Can I get insured, if I have a pre-existing condition?

The always nagging question:  Can I still get insured, if I have a pre-existing condition?  The answer is YES!  When applying to a major health insurnace carrier for an individual policy, the insurance carrier has the opportunity to review your medical history and deny you based on the results.  This is the main difference between group and individual insurance.  With group insurance, an insurance carrier can not deny an individual based on their medical information. 

With an individual policy, after reviewing your medical history an insurance carrier is either go to: 

1. Approve you as a stardard offer.  

2. Approve you with an exclusion, wavier, or rider.  

3. Approve you with an adjustment rate. 

4. Or deny you, all together.

If you are denied coverage from a privately held health insurance carrier, there are options to get insured. For example, in Illinois there is a state sponsor health insurance plan for people that can not get insured elsewhere.  ICHIP, The Illinois Comprehensive Health Insurance Plan is a guaranteed issued health insurance plan for people that are in a high risk pool.  The monthly premimum are substantial higher and there are specific enrollment requirements.  Please contact a Gizmo Health representive for ICHIP enrollment details.

What is Co-insurance?

Co-insurance is the portion of the plan where the member and the insurance carrier work together to pay for the cost of the medical claim/bills.  The co-insurance portion comes into play after the member have satified their deductible requirements and any office visits charges. Co-insurance is usually displayed as a percentage. The percentage represents the amount that the member is responsible for. Most plan have 80/ 20 coverage, which means that the insurance carrier pays 80% of the cost and the member pays the remaining 20%. Once the member has reached the plan's co-insurance maximum out of pocket limit, the percentages change.  The insurance carrier will cover the plan at a 100% up to the plan's lifetime maximum. At this period, the member just needs to continue to pay for their monthly premium.

Example: If the plan has 20% co-insurance and the claim is for $1,000.00. You will pay 20% of $200.00, while the insurance company is responsible for the remaining 80% or $800.00.  

New BCBCIL HSA Deductable starts 1/1/2009

Blue Cross and Blue Shield of Illinois introduced a new deductible option to the BlueEdge Individual HSA (health savings account) plan. Along with the existing deductible offerings of $1150, $1750, $2600 and $5000, a $3500 deductible option is being added beginning January 1, 2009.

The new $3500 deductible HSA will be available at both 80% and 100% coinsurance coverage levels, and with or without maternity. Marketing of the $3500 deductible began November 15, 2008 with January 1, 2009 or greater effective dates. Also, January 1, 2009, the deductible level for the $1,100 plan will increase to $1,150, in keeping with the IRS HSA minimum deductible guidelines.

To apply click:https://services.hscil.com/il/eapp/wxpm1653.pl?id=6123&source=WEB2009520

or visit http://www.gizmohealth.com/

How to select a Deductible Level with your Health Insurance Plan

When selecting a deductible level with your health insurance plan, you should take all things into considation.  Your overall health, age, and what you can afford.  If you are young and relativily health, but can't afford an expense plan. I would suggest a high deductible plan. You will be save money on your monthly premium in exchange for the risk of having to pay more out of pocket if something does happens.  

  If you are older and have some medical issues, you should probably go with a lower deductible plan.  You are probably going to need to go to the doctor's office more often or even visit a hospital.  These exspenses can added up quickly.  With lower deductible plans you are not going to have to pay as such, because you are going to reach your deductible level sooner (The insurance carriers are going start pay their portion of your medical exspenses with the co-insurance).  BUT, the your monthly premium is going to be significantly higher.

The higher deductible plans aren't going to cover prescription drugs/ doctors office visits with a co-pay.  If you are looking for more of an old fashion traditional health insurance plan with a low deductible and twenty percent co-insurance, and a co-pay on your office visits and presciption drugs.  The high deductible health plan (HDHP) is not for you!

People who go with a higher deductible plan can sometimes offset the cost of your medical exspenses with a HSA account.  Some high deductible health plans will have a HSA account attached to them. HSA is a health saving account which allows you to put money aside pre-tax to pay for their medical exspenses.  In 2008, you could contribute up to $2,950.00 for a individual plan and $5,850.00 for a family plan.  HSA's are kind of structured like an IRA's, in that they accrued interest and the balance rolls over for year to year.  The adventures of these plans are that you have more control over your medical spenting.  

When you open a HSA, you are issued a debit card or checkbook to pay for doctor visits, precription drugs, and even your monthly premium.  One thing who should be aware is that there are penialties for withdrawing funds for stuff that are not medically related.  If you have any questions, Gizmo Health agents will anwser any questions that you might have.  You can reach them at 1-312-884-5150.

Payment Information for the insurance carriers

When apply for individual health insurance coverage, most insurance carriers require an inital payment (usually the first month's premium).  BlueCross BlueShield of Illinois, Aetna, Humana, United Healthcare, and Celtic all require a payment to process the application.  Unicare is the only insurance carrier that doesn't require a inital payment.  

If you are approved, the insurance carrier will accept your payment and start the policy as of your effective date.  If you are denied, the insurance carrier will accept the payment and will issue your a check for the exact same amount. The issue that some people have run into is that the insurance carrier cash ALL checks (so make sure that your bank account has sufficant funds to cover the cost and avoid overdraft fees).  People were thinking that the insurance carriers just hold on the check until they get a response of the underwriting department.  Which is untrue! 

When you use www.gizmohealth.com, there is no application and service fees.  Their webpage and brokers services are completely free to you, because they are compensated by the insurance carriers based on the number of clients that have with that carrier. Gizmo Health is a third party brokerage firm, that focuses on a solid relationships with the insurance carriers and excellent customer service.  Gizmo Health will give you an honest opinion based on your individual health insurance needs. 

Uninsured in Illinois

1.8 million Illinois residents lack health coverage. 1.3 million of those uninsured live in the Chicagoland area. Latinos currently represent more than 30% of Illinois uninsured.

HPV vaccine free for Aetna clients

Human Papillomavrius vaccine (HPV) Covered at 100% - Aetna’s Individual plans cover the vaccine (Gardisil) for girls ages 9 to 18 at 100%. No copay or coinsurance.

According to Center for Disease Control website (link below) the retail value is $375.

To apply directly to Aetna click: https://ips.aetna.com/Retail/Home_Login_Consumer.aspx?bid=2TzPPz%2fIcZA%3d


Gardisil: http://www.gardasil.com/

Center for disease control: http://www.cdc.gov/std/hpv/default.htm

To contact us at: http://www.gizmohealth.com/ call 312-884-5150