Portable health care insurance gets rolling

Employees covered by group plans are often forced to remain at jobs only because they have suffered reversals in health. Were they to leave, they fear that they and their families might lose insurance benefits and new employers might be unwilling to
Once the Clinton Administration's massive health reform program was unceremoniously laid to rest, Congress began to nibble away at the social ills which prompted the ambitious initiative in the first place.

Among these is the sad fact that health insurance hasn't been "portable."

Employees covered by group plans are often forced to remain at jobs only because they have suffered reversals in health. Were they to leave, they fear that they and their families might lose insurance benefits and new employers might be unwilling to cover them.

Since 1985, when the Consolidated Omnibus Budget Reconciliation Act (COBRA) brought some relief, most employer-sponsored group health plans have been obliged to offer employees and their dependents the option of purchasing continued health coverage in case of termination or reduction in hours of employment, death, divorce or legal separation, enrollment in Medicare or the end of a child's dependency under a parent's health plan.

COBRA's maximum coverage period is 18 months. And, other than COBRA, no federal requirements apply to group health plans, insurers or health maintenance organizations (HMOs) fostering the portability of coverage.

But now all of that has changed. The Health Insurance Portability and Accountability Act of 1996 will impose portability requirements on group health plans in three ways.

It will prohibit excluding individuals from coverage based on health and related factors that have traditionally been taken into account. Thus, medical underwriting will be outlawed.

The new law will require that coverage offered by health insurers and HMOs generally be guaranteed renewable at the plan sponsor's option. Health insurers in the small-group market must also provide coverage to employees on a "guaranteed issue" basis.As a result, employers with two to 50 employees will be able to secure coverage without any underwriting at all.

The new will law place limits on exclusions of preexisting conditions. A preexisting condition is one for which medical advice, diagnosis, care or treatment was recommended or received within the past six months. When the laws take effect, health plans will be able to exclude coverage for such conditions for no more than 12 months (or 18 months for late enrollees). HMOs are permitted to substitute a two-month waiting period (three months for late enrollees) for a preexisting-condition limitation.

The new limits on preexisting-condition exclusions mean some administrative hassle. For one thing, the law mandates that health plans credit any prior group coverage toward preexisting-condition exclusion periods and a health plan will now need to provide a certificate of coverage to a former enrollee, documenting the length of coverage under the plan.

In addition, health plans must enroll individuals who initially decline health coverage because of other coverage if they seek to enroll within 30 days of losing their other coverage. And individuals who become dependents because of marriage, birth or adoption will also be entitled to special enrollment periods.

Not surprisingly, there is a price for all of this, and prudent employers will begin to assess the new law's impact on them and how best to control that impact before the portability rules take effect -- for plan years beginning after June 30.

They will need to consider whether the potential cost savings of applying a limited preexisting-condition exclusion outweigh the added administrative expense. They will need to assess whether market conditions still warrant providing extended health coverage until age 65 for early retirees, who may have an easier time securing affordable individual coverage in light of new "guaranteed issue" requirements benefiting individuals.

In addition, employers will need to review contractual arrangements with service providers. And they will need to see that health plan documents and disclosures are revised to reflect any changes before they take effect.

Marc Lane is a business and tax attorney, a Master Registered Financial Planner, a Registered Financial Consultant, and a Certified Investment Specialist. Marc is the author of 30 books on business organization, taxation, and personal finance. His newest book, "Advising Entrepreneurs: Dynamic Strategies for Financial Growth" draws from his experience working with those who have successfully built their businesses. Marc is an Adjunct Professor of Law at Northwestern University and an Adjunct Professor of Business at the University of Illinois. His practice areas include Individual Taxation, Corporate Tax Planning, Business Tax Planning, Estate Planning, Investments, Retirement Planning,Elder Law, International Trade, Business Law, and Wills, Trusts and Estates. Additional articles, case studies, and a free email newsletter are available at www.marcjlane.com.

How to Shop for Individual Health Insurance

Thompson

If you find yourself in the position of shopping for an individual health insurance policy, there are certain things you'll want to keep in mind. Whether you are coming out of a job that covered you before, or are at the end of your COBRA benefits, or simply have never had coverage before there are things you can do to get coverage on yourself and your loved ones.

