HIPAA Law



             


Monday, March 24, 2008

Senior Health Care Insurance

Senior Health Care Insurance

Health Insurance For Seniors On The Net

When a good friend of mine inquired where he could obtain information about medical insurance for his out-of-state, elderly mother, I told him to try the Internet.

He reported back to me about a week later, in desperation: "I am giving up, I am too confused." He had taken on an overwhelming project with his widowed mother, living in another state. As the only child, and following the sudden death of his father, it was his responsibility to care for his mother.

In this world of technology, the family unit is often living in different geographical areas and the family members are usually quite involved with their own lives, careers, and families. In addition, when both parents are alive, often one or both parents are quite independent and do not require a lot of assistance. As time goes on things, of course, change, and sometimes change very suddenly. There can be a crisis, with regard to the health care needs of one or both aging parents.

With our baby boomers facing this problem in ever increasing numbers, and with the information highway in full bloom, there is a definite need for planning.

Protecting your parent's assets and health is a huge and daunting undertaking, which requires a tremendous amount of education and practical application. Our seniors face many diverse responsibilities upon reaching age 65. To name just a few: Estate planning, taxation, Medicare, social security, wills, insurance, and various other legal and financial matters. All of these different areas require expertise from accountants, lawyers, estate planners, insurance agents, home brokers, financial advisors, and others.

The Internet is a good starting point for most people to find resources for questions and solutions for your problems. There is, however, no replacement for good solid intelligent advice from an expert.

Twenty years ago, insurance for elders was sold by "senior insurance specialists", with just a handful of companies in each state. The programs were most often Medi-gap or Medicare supplemental policies, which covered the expenses not covered by Medicare, including hospital and doctor deductibles, durable medical devices, and non-approved Medicare costs. Ironically these specialists did not sell a lot of nursing care policies, even though Medicare paid a national average of less than 2% of these expenses. With the advent of "financial and estate planning" and more insurance companies entering this market, a more broad and diversified product line became available to agents, brokers, planners, and seniors.

Part of this new diversification was the "home health care plan", sold by itself, and in conjunction with senior health insurance products. The appeal of the "home health care policy" was that a senior could stay at home and still receive medical and custodial benefits, allowing a person to recuperate in the comfort of their own home.

This was the answer to a huge problem. The last place an older person wanted to go was a "retirement home", or "rest home", or, God forbid, the "nursing home." It appeared that seniors could now rely on this new innovation without worry of having to move out of their home environment in the event of a health problem.

As with most things," if it is too good to be true".... The home health care policy is no exception. The problem is, there is not enough coverage for a lengthy illness or recuperation time. The fact is, the new trend is toward an "all in one" type facility, allowing for a variety of levels of care all in one location. In other words a senior could start off with little or no health care concerns in an independent, less expensive area, and then go to an assisted living, or nursing care facility, all within the same compound.

A "nursing home" requires a nurse on the premises 24 hours per day, assisted living is just eight hours. The advantages to this are financial. The patient or senior is only charged according to the care level required during the time he or she is admitted to that facility. Another benefit is it alleviates a lot of planning because the care is delivered, as it is needed. The medical attention is available to all residents regardless of their current health.

Some people are offered a lifetime package, which covers their care for the rest of their life, regardless of their current age. It also allows for social outlets to an otherwise somewhat isolated group. On-line shopping services have become a huge business. It is definitely here to stay and many insurance policies are purchased from Internet quotes and on-line applications.

There are literally hundreds of thousands of insurance agents and brokers advertising on the Internet. Most of them will provide instant on-line quotes and even applications for the potential insured. I highly discourage a layperson to purchase insurance in this fashion. A little knowledge can be dangerous.

The federal government has mandated to all states through legislation, the standardized senior health insurance policy guidelines, which are governed and regulated by each state insurance department.

There are plans for almost every level of health. Some are designed and priced for a less than healthy individual. Others are for a person with minimal health concerns. . The whole concept of insurance is to provide protection for "unanticipated" sickness or injury, especially catastrophic expenses, which would devastate a person's net worth. The more small expenses a person is willing or able to pay (self-insure), the lower the rate. I recommend this strategy when evaluating your insurance options.

