Illinois guaranteed health insurance plan for pre-existing conditions

Effective Today!!
Illinois will start taking applications for health insurance coverage for individuals who meet the below eligibility requirements:

1. Must be a state resident
2. Must have been uninsured for at least 6 months; and
3. Have a pre-existing medical condition.

For more info on the plan please visit http://bit.ly/new_state_plan

A few simple facts on the plan:

• $2,000 annual deductible
• You then pay 20% until an additional, $2,350 is spent in additional out-of-pocket expenses
• Rx will be covered at 80% to a maximum out-of-pocket of $1,600 to the insured being paid at 20%

The Network of providers in Cook County is Health Link, http://www.healthlink.com/home_participant.asp

You can access a list of doctors and hospitals from this link.  you will want to click the network, "State of Illinois Plan"

Please contact The Shoppe with any questions.

-The Shoppe

Prescription Drug Coverage with Health Insurance

If you are looking to purchase health insurance coverage and are currently taking prescription medications (Rx), then this blog will explain how the most competitive carriers The Health Insurance Shoppe represents will cover your prescription medication.

If you are currently insured (privately) than this will help explain your current prescriptions benefits.

Before I go into explaining how each carrier provides benefits, it is important to note, that as long as there is not an exclusion rider on your plan than you will never pay the retail cost of the drug.  When you purchase prescriptions at a participating pharmacy within your plan you are to pay the negotiated (discounted) rate.  If your plan does not have a copay for prescription drugs then it is best to shop around with local pharmacies to see who has the lowest retail cost and accepts your health insurance.

The second thing to note is all carriers mentioned below, except Humana, will not cover prescription medications for the first year of the plan if they were being used within the 12 months prior to application.

Blue Cross and Blue Shield of Illinois (BCBSIL)


All plans other than the SelectBlue, SelectBlue Advantage and BlueChoice Select with a $500 or lower deductible will require you to pay the negotiated rate of your prescriptions towards your plan deductible.  Once you satisfy the plans deductible you will begin to pay 20% on the negotiated rate towards your plans out-of-pocket expense limit.   Once the plans out-of-pocket expense limit is met the insured will continue to pay 20% The only plan offered by BCBSIL that will begin to cover prescriptions at 100% after the deductible is satisfied, is the BlueEdge HSA with 100% coverage.


The first 3 plans mentioned with a $500 or lower deductible will provide an upfront $10 copay for Generics and will require the member to pay 35% on the negotiated rate for Preferred Brand name drugs and 50% on Brand Name drugs.  The total paid would not apply to the plans deductible.


Aetna


Other than HSA qualified plans, Aetna will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $30 copay on Preferred  Brand drugs and a $60 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Aetna may increase your premium to take on the cost against risk.


Humana


Other than HSA qualified plans, Humana will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Humana may increase your premium to take on the cost against risk.


United Health Care (UHC)


Depending on the health insurance plan, UHC will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $250-$1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Celtic


Other than HSA qualified plans, Celtic will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $70 copay for Brand Name drugs.  The copay paid will not apply to the plan


Hope this information helps in making a decision towards purchasing a plan of coverage.

Please call with any questions.

-The Shoppe

Dental Insurance

The Shoppe has been receiving a lot of inquiries in the past couple of months on stand-alone dental insurance.  Stand-alone is coverage that does not need to be purchased at time of acquiring a health insurance plan.

Plan can range from $14-$38/month (for single coverage) and range from HMO to PPO plans of coverage.

What does Dental Insurance cover?
Dental insurance will cover your preventative care which is two annual cleaning and X-Rays that come with.  As long as your dentist accepts your dental insurance you would not owe anything for these services.

Preventative will be the only immediate benefit and you will be subject to a 6 month waiting period for Basic Services and a 12 month waiting period for Major Services.

After the waiting periods you would only be able to receive anywhere from $1,000 - $1,500 at the most in annual benefits, payable by the insurance carrier.

Basic Services
All Basic Services will be subject to a 6 month waiting period other than dental coverage with BCBSIL that must be acquired with a plan of health insurance and begins at $26.55/month for single coverage.  Basic Services include:

• Fillings, resin or amalagram
• simple extractions (not wisdom teeth)

After the waiting period these services are typically covered at 50% or 80% by the insurance carrier with benefits payable to the plans maximum at the negotiated rate of service if in-network or up to the maximum allowable amount if services are rendered at a non-participating dentist.

Major Services

All Major Services will be subject to a 12 month waiting period other than dental coverage with BCBSIL as mentioned prior.  Major Services include:

• Endodontics (root canal / therapy)
• Periodontics (gum surgery / oral surgery)
• Crowns
• Bridges
• Dentures

After the waiting period these services are covered at 50% by the insurance carrier with benefits payable to the plans maximum.

The thought process to getting coverage is that you are paying a premium to receive services after a 6 - 12 month waiting period, but at the same time will receive cleanings at no cost.  If your teeth are in good condition and you maintain cleanings annually or semi-annually than your cost for the cleanings will be lower than the cost of the dental insurance premium.

If you are planning on having basic or major services done in the next 6 months, than dental insurance will not be a benefit unless you acquire a health insurance plan with BCBSIL and elect their dental coverage which does not have waiting periods.

The final thing to note is whether or not your dentist, endodontist or periodontist accept dental insurance.  If they do not, than  it will not be a benefit to obtain dental insurance for the payouts will not be worth the premium paid.

For questions on stand-alone dental coverage please call The Shoppe.

Thanks,

The Shoppe