According to the NC  State Health Plan rate sheet, the child only rates are:

• Basic Plan (70/30) – $150.66
• Standard Plan (80/20) $200.36
• Plus Plan (90/10) $269.78

If you have one or two children and would like to compare rates, fill out a child quote request form and we’ll email you a free, no obligation quote.  You can compare the rates and benefits and decide if you would like to learn more.

The latest example of this was seen in Arizona when LifeWise decided no longer offer health insurance in Arizona.  Fortunately, Blue Cross Blue Shield (BCBS) of Arizona agreed to accept their customers with “no further medical underwriting”.

As the old adage says sometimes “you get what you pay for”.

If you are shopping for health insurance for your child, remember that for extra dollars you can buy health insurance that you can depend on.  Contact us today for a health insurance quote.

1. Talk to a professional to decide on the best plan that will fit your needs. It is important to find the best plan for your health insurance needs. Finding a plan that fits your needs is not just about coverage, but also about budget. You want to make sure you are getting the best coverage for your money.  An experienced broker can help you buy reccomending a plan that provides you with the coverage you need at a price that fits your budget.
2. Find out if your doctors are in-network before purchasing a plan. Finding out if your chid’s doctor is in-network is an important and easy step. This information can be found by looking on the insurance carrier’s website or by asking your doctors office if they accept your particular insurance carrier and plan.  Some “low cost” plans may not be accepted by your child’s doctor or hospital or they may require you to file the claims directly with your health insurance company. 
3. If your child is taking any prescription medications be sure to find out how they will be covered on your new plan. Whether you are choosing a plan that has prescription coverage by paying a copay or being applied to your deductible the cost of the prescription is something you should know.
4. Make sure you understand any waiting periods. Waiting periods can apply to your new plan if you have not had continuous coverage, a lapse in coverage of more than 63 days. Be aware of any waiting periods and how to avoid a waiting period in the future.
5. Know how your plan will renew and what is to be expected at the time of renewal. Different carriers have different procedures for renewal. Most plans renew annually and some plans require action at renewal. If you want to make changes to your plan, renewal is a good time for changes.

Buying health insurance for your child in North Carolina can be quick and easy.  Get a  free quote on Health Insurance for Children in NC

Why do I need health care insurance and what are its limitations?

Health insurance helps protect you against high medical costs that could arise if you get sick or experience an accident. Though you may not be sick now, paying for health insurance protects you later if you or a member of your family get sick. There is no way to completely predict who will get sick, when they will need care, and how much that care will cost. Health insurance works by pooling large numbers of people together and then spreading the risk for high costs among everyone. That way, if you pay some money now, you can get benefits later if you need them.

Of course, health insurance can have major limitations. Most policies cover a defined range of treatments, tests, and doctors’ visits. If you need a treatment or drug that is not covered, you could pay for it yourself. Most insurance also charges you more than just the premium. For example, you are likely to be required to pay copayments (fixed per-visit or per-prescription costs), deductibles (dollar thresholds you must pay before coverage kicks in), or other payments.

Policies may also limit the amount of covered care you can receive, the number of times you can go to a doctor in a year, or the total dollar amount for care. They may require you to pay a large portion of costs even after you’ve paid your premiums.

What is a health maintenance organization (HMO)?

An HMO is the type of insurance that often has the lowest out-of-pocket costs to you, the patient. You may pay a small deductible along with copays for visiting the doctor or filling a prescription. HMOs keep costs lower by limiting the network of health providers you can see. Generally you must stick to the primary care physicians and specialists in the closed network. That means if a particular doctor is not in the HMO’s network, you may have to pay extra to see him or her, or not be allowed to use their services at all.

What is a preferred provider organization (PPO)?

A preferred provider organization has a network like an HMO, but you are allowed to go outside the network if you pay higher fees. Out-of-pocket costs of the insurance are usually greater because of this expanded choice. PPOs offer a lot of choice of doctors and hospitals, but they usually cost you more.

What is a point-of-service plan (POS)?

