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Did you know the average cost of a three-day  hospital stay is $30,000? Or that a broken leg  can cost up to $7,500? Health coverage can  help protect you from unexpected high costs.  Not having health insurance could also cost  you extra in taxes—penalties in 2014 for  uninsured people are either 1 percent of  yearly household income or $95 per individual, whichever is greater. These  penalties will increase every year.

HollandStivers & Associates, LLC can  help you determine the best plan for you.    Call our Insurance Specialist, Wendy  Cooper, is available weekdays for a FREE  consultation starting November 15th.

Health Care Reform FAQ: Rights & Protections

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Whether you need health coverage or have it already, the Affordable Care Act (ACA) offers new rights and protections that make coverage fairer and easier to understand.

Whether you need health coverage or have it already, the ACA offers new rights and protections that make coverage fairer and easier to understand.

Some rights and protections apply to plans in the Marketplace or other individual insurance, some apply to job-based plans and some apply to all health coverage.

How does the health care law protect me?

The ACA changes the way health insurance companies operate, extends the opportunity to get insurance to people who were not previously covered and expands the benefits of many policyholders while lowering the cost of care. Some of the specific ways it accomplishes this include:

  • Creating the health insurance marketplace (Marketplace) as a new way for individuals, families and small businesses to get health coverage
  • Requiring insurance companies to cover people with pre-existing health conditions
  • Helping you understand the coverage you’re getting
  • Holding insurance companies accountable for rate increases
  • Making it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick
  • Protecting your choice of doctors
  • Covering young adults under age 26
  • Providing free preventive care
  • Ending lifetime and yearly dollar limits on coverage of essential health benefits
  • Guaranteeing your right to appeal your insurance company’s decisions

What if I don’t have health coverage?

If you can afford it but don’t have health insurance coverage, you may have to pay a penalty—and must also pay for all of your health care.

The penalty for 2014 is 1 percent of your yearly income or $95 per person for the year, whichever is higher. The penalty increases every year. For 2015, the fee is 2 percent of income or $325 per person, whichever is higher. For 2016 it is 2.5 percent of income or $695 per person, whichever is higher. After 2016, the fee will be adjusted for inflation.

It’s important to remember that paying the penalty won’t get you any health insurance coverage. You will be responsible for 100 percent of the cost of your medical care.

To avoid the penalty, you need insurance that qualifies as minimum essential coverage. If you’re covered by any of the following, you’re considered covered and don’t have to pay a penalty:

  • Any Marketplace plan, or any individual insurance plan you already have
  • Any employer plan (including COBRA), with or without grandfathered status (this includes retiree plans)
  • Governmental plans, such as Medicare, Medicaid or the Children’s Health Insurance Program (CHIP)
  • TRICARE (for current service members and military retirees, their families and survivors) and veterans’ health care programs
  • Peace Corps Volunteer plans
  • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014.

Other plans may also qualify. Ask your health coverage provider.

Who doesn’t have to pay the penalty?

Some people with limited incomes and other situations can get exemptions from the fee. You may qualify for an exemption from the fee if you:

  • Are uninsured for fewer than three months of the year
  • Have very low income and coverage is considered unaffordable
  • Are not required to file a tax return because your income is too low
  • Would qualify under the new income limits for Medicaid, but your state has chosen not to expand Medicaid eligibility
  • Are a member of a federally recognized American Indian tribe
  • Participate in a health care sharing ministry
  • Are a member of a recognized religious sect with religious objections to insurance
  • Are incarcerated (either detained or jailed) and not being held pending disposition of charges
  • Are not lawfully present in the United States

Also, if you have certain circumstances that affect your ability to purchase health insurance coverage (for example, you are homeless or you were evicted in the last six months), you may qualify for a hardship exemption from the penalty. You can apply for a hardship exemption through the Marketplace.

What happens if I get insurance but then can’t pay my premiums?

In general, your coverage obtained through the Marketplace may be terminated if you fail to pay your portion of the monthly premium. However, issuers must provide a grace period of three consecutive months for QHP enrollees who:

  • Receive a premium tax credit;
  • Have paid at least one full month’s premium during the benefit year; and
  • Then fail to pay their portion of the monthly premium.

If you fail to pay all outstanding premiums following the three-month grace period, the issuer must then terminate your coverage, retroactive to the last day of the first month of the grace period. For all other QHP enrollees, QHPs must grant a grace period in accordance with applicable state law.

