California Individual And Group Health Insurance Plans

Education officials are now urging foreign students in the city to ensure that they have medical insurance, Shanghai Daily reported.

The warning came after a Laotian student at Fudan University was diagnosing with leukemia. He bared a big medical bill for a bone marrow transplant. The city's existing university student insurance plan doesn't cover foreigners.

Democratic lawmakers in the coming year likely would seek to "close the gap" between those with health insurance and for those who lack coverage, plus reduce inequalities between higher- and lower-income U.S. residents, the Wall Street Journal reports. According to the Journal, "some Democrats would still drool over proposals for government health insurance for all," but anyway others "prefer piecemeal approaches." For example, one proposal will provide tax credits to companies with as many as 100 employees to help purchase health insurance policy for employees through a pool sponsored by the federal government and modeled after the Federal Employees Health Benefits Program.

Resolution Health East Africa, a Kenyan medical insurance provider has recently launched new medical insurance products in the fast growing market.

The products that come in branded packages namely Premier plus, Premier, Executive, Superior, Advantage and other corporate plan offer a very impressive choice for clients with various variations, covering illnesses and accidents.

NEW DELHI: With health spending on the rise, the government is now planning to come up with health insurance by way of private players.

"We are scheduling a health insurance on public-private model. It is yet to take off," Health Minister Anbumani Ramadoss said today as addressing a national peak on Public Health Initiatives organized by The Associated Chambers of Commerce and Industry of India (ASSOCHAM).

The minister said Prime Minister Manmohan Singh has spoken his "concern" on the subject and the ministry is working out the right model.

ALBANY -- It's just a beginning to look a lot like Christmas for home health insurance companies. Four of five companies with very vital local membership now reported higher revenue and net income for the third quarter, vs. the year-ago period.

Albany-based Capital District Physicians' Health Plan reported that the revenue of $251.9 million in the third quarter, up from $216.9 million a year earlier.

The Los Angeles Times - By Lisa Girion, Times Staff Writer -Nov. 14: Under mounting pressure from consumer advocates, the state's HMO regulator plans to introduce a rule that would make it harder for health insurers to drop policyholders after they get sick.Cindy Ehnes, director of the Department of Managed Health Care, is expected to propose that insurers be required to maintain coverage unless they show an individual lied about his or her medical condition to obtain it.Health plans routinely cancel policies because of inaccurate or incomplete information on medical history questionnaires, regardless of whether the policyholder meant to deceive the companies.Ehnes plans "to move forward with some kind of clarifying regulation," department spokeswoman Lynne Randolph said Monday, declining to provide details. Consumer advocates said such a rule was long overdue, but industry officials warned that it could drive up costs and result in higher premiums for consumers. Health insurers say they revoke only a small fraction of policies.The push for a stronger rule comes after a series of Los Angeles Times articles examining insurers' cancellation practices.At issue is individual health insurance, which, unlike group coverage, allows insurers to reject applicants deemed to be too risky based on their medical history and their answers to a detailed health questionnaire.Randolph disclosed Ehnes' plans in response to a petition the department received Monday from consumer advocates. The petition demanded that the agency move to stop the industrywide practice of canceling policies over misinformation in applications, whether or not the policyholder intended to lie.The petition was filed by the Foundation for Taxpayer and Consumer Rights, a Santa Monica group that was instrumental in the adoption of auto-insurance rate reforms and enhanced patient protections against HMO treatment denials. The group's petition says a 1993 state law clearly prohibits the cancellation of health insurance unless a company can prove "willful misrepresentation."Foundation spokesman Jerry Flanagan said insurers were free to violate that law because the department failed to enforce it until recently and never adopted implementing regulations. "These regulations are 13 years overdue," he said.But industry officials say the law allows insurers to cancel policies when they find policyholders failed to disclose all relevant facts in their medical history on applications, regardless of whether the applicant intentionally lied.That helps root out fraud and keep health insurance relatively affordable in California, said Chris Ohman, president of the California Assn. of Health Plans. If the department moves to a tougher standard for revocations, he said, costs will go up."We don't think there's need for new regulations, and we think the standard is well set and it's been in practice for a number of years," Ohman said. "The last thing we would want is for individual insurance to increase in cost, exacerbating the affordability problem."WellPoint Inc., parent of Blue Cross of California, maintains that it is following the law and that there is no need for new rules. "The current law is clear," said Shannon Troughton, a spokeswoman for Indianapolis-based WellPoint.The cancellation backlash erupted last spring when a raft of policyholders filed lawsuits alleging that Blue Cross, Blue Shield of California, Kaiser and other health plans illegally revoked their coverage after they got sick as a way to avoid paying expensive claims.The plaintiffs included the family of a 6-year-old Murrieta girl who was dropped by the insurer in the midst of treatment for a life-threatening tumor in her jaw. Also among the plaintiffs was a Riverside couple forced to put their home up for sale after they were hit with a mountain of medical bills.Hospitals then filed a proposed class-action suit against Blue Cross, alleging that the company was ignoring a law that required insurers to pay for authorized medical care even if coverage was later revoked.In October, Blue Cross settled for undisclosed amounts more than 70 suits and claims filed by patients who alleged that the state's largest health plan illegally dropped them.The department launched investigations into not only the individual policyholders' complaints but also the insurers' cancellation practices. Those investigations are not expected to be completed until next year.But Ehnes has seen enough to conclude that a new regulation is necessary, said Randolph, the department spokeswoman. The department, which was set up in response to perceived abuses in the way health maintenance organizations decide to authorize or deny treatment, had sided with insurers in all 289 cancellation complaints consumers had filed since 2000. In September, however, the department did an about-face. Ehnes issued its first sanction in a cancellation, fining Blue Cross $200,000 after finding the it illegally revoked the policy of a Southern California woman. In early October, the department ordered Kaiser Foundation Health Plan to reinstate coverage of a Northern California woman with kidney disease.

