2018 Projected Health Insurance Changes

We wanted to give you an initial taste of changes coming for 2018 individual health insurance plans, which is about as fun as going to the dentist when you have a sore tooth.

First of all, any changes going through congress right now are not projected to impact 2018 plans since health insurance carriers have already submitted their plans and rates, but you never know. Most likely any changes would be for 2019 or 2020 plans.

2018 Overview

The carriers have told us that the core structure of their plans are going to stay the same for Gold, Silver and Bronze plans, yet the prices will be going up (as usual). Most other aspects should stay the same…except the increasing prices.

For most people the ONLY option will be buying through the WA Exchange, as those in King, Snohomish and Pierce counties won’t be able to buy a plan direct from the carrier.

The PPO plans with “In-Network” coverage outside of Washington State are going away, yet there will continue to be the Emergency Network if you have a major medical issue while out of state. For those that intend on being outside of WA for more than 6 months really should get a plan in that other state or country.

If you live in Klickitat or Grays Harbor county there are no proposed plans. If none of the carriers step in those people would be offered a plan through the WA High Risk Pool.

2018 Health Insurance Carriers

  1. Regence has decided to pull out of MOST of Washington State (will be in a few Eastern WA counties).
  2. Kaiser Permenate (formerly Group Health Cooperative) will have HMO plans only.
  3. Molina lost a lot of money in 2016. It seems like their plans will stay the same at this time yet be prepared for larger increases since they were the cheapest in 2017.
  4. Premera and LifeWise are quite expensive in 2017 and will probably be about the same upper price for 2018.
  5. AM Better will have similar narrow networks.

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

 

Accident Prone? Get a Plan to Cover your Deductible!

If you are accident prone, often get injuries, or simply participate in activities where you could get hurt this is plan was made specifically for you, really it has your name on it!

Many people meet their Health Insurance Deductible and this is a way to get those bills covered. It’s a simple way to get reimbursed once you have had medical expenses due to ONLY an accident.

By now you already know if this plan is a good fit for you, or someone in your family. So give us a call after giving this blog a quick read.

Call for a Quote at 425-802-2783 or

Click here to Email health@achieve-alpha.com

This Accident Plan is a direct reimbursement plan that is not linked to a health insurance plan, so it will pay up to the policy maximum.

Due to the increasing prices of health insurance more people are getting a Bronze plan, yet being exposed to a $6,000 Deductible is a bit scary. This solution would help ensure that in an accident you would have extra financial protection. However, it will not cover ongoing illnesses, sicknesses, medications, or cancer. It’s only for those NEW acute injuries or accidents.

To be very honest, this Accident Plan with AIG is the best bang for the buck in Washington State, yet not an immediate payout structure like Aflac. They pay out quicker, yet often their coverage is more limited and more expensive (yes you read that correctly). They have more overhead from TV ads (which you pay for). If that is what you want then go right ahead. There is no such thing as one best company, it’s which one works best for you!

Example AIG Accident Policy Quote

Accident Plan Coverage Examples

Sporting events are another activity where an accidental injury may occur. A baseball pitcher who develops a rotator cuff injury during the act of pitching would not qualify as an accidental injury. However a batter who is hit on the wrist by a pitch, which causes a fracture, has sustained an accidental injury. Joggers who develop ligament strain and tears during the course of their running routine have not suffered an accidental injury. However, if they misstep off a curb and fracture their ankle they have suffered an accidental injury. Clearly the demonstration of the “accidental” event within the course of normal participation in an activity can be made and an injury associated with that event would be covered if “care” as defined within the terms of the policy contract is provided.

Dollar-for-dollar reimbursement for:
• Emergency Room
• Hospital
• Urgent Care Center
• Surgery
• Diagnostic Exams
• X-rays
• Physical Therapy

Here is an overview of the rules:

  • Initial care must be received within 72 hours (3 days) of the accidental injury.
  • Accident Emergency Care Benefit: such treatment or attention must be received from an Emergency Room, Hospital, Urgent Care Center or Physician’s office and in the United States.
  • Accident Follow-up Care Benefit is also covered, up to three visits which must be completed within 30 days of the accidental injury or discharge from the hospital. Outpatient surgery is covered as one of the three visits under the Follow-Up Care Benefit.
  • Fractures sustained as a result of a covered accidental injury must be diagnosed within 14 days of the accidental injury.
  • One Major Diagnostic Exam per accidental injury will be covered if completed within 14 days of the accidental injury. Major diagnostic Exam is limited to: CT Scan, MRI, or EEG (electroencephalogram).
  • Physical Therapy visits received as a result of an accident as prescribed by a physician, rendered by a physical therapist must begin within 30 days of the accidental injury or discharge from the hospital.
  • X-ray covered due to an accidental injury if completed within 14 days of the accidental injury.

