For the second time since September, St. Landry Parish School officials will consider offering an optional health care plan they say is aimed at reducing annual premium costs for both employees and the district.

The matter of whether to provide school workers with the option of enrolling in a gap insurance medical plan offered by Taylor and Sons, Inc. is scheduled to be discussed at a regular school board meeting Aug. 5.

Kevin Thompson, who represented Taylor and Sons during a Tuesday Personnel and Benefits Committee meeting, said those who select the optional Med-Plus plan can still remain with the state’s Office of Group Benefits, which handles insurance and prescription claims and Blue Cross-Blue Shield, which provides insurance coverage for most of the district’s nearly 2,000 workers.

A similar plan that touted reduced insurance costs was presented to board members by Thompson and Taylor and Sons last year, but the offer was rejected due to a restricted enrollment process and the district’s decision to virtually begin the upcoming school session.

More:St. Landry superintendent recommends masks, social distancing when school resumes

Also some board members wondered at the time whether there were possibly other companies who offered similar plans in order for them to make a comparison to the gap insurance presented by Taylor and Sons.

Board member Mary Ellen Donatto had a similar question during Tuesday’s meeting when she asked Superintendent Patrick Jenkins whether he knew of other insurance companies offering employee gap plans that are normally used to pick up the costs for additional individual insurance spending.

Donatto also questioned the timing of the Oct. 1 employee enrollment period which would be preceded by employee engagement sessions beginning in August by Taylor and Sons.

“I just find this as kind of quick to get everyone educated, especially in light of the (COVID) situation that we are in,” Donatto said.

More:St. Landry could build new schools for the first time in 60 years if propositions pass

Jenkins said he isn’t certain whether there are other companies offering gap plans similar to the one used by Taylor and Sons.

The school district pays 75% of the monthly premium costs for active and retired employees.

Jenkins said the Med Plus plan with the gap option gives both the school district and the workers a chance for saving money on health insurance costs.

“For a family, this plan could save them almost $3,000 a year and that’s money that they can put back into their pockets. This is just something that is supplementary to what they have already,” Jenkins added.

More:School district officials anticipate budget surplus after facing steep deficit

In her annual budget message for 2020-21 District Finance Director Tressa Miller said she expects employee insurance costs rise about 5.5%, something that will cost the school system an additional $280,000.

Board member Kyle Boss said talk of changes for their insurance plans is an issue that quickly captures the attention of school employees.

Boss said he began have numerous inquiries about the possibility of the board deciding to move to other options with their insurance even before the start of the Tuesday meeting.

“You talk to insurance (with employees) and they don’t want to hear anything about it,” Boss said.

Thompson said Taylor and Sons has 19 Louisiana school districts participating in the Med-Plus plan, which is paid for by the school systems that have their workers enrolled.

Workers who sign up for the Med-Plus option receive lower premiums whose costs which would be assumed by the school district, zero deductibles and co-insurance, no co-payments while the same providers would deliver prescription drug coverage.

Board members Myron Guillory, Raymond Cassimere and Milton Ambres said they saw no reason why an optional insurance plan should be excluded from the Aug. 5 meeting agenda.

Donatto added that she wants the employees to understand “positively clear” that they are not obligated to make any alterations to their current insurance plans.

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Originally Appeared Here

SANTA MONICA, Calif., July 29, 2021 /PRNewswire/ — Vulnerable Americans who needed comprehensive medical insurance were fooled into buying limited healthcare plans that didn’t meet their needs by a group of insurance agencies that used misleading advertising, according to a new federal lawsuit filed by California-based McLaren Insurance Solutions. The lawsuit alleges that Insurance Care Direct (ICD) and its various business entities engaged in a malicious scheme that hurt families and individuals. Insurance Care Direct claims to be one of the nation’s largest health and life insurance agencies.

Filed July 27, 2021, in the United States District Court for the District of California, the complaint (Case 2:21-cv-06066) describes a scheme hinged on false and deceptive advertising. Families and individuals looking to purchase healthcare coverage were led to believe they would be receiving comprehensive health insurance through reputable insurers like Humana, Blue Cross/Blue Shield, United Healthcare, Cigna, Aetna, or others. But instead, the ICD scheme forced nearly every person who reached to purchase a limited benefit plan that exposed the consumers to the risk of being under- or un-insured.

