what is insurance

Suzy, a referral from another client, called me last Friday, asking to set up an appointment to discuss health insurance. We agreed on yesterday afternoon (July 30), and boy did we luck out with that . First, the backstory: Suzy's divorce was finalized last November, and it appears that her divorce decree did not require her ex-husband to continue her insurance. So she called his employer to find out about COBRA (it's a fairly large company) and was told that they were in the midst of some kind of audit, but were able to tell her how much the premiums would be ($700+/month - Yikes). They also told her they'd be in touch with the paperwork. That never happened. But her medical bills kept being covered, so no harm, no foul, and no $700 a month out of her bank account. Until early June, when her doc called to say that [insurance company] had denied the latest claim because she no longer had insurance with them. Oy. So she called to find out the story, and as best she could t...

Caddy tax impact in 2015: $91 Billion Caddy tax impact in 2019: $197 Billion This is why Caddy tax will live a long life on paper. Congress needs the expected revenue to hide the cost of ACA and implementation would be political suicide. https://t.co/ljyghPkeyB � Patrick Paule (@patpaule) July 30, 2019

This is indeed a poser: " Judge rules Denver man who 'killed his wife' can use up to $500,000 from her life insurance to pay for his defense " As we've noted before, folks who commit crimes (such as murdering their spouse or children) are generally not allowed to profit from that action. For example: " California dad charged with insurance fraud after he drove off cliff, killing autistic sons " The idea is that to allow folks to benefit from their crimes would be against the public good. Thus, convicted murders aren't allowed to profit from the sale of their autobiographies, or receive life insurance proceeds from the policy of their now-deceased dependents (whom they caused to be deceased). Except: "... the higher court ruled that the statute does not to apply to a third party - in this case a legal defense team - that is paid for a 'legally enforceable obligation " That's because the accused is entitled to the " presumption o...

From FoIB Holly R: Patients with rheumatoid arthritis will soon have a�relatively�more affordable treatment option. https://t.co/9Fk8L02x80 � GoodRx (@GoodRx) July 29, 2019 Eticovo, is a "biosimilar" med for the dreaded condition, which is " an autoimmune disease in which the body�s immune system ... mistakenly attacks the joints ." This usually leads to major pain and mobility issues, so the increased availability of an affordable treatment option is most welcome. Related (sorta): You can use your HSA account for a lot more than you think https://t.co/GCQY4WlJyF via @usatoday � Direct Health Care Network (@DirectHealthCa1) July 27, 2019 Beyond the obvious things like flu shots and doc visits, sunscreen and even contact lens solution can be run through your account. Caveat : Once you've used funds for trivial expenses, you may be hard-pressed to come up with the scratch if something serious arises.

Last week, we talked about appeals bonds ; today we're treated to an interview with Mutual of Omaha 's Demerri Bond, who manages the company's long-term care insurance underwriting team. Before joining MoO some 20 years ago, she was actually a long-term care nurse . Wow. Here she is explaining some of the ins-and-outs of underwriting long-term care plans: [Special IB Thanks to MoO's Allen Gregoire ]

Yesterday, we reviewed the ramifications of Oberlin College's courthouse loss to Gibson Bakery, to the tune of some $36 million . With which, it appears, Oberlin is loathe to part. Understandable. So during the appeals process, the clock continues to tick on the interest accruing on this award, to the tune of $4,000 a day . Yikes. As we noted, this could very easily lead the college to an even more dire financial situation, and the Gibson's are (also understandably) concerned about there being anything left to collect. In such cases, one is required to post a bond to 'insure' against that eventuality, but Oberlin officials requested to be relieved of that burden. Turns out, Judge Judge John Miraldi was having none of that: " After considering the Parties respective briefs, the attached exhibits, and applicable precedent the Court hereby orders that the judgment is stayed, as of the date of this entry, subject to the following conditions ... Within seven (7) days...

Readers may recall our post last month regarding the plight of Oberlin College in Ohio. At the time, they had just lost a lawsuit brought against them by a local bakery that the college had apparently victimized. As we noted at the time, the institution's insurers may balk at covering it at all: " [I]t appears that the insurer, Lexington Insurance Company, is likely to disclaim coverage for the intentional torts which gave rise to the verdict ." But wait, it gets better (well, for certain values of "better"): " Will Oberlin College be able to secure a bond? Probably, but it might not be as easy as you would think ." What's this about a bond, you ask? Well, as expected, the college is appealing the rather large judgment; the challenge is that such appeals take a while, and the interest alone on that sum is over $4,000 a day . The Gibson family is concerned that Oberlin might metaphorically "bleed out" and have nothing on which they can co...