A point-of-service plan combines an HMO-like network with the freedom to see any doctor outside the network. If you stay inside the network, you pay regular HMO copays and co-insurance (Paying a certain percentage of costs up to a capped level). If you go outside the network, you likely won’t have any co-insurance, but you will have a higher deductible. For instance, you could be required to pay the first $1,000 for any care you receive, in addition to your premiums.

What is an indemnity plan?

An indemnity plan has no provider network. Instead it pays for care regardless of which hospital or doctor you go to. There is a lot of freedom with an indemnity plan, but because there are no closed networks, it is harder for the insurance company to negotiate to control costs. That means that premiums and deductibles may be very high, to help the plan cover high health care costs if you get sick.

What is a health savings account?

Health savings accounts are accounts that allow you to save a certain amount of money tax-free as long as you spend it on health costs. Current law limits yearly HSA contributions to $2,650 for individuals and $5,250 for families. HSAs are used in conjunction with low-premium, high-deductible plans that cost less up-front but require you to spend more of your own money if you need care. Employers may also contribute to these accounts.

What is a flexible spending account?

A flexible spending account may be set up by your employer to help cover medical expenses. The account allows an employee to deduct a set amount of money from their paycheck, tax-free, that can be set aside to pay for medical costs such as out-of-pocket costs or uncovered care. Employers may also contribute to these accounts.

Companies may place a limit on how much money can be set aside in such an account. In addition, the employee will lose the money if they don’t spend it by the end of the year.

How can I protect my private medical information?

Most doctors, nurses, clinics, hospitals, health plans, and insurers are required to follow the rules of the Health Insurance Portability and Accountability Act. That law gives you the right to:
o Ask to see your health records
o Have corrections added to your records
o Receive notice that tells you how your health information can be used or shared
o Decide if you want to give your permission BEFORE your health information is used or shared for certain purposes like marketing.
o Get a report on when and why your health information was shared
o File a complaint with your health insurer, health provider, or the federal government if you feel your privacy rights were violated

What is the difference between group and individual insurance?

Group insurance is typically offered through an employer. It insures a group of people, i.e., the company’s employees, all together. Individual insurance is what you buy if you are self-employed or if you choose not to take insurance through your job. Individual insurance is almost always more expensive because you don’t have the advantage of collective buying or negotiating with the insurance company. But one advantage of individual insurance is that you may deduct your premiums from your taxes.

What is a pre-existing condition? How does it affect my current insurance?

A pre-existing condition is a medical condition, such as diabetes, that you already have when applying for new insurance. Insurance plans may try to exclude coverage of your pre-existing condition before insuring you. But generally they may not exclude illnesses that occur after insurance starts. Usually you take a physical at the start of a new policy so that the plan can determine if you have any pre-existing conditions.
How does it affect getting a new insurance policy?

As stated above, insurance plans may try to exclude coverage for pre-existing conditions before insuring you. They may offer insurance only at a higher cost in the form of deductibles, copayments, and coinsurance, or they may choose not to offer you coverage at all.

What is the Health Insurance Portability and Accountability Act (HIPAA) and its impact on my having insurance?

Passed in 1996, HIPAA is designed to protect health insurance coverage for workers and their families when they change or lose their jobs. HIPAA prevents group health insurance plans from singling any one person out for higher premiums based on age, sex, health status, or other factors. HIPAA also limits how plans can exclude covering you for pre-existing conditions. In effect, HIPAA lets you “carry over” coverage of a pre-existing condition to a new insurance policy if you had roughly equal coverage before.

Why should I worry about a “coverage gap,” not having insurance for 63 days or more?

The “carry over” of coverage mentioned above only applies if your previous coverage ended less than 63 days before your new coverage begins. That means that for your new plan to cover a pre-existing condition, or limit exclusions for a pre-existing condition based on previous coverage, that coverage must have ended no more than 63 days ago. That’s why you may hear 63 days quoted as a HIPAA definition of “continuous coverage.”