“ICD used deceptive and misleading marketing tactics to rip people off,” said Jim Gale, one of the attorneys representing the plaintiffs. “This wasn’t about getting people coverage. This was about ICD making money and padding its pockets on the backs of unsuspecting victims.”

The lawsuit alleges the people who bought these policies were carefully and deliberately targeted and deceived by ICD.

“Limited healthcare benefit plans can be right for many people,” said Gale. “But they are not the same as comprehensive plans, and ICD and its many pseudonym entities simply deceived people through its advertising and marketing.”

The ICD scheme involved operating websites under unregistered fictitious names, such as “Affordable Healthcare of California.” Unwary consumers would go to these sites that were filled with logos from well-known insurance carriers. Seeing these familiar companies, consumers would believe they were on a trustworthy website selling quality healthcare plans.

Consumers were then directed to share their personal information, including a phone number and email address, to receive “instant health plan quotes.” But instead of seeing a quote, they would receive a phone call from an agent who would then force the consumer into a limited benefit plan when they thought they were buying a comprehensive plan that would provide full healthcare coverage.

“As we detail in our lawsuit, ICD is a well-oiled marketing machine that takes advantage of people who are vulnerable,” said Gale. “It’s a classic bait-and-switch.”

In fact, in a recent bulletin, the Texas Department of Insurance warned insurance companies, agents, and marketers of discount health care programs, that this type of activity could lead to cease and desist orders, fines, suspensions, as well as possible criminal referrals.

The lawsuit also explains how ICD hired well-connected former politicians to escape regulatory scrutiny, such as former United States Senator and Governor of Nebraska, E. Benjamin Nelson and former Oklahoma Insurance Commissioner, John Doak.

In addition to the false advertising and unfair competition alleged in the complaint, ICD conducted their insurance business without a registered agent, which is a direct violation of insurance regulations. In fact, the person designated as the company’s agent admitted under oath that he was just a “figurehead.”

Attorneys for McLaren have already heard from many victims of this scheme and expect to hear from more. If you suspect you are a victim, email [email protected].

Attorneys for McLaren are available for comment upon request.

SOURCE McLaren Insurance Solutions

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Originally Appeared Here

BAKERSFIELD, Calif. (KERO) — While Dignity Health and Anthem Blue Cross are still in contract negotiations, what does this means for your health needs in the meantime?

As of July 16, Dignity Health is no longer considered in-network for Anthem Blue Cross insurance holders, but some health care will still be covered by Dignity Health physicians.

Dr.Quinn explained, “Hypertension, depression, and cancer are all considered serious conditions but each condition will be handled on a case by case basis then there is acute non-emergency pain like pink eye those services may be more difficult to cover. Dignity health’s goal is to work with patients to make sure that they do not have delayed care.”

Dr.Quinn is advising that patients use their best judgment in the event of an emergency. If you or your child have an emergency Dignity Health emergency services is still available.

Each situation will be handled on a case-by-case basis. If you are still unsure if you will be covered, contact Anthem Blue Cross customer service on your insurance card.

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Originally Appeared Here

After being laid off from her job as a systems analyst for a specialty chemicals company in December, Gabriela de Pompignan opted to hang on to her former employer’s insurance coverage under the federal law known as COBRA. Typically, laid-off workers pick up the total cost of premiums under COBRA, but her company paid roughly 75% of the expense for the first six months, leaving de Pompignan with a $659 monthly bill for the family plan covering her, her husband and their 9-year-old son.

Since both de Pompignan and her husband, a lawyer, were unemployed, her company’s temporary financial support was crucial to making their premiums affordable. What de Pompignan didn’t realize, however, was that she was eligible for an even better deal. Under the American Rescue Plan Act that President Joe Biden signed in March, COBRA premiums for laid-off workers are covered in full by federal funding for six months from April through September.

Neither her former employer nor the company administering COBRA benefits for her workplace told her about that option.

Under federal rules, she should have been sent a notice by May 31 informing her about the subsidy, which is generally available to people who were involuntarily laid off or whose hours were reduced and who are eligible for continued employer coverage under COBRA.

For people like de Pompignan who lost their jobs before April 1, the window to take advantage of the subsidized coverage is closing. They have 60 days from the date their employer notified them of the COBRA subsidy to sign up for it — that’s July 31 if their employer notified them at the end of May. People notified earlier may have already missed their opportunity.

People can sign up for the subsidy even if they didn’t elect COBRA coverage earlier, or if they had COBRA earlier and dropped it because it was too expensive or for another reason.