I could have sworn we'd blogged on this topic before, but apparently not: " Florida company offering 'alien abduction insurance' has sold nearly 6,000 policies " And such a deal, too: for under a Jackson (or two sawbucks) one can buy $10 million worth of coverage. But there's a slight catch. Click on through to find out what that might be. Oh, and no word on whether or not that Edgar suit is covered. [Hat Tip: FoIB Sam B]

Grey collar folks are generally defined as those that fall in-between traditional white collar (accountants, engineers) and blue collar (mechanics, truck drivers). In this case, my client (we'll call him Steve) owns and operates a drywall contracting company, and splits his time about 75/25 between being on the job and manning the office. Disability Insurance (DI) is designed to replace income lost from a serious illness or injury, and one of the key components in computing a premium is assigning an occupational rate class. A typical white collar class might be 3A or 4A, while a typical blue collar might be 1A. The higher the class, the lower the rate, so obtaining a favorable rate class is desirable. In Steve's case, he might be a 3A but for the amount of time on the jobsite. For that reason, Assurity Life (which is the carrier we'll likely be using here) classifies him as 1A., but then bumps him up to 2A because he owns the business. A very nice compromise, resulting i...

In no particular order: � As we've long documented here, Britain's Much Vaunted National Health Service� has a fetish for offing innocent children: " Coroner demands NHS 111 changes after six-year-old Sebastian Hibberd's death " The poor 6 year old was another victim of free health "care." Fortunately for Oliver Cameron, his parents were afforded a unique, lifesaving opportunity: " [T]hanks to the tireless efforts of his parents and doctors at Boston Children�s Hospital, Oliver is alive and thriving today ." He had been born with a non-cancerous tumor, the likes of which British doc's were unable to treat. #MedicalTourism tourism in action. � Meanwhile, on this side of The Pond, our northern neighbors, subject to whims and vagaries of CanuckCare�, seldom fare so fortuitously: Canadian Medicare, our northern neighbor�s universal health care system, generally receives rave reviews from proponents of socialized health care, yet the Fraser I...

John Hancock , long a fixture on the Long Term Care insurance scene, is enhancing some in-force plans, at no additional cost to their insureds): "We are excited to let you know that John Hancock is planning to pilot a variety of wellness programs for our Long Term Care (LTC) policyholders that will provide them with information that may help them live longer, healthier, and more independent lives ." Nice! (Particularly for those with lifetime benefits) The first one, called LIFT Wellness is a voluntary program that includes an in-home visit by an RN who will " conduct an assessment, and may recommend certain [lifestyle] changes and/or home modifications with a focus on fall prevention ." The program itself is being offered free of charge, one presumes that the cost of any actual renovations done will be borne by the insured (which is fair). And speaking falling, our friend Roger D reminds us that some Medicare Advantage plans offer a complimentary fall detection d...

A ways back, I wrote some disability insurance coverage on a young surgeon: some with Union Central Life (now Ameritas ) and then later some more with MassMutual . Both solid carriers with excellent reputations. Recently the surgeon became unable to work due to a series of severe (and acute) medical issues, and may actually need an organ transplant as a result. Needless to say, he's out of the OR for a while, maybe permanently. Because these plans were written so long ago, and I no longer actively represent either carrier, there are hoops through which we need to jump to bring me "back in the loop " so that the various claims folks will talk to me about the pending claim. No problem, understand completely. So my client asks the claims rep for each carrier how to make that happen. Both basically say they just need to hear from me and they can get that ball rolling. So I emailed both and, after not hearing from either for a day, called and left voicemail. The MassMutual rep...

