitely a lot of variable�s involved, such as size, level, stage, etc.  Most can be written standard or with a flat extra for so many years ." The more you know....

Price transparency in health care has long been a recurring theme here at IB, going back to our earliest days: " Recently, I had the opportunity to interview Dr Dexter Campinha-Bacote, Aetna Medical Director. He�s the �go to guy� for Aetna�s new transparency pilot program ... employers asked Aetna to develop tools that their employees could use to make �better informed decisions.� One of these tools is the pilot transparency program ." But we also know that for transparency to work, there has to be buy-in from health care providers , as well. An d so : " Makary is part of a movement of medical professionals who want healthcare to reflect the free market, with transparent pricing and clear information on quality, allowing patients to decide which entities succeed and fail, rather than the insurance companies " The Free Market Medical Association (FMMA) now boasts over 20 chapters nationwide, and now offers " an online pricing tool where patients can find prices ...

Now that summer storm season is in full swing (stay safe, folks!), we can expect to see a lot of stories about downed trees. So how does one's homeowner's insurance work when that happens? [ ed: as usual. coverage varies by plan and state, so  be sure to consult your own agent about your specific coverage ] The fine folks at Cincinnati Insurance have put together a helpful video about the subject: And they've also provided an infographic to help us understand the signs of a dead or dying tree.

Shot: "In a first-of-its-kind study, researchers examined every regulation issued by HHS from 2001 through 2017: ... 71% of HHS rules are unconstitutional based on who finalized and issued them." https://t.co/yEKIAEh8I3 � AssocAmerPhys&Surg (@AAPSonline) June 5, 2019 Chaser: The ACA was passed on 3/23/2010. 2,800 pages of instructions to federal agencies. These pages have spawned around 90,000 pages of FAQs, IRS, DOL, and IRS regulations.The employer mandate sections (26 US 4980h) went fully into effect on 1/1/2016 for every business in America. 1/3 � Michael Bertaut (@MikeBertaut) June 6, 2019

I attended an interesting Continuing Education class yesterday on Understanding Tax Implications of voluntary group products (like dental and vision, etc). One question that came up was about the wisdom/pitfalls of running these premiums through one's POP plan, and we'll explore that in another post. But it reminded me about this post from my Answers.com gig; it's an explanation of what a Premium Only Plan is and why it can be a valuable extra benefit: Because of wage controls put in place during the Second World War, many of us get our health insurance benefits through our employers. As times have changed, and the cost of these benefits has risen, most employers who continue to offer group insurance coverage have required employees to foot more and more of the premium burden. Typically, this involves deducting the employees' share from their paychecks. So, along with FICA and FUTA and the like, one also sees a deduction for health insurance coverage. The employer's...

As usual, FoIB John Goodman has the definitive takedown of why so many on the left just don't 'get' the economics of health care [ ed: To be fair, lots of rocket surgeons on the right are equally ignorant ]. In his latest Forbes essay, John points out that: " Editorials like the one in the Times tend to treat a dollar spent on health care as though it is different from a dollar spent on something else. It isn�t. It�s the same dollar ... In a Public System, Patient Needs Compete against Taxpayer Needs " He also notes something else that often goes unremarked: that Medicare plans are generally administered by private (commercial) insurance companies. And why is that? Well, you'll want to read the whole thing to see why that actually makes a lot of sense. [Hat Tip: Co-blogger Bob V ]

As regular readers know, it's become somewhat the norm for carriers to drastically cut, or even abolish , agent compensation. And it's also commonplace for so-called agent associations to ignore this . That's because the dirty little not-so-secret is that they're run by and for the benefit of the carriers, not the agents. With one notable exception . In the event, UHC decided to completely do away with agent commissions on larger group health cases. Unfortunately for the carrier, however, the "notable exception" had already successfully lobbied to make that move a lot more difficult: " Louisiana Insurance Commissioner Issues Cease and Desist Order to United HealthCare ." The commish issued that order to derail UHC's plan to " implement the removal of producer commissions from upcoming renewals of certain group health insurance products ." On the one hand, kudos to HAFA for pushing legislation that curtails this abuse, and to the Pelica...

Shot: "In some cases, [UK physicians and surgeons] end up paying the NHS to work. Doctors respond to these perverse incentives the same way all rational actors do: by closing up shop." https://t.co/k7tWVxIfF8 HT @msingletonmdjd � AssocAmerPhys&Surg (@AAPSonline) June 2, 2019 Chaser: The UK is seeking to save their healthcare debacle by instituting a model similar to DPC. ? @TPPF ? ? @RightOnHC ? #free2care https://t.co/DLHLtTUe91 � David Balat (@DavidBalatHC) June 2, 2019 Hunh.