Another consideration when reviewing various insurance plans is to look at the company itself. How long has the company been selling this type of insurance? Do they have a lot of complaints filed with the local department of insurance? Are the rates stable? Does it pay claims on time? Service? Most agents talk about the rating. These ratings are as follows: A+, A, A-, B+, B, B-, C+, C, C-, or "not rated".

Do not be fooled by rating alone. It is good to have a high rating, but it is far better to have a company that has longevity, stability, innovation, service, and expertise. The problem is that some companies enter into a market and quickly leave without explanation. This does not give security to the policyholder.

The most important consideration should be a review of the profit/loss ratio for that product. This will establish stability, and longevity in the market. An insurance company with a moderate profit in a particular line of business will remain in that market. On the other hand, a company with losses will make changes and possibly even withdraw. This is information not normally available to Internet users.

Before entering into an insurance contract, the senior person, the family, and other advisors must be realistic, and a careful evaluation of the entire picture must be examined. The age, the health of the senior, the financial resources, the personality and attitude of the senior, and most importantly the desires of the senior, should all be considered.

Early planning is important, as qualification becomes increasingly more difficult as the applicant's health declines. The senior health care market is complex. I will offer some words of advice to attempt to alleviate potential pitfalls. *C hoose a well-informed, seasoned, and service oriented agent or broker to assist your decision making process. The professional can offer invaluable information, but do not be afraid to ask a lot of questions and even get a second opinion. *Do not wait until your parent or loved one is sick, or injured. Plan ahead and take the time needed to cover all the options. *C hoose an experienced insurance company. A Company that has been in the marketplace for a significant time and has maintained a balance of rates and benefits and sound risk selection with moderate rate increases over time is your best bet. *T he plan should be flexible, with a broad range of options and benefit selections to the insured. There should be no tricks, or complicated language for the coverage. An incredibly low rate is a red flag for trouble in the future. *Do not rush or be rushed by an over aggressive sales person.

This policy will not be inexpensive and will need to be read and reviewed for a clear understanding of the contents. This is one advantage to the Internet. You are allowed to read indefinitely before you act.

A long-term care program, with or without insurance coverage, will only work if the senior has input into the care selection process. If there are any questions about the accreditation of a facility please call the "Continuing Care Accreditation Commission at 202-783-7286.

WILLIAM H. PRITCHETT SR.

BIO: MR. PRITCHETT HAS BEEN INVOLVED IN THE SENIOR CARE HEALTH FIELD FOR OVER 20 YEARS. HE IS THE FORMER PRESIDENT OF GREAT REPUBLIC HEALTH COMPANY, AND IS THE FOUNDER/C.E.O OF EMPIRE HOMECARE RESOURCES, INC., A NATIONAL WEBSITE FOR SENIORS AND THE DISABLED. HE IS A GRADUATE OF THE UNIVERSITY OF WASHINGTON, AND HAS WRITTEN "CARING FOR A FAMILY MEMBER AT HOME" AND HAS PRODUCED SEVERAL HOME HEALTH CARE VIDEOS.

willprt@cs.com

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Wednesday, March 12, 2008

How to Save Up to 70% on Health Insurance Premiums

Are you tired of paying too much for health insurance premiums?
Only 5 or 6 years ago health insurance seemed very affordable
with fantastic coverage to match. Well, if youre an individual
or family who pays for health insurance today chances are youre
literally getting punched in the pocket book, and it hurts.

Dramatically health insurance has changed over the last five years
and this article will no doubt arm you with the knowledge you need
to get the most out of your next health insurance plan. First,
an individual or family needs to identify with what they need out
of a health plan. Notice I say need, because unless you make more
money than you know what to do with there is no way in the world
most people can afford the "Perfect" plan with all the bells
and whistles.

Do you need a doctors office co pay?

Most people dont realize this will save you up to 30%
with some companies by cutting this benefit out of your
health insurance plan. Doctors continually raise their fees
for visits and most of the time the consumer will go much faster
to the doctor if he or she has a $10 co pay as opposed to paying
the $50 the doctor may charge. Insurance companies pay millions
for these fees and trust me, after the first 12 months of your
plan being in effect youre the one who will be paying by a
huge increase in your premium. Ive seen insurance plans go up
79% after the first twelve months. Totally ridiculous.
The consumers cannot afford this.