This is at once fascinating and disturbing: 1/ A woman discovered her ex husband was defrauding health insurance companies for millions. She tried bringing him to justice. It didn�t go as expected. (This story is one of the wildest I�ve reported.) Here�s what happened: � Marshall Allen (@marshall_allen) July 19, 2019 UPDATE : Here's the #Unroll if you'd prefer that format. [Hat Tip: FoIB Holly R]

Had a call the other day from an acquaintance whose 30-something daughter had been experiencing severe and debilitating health issues for the past two or so years. She had lost significant weight (and she was hardly exactly ' zaftig ' to begin with), and had begun seeking non-traditional, "alternative medical" treatments, to the tune of tens of thousands of dollars. My acquaintance called because he knew I dabbled in the health insurance field, and hoped I could give his family some advice and insight on what options might be available. Oh, there's an interesting twist, which may play an integral part: the daughter, who had never given up her US citizenship, had nonetheless spent the past few years living abroad, and had moved back here just before she became ill. This is important, because one of the Special Open Enrollment triggers is " Changed your primary place of living ." Now, it actually gets more specific: " Moves that may qualify you for ...

Last fall, we reported on this tragic story: " California dad charged with insurance fraud after he drove off cliff, killing autistic sons " Turns out, "Father of the Year" (non-)contender Ali Elmezayen had purchased the policies just over two years prior, presumably planning ahead to avoid the contestability clause which " allows the carrier to review a recently approved policy to see if there were any misstatements or misrepresentations " and goes away after the first two years. So it appears that Mr E thought that a two week "cushion" would be sufficient. Ooops: " A father has been charged with capital murder after his two autistic sons tragically drowned when he drove his family off a Port of Los Angeles pier in California ... Just before the incident, Ali had purchased several accidental death insurance polices. ." And of course "accidental death" nature of the plans was a nice touch: these policies are generally a fracti...

So one of my hats is CE (Continuing Education) provider. My primary role in that capacity these days is "back office support;" that is, I file courses for state approval, create and provide class rosters and completion certificates, and file completed class rosters to the states in which I'm a licensed provider. Unfortunately, I don't get much opportunity these days to actually teach , and I miss that dearly. Anyway... One of my CE clients taught a couple classes the other day (well, technically, the same class, twice, at two different locations). She had previously taught this same class last fall (at the same locations). In Ohio (and, I imagine, in most if not all other states), one cannot get credit for taking a course more than once in a cycle. Determining whether or not this applies is fairly simple; agents can check their transcripts online in a matter of seconds. Of course, this doesn't always happen, and in today's little object lesson, 5 of the 15 st...

Today is especially relevant for my late sister's friends and family: July 17, 2019 is Glioblastoma Awareness Day. We hope today will bring added awareness, building on the efforts of the GBM advocacy community and organizations like @NBTStweets who have dedicated so much time and energy to fighting this disease and supporting those affected by it. � Lindsey Graham (@LindseyGrahamSC) July 17, 2019 Please pass the word.

Medicare questions you never asked (because there are things no one ever told you about). Don't you hate it when you buy something and then find out it didn't work as promised? Some things can be returned for a refund. Others cannot . . . Your Medicare plan is one of those things. Easy to get into at age 65. But you could run into a roadblock if you later have buyer's remorse. Gary is a friend and is learning about Medicare the hard way. Gary is just now learning prior authorization. Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It�s all about the money. His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits. Proton Therapy � It Helps Only a Few at a Wildly Extravagant Cost � MedPage Today All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in savin...

Medicare Advantage plans good or bad? Like everything else, it depends on your perspective. But how will you know if an Advantage is right for you if you don't know the r ight questions to ask? Too many people don't UNDERSTAND MAPD plans. No premium to pay. Dental and vision coverage included. What's not to love? How about access to health care ? Some folks have medical conditions that require specialized care and there may only be a handful of Medicare Advantage providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO. The choice of plans is not JUST dollars and cents . Too many agents either ignore this aspect or don't understand it. How Medicare Advantage plans are sold, what you are told and what is omitted, can make Advantage plans bad for you. Learn more about Medicare Advantage plans - https://www.georgia-medicareplans.com/are-me...

The resurgence to repeal the Cadillac Tax is front and center - again. This time it is due to the overwhelming support in the House of Representatives which allows for a bill to move to the floor when there is a supermajority of co-sponsors. In this case the Middle Class Health Benefits Tax Repeal Act of 2019 has 361 co-sponsors - 83% of all members. So, why then with such huge bipartisan support will repeal fail? It is simple, from an IB post back in January of 2018: " But here's the truth. Congress needs the Caddy Tax. They need it for the revenue on paper. When CBO scores in ten year windows it shows an accounting sleight of hand that many of us don't know. It shows as revenues - whether collected or not.   Having IOU's is how they trick us in to believing that they are good stewards of our tax dollars. Sad truth is they simply don't care about spending your money. They care about you voting to re-elect them. Which is why kicking the can down the road is the av...