Those laid off or furloughed after April 1 have 60 days to sign up for regular COBRA coverage and the temporary financial assistance.

De Pompignan learned about the subsidy only because she happened upon a news story that described it.

“I don’t know their reasons for not communicating this option to us,” said de Pompignan, 45, who lives with her family in Mendham, New Jersey. “But I did feel frustrated.” She added that many workers who have been laid off “could be struggling to get their health insurance paid for during such difficult times.”

In a statement to KHN, Trion Group, the company that administers her former employer’s COBRA coverage, said, “As a COBRA administrator, we rely on our clients to provide us information on which of their former employees are eligible for the ARPA subsidy. Once we were notified of the error in Ms. de Pompignan’s initial status, we immediately made the change in our system and sent her eligibility notification.”

Consumer advocates say they’re worried many more people may have been left in the dark about the subsidy since notices weren’t required to be sent to former workers until the end of May, two months after the benefit started.

“Even if everybody got the notices out on time, are folks reading them and understanding what they’re eligible for and what their options are?” said Katie Keith, an associate research professor at Georgetown University’s Center on Health Insurance Reforms.

Karen Pollitz, a senior fellow at KFF, said she talked with some people who were notified promptly, while others weren’t informed about the subsidy until the very end of May and had to get reimbursed for the first two months of the subsidized premiums. (KHN is an editorially independent program of KFF.)

The Department of Labor said it has “conducted extensive outreach and education to promote awareness of the available premium assistance” to help workers and employers.

The outreach includes virtual webcasts and webinars, social media, radio and TV public service announcements, billboards and posters, according to Labor officials. They added that consumers or employers with questions can contact the department online or by phone.

Under federal COBRA law, people can generally choose to continue their employer health coverage for up to 18 months after being laid off. They usually have 60 days to decide, though that deadline has been extended while the pandemic continues. The law applies to employers with 20 or more employees.

Without the special federal subsidy, however, it’s a pricey benefit: People are usually responsible for the entire premium plus a 2% administrative fee.

People who work at smaller companies — those with fewer than 20 employees — that are located in states that have so-called mini-COBRA coverage continuation laws can also take advantage of the subsidy. But there’s a catch: To qualify, workers generally must already have elected COBRA continuation coverage before April 1 or become eligible after that.

Getting the word out was hampered by the program’s short time frame. It was challenging for employers to figure out who was eligible for the subsidy and get notices out within such a tight timeline, experts said. The law passed in March, and guidance from the Department of Labor and the IRS about implementing the law came in April and May. Notices to workers were due May 31.

“My sense is that employers were working around the clock to make sure the notices went out,” said Katy Johnson, senior counsel for health policy at the American Benefits Council, which represents large employers.

But as de Pompignan’s experience illustrates, some people slipped through the cracks.

With her employer subsidy running out in June, de Pompignan called the service center at Trion Group to find out what her coverage options were. The representative who answered the phone suggested de Pompignan look into marketplace plans.

After de Pompignan saw the news story about the COBRA subsidy, she contacted her former employer to ask if she was eligible. The answer was yes, she likely was. It was only then that she received the paperwork.

De Pompignan, who paid her portion of the COBRA premium for April, May and June, said she’s been assured she’ll be reimbursed.

Because de Pompignan’s job loss was initially incorrectly coded as “voluntary” by her employer, Infineum, “[it] caused the Trion system to exclude her from communications regarding the federal subsidy,” according to Hedy DiSimoni, the human resources benefits and payroll leader at Infineum. De Pompignan will receive a refund for the first three months of premiums she paid before being notified, DiSimoni said.

Once the subsidy ends in September, de Pompignan said, she’s not sure what her family will do if she and her husband are still unemployed.

They could continue their COBRA coverage, paying the full premium. They’ll also have an opportunity to sign up for coverage on the state marketplace, under a special enrollment period.

For some people, marketplace coverage may be a better option.

Anyone who received unemployment insurance benefits for even one week this year can receive a silver-level plan without premiums and with cost-sharing assistance, which could dramatically reduce their out-of-pocket costs, said Sabrina Corlette, a research professor at the Georgetown University Center on Health Insurance Reforms.

“It’ll probably have a lower deductible than a COBRA plan, and it doesn’t turn off after September,” Corlette said.