Blue Shield Press Release - Nov. 10: Blue Shield of California's Access + HMO and Medicare Advantage HMO have been awarded Accreditation status of Excellent from the National Committee for Quality Assurance (NCQA), an independent, non-profit organization that assesses and reports on the quality of the nation's managed care plans. Blue Shield's Accreditation status the highest possible level is based on a voluntary review of how a health plan ensures that its members are receiving high-quality care.The NCQA Accreditation survey process includes on- and off-site evaluations of more than 60 standards and selected HEDIS performance measures conducted by a team of physicians and managed care experts. A committee of physicians analyzes the team's finding and assigns an accreditation level every three years based on the performance level of the plan being evaluated to NCQA's standards. "Achieving an Accreditation status of Excellent is a significant achievement for a health plan," noted Eric Book, M.D., Blue Shield of California's chief medical officer. "It is only awarded to those plans that both meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement and have HEDIS results in the highest range of national performance.""Blue Shield is committed to continuous quality improvement, and I believe that has been validated by NCQA," said David Joyner, senior vice president of Network Management. "This accreditation tells our members that the care they receive and the physicians who provide that care meet or exceed the industry's highest standards of quality. Each of our employees, providers and management contributed to the NCQA accreditation process in some way, so we are extremely proud of this achievement." The NCQA Accreditation process evaluates how well a health plan manages quality throughout every part of its delivery system physicians, hospitals, affiliated providers, and administrative services to continuously improve health care for its members.

