Sunday, April 12th, 2009 | Author:
6021462311 09f701b5ca m Tonik Health Insurance

. One such item, medical malpractice liability reform, got a hearing last week before the House Judiciary Committee as Republicans paraded several witnesses before the committee to showcase the need for legislation from the physicians’ perspective. Since it is very unlikely that the American Medical Association’s wish list would ever become law, the best result from the committee process would be a bill that skirts the more controversial items (e.g., cap on damages) and focuses on attainable and meaningful reforms, such as health courts, stronger pre-trial evaluation and settlement pathways.  This would be a path Aetna would strongly support.

In March 2010, Governor Brewer signed a fiscal year 2011 budget that stripped funding for the state’s Children’s Health Insurance program (KidsCare) and cut $385 million from AHCCCS, effectively repealing an expansion of AHCCCS to childless adults approved by voters in 2000. However, following enactment of the PPACA, the state rescinded the scheduled cuts to comply with the law’s “maintenance of efforts” (MOE) requirement. The MOE requirement prohibits a state from having eligibility standards, methodologies, or procedures for adults that are more restrictive than those in effect on March 23, 2010, until a health insurance exchange in the state is fully operational, and for all children in Medicaid and CHIP through September 30, 2019. The MOE requirement provides an exception for non-pregnant, non-disabled adults earning more than 133 percent of the federal poverty level if a state is projected to have a budget deficit. Arizona faces a mid-year budget deficit estimated at $825 million. A $1.4 billion shortfall is projected for the 2012 fiscal year.

. The high court will review three legal challenges to California’s proposed and adopted reimbursement cuts. The Supreme Court’s ruling on the case could have major implications for efforts to address California’s budget deficit. Last week, Gov. Jerry Brown (D) released a budget proposal that would reduce Medi-Cal payments to health care providers by 10 percent to cut program spending by about $719 million in fiscal year 2011-2012. In addition, the case could have implications for other states seeking to address budget deficits by cutting Medicaid payments. With federal courts in California blocking the cuts, 22 states have joined California in appealing the issue to the Supreme Court.  The court is expected to hear oral arguments in the case next fall. A decision is expected in late 2011 or early 2012.

Few details were provided, but the original report recommends that SustiNet become a licensed insurance plan. ”We don’t need health insurance anymore, we need to move towards health assurance — health care that will be there for us, and the SustiNet plan will do that,” Donovan said. Lawmakers will face a $3.7 billion budget deficit by July 1. Rep. Betsy Ritter, D-Waterford, co-chairwoman of the Public Health Committee, said the plan will have to go before multiple legislative committees, with the actual bill some weeks away. A financial analysis on upfront costs is not yet available. Aetna is working with the Connecticut Association of Health Plans (CTAHP) and AHIP to secure an objective fiscal analysis of SustiNet’s, as a public option, true cost to the state, and of the strong, positive impact health insurers have on the state’s economy.

The Governor specifically stated he is open to any and all good ideas for addressing this budget issue. In other news, a joint meeting of the Senate Health Committee and the House Economic Development, Banking, Insurance, and Commerce  Committee was convened for an update on the state’s effort to implement health care reform. Rita Landgraf, Secretary of Health and Social Services, along with Bettina Riveros, Health Care Commission Chair, advised legislators the commission will spend the next six to eight weeks holding stakeholder meetings across the state seeking input on establishing a state health insurance exchange.

]]>

:  As the head of this workgroup for Governor Perdue is continuing under Governor Deal’s administration, it is likely that there will be some enabling legislation during the 2011 session, though it is unclear what that will be. The legislative session began January 11, 2011 and continues for 40 legislative days.

The General Assembly convened in Des Moines on January 10 and is expected to adjourn on April 29, 2011  In the November elections, Republicans took control of the House and gained a few seats in the Senate, narrowing the Democrats’ majority there. Republican Terry Branstad was sworn in as governor for the second time. Having served in the post from 1983 to 1999, Branstad is the longest-serving governor in Iowa’s history. The state’s budget deficit is projected to be more than $785 million for fiscal year 2012 and will dominate legislative discussions. House Speaker Kraig Paulsen has vowed to remedy the deficit through spending cuts rather than tax increases. The Governor’s proposal to revise the state’s annual budget to a two-year cycle will also be debated.

