what is insurance

S uccinct :   [click to embiggen] Long live the Much Vaunted National Health Service�. (SWIDT?)

From our friends at Lexis-Nexis : " Homeowners insurance: 7 things to know about what hurricane-related damage is covered " These include special deductibles (typically found in policies issued in hurricane-prone locales) and exclusions like water damage (which is where flood insurance can come in handy) Don't assume, and if you have any questions make sure to call your agent. We're here to help. UPDATE : PSA: Florida Residents Reminded Not To Open Fire on #HurricaneDorian pic.twitter.com/HenIFJSr0e � Breaking911 (@Breaking911) August 29, 2019 (No nukes, either)

From Bill Comfort, CLTC :   [click to embiggen] Says it all, really. Have a plan.

As in Short Term Care insurance. Recently saw this: The new short-term care insurance product will help purchasers pay for short-term use of home health care, adult daycare, hospice care, assisted living facility care and nursing home care, according to AARP and American Enterprise. @AARP https://t.co/Qn2gWdEvCA � ThinkAdv Life/Health (@TA_LifeHealth) August 26, 2019 To which I replied " And I'm sure it will be every bit the value that AARP's affiliate MedSupp plans are. And BTW: This is hardly "new " Indeed. In fact, we blogged on them here over 7 years ago: "... these policies typically have benefits that last for a year (or even less) " Hence the "Short" Term label. La plus ca change....

From our favorite actuary: The individual market is 37% larger than it was in 2013. That�s because the federal govt is covering much of people�s premiums, not because we added �protections� which drive up base premium rates. https://t.co/wd4UdvwbEp https://t.co/llUlFKLwqJ � Greg Fann (@greg_fann) August 23, 2019 Or more succinctly: #ImagineThat

Hard to beat this: Well yes. A study of cataract surgery in the UK showed that delaying surgery at least a year resulted in many patients dying, becoming too sick or forgetting about it so the numbers of actual procedures were reduced. It is a form of self-rationing then allows access to others. � kokomored (@kokomored1) August 22, 2019   The study found that patients " with poor eyesight are being forced to wait almost six months for operations ... Lengthening delays and the growing demand for cataract operations are forcing the NHS to send increasing numbers of patients to be treated privately ." But I thought the Much Vaunted National Health Service� was the ' ne plus ultra ' of government run health "care." Hunh.

Well, technically " Grandfathered :" the plan in question dates from 2010, when we wrote it for a younger couple and their 3 (now 4) children. This was one of my favorite plan designs: Anthem's Lumenos HSA product, a legit cat (catastrophic) plan with a $10,000 family deductible, then 100% after. Fit their needs well, and was a great value. Fast forward 9 years, and (sadly) they're divorcing. Which wouldn't be the end of the world insurance-wise but for a couple complications: First, now ex - hubby has opted for a Sharing Ministry for himself and the kids, and has failed to pay the August premium. Oh, did I mention that I just learned about all this yesterday? /sigh Anyway, Jane reached out to me to fill me in and to ask about her options, . since she would prefer an actual insurance plan. It doesn't look like she'd be eligible for a Special Open Enrollment opportunity (since her plan isn't ACA-compliant), but perhaps she could keep the Lumenos/Anthe...

The ongoing saga of Mount Carmel Health System in my home state of Ohio should be a wakeup call for all Medical Organizations. Specifically, that Doctors are fallible. But to the root of the problem, how did this happen. It happened because Medical Organizations are created by Doctors who have a " negativity bias ." How does the negativity bias affect patient care? Catherine Hambley, PhD discusses this in an article, �What you can do about the negativity bias in Medicine. � The negativity bias is alive and well in medicine . It starts in medical school where students are frequently exposed to teaching methods that create feelings of shame, ineptitude and incompetency. Early on in their careers, physicians learn both the importance of preventing and avoiding errors as well as the need for perfection.� This trait is then carried over into their working lives and into the Medical Practices and Organizations in which they create and work. Staff is expected to maintain this super...