Michelle Andrews:
andrews.khn@gmail.com,
@mandrews110

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Originally Appeared Here

NEW YORK, July 27, 2021 /PRNewswire/ — Stellar Health (“Stellar”) announced today it is working with Pittsburgh-based Highmark Inc. (“Highmark”), one of America’s leading health insurance organizations, to drive payment transformation and value-based care.

The initiative is an extension of Highmark’s value-based payment and care platform, True Performance. Stellar will help Highmark accelerate new payment models and value-based care (“VBC”) for small, independent practices.

These practices are typically independent of larger medical group or hospital system affiliation and are integral to value-based care delivery in Highmark’s network. The initiative focuses on practice engagement, quality improvement, management of chronic conditions, reduced ED and inpatient utilization, and affordability of care for Highmark members.

Stellar, an innovative value-based care company, activates practices by translating value-based metrics to meaningful and granular workflow steps for providers and their care teams. Stellar’s work with Highmark will build on the success of the existing True Performance suite of programs, which has helped Highmark avoid more than $1.5 billion in health care costs since being established in 2017. Today’s announcement will push that further by allowing practices to deliver the right care at the right time, and reward providers in real time for the completion of quality and utilization value-based measures.

“We have followed Highmark’s success in value-based delivery for years, and our mission at Stellar Health to lower costs and improve health outcomes aligns very well with what they are doing,” said Michael Meng, CEO of Stellar Health. “The True Performance initiative with Stellar aims to reward and incentivize providers and care teams in real time, and our platform does exactly that. We are looking forward to working with the provider groups in Highmark’s network and encourage them to engage with us if they are interested in driving value as well.”

Highmark has chosen to work with Stellar due to their deep experience and their platform’s ability to support Highmark’s strategy of expanding VBC models to small, independent practices.

“We are continuing to accelerate our value-based care strategy through our True Performance Primary Suite, both internally and with external partnerships,” described Sean Burns, Vice President of Provider Payment and Network Infrastructure at Highmark. “Over the past few years, we have developed a robust program that allows practices to thrive in the new value-based care landscape, but we also needed to truly engage and activate small, independent practices. We have evaluated various tools and potential partners, and after a comprehensive and exhaustive search, have decided to work with Stellar Health because of their success in engaging providers of all kinds in value-based care.”

Stellar is committed to driving value-based care outcomes for patients across the state of Pennsylvania. As a sign of this commitment, Stellar has brought on a new board of Advisor – Paul Mango, who is a former PA governor candidate, deputy chief of staff for HHS, McKinsey healthcare consultant and ex-Army Ranger. “Stellar’s product is built for driving outcomes and will find success in engaging the providers that Highmark is looking to include in this initiative,” said Mango.

Stellar works across all lines of business, but this initiative will first focus on Highmark’s Medicare Advantage and Commercial lives. Providers will receive Stellar’s no-cost platform and will get paid early and often for all the extra time spent completing value-based activities.

Stellar and Highmark will start onboarding practices in 2021 with an initial two-year implementation timeline across 50,000 Highmark members. If you’re a small, independent practice in the Highmark network, please contact [[email protected]] for more information on how to participate in the program.

About Stellar Health: Stellar Health is a point-of-care, cloud-based platform that activates primary care providers to achieve value-based care goals that improve patient outcomes, such as optimizing the patient care journey and improving quality scores through transitions of care and high-value referrals. The Stellar Health Platform helps primary care providers continually engage with their patients by providing them real-time information and tangible action-based incentives for improving quality of care. Stellar Health’s mission is to enable all physicians to engage and succeed in value-based care by bridging the incentive gap between providers and payors. If you would like more information, please contact Stellar Health at [email protected] or visit their website at www.stellar.health.

About Highmark Inc.: One of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of more than 6 million members in Pennsylvania, Delaware, New York and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com.

Contact Stellar Health – Stavroula Zimaras
Email: [email protected] Phone Number (929) 382-4886
Website www.stellar.health

SOURCE Stellar Health

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Originally Appeared Here

A controversial health cost-sharing organization filed for bankruptcy earlier this month, potentially leaving Granite Staters reliant on the organization without a way to pay medical bills.

Sharity Ministries is a Christian nonprofit that offers an unconventional alternative to health insurance. Clients buy into the program — at a rate usually much lower than the cost of conventional insurance — with no legal assurance that the organization will pay for their medical claims.

Following an onslaught of state lawsuits and investigations, the group filed for bankruptcy in Delaware on July 8. Shortly after filing, their website was updated to inform their customers they were no longer providing services.

