Finding Affordable Health Insurance In Dallas Tx can be quite a challenge in today’s market regardless if you are an individual or a company.  If you are like most people, you probably have experienced an increase in the past year of at least 20 -30%.  Over time consistent increases to the cost of your health insurance premium can make coverage no longer affordable, which puts you and your family at risk in the event you require coverage and are no longer able to afford it.  More and more people are entering this category because of rising costs.  The question is what is it that you can do about finding affordable health insurance here in Texas.

There are two main options that you have available in selecting affordable health care.  The first choice which is what most people do first is to reduce the benefits selected with your Major Medical Insurance plan.  Most people will elect to eliminate features that they are not using in their plan, or increasing the deductible to where it is in the thousands of dollars.  Ask yourself this, if your deductible for your health insurance plan was $10,000 could you afford to pay that amount, and this does not include any co-insurance amounts yet.  The sad reality is that more people than ever are choosing this route and putting their families at financial risk because of taking on these costs.  While this is effective in helping to reduce premiums, you can only raise the deductible so high, and you can only eliminate so many benefits from the plan before it defeats the purpose of having it.  There is another solution to this problem depending on your situation.

The other option you have available for Affordable Health Insurance in Dallas Tx is what is known as a limited benefit indemnity plan.  The name of the plan does not do it justice as limited benefits refers to the plan pays out a set amount of dollars for a procedure.  Here is the hidden news about Major Medical plans, they have the same limitations.  Health insurance carriers all have schedules they use to determine how much they will pay for a given procedure, the difference here is that you know what these amounts are up front.   Ask yourself this question, if you were having trouble with your car, would you go to a mechanic to work on it without knowing how much it was going to cost for them to work on it?  Probably not, but the majority of Americans do this every day when it comes to Health Care.  You would shop around to find the best mechanic at the best rate to take care of your vehicle to get it back in working order.  A limited benefit plan lets you know how much it will pay for a procedure which then allows you to become a better consumer through shopping around for who will give you the best rate.  A benefit with these plans is that there is no deductible.  When set up properly these plans may limit or eliminate out of pocket expenses with certain procedures, which for many families can help reduce financial turmoil when it comes to covering health care expenses.

If you would like to know if a Limited benefit indemnity plan is the right fit for you, contact Byron Ingraham with TxInsurancePro.com

The insurance industry is faced with fraud cases of all types.  Costs associated with paying fraudulent insurance claims ultimately affect insurance rates.  In order to combat fraud of all types, insurance companies employ highly trained investigators to examine possible cases of insurance fraud.

Recently,  a Texas family pleaded guity in a large supplemental insurance fraud scheme.  According to the U.S. Attorney’s Office and the Associated Press,  seven family members including one probation officer have been convicted as co-conspirators in a $3 Million insurance fraud scheme.

The Texas family was among a group of 27 defendants that attempted to defraud AFLAC by filing thousands of false claims under the company’s Accident-Only Supplemental Insurance Plan.

According to a news release from the U.S. attorney’s office for the Southern District of Texas, U.S. Attorney Kenneth Magidson, a former probation officer along with his mother, two aunts, and three cousins, pleaded guilty on november 14 in McAllen in the insurance and wire fraud scheme.

According to the Insurance Journal, “the six others who pleaded guilty were Mary Cedillo of Edinburgh, Martha Ortega, Yolanda Segovia, Candida Chavez, Lori Chavez and Anissa Chavez of McAllen, Texas.”

U.S. attorneys stated that the defendents used the same two Reynoso, Mexico doctors to prepare and file approximately 21,000 false injury claims with Aflac.

The investigation into this insurance fraud ring, was conducted by the FBI.  Assistance was given by Aflac’s special investigations unit in Georgia.

Ten people pleaded guilty in the case in early November and 20 others pleaded guilty in early August.

Source: U.S. Attorney’s Office, Associated Press, Insurance Journal

Article written by David W. Taylor

Accident insurance in Texas is extremely important.  As the summer months turn towards fall, we are reminded of children returning to school and participating in sports.  In my family, that means football!! While nobody wants to think about injuries to their children, facts prove otherwise. That got me to thinking about the importance of having Accident Coverage for my boys as well as my family.

Accident Insurance Policy Features

Health Insurance industry experts expect health insurance and health care costs to continue increasing over the next few years even after the passage of new U.S. federal regulation. If you are a normal person like me, you have not taken time to read the entire bill to see how new health insurance regulation will affect you. As a professional insurance agent, I give you these tips to help you save money on your health care and health insurance related costs.

1. Cash Pricing. By asking for the cash price, medical facilities are more likely to give you a better price because they know they get their money up front. If you do not use cash and file with your health insurance company or your dental insurance company, the doctor has to wait as much as 90 days before he gets paid.

