Employers test mix of strategies to avoid PPACA Penalties (TAXES) – Texas Small Business Owners

Employers test mix of strategies to avoid PPACA Penalties (TAXES) – Texas Small Business Owners

 

If you are an Employer have you developed a Plan for 2014?

 

We can help you review your options to help you develop a plan to avoid the PPACA TAX Penalties and keep your employees happy.  Do you have more than 51 employees?  Is your business in Texas?

 

Some Employers are looking at reducing the hours of part-timers in response to Obamacare to avoid the PPACA Penalties.  This is not the only strategy that we see in an effort of the Small Business Owner the expense of buying health insurance for everyone.  Small Businesses are concerned on how PPACA will impact their business and bottom line. A recent Gallup survey found that 48 percent of small-business owners state the law is going to be bad for business, compared with 9 percent who say it’s going to be good, and 39 percent who expect no impact at all.

 

Are you trimming your staff, or reducing the number of hours of your workforce?  The law requires large employers offering health insurance to include part-time employees working 30 hours a week or more. The Federal Reserve Bank of Minneapolis found that 11 percent of employers are shifting to more part-time employees or planning to do so in response to the new healthcare requirements.

 

Other options depending on your market are sharing employees.  It looks like the Small Business owners are developing a lot of creative strategies when it comes to addressing the employer mandates of the Patient Protection and Affordable Care Act of 2010.  What are you planning to do to survive?

It looks like some companies are resisting growth, while other companies are looking at new ways of getting the job done, one example is Sharing Employees.  Some businesses, (those in the food-service world) are working together to split an employee’s workweek between themselves and competitors. A cook might work 15 hours at one restaurant, put in 15 hours at another and wrap up with 10 hours at a third.

 

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Texas Risk Pool – Health Insurance Questions –

Texas Risk Pool – Health Insurance Questions

Are you a residence of Texas?

The Texas Health Insurance Pool was created by the Texas Legislature to provide health insurance to eligible Texas residents who, due to medical conditions, are unable to obtain coverage from individual commercial insurers.  The Pool also serves as the Texas alternative mechanism for individual health insurance coverage, guaranteeing portability of coverage to qualified individuals who lose coverage under an employer group plan, church plan or state plan, as mandated by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).

What is Continuation of coverage?

Prior or recent coverage from you prior or Current Insurance plan ensures that your new Insurance plan grants you credit for your prior Coverage and waives the pre-existing exclusion period for your pre-existing conditions.  Prior or Current coverage does NOT guarantee Coverage to your new policy, you will still have to be medically underwritten, you can be declined coverage, Rated Up, or have exclusions applied to your new policy.

 

Applicants with Certain Medical Conditions, who are NOT eligible to enroll in any Medically Underwritten Plans, may be eligible for coverage under the Texas Health Insurance Risk Pool.  The Texas Health Insurance Risk Pool is an individual Health Insurance program created by the Texas Legislature to provide Health Insurance to Texas Residents who cannot obtain adequate Health Insurance Coverage as a result of the their Medical Conditions.  Interested persons may contact the Texas Health Insurance Pool at 1-888-398-3927 or visit their website at www.txhealthpool.org or Contact me and I will help you with this Process, we have helped over 12 people this year get signed up with the TX Risk Pool. 

 

Have you heard of the Federal Risk Pool (PCIP) it ran out of funds and on 02/16/13 it is no longer issuing any new policies?  The Federal Government had estimated that 400,000 people would sign up for this coverage, but only 100,000 selected this plan, and they were NOT able to fund it any longer.  The Affordable Healthcare Act does not start until 01/1/14 with the Guarantee Issued Policy.  If you are interested we can help you shop for insurance coverage during the OPEN ENROLLMENT Period starting October 2013 for policies effective 01/01/2014.

 

The TX Risk Pool Program continues to serve the State of Texas as an important “safety net” for individuals who have been denied health insurance coverage because of pre-existing conditions.  Can you afford the Pool’s premiums, and if you do not have other coverage options you could qualify for Assistance.

• POOL ENROLLMENT AS OF APRIL 2013:         23,179
• TOTAL TEXANS ENROLLED SINCE INCEPTION:    91,220

 

Are you currently on the TX Risk Pool?  As you may know, implementation of the federal Affordable Care Act (the ACA) is moving ahead.