The basic thing to know is that if you have a shot a group health insurance, whether through a job or an association you're a member of, that is usually much more affordable than buying individual health insurance on your own. First you need to figure out your health insurance goals; in other words, what are you after? If you're young, healthy as a horse, no dependents and not attempting Mt. Everest next week, you may want to opt for a policy that covers only the catastrophes, and cover the rest out-of-pocket. On the flip side of that, if you're the sole bread winner with a family to support, the scenario is different.

The basic choices you'll have are Fee-for-Service, Managed Care Plans, and Association-based health insurance. Fee-for-service is the traditional indemnity plan, harder to acquire, more expensive, but usually great coverage. Managed care plans include most HMO's and PPO's. These offer lower costs but your choices are somewhat limited. Another way to get insured is through a group or association you may already be a member of, such as professional, religious or trade organizations. Often they may offer health insurance. It's worth checking out, as sometimes you can strike gold in this vein.

Things to consider when you're looking for any policy are what's covered on this plan, how much are the monthly premiums, what is the yearly out-of-pocket, what is the deductible, how much are office visits, does it cover preventative medicine, vision, dental? And I'm sure you can come up with many of your own. Sit down before you go shopping and make a list of your needs and wants, and decide in advance what you're willing to give to get. Be aware that once you start getting quotes they can vary as much as 50% for the same person! Remember, you're shopping, and nobody's making you do anything. If one insurer isn't cutting it, move on to another. If you're coming at this cold and have no good recommendations it may be wise to use a broker who represents several companies, as he or she wil be more likely to find the best policy for you, as opposed to selling the company they work for.

Shopping for individual health insurance can be frustrating and time-consuming, but if you come armed with facts you'll be able to navigate this highly competitive and ever-changing field.

Keith Thompson is the webmaster at http://www.health-insurance.giftsforbiz.com,a site geared toward helping you find great individual health insurance!

The Need for HIPAA Complaint Medical Billing Software

 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes seven sets of rules that will affect your practice. The Department of Health and Human Services, or DHHS, issues these in the form of the ""Notice of Proposed Rule Making"" or NPRM. Every practice, regardless of size, must comply with HIPAA privacy, security and transactional regulations. Moreover, adherence to all subsequent regulations is also required. This covers most everything in your practice, including your medical billing software.

When you are shopping for medical billing software, ask how and for whom the system was designed, and whether the data will be safe and secure on backed-up, protected, HIPAA-compliant servers accessible only to authorized persons. Look for companies who provide free updates to ensure continued efficiency and HIPAA compliance. The new HIPAA standards require huge changes to how healthcare organizations deal with their patient information, including coding, security, patient record management, reimbursement and care management. HIPAA‘s provisions include stringent codes for the unvarying transfer of electronic data, including routine alterations and billing.

Clearly your approach to HIPAA medical billing software must include a serious investigation of software security. Most computer experts will agree that there is no such thing as absolute computer or software security, so working closely with your HIPAA software providers to help determine data deficiencies is a good idea. HIPAA Complaint Medical Billing Software can be easily expanded to meet future needs, and can be targeted directly to the size and complexity of your practice. Options for new HIPAA compliant software have never been better, as there is unlimited scalability, a wide range of customization choices, and a large selection of useful features that will prevent the patients' privacy from being compromised.

Innovations in the technology of medical billing software have created a new criterion for digital precision. Make certain that the HIPAA compliant medical software packager you chose includes all finalized aspects of HIPAA to guarantee full compliance with HIPAA standards as they relate to the electronic transfer of protected health information. The regulations themselves took effect in February 2003, and affect every medical practice in the United States. Effective April 2005, HIPAA mandates security measures to physically and electronically secure electronic protected health information (PHI) against unauthorized retrieval, reliably store the electronic data, and provide for emergency access to the data.

Since most medical billing software packages are now designed to be HIPAA compliant, it is just a matter of choosing the right software for your practice, and your medical billing software will run as smoothly and efficiently as ever.

Medical Billing Software Info provides comprehensive information about medical insurance billing software, HIPAA compliant medical billing software, easy and free medical billing software, and medical billing software prices and reviews. Medical Billing Software Info is the sister site of Medical Billing Web.