By Todd Zwillich
Researched by Michele Foust
WebMD Special Report Reviewed by Louise Chang, MD

By TOM MURPHY – Jul 13, 2008
Associated Press

Low health insurance caps leave patients stranded

By TOM MURPHY – Jul 13, 2008

Mary Wusterbarth thought her toddler was struggling with an ear infection when she seemed sluggish. Instead, a virus had attacked the little girl’s heart, damaging it beyond repair. Brea needed a transplant.

Within three weeks of a 2007 doctor visit, the 20-month-old had exhausted the $1 million lifetime maximum on her health insurance. Her parents have scrambled ever since for ways to cover thousands of dollars in monthly medical costs.

“We have no idea what kind of financial future we have,” said Wusterbarth, of Wake Forest, N.C. “The medical bills come almost daily. There’s never an end.”

Insurers set lifetime limits to keep rates low on some policies, but holders are learning that individual caps that seemed large quickly max out as health care costs soar. Several patient advocacy groups are prodding insurers to raise the caps, which generally don’t adjust for inflation. Congress also is considering two bills that would do that.

Only 1 percent of employer-offered group plans — the largest health insurance segment — had caps as low as $1 million last year, according to a survey by The Henry J. Kaiser Family Foundation. But 22 percent had caps of less than $2 million, and some want to see all these relatively low maximums eliminated.

Insurers, however, say most health coverage already offers either a comfortable maximum of several million dollars or unlimited coverage. They note that more government regulation could lead to higher coverage costs, and low lifetime caps help them offer a greater variety of coverages.

“I think the discussion needs to move into why do some health care services cost hundreds of thousands of dollars and what can we do to address those issues,” said Robert Zirkelbach of America’s Health Insurance Plans, a trade association representing nearly 1,300 insurers.

Kelly and Tom Treinen used to think the $1 million individual cap that came with the insurance they had for seven years offered plenty of protection. In fact, they chose that plan, which Kelly received through her job as an elementary school principal, over a higher-priced option through Tom’s business. That one offered a $5 million cap.

Then doctors diagnosed their teenage son, Michael, with an aggressive form of leukemia in May 2007. His treatment called for 10 doses of a chemotherapy drug that cost $10,000 per dose. A 56-day stay in an intensive care unit cost about $400,000.

Michael reached his $1 million lifetime maximum in less than a year. The Noblesville, Ind., family had to issue a public plea for help after a hospital told them it needed either $600,000 in certified insurance or a $500,000 deposit to continue preparing for a critical bone marrow transplant.

The Treinens raised $865,000 in six days. Money came from all over the United States and as far away as Germany. But Michael’s cancer had stopped responding to chemotherapy, and he died May 25 before he could receive the transplant.

The family had no idea how fast costs were piling up. Some initial bills didn’t arrive until months after treatment started. Then they would receive multiple mailings for each treatment, each listing a different amount — the hospital cost, the insurance discount, the amount they owed.

“When you’re dealing with constant care of your child, you’re not going home with a calculator and adding up to see where you’re at,” Kelly Treinen said.

Insurance can shield patients from the true cost of health care, said Jerry Flanagan, health care policy director for California-based Consumer Watchdog. He noted that most people have no idea how quickly $1 million “can evaporate,” unless they’ve been seriously ill before.

“You can eat through a million-dollar lifetime cap in two or three surgeries,” he said.

Low lifetime maximums are found more often in small-employer group plans, Flanagan said, noting that those businesses generally have less insurance buying power. He said employers often give their workers a choice on plans or premiums but not on lifetime maximums.

The Kaiser Family Foundation study says a greater percentage of employer-offered group plans are providing lifetime caps of at least $2 million, and the percentage that offers caps below $2 million has declined slightly.

But medical costs for employer-sponsored health plans should increase 9.9 and 9.6 percent this year and next, according to PricewaterhouseCoopers Health Research Institute.

“The nature of caps is that over time it becomes easier and easier to hit (them) because the cost of health care services keeps going up,” said Mike Thompson, a health care and employee benefits expert with the firm.

A coverage cap of $1 million in the 1970s would have had to grow to more than $10 million today to keep pace with rising costs, said Glenn Mones of the National Hemophilia Foundation.

