Questionnaire for Indian Insurance Company - PowerPoint

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					       SHIBA HelpLine
    Statewide Health Insurance
         Benefits Advisors

         Health Care
          Coverage
Understanding Your Options



Sponsored by the Office of the Insurance Commissioner
                SHIBA HelpLine
               mission statement

   SHIBA HelpLine provides free, unbiased
 information about health care coverage and
     access to help improve the lives of all
   Washington state residents. We cultivate
 community commitment through partnership,
          service and volunteering.

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                    SHIBA HelpLine
                     contact info:

             Statewide: 1-800-562-6900
               Local: _____________


      http://www.insurance.wa.gov/shiba



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                          Questions:

                Do you know
                 someone with no
                 health coverage?
                Can they afford the
                 costs of coverage
                 they may have?
                What do they do
                 when they get sick
                 or hurt?
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                         Today’s overview
             1.   Health care coverage basics
             2.   Options you may already have
             3.   Options based on income and assets
             4.   Options based on work
             5.   Options you may buy
             6.   Options if you have pre-ex. conditions
             7.   Other options
             8.   Shopping tips + watch out for fraud
             9.   For more information
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                        Health care coverage
        What is it?
                Any product or resource that helps pay
                 for medical services and other health
                 care costs
                You may have to pay a portion of
                 costs (especially with insurance plans):
                     Premium – monthly charge
                     Deductible – what you pay at the start
                      of calendar year before plan starts to pay
                     Copay/coinsurance – your cost per visit
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                     Health care coverage

        Why get it?
                Uninsured people may avoid getting
                 treatment
                Small medical conditions can become
                 major health and financial problems
                Think about how much you are willing
                 and able to risk


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                     Health care coverage

        You might use more than
         one product or resource
                Some you must use alone
                Some you may piece
                 together
                Sometimes family members
                 will need different things


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                        Options you may
                         already have
            VA benefits – for some veterans
                1-800-562-2308 (Washington state)
                http://www.dva.wa.gov/
            TRICARE – military insurance
                1-800-538-9552 or 1-888-874-9378
                http://www.tricare.mil/
            ChampVA – survivors of veterans
                1-800-733-8387
                http://www.va.gov/hac/forbeneficiaries/champva
                 /champva.asp
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                        Options you may
                         already have
        Indian Health Services or Tribal Clinics
                Each tribe sets criteria and benefits
                May also cover children of tribal members
                Contact Tribal clinics directly
                Contact IHS at: 503-414-5555 or
                 http://www.ihs.gov/
        Urban Indian Clinics (King and
         Spokane counties)
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                        Options based on
                       income and assets
            Not available for everyone
            Some programs for specific
             groups (children, pregnant
             women, disabled, etc.)
            Often specific criteria to qualify
            SHIBA can help you!
                Screening to see if you may qualify
                Refer you to where to apply
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                            Options based on
                           income and assets
       State Medicaid (DSHS)
        Many different programs

                Apple Health for Kids
                “Provider One”
            Often free, some have small premiums
            No wait period for pre-existing conditions
            Enrollment based on income and assets
            Must be in a “category”

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                          Options based on
                         income and assets
       DSHS “categories” - People who:
              Are Age 65+              Have a Disability
              Are Blind                Are Expecting
              Are Children under       Are in Families with kids
               age 19                    under age 19

      Apply/ask questions:
            1-877-501-2233 or 1-800-562-3022
            http://www.dshs.wa.gov/
            Your local Community Services Office
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                          Options based on
                         income and assets
       Apple Health for Kids (DSHS):
        Low-cost coverage for kids under age 19

        In 2011, folks qualify with income less than:

                $3,678/month for a family of two
                $5,589/month for a family of four
            Contact Apple Health for Kids:
                1-877-543-7669
                http://hrsa.dshs.wa.gov/applehealth/
                Your local Community Services Office
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                          Options based on
                         income and assets
       Basic Health:
            Coverage for some people ages 19-64
            Must prove citizenship and have income under
             133% FPL:
                Under $1,734 per month (single person)
                Under $3,534 per month (family of 4)
            A long wait list – but some folks may bypass
            Contact Basic Health:
                1-800-660-9840
                http://www.basichealth.hca.wa.gov/
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                        Options based on
                       income and assets
       Basic Health: Who can join right away?
            Foster parents and personal care workers
            Health Coverage Tax Credit recipients
            Tribal sponsored account recipients
            Some Washington National Guard members and
             reservists
            Basic Health Plus and Maternity applicants BH
             referred to DSHS, if DSHS found them ineligible
            BH recipients who left for Medicaid and then
             lost Medicaid
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                           Options based on
                          income and assets
       Clinic care
            Community clinics:
             http://www.chs.hca.wa.gov/clinics.html
            Rural health clinics:
             http://www.doh.wa.gov/hsqa/ocrh/RHC/Fed_De
             signRHCs.pdf
       Charity care
            Hospitals must write off (or not collect) all or
             part of some bills
            Other providers may do this as well
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                      Options based on work
      Health insurance through work
            Every plan is different:
                What it covers
                Who it covers
                What it costs
            May be through your own job
            May be through job of your spouse,
             domestic partner, or parents
            May cover adult children up to age 26
            Retiree coverage: Through former work
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                      Options based on work

     COBRA coverage
        A way for workers (and people their policy
         covers) to keep coverage they might lose
        Many large employers (20+ workers) must
         offer it for “qualifying events”
                Job loss or reduction of hours
                Death or divorce of covered spouse, etc.
        Extends coverage up to 36 months
        Costs to keep coverage may be very high
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                      Options based on work

        Other continuation coverage
                Option to keep coverage you might lose
                Through some COBRA-exempt employers
                Ask employer/benefits dept. for details
        Association plans – through some
         professional groups or trade associations
                Often available in specific industries
                May be through chambers of commerce, religious
                 or fraternal organizations, trusts and unions

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                      Options based on work

        Special options for
                Small businesses
                Self-employed
                Sole proprietor
                Get details from Insurance Commissioner’s
                 Office: 1-800-562-6900 or
                 http://insurance.wa.gov
        Health Ins. Partnership (HIP)
                Help some small businesses cover workers
                1-800-377-0976 or http://www.hip.hca.wa.gov/
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                     Options based on work

     For more information:
      Employer/benefits department

      Insurance Commissioner’s Office

                1-800-562-6900
                http://insurance.wa.gov/
                Based on whether the plan follows state
                 or federal law, they may also refer you to
                 U.S. Department of Labor:
                 1-866-444-3272
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                       Options you may buy
     Individual insurance:
        Buy insurance directly from ins. company
        Variety of coverage options and plans
        Costs vary greatly based on:
                Your age
                Whether you smoke
                Where you live (county)
                How many people you want to cover (yourself or
                 other family members)
                Plan benefits (size of deductible, catastrophic or
                 comprehensive coverage, etc.)
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                     Options you may buy

     Individual Insurance:
      May have a wait period before covering
       pre-existing conditions
                9 month wait
                6 month “look back” for pre-existing
                 conditions
                Plans may waive this if you had
                 comprehensive coverage right before
                 buying individual insurance

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                   Options you may buy

    To buy individual insurance:
       Most applicants must first complete and
        pass Standard Health Questionnaire (SHQ)
            Written health screening
            Same screening used by all insurers
            See example and scoring information at
             https://www.wship.org/
       Some people may buy without SHQ
            Kids: Sep. 15-Oct. 3

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                    Options you may buy
    When can I buy health insurance without SHQ?
       Move within state + outside plan service area
       Follow doctor from one plan network to another
       Use up COBRA/lose it when your old job stops offering
       After 24 mos. continuous group coverage and you:
            Lose a COBRA-exempt group plan due to qualifying event
            Qualify for or drop COBRA; or leave Basic Health
            Lose your plan because your employer went out of business
       Add a newborn/newly adopted child to the plan
       Ask about your situation: 1-800-562-6900 or
        http://www.insurance.wa.gov/index.asp
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                       Options you may buy