We last blogged on telemedicine last Fall: " [U]nlimited same-day/next-day doctor appointments for acute issues at $10 a visit and around-the-clock telemedicine for no out-of-pocket cost ." It was in that post that we first learned the newest buzz-phrase "Virtual Primary Care." Anyway, fast forward a bit, and now the feature will be a required benefit in health insurance plans marketed here in The Buckeye State: " Private insurance companies in Ohio are now required to cover doctor visits over the phone or on the computer. " The new reg is touted as a benefit to both consumers (for convenience) and providers (who will now be assured of reimbursement): " Doctors have been anxious to include telemedicine in their practice but until law guaranteed insurance payments, some were reluctant to purchase equipment and learn how to do it. " Quite so. Of course, no one's addressing the actual elephant in the room: who pays for this? If you guessed ...

One of my life insurance clients called the other day to see if I could help her with her sons' policies. Seems she had bought each of them a Universal Life policy some years ago (before we'd met) and she wanted to professional advice. I was of course happy to oblige, and asked her a few questions: The plans were about 20 or so years old, and written by her Auto Owners Insurance agent. He has since retired, and the agency to which the plans were re-assigned hasn't been particularly helpful. She did have the annual statements handy, and we were able to determine that the plans were doing well so far (a welcome relief: they often get "upside down" this far in). But it seemed to me that it wouldn't hurt to increase the premium a bit as a hedge against future slumps. To that end, I suggested that she contact AO directly to see about obtaining in-force illustrations (aka " what-ifs ") for each plan. Here's why: due to various tax laws over the years,...

Don't know how I missed this [ ed: yes I do, it flew completely under the radar ] but: " Simple Health claimed to offer comprehensive health insurance or PPOs that would cover many medical needs, but instead sold only medical discount memberships, limited benefit plans, and other products that provide a small reimbursement or discount for a few services ." And then folks started to complain. A lot. I've used the marketing company, Health Insurance Innovations, for various short term medical plans, but thankfully never used their Simple Health "plan." Anyway, the cacophony has apparently reached a crescendo, and the Rocket Surgeons in DC � have opened up a Special Open Enrollment Period (SEP) for folks who've been bamboozled: " The SEP will run from July 1, 2019 until September 4, 2019.  Eligible consumers should have received a notice ... advising them of the availability of this SEP. CMS will evaluate an individual�s eligibility for the SEP using ...

The MEWA pool that is: " Previously only available to larger employers, the Ohio Chamber Health Benefit Program now provides small businesses access to features from UnitedHealthcare Primary Advantage� plans ." Like its competitors from Anthem and Medical Mutual of Ohio, this plan (which is yet to be released in the wild) will require membership in a local Chamber of Commerce, and will likely offer the potential of better rates than off-the-shelf ObamaGroup plans. How's that, you ask? Well, unlike ACA plans, these are medically underwritten, so healthier groups benefit from actual risk assessment (instead of one-size-fits-all Community Rating). So far, though, it's vaporware . Will be interesting to see how it stacks up with already established plans.

� While we continue the rush to implement #Medicaid4All here in the States, it's instructive to see how that's working out for our Neighbors to the North�: " [M]ore than 63,000 Canadians left their country to have surgery in 2016 ." As Americans contemplate overturning our health system in favor of one similar to Canada�s, we must ask why so many leave. Oh! " After being advised that they need a procedure done, only about 35% of Canadians had their surgery within a month ." Why do Bernie, Elizabeth and the rest of the field hate Canucks? � This isn't really "news" to those of us who've been paying attention, but: " End of �individual mandate� hasn�t killed Obamacare " It's always been about the Benjamins (both premiums and cost-sharing). � The Much Vaunted National Health Service� continues to cover itself with glory: " GP surgeries in England ordered to stop half-day closing  Practices will have to seek permission t...

Thank s to co-blogger Patrick P : He says to pay particular attention to the 2nd sentence: ACA's exchange is basically an entitlement, not an insurance product. It's worth bearing in mind, this was all *before* mandate repeal and STLDI deregulation went into effect: https://t.co/nLF8xGSxV5 pic.twitter.com/wztJmhoJcl � Chris Pope (@CPopeHC) August 12, 2019 The more you know...