From our friend Holly R: NEW: Stetson Baptist Church in Florida pays off $7.2 million in medical debt for 6,500 struggling Central Floridians https://t.co/DmAPU6hbYk � Ryan Saavedra (@RealSaavedra) July 10, 2019 Which is a sweet gesture, until one realizes the unintended consequence: " According to the IRS, if you have canceled, forgiven, or discharged debt for less than the amount you pay, the amount of the canceled debt is taxable income ." Ooops. Now, the taxes on this difference are, obviously, a lot less than the debt itself, so this isn't a slam on the idea . But if the recipients are unaware of the largess, or of this tax rule, they may be in for a nasty surprise at year's end. " You get a car, and you get a car..." Adds up.

At my recent annual physical, i was prescribed, at the tender age of 39(shut up), my first-ever maintenance med: 10 mg daily of Lisinopril for moderately high blood pressure. [ ed: this came as somewhat of a shock, inasmuch as I'd heretofore been considered a carrier ] It's become fashionable of late to dump on Pharmacy Benefit Managers ( PBM's ) and specifically Aetna and CVS. Well, I'm insured under an (HSA-compliant) Aetna plan, and I had the scrip filled at my local CVS for the princely sum of .... wait for it ... $2.21 for a monthly supply. I think we can swing that (at least for the nonce). #ForWhatItsWorth

UPDATE : Monsieur L ambert has passed away. " Vincent Lambert, 42, died Thursday in a hospital in Reims nine days after doctors stopped providing artificial feeding and hydration, ending years of legal flip-flopping over whether to keep him alive ." [ ed: original post below ]   The name of the French national health care system, La S�curit� Sociale , pretty much guarantees that this would be the outcome: " French Quadriplegic Being Starved To Death By The State " In 2008, then 31 year old Vincent Lambert was left in that condition as a result of a terrible car accident. Flash forward 11 years, and the poor man has been ordered starved to death by the (warm, compassionate, caring) French government: " The Cour de Cassation overruled an appeals court which had directed doctors to keep Mr Lambert alive pending a review of his situatoin by the Unitoed Natons Committee on the Rights of Persons With Disabilities ." This echoes Iceland's take on Down Syndr...

Shot: " Cone Health CEO Terry Akin urged staff to contact legislators to advocate for hospitals' position on the issue ." Chaser: " Burn in hell, you sorry SOBs " #Pithy Short take:  North Carolina Health Plan honchos have proposed a new reimbursement scheme for Tar Heel State hospital systems that include some pretty draconian caps, and one provider's manager followed orders ( maybe a bit too zealously). [Hat Tip: Co-blogger Bob ]

So, working with a customer who needs a short term medical plan for his wife, who is an American citizen living abroad. I was able to find only one carrier that didn't require a recent stateside residence, and so I quoted that carrier. As always, I quoted using the maximum lifetime benefit (in this case, $1 million). The client asked about $1,000 and $2,000 deductibles (which I think is a mistake, but that's what he asked for). So I quoted as he asked, and the premium came out to $325 per month for the $1,000 deductible plan, and $256 a month for the $2,000 version. He balked at that, claiming that I'd previously quoted a much lower rate. I pointed out that we had been looking at a $5,000 deductible (which would have been well under $200 a month). He thought that still might be spendy, and he would check with his home country's options. I wished him well and told him that I'd be happy to write this plan if the home country option didn't pan out. This morning, I...

A Twitter friend pointed out that: If someone tries 2sell U a health insurance plan and says it is #ACA compliant, affordable and covers U from day 1, Stop, get the name of the company and get a 2nd opinion. ACA plans do not cover U from day 1 and cannot B purchased after open enrollment without an SEP situation. https://t.co/2jQdv5iRGr � Sheron E Sidbury (@SheronESidbury) July 8, 2019 Although I knew what she was saying, I asked for clarification (to make sure we were on the same page), and she helpfully responded: " When you sign up 1-15 you are not covered until the First of the following month. From the 16-31st the plan starts the 1st of the second month ." That is, if you sign up on June 3rd, your coverage doesn't begin until July 1st. And if you sign up September 17, your coverage doesn't start until November 1st. This is where a Short Term Medical plan could come in mighty handy (too bad for the folks in states such as Connecticut and California, that outlaw ...