Another huge problem which Ill go more in depth
in another article is prescription drug cards.
I really cant see where the consumer wins here either.
Dont get me wrong, if youre on an employer sponsored
group health insurance plan your probably getting a good deal
but I can assure you that your company is paying out the nose
for the coverage youve come to love. I talk to people weekly
who literally work for their health insurance coverage.
If you can do without a prescription drug plan I would.
It can generally save you 20 to 40% off your premium by
not having this benefit.

Consumers usually pay 500 to 700 dollars a year
for this benefit alone while the average family who can
qualify for individual or family medical plans dont spend near
this amount of money. And, once again when you finally use your
card the insurance company will generally offset the cost at
your renewal date by raising your health insurance premium.
Cut out these things and go with a deductible of $1,000 or higher
and you will definitely save yourself money both in the short
and long term. Most of us can pay for the occasional doctor visit
and prescription rather than giving our money up front to the
Insurance Company. Just a little food for thought.
Only 5 or 6 years ago health insurance seemed very affordable
with fantastic coverage to match. Well, if youre an individual
or family who pays for health insurance today chances are youre
literally getting punched in the pocket book, and it hurts.

Dramatically health insurance has changed over the last five years
and this article will no doubt arm you with the knowledge you need
to get the most out of your next health insurance plan. First,
an individual or family needs to identify with what they need out
of a health plan. Notice I say need, because unless you make more
money than you know what to do with there is no way in the world
most people can afford the "Perfect" plan with all the bells
and whistles.

Do you need a doctors office co pay?

Most people dont realize this will save you up to 30%
with some companies by cutting this benefit out of your
health insurance plan. Doctors continually raise their fees
for visits and most of the time the consumer will go much faster
to the doctor if he or she has a $10 co pay as opposed to paying
the $50 the doctor may charge. Insurance companies pay millions
for these fees and trust me, after the first 12 months of your
plan being in effect youre the one who will be paying by a
huge increase in your premium. Ive seen insurance plans go up
79% after the first twelve months. Totally ridiculous.
The consumers cannot afford this.

Another huge problem which Ill go more in depth
in another article is prescription drug cards.
I really cant see where the consumer wins here either.
Dont get me wrong, if youre on an employer sponsored
group health insurance plan your probably getting a good deal
but I can assure you that your company is paying out the nose
for the coverage youve come to love. I talk to people weekly
who literally work for their health insurance coverage.
If you can do without a prescription drug plan I would.
It can generally save you 20 to 40% off your premium by
not having this benefit.

Consumers usually pay 500 to 700 dollars a year
for this benefit alone while the average family who can
qualify for individual or family medical plans dont spend near
this amount of money. And, once again when you finally use your
card the insurance company will generally offset the cost at
your renewal date by raising your health insurance premium.
Cut out these things and go with a deductible of $1,000 or higher
and you will definitely save yourself money both in the short
and long term. Most of us can pay for the occasional doctor visit
and prescription rather than giving our money up front to the
Insurance Company. Just a little food for thought.

Ryan Orrell has been a specialist in the field of
health insurance since 1996 counseling hundreds of individuals
and families on policies which may be right for them.
Ryan is president of http://www.quotemonster.com,
an online shopping service designed to help individuals
and families find affordable health insurance plans.
This article is also posted on the Web at
http://www.quotemonster.com/health-insurance-article-1.html

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Tuesday, February 26, 2008

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!

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Wednesday, February 13, 2008

What to look for in good Health Insurance


Health insurance is a kind of protection that provides payment of benefits for covered sickness or injury. Included in health insurance are various types of insurance such as accident insurance, disability income insurance, medical expense insurance, and accidental death and dismemberment insurance.

Before sign the health insurance policy make sure that you have read thoroughly the benefits section. Take note of any health care service that is not covered by your health insurance policy. Also, pay specific attention to how the health insurance policy is worded. Sometimes, health insurance companies hide the health insurance coverage exclusions within the definitions of words.

For instance, a health insurance company may define the term emergency as anything that is life threatening condition that cannot be reasonably treated by a primary care physician. Whereas, your definition of emergency may be anything that requires quick medical attention.

Clearly, there is conflict for the two definitions. If you find yourself in an emergency situation where you incur a broker arm, for instance, your insurance company may deny coverage for emergency room treatment of a broken arm for the reason that the broken arm does not fall under the life threatening category.