In medical terms, a �Never Event� is an event that should never happen, like a wrong site surgery or killing a patient. An article in today�s medical reading clearly demonstrates a real time Billing Never Event, that unfortunately occurs much too often in medical clinics. According to WCPO in Cincinnati (OH), a mom had to be pay a bill before her daughter would be seen at a walk in clinic. The story begins:   � Jessica Vance wanted to avoid a $1,000-plus emergency room bill, when her 8-year old daughter recently developed a cough and fever.   So she took her to a walk-in clinic inside a local grocery store.� Problem number one: Why doesn�t this family have a Family Practice Doctor? One of the cited reasons for America�s high health costs is the use of Emergency Rooms for non-emergent conditions, such as this case. If mom had established herself with a Family Practice Doctor, she would have either been seen that day, or at the very least prescribed a medication with a follow up...

Oh yeah: Preventive Care Can Now Be Covered for Specified Chronic Conditions Before HDHP Deductible https://t.co/TTjgEGqf3q � Healthcare Reform (@Health_Reforms) August 12, 2019 So what does this mean , exactly? Well: ACA-compliant plans have certain features and rules, one of which is that chronic care can't be considered a first-dollar expense. That is, unlike, say, a routine physical, chronic expenses must first be applied to one's deductible and co-insurance (if any). Turns out that a lot of folks who actually suffer from these issues would like relief from this requirement. This becomes a problem for HSA policy holders, because doing that would render their plans non -compliant (and result in all kinds of nasty consequences). And so, the generous folks at the IRS have issued a ruling that reverses (or negates) that, and specifically allows such plans to cover some chronic expenses "first dollar." Which is nice, but just as insurance ? care , coverage ?  ...

Courtesy of our Neighbors to the North�: Father with ALS Euthanized after Denied Sufficient Care https://t.co/od9XSD5Bfi � �e Political Hat (@ThePoliticalHat) August 14, 2019 But hey: Free!

When Summer starts to fade, and we cast our eyes on Fall and the annual Breast Cancer Awareness Walk. Our friends (and teammates) at InsuranceWorks are kicking off their efforts early: " Insurance Works for You! Is giving you an opportunity to DONATE to Making Strides against Cancer Walk without asking you for money. If you call or e-mail between September 1st and September 30th and request an insurance quote for Life, Home or Auto Coverage. we will donate $ 1.00 for each quote completed. Call at 937-424-5633 or email and mention the American Cancer Society ."

The stupid, it burns : " [T]he mayor of San Jose, Calif., on Monday proposed what is being called a first-in-the-nation move to require all gun owners to carry liability insurance for their weapons ." Really? And how would that work? Oh: " [T]he insurance would cover any accidental discharge of a firearm and any intentional acts carried out by a person who has stolen or borrowed the gun. It would not cover the policyholder for any intentional discharge that he or she carries out ." So let me get this right: I would be forced to buy an insurance policy (that does not, in fact, actually exist ) to cover the illegal actions of a person who steals my firearm? Do I have that correct? How many pills did you actually take ? We've written about the concept of CCW insurance and the like for quite a while. Here for instance: " The United States Concealed Carry Association (USCCA) provides a policy for its members designed to provide immediate assistance after an inc...

Good news from an Insurer in today�s readings: � Health insurer Anthem plans to launch a new mobile app that will enable its 40 million members to get quicker access to personalized health information and treatment options. Through the app, members also will be able to text with a doctor at a lower cost than visiting a physician's office .� Well good news for the patient, but it is another nail in the coffin for the Primary Care Physician. Anthem is using an app, called CareSpree, which will allow patients the ability to put in their symptoms and through AI receive possible diagnosis. Anthem incorporated technology from a digital health company, K Health, to create an artificial intelligence that will offer potential diagnosis based on historic data from medical records. It will take into account the users� medical history, age, and gender. � The app will enable Anthem members to see how  doctors have diagnosed and treated other patients experiencing similar symptoms. The health i...

