Option 4: Depending on your State, consult a local agent about an individual/family HMO plan in your area (most HMOs are only for small and large employer groups). These plans will generally cover maternity for a very low out of pocket, but there are not nearly as many of them as there used to be.

For example, Texas had an HMO named Scott & White until recently, where maternity related expenses were a covered expense. This was literally the only option for the self-employed in Texas, but they have discontinued the product.

The bottom line is to prepare for the expense of having a baby BEFORE you become pregnant. If you wait until after you’re pregnant or have a surprise pregnancy, your options will be very limited.

Remember, insurance cannot be purchased to pay for your bad decisions after the incident has occurred. You must have the proper coverage in place before the medical necessity has arisen. The only option for that would be the PCI plan mentioned above and that option may or may not be available much longer. It greatly depends on the upcoming presidential election and the Supreme Court decision regarding the constitutionality of certain parts of healthcare reform.

This is the same concept of expecting the auto insurance policy you bought today to pay for the repairs to your car from the accident you had last week. If a hurricane is barreling toward your home, you cannot call the Texas homeowners insurance company to purchase a policy that will rebuild your home. It’s too late.

By Steven Wendlandt

Option 1: Purchase a Health Savings Account policy (HSA policy). While HSAs will only cover complications of pregnancy (ectopic pregnancy, emergency c section, etc.), the funds deposited in your HSA can be used for virtually anything medically related including prenatal/postnatal, routine birth, sonograms, blood work related to maternity expenses. Here’s how it works…..

An HSA policy gives you the option to open an HSA account at any bank you like. As a single person, you can deposit up to $3,100 per calendar year and a family can deposit up to $6,200 all of which is 100% tax deductible. The next step is to ask your OBGYN and your local hospital what the cash price would be for their services. Pay them with the funds you’ve set aside in your HSA account. The net result is that you’ll normally negotiate a lower price than you would have paid otherwise if it were covered under the policy. Pay those lower fees with pre-tax dollars and it’s like double coupon day at the grocery store!

Selected Benefits also offers a hospital cash plan that will pay you a lump sum benefit of $2,000 if you’re hospitalized for any reason including maternity. If you employ this strategy, you’ll come out with a total cost of about $1-2,000 less the cost of the insurance products (which you would have paid anyway).

Option 2: Enter the Pre-Existing Condition Health Insurance Plan (PCI Plan). This was created during recent healthcare reform and is designed for those who have not had coverage in at least 6 months and who also have a pre-existing condition. Pregnancy will definitely get you in door.

These plans still have a deductible and out of pocket as does any health insurance plan, but the lowest deductible is $1,000 with a maximum out of pocket on that plan of $4,000 (including deductible). You’ll also need to factor in the cost of the monthly premiums as well.

By Steven Wendlandt

The Pre Existing Condition Health Insurance Plan (PCI Plan) This is ultimately one of the best options if your child has pre-existing conditions that require expensive treatment. The monthly premiums are very inexpensive compared to the value you will receive and are not based on your individual child’s medical needs. Rates are simply based on your State of residence and the age of the child. In order to qualify, you must have a pre-existing condition and must have been uninsured for at least the last 6 months.

Texas Health Insurance Risk Pool This is a good option if your child has expensive needs and has had continuous health insurance coverage with no break greater than 63 days. If your break exceeds 63 days, then you will be subject to a pre-existing clause depending on when your previous coverage ended. Rates for the Texas Risk Pool (and the Risk Pools offered in other States) are generally more expensive than rates in the PCI plan mentioned above.

The PCI plan option or your local State’s High Risk Health Insurance Pool will always be the best option if your child has expensive medical needs. Just remember, each program has its’ own eligibility requirements which are subject to change at any time.

If you are a Texas resident and are interested in learning more or purchasing a Texas temporary health insurance policy or an individual or family health insurance policy, please call Selected Benefits at 866.270.6209.

By Steven Wendlandt

Employer Group Health Insurance The first option, if available to you through your employer, is to add the child to your employer’s group health insurance policy. Many of you will find this a very expensive option. The ultimate cost will depend on how rich the benefits of the underlying plan are. While the coverage may be excellent in comparison to the other options, the cost can be up to $300-400 per month or higher.

If you have a child that will fully utilize the coverage due to health reasons, then this may be the best option since there are generally minimal, if any, pre-existing issues. In addition, all preventive care visits will be no charge per the r3ecent passage of the Affordable Care Act. Make sure to consult the HR department of your company (or the person in charge of benefits) about the plan details and cost before making your decision.

Individual or family health insurance policy You may either add your child to your existing individual or family health insurance plan. The child cannot be declined for coverage or have exclusions placed on pre-existing conditions, but the insurance carrier can and will increase the premium significantly if there are expensive medical needs. Preventive care is also free with this option.