Therefore, you should read over carefully the health insurance policy definitions, paying close attention to the seven key words:

medical emergency
medically necessary
accidental injury
experimental or investigational
pre certification
pre-existing condition, and
reasonable and customary


These words and any words that are open to interpretation should be regarded with wariness. Find out how your health insurance company defines each of these.

Finally, find the section describing the procedures you must follow in order for your insurance company to reimburse you. These policy conditions or prerequisites are typically worded in a positive tone. Read through each condition carefully, make notes and call your health insurance company with any questions.

You should also compare health insurance contracts before you sign one. In order to compare exclusions, take two policy contracts and find the exclusions sections. If you want to compare a number of health insurance contracts then you could use an online service.

After you obtain your free quote for the health coverage you desire, apply for it online, and you'll obtain all the information that you'll need to compare exclusions of each health insurance policy (though sometimes this will require more research.)



Mike Spencer recently became unemployed and moved into self employment. He was forced to find his own health insurance plan to protect his family. It wasn't as easy as he first thought. Here he shares the pitfalls of various plans and what you need to look out for when picking a good plan for you:http://www.1st-for-health-insurance.com/articles/what-is-health-insurance.html

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Monday, February 4, 2008

HIPAA Compliant FTP Hosting

FTP Hosting ? an overview

?File Transfer Protocol?, commonly known as FTP, is a reliable protocol to exchange large volume of digital information from one computer to another. FTP hosting technique has simplified file transfer process over the Internet. FTP hosting comes with two components ? FTP Server and FTP Client. Moreover, each FTP user will get a unique FTP account with user name and password. Irrespective of file type and file size, FTP account holders can upload the files in FTP Server through their FTP account. Similarly, FTP account holders can download copies of the uploaded files from FTP Server.

FTP hosting services provides complete security in file exchange process. Only authorized FTP account holders can view and access the files. Further, you can restrict a FTP account holder to access other FTP accounts. Irrespective of business volume, companies require to transfer files over the Internet. Though it is true that Hyper Text Transfer Protocol (HTTP) provides the facility to share information over the Internet but due to its limitations, FTP became popular across the globe.

FTP Hosting for Health Care Services

In Medical Transcription or other Health Care Services, medical reports are stored and exchanged in digital format. The growing necessity of exchanging large volume of medical reports and files over the Internet allows the Health care Service providers to use File Transfer Protocol as an alternative of Hyper Text Transfer Protocol. After the introduction of Health Insurance Portability & Accountability Act of 1996, extra guidelines are drawn for FTP hosting. All types of Health Care Services, who store and exchange medical files and reports over the Internet will fall under this Act and have to follow HIPAA regulation throughout the business process to ensure quality service and security of digital medical files and reports.

HIPAA

Health Insurance Portability & Accountability Act, commonly known as HIPAA, is a set rule to protect health related electronic information. The effect of HIPAA rules is applied to all types of health care organizations and support services. According to Health Insurance Portability & Accountability Act, all the health care organizations and support services should maintain necessary security measures to protect personal health information.

Medical institutes and support services prepares and stores health information of the patients in digital format. Based on the requirement, these digital reports are exchanged from one computer to another over the Internet. Health Insurance Portability & Accountability Act ensures complete security of digital health information that includes ? secure storage system and secure transmission of digital information over the Internet.

HIPAA Compliant FTP Hosting

The growing importance of Health Insurance Portability & Accountability Act in health care sector has given the birth of HIPAA compliance FTP hosting services. The objective of HIPAA compliance FTP hosting services is to protect unauthorized people from accessing digital heal information or medical report.

Following are some general features of HIPAA compliance FTP hosting service:

  • HIPAA compliance FTP servers are considered as highly secured data centers.
  • The system will automatically generate and run several threads during transferring digital medical files from one location to another. This is known as Multi-thread File Transfer and makes the process faster than normal File Transfer Protocol.
  • HIPAA compliance FTP hosting service comes with 128-bit transfer encryption. Digital files are transferred in the encrypted form. There is also another process ? symmetric or secret key encryption, which encrypt files and upload them in the server with a unique ?key?. The system will store the encrypted data in HIPAA compliance FTP server. Only the authorized person, who has that ?key?, can download the encrypted digital medical report from the server.
  • Like general FTP hosting services, the methods of uploading and downloading digital medical files are user friendly.
  • HIPAA compliance FTP hosting services allow the users to apply FTP services with existing firewalls.
  • Unique user name and password for HIPAA compliance FTP account holders.
  • HIPAA compliance FTP hosting services restrict anonymous FTP account holder from accessing the server.
  • Some HIPAA compliance FTP hosting services provides ultimate security by using ?Intrusion Detection System? and other security tools, which are compatible with all types of operating systems.

