Trips to either an urgent care facility or Emergency Room can occur much more often in families with kids active in sports.  Sprained knees, fractured wrists, and concussions are just a few of the injuries that can happen to active kids.  In the event of a head injury, the cost to run tests such as a CT Scan and MRI can run between $1200 and $4000.  With almost all insurance policies, these costs will be considered out-of-pocket expenses and will be applied to the deductible and coinsurance.

We recommend that our clients consider an Accident/Injury policy to supplement their major medical plan, especially if they carry a high-deductible plan.  This policy will cover up to $10,000 after a $100 deductible.  Most people are very suprised to find out how little these plans cost.

 A recent email message from my son’s flag football league alerted me to some  relevant statistics:

“Most of the recent fervor surrounding concussions and sports-related brain injuries has been focused on football, but new studies suggest heading in soccer may be just as dangerous. The past 10 years have seen a disturbing trend in youth sports-a dramatic rise in the number of sports-related concussions. According to a recent report from the American Academy of Pediatrics’ sports medicine council, ER visits for children 14 to 19 years old tripled from 7,000 in 1997 to 22,000 in 2007. Visits among children 8 to 13 doubled from 3,800 to 8,000.”

I allow my boys to play rough.  So, I am not suggesting that we avoid all sports and activities that can result in injuries.  However, it is comforting to know that if an injury does happen (to anyone in my family), we can have all the necessary tests done and get excellent medical care  – and never pay more than $100.

There are some exclusions for very hazardous activities. Please call for more information.

Greg Sanders                 Peachtree Insurance Advisors                  www.insuranceAdv.com

I have had numerous clients with total cholesterol readings well above 220 (the highest acceptable level for many carriers).  Many of these clients were advised by their doctors or healthcare practioners to lower their cholesterol by diet and exercise.   They were cautioned about the potential negative side effects of cholesterol lowering medication in many cases.  However, the life insurance carriers would not look favorably on total readings above 220, even if the applicant was seeing great results with their “alternative” regimen. 

The total cholesterol reading is not the only factor underwriters consider.  Traditionally, underwriters have focused on two specific measures with respect to cholesterol: total cholesterol and the cholesterol/HDL ratio. Having a high reading for either measure would often result in the client receiving a higher rate. 

There are now two carriers who will look at only one measure: the cholesterol/HDL ratio, regardless of the total cholesterol number. 
 
Individuals with cholesterol/HDL ratios up to 5.0 can potentially qualify for Preferred Best rates.  Those with ratios up to 7.0 can qualify for Preferred rates – even if they are on medication!     

Even if one’s total cholesterol reading is 300, it is still possible to qualify for the Preferred Best rate!

Carriers are now more willing to look at the “entire picture” when considering applicants.  I had a client — 9 years ago — who was forced to accept a Standard Plus offer because his total cholesterol was 290.  His doctor told him it was a hereditary issue and not to worry.  This client was extremely active and healthy.  His father (French Canandian) and his grandfather had a history of high total cholesterol, but they were very healthy and never had heart disease.  Despite these facts, the life insurance underwriters wouldn’t budge from their guidelines.

Today, this client would receive a much better rate class and would save over 25% on his premium. 

Greg Sanders    Peachtree Insurance Advisors   678-236-1600    www.insuranceADV.com

The Pre-Existing Condition Insurance Plan was created to make health insurance available for those that have a problem getting insurance due to a pre-existing condition.
 
Web site:  https://www.pcip.gov/
 
The ability to apply online or over the phone is available on the web site.  You can also call our office for applications and a Benefits Summary.
To be eligible for this coverage:
You must be a citizen or national of the United States or lawfully present in the United States.
You must have been uninsured for at least the last six months. This includes High Risk Pool Coverage and insurance coverage that may only exclude coverage for a pre-existing medical condition.
You must have had a problem getting insurance due to a pre-existing condition.

Pre-Existing Condition Insurance Plan: Georgia Pre-Existing Condition Insurance Plan Run by the U.S. Department of Health and Human Services in GA

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods.
The monthly premiums for your Georgia are:
Age:    00-34        35-44         45-54       55+
             $323          $387          $495        $688

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network.