The Los Angeles Times - By Ricardo Alonso-Zaldivar, Times Staff Writer -Nov. 13: Washington - Alarmed by the relentless erosion of employer-sponsored medical benefits, the health insurance industry today unveiled a proposal to extend coverage to more than 46 million uninsured persons.Combining solutions favored by Democrats with some that Republicans have backed, the proposal by America's Health Insurance Plans calls for providing coverage within three years to all uninsured children, currently numbering about 8 million, and within 10 years to virtually all adults.The trade group's plan would rely on a mixture of expanded federal and state programs and tax credits for workers and their families to purchase private health insurance."We should transcend the rigidly partisan political debates that have led only to stalemate," the group said in a statement accompanying the proposal. "Our nation needs a pragmatic approach driven by a broad understanding of the nature of the challenge and a strong commitment to the goal of covering all Americans."AHIP, as the group is known, represents almost 1,300 companies that provide health insurance policies, including traditional fee-for-service plans and managed-care plans such as health maintenance organizations.The insurance industry said its plan would cost the federal government $300 billion over 10 years, but the proposal lacked specifics on how it would be financed. Other estimates of providing coverage for all have been higher, $50 billion to $80 billion a year. By comparison, the federal government already spends more than $530 billion a year on two giant healthcare programs, Medicare for the elderly and Medicaid for the poor.The high cost of health insurance is the main reason for the rising number of uninsured Americans. The Kaiser Family Foundation's 2006 healthcare survey found an average cost of almost $11,500 a year for an employer-sponsored family plan. Employers, particularly smaller businesses, have been shedding coverage as costs have risen, and many individuals find it too costly to purchase a plan on their own.With Democrats taking over Congress next year, many policy leaders in the medical community, labor unions and even corporate boardrooms are hoping to revive a national debate that has been dormant since the collapse of the Clinton administration's plan more than 10 years ago."The election shows that Americans pay attention and they're willing to support change," Dr. Raymond J. Gibbons, president of the American Heart Assn., said Sunday at the group's annual scientific conference in Chicago. "There has been woefully little public discussion and, as a result, we haven't had the kind of national dialogue that's needed to find a solution."Polls show that Americans strongly back guaranteed coverage for all, but support melts away if it would mean significantly higher taxes - suggesting that the next debate on overhauling healthcare will focus on controlling costs.Already, U.S. employers say the high cost of health insurance for their workers puts them at a competitive disadvantage in the global marketplace. General Motors, for example, spent $5.3 billion for healthcare in 2005, more than it did on steel.The health insurance industry's proposal would build on the current system, a mix of federal and state programs, employer plans and individuals buying their own coverage.It calls for the expansion of the federally funded State Children's Health Insurance Program to cover all children in families with incomes up to twice the federal poverty level. That would help most children in low-income working families, since a family of four making up to $40,000 would be able to receive benefits.Similarly, the plan would expand Medicaid eligibility to adults earning up to the federal poverty level, which is $9,800 for a single person.The idea of using existing government programs to solve the problem of the uninsured has strong support among Democrats. But the insurance industry proposal also calls for two new tax breaks, a kind of approach traditionally favored by Republicans.A new $200-per-child tax credit, or up to $500 per family, would go to middle-class families who could show that their children were covered. The plan also calls for the creation of universal health accounts, a kind of tax break that would make it more affordable for the self-employed and those not covered by an employer to buy coverage on their own.