: . In his order he directs the Indiana Family and Social Services Administration (IFSSA) to cooperate with appropriate state agencies, including the Department of Insurance (IDOI), to establish and operate the exchange. The IFSSA Secretary or the secretary’s designee will serve as the incorporator of the Exchange. If, after careful analysis, the state deems it appropriate to proceed with creation of the exchange, a board of directors will be selected. The board will include representatives of state agencies and the Indiana General Assembly. Standing Committees will be appointed that have stakeholder representation. . HIP, the state’s consumer-directed program for covering the uninsured population, is scheduled to expire in 2012. Daniels notes he has received communication from HHS staff indicating the state plan amendment will be rejected due to HIP’s required level of contribution from participants.  The Governor said the state intends to utilize the program for the newly eligible Medicaid population pursuant to PPACA. Daniels cautioned that Indiana does not have the time and financial resources necessary to complete new rigorous requirements for applying for a waiver extension if the amendment is rejected. The current 45,000 enrollees in the program would have to be transitioned into traditional Medicaid.

The 96th General Assembly convened on January 5 and is expected to adjourn on May 30, 2011. With 106 members to the Democrats’ 57, the GOP has the largest number of seats it has ever held in the House and is just three members short of being veto-proof.  Given the large Republican majorities in the General Assembly and 70 percent voter support for Proposition C – an effort to turn back health care reform, the legislature will be under pressure to do nothing to move Missouri closer to enactment of federal health reform.

, a bill requiring statutory authorization by the General Assembly to implement PPACA, a bill expanding the autism mandate, an MLR bill for large carriers requiring a 90 percent MLR for Missouri-associated revenues and 85 percent for smaller carriers, a bill requiring the state employee health plan to offer a minimum of three high-deductible options with differing annual deductibles and annual out-of-pocket expenses, a bill prohibiting “Most Favored Nation” clauses, legislation creating transparency and publication of carriers’ fee schedules and requiring carriers to contract with providers willing to meet certain provider participation terms and conditions, and creation of a uniform group application for insurance.

: with six bills relating to implementation or rejection of PPACA introduced to date. Bills of interest include legislation creating an Exchange Task Force, an interim committee for PPACA study, and several bills challenging the individual mandate, prohibition of abortion coverage, and a cochlear implant mandate. In addition, a bill banning discretionary clauses in health and disability income insurance contracts has been introduced.  The legislature began its work on January 6 and is tentatively scheduled to adjourn on May 26, 2011.

The legislature convened on January 5, 2011, and is scheduled to adjourn on June 30, 2011. Governor John Lynch will continue as the state Executive; however, Republicans have gained control of both chambers in the legislature. In addition to the state’s budget deficit, implementation of federal health care reform will continue to be a priority for the governor and the legislature. Given the Republican majority and anticipated revenue shortfalls, there will be limited, if any, activity on health insurance issues. The legislature will, however, be paying close attention to federal health reform implementation issues and activities. . In 2010, the state enacted legislation granting certain powers to the commissioner with respect to implementation of PPACA.  This legislation also created a legislative oversight committee, to which the Department of Insurance (DOI) must report monthly. This month the DOI submitted a request for a waiver of the 80 percent minimum loss ratio (MLR) requirement for individual health insurance market policies until 2014.

: . One option is to let HHS run the state’s exchange, While that could save money, it would also mean ceding key operational and regulatory issues to the feds. It might also jeopardize existing consumer

Related Post

Pages: 1 2
You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

8 Responses

  1. 1
    Mr. Bills 

    Yes, as far as Tonik Health Insurance goes, Anthem Blue Cross Blue Shield of Colorado has a great product. Tonik is cool because it covers medical, dental, and vision. I bought Tonik several years ago through 1-877-MY-TONIK (http://tonikhealthinsurance.com/Tonik-Colorado.html). And I pay just over $100 a month. I haven't used it except for the dental, but that has worked out well for me. It is a PPO and I did check around a great deal when I bought the plan, and it seemed the best for my money.

  2. 2
    UrbanFan 

    Tonik is a product of Anthem Blue Cross. they are a good dependable company.

    Maternity is NOT covered!

    Generic only prescription coverage.