     Individual insurance:
        Compare plans and benefits:
                http://www.healthcare.gov
                http://www.insurance.wa.gov
        Call the Insurance Commissioner’s Office at
         1-800-562-6900 for detailed questions about:
                SHQ
                Wait periods
                Portability (going from one plan to another)
                Comprehensive and catastrophic plans
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                       Options you may buy

     Washington Health Program:
        “Limited benefit” plan:
                Covers up to $75,000 or $100,000 per year
                Premiums may be lower than for individual ins.
                If you have higher medical costs in a year than the
                 limit, you may be responsible for those bills!
        Premiums based on your age, county, tobacco
         use, number of covered family members, and
         benefit limit you choose ($75,000/$100,000)
        You also pay deductibles and coinsurance
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                      Options you may buy

     Washington Health Program:
        Folks must pass or be exempt from SHQ
        Open to folks who live in Washington and
         don’t have Medicare, Medicaid, or WSHIP
        HCA decides if you qualify
        You get insurance through a private company
        For more information:
                1-800-660-9840
                http://www.washingtonhealth.hca.wa.gov/
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                      Options if you have
                    pre-existing conditions
      Pre-existing Condition Ins. Plan (PCIP)
       For people who:

                Fail the SHQ, or would likely fail
                Live in WA state and are in US legally
                Have been uninsured for 6 months or more
            Same premium rates as individual insurance
            Details + list of qualifying med. conditions
                1-877-505-0514 or
                https://www.wship.org/PCIP-WA/
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                       Options if you have
                     pre-existing conditions
     Washington State Health Insurance Pool
       (WSHIP)
      Provides coverage to people unable to buy
       individual insurance due to health
      Must have completed and failed the SHQ

      Premiums are higher than individual plans

      Get details about coverage and discounts at:

                1-800-877-5187
                https://www.wship.org/default.asp
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                          Other options
       Programs for specific illnesses or conditions
       Student insurance plans at colleges
       Care at community clinics or free clinics
       Financial help/charity care with hosp. bills
       Patient assistance programs for Rx
       Discount plans: Discount on medical/Rx’s
       For more information:
            1-800-562-6900 – Ask for SHIBA!
            http://www.insurance.wa.gov/consumers/health
             /cantafford.shtml
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                         Shopping Tips

     Take your time and ask the plan:
        Benefits, limitations, exclusions?
        Claims - how to file?
        What doctors can you see?
        Costs (premiums, deductibles, copays, coinsurance,
         non-covered services)?

     Ask the Insurance Commissioner’s Office:
      Are there complaints against insurance plan, agent,
       or broker? Is agent or broker licensed?
          1-800-562-6900
          http://www.insurance.wa.gov/index.asp
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                Watch out for fraud!

     What is fraud?
      Intentionally twisting the truth to
       mislead someone into parting with
       something of value.
      Billing for services or prescriptions not
       provided
      If you suspect fraud/abuse related to

       health care coverage, please call the
       Insurance Commissioner Hotline at:
               1-800-562-6900
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              For more information


                1-800-562-6900

              TDD: (360) 664-3154

             www.insurance.wa.gov


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                SHIBA HelpLine
                volunteer opportunities
       Do you want to help explain health care
        benefits or options to:
            Friends?
            Neighbors?
            Community?
       Help people become better informed
        consumers?
       Call 1-800-562-6900


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              Need help with other
              insurance questions?
    The Office of the Insurance Commissioner can also help
    you with questions, information and complaints about all
    types of insurance, such as:
             • Homeowner           • Annuities
             • Auto                • Health
             • Life                • And more!
             Call our Insurance Consumer Hotline
                 1-800-562-6900
               www.insurance.wa.gov

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