“The decision has been made that it is in the best interest of our members to cease operations effective immediately,” the website read.

About 1,200 Granite Staters paid into plans from Sharity Ministries in 2009, though the N.H. Insurance Department does not have records of the number of residents still covered by Sharity in 2021.

Deputy Commissioner D.J. Bettencourt said the department asked Sharity for a list of its New Hampshire members in order to reach out to people that may have been affected but were never provided a list.

Several mediaoutlets across the country have documented several instances in which consumers were left with sizable, unpaid medical bills. In April, disgruntled former customers filed a class-action lawsuit for “refusing to pay claims for health benefits that would otherwise be covered under state and/or federal law.”

The group has also been scrutinized by several state regulators, including those in New Hampshire, who filed a Cease and Desist Order against the organization in 2019 for misleading consumers and administering health insurance plans without proper certification. Andrew Demers, a spokesperson for the insurance department, said the regulatory action is ongoing and likely will not be abandoned in light of the bankruptcy filing.

The insurance department has received some complaints over the past several years from people who said their medical bills were not paid by Sharity.

In a statement sent out Monday morning, Chris Nicolopoulos, the commissioner of the N.H. insurance department, said those covered by Sharity Ministries should urgently reevaluate their health insurance.

“It is very important for consumers to remember that if you were a member of Sharity, you likely do not have any health care coverage at this time,” he said.

Bettencourt encouraged any New Hampshire residents left uninsured to take advantage of the Affordable Care Act special enrollment period, ending Aug. 15, to find a new plan.

“We encourage consumers to consider more traditional health insurance coverage,” he said.

He said some healthcare sharing ministries seem to work, but consumers need to vet their insurance providers to make sure they abide by state and federal regulations.

“It comes down to what’s the philosophy and what’s the approach,” he said.

Any consumers that have a health care sharing plan with Sharity, Aliera Healthcare, or Trinity Healthshare should immediately contact the the N.H. Insurance Department if they have paid a premium for July 2021.

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Originally Appeared Here

Health care enrollment open for those receiving unemployment

From job loss to sickness, so many people have faced hardships during the coronavirus pandemic, and health care is even more important right now. A special enrollment period ends Aug. 15.

MILWAUKEE – From job loss to sickness, so many people have faced hardships during the coronavirus pandemic, and health care is even more important right now. The Health Insurance Marketplace at HealthCare.gov is offering low-cost private health insurance to anyone who is receiving — or already received — unemployment benefits in 2021 during a special enrollment period. 

Many were left reeling during the pandemic, as jobs were cut and workers furloughed, left without health insurance while some even battled illnesses.

“Access to health insurance, quality health insurance is critically important,” said Dr. LaShawn McIver.

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McIver says paying out-of-pocket can cost thousands of dollars. There’s an opportunity right now to maintain the cost of your care.

“Now through Aug. 15, there is a special enrollment period underway as a result of the American Rescue Plan,” said McIver. “Consumers can benefit from greatly expanded financial assistance.”

McIver said as of July 1, anyone who’s received unemployment compensation will benefit greatly.

“Four out of five individuals are finding plans as low as $10 a month or less, and for a family of four that may have gotten premiums for $400, they are finding plans for $163 or less,” said McIver. “If you received any type of unemployment compensation this year, there are also special provisions. People are paying as low as $0 a month for their premium.”

McIver added that the help has been expanded in significant ways.

“In addition, those in higher income brackets are finding out they are able to benefit from this expanded financial assistance,” said McIver.

As the director of the Office of Minority Health, McIver feels this can promote and improve health equity, especially in communities that are underserved.

“I can’t underscore how important it is to have access to quality health care plans so you can maintain good health,” said McIver.

If you received unemployment benefits in 2021, you can see what assistance you qualify for or even sign up. The special enrollment period ends Aug. 15.

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Originally Appeared Here

Published: 7/24/2021 10:00:10 PM

Modified: 7/24/2021 10:00:11 PM

Don’t blame teachers for health costs

I am weary over the annual battle with employees and unions when it comes to health insurance and benefits. It is even more infuriating when a longtime Dresden School Board member like Neil Odell has such a lack of insight and creativity to call out the teachers union over its demand for affordable health insurance (“Brace for Vt. NEA’s health care demand,” July 19).

