March 29, 2006 by bob.

Every once in a while I come across a site that is truly informational and unbiased. This is one of them.

The National Association of Insurance Commissioners (NAIC) today launched a comprehensive public education program to assist consumers with information about insurance issues. Under the banner of Insure U, the campaign has two objectives: to help consumers get smart about insurance as their needs change at different life stages, and to educate them about how to avoid being scammed by fake insurance companies. The program includes an online education site and public service announcements in English and Spanish.

The Insure U curriculum includes a basic introduction to the four major types of insurance – auto, home, life and health – as well as special considerations for young singles, young families, established families and empty nesters/seniors. Consumers can test their knowledge about insurance by taking an online quiz. Upon successful completion, they can download an Insure U diploma.

I encourage you to take some time, tour the site then collect your diploma.

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March 28, 2006 by bob.

If you look at the title of this blog it says Health Insurance. This post is about life insurance.

This is my blog. I can put what I want here. Deal with it.

Today I was talking to a client about life insurance. They work for a big company and have fairly good benefits, some of which are subsidized.

This person had maxed out their supplemental life insurance at $166,000 and wanted more coverage. He was looking for another $400,000.

I worked up some numbers and gave him the quote. Then I asked about his supp life.

Seems he is currently paying $28 and change every month. Not a bad deal . . . until next year.

In 2007 his premium jumps to $40 per month, almost $500 per year for $166,000.

The premium will go up again in another 5 years, and again 5 years after that.

I suggested he combine the $166,000 with the $400,000 we are going to apply for in a few days. By adding the $166,000 to the $400,000 he can get the full $566,000 and save about $10 a year.

Doesn’t seem like much but here is the kicker.

The premium on the $566,000 stays level for the next 30 years. That is not the case on the supp life with his employer. That premium will go up every 5 years.

The coverage on his $566,000 stays level for the next 30 years.

The $166,000 will cut by a third at age 70 and another 50% at age 75.

Right before he turns 70 the premium on the $166,000 will no longer be $40 a month. By then, if he still can afford it, it will be $203 per month.

This is not all that unusual. Some employer coverage, especially if it is subsidized, can be quite affordable.

Sometimes, but not always, dependent health insurance can be a good buy outside of the employer plan.

Sometimes, but not always, the supplemental life insurance can be as well.
Too bad most folks don’t know that.

If you are reading this, consider yourself one of those who just learned something new.

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March 24, 2006 by bob.

This PHI (protected health information) thing is getting out of hand. In case you have been a Tom Hanks Castaway, PHI is part of HIPAA (Health Insurance Portability & Accountability Act) that medical providers must now follow.

The good news is, now everyone in the doc’s waiting room doesn’t have to know you have a sexually transmitted disease.

The bad news is, my job just became more difficult.

Some have even suggested the typical “office shower” (not that kind) is now taboo. If you want to tell someone you are pregnant, OK. But putting that information in a memo in the break room, or having some kid in a stork outfit surprise you at work one day is PHI and not to be shared.

So what has my shorts in a wad?

Last week I was following up on an application that was taking too long in underwriting. Anything more than 48 hours is too long for my purposes.

The online status wasn’t helpful. All I knew is the process was on hold pending an APS (attending physicians statement).

Don’t you just love the lingo we have? Where would the world be without acronyms?

So I call the hotline and spend a few minutes on hold listening to Barry Manilow music. Finally some kid comes on the line asking how he can help.

You can help by replacing Barry Manilow with Iron Butterfly or Steppenwolf.

Of course he had no idea who these folks are so I moved on.

All I needed to know was which doc was the “P” in the APS. Simple enough request. I just wanted to speed things along.

The kid says “I can’t tell you.”

Why not?

“It’s PHI.”

You do realize I have the application in front of me, complete with a medical history and a list of all the docs this person has seen since they were first spanked, right?

“Yes, but I can’t tell you which doc.”

“But if you were to guess which one I could tell you if you are right.”

Now what kind of silly rule is this? They can’t tell me but if I guess correctly I get to move on to the next step.

This has got to be one of the dumbest interpretations of PHI I have encountered so far.