If your coverage is terminated for non-payment of premiums, you do not qualify for a special enrollment period due to the resulting loss of minimum essential coverage. However, you may become eligible for a special enrollment period based on other circumstances. Additionally, during the annual open enrollment, you will be able to apply for a determination of eligibility, and, if you are determined eligible, youwill be permitted to select a QHP for 2015. In both of these cases, the enrollment would be considered a new enrollment. Thus, the issuer cannot attribute any new premium payments from you toward the outstanding debt from the prior, terminated coverage.

What kinds of health insurance don’t qualify as coverage?

Health plans that don’t meet minimum essential coverage don’t qualify as coverage. If you have only these types of coverage, you may have to pay the penalty:

  • Coverage only for vision care or dental care
  • Workers’ compensation
  • Coverage only for a specific disease or condition
  • Plans that only offer discounts on medical services

What if I’m pregnant or plan to get pregnant?

All Marketplace plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage takes effect. Having a baby qualifies you for a special enrollment period. This means that after you have your baby you can enroll in or change Marketplace coverage even if it’s outside the open enrollment period. When you enroll in the new plan, your coverage can be effective from the day the baby was born.

Also, maternity care and childbirth are covered by Medicaid and CHIP. These state-based programs cover pregnant women and their children below a certain income level. Eligibility and benefits are different in each state. Medicaid and CHIP income levels are different.

Check your state’s health insurance website to see whether you’re eligible right now for coverage for yourself and your baby through Medicaid or CHIP.

What if I have a grandfathered health insurance plan?

If you are covered by a grandfathered plan, you may not get some rights and protections that other plans offer.

“Grandfathered” plans are those that were in existence on March 23, 2010, and haven’t been changed in ways that substantially cut benefits or increase costs for consumers. There are two types of grandfathered plans: job-based plans and individual plans (the kind you buy yourself, not through an employer). To find out whether your plan is grandfathered, check your plan’s materials, or, for a job-based plan, check with your employer.

All grandfathered plans must still end lifetime limits on coverage, end arbitrary cancelations of health coverage, cover adult children up to age 26, provide a summary of benefits and coverage and spend a certain percentage (either 80 or 85 percent) of premiums on health care.

Grandfathered plans do not need to cover preventive care for free, guarantee your right to appeal insurance companies’ decisions, protect your choice of doctors and access to emergency care, or publicly justify premium increases of 10 percent or more.

Additionally, individual grandfathered plans do not have to end yearly limits on coverage or provide coverage to people with pre-existing health conditions.

How do I appeal a health plan decision?

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. Insurers have to tell you why they’ve denied your claim or ended your coverage, and they have to let you know how you can dispute their decisions.

There are two ways to appeal a health plan decision:

  • Internal appeal. If your claim is denied or your health insurance coverage canceled, you may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process.
  • External review. You can take your appeal to an independent third party for review. Doing an external review means that the insurance company no longer gets the final say over whether to pay a claim.

Source: Healthcare.gov

Life Insurance Medical Exams

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Life Insurance Medical Exams

Quote StickyWhen applying for a life insurance policy, you may be required to undergo an insurance medical exam (IME), which is used to determine your premium. This exam is done in your home by a health care professional who is hired by the insurance company. In addition to the exam, you will also have to provide information about your medical and family history. The following outlines what you can expect from the medical exam process.

The IME Process

A paramedical professional will gather your medical history, height, weight, blood pressure, pulse and possibly blood and/or urine samples. Additional tests will be ordered based on your age and the policy amount desired.

Blood tests are used to detect the presence of antibodies or antigens to the HIV virus, cholesterol and related lipids, liver and kidney disorders, diabetes, hepatitis, prostate antigens and immune disorders. Urine tests are used to detect the presence of nicotine, medications and illegal drugs.

Exams do not include sensitive issues, such as breast or prostate exams.

If there are any additional questions after the exam, you may be asked to submit more information.

After the results are received by the insurance company, you will be given a risk rating, either flat or table, for your medical history and conditions. For example, an underwriter would give a flat rating to someone who just had surgery because the situation is temporary, and someone with high blood pressure would receive a table rating. In general, table ratings increase premiums because they are permanent or somewhat permanent conditions.

Test results are not shared with you unless you specifically request it, either in a letter with your application for insurance or sent directly to the insurance company following the exam.

In the event you are declined by the insurer due to a health risk, your insurance agent can argue the rating on your behalf.