I have written to him and to the board multiple times over the years suggesting that they join other health care organizations — the Vermont chapter of Physicians for a National Health Program, Health Care for All and the Vermont Workers’ Center Health Care is a Human Right campaign — to extricate ourselves from this trap of escalating costs, but not the way that some would like. The sad truth is that health care insurance costs long ago spiraled out of control because there are stakeholders who are profiting from our miserable reality.

School boards are not alone in this crisis. A huge chunk of municipal taxes goes to town and city worker health benefits. In order to attract employees, most employers need to pay part of worker health insurance costs and, of course, everyone who lives, breathes and works has to pay for this expensive product, which doesn’t even cover what is needed, or we go without it altogether. Everyone suffers collectively without universal health care. Teachers are also taxpayers.

We already know that the United States pays more than every other developed country for health care, with worse outcomes. When will the school boards, the cities and towns, and the unions realize that health insurance should not be a bargaining chip? We should all be fed up over these negotiations and point the finger at the real culprit — Congress — for taking contributions from the insurance, pharmaceutical and medical industries.

It is past time to remove this burden. We should not be blaming the teachers. Every person deserves health care and we should pay progressively for it. This is the answer.

SHARON RACUSIN

Hanover

Our right to peaceably assemble

The First Amendment to the Constitution is first for a reason. It reads, in part, “Congress shall make no law … abridging … the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” Our Founding Fathers realized that the ballot box alone did not guarantee that the people’s representatives would always be responsive to the people’s will. Citizens have the right, and sometimes the obligation, “peaceably to assemble, and to petition the Government for a redress of grievances.”

The time to exercise that right is now.

As legislation to restrict voting is being introduced in statehouses across the nation, and as the gerrymandering of voting districts based on the 2020 census threatens to skew elections for the next decade, citizens of the Upper Valley have an opportunity to voice their opposition to these antidemocratic schemes and to support legislation that protects voting rights. Open Democracy has scheduled a nonpartisan rally in support of S.1 (the For the People Act) for Thursday, from 4-7 p.m., in Lebanon’s Colburn Park. The For the People Act protects voting rights and curtails gerrymandering. In a provision especially relevant to New Hampshire, the bill requires states to establish independent commissions to carry out congressional redistricting. Join this rally in support of the For the People Act. The future of our democracy is at stake. Register to participate at www.opendemocracynh.org/lebanonforthepeople.

NANCY GRAHAM

West Lebanon

LYNN GARFIELD

Lebanon

Incentives the key to climate action

The Hartford Selectboard and School Board declared a climate emergency in 2019 and resolved that the town shall achieve net-zero greenhouse gas emissions by 2030. In addition, Hartford’s response to the climate emergency “must be just and equitable, especially with respect to the most vulnerable and impacted members of society.”

The well-researched and exhaustive plan reveals that 98% of CO2 emissions come from buildings and vehicles. To satisfy the net zero goal, other considerations are relatively minor.

So, how does Hartford massively reduce greenhouse gas emissions from buildings and vehicles in 8½ years in a way equitable to the most vulnerable and impacted members of society when most of Hartford’s residents would be vulnerable and impacted? The solution can only be realized through incentives, not mandatory compliance or regulatory burden alone.

For buildings, the town might offer property owners financing on extremely favorable terms to be used toward efficiency improvements (insulation, ventilation, windows, solar panels, etc.). For vehicles, the town might implement changes in transportation and infrastructure to reduce internal combustion engine use, public and private.

Let’s consider 2,000 houses on the grand list. Most need energy improvements. If, on average, each needed $75,000, the town would need to provide $150 million. If the transportation sector required some similar amount, perhaps the town would need to finance $300 million total.

Those numbers may seem ludicrous, but given the magnitude of the challenge, and the parameters of the resolution, I think the above roughly states reality.

The federal government is currently receptive to this kind of thing, and interest rates are low. With careful management and execution, Hartford would become known for its proactive approach. Property values would rise, there would be growth, and the town might make good on the immense challenge of the 2019 resolution.

Again, thanks so much to the climate action plan committee for providing the groundwork for a response.

BRAD GOEDKOOP

Wilder

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Originally Appeared Here

A health insurance policy plays a significant role in providing financial stability for an individual and his/her family at the time of medical emergencies. Typically, a health policy offers to cover hospitalisation expenses along with pre- and post-hospitalisation expenses, day care treatments (treatment procedures that require hospitalisation for less than 24-hours), and accidental injuries, among others. While it is important to have sufficient coverage amount at all times, sometimes a base policy may still not be enough to cover other expenses. You can then consider going for one or two riders/optional covers, depending on the need. Keep in mind that these add-ons involve payment of additional premium. Here are a few riders worth considering.