On a related note, I got an email from our neighborhood gossip. Said something about a lady who lives on our street who just had a baby. I didn’t even know she was pregnant. Just thought she was “big for her age.”

Guess I need to tell Ms. Nosey Neighbor she just violated someone’s HIPAA rights by giving out PHI. Maybe then she will take down that stupid cut-out stork from the front yard.

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March 14, 2006 by bob.

This has been one of those weeks . . . and it is only Tuesday.

A woman paying $800 per month for health insurance says she cannot afford to keep her policy. She has 4 different policies, one for each of her family members. Each one has a different deductible, ranging from $1000 to $2500.

She now wants everyone covered under one policy and is willing to boost her risk to $5000.

I give her a price that will cover her husbands pre-existing condition, his tobacco use, and her size 16 body.

She says that price is too high compared to one she got off the internet.

I am familiar with this carrier. They will not cover her husbands pre-existing condition, they will rate her for her weight (something my quote already considered) and the have a limit of $5,000 on prescription meds.

She doesn’t care about my observations. She already has a better price. Besides, her meds don’t run anywhere close to $5,000 per year.

I point out it doesn’t matter what you paid in the past, the reason for buying insurance is to cover things that could happen in the future. Since I have 3 clients whose Rx bill runs in excess of $2,000 per month, I feel I might know a bit about this topic.

She also says she has never heard of the carrier I have quoted. That’s OK because they probably never heard of her either.

She is 42 years old.

The carrier I quoted is over 100 years old and has always specialized in health insurance.

The carrier with the lower price has not been in the individual health insurance business for at least 15 years.

She still wants the lower price plan.

You get what you pay for. If that is her decision nothing I do is going to change her mind.

Woman number 2 tells me she doesn’t have health insurance. Her husband is covered under a plan at work but he is leaving that job and needs coverage.

They can’t afford more than $350 per month.

Her children don’t need health insurance, they are on the state welfare health plan.

This should have been my first clue things won’t turn out the way I want them to.

She has pre-existing conditions, and she cannot afford her asthma medication.

She also has Lupus but claims it has been in remission for 20 years. She also claims she has had no treatment in the last 10 years for Lupus.

I show her a plan for $360 that will cover her asthma meds. Since her Lupus is outside the boundaries of the questions on the application, she should be good to go.

She likes the plan and wants to talk it over with her husband.

I follow up the next day.

Her husband said they cannot afford a $5,000 deductible.

I quote her a $10,000 deductible for $70 less.

No, she says. They cannot afford to pay $5,000 if they had a serious illness.

How much can you afford?

Maybe $1,000.

OK, that plan is $800 per month.

We can’t afford $800.

What can you afford?

About $350.

I have a plan with a $5,000 deductible for $360. It will cover your medicine with a $35 copay.

We will just set up a savings account. The only thing we need insurance for is for a doctor visit once or twice a year and my medicine.

What if something bad happens and you run up a $40,000 bill?

We will fill bankruptcy. We have done it before and will just have to do it again.

So it is better to lose everything than cover all but $5,000 of your medical bills for a $360 per month premium?

Yes.

I just looked at the calendar.

It is a full moon.

That explains it.

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March 14, 2006 by bob.

Insurance applications are mostly based on the honor system. You are asked to put down information that you know to be correct and the carrier relies on that information to evaluate you as a risk.

Depending on the coverage applied for, there usually are additional background checks. This might include checking with M.I.B. (Medical Information Bureau), your states DMV (Department of Motor Vehicles), a credit check and a criminal history background check.

Sometimes you may be asked to submit body fluid specimens and maybe even have a physical exam.

But it still comes back to honor. The carrier EXPECTS you to honor a code of ethics and be truthful in your answers.

Speaking of honor, a former mayor of our great city was recently tried in federal court. Several wrongdoings were alleged including extortion, bribery, illegal use of campaign funds, racketeering and tax evasion.

During the trial which lasted about 2 weeks, the jury was not sequestered. Hizzoner was free to hold nightly press conferences where he would spin the events of the day in his favor. He would swagger up to the reporters, smile and stare into the camera as he talked about the lies by the prosecution that proved nothing and only served to smear his reputation.

