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You make "absolute" statements all the time TM - and many call you on it. Then, you get PO'd when you are called on it. It is your MO
GD.. flipping read the post we were going back and forth on NOT the ones you want to pull up from the past.
I DID NOT STATE ANYTHING IN AN ABSOLUTE.
I'm PO'd because your pulling something you claim I did IN THE PAST.. and NOT what I actually DID RIGHT NOW>> RIGHT HERE ON THIS HERE BiOARD.
OR.. shall we go into all the things You have said and done in the past on these boards that we can call you out on .. remember the one about how illegals should be left to die on the streets becasue they shouldn't get heatlhcare..
but then that is not relevent nor anything you actually said no this thread on this topic.
So again..get off your high horse. read the damn post that we are talking about..
I did not speak in absolutes on that post.
BY THE WAY.. you're one to freaking talk you always speak in absolutes as if your the GOD of CD and what you say is absolute gospel..
So.. I would be careful.. because then you are just being one big.. well you know.. starts with h and ends with a t!
I have no problem with continuing to pay FICA taxes. I'm looking for a way to get my insurance expenses down a little.
Medicare covers the worst demographic for a health insurer: the elderly. Adding some healthy people to the Medicare pool would help bring in more money, help Medicare remain solvent a little longer, and hopefully reduce the cost of insurance a little for the younger people buying into it.
If a govt option is to be on the table, it makes sense to expand Medicare as that choice because its infrastructure is already in place, so it will cost less than starting a whole new program from scratch.
I actually support Medicare for all if your doctor certifies that you have a pre-existing condition so your uninsurable or can't afford private insurance at the rates private companies feel they must charge to have a business model that meets investor expectations. I also think that employer based health insurance is not long for this world. It costs business about a trillion dollars a year which comes out of the pockets of shareholders. It is the primary reason the American auto industry is failing. How can GM compete against Toyota if it has to raise the price of a comparable model by $2000-3000 vs. the Toyota product and provide absolutely no value to a prospective buyer? What will happen has already happened. In the 1980s business was facing insolvency due to define benefit pension obligations to retired employees. This problem was solved by getting rid of these pensions for what we know as the defined contribution plan known as the 401k. Most employers make little or no matching contribution to these plans so the burdon is entirely on the employee.
Your 401k is under no legal obligation to payout anything at retirement if market conditions dictate. The 2008 stock market crash erased nearly $10 trillion of market value and basically erased any 401k earnings for the last 8-9 years. So what is the business communites idea for fixing this trillion dollar problem. One solution is making the employee pay for the majority or all of his halthcare premium. Another solution is only offereing what is known as the 401k of health care the HSA or Healthcare Savings Account. This will be manditory and will be sold as empowering you to decide just how much healthcare you want. This is like telling employees that the stock market will allow you to become richer than you might be with that defined benefit pension plan.
First... group coverage is NOT more expensive. It's LESS expensive than individual coverage. Usage is offset by those within the group that do NOT use it..that is why it's cheaper. However, when an individual within the select "group" gets ill and money is paid out EVERYONE's deductible increases.
There are states that allow individual carriers to underwrite new applicants and decline, post-pone, rate-up or exclude certain conditions or body parts based on health status. In this particular persons situation that's the case since he has been declined for individual coverage when he applied. In a state like this individual coverage will be less expensive than group because it is underwritten and allows the insurance company to pick and choose who it wishes to insure. Group coverage by law (HIPPA) can not be declined but, can be rated up as much as 400% of the base rate. Once in place any new employee that enrolls and his family if they choose, must be accepted at the same rate as other employees (and their family member if applicable). Since a family member could be seriously ill and that illness can not be considered a pre-existing condition if the new employee has 12 months of creditable prior group coverage, rates on group plans are higher from the start to compensate for this risk....risk which can not be predicted like other risk is. Rates are based on risk......risk that an actuarial calculates using historical statistical data.
The larger the pool (group) the more typical and consistent the group will be with the data that was used to calculate the risk.....which is what lowers group rates....the level of accuracy the insurer can rely on in terms of the risk associated with the group. Having to insure already ill family members is unpredictable in terms of the number that may enroll and the cost of the illness if they do. The frequency at which a specific illness will occur per 1,000 otherwise healthy people is something that is known and available. Whether or not a new employee with an ill family member will be hired (and therefore have to be insured) is something that is inconsistent. Mandates like HIPPA throw this consistency out of whack as well because of the risk that it makes impossible to predict.
A groups deductible does not increase based on claims. Upon renewal an the employer may elect a different deductible amount for the plan to help offset rate increases.