Hospital cash benefit

While a health policy takes care of hospitalisation expenses, you may still end up paying for certain charges while are still hospitalised. These expenses are usually inadmissible at the time of filing a claim, and include the cost of hospital gowns, gauzes, adhesive bandages and maintenance and housekeeping charges and conveyance charges. This is where the hospital cash or daily cash benefit comes in handy. It means, if the policyholder gets hospitalised, your health insurer will pay you a lump sum amount for every day of hospitalisation up to a certain number of days up to a maximum limit (varies with insurers). For instance, in ICICI Lombard’s Complete Health Insurance plan, the hospital daily cash made available is ₹3,000 per day for up to a maximum of 10 days of consecutive hospitalisation (minimum 3 days) for sum insured (SI) of ₹15 lakh and above. The daily cash limit is ₹2,000 per day if the SI is less than ₹7 lakh.

Most insurers including Tata AIG, ICICI Lombard, HDFC Ergo Health, Max Bupa, Bajaj Allianz, Star Health and Digit, offer hospital cash benefit as an optional cover for additional premium, while some insurers offer this as an in-built cover.

Tata AIG’s Medicare, for instance pays 0.25 per cent of SI up to a maximum of ₹2,000 per day of hospitalisation for shared room accommodation.

Critical illness

A critical illness (CI) cover is offered as a rider or as an optional cover by many health insurers. Under this, the insurer will make a lumpsum payment at the time of diagnosis, after which this cover terminates. Remember that, there is no restriction on the usage of the amount received. Primary breadwinners of their families, who don’t want to take chances on their health can consider this rider. Do note that the insurer will make payment only for certain diseases mentioned in the policy document and the payment varies across insurers and diseases. For instance, HDFC Ergo’s Optima Secure plan offers critical illness cover with SI of ₹10 lakh to ₹2 crore CI. Similarly, 100 per cent of the SI opted is paid out in case of Manipal Cigna’s ProHealth plan. Both policies also offer expert opinion if the insured requires it for the CI.

OPD benefit

Another rider cover to consider is OPD (outpatient department) where it covers expenses such as doctor’s consultation fees, pharmacy bills, dental treatment expenses and non-allopathic treatment. Most of the health policies offer OPD in-built in the policy but there are a few that offer this as an optional or add-on cover. Policies including ICICI Lombard’s Complete Health Insurance plan and Max Bupa’s Go Active offer in-built OPD cover while policies such as Activ Health from Aditya Birla Health and Care’s Care Freedom offer it as optional cover. Ideally those who go to the pharmacy or consult doctors often can go for an OPD cover.

But, if your plan already has OPD in-built there are other optional covers to consider. One is a maternity cover, offered by many insurers, which can be considered if a couple plans to have a baby.

Alternatively, reduction in waiting period cover can be opted. This comes in handy for those who are already suffering from pre-existing conditions such as asthma or diabetics. Generally, the pre-existing disease waiting period ranges from 2-4 years across insurers. With this rider cover, upon payment of additional premium, your waiting period of say, four years, will come down to say 1-2 years. You can also use the cover to reduce the maternity waiting period (usually 4 years), if the insurer offers it.

Hospital cash can pay for inadmissible medical expenses

Critical illness cover offers lumpsum payment

OPD benefit is useful to pay for doctor’s consultation fees, non-allopathic treatment

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Originally Appeared Here

While I agree with Casey Mulligan that employer health insurance is much better than the government alternative (“Three Cheers for Employer Health Insurance,” op-ed, July 17), it is far from a panacea. Having dealt with it as a physician, patient and employer, our current system leaves much to be desired.

As a physician, I’ve seen how commercial insurers have imposed on doctors onerous requirements designed to deny patients care, thereby maximizing profits. As a patient, I pay a large premium and still have a huge deductible that I never meet, leaving me to shoulder tremendous out-of-pocket costs. Worse, many of my lower-wage-earner patients have a nice insurance card that they can’t afford to use. As an employer, I’m squeezed more every year by rising health-insurance costs that make employee benefits one of our biggest expenses.

Jason Acevedo, M.D.

Abilene, Texas

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Originally Appeared Here