2. Prescription Discounts. When you have to get your prescriptions filled, always ask for discounts. Not all health insurance companies pay 100% of medication costs. So, if you find yourself in the position of paying too much for medicine, ask your pharmacist for a discount plan. You will be surprised, many medical discount plans are free, but you have to ask for them.

3. Go Generic. Since there are millions of people that now have to take medications for things like high blood pressure, diabetes, and even allergies these prescriptions have become quite routine. If your doctor prescribes medication, ask if there is a generic equivalent. Many times, the generic equivalent provides just as good results as the name brand medication.

4. Ask for $4 prescriptions. Another product of being highly medicated is that many of us take drugs that have been reduced as much 99%. Another way to lower your health care related expenses is to shop at larger pharmacies like Walgreen’s, CVS, and Wal-Mart. Often, you can get 30 day supply of medicine for $4 or less.

5. Consult with a Pharmacist. One of the best ways to lower your health insurance and health care costs is to talk to your pharmacist. In many states your local pharmacist can actually write prescriptions. Your local pharmacist can give you expert advice on why you take certain medications. Your pharmacist can also make recommendations to you and your doctor regarding lower cost alternative medications that can save you money without compromising your health.

6. Consider Medication Therapy Management. As a result of the new legislation, many pharmacists are starting their own private practices for medication therapy management. In exchange for a nominal fee that is often paid by private and government health plans, your pharmacist can consult with you on a regular basis to make sure you take your medicines as prescribed. By consulting with a medication therapy specialist not only can you save money on your health insurance, but you can also get advice that may improve your health the long run.

Note: This article focuses only on the impact of H.R. 3590 and H.R. 4872 (“health care reform”) on the health insurance industry. It does not cover the thousands of changes to U.S. health care (vs health insurance) and should not be used as legal or tax advice.

The U.S. House of Representatives has passed H.R. 3590 – the Patient Protection and Affordable Care Act (the “Senate Bill”), and H.R. 4872 – the Health Care and Education Reconciliation Act of 2010 (the “Reconciliation Bill”) which makes changes to the Senate Bill. President Obama signed the Senate Bill into law today. The Reconciliation Bill must first pass the Senate before it can also be signed into law.

Below is a summary of the key points in the bills affecting the health insurance industry. These changes are divided into three major categories:

1.Changes Beginning in 2010
2.Changes Beginning in 2011
3.Changes Beginning in 2014.
During the next few days, and when health care reform is finalized, we (and you through your comments) will be discussing in detail the impact of each item on insurance agents, employers and employees.

1. Changes Beginning in 2010

Temporary High-Risk Pool

Senate Bill: In 90 days, a temporary national high-risk pool will be established to provide health coverage to individuals with pre-existing medical conditions. Individuals who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums. Premiums for the pool will vary by no more than 4 to 1 due to age and maximum cost-sharing will be limited to the Health Savings Account (HSA) limit ($5,950/individual and $11,900/family in 2010).

Reconciliation Bill: same as above

Employer Subsidies — Phase 1

Senate Bill: Provide small employers with 25 or fewer employees and average annual wages of less than $50,000 with a tax credit if they purchase health insurance for employees. Beginning in the 2010 tax year and ending in 2013, Phase 1 of this subsidy will provide a tax credit of up to 35% of the employer’s contribution toward the employee’s health insurance premium if the employer contributes 50% or more of the total premium cost (or 50% of a to-be-established benchmark premium). The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000, but the credit will decline as the company size and average wage rates rise. Tax-exempt companies are eligible for tax credits of up to 25% of the employer’s contribution toward the employee’s health insurance premium.

Reconciliation Bill: same as above

Increased Dependent Coverage

Senate Bill: In 6 months, insurance companies must provide dependent coverage for children up to age 26 for individual and group health plans.

Reconciliation Bill: same as above

No Lifetime Maximum

Senate Bill: In 6 months, insurance companies will be prohibited from placing lifetime limits on individual and group health plans.

Reconciliation Bill: same as above

No Exclusions for Children

Senate Bill: In 6 months, insurance companies will be prohibited from placing pre-existing condition exclusions on a policy-holder’s children.

Reconciliation Bill: same as above

2. Changes Beginning in 2011

Health FSA Contribution Limit

Senate Bill: Beginning in 2011, the amount of contributions to health FSAs is limited to $2,500 per year.

Reconciliation Bill: Delays this provision until 2013.

Over the Counter Drugs Excluded from HRA/HSA/FSA

Senate Bill: Beginning in 2011, the costs for over-the-counter drugs not prescribed by a doctor will no longer be eligible for tax-free reimbursement through an HRA, FSA or HSA.