The foundation’s vice president for public policy says he’s seen more patients approach their lifetime caps in recent years. People with hemophilia can spend more than $200,000 a year just on drugs that prevent internal bleeding.

His foundation renewed a lobbying push in Congress this year for higher lifetime caps because it sees a better political climate for one.

U.S. Rep. Anna Eshoo, D-Calif., unsuccessfully pitched a bill on lifetime caps in 1996. She will try again this summer because she sees better odds with a Democrat majority in the House of Representatives. Sen. Byron Dorgan, D-N.D., introduced a similar bill in March in the Senate.

Mary Wusterbarth, a stay-at-home mother with two other children, thinks legislation on minimum lifetime caps is an excellent idea. Her daughter, Brea, is 3 now and doing well. But family finances aren’t as healthy.

The Wusterbarths spent more than $20,000 to adopt Brea from China in 2006. Then her heart began to fail, just months after she arrived at their Louisiana home.

She qualified for Medicaid while hospitalized for the transplant, but that coverage ended once she was released. The family has since moved to North Carolina, where Brea’s father, Danny, works as an operations manager for a distribution center.

They drained their savings and spent more than $60,000 out of pocket on medical bills in the past year. Church donations have helped, and they negotiated some discounts to wind up with $50,000 in insurance coverage for Brea they hope will last the next six months.

But Danny Wusterbarth makes too much money for Brea to receive Medicaid coverage. Insurers won’t cover Brea because of the medical history, a common problem with people who reach caps.

Brea’s anti-rejection drugs run about $3,000 a month. The biopsies she needs every few months to check for rejection can cost $40,000. She’ll also need another transplant in about 10 years. Her mother isn’t sure where all the money will come from.

“We were actually told that if we would get a divorce or if he would quit his job, then she could get all the help she needed,” Wusterbarth said. “But that’s not the way we do things, so we just take it day by day.”

Children are generally dropped from their parents’ health insurance when they turn 18 or 19 or graduate from college. But 16 states now require insurers to cover dependent children on their parents’ policies until the children are in their mid-twenties — and sometimes up to age 30.

The new rules can help cover adult children who don’t have health insurance through their jobs or don’t have jobs. To qualify, grown children must be unmarried and live in the same state as their parents. But they don’t need to live with their parents or even be considered dependents for tax purposes.

This can be an attractive option for adult children who have health problems and could have trouble qualifying for affordable insurance on their own. But other young adults might be better off declining the deal. In many states, healthy people in their twenties can purchase insurance on their own for less than $100 per month.  That could be less than the cost of keeping a child on your family policy.

In most states (other than New Jersey), insurers don’t charge extra specifically to keep older children on your policy. But your rate might drop if you remove your child, especially if you’re insuring only one child and can switch from family coverage to rates for a single person or a couple. You’d have to compare the price with what it would cost for your child to purchase individual insurance.

If you still have other children on your policy, you may be able to insure older ones at no extra charge (as long as your insurer doesn’t base premiums on the number of children). That would be the best deal.

For a list of each state’s age requirements for dependent coverage, see the National Conference of State Legislatures’ Web site. Note that these laws don’t apply to employers who self-insure.

Washington Post

Get a Quote on Health Insurance for Child in NC

WASHINGTON (AP) — Health care is returning as a campaign issue, with special interest and advocacy groups preparing to spend at least $60 million to push politicians to embrace universal access to medical coverage.

The efforts, one by a coalition of labor and liberal groups and another by AARP, also include direct appeals to the presidential contenders and congressional candidates to change a system in which millions of people are without coverage.

A coalition of labor unions and Democratic-leaning organizations called Health Care for America Now on Tuesday was announcing a $40 million campaign to promote affordable health care coverage for all. The group is spending $1.5 million on a national cable ad, and print and Web advertising. It also plans to spend $25 million on advertising through the end of the year. The effort will concentrate on key congressional districts in 45 states, where the coalition also plans to deploy 100 organizers.

A top goal is to encourage lawmakers to devise a plan that would offer consumers the choice of retaining their current private coverage, choosing a new insurance plan or joining a government-run plan. The options are designed to address one of the insurance industry’s central criticisms of President Clinton’s failed plan.