Advantages of HIPAA compliance FTP Hosting

The main advantage of HIPAA compliance FTP hosting services is data encryption. HIPAA compliance FTP hosting services will encrypt each data files in separate pieces of data, which are known as ?key?. You have to use the software xTyFTP during the process of uploading medical records in the FTP server. The software will encrypt the digital file in the computer and provide the ?key? to the authorized user decrypt.

HIPAA compliance hosting services will store the encrypted file in the server. However, if any unauthorized user accesses the file from the FTP server, he/she will get the encrypted form and the content will remain hidden without the right ?key?.

Apart from data encryption, which is considered as the core feature of HIPAA regulation, HIPAA compliance FTP hosting service requires secure procedure in data handling and serious maintenance of necessary policies, e.g., restricting unauthorized users from damaging digital information.

Adam is a Network Engineer with "InstantFTPsites.com". You can learn more about "FTP Hosting" services online at http://www.InstantFTPsites.com.

? 2006 InstantFTPsites http://www.InstantFTPsites.com You may reprint this article online and in print provided the links remain live and the content remains unaltered (including the "Author Biography").

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Tuesday, January 29, 2008

HIPAA Made Easy

HIPAA made easy

In 1996, a major legislative act was passed affecting health care administration called the Health Insurance Portability & Accountability Act or HIPAA. Whenever the legislature writes new laws it's up to the rest of society to understand the legal jargon and find how what the new law is all about. That's the aim of this article- to help simplify and state the main concepts of HIPAA.

There are two main parts to HIPAA that need to be understood. * The first part of HIPAA amended the Internal Revenue Service Code of 1986. * The second part is directed at streamlining and standardizing some of the administrative aspects of health care administration and information systems.

The second role of HIPAA is what will be focused and discussed as this is the part which mostly affects health care providers. Again the purpose of HIPAA was to simplify health care administration. There are deadlines for compliance; HIPAA does provide penalties and legal action for noncompliance. There are four parts to HIPAA: * Standards for Electronic Transactions * Unique Identifiers Standards * Security Rule * Privacy Rule Before HIPAA there really wasn't much standardization among health care providers regarding filing claims and identification. This created a lot of problems, headaches and extra work. HIPAA aims at saving time and making the process more efficient. It affects how health care providers file and process claims and conduct other business electronically. HIPAA also makes provisions for how health care providers are identified. There was no standardized way of identifying health care providers in: (1) being identified to Medicare and other government health organizations and (2) in being identified with other health care providers. The security and privacy rules were created to ensure secure transmission of electronic data and to protect individuals' personal medical information.

Many health care providers use electronic means for filing, billing and claim work. There has yet to be any adopted standards for this, with each individual provider using whichever forms they like. This led to complications in filing claims with Medicare and in transferring information from provider to provider. HIPAA has changed that though making electronic filing forms standardized. When filing electronic claims or when sending an electronic medical record providers will now be using the same forms. Medicare will require that all providers use the same form when filing an electronic claim with them. Providers who do not file or process claims electronically will not be affected by HIPAA. Also a standardized set of codes must be used on records in relation to physical conditions, diseases, health, etc. Most providers and institutions already use this practice. There will be enforcement of compliance; HIPAA has set deadlines for when providers must be using the approved forms.

Also new with HIPAA is how providers will be identified. Health care providers, doctors, hospitals and health plans are required to have a unique identifier and current they are using either tax-id numbers or employer identification number.

The security and privacy rules contain provisions to ensure that people's personal records and information will be protected and kept confidential. Along with all other privacy laws there will be penalties for non compliance, HIPAA provides for fines up to $250,000 and possible jail time for severe enough violations. But don't be worried about too many places avoiding compliance, HIPAA was created to make the massive process of health care administration easier.