• Effective January 1, 2014, Texans will be able to buy guaranteed health insurance coverage, with no medical underwriting and no preexisting condition exclusions or waiting periods. Coverage will be available from any insurance company offering individual health insurance products—  either directly, or through a federal insurance exchange website. Premium assistance will be available through the exchange for individuals who qualify based on income.
• Under the current federal timetable, early enrollment through the new health insurance exchange is scheduled to begin 10/01/2013, with coverage to be effective 1/1/2014.
• We can provide updates to Pool members when the Texas Legislature makes a decision about the Pool’s future. Whatever happens, we can assure you that Pool coverage will remain in place until at least January 1, 2014.  Let us help you find a plan that fits your needs and your budget.  We can help you decide if you will qualify for assistance with the Federal Government (the Federal Government has projected that 19% of the people in the United States will qualify).
• As we learn more details about the exchange and new marketplace enrollment opportunities we will be happy to  send you all available information so that you can make the best possible choice about your new insurance coverage.
• In the meantime, you can get more information about the ACA and the insurance exchange marketplace at: www.healthcare.gov or contact me and we can add you to our Mailing list.

 

You can click here for the TX Risk Pool application (see attached PDF file).

The Texas Risk Pool provides premium assistance to qualified lower income enrollees.  See the Premium Rates page of this website for more information.

Eligibility

1. You are eligible (for Health Pool coverage) if you are under age 65 and you have  been for at least 30 days and remain a legal resident of Texas and a United States citizen, or a legal permanent  resident of the United States for at least 3 continuous years,  and if you provide the Health Pool’s administrator with one of the following:
        A.   Notice of rejection or refusal by an insurance company to issue substantially similar individual health benefit plan coverage due to health reasons;
        B.   A certification from an agent or salaried representative of an Insurance Company on the Pool’s  Application  form, that states the agent or representative is unable to obtain substantially similar individual health benefit plan coverage for you with any state-licensed Insurance Company, which the agent or representative represents, because you will be declined for coverage, as a result of your medical condition, under the underwriting guidelines of the Insurance Company.
   C.   An offer by an Insurance Company to issue substantially similar individual health benefit plan coverage that excludes a medical condition or conditions; or
   D.  Doctor’s office letter stating you have been diagnosed with or treated for one of the Qualifying Medical/Health Conditions within the last 5 years.
   .
2. You are also eligible (for Health Pool coverage) if you are under age 65 (or over 64 and not eligible for Medicare), you are a legal resident of Texas, and if you have maintained health benefit plan coverage for at least 18 months preceding application for coverage to the Health Pool, with no gap in coverage greater than 63 days, and your last health benefit plan coverage was provided through employment, with a U.S. employer.  (United States citizenship or 3-year legal permanent residency is not required for this HIPAA eligibility category.)  See outline of Coverage for definition of Federally Defined Eligible Individual.
   
3. You are also eligible (for Health Pool coverage) if you are under age 65, you are a legal resident of Texas, and if your last health benefit plan coverage was provided by another state’s qualified HIPAA program, such as a risk pool, that terminated because you no longer reside in that state.  You must apply to the Texas Pool within 63 days of the loss of coverage in the other state plan. (U.S. citizenship or 3-year legal permanent residency is not required for this HIPAA eligibility category.)
4. Dependents and Family Members, as defined in the Outline of Coverage, are also eligible if they are under age 65, and U.S. citizens or 3-year legal permanent residents.

Non-Eligibility

You are NOT ELIGIBLE (for Health Pool coverage) IF:

I.    You have other health coverage in effect on the date Health Pool coverage would otherwise be effective.  (NOTE:  In the case of coverage by Medicare, you are allowed to retain Medicare coverage if you otherwise qualify for the Pool.  The Pool’s coverage will be secondary to coverage provided by Medicare, except for outpatient drug coverage, which is not a Pool benefit for Medicare beneficiaries.   In the case of an individual policy of health coverage, you will be required to terminate such individual policy within 60 days after the effective date of a Pool policy. A Pool enrollee is allowed, however, to keep an existing individual policy with medical condition waivers, but the Pool will pay secondary to such coverage); or

II.    You are eligible for or covered by employer-sponsored health coverage, including a self-insured health benefit plan, or continuation of coverage under state or federal law.  (NOTE:  If you or your dependents were covered by prior group coverage, you and your dependents may be eligible for COBRA or state continuation of coverage.   A dependent, covered under the terminating prior group coverage, is entitled to continuation, regardless of the continuation election of the employee.)   (NOTE:  You may apply to the Pool if you are a part-time employee, the group plan offered by your employer is more limited than the Pool’s coverage (as determined by the Pool), and your employer does not pay or reimburse any portion of the cost of the group coverage. You may also apply if you are still within your 9-month State Continuation period or 18-month COBRA period, but did not elect it, or it later lapsed.  If you qualify under this exception, however, you will be subject to the Pool’s pre-existing condition exclusion period for at least 180 days.)