PR Newswire - Nov. 13: Washington - Employers who do not make changes to their benefit packages are being told by carriers to expect double-digit increases in healthcare costs, according to PricewaterhouseCoopers, which today released the first reported projections of medical cost trends for 2007. The projections are used by insurance carriers and employers to set health insurance premiums levels and design benefit packages in 2007. Employers are expected to adjust their health benefit design to avoid double-digit increases in premiums.According to PwC, insurance carriers anticipate medical costs to rise across all plan designs, including health maintenance organizations (HMOs), preferred provider organizations (PPOs) and consumer directed health plans. But the rate of increase will be slowest among consumer-directed health plans, in which members have higher deductibles and pay more of the direct costs of their care upfront. In 2007, PPO costs are expected to rise 11.9 percent, HMOs by 11.8 percent and consumer-driven health plans by 10.7 percent.A detailed analysis of medical cost trends can be found in a new report by the PricewaterhouseCoopers Health Research Institute, titled "Behind the Numbers: Medical Costs Trends for 2007." The report marks the first time that PricewaterhouseCoopers has provided an estimate of year-ahead medical costs trends, and is based on a survey of health insurance carriers, proprietary research and extensive analysis of publicly available reports and government data. "Medical costs continue to grow faster than wages, and this trend is an important driver of insurance company premiums," said Jack Rodgers, managing director of the Health Policy Economics Group at PricewaterhouseCoopers."The fact that medical costs are expected to increase by double digits, however, does not mean that health insurance premiums will increase at the same rate," Rodgers said. "Employers have the ability to influence premiums through strategic and creative benefit plan design. This is a reason that the growth rate of premiums has actually declined each year since 2003 even though medical costs assumed by insurers have accelerated," he added.The report notes that American workers have been shielded from the rising cost of healthcare for decades, and that the burden of rising medical costs has been borne largely by employers and the government. According to PwC, Americans spent six percent of their personal budgets on medical costs in 1960, the same percentage of consumer spending as in 2004. Both the government and U.S. employers are now looking to share more of the responsibility, if not the actual costs, with their employees in an attempt to curb rising spending levels.Using medical cost trend projections, employers can customize health benefit packages, offering incentives and increasing the level of cost sharing in the form of co-payments, deductibles and premiums. Consumer directed health plans offer employers greater flexibility to make adjustments than traditional plans such as HMOs and PPOs."Increases in health spending are a source of contentious debate and finger-pointing," commented Barry Barnett, partner and healthcare analyst in the global human resource solutions practice at PricewaterhouseCoopers. "In reality, spending increases because of a myriad of overlapping societal, economic and behavioral issues. Health plans and employers must consider all of these factors in setting premiums levels and look closely at what is driving up health spending and how to mitigate it."The report includes an analysis and discussion of the inflators and deflators of health spending. PricewaterhouseCoopers identified the following as inflators of health spending:* New treatments and technologies, including the increased use of new prescription drugs and diagnostics. While these contribute to early diagnosis and treatment, and in many cases are worth the increased cost, their availability obligates some physicians to order more tests as defense against potential litigation.* Increased demand for services by workers shielded from true costs who may overuse or inappropriately use the services* An aging population and declining health status due to such rising problems as obesity.* Cost-shifting, whereby private insurance must fill the gap for patients unable to pay for services.The PwC report also identified the expected deflators of health spending, including:* Cost sharing - When workers absorb more of the cost of their care they respond by using fewer or less expensive services and drugs.* Price transparency - When consumers see prices, they may reduce costs by shopping around for better values.* Digital backbone - electronic records and auto-adjudication can lower administrative costs and duplicative testing which can amount to as much as one-third of health spending.* Health and wellness programs - employers are starting to see a return on investment in health promotion activities such as smoking cessation programs that address costly health conditions."It is too early to say definitively that consumer-directed plans will lower overall health spending, but given their more flexible frameworks, they seem a promising way for employers to keep premium costs down," added Barnett. "Overall, the cost trend for 2007 is going to be affected by economies among providers and those who are covered. Workers, most significantly, will assume a greater share of the cost burden, thereby increasing their discernment in selection of services and in their overall wellness. Especially in the area of consumer-directed health plans, we see a significant potential for lowering medical costs."Currently only three million Americans - compared to 240 million in other private coverage plans - are in consumer-directed health plans. Noting that consumer-driven health are expected to have the lowest spending increase, the report concludes that greater acceptance of consumer-directed health plans, especially those that incorporate patient education and information tools, could have a strong impact on future medical costs.

WASHINGTON: Most Americans think that people who smoke need to pay more for their health insurance.

A study released Tuesday by the National Opinion Research Center at the University of Chicago had found that sixty percent of population believes that smokers need to pay more for health insurance and another 29 percent said the obese need to pay more. Only 12 percent believe it is suitable for people with family histories of heart disease or cancer to pay more.

Work on establishing the Health Insurance plan for government employees has come up to a stop. The scheme was provisionally being handled by a foreign company when this process was brought to a halt.

The insurance scheme that was being handled by Global Maldivian Administration came to a halt as the arrangements that have to be made with the Maldives Monetary Authority were not finished yet, said an official of the Ministry of Higher Education, Employment and the Social Security.

LACONIA, N.H. A 25 percent increased in health insurance premiums would surely hit Laconia (New Hampshire) schools hard during the coming budget season.

School officials say they are anyways also facing a big increase in the cost of retirement benefits.

Together, the increased costs amount to be more than one (M) million dollars, but the tax cap would only permit a budget increase of about 700-thousand dollars.

NEW DELHI: The government said insurance companies should voluntarily fix a target for providing cover to priority sectors.

Minister of state for finance Pawan Kumar Bansal said health insurance should be made available and affordable to the poorer section of the society.

He also said it would not be mandatory for insurers to provide health insurance cover to those above 55 years.