If this doesn’t sound too great, then there are other options available in Georgia.   Please call us for an assessment of your situation.

Peachtree Insurance Advisors       Greg Sanders         678-236-1600    www.insuranceADV.com

Information about this insurance program is available at www.healthcare.gov or at www.pcip.gov

Although there is still some mystery surrounding the new High Risk Pool, it is official as of today — July 1.  Yesterday, I was checking out the site and there were lots of kinks.   For example, I clicked on the application link for the Federal High Risk Pook and the Oregon application appeared.  I clicked on the Georgia option and got nowhere. 

Today, however, I clicked on Georgia and found the following:

 Unless the lab results indicate an unknown health condition such as high liver enzymes, there shouldn’t be surprises.  A knowledgeable advisor will gather all the  health history and other pertinent information before shopping the market.  Carriers have different underwriting guidelines, so one company might offer the “preferred best” rate while another only offers “preferred” for certain minor conditions. 

However, some people don’t qualify for the best rates — with any carrier — due to factors such as height/weight, tobacco use, high blood pressure, etc. 

A good agent will let you know if there is any chance you can qualify for a better rate by shopping with other carriers.  When the lab results, paramed exam and doctor’s records have already been obtained, it is much easier to shop with other carriers and get firm offers from the Underwriters at those carriers.

If a better offer isn’t possible, then it is important to find out the process for lowering rates in subsequent years.  For example, if someone  receives a rate that is 20% higher due to slightly elevated cholesterol numbers, a plan for action is called for.  Many carriers will offer a better rate after one’s cholesterol is controlled for at least 6 months.  However, they might not lower the rate until the first policy anniversary.  It is also possible to get a better rate for losing weight and maintaining a lower weight for at least one year.

It can be important to find out this information prior to accepting an offer from a life insurance carrier.  Some carriers make it nearly impossible to qualify for better rates without completely reapplying.  Other carriers have a simple, streamlined process.  An experienced life insurance agent will be able to readily access this information.

One more note about unfavorable underwriting decisions.  Some people are inclined to wait until they are eligible for the better rates.   It is always best to get some insurance — even if it means shortening the term length or lowering the face amount.   If one’s health takes a turn for the worse it could result in becoming uninsurable before reapplying.

Remember — purchasing life insurance is really about protecting the ones you love. 

Greg Sanders — Peachtree Insurance Advisors — www.insuranceAdv.com — 678-236-1600

 This advisor had been working with a medical doctor, attempting to help her with her health insurance needs.  After spending some time preparing quotes and discussing benefits, she realized that her client needed special attention.  Like many financial advisors, she did a very limited amount of health insurance business and only represented a few carriers.  When this doctor peppered her with questions about networks, pre-existing conditions and benefits, she couldn’t adequately address her concerns and felt her client would be better served by an expert.  

After receiving a call from the advisor explaining her predicament, I then called this doctor to pick up on things.  I was able to quickly assess her situation, perform medical underwriting pre-screens, and zero in on her best options.  Since she took two generic medications to control her blood pressure and cholesterol, she wasn’t thrilled with the idea of paying additional premium to cover these conditions.  She was open to a higher deductible plan that would save her money.  Without getting into the details, suffice it to say that we found a carrier and a plan that suited her needs perfectly. 

The best part is that I was able to call her this morning (one week after she applied) and tell her that her application was approved with no exclusions and no rate-ups. I also called the financial advisor to share the good news and thank her again for the referral.   I really enjoy making those phone calls and seeing my clients happy about the decisions they made.

According to an article in Newsweek , “physicians estimate that 35 percent of diagnostic tests they ordered were to avoid lawsuits, as were 19 percent of hospitalizations, 14 percent of prescriptions, and eight percent of surgeries, which amounts to some “$650 billion in unnecessary care every year.” 

The health care reform legislation didn’t address tort reform, so this is still an area that is contributing to the extemely high costs of health care.  Overall, the health care reform legislation will do very little  to reign in medical costs.  In fact, these costs are expected to rise considerably over the next few years.  Taking charge of your health care — rather than always assuming the doctor knows best —  is very important these days.