It’s important to know that your IME results are shared with the Medical Information Bureau. If you decline a life insurance policy after an exam and apply with another insurer at a later date, your application may raise a red flag.

Best Rx Before the Exam

Some things to consider before having an IME include:

  • Request a morning exam—it’s the least stressful time of the day.
  • Get a good night’s rest the night before the exam.
  • Do not drink alcohol the day prior to the exam.
  • Avoid drinking caffeinated beverages for at least an hour prior to the exam.
  • Don’t eat salty or high-fat foods for at least 24 hours prior to the exam.
  • Do not engage in strenuous exercise for 24 hours prior to the exam.

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This article was written by Zywave LP, an entity unrelated to HollandStivers & Associates LLC. The information contained in this article is not intended to be tax, investment, or legal advice, and it may not be relied on for the purpose of avoiding any tax penalties. HollandStivers & Associates LLC does not provide tax or legal advice. You are encouraged to consult with your tax advisor or attorney regarding specific tax issues. © 2013 Zywave, LP. All rights reserved.

 

 

Life Insurance Policy: Basic Terms

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Life Insurance Policy

Quote StickyLife insurance is an important component of estate planning for those with dependents or a spouse who will need continued financial support. When it comes to choosing a policy, you have options. This glossary will help you understand the basic types of life insurance coverages available along with the general terms included in a policy.

Policy participants

Policy owner – The individual or entity that maintains the policy. The policy owner is typically responsible for policy maintenance (changes, renewal, etc.) and premium payments.

Insured Life – The person on whose life the policy is issued.

Beneficiary – The person or party chosen by the owner of the life insurance policy to receive the policy benefit.

Contingent Beneficiary – The party designated to receive proceeds of a life insurance policy if the primary beneficiary of the policy is deceased.

Irrevocable Beneficiary – A designated beneficiary of a life insurance policy that cannot be changed unless consent is given by the beneficiary themself. This may also be called an “absolute beneficiary.”

 

Policy types

Term Life Insurance – A life insurance policy that provides a stated benefit upon the holder’s death, provided that the death occurs within a specifically stated time period. Unlike a permanent life insurance policy, a term life insurance policy does not build up a cash value.

Convertible Term Insurance Policy – A term life insurance policy that gives the policy owner the right to convert the policy to a permanent plan of insurance.

Permanent Life Insurance – Life insurance that provides coverage throughout the insured’s lifetime and also provides a savings element.

Renewable Term Life Insurance – A term life insurance policy that can be renewed at the end of the policy term.

Universal Life Insurance – A form of life insurance that combines a term policy with a savings element that is invested in a tax-deferred account. The cash value of this account may become available to the policyholder. The death benefit, savings element and premiums can be reviewed and altered as a policyholder’s circumstances change.

Variable Life Insurance – A life insurance policy in which the policy owner decides how the cash value of the policy will be invested. The amount of the death benefit depends on the level of success or failure the investment has.

Whole Life Insurance – A basic type of permanent life insurance. It provides coverage that lasts a lifetime and also builds up a cash value that you can borrow against, withdraw or use to pay future premiums.

Policy terms

Cash Value – The savings element that accumulates over the lifetime of an insurance policy. This is the amount of money that becomes available to the policy owner in the event of cancellation of a life insurance policy. This may also be called “cash surrender value” or simply “surrender value.”

Dividend – A return of part of the premium.

Face Amount – The amount specified on an insurance policy that is to be paid in the event of death or maturity.

Original Age Conversion – A conversion of a term life insurance policy to a permanent plan of insurance at a premium rate, based on the insured’s age when the original term policy was purchased.

Policy Anniversary – As a general rule, the date on which coverage under an insurance policy became effective.  

Premiums – Amount paid to the insurance company to buy a policy and keep it in force. 

 

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This article was written by Zywave LP, an entity unrelated to HollandStivers & Associates LLC. The information contained in this article is not intended to be tax, investment, or legal advice, and it may not be relied on for the purpose of avoiding any tax penalties. HollandStivers & Associates LLC does not provide tax or legal advice. You are encouraged to consult with your tax advisor or attorney regarding specific tax issues. © 2012 – 2013 Zywave, LP. All rights reserved.

 

 

Single Parents: Insurance Needs

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Single Parent

As a single parent, the types of insurance you need are similar to married couples. What is unique is the amount of coverage needed, as there isn’t a second parent or a second income to help shoulder a financial crisis. Three types of coverage recommended for single parents are life insurance, disability insurance and medical insurance.

