The Texas Insurance Commissioner had requested the waiver to give insurers in the state time to meet the ratio requirement of spending 80 percent of premiums in the individual market on direct medical costs and health care quality improvement, and only 20 percent on insurer administrative costs. The Texas DOI requested a tiered implementation of 71 percent, 74 percent, and 77 percent for reporting years 2011, 2012 and 2013, respectively.

The Affordable Care Act allows the HHS Secretary to adjust the MLR standard for a state if the state demonstrates that meeting the 80 percent MLR standard may destabilize its individual market.

HHS announced on Friday that issuers in Texas’ individual market should be able to meet the 80 percent medical loss ratio standard in the near future and that no adjustment to the MLR standard is necessary.

Specifically, HHS determined:

Texas, if it now chooses, has 10 days to submit a request for reconsideration, to which HHS would then have 20 days to respond.

To date, HHS has rejected 10 states’ requests and approved six requests to varying extents. Two requests are still pending.

The Texas Department of Insurance (TDI) issued a bulletin in December announcing its strategy to comply with the standards until 2014.

TDI instructed health carriers to continue to utilize the Texas external review process for fully insured business and to voluntarily comply with these temporary standards:

Waive any exhaustion requirement if:

• The internal appeal process timelines are not met; or

• In an urgent care situation, the claimant files for an external review before exhausting the internal appeal process

Independent Review Organizations (IRO) must inform the issuer and the claimant of an urgent care decision within four business days or less from receipt of the request for review and provide written notice of its decision within 48 hours of the oral notification. (BCBSTX will comply with this requirement by contacting TDI if we are aware of a situation where the IRO does not follow the timeframes.)

Blue Cross and Blue Shield of Texas (BCBSTX) has revised the chart published last month defining how pre-existing condition waiting periods will be applied to insured and self-funded (ASO) business.

• Insured – BCBSTX will waive pre-existing condition exclusions for all enrollees up to age 19, and for all dependent children up to age 26. However, for employees and spouses age 19 and older, BCBSTX will apply pre-existing waiting periods.
• ASO – The default is to administer consistent with insured business; BCBSTX will accommodate customer requests for alternate configurations based on specific options outlined in the chart below.

Insured Business Configuration

ASO Configuration Possibilities

The payouts received from a Charitable Gift Annuity are much lower than those received under other type of annuities. Payouts from Charitable Gift Annuities are deliberately low and non-competitive on purpose because the primary purpose of buying a Charitable Gift Annuity is the giving part. It is not meant to be a competitive investment, and it was established in that way primarily to stem competition between providers in providing this type of annuity.

The low rates offered on Charitable Gift Annuities provide a safety margin for the charity. Under the regulations that set the limits on the payouts, the charity receives twice as much as needed to make payments to the annuitant. Another big difference between charitable gift annuities and other types of annuities is that Charitable Gift Annuities are never considered insurance products. In fact, many states have laws that require the annuity contract to specifically disclose that “a Charitable Gift Annuity is not insurance under the laws of this State, is not subject to regulation by the State’s Insurance Division and is not protected by the State’s Guaranty Fund.”

As with all other annuity types, care must be taken to ensure that the annuity is sound, and not fraudulent. Because state’s do not regulate Charitable Gift Annuities, the potential for fraud exists, and consumers must be on guard. Despite the extra care that must be taken when buying a Charitable Gift Annuity, these types of annuities are a great way to fund a favorite charity while providing a stable income stream in retirement.

There are four parties that then have an interest in your annuity and the premium you used to purchase this annuity:

1. The Annuitant – That’s you, and your interest is created because it is your money that was invested in this annuity, and the one that decides who receives the payments from this annuity.

2. The Insurance Company – Their interest is created because they received your premium (money) and invested it and used those earning to pay you, themselves, and other annuitants.

3. Other Annuitants Who Purchased At The Same Time – Some annuitants will live longer than others. The money that is not paid to the shorter lived annuitants is used to pay those that do live longer.

4. Your Heirs – If you opt out of the guaranteed period, or if you live past the guaranteed period, then your heir, or your estate receives nothing. That money is used by the insurance company to pay the benefits guaranteed to the longer lived annuitants.