Health Care Sharing Ministries, to be precise. We've long been proponents of the concept , perhaps not so much the execution. Be that as it may, HCSMs have proven to be a viable model, with at least a million souls enrolled. And we also know that, like Direct Primary Care, these non-insurance plans are ObamaCare-compliant; that is, they satisfy the (Evil) Mandate. Our concern has always been that folks are prone to conflate such alternatives as " the real McCoy ." and this can lead to problems. The question arises, then, as to whether there's a role for The State to play, given that the plans are themselves unregulated and unsupervised (which are not necessarily "bad" things). And it looks like we have a contender: "Not Insurance" https://t.co/RIAEB9Fqi7 � Michael Bertaut (@MikeBertaut) August 6, 2019 As I mentioned in response, Mr Kreidler (the Evergreen State's insurance commissioner ) isn't wrong: " member contribution payme...

This sad story out of The Evergreen State raises a few questions: " A Washington state man allegedly killed himself after killing his wife, and left a note for authorities saying that he was driven to do so because they could not afford to pay for medical care for her serious health conditions ." Apparently both he and his 76 year oild wife had been dealing a with some severe and expensive, health issues, and as a result facing an uncertain financial future. But: they were both in their 70's, which seems to me to mean that they were on Medicare. Most folks on Medicare have either a supplement or a Medicare Advantage plan, both of which are supposed to mitigate the likelihood of just this result. So I reached out to both co-blogger Bob V and FoIB Scott M, both of whom are active in the over-65 market, for their thoughts. Bob offered this take: " Hard to say Original Medicare + supplement = minimal OOP except Rx. No cap on Rx. Advantage = a lot of OOP . . . usually ca...

[Hat Tip: FoIB Beverly G ]

There's generally a lot less confusion and ill feelings. Case in point: the Queen of Soul, Aretha Franklin, who passed away last year after a losing fight with pancreatic cancer. So why is this an issue for InsureBlog? Well, because life insurance, wills and trusts are all part of a complete estate plan, and can help stave off intra-family squabbles and even IRS issues. In this case, however, it seems that there may have been too many wills: " ...a 2014 document shows her son Kecalf Franklin was also named a representative. In a 2010 document, the names of White and Owens were crossed out, but they appear again in the handwritten will ." By the way, leaving conflicting (or, often no ) instructions on how one would like one's affairs settled post-death, is surprisingly common among celebrities who, one would presume, have access to top-flight legal and tax counsel. For example, Honest Abe, himself a lawyer and MLK Jr, Jimi Hendrix and even Prince all neglected to hav...

Here's something you don't see every day: " Blue Cross wants to lower rates for Obamacare policies " The Tar Heel State's largest health insurer claims to have " figured out how to make money after six years of selling subsidized policies under the Affordable Care Act ," and want to pass along some of those savings to its insureds. Now how did they accomplish this feat? Well, by switching from an ' ala carte ' claims model to a bundled one, where instead of multiple claims from various providers (hospitals, radiologists, surgeons, etc) they pay one "global" claim. Interesting. Oh, the kicker? They have to petition the bureauweenies in Raleigh for permission to lower those rates. #Racket [Hat Tip: FoIB Jeff M]

What the heck is a pharmacy gag rule? Is it because the medicine tastes bad? President Trump signed the gag rule for Obamacare plans and group plans last October. The law went into effect immediately for those covered participants. Seniors on Medicare will have to wait until January, 2020 before they are welcomed to the club. The good news is, now your druggist CAN tell you about lower prices if you DON'T use your drug plan. The bad news is, you have to ASK if you want to save money.

As summer winds down and back-to-school supplies are going on sale, a lot of folks are planning on one last trip abroad before Fall (or even for Fall). Our friends at Global Underwriters offer this helpful info: " Medical emergencies are never planned and no one, especially when traveling internationally, wants to be caught off guard. The costs for medical care and emergency medical evacuations can be enormous. Often, these expenses come up unexpectedly and payment is required immediately. On average, emergency medical evacuations cost upwards of $25,000, and insureds requiring more specialized care can see that cost increase to over $100,000. Your clients entrust you with making good decisions about the different types of insurance coverage's that they need. Recommending international Travel Medical and Evacuation Insurance to your group and individual clients is the right thing to do and its far more cost effective than having your client stuck trying to pay for these expe...