III.   You have terminated Health Pool coverage within 12 months prior to application for Health Pool coverage, unless there’s a good faith reason for such termination; or

IV.   You are confined to county jail or prison; or

V.    You had prior Health Pool coverage terminated for  fraud; or

VI.   You had prior coverage with the Health Pool that was terminated for nonpayment of premiums within 12 months prior to application for subsequent coverage; or

VII. You have received $3,000,000 in benefits from the Health Pool; or

VIII. You will have premiums paid or reimbursed by or through a government sponsored program or government agency, or by a health care provider.

Preexisting Conditions

1. Definition – Preexisting Condition means a disease or condition for which the existence of symptoms would cause a prudent person to seek diagnosis, care or treatment during  the 6 months before an Insured Person’s effective date of Pool coverage, or for which medical advice, care or treatment was recommended or received during the 6 months before an Insured Person’s Pool coverage date. Preexisting Condition includes a preexisting pregnancy or a complication of a preexisting pregnancy, whether the complication occurs before or after the effective date of Pool coverage. Preexisting Condition does not include genetic information in the absence of a diagnosis of the condition related to the genetic information.
2. Preexisting Condition Exclusions/Limitations

   Unless you have credit for prior coverage, during the first 12 months following the effective date of Health Pool coverage the policy does not pay benefits for any charges or expenses for any Preexisting Conditions (except as indicated below).

   A.  The Preexisting Condition limitation does not apply if an individual was continuously covered for an aggregate period of at least 12 months under Creditable Coverage that was in effect up to a date not more than 63 days before the individual’s effective date  of coverage through the Health Pool (excluding any waiting period under the prior health coverage) provided that the individual’s application for coverage through the Health Pool was made no later than 63 days following termination of the prior health coverage.
   B.  The Preexisting Condition limitation will not apply to an Insured Person who has been  continuously covered, since birth, adoption or Your suit for adoption of the Insured Person by Creditable Coverage which was in effect up to a date not more than 63 days before the Insured Person’s effective date under this Policy, excluding any waiting period, provided that application for coverage under this Policy for the Insured Person is made no later than 63 days following the termination of such Creditable Coverage.
   C.  In determining whether a Preexisting Condition limitation applies, credit is given for the time an individual was covered under any prior Creditable Coverage (including any waiting period for such coverage) that was in effect at any time during the 12 months before the effective date of Health Pool coverage.

3. NOTE: An individual who qualifies under the state continuation or COBRA exception will be subject to a minimum 6-month waiting period.

Qualifying Medical/Health Conditions

 

§  Addison’s Disease §  AIDs/HIV §  Amyotrophic Lateral Sclerosis (ALS) §  Angina Pectoris §  Arthrogyrposis §  Artificial Heart Valve §  Brain Tumor §  Bronchopulmonary Dysplasia §  Cardiomyopathy §  Cerebral Palsy §  Childhood Asthma §  Chronic Liver Failure §  Cirrhosis (non-alcoholic) §  Congenital Heart Disease §  Congestive Heart Failure §  Coronary Artery Disease §  Crohn’s Disease §  Cystic Fibrosis §  Dementia (including Alzheimer’s) §  Dermatomyositis §  Diabetes Mellitus §  Down¡¯s Syndrome §  Epilepsy §  Fredrich’s Ataxia §  Guillian-Barre Syndrome §  Heart Attack §  Hemophilia §  Hepatitis §  Hodgkin‘s Disease §  Huntington’s Chorea §  Hydrocephalus §  Inborn Errors of Metabolism §  Intermittent Claudication §  Lead Poisoning with Cerebral Involvement §  Leukemia §  Leukodystrophies §  Lupus §  Metastatic Cancer §  Muscular Atrophy or Dystrophy §  Myasthenia Gravis §  Myotonia §  Organ Transplants (except Corneal) §  Paraplegia or Quadriplegia §  Parkinson¡¯s Disease §  Pediatric Carniofacial Abnormalities §  Peripheral Vascular Disease §  Polycystic Kidney §  Polymyositis §  Psychotic Disorders §  Rheumatoid Arthritis §  Scleroderma §  Sclerosis, Multiple, Disseminated or Posterolateral §  Short Bowel Syndrome §  Sickle Cell Anemia §  Silicosis (Black Lung) §  Spina Bifida §  Stroke §  Syringomyelia §  Tabes Dorsalis (Locomotor Ataxia) §  Tumor, Malignant §  Ulcerative Colitis §  Wilson’s Disease

 

 

Let us Help with Your Health Insurance Needs

North Texas Tornadoes and Severe Weather: Blue Cross and Blue Shield of Texas Responds to Help Members

North Texas Tornadoes and Severe Weather: Blue Cross and Blue Shield of Texas Responds to Help Members