So, got this yesterday from the CDA ( The Council for Disability Awareness ): " In a new survey of the awareness and ownership of disability insurance across today�s workforce, The Council for Disability Awareness (The CDA) uncovered that the 32 million, unmarried women workers, who make up 25 percent of today�s American workforce are underinsured for a disability ." Which is, no question , a shame. But I immediately replied: " That�s interesting. How about similar stats on men, who make up 66% of the workforce? I�ll wait� ." Breath status: [x] NOT held.

So last Friday evening, we attended a local food truck rally (and very cool fireworks display) and learned about two very worthy causes: � Warrior Weekend to Remember honors combat injured vets and Gold Star families (and even first responders and their families) with an incredible weekend experience that includes: - Indoor Kart racing - Skydiving - Hot air balloon rides - A bonfire and concert And more! Click here to learn more about this fantastic program. � The 1st Annual PNC Community Mutt Strut is coming up in October, and includes a dog parade, vendors and food, even door prizes. Approximately 22 veterans a day commit suicide, and it's the Mutt Strut's purpose to change that by providing service dogs to vets with PTSD, brain injuries, and other combat-related mental health issues. You can learn more about the organization, and the parade, by clicking here .

https://t.co/zcu1xnvtfx � Lynne (@EFSBenefits) July 6, 2019

Been meaning to do this for a while, but was challenged finding " just the right one ." People often ask me " how much life insurance do I really need? " I have a special form that I give these folks to do their own assessments (lest they think I'm "goosing" the numbers). But in this digital age, I realized that it may be preferable to offer an online tool, preferably one that keeps such information anonymized. A friend suggested that I have a gander at the Life Happens site, and sure enough, there's a very nice, intuitive, anonymous widget that I think fits the bill quite nicely. Available now in the sidebar, under "Resources." Check it out !

Alternately :

That India had adopted the HMO model: " An Indian man who had been declared dead woke up just before he was set to be buried during a funeral ceremony ." He'd apparently been in an accident and was taken off life support, " coincidentally only after the man�s family told the hospital that looked after him they no longer had the funds to pay for his care ." " Coincidentally ." Yeah, go with that.

Co-blogger Bob offers a poser: " Unusual situation referred to me by agent in another state. Mother-in-law relocated to Atlanta from Pakistan. Green card holder, age 71. Health status unknown (didn't ask). Looking at possible options. Coming up empty or "are you kidding". � Medicaid - possibly the best option depending on how they define household income. � Obamacare - I assume she can qualify but no subsidy. Outrageous premiums and OOP � International travel medical - pre-ex snake pit � Health share ministry - must be Christian? Other religious affinity including Muslim? Pre-ex? Not readily accepted by docs/hospitals since no guarantee of payment. HSM is a very remote possibility but want to throw that out as an option ." I checked the 404Care.gov site, and was surprised to learn that " Gained citizenship or lawful presence in the U.S ." triggers a Special Open Enrollment opportunity. So, armed with her new zip code, I went plan shopping. The least...

� Item #1: " Medtronic recalls MiniMed insulin pumps as FDA warns about hacking risk " This is a major issue with the whole Internet of Things phenom. The danger, of course, is not just the threat of ransomware ' per se ,' but that actual lives could be put at risk. #ScaryTech � Item #2: We haven't heard from our friends at the MVNHS� lately, let's correct that, shall we: " NHS beds crisis 'critical' as more sick Brits left stranded in hospital corridors last month than at the height of winter " Which is even more alarming, in that the stated goal is to have no more than 85% of available beds occupied. #GoodLuckWithThat � Item #3: So-called "balance billing" (aka "surprise billing") is nothing new to regular readers: " These hidden providers are like gunslingers in the wild west. They are not beholding to any rules and are free to charge whatever they want. If you don't pay they can ruin your credit and there is ...

How many times are we told to "read the fine print" versus how many times we actually do ? Well, here's a case where someone did , and it paid off bigly: " When she decided to plan a getaway to England with some girlfriends, they purchased travel insurance ... When the company ... sent her the insurance policy, she sat down to read it ." Which turned out to be quite providential: " We estimate that less than 1 percent of travelers that purchase a travel insurance policy actually read   all of their policy information � and we�re working to change that .� That's nice, but how, exactly? So glad you asked: " [T]he first person to email the company and mention the fine-print contest [will] win $10,000 ." And so she did, and so she did.  Mazel tov!