Top 3 Differences Between Carriers

Each carrier the shoppe represents has their own place in the market, behind monthly premiums.  Below are the 3 key differences per carrier the shoppe represents.

BCBSIL

1. ER is offered at 3 coverage levels, dependent on plan  to either cover the bill 100%, waive the deductible, requiring the insured to pay 20% or subject the bill toward the plan deductible (HSA plans)
2. There are no prescription copay's unless a $500 or lower deductible is selected to then receive a $10 copay for generics.  All other plans have the insured paying the contracted rate towards the plan deductible to then be covered at 80% or 100% once satisfied
3. 12 month waiting period for pre-existing medical conditions; waived if insured has 12 months of credible coverage with another BCBS plan

Humana

1. ER is subject to the plan deductible with optional SAB benefit to be purchased which will reduce ER bill by $1,000 or $2,500, and will only reduce for accident, not illness
2. All plans other than HSA provide an immediate $15 copay for generic drugs and have a separate $500 and higher prescription drug deductible that the insured pays the contracted rate towards for Preferred and Brand Name drugs before copay's are received
3. Waives the 12 month pre-ex waiting period for conditions that are disclosed on application, leading to a possible premium increase to cover risk from day one of coverage

UnitedHealthCare

1. All plan deductibles, no matter the plan, are considered "decreasing"...meaning that each calendar year the deductible has not been met it will reduce by 20%
2. Many optional benefits such as SAB rider, lower prescription drug deductible and limited office visit copays (to reduce premium)
3. Waives the 12 month pre-ex waiting period for conditions that are disclosed on application, leading to a possible premium increase to cover risk from day one of coverage

Aetna

• 90% of the time, Aetna will be the most expensive in plan premium
• Aetna does not place condition specific exclusion riders and will increase premium to cover medical risk
• 12 month waiting period for pre-existing medical conditions to be waived if insured has prior credible coverage for 12 months, not carrier specific

Celtic

• 80% of the time, Celtic will be the lowest in monthly premiums for applicants 19-35 years old
• Limited office visit copay plans
• After 1st year of coverage, plan will renew semi-annually

Assurant

• 90% of the time, Assurant will be the most expensive in plan premium
• Offers 3 networks to choose from to reduce monthly premium
• Non HSA plans start with a $700 facility fee copay in addition to the deductible that does not apply to the plan

I hope this has been helpful.  Please contact the shoppe with further questions.

Sincerely,

Jordan

Contraceptive Coverage for Women, effective 8/1/2012

This week the U.S Department of Health and Humana Services (HHS) announced that new health insurance plans that are in compliance with The Affordable Care Act (ACA) must provide contraceptive coverage to females at 100% with no cost obligation.


New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012.  The rules governing coverage of preventive services which allow plans to use reasonable medical management to help define the nature of the covered service apply to women’s preventive services.  Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.

For more information on the HHS guidelines for expanding women’s preventive services, please visit:http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. The guidelines can be found at:www.hrsa.gov/womensguidelines/.

To learn more about the Affordable Care Act, please visit www.healthcare.gov.

-The Shoppe