The payout amounts from your annuity come from three sources:

1. The premium you receive back from the insurance company. This amount is prorated over the estimated number of years you are expected to live, and consists of a percentage of each payment you receive.

2. Interest on your premium that the insurance company made by investing your money wisely and safely.

3. Money that was not paid to other annuitants that did no live as long as you.

There are many things to watch out for when purchasing an annuity. Financial Planners and Investment Advisors dislike annuities, and spend a lot of time trashing annuities, even while they have no compunctions in selling variable annuities themselves, the worst type of annuity for the consumer. There is a lot of bad information out there regarding annuities, but, a single premium immediate annuity, which is the most insurance-like annuity there is, can be the best solution for creating an income stream after retirement.

When you buy an single premium immediate annuity your are purchasing what is also called a life annuity. The word annuity refers to a regular series of payments. So, in essence, you are buying payments for life when you purchase a life annuity.

The payouts from the annuity are guaranteed to last for the amount of time specified in the contract, usually for life, but it may be for a shorter term read your contract carefully, and make sure it guarantees payments to last for the rest of your life. If you opted for a guaranteed period, there should also be a mention of a death benefit in case death comes sooner than expected. Your beneficiary should be named in your contract. The contract will also specify the amount of those payouts, thus making planning the rest of your retirement much easier because you know upfront what to expect.

Do keep in mind that even thought you do receive contractual guarantees, these guarantees are still dependent on the claims paying ability of the insurance company that issues your annuity. As a responsible consumer, you do need to make sure you choose only top-rated companies that have sufficient assets to back their policies.

Even though most states have guaranty associations in place should an insurer fail, the protection provided by these associations is limited, and may not provide the same level of benefits that were specified in your annuity contract. Choose wisely, and don’t take your agent’s word for it. Do the research, and select only insurance companies that are rated highly, and have a history of paying claims.

This book covers every single step of what you need to do, from the initial telephone calls to the medical examination and then finally the actual settlement, that a claimant should employ to obtain the best possible settlement of their auto accident insurance claim.

But the most important part of this revolutionary and helpful book is the introduction of The BASE Formula – The Baldyga Auto Accident Settlement Evaluation Formula. BASE is a never before publicized settlement process that the author has created through long years of personal experience in settling claims. Auto accident insurance claim professionals are calling BASE “spectacular” and “amazing” because it explains, in simple, easy to understand language, exactly, right down to the last hundred dollar bill, how much ones “pain and suffering” is worth.

This book is easy-to-read, comprehensive and most importantly contains outstanding instructions in addition to the innovative BASE Formula and helps the reader place an accurate value on “pain and suffering.” With the advice provided in this book the reader will get all the help they need to settle their claim for a much higher amount than they ever expected.

When the annuity contract allows the annuity buyer, or annuity owner to add additional funds or money to the annuity, then the annuity is called a flexible premium annuity. When an annuity contract allows only one single investment, then that annuity is referred toa s a single premium annuity.

Annuity owners wishing to add additional funds to a single premium annuity are not able to do so to an existing annuity and must create a new contract or purchase a new annuity. Single premium annuities are mainly purchased as fixed rate annuities because the annuity buyer is able to lock in a set rate of return for a specific period of time that is similar to a Bank CD.

Immediate annuities are a good choice for consumers that wish to receive monthly, quarterly, semi-annual or annual income beginning at the time of purchase. The contract owner, or annuitant, purchase this type of annuity when he or she desires income on a regular basis beginning within a month, quarter or year.

Deferred annuities are best for “saving” money for future needs. Deferred annuities are set up so that the funds invested in this annuity grow and compound tax deferred for an undetermined period of time. At some point in the future, the annuity owner can annuitize, or begin to take income from, the annuity through a series of withdrawals.

The person that can take out income from the annuity will be specified in the annuity contract made at the time of purchase. The contract owner owns the annuity. In the majority of cases the contract owner is the person that put up the finds for the annuity. The annuity contract is made between the insurance company or carrier, and the contract owner or annuity buyer.

Annuities, because they are insurance products, also contain a death benefit which is important to consumers because then they can leave the funds to an heir, or heirs, in case something happens to them, and they are unable to enjoy the income created by the purchase of their annuity.