“We’ve got to make the plan that we put forward reasonable to people who don’t have health insurance and desperately need it, but also not threatening to people who do have fairly decent health care and would gladly support health care change as long as it doesn’t undermine what they’ve got,” said Roger Hickey, co-director of the liberal Campaign for America’s Future, part of the Health Care for America Now coalition.

Still, sharp disagreements are certain to surface.

The insurance industry’s proposal for expanded health care puts more emphasis on private plans than on public ones. And the coalition’s ad, which is to air Tuesday on cable, makes clear that the old battle lines remain. “We can’t trust insurance companies to fix the health care mess,” the ad states.

The AARP-led group is airing an ad on national cable and in markets in key states calling on the presidential candidates — Democrat Barack Obama and Republican John McCain — to keep discussing health care and financial security. The seniors’ advocacy group, acting on behalf of a coalition called Divided We Fail, plans to spend more than $20 million through Labor Day to push for bipartisan solutions to health care and Social Security.

McCain would provide refundable tax credits of $2,500 for individuals and $5,000 for families that buy health insurance, but would not require universal coverage. Obama would require coverage for children, not adults, and would aim for universal coverage by requiring employers to share the cost of insuring their employees.

“We felt we needed more than policy ideas, but the political will to actually get something done,” said Nancy LeaMond, an AARP executive vice president.

To that end, the AARP is working with partners from across the ideological spectrum — the Business Roundtable, the National Federation of Independent Business and the Service Employees International Union. They are asking candidates to sign pledges that state: “I am committed to working with my colleagues across the aisle to develop and implement policies that provide all Americans with access to quality, affordable health care and lifetime financial security.”

To the membership of Health Care for America Now, bipartisanship is less important than adherence to its principles, which also include greater regulation of health insurance companies, costs based on a family’s ability to pay and cost controls without sacrificing quality.

“The whole goal is to create a mandate next year for the president and Congress to enact health care reform that meets our principles,” said Richard Kirsch, the coalition’s campaign manager and a health care advocate who has worked on reform legislation in New York.

Health Care for America Now members include such unions as the SEIU, the AFL-CIO, and the American Federation of State, County and Municipal Employees, and Democratic-leaning organizations such as the Center for American Progress, MoveOn.org, and the Campaign for America’s Future. Many of the groups have endorsed Obama or have members advising his team.

Neither coalition plans to become involved in the presidential contest, though Kirsch made clear that Obama’s plan meets Health Care for America Now’s principles and McCain’s does not.

With the number of autistic children growing, researchers are targeting new technologies to help detect the disorder at ever-younger ages in hopes of reversing some of autism’s worst symptoms.

Most autistic children currently aren’t diagnosed until they are about 4 years old, using conventional detection methods of observing behavior. Although specialists are able to identify the condition starting at about 30 months, most parents don’t seek evaluations that early because they don’t notice anything unusual about their children, or don’t know what symptoms to look for. Now, scientists are using new techniques to study children as young as a few months old for signs of possible autism and to flag them for more extensive analysis.

By identifying children early who may be at risk of developing autism, even without a definitive diagnosis, parents can consider initiating behavioral therapy, the most widely validated treatment for the condition. Studies of autistic children indicate that preschool-age kids receiving intensive treatment show greater gains in language and IQ scores than children whose treatment begins at older ages. Behavioral therapy includes such measures as encouraging children to look at people’s faces, express emotions and curtail any repetitive tics. But diagnosis and therapy can be expensive, and insurance coverage for autism treatment is spotty, especially for early intervention.

Researchers at Canada’s McMaster University recently announced that they had developed a computerized test using eye-movement sensors that aims to predict the risk of autism in children as young as 9 months. The system, which administers five eye-tracking tests over 10 minutes, measures the direction and fixation of a child’s eyes when confronted with computerized images, including human faces.

More at WSJ.com

Buying health insurance for your child in North Carolina can be quick and easy.  Get a  free quote on Health Insurance for Children in NC