This is an excellent option if there are no major pre-existing needs since the insurance carrier will normally insure your child at the “preferred risk” rates. If you, as the parent, also wish to obtain coverage at the same time, the premiums are normally less expensive with the child as a dependent on a parents plan rather than as a child only policy.

Temporary Health Insurance This is generally a much less expensive option as they are available as “child-only” policies, but there are drawbacks. Temporary health insurance policies do not cover preventive care and in most cases, do not offer doctor co pays. Selected Benefits Health Insurance, however, offers a temporary health insurance policy in Texas which has both doctor and prescription co pays. Prescription coverage is generally included, but not on pre-existing medications. Of course, pre-existing medical conditions are not covered either since these plans do not meet the minimum requirements of the Affordable Care Act.

This option would only be best if your Son/Daughter has no pre-existing conditions whatsoever. In addition, this is not a permanent solution (thus the name), so make sure you have another suitable option once the term ends in 6-12 months. Some carriers will extend to a second term, but normally not a third.

By Steven Wendlandt

If you have a covered accidental injury and need to visit a doctor or hospital, make sure to give them your health insurance ID card. The first step is for the provider to file a claim against your Texas health insurance policy. If you have a PPO plan, the health carrier will re-price the services as long as you use an “in-network” provider and normally pay their portion of the claim to the provider. At that point, you’ll begin to receive bills from the various service providers who treated you for the claim.

Here’s an example: Let’s say you have a broken leg and go straight to the ER. They will take a few x-rays, confirm the diagnosis and provide treatment. This normally consists of pain meds, a cast, etc.

Once you’re home recovering, the bills will begin to arrive for your portion of the charges that your health insurance policy did not pay for. You’ll normally receive one from the ER, one from the doctor on call who treated you, one from the x-ray technician and one for materials. Don’t pay these bills.

At that point, you would contact the accidental injury carrier and they will file a claim. They’ll just need some basic information such as how the injury occurred and they’ll also want you to send them the bills either by fax or via scan/email. You’ll be charged a $100, per incident, deductible and then they’ll pay all of the bills related to the injury that your health insurance didn’t pay for.

These policies are very cost effective and are well worth the price since they pay the first expenses of any injury up until your health insurance kicks in. In many cases, they actually pay more out of pocket than your health insurance will.

If you are a very active person or have children who are, I highly recommend these plans. For more information on these and our other products, please call us at 866.270.6209 or visit us at Health Insurance Texas.

By Steven Wendlandt

Here’s a recent example with one of our clients: Stanley Johnson is employed as a senior manager at a local chemical plant and he has access to excellent benefits which are free of charge for him. These are offered as part of his compensation plan and it’s a $1,000 deductible plan with an additional $3,000 maximum out of pocket on major medical. The plan includes both doctor and prescription co pays.

Here’s the disconnect: Stanley has a wife and 2 kids (ages 46, 12 and 10 respectively in zip code 77027) and the rate for their portion on the group plan is $1046/month. It’s a great plan, mind you, but they don’t plan on having any more children, so maternity is unnecessary.

Stanley was primarily interested in saving money, so we told him to keep the group plan on himself (since it’s free) and we placed his wife/kids with the Cigna Open Access 2000 plan at $517/month. This plan carries $1,000 more risk than the group plan on major medical, so we also added a $5,000 accidental injury plan for $39.95/month (for the entire family) which all but eliminates any accidental injury risk. We also placed his family on a $10,000 critical illness policy for an extra $40/month, again, all but eliminating and critical illness risk (heart, cancer, etc).

The net result was better coverage for the family with much less overall risk and a much lower premium. His total savings were $449 per month (that’s over $5,300/year!) and he eliminated all but $100 of accidental injury and critical illness risk on his entire family (including himself).

If this sounds like it could work for your family, please don’t hesitate to call us at 866.270.6209 and we’ll be happy to analyze your situation completely free of charge with no obligation.

By Steven Wendlandt

We work with quite a few teachers, police officers, fireman, etc and this is a very common question. One would think that with such a large group of people, rates would be cheaper, but that’s not the case especially if you’re insuring a family.

The employer is required by law to pay for at least 50% of an employees’ group health insurance premiums, but is not required to pay anything toward the remainder of the family. In many instances, the employer will pay 100% of the employees’ premium as an incentive to attract competent employees.

This is generally a great deal if you’re a single person, but kind of a bad deal if you have a spouse/kids to support. Why is this?

Most group health insurance plans are required to offer more comprehensive coverage in certain areas, but many of those areas are unnecessary for the average person. For example, most large employers offer maternity coverage, severe mental health coverage and also alcohol and drug abuse coverage. These are items that are generally not available under most individual and family Texas health insurance policies, but for most people, that’s just fine.