Rick Lorenzen writes for 10x Marketing. To learn more about HIPAA compliance, electronic claim software and electronic medical record software visit www.AdvancedMD.com.

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Saturday, January 19, 2008

HIPAA and privacy guide 101

HIPAA has led to sweeping changes to health care administration and information systems as health care organizations struggle to achieve cost-effective compliance by 2003. The US Congress enacted the Health Insurance Portability and Accountability Act or HIPAA in 1996. The act covered a wide array of issues surrounding the health insurance industry but in particular it required administration simplification, which addressed the issue of security and privacy of health information.

HIPAA is designed to standardize the way all health care organizations electronically exchange sensitive patient data and to protect patients from unauthorized disclosure of their medical records (whether paper or electronic). HIPAA outlined standards to improve the nation's health care system by incorporating electronic data exchange between health care providers. The idea of course was to allow various health providers to access the records of a particular patient. So, when a patient visits a new hospital, the covering doctor can access that patients past record and in so doing provide him with better care. However, as one could envisage, this raised a great number of apprehensions with respect to the privacy and confidentiality of people's medical records. So the legislature created a fundamental list of rules and regulations with which health care providers must comply. And the creation of these rules and regulations gave birth to the industry that is called HIPAA Compliance.

To ensure HIPAA compliance, there are certain key provisions, which need to be followed. For instance, individuals should be able to access their records and request correction of errors. Also, they should be informed about how their personal information will be used. The 'protected health information' (PHI) indicates that the information cannot be used for marketing purposes without the clear consent of the patients in question. People should be able to ask their covered entities (which maintain PHI about them), to ensure that their communications with the patient are confidential. It should be possible for people to file formal privacy-related complaints to the Department of Health and Human Services (HHS) Office for Civil Rights. Covered entities should document their privacy procedures, however, they have discretion on what to include in their privacy procedure. They are required to designate a privacy officer and train their employees. Covered entities can use an individual's information without the individual's consent if the purpose is to provide treatment, obtain payment for services and to perform the non-treatment operational tasks of the provider's business. Some of the agencies, government bodies and individuals who can access the medical records of a person under HIPAA compliance rules are the insurance companies, employers, courts, hospitals, or individual physicians. This is also considered as a downside of the HIPAA Privacy rule because sponsors of a research study; makers of drugs for the particular study and the researchers involved in the study are included in this list.

However, the ultimate objective of HIPAA is to increase the efficiency and effectiveness of health information systems through improvements in electronic health care transactions as well as to maintain the security and privacy of individually identifiable health information.

Mansi gupta recommends that you visit HIPAA and privacy for more information.

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Monday, December 3, 2007

Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

 
Health Insurance; COBRA; OBRA; HIPAA; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: medical insurance coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health insurance coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have ENOUGH coverage.

1) From your Human Resources Department (or wherever else you would go to get information about your health insurance) get what is called a "Summary Plan Description" (SPD). This document should be kept where you can always find it, as it contains all the information you will need about what your insurance covers and what it doesn't.

2) Look up "Coverage" and "non-coverage" in your SPD.

These will tell you what your plan covers and doesn't cover. You need to see if, perhaps, you or one of the covered members of your family has a condition or circumstance that might not be covered, where you need additional coverage. For example, let's say that your family has a history of cancer; perhaps your plan restricts the number of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get additional "cancer insurance" (I think that AFLAC might provide this type of coverage).

It would be a good idea to contact a Health Insurance benefit Broker and ask him/her to read your SPD and see if you have any gaps in coverage. They then can help you supplement coverage BEFORE YOU NEED IT!

NO HEALTH INSURANCE COVERAGE

You might be one of the growing members of our society that, through one circumstance or another, does NOT have health insurance coverage for your family. In this case, I strongly encourage you to contact a Health Insurance Broker and get immediate coverage of what is called "catestrophic" (not sure if I spelled this correctly) coverage. In this type of coverage, you will generally have large deductibles, but will have coverage if, say, one of you has to go into the hospital.

CONTACTING A BENEFITS INSURANCE BROKER

Whenever you call or email a Health Insurance Broker, it is very important to prepare ahead of time. WHAT, specifically are you looking for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your critical needs.

