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Pre-Existing Conditions And How They Can Affect Your Individual Texas Health Insurance
Posted by | Posted in Health Insurance | Posted on 11-08-2010
There are nearly four million Texans with some type of “pre-existing medical condition.” Besides having difficulty obtaining health insurance, these Texans may experience other insurance-related problems, including claim denials, higher premiums, cancellations, or refusals to renew their policies.
Before issuing a policy, health insurance companies offering individual policies evaluate certain information about you to determine how likely you are to have a claim. This is called “underwriting.” For any health policy, a company might consider your age, occupation, current health status and your medical history. If your individual risk factors indicate you are likely to have a claim, the company may charge you more for your policy or refuse to cover you.
Most individual health insurance companies have clauses regarding pre-existing conditions. Limits on pre-existing conditions are a standard part of most health plans. These limits ensure that benefits are paid only for conditions that occur after your health coverage becomes effective. Paying only for approved services and covered conditions helps control healthcare costs and prevent possible insurance abuse.
If you are seeking an individual health insurance policy and you have a current or past health problem, you must disclose it on your insurance application. Failure to disclose pre-existing conditions could jeopardize future claims or invalidate the policy. Individual health insurance companies may completely exclude coverage for pre-existing conditions by attaching an “exclusion rider” to your policy.
If you list pre-existing conditions on your application and the company issues you coverage without attaching an exclusion rider, the company must begin covering your pre-existing conditions when the policy’s pre-existing waiting period expires. Pre-existing condition waiting periods can be a maximum of two years on individual policies. Exclusion riders can be in-force indefinitely.
In Texas, if you move from a group, government, or church health plan to an individual health policy, you won’t be subject to a new pre-existing condition waiting period if you had 18 months of prior coverage, with no more than 63 days lapse in coverage. If you move from a group, government, or church health plan to an individual policy with less than 18 months of coverage or have a lapse in coverage greater than 63 days, you will receive credit on the new policy’s pre-existing condition waiting period for the time you were covered during the preceding 18 months.
When it comes to applying for an individual health insurance policy, be forthcoming and honestly answer all questions about your medical condition. If you withhold information about an illness or medication, the health insurance company you’re applying to may deny subsequent claims.
In addition, understand your individual health insurance policy and read the policy wording carefully. Make sure you understand the limitations and exclusions of your coverage. And ask questions, especially if you don’t understand the policy wording, or are unsure about specifics of your coverage. Don’t be afraid to ask for clarification about policy details. If you do not understand some or all of your policy, call your health insurance company and ask for an explanation. And try to get your answers in writing.
If you’re young and healthy and don’t have any significant pre-existing medical conditions, you should take a look at the revolutionary comprehensive individual health insurance solutions created by companies specifically for young, healthy individuals.
Watch the video related to health insurance
Thousands of Hoosiers will soon see their health insurance rates jump by as much as 38%. State lawmakers asked pointed questions demanded answers during a hearing with WellPoint executives Wednesday.
Help answer the question about health insurance
Am I able to write off Health Insurance Premiums for tax purposes at the end of the year?I am looking to purchase my own health insurance instead of going through my company. I know that the company takes out the cost on a pre-tax basis, but their insurance is not the greatest. If I do decided to sign up for health insurance, will I be able to use the cost of my own health insurance as a deduction fo tax purposes?
1) Most employer provided health insurance is deducted "pre-tax" so there is no deduction on the tax return.
2) Your parents must be your dependents (or would have been your dependents except for the gross income test) for you to take a deduction anyway. So, unless you are supporting them: No.
If you are self employeed you should take a serious look into Health Savings Accounts, for several reasons, starting with there is a huge savings on your monthly premiums regardless if you are insuring yourself or you and your family. Things that are considered by the insruance companies are the area you live in, the type of work you do and any pre-existing conditions you might have. If you are in the state of California, and you have employees, you need a minimum of two employees and/or 75% of the payroll to participate in the plan (regardless of HSA or regular insurance) to get a guaranteed issuance of the insurance.
If you are not self employeed but do have a job, again the HSA is great way to go, because you can make pretax contirbutions to the plan, take it with you where ever you go, and keep the insurance with you when you retire… which as common sense tells us, you are going to need healthcare much more in your retirement years (ie when you are older) then you will now. Also any qualified medical expenses can be paid tax free from the account, and once you hit your deductable out your account, anything above that is paid for by the backing insurance company.
One note about the non bias oppinon of "brokers," they get paid on a commission as well by the companies they represent, and some companies pay more than others. Just because you are working with an "independant" does not mean you are getting the best price, or service. You want to work with someone who knows the products that they work with inside and out, or have access to the people who do so that all your questions can be answered to your satisfaction. Some times a huge selection does not mean a huge savings in time and money.
Multiple member LLC's can be taxed 3 different ways:
1. As a partnership
2. As a C corporation
3. As an S Corporation
The deductability of health insurance premiums for your LLC will depend on which of the 3 types of entities your LLC elected to be taxed at (the default is the partnership form of taxation).
Typically, you will be able to deduct 100% of your health insurance premiums although there are some specials considerations for owner/officers of S Corporations who own more than 2% of the company.
If you speak with a CPA or qualified tax advisor they should be able to give you plenty of good tips. One thing that you may want to mention is a medical reimbursement plan. Here is some more detail on medical reimbursement plans:
so true,insurance companys suck ass
Says a lot about those owners imo.
Well, if she's 40 and perfectly healthy, it's going to cost her about $500 a month to have a low/no deductible plan that covers checkups.
You BUY it on a month to month basis. If you want low monthly payments, you have to cut the coverage – like take a $10,000 deductible. Or higher. That would cut payments down to maybe $200 a month or less.
The older she is, the less healthy she is, the more it costs.
Your best bet, is to find a local, independent agent, who can help you balance cost with coverage.
i htought the main reason of living in a society was to help each other out, am i wrong?
The purpose of any type of insurance is to protect against catastrophic loss. Using health insurance as an example, most everyday medical expenses are not very expensive (a physical exam averages $150.00+/-), but if you are admitted to the hospital for an emergency your medical bills would be in the tens of thousands of dollars at a minimum. If you do not have insurance you "self-insure" againts that potential catastrophic loss. Without insurance, the average person would face financial ruin if faced with a major loss.
I love how he says sh*t that needs to be said within his comedy. I’ve had this conversation with other people countless times.
No.
The insurance through your husband's employer does not meet the test of having been established through the S-corp.
most insurance will cover the costs you mention if the doctor thinks it is medically necessary.
You've asked a very broad question. There is no simple answer.
In truth, health insurance works a little differently in each state.
To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.
2) What happens if someone can't afford it is… they don't get it, usually. Except if your income puts you below the "poverty level", in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)
3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)
4) Yes, the patient has some say over procedures. However, if the patient opts for an "experimental" procedure, or one that isn't deemed "medically necessary", then health insurance may refuse to cover any charges at all.
In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)
** Edited to add:
It's not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with "managed care" (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations — also known as PPO, HMO, and POS) and may very well revoke a company's charter to do business in the state should the company be turning down too many legitimate claims.
However, insurance companies are sticklers for following the "standard" for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that's considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered "standard." If the patient wants treatment that isn't yet considered "standard", they would balk. Period.
This guy is funny I smoke pot and This guy is potatstic. My friends call me potking. I smoke pot. I like jamie kilstein . pot.
should i take a viagra!!! lol (sorry for bad spelling)
Wow, I remember when club owners told me I couldn’t give this guy open mic time in Chicago.