I am sure the members of the jury adhered to their charge to avoid watching the news in an attempt to remain unbiased.

During two days of testimony former girlfriends of Hizzoner were put on the stand to testify about trips to Paris and other exotic places where gambling was a major attraction. Every one of these trips was paid for in cash. Lots of cash.

There were even some Kodak moments where the mayor posed in front of landmarks like the Eiffel Tower.

Did I mention the mayor was happily married during this time?

Hizzoner talked in his nightly spin cycle about how these allegations failed to prove any wrong-doing but only served to smear his good name and reputation.

Uh-huh.

Somehow he failed to mention that he might be incriminated, not for having a lovely accessory on his arm, but that the cash was unaccounted for in his financial records.

The mayors wife was noticeably absent from court when the girlfriends testified.

At the conclusion of the trial, many of the charges involving bribery and extortion were not proved to the satisfaction of the jury.

He was however convicted of tax evasion.

So at the end of the day, if you are to believe the jury, the mayor is not guilty of anything other than cheating on his wife, and cheating on his taxes. Other than that, he is an honorable fellow.

In fact he even proclaimed in his last press conference that his “honor had been restored”.

Really?

How did I miss that?

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March 9, 2006 by bob.

I have a new client and coverage was approved last week. Not only was her coverage approved but there are no exclusions for her pre-existing condition.

Actually, she has two pre-ex conditions.

One is not so bad but can recur.

The other has not been an issue but could develop into a situation that would require surgery. The condition will get her declined by at least one carrier, possibly more.

At the least, every other carrier that might accept her will exclude both conditions.

Today she called to tell me she is looking at other plans and wants to compare with her new plan. Apparently she forgot the benefits we discussed a few weeks ago when I accepted her application.

She must have also forgotten where she put the outline of benefits I used and went over in great detail.

With all this forgetfulness, I am beginning to think there may be other medical problems as well.

Of course those would be excluded by other carriers.

How soon she forgets . . .

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March 6, 2006 by bob.

I am outraged.

Last week I made reservations at a 5 star restaurant. I planned on having a fine meal complete with appetizers, wine, dessert and coffee. This restaurant is known for meals that tantalize all the senses.

I even asked my wife to join me. Why waste a good meal by dining alone?

We had an excellent meal in spite of the waiter who was a bit stuffy.

When the bill was presented I discovered I did not have my wallet. Must have left it at home.

I tried to explain that I wanted to pay the bill, but I just didn’t have the money. I thought they were going to create a scene when my wife came to my rescue.

She paid the bill for me.

How is this any different from those who claim they cannot afford health insurance, then demand care and complain when the bill arrives? The uninsured created over $21 BILLION in lost revenues in 2004. Caregivers that were stiffed just as the restaurant would have been if my wife had not paid the bill for us.

Guess it is a good thing I decided to invite her . . .

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March 6, 2006 by bob.

Why is it some people have an entitlement mentality? It used to be that the wealthy, were labeled as spoiled brats because they had everything they ever wanted without having to ask. I never quite figured out where the phrase, “born with a silver spoon in their mouth” came from. The little bit I know about the childbirth process automatically tells me that the mothers of these children must have dreaded the delivery process even more than mothers of the common people.

Thanks to FDR and later LBJ a portion of our society, those “less fortunate”, have also enjoyed generations of having things provided for them without having to work or even ask.

Now this entitlement mentality seems rampant, affecting people of all classes regardless of how much they have in the bank.

Yesterday I was in a meeting with a man who is retired military. I have a great deal of respect for those who put their life on the line for their country. It doesn’t matter if they served for 3 years or 30, they still get my respect and appreciation.

What gets my panties in a wad is the sense of entitlement this man had and a lack of appreciation for what is provided for him virtually free. We were discussing health insurance.

Notice my segue into the blog topic? Bet you thought I couldn’t make the connection.

He felt he was being betrayed by the government over his Tricare benefits. When he joined the armed services, certain benefits existed for active duty personnel as well as retirees. One of the retiree benefits is health insurance under a program now known as Tricare.