Into its citizens' DNA, that is. Via email from FoIB Holly R: " Jan Meisels Allen, Chairperson of the IAJGS Public Records Access Monitoring Committee, reports that the UK National Health Service will offer five million Britons free DNA tests to help predict their risk of major diseases. Individuals will be able to volunteer to receive personalized reports based on the DNA analysis ." Oh, goody. And who, exactly, will be privy to the results? Well, let's look under the hood bonnet for a clue: " The project is a �79 million government investment with an additional �160 million from charities and businesses to support research on early diagnosis, prevention and disease treatment ." [ emphasis added ] Gee, perhaps there's a clue there, Sherlock ans. To be sure, there's this disclaimer: " Ministers said the anonymised data " Sure, if you say so. Still , as they say, " i f you're not the customer, you're the product ." Britain...

Three years ago we brought you the story of Derek Peterson, " the chief executive officer of Terra Tech, a publicly traded pot company based in Irvine, CA ." Even though he didn't indulge in his product, Mr P still found obtaining life insurance quite challenging. But that's nothing compared to retailers who can't find Workers' Comp or even just a Business Owners Policy: Lack of #insurance is a huge problem for cannabis-related businesses. Think about no fire or #workerscomp coverage for example. https://t.co/9HUT6fttK7 � Rosalie Donlon (@RosalieDonlon) July 30, 2019 While not (yet) law, the new regulation " would help businesses operating in the growing cannabis sector to obtain insurance products. " And why, exactly, is this necessary? " Without this legislation, insurers will understandably be reticent to insure businesses operating in the cannabis sector ." Good times ahead (perhaps) .

I suspect most folks know that their group term life insurance plan isn't portable (meaning it generally stays behind when you leave), but some believe that their retiree-based coverage is sacrosanct. As co-blogger Bob points out, maybe not: " Workers who retired after years of folding shirts and selling refrigerators for Sears Holdings Corp. banded together earlier this year to complain when the retailer�s bankrupt shell terminated their life insurance plan ." Yikes. Okay, bit what about those who've already shuffled off this mortal coil? Well: " Retirees who died after the plan was terminated but before the proposal is approved would receive an administrative claim of $5,000 " The bottom line is that most of these folks' beneficiaries will receive the princely sum of $135. Exit question: Are these funds taxable?

A regular reader and commenter has given us permission to share his story: " I have used GoodRX for prescription pricing in the past, although my local pharmacist has found some other codes to get me better pricing; I take what they give me if it seems reasonable. Recently I was sold on getting Kroger's in-house plan, which you have to pay for, and it auto renews each year. I get two of my meds for "free," and a better price on the other two. So I do save about a hundred dollars a year. But I take a 5th med, and if I were to use the Kroger plan pricing, I would pay about $70 more for it than with GoodRX at the same pharmacy. Okay, here is where it gets interesting: the Kroger plan is administered by GoodRx. So some of GoodRx's prices are actually better than the plan that they administer for Kroger. Go figure. And I note that prices change, and I have been blindly going to Walmart for that 5th med, when I should have checked GoodRX each time and just picked the b...

Healthcare "Down Under" is a bit different than here; it's kind of an amalgam of public and private coverage. (Come to think about it, maybe it's not so different, after all). How they handle requiring folks to be insured is quite differ e nt . How's that working out for them? Interesting to note that the ability to qualify for discounted premiums by maintaining continuous coverage did far more to boost private insurance enrollment in Australia than an individual mandate tax. https://t.co/SxFwiflcJG � Chris Pope (@CPopeHC) July 26, 2019 Hunh.

So the latest "shiny new thing" out on the employee benefits horizon is called the Individual Coverage HRA, or ICHRA for short. These are not to be confused with the previous "shiny new thing," QSEHRAs . Thanks to the folks at Benefits Consulting Training (formerly NAABC), we have a recap of what these are all about (please see your own benefits advisor for details as they relate to your own situation): �  Any employer can offer this HRA �  Available to any employee not eligible for the employer group health plan and the employee is covered by an individual health insurance plan that meets ACA guidelines � Amounts can differ between classes of employees � The HRA can reimburse all Section 213(d) expenses and be designed to be compatible for those covered under an H S A health plan. �  Employee portion of premium not paid by the HRA can be pay deducted pre-tax through a Cafeteria Plan. �  Employers who want to offer this for January 1, 2020 need to begin working o...