As a policyholder, it is important to understand why certain tests are ordered.  Unless you want to get saddled with unnecessary bills, make sure your doctor explains why each test, each prescription, and each surgery is needed.  Also, if a doctor recommends a hospital stay “just to be safe”, make certain you understand the pros and cons of choosing another course of action.  It may just be easier and “safer” for the doctor, however, for you it may be an inconvenience and a HUGE expense.  Keep in mind, doctors admitted that almost 20% of hospitalizations were recommended to protect themselves — not their patients! 

We do everything we can to help our clients save money and make smart decisions about their health insurance. In addition to becoming “insurance smart”, becoming more informed about your health care will improve both your physical and financial health.

Greg Sanders — Peachtree Insurance Advisors — 678-236-1600 — www.insuranceADV.com

As an independent agent, I received several offers to represent Imerica, but I decided not to do it.  I only purchase insurance from “top-tier” carriers and that is what I advise my clients to do as well.   A company must have strong financial ratings, not only from AM Best, but from other independent rating agencies. 

It is always best to carefully consider a company’s financial strength when purchasing an insurance product — whether it is life, health, long-term care or disability insurance.   Always ask about an insurance company’s financial strength, history and outlook. 

Greg Sanders — Peachtree Insurance Advisors — 678-236-1600 — www.insuranceadv.com

Carriers will often require proof such as rent or mortgage payments, utility payments or employment.   A few carriers require one year of residency in the U.S and one carrier (Humana) requires two years.  Suprisingly, there is only one carrier that does not require a minimum period of residency.  This carrier recently changed the requirement to make it more favorable to non-U.S. citizens.  They only require a Green card or a visa, and the applicant must plan on living in the U.S. for at least one year with no extended travel (more than 3 months).

Some carriers will rquire established care with a US physician and a recent physical.  These requirements vary according to each carrier.

Of course, there are options to obtain coverage immediately for those moving to the U.S.  and want coverage before they find a place to live or establish residency.   International coverage can be applied for through several reputable sources.  The company offering international major medical insurance that we have found to be the best is HCC Medical Insurance Services, A Lloyd’s Coverholder.  Quotes can be obtained at  http://www.insuranceadv.com/content.asp?c=297&ID=906

Whatever the situation, we have done the homework and know the eligibility requirements for ALL the major carriers in Georgia.  I often hear people say, “I was told I would be declined by every carrier because I have X condition.”  Well, the agent probably checked with a few carriers and gave up after three or four of them said “decline”.  For example, almost every carrier will decline diabetics.  The operative word is “almost”, since there is one carrier that will offer coverage in many instances. 

It is important to work with an agent who represents all the major carriers and is familiar with underwriting guidelines.  We do extensive work on the front end — called medical prescreens.  If an applicant has multiple health issues, we will check with the carriers first and then advise our clients as to the best course of action.  This results in a very high acceptance rate.

Greg Sanders — Peachtree Insurance Advisors — www.insuranceADV.com — 678-236-1600

A recent News Flash from Blue Cross Blue Shield of Georgia highlighted this overlooked aspect of children’s health.  The following excerpt demonstrates the importance of vision exams:

“According to the Vision in Preschoolers Study, the National Institutes of Health, the National Eye Institute and NEI Clinical Studies, vision problems are the fourth most common disability in the United States, and one of the most prevalent conditions in childhood. In addition, the American Public Health Association (APHA) recently reported that one-in-four children in kindergarten through sixth grade has visual disabilities that affect their ability to learn. Some studies indicate that 80 percent of learning in children occurs visually; yet 86 percent of children do not receive a vision exam during these formative years. ”

There are many ways to have vision exams done at reasonable  costs — with or without vision insurance.  As the father of three young children, my wife and I have looked into vision coverage extensively.   One of our children had a problem focussing while reading books.   We discovered that he had a problem with eye teeming.  That has since been resolved through a computer program designed to improve eye teeming. Our son is now doing great! 

I have also found some good low-cost options for many clients over the years. 

Greg Sanders  678-236-1600 

www.insuranceADV.com