Pre-existing Conditions

Healthcare Reform and Plan Options

By Thomas Cazneau

Many changes will be made within America’s healthcare system starting January 1, 2014. By
then, all American citizens and other legal residents must obtain medical coverage or else pay a penalty. This is due to the Affordable Care Act, which was upheld by the Supreme Court.
Although there will be a few exemptions to this mandate, most of us will be affected by
Healthcare Reform.
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How Health Care Reform Could Affect You

By Thomas Cazneau

The Supreme Court’s decision to uphold the Affordable Care Act could have varying effects on Americans. Below is a summary of how health care reform could affect you, your family, or your business. For details, click Health Care Reform: Your Options Now and in 2014.

The Uninsured
One of the main mandates of the Health Care Reform is that, starting January 2014, most Americans and legal residents must obtain medical insurance. Affordable Care Act the UninsuredOtherwise, those who are uninsured will receive a penalty of $95 for one person or $285 per family or 1% of the income, whichever amount is greater. By 2016, the Health Reform penalty would go up to $2,085 per family or 2.5% of the income. For large companies of 50 employees or more, the penalty is $2,000 after the first 30 employees. Small businesses (less than 50 employees) are not required to offer health benefits.
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Health Care Reform: Where do we go from here?

Health Care ReformBy Esmeralda Mercado

In one way or another, all Americans are impacted by the Supreme Court’s decision to uphold the Affordable Care Act. So, where do we go from here? How do we plan and get ready for changes, good and bad? Here are some ideas of things we can do now, before health insurance becomes mandatory, and things we can plan for in 2014.

There are many reasons why people change Health Insurance Plans.
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Options after a Health Insurance Denial

Health Insurance Denied
By Angie Perez

What do I do if I’ve been denied health insurance? Where can I go? Who will insure me? What are health insurance company’s requirements for someone looking for coverage? Do I qualify for coverage if I have a preexisting condition? If I’ve been denied for health insurance before, will I be denied again? All of these questions go through most shoppers’ minds as they begin the process of looking for insurance. Look no further; you will find all the answers to these questions by the time you have completed reading this little article. For information about your other options for medical coverage, click What to Do if Your Health Insurance is Denied.

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Health Insurance Denials: When One Door Closes, Look for Other Open Doors

What to do when you're deniedPresently, insurance companies can still deny medical coverage to adults, based on their health status. This will change in 2014 when the Affordable Care Act law that prohibits denials due to pre-existing conditions is fully implemented. For now, only children under age 19 are protected by the mandate.


A Mother’s Story
Recently, a parent shared her adult sons’ frustrations in trying to get health coverage with Kaiser Permanente. Debra’s son was born at Kaiser Permanente and had been a member for well over 25 years. He was covered under his parents’ group insurance but was cancelled when he reached the maximum age limit for dependent coverage. When he tried to get his own Kaiser individual health plan, he was denied due to all the prescriptions he was taking. Per Debra, “(My son) was taken care of by Kaiser for several years… you helped him through things. Now that he has to get his own plan, you refuse to let him be a patient for something that has been ongoing for numerous years. What has happened to Kaiser Permanente? The more money you get, the worse you have become! It looks like discrimination by an insurance company that had this person as a member his whole life and now you’re too good for him?! Shame on Kaiser and whoever it was that sent my son that degrading letter!”
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How I Sell Health Insurance – 3 Common Scenarios

As benefit specialists for Kaiser Permanente affordable medical insurance, the role of our health insurance agents is to understand the personal medical care needs of guests and to educate them on the options that best fits their situation so that they can make an informed decision in selecting the plan that’s right for them, their family, or their business. Below are some common scenarios that come up frequently and the plans or resources that are often recommended. Perhaps, you will find answers to your own situation in one of these examples.
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Kaiser Colorado Health Insurance for Children

Currently, a child under age 19 can obtain private health insurance through Kaiser Permanente by applying in one of two ways:
• Under a family application with at least one parent, or a legal guardian.
• On a single subscriber basis if there is a qualifying event.

During the month of August 2011, Kaiser Permanente will accept child-only applications even if there is no qualifying event. During this open enrollment period, child-only forms received in August will be approved for an October 1st effective date. If you are interested in enrolling your minor during the open enrollment, be sure to submit the application in August as it will be rejected if it is received before or after August, unless there is a qualifying event.
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Pre-Existing Conditions and Kaiser Permanente

With the exception of children younger than 19 and adults who are seeking group health coverage, people with pre-existing health conditions can still be denied for private medical insurance. The eligibility criteria varies according to each insurance company, but basically, underwriters are looking for health issues that are recurring, chronic, or severe.

High risk medical conditions commonly result in ineligibility for private health care. Other issues that could potentially result in non-approval would be behavioral disabilities, a worker’s comp injury where the claim is still open, and being an expectant mother or father. Other situations where a person could be denied would be silicone breast implants, being at an unhealthy weight for your height, heavy or frequent alcohol or tobacco use, taking illegal drugs, or having a prescribed medical procedure or treatment that has not been taken care of. Read more »