Life Insurance

Parents, on average, don’t have enough life insurance. Less than half of all married couples with children have life insurance, and the number drops to only about one-third for single-parent households with children living at home, according to a 2011 Genworth Financial LifeJacket study. All parents should consider buying some type of life insurance, but especially single parents. Otherwise, if you should die unexpectedly, your children could be left with nothing. While single parents are the ones who need life insurance the most, they are often the ones without the time and money to get what they need. But life insurance doesn’t have to be expensive. Many single parents are surprised to learn that they can get the amount of coverage they need at an affordable price. And even if you can’t afford what you need, a little coverage is better than nothing.

You may already have group coverage through an employer, but this is often not enough. A good rule of thumb is to get enough coverage for six to eight times your annual salary, and more to cover debts or your children’s education. You’ll have to choose between two types of life insurance:

  • Term Life: Just as its name implies, term life insurance covers you for a specific period of time, or term. You can choose a 10-, 15-, 20- or 30-year term. Since it offers a death benefit but no cash value, term life insurance is an inexpensive way to protect your beneficiaries for a specified period of time.
  • Whole Life: Whole life is a type of permanent life insurance. It provides coverage that lasts a lifetime and also builds up a cash value that you can borrow against, withdraw or use to pay future premiums.

Purchasing adequate life insurance coverage will not only protect your children from financial ruin in the event of your death, but it should also help ensure that they aren’t split up. When there is money available to cover their living expenses, the guardian you choose will be better able to provide for them. Just make sure to choose a guardian and a beneficiary for your policy carefully. Naming minor children as beneficiaries can complicate probate.

Disability Insurance

Disability insurance is important for single parents for the same reasons. Your ability to earn income is one of your most valuable assets. If you lose that ability through an injury or illness, your family could face financial hardship. Many people don’t think they’re likely to become disabled, and they don’t think disability insurance is worth the money. However, disability is more common than you may think. According to the U.S. Census Bureau, nearly one in five Americans will become disabled for a year or more before the age of 65. Social Security data predicts that one in four 20-year-olds today will be disabled for more than three months at some point in their working lives. Women face an even higher probability of becoming disabled because of pregnancy-related conditions or female-only cancers. Even if you work in a seemingly safe environment, you may still need disability coverage for a debilitating illness—illnesses account for 95 percent of disability claims, according to the 2011 Long-Term Disability Claims Review, conducted by the Council for Disability Awareness.

Keep in mind that “disability” may be defined differently depending on which policy you choose—some cover you if you’re unable to continue working at your current occupation, while others will only pay benefits if you’re unable to work at all. Work with an insurance broker to determine the proper coverage amount to purchase. Another thing to keep in mind is the amount of coverage. You may already have some form of disability insurance through your employer, but again, this may not be enough. Most policies aim to replace 50 to 70 percent of your income, but you should work with an advisor to determine the coverage you need.

There are two types of disability insurance available, and it can be smart to get both kinds for full coverage:

  • Short-term disability policies have a waiting period of up to 14 days with a maximum benefit period of no longer than two years.
  • Long-term disability policies have a waiting period of several weeks to several months, with a maximum benefit period from a few years to the rest of your life.

Medical Insurance

If you have medical insurance through your employer, you may already have your child covered under your plan. If you’re divorced, your child may instead be covered under your ex-spouse’s plan. This is typically determined during the divorce proceedings, and usually the custodial parent becomes responsible for the child’s medical insurance.

You may want to consider seeking an individual medical insurance policy for your child if you and your ex-spouse don’t have an employer-sponsored plan available. Both you and your child should be covered, because a medical emergency can come out of nowhere and completely wipe out your savings. Look for special kids’ policies, which should be cheaper. If you cannot get coverage from an employer-sponsored or individual plan, you may qualify for Medicaid or various state-run programs instead.

When it comes to insurance, it’s better to be safe than sorry. Single parents especially need to insure against as much risk as possible because there isn’t a second parent or a second income to help make ends meet. Make sure you and your family have adequate coverage so you won’t have to worry so much about all of the things that could go wrong.

 

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This article was written by Zywave, LP, an entity unrelated to HollandStivers & Associates LLC. The information contained in this article is not intended to be tax, investment, or legal advice, and it may not be relied on for the purpose of avoiding any tax penalties. HollandStivers & Associates LLC does not provide tax or legal advice. You are encouraged to consult with your tax advisor or attorney regarding specific tax issues. © 2013 Zywave, LP. All rights reserved.