Contact your Blue Cross Blue Shield of TX (BCBSTX) Agent or account representative if you have any questions. Assistance Available for Members Impacted by North Texas Tornadoes and Severe Weather During a natural disaster, you never know where you may end up. We at Blue Cross and Blue Shield of Texas (BCBSTX) understand that a number of our members living, working or traveling in the North Texas area may be impacted and/or displaced as a result of the tornadoes and severe weather that occurred yesterday, May 15. BCBSTX is prepared to assist these members by:

Explaining the options for accessing care Helping to locate a network provider, hospital or dialysis center Assisting with early refills of prescription medications Working to ensure transition of care or continuity of care needs are met Accessing member identification information Please share this information with your employees:

For an emergency situation, members should go directly to the nearest hospital. For non-emergency care needs, members can call the customer service number on the back of their member ID card to locate a network provider. When arriving at the participating doctor’s office or hospital, the member will need to present his/her BCBSTX ID card. If a member does not have his/her member ID card, needs help finding care or has coverage questions, our customer service representatives will provide assistance. Members can also log in to Blue Access for MembersSM on the BCBSTX website or access our mobile site to search for a doctor, access their ID card and more. BlueCard® participants (indicated by a suitcase on the member ID card) can call the National BlueCard access number to be routed to the appropriate customer service center. Watch for continuing updates as we respond to the needs of our groups and members impacted by this natural disaster. Please contact your BCBSTX account representative should you have any questions. Important Blue Cross Phone Numbers

BCBSTX Customer Service for all group plan members: 800-521-2227 BCBSTX Customer Service for individual/family policyholders: 888-697-0683 BCBSTX Customer Service for Medicare Supplement policyholders: 800-654-9390 Federal Employee Information: 800-442-4607 National BlueCard access: 800-810-BLUE (2583) Other Resources American Red Cross   Name(required) Email(required) Website Message

Health Care Reform – Update are Top Dem seeing a ‘train wreck’ for PPACA

Top Dem sees ‘train wreck’ for PPACA.

A senior Democratic senator who helped write the Patient Protection and Affordable Care Act (PPACA) stunned administration officials Wednesday, saying openly he thinks it’s headed for a “train wreck” because of bumbling implementation.

“I just see a huge train wreck coming down,” Senate Finance Committee Chairman Max Baucus, D-Mont., told Obama’s health care chief during a routine budget hearing that suddenly turned tense.

Baucus is the first top Democrat to publicly voice fears about the roll-out of the new health care law, designed to bring coverage to some 30 million uninsured Americans through a mix of government programs and tax credits for private insurance that start next year. Polls show the public remains confused by the complexity of the law, and even many uninsured people are skeptical that they will be helped.

Read More…from LifeHealthPro news release dated today (04/17.2013).

That has always been the question how will the Government Pay for the Affordable Healthcare Act?  We should all know that nothing is FREE, somebody has to pay for it.  I’m impatiently  looking for the Rates, The word out is that the Rates are going up for the Young Healthy People (19 – 38), and the Rates for people over 50 will either stay the same or might even decrease.

My understanding at this time is that we will see a hidden TAX on every policy sold whether it is sold through the Public Exchange or any of the Private Exchange, and this will be passed on to the Consumer.  I really can’t see any of the current Health Insurance plans going down with Medical Expenses continuing to Increase (this is what the Insurance is designed to cover) I’m really expecting all plans to have a higher premium 01/01/2014, I just don’t know how much they will go up.

Should we expect this Affordable Healthcare Act to crash like the PCIP Federal Risk Pool did February 2013.  it just kind of quietly faded away.  The Federal Government estimated over 500,000 people would sign up for the PCIP Federal Risk Pool coverage, and the Federal Government had to stop accepting applications in February 2013 because they were running out of funds, at that time they only had a little over 100,000 people signed up.

Do you think the Affordable Healthcare Act will help you?  Have you seen the 15 page application that is required to be filled out if want to see if you qualify for assistance from the Federal Government?

 

Affordable Care Act updates – Federal Government Releases Rules on SHOP, Exchanges, Insurance Market Reforms, Health Insurer Fee

Federal Government Releases Rules on SHOP, Exchanges, Insurance Market Reforms, Health Insurer Fee

The following message will be sent to employer groups later today.

Federal Government Releases Rules on SHOP, Exchanges, Insurance Market Reforms, Health Insurer Fee

The following message will be sent to employer groups later today.

The federal government on March 1 issued two final rules, one interim final rule and two proposed rules covering key provisions of the Affordable Care Act.

They are:

• A final rule on the HHS Notice of Benefit and Payment Parameters
  • Provisions for the State Notice of Benefit and Payment