COBRA

COBRA is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, generally 18 additional months.

1) COBRA is "triggered" (that is, you, or a covered member of your family, become eligible for COBRA) by events such as the following: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a spouse; a covered chile's birthday makes them ineligible for coverage. These are the main "triggering" events for COBRA.

2) Now, when eligible for COBRA, you will be asked to pay for 100% to 105% of the company's employee/employee and family coverage amount. You should get a letter from your company explaining what that amount will be. BEFORE YOU DECIDE TO TAKE COBRA, there are some important things for you to consider.

What will be your cost, and what will be the coverage for that cost? Sometimes the cost is too much for the coverage. In these cases, you might want to select HIPAA coverage, instead (see HIPAA below).

Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.

Part of this decision should be whether or not you or a member of your family has what is called a "pre-exisitng coverage" condition.

Here again, before automatically taking COBRA, it would be wise to contact a Benefits Insurance Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits Insurance Broker, and he is absolutely fantastic!

OBRA

What, you ask, is OBRA? I've never heard of it, you say, and no one I know has heard of it either! Well, that's because, 99% of Human Resource or Benefit folks that I know have never heard of it! OBRA is a federal law that was passed that extends COBRA for an additional 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is this important? Thanks for asking, let's see if I can explain.

If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started looking to bridge my health insurance from working to Medicare, I assumed that when I got through all of the hoops to qualify for SSDI (Social Security Disabililty Insurance) I'd IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, you have to wait for 5 months before you get your first check. AND, the rules state that, you are eligible for Medicare 2 years (24 months) FROM THE DATE OF YOUR FIRST SSDI PAYMENT. Well, if you add 24 + 5 you get, 29 months between qualifying for SSDI, and Medicare coverage.

OK, I said earlier that COBRA is for 18 months of coverage. Well guess what 18 months of COBRA + 11 months of OBRA equal - 29 months!

BUT, there are two catches to OBRA; first of all, you have a small window of 30 - 60 days to apply ( this window opens the date of your SSDI approval); and, it can cost up to 150% of your plan coverage amount. BUT, if you have a "previously existing condition" this might be the best way for you to proceed.

Again, it is important to contact a Health Insurance Broker to help you with the risk/cost ratio of all of these situations.

It is also improtant to know all of these deadlines as you plan to ensure that you and your family have important health insurance coverage.

HIPAA

HIPAA is a federal law that is called, briefly, the "portability" law for health insurance. What that means is that when you leave a group (read company-paid plan), the carrier that provided that plan, must offer to you, another plan, different from COBRA, when you leave the group coverage. Generally this will be what is called a "bare bones" plan. Again, the best thing for you to do is to call/email a Health Insurance/Benefits Broker with all of your information: SPD, COBRA info, HIPAA info, needs, cost limits, and let him/her help you find the optimum plan coverage for you.

MEDICARE

OK, now, finally, we've reached Medicare! BUT (you really didn't think it would be that easy, did you?) if you have qualified for Medicare because of disability, there are RESTRICTIONS (of COURSE there are!).

First of all, if you are qualifying for Medicare because of disability, you are probably under the age of 65 - normal retirement age.

Medicare coverage does NOT cover prescription drugs, which, those of us with disabilities probably need, and which cost lots.

But, Congress prescribed that states (all but 11) offer what is called "Medicare supplement" plans, some of which do offer prescription coverages. BUT, these plans ARE NOT REQUIRED TO, and do not, offer these medicare supplement plans that offer prescription coverages to folks who qualify under age 65! So, if you are qualifying because of disability, your medical insurance plan doesn't cover one of your primary cost expenditures!

Here again is where you need to contact a health insurance/benefit broker. Again, he/she can work with you, and your specific circumstances, to get you the coverage you need.

Hope that this information was helpful to you. If you have any questions, please feel to ask them by commenting on this blog, and I'll be happy to get you an answer.

About Disabilitykey.com & Carolyn Magura:

Disabilitykey.com is a website designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with disabilities.

Carolyn Magura, noted disability / ADA expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her “full salary” while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click here to receive Carolyn 's easy-to-read, easy-to-follow direct guide through this difficult, trying process. If you are disabled, don't let this disabiling process

 disable you. Read Carolyns Disability Key Blog.

 

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