Secondly... yes, he will recieve a HIPAA certificate so that when he/she goes out in the world to purchase insurance they will be covered without the pre -existing condition clause put into affect. In otherwords the insurance that the person purchases can not exclude the pre-existing condition for any length of time as it was previously covered - as long as there was not a lapse of between 60 - 90 days.
They have no more than 63 days to use the certificate to apply for individual coverage not 60-90 days.
HOWEVER>. HIPPA certificate does NOT guarantee coverage.. not at all. If you live in a state like NY where people can purchase private insurance and plans are NOT medically underwritten that may apply. However, in most states (definately in my state) there are different plans. Most of them , like Aetna, Oxford, Geisinger etc.. are medically underwritten. HIPPA means SQUAT. they reject me for insurance BECAUSE I have a pre-existing condition. If your state happens to have a carrier that WILL take you on.. called a guarantee issue (non medically underwritten policy) than you will pay 3x's the going rate for your age group . If you have the HIPPA and are within the time frame then they will pick you up and cover your condition. If you are beyond the HIPPA period, however, they will take you but they will nto cover your pre-existing condition for 12 months.
He must have had 12 months of prior creditable group coverage and have exhausted all COBRA available to him as well with a lapse of no more than 63 days at any time. A HIPAA certificate can be issued in which he must use within 63 days. Coverage is then guaranteed and without any pre-existing conditions, although there is no limit on premiums. If you are beyond 63 days, whether you have a HIPAA certificate or not, it's useless and they will underwrite the same as any one else applying for coverage without a HIPAA certificate.....which means they can decline you.
Keep in mind to, that insurance companies usually have an "open enrollment" period. In otherwords you can't just call up and sign up that day .. you must wait till their next enrollment period. IF that enrollment period falls BEYOND the 60 days .. well your HIPA certificate means squat because you have fallen uninsured beyond the 60 day limit.
Individual plans don't have open enrollment periods (so to speak), that's something group plans have when you want to enroll (add) a family member(s) that you previously waived coverage for when you enrolled....Medicaid also has an open enrollment period for people that are eligible and wish to change carriers.
Individuals plans offer effective dates for starting the insurance you're applying for. Although almost extinct (if not completely), there are insurance companies that work only through brokers that will offer immediate effective dates when witnessed by the broker.....the effective date will be honored if the application is approved after underwriting. Otherwise companies will offer an effective date of the first of the following month after approval (some offer a choice of the 15Th as well)......so if you get tied up in underwriting because they're waiting for records from one of your doctors and the first of the month passes, generally your next earliest effective date will be the first of the next month, assuming you're finally approved before the month is over.
I'm an insurance broker (since 1995) that specializes in health insurance. I don't know what the circumstances were as to why you were told your HIPAA certificate meant nothing because it does. Any company marketing individual insurance in your area must make available two of their plans for people applying with HIPAA certificates. I'm not familiar with Geisinger or Oxford but, I am with Aetna. Here in AZ, Aetna only markets group coverage and they don't offer individual.
Last edited by Danno3314; 08-07-2009 at 12:01 AM..
OR.. shall we go into all the things You have said and done in the past on these boards that we can call you out on .. remember the one about how illegals should be left to die on the streets becasue they shouldn't get heatlhcare..
Gosh, when did GreatDay post that? If you can find it, I'd love to +1 it.
Illegal immigrants have their health care in their home countries.
Third.. YOu ARE DEAD WRONG about Group insurance being more expensive than private insurance.. ie: one individual purchasing it along vs. a company. THE SAME POLICY.. with the SAME CRITERIA WILL cost an individual MORE than it would cost a group or employer purchasing it.. GROUPS get a discount. They have OTHERS to distribute the "cost sharing" so to speak .. when an individual DOESN'T .. so they are charged MORE.
I'm not the only one who has informed many about private being more expensive than individual.
What you're saying used to be the case but, it's because of the mandates that are placed on carriers some at the state level and makes this no longer true. In a state where carriers must accept and cover all pre-existing conditions for any one applying for individual coverage (like NY as you mentioned), individual coverage would be higher than group there. The reason individual coverage can be cheaper is as I mentioned the ability to decline and/or modify the coverage being offered to an applicant. I'm 47 years old and healthy, here in AZ I can get a ppo policy with BC/BS for example in the $200's/month range (depending upon the deductible I choose) but, in NY the rates vary widely depending upon the county and the carrier you choose....overall though they're outrageous any where from a little under $1,000/month to over $2,000/month. See for your self:
Its great that your insurance company works for you but, shopping for new health insurance is just not affordable for many these days.
Then maybe they should shop around or cut back. That's what we did. It's all about choices.
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