    (no brand name drugs covered, are you current Rx brand or generic)

    $10,000 annual out of pocket … is your maximum exposure on this plan … 10k is the most you are going to pay out in the event of major services (surgery etc.)

    I think you should look into the H.S.A plans.
    Health Savings Accounts.

    Are you in California ?

    Blue Shield has a PPO 2400/4800 plan – that would work much better then tonik …
    I would find a local agent to shop the market for you …
    or email me.

    :-)

  3. 3
    alex 

    health-quotes.isgreat.org – here is my health insurance plan. As I remember they can provide such a service.

  4. 4
    dm 

    Kaiser is the best value in health insurance. Since you are unemployed, find out if you qualify for their STEPS plan. (www.kp.org)

    Also, depending on your assets, you may qualify for govermental health insurance. Check with your local social service agency.

  5. 5
    Mr. Bills 

    Yes, I had Tonik health insurance for a few years now. I broke my ankle and needed a cast and about 7 office visits and 5 P.T. sessions. I only paid $1500.00. I think this was a deal because I was hiking in Yosemite and it was a heck of a trip to the hospital. For what I pay a month Tonik is well worth it. I think my whole bill would had been around 10 or 12 thousand dollars.
    I also use the dental and vision. The dental pays for all my cleanings and exams and once I had 2 cavities and I only paid about $50. I also used a coupon at lenscrafters and then I submitted a claim to Tonik and they gave me $100. So I only paid about $44 for a pair of frames that was over $200. I originally got my plan through http://www.tonikhealthinsurance.com

  6. 6
    sandonee 

    You're not going to get coverage for a preexisting condition in Georgia, on a private health insurance plan.

    Ain't gonna happen.

    You are NOT in good health if you have skin cancer – or even if you suspect you have skin cancer. Preexising means, you need to see a dermatologist for skin cancer. It does NOT mean "I think I might have skin cancer but haven't been diagnosed yet so it doesn't count."

  7. 7
    Ryan C 

    It depends on what you want from your health insurance. Tonik is a Blue Cross Blue Shield product, so you would be part of a network that consistently ranks high in health insurance satisfaction surveys. And it’s been a hit: in less than two years it’s become BCBS’s second-best selling health plan in California. However, it might not offer much more than your student health plan. For example, it doesn’t cover pregnancy (not a problem for you) or brand name drugs. But it does offer vision and dental for a really low price. UniCare has a similar plan marketed to “young invincibles” called “Sound.” You might want to compare the two plans and see if they are both available near you.

    If I were you, I’d make a list with three columns. One for what you want/expect from health insurance, another one for your student health plan, and another for Tonik (or any other health insurance). Then, just fill in the blanks with how the college plan and the private plan meet your needs. It’s simple, I know, but putting things down on paper usually helps me think things through. You might not even need the additional insurance.

    If you are interested, though, check out MostChoice.com. I’m a writer there, and they have a simple approach to shopping for insurance: make locally licensed agents do all the legwork. They have instant quotes and plan details for free, and they have a network of agents that can answer your questions and guide you to a plan that’s right for you. There’s no cost, and you’re not obligated to buy insurance from any of the agents that call you. Just ask your questions and wait for an agent to deliver the right solution.

    You can visit MostChoice here: http://www.mostchoice.com/health-insurance.cfm

    Take care. I hope this helps.

    Barnes @ MostChoice.com

  8. 8
    Helen Scott 

    You need a trusted adviser to help you through the process of purchasing health insurance so that you understand what you are purchasing. You probably already know that there is much more to health insurance than what is the cheapest policy.

    Ultimately, you are the one who determines how "cheap" your health insurance policy will be because you decide how much you will participate in sharing the cost of your health care with your insurance company.

    If you choose a plan that covers everything i.e. doctors office visits, prescription drugs, preventative health benefits, maternity coverage and you choose low deductibles and low copays your monthly premiums will be significant.

    On the other hand if you are young and healthy and rarely use the health care system you might be able to consider a plan that covers only the major health catastrophe which will result in, maybe not "cheap" but, a relatively low monthly premium. You then can use the monthly premium savings to pay for the occasional doctor visit and still come out ahead.

    Check with the agent that writes your home or auto insurance he/she can provide you a health insurance proposal that takes into account your budget and health situation.

Leave a Reply » Log in