Reconciliation Bill: same as above

3. Changes Beginning in 2014

Individual Mandate

Senate Bill: Phasing in at smaller amounts from 2014-2016, individuals must have coverage or pay a penalty of the greater of $750 per year up to a maximum of three times that amount per family or 2% of household income. Exceptions will be made for religious objectors, those who cannot afford coverage and individuals who meet other special criteria.

Reconciliation Bill: Changes the penalty to the greater of $695 up to a maximum of three times that amount per family or 2.5% of income.

Individual Premium Subsidies

Senate Bill: Beginning in 2014, the federal government will give tax credits (called “premium credits”) to individuals with incomes between 100 and 400% of the federal poverty line (FPL) that cap an individual’s health insurance cost on a sliding scale from 2.8% to 9.8% of income respectively.

Reconciliation Bill: Increases the tax credits to individuals by reducing the cap on an individual’s insurance cost to 2% to 9.5% of income.

Employer Mandate

Senate Bill: Beginning in 2014, a company with more than 50 full-time employees that does not offer coverage and has at least one full-time employee receiving an individual tax credit (see Individual Subsidies above) must pay a penalty of $750 per full-time employee. An employer with more than 50 employees that does offer coverage that is “unaffordable” or does not meet the “minimum coverage requirement” and has at least one full-time employee receiving an individual tax credit, will pay the lesser of $3,000 for each employee receiving a credit or $750 for each full-time employee.

Examples: An employer with 50 full-time employees that does not offer health coverage will pay a penalty of $37,500 ($750 per employee for 50 employees). An employer with 100 full-time employees that does not offer health coverage will pay a penalty of $75,000 ($750 per employee for 100 employees).

Reconciliation Bill: Modifies the employer penalty for not offering coverage by subtracting the first 30 full-time employees from the payment calculation. The bill also increases the payment amount for firms that do not offer coverage to $2,000 per full‐time employee.

Examples: An employer with 50 full-time employees that does not offer health coverage will pay a penalty of $40,000 ($2,000 per employee for 20 employees). A 100-person employer not offering health coverage will pay a penalty of $140,000 ($2,000 per employee for 70 employees).

Employer Subsidies — Phase 2

Senate Bill: Beginning in 2014 and available for 2 years, small companies that purchase coverage through the state exchanges (see Health Insurance Exchange Mandate below) will be eligible for a tax credit of up to 50% of the company’s contribution toward an employee’s health insurance premium if the company contributes at least 50% of the total premium cost. In Phase 2, the full credit will only be available to companies with 10 or fewer employees and average annual wages of less than $25,000. Similar to Phase 1, the size of the credit will decrease as company size and average wage increases. Tax-exempt businesses are eligible for tax credits of up to 35% of the company’s contribution toward the employee’s health insurance premium.

Reconciliation Bill: same as above

Insurance Carrier Rating Rules

Senate Bill: Beginning in 2014, medical underwriting and pre-existing condition exclusions for individual and small group health insurance plans will be prohibited in all states. Insurers will be prohibited from denying coverage or setting rates based on gender, health status, medical condition, claims experience or other health-related factors. Premiums will vary by age (limited to a 3:1 ratio), family structure, geography, actuarial value, tobacco use (limited to a 1.5 to 1 ratio) and participation in a health promotion program.

Reconciliation Bill: Adds a provision to grandfather existing individual and group health plans with respect to the new benefit standards.

Health Insurance Exchange Mandate

Senate Bill: By 2014, each state must create an American Health Benefit Exchange and a Small Business Health Options Program Exchange, administered by a governmental agency or non-profit organization. The exchanges must provide a place where individuals and small businesses with up to 100 employees can purchase coverage that meets certain requirements (see Insurance Coverage Requirements).

Reconciliation Bill: same as above

Insurance Coverage Requirements

Senate Bill: Beginning in 2014, any health plan offered through the state-based exchanges must provide health benefits that include cost sharing limits. No out-of-pocket requirements can exceed those in Health Savings Accounts, and deductibles in the small group market cannot exceed $2,000 for an individual and $4,000 for a family. Coverage must be offered in four different benefit categories: Platinum (90% coinsurance), Gold (80% coinsurance), Silver – (70% coinsurance), and Bronze (60% coinsurance). Additionally, a catastrophic-only plan must be offered to individuals under age 30 and to others who are exempt from the individual responsibility requirement.

Reconciliation Bill: same as above

Miscellaneous Provisions

•One provision requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2
•The bill also provides provisions to establish a new employee benefit cafeteria plan to be known as a “simple cafeteria plan” that includes self-employed individuals as qualified employeesWr

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