CLICK HERE FOR SIGNIFICANTLY MORE DETAILS

Talk to you soon!

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

Details about Accident Plan

Below are additional details that is good to know about the Accident Plan…

Click here to return to the Main Page on the Accident Plans

Technical Details of the Accident Plan

An ACCIDENT means the unforeseen occurrence of an event that results in an accidental injury to an insured person wholly independent of disease, bodily infirmity, illness, infection or any other physical condition.

An ACCIDENTAL INJURY means a bodily injury to an insured person as the result of an accident, after coverage under this policy takes effect and while this policy is inforce, which results in care within 72 hours (3 days) after the injury is sustained. The following are examples that help describe the difference between an injury and an accidental injury.

How to File an Accident Expense Claim

The claims process begins when you contact the Customer Service Center to request health claim forms. This may be done via their Customer Service phone number (800) 811-2696. You MUST complete the form and submit it, along with any documentation, including Explanation of Benefits (EOB), to the address provided. After receiving all required documentation, they will begin review of the claim. Normal processing time is 10 business days from receipt of all required documents.

Accident & Health Claims – 800-811-2696

ACCIDENT FOLLOW UP CARE BENEFIT: Follow-up treatments are limited to three follow-up treatments. The follow-up treatments must occur within one year of the Accidental Injury or discharge from the hospital, and must be furnished by a Physician in a Physician’s Office or in a Hospital on an outpatient basis. Benefit NOT payable for the same visit that the Physical Therapy Benefit is payable or on the same day for which the Accidental Emergency Care Benefit is payable.

AMBULANCE BENEFIT: Benefit only payable if Accidental Emergency Treatment Benefit is payable
DRUG BENEFIT: Benefits for drugs administered in a Hospital or Urgent Care Center.
FRACTURE BENEFIT: Diagnosis of the Fracture must be within 14 Days of the Accidental Injury.
MAJOR DIAGNOSTIC EXAMINATIONS: Benefit is limited to one Major Diagnostic Exam per Year for each Insured Person. Major Diagnostic Exams are limited to a CT Scan, MRI or EEG (electroencephalogram).
PHYSICAL THERAPY BENEFIT: Physical Therapy must begin within 30 days of the Accidental Injury or discharge from the Hospital and must be completed within six months after the Accidental Injury. Benefit is limited to one Physical Therapy treatment per day, up to a maximum of ten treatments for each Accidental Injury.
PROSTHESIS BENEFIT: Benefit limited to a maximum of one Prosthetic Device received within one year of the Accidental Injury.
X-RAY BENEFIT: The x-ray or set of x-rays must be performed within 14 days of the Accidental Injury.

Insurance Company Legal Mumbo Jumbo
Here is a description from AIG about making sure actual accidents are covered and how they avoid fraudulent claims.

“We reserve the right to request that a Physician of our choice review any Diagnosis in the event of a dispute or disagreement
regarding the appropriateness or correctness of a Diagnosis. We also reserve the right to require that an Insured Person submit to
an examination to confirm a disputed Accidental Injury. We reserve the right to request that an independent and acknowledged
expert in the applicable field of medicine review the evidence used in making any disputed Diagnosis. We will pay for any such
requested examination or review.”

EXCLUSIONS
For any Insured Person:
(a) We will pay NO benefits under the policy if covered services provided are not related to a covered Accident.
(b) We will pay NO benefits for any Accident or any loss caused in whole or in part by, or resulting in whole or in part from the following:
i) the Insured Person’s suicide or attempt at suicide, or intentional self-inflicted injury or sickness, or any attempt at intentional
self-inflicted injury or sickness while sane or insane;
ii) the Insured Person’s alcoholism or drug addiction;
iii) the Insured Person’s commission of or attempt to commit an assault or felony;
iv) the Insured Person engaging in an illegal activity or occupation;
v) the Insured Person’s voluntary participation in any riot or civil insurrection;
vi) declared or undeclared war, or any act of declared or undeclared war; and
vii) any illness, loss, or condition specifically excluded from the definition of any Accident.

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

Achieve Alpha