Workers’ Health Insurance Info

In April 2006, the headlines on Boston’s Beacon Hill read like this:

“Massachusetts Plan Gives All Residents Access to Health Insurance.”

“Lower-Income Residents Will Receive Premium Subsidies.”

“Employers, Individuals Face Levies If They Lack Coverage.”

In the coming years, bigger news for workers nationwide will be heard, if their states adopt reforms similar to those passed by the Massachusetts legislature and signed by former Governor Mitt Romney, prompting headlines that might read: “With Health Insurance a Given, Workers Feel Freer to Change Employers.”

Reforms should be pushed.

by Andrea

An HMO or  Health Maintenance Organization, is a type of insurance plan with the intention of  focusing on the long term care of its insured and on an average is less expensive than a Major Medical Plan. Every patient is given a Primary Care Physician, who is answerable for giving defensive care and coordinating care for the patient if additional consultant or hospitalization is essential. This somehow keeps the costs down. In addition to the limited choices of a HMO plan, choosing for a  physician or consultant in your network and not covering the services that are deemed unnecessary, controls costs.

by Andrea

As an employee, we do not often have a selection in what kind of health plan our employers provide. Some companies do have a variety of plans to select from and individuals and those that are self-employed need to be able to choose a plan that will fit their needs and also their budget. Others are buying a separate self employed health insurance for their own protection, so make sure you understand or aware the kind of coverage you need. At the same time, paying for a health insurance nowadays is no longer as unproblematic as signing a form and allowing payments to be deducted from your take-home pay.

If you lost your health insurance because you got fired from your job, you could qualify for individual coverage. You could get this under the benefits provisions in the plan or policy or from the Federal law mandated COBRA extended coverage. This is limited to 18 months normally, 29 months if you are disabled, or 26 months if you are a spouse or dependent of a deceased insured or divorced from an insured. If you have any questions, you could contact your union or association representative or your company’s benefits office. You could also ask any insurance agent for further clarification.

The third type of managed care plan aside from HMO and PPO is the POS Plan. A Point-of-Service or POS Plan is a hybrid of the Health Maintenance Organization or HMO Plan and the Preferred Providers Organization or PPO Plan. In POS, the primary care doctors will make referrals to other providers included in the plan. If a member chooses to leave the network, the POS plan will pay for a set amount of the bill. These kind of plans costs more than HMOs but they are more flexible because you could call a doctor on your own whenever you want and even if your primary care physician doesn’t.

A record 46.6 million Americans had no health insurance in 2005. Fewer people received coverage through their employers. according to U.S. census figures released Tuesday.

Almost 1 in 6 Americans, or 15.9% of the country was not insured for some or part of last year, compared with 45.3 million, or 15.6%, in 2004.

The number of people covered through their jobs slipped to 59.5 percent from 59.8 percent in 2004, according to data from the census’ Current Population Survey.

Data may be in 2003, but still hold relevance. Quick Stats from according to data from the Agency for Healthcare Research and Quality (AHRQ): February 21, 2003

January to June 2000, more than 60% (71 million) of working Americans under 65 years of age had health insurance that they got through their primary place of employment.

The data wer collected by AHRQ’s Medical Expenditure Panel Survey. They are published in a new statistical brief giving details of the characteristics of U.S. workers who have health insurance obtained from their primary employers. The statistical brief does not focus on other sources of insurance coverage obtained through a family member’s employment, an individually purchased private policy, public insurance, or another job.

Health insurance –it pays for medical expenses. This is the general description. Sometimes it would include insurance for disability, long-term nursing or custodial care needs.

Souces: government-sponsored social insurance program, or from private insurance companies.

How: either on a group basis, or individually,

Purpose: to help protect selves from high or unexpected healthcare expenses.

Social welfare programs may be funded by the government.

by Andrea

Firms with in excess of  200 employees has to provide health coverage plans for their  workers and their families as dictated by law. Meanwhile, employers with 20 to 49 workers alone would be exempted from this proposition not until directions were given as soon as possible. The amount would need employers to pay at least eighty percent of the cost, leaving the workers to pay the remaining twenty percent. Contributions for low-income workers, however, will require for a five percent deduction from their pay. Businesses and restaurants called this a hard hitting measure and if this will be the law’s new policy, a lot of firms would go under or lay off some workers.

Social health insurance (SHI) is a method for financing health care costs through a social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies. It is one of the five main ways that health care systems are funded.  SHI systems are characterized by the presence of sickness funds which usually receive a proportional contribution of their members’ wages. With this insurance contributions these funds pay medical costs of their members, to the extent that the services are included in the, sometimes nationally defined, benefit package. Affiliation to such funds is usually based on professional, geographic, religious/political and/or non-partisan criteria.