His complaint was that Tricare used to be free, now he has to pay for it.

This raised my antenna, so I just had to jump in and ask. What kind of benefits do you get, and how much does it cost.

This was like priming a pump.

“Everything used to be free, now they charge me a premium for my health care.”

Yes, I understood that part, so how much do you actually pay?

(Once more stating the known variable) “It used to be free, now I have to pay $230.”
I naively assumed this was a monthly premium, but I needed clarification so I could fully grasp the scope of his beef.

“It used to be free, just like the promised.”

(Yes, I have already mastered that part of the conversation).

“Now it is $230 a year.”

I am sure my jaw must have hit the floor at that time. Now he has me really curious. What kind of benefits are provided for $230 a year, less than $20 per month?

Office visits are $12. Emergency care is $30. Inpatient care in a hospital is the greater of $11 per day or $25 per admission.

All of this with no annual deductible.

OK, now I see his point. Makes perfect sense. He is entitled to all of this for free. How foolish of me.

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March 4, 2006 by bob.

In an effort to stay on top of the world of insurance and related matters, I do occasionally stray from my cave (as the wife refers to it) and actually venture out in the world. I keep trying to convince her that, thanks to Al Gore, we now have the internet to provide virtually all our needs.

The daily rag used to be delivered almost to my door, although it usually landed in the street, or on a windy day in my neighbors’ yard, and his neighbors’ yard, and his neighbors’ yard . . . and would bring me selected information on the outside world. Now I simply point & click and the news I want, when I want it appears before me.

Apparently there is a retail store where the common people can find mass quantities of no-name cheap goods. I have probably heard the name a few times but in keeping with my creed to refrain from maliciously attacking people just because they have no tastes for the good things in life, I will simply refer to this store as AllMart.

It seems this store has a reputation not only for cheap wares but also has created a stir in some communities because of their benefit package. As I understand, AllMart locates their stores in communities that have few, if any job opportunities for unskilled workers. AllMart then engages in the under-handed practice of hiring these unskilled laborers for menial jobs that pay a competitive wage and provide benefits including a 401(k), stock options and health insurance.

This appears to me to be overly generous but some will disagree. They claim the benefit package, in particular the health insurance, is not adequate to cover all the needs of the employees and their families. I do find it curious that those who complain about the health insurance are not employed by AllMart, but rather have mundane jobs in fields like social services, creative writing and art. Apparently there is something in their brain that is malfunctioning that causes them to be overly critical of “big business”. There seems to be a disconnect that prohibits them from realizing it were not for “big business” they would not have a paycheck. This must be why they were unable to receive a business degree in college and had to settle for something in the field of liberal arts . . . an appropriately named field I might add.

But I digress . . .

The latest news item about AllMart involves something referred to as Plan B, also known as the morning-after pill. This is a pill for those who are unable to think beyond their animal desires and fail to take measures to prevent contraception.

No doubt, many of these people are social workers, creative writers and artists.

Now that AllMart will be stocking the morning-after pill I imagine these same critics will now patronize the store after they sober up and realize the bum they picked up the night before might not have been such a good idea after all.

I believe this may be what some refer to as Karma.

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March 3, 2006 by bob.

I fired a client today and it felt really good.

OK, they weren’t yet a client, only a prospective client. Still, I got a rush doing it. They were quickly becoming a pain in the butt. Some folks are like that. Generally, I am a nice guy with a low boiling point but even nice guys have their limits.

I hit mine today.

This woman kept asking me ways to cheat a carrier out of money. Hell she is already cheating the taxpayers, now she wants to get in the pockets of the carriers.

I hate carriers just as much as the next person, but I also respect what they do. Without carriers a lot more people would go bankrupt. Without carriers I would have to find some other way to earn a living. Somehow I just can’t see myself asking if you want to Super-Size your order.

I understand carriers and I definitely know how to maximize policy benefits. I can squeeze more benefit dollars out of a carrier than just about anyone. That’s why my clients love me so much. Dollar for dollar they get more benefit for their premium than they can do on their own.

It feels really good to help someone find great value for their premium dollars.

Almost as good as firing someone.

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