Since the private Texas based health policies aren’t required to offer those coverages, they are normally much less expensive. If your family planning is complete, have no need for severe mental health benefits (institutions, rehab, etc) and you have no alcohol or drug problems in your immediate family, why pay for it?

If your group health plan is very inexpensive or even free for you, why not drop your spouse and/or kids from the plan and place them with one of the many plans we offer. Selected Benefits, in almost all cases, can insure the remainder of the family for a fraction of what it would run on the group health insurance plan. We can normally save most families at least several hundred dollars per month.

By Steven Wendlandt

Health insurance markets are, by design, constructed so that the monthly premiums that the younger, healthy people pay will go toward the expenses of those who contract illnesses or have accidents. Simple as that. That’s the reason why an insurance carrier can and will either place an exclusion waiver on the condition if you attempt to apply or they will just decline you altogether. These policies are generally much less expensive than the other alternatives for those who did not elect to participate in the health insurance marketplace.

If you need medical treatment and do not have coverage, you generally have three options in the great State of Texas:

1) The Texas High Risk Pool. This is a group insurance pool for higher risk individuals that currently do not have coverage. You must not have current coverage and must meet the general eligibility requirements to gain entry. Be careful though, if you have not had coverage elsewhere within the last 63 days, then you must wait one year before your pre-existing condition is covered.

2) The PCI Plan: This is a program created in Spring of 2010 from the Affordable Care Act and it stands for the Pre-Existing Health Insurance Plan. This plan is very cost effective and has no waiting periods on pre-existing conditions. The eligibility requirements are that you must not have been covered by another insurance carrier within the last 6 months and you must have a pre-existing condition.

3) Texas Medicaid: This program is designed to provide inexpensive coverage to those who are near or below the poverty level. Eligibility is based primarily on income and assets, so this will not work for the majority of Texans.

Overall, the best way to approach medical care is to stay continuously covered by health insurance. If you have a lapse in coverage of over 63 days, then you may have created a problem regarding a new medical condition or with your existing conditions.

Please feel free to call us at 866.270.6209 with any questions on this topic and we’ll be happy to place you with the best option for your needs. As always, our services are provided at no charge to our clients.

By Steven Wendlandt

Selected Benefits – Texas Health Insurance has pioneered a better way to obtain the coverage you need at a much lower price. What we recommend is combining a short-term accidental disability policy with a high face amount critical illness policy.

Based on the numbers, most accidents do not result in a permanent disability and can therefore be insured on a shorter term basis. We normally recommend a two year benefit with a 30 elimination. Your payments will begin after the 30 day waiting period and will last for up to two years should you be unable to return to work (highly unlikely).

On the sickness side, we recommend a high face amount critical illness policy that will pay you an immediate lump sum benefit upon the verification of the diagnosis. There is no waiting period to receive your monies other than a few weeks for the insurance carrier to verify to illness. The policy will then pay you the entire face amount of the plan ($50,000 up to $500,000 depending on what you purchase) to be used as you wish. Most people will use the monies to pay off any related medical expenses and pay their regular monthly living expenses. You’ll normally have a quite a bit left over once you’ve recovered from the sickness and are free to use those leftover monies any way you wish. Almost everyone will receive a higher payout over time than if they paid a similar premium for accident/sickness disability coverage. These critical illness policies generally cover about 22 conditions in the categories of cardiovascular, cancer and other miscellaneous illnesses.

The best part is that you will pay a much lower monthly premium than if you had bought the traditional accident/sickness disability combination. If you’re interested in receiving a quote for this type of coverage, feel free to call one of our agents at 866.270.6209.

By Steven Wendlandt

Critical Illness Plans: These plans are designed to pay you a lump sum benefit of the face amount of the policy (after a $100 deductible) for any covered sickness. Our most popular plan is from Humana One and is available in coverage amounts from $5,000 up to $50,000. Most clients view this a viable alternative to a “sickness” disability policy in that if they contract cancer, for example, they can use the extra monies to pay for living expenses while they are taking time away from work to recover. At a minimum, we recommend enough to cover the maximum out of pocket of your health insurance plan, but many clients purchase more coverage since the payout on this plan is independent of your health policy (unlike the accident plan mentioned above). Covered illnesses include heart attack/angioplasty, invasive and non-invasive cancers, major organ failure, coma, stroke, blindness, paralysis and loss of speech.

Another feature of the Accident/Critical Illness plans is that they can be used in combination with a higher deductible health plan to actually reduce overall risk while also reducing premium. If you have an interest in adding any of these supplemental policies to your existing plan, please visit us at www.selectedbenefits.com or call us Toll Free at 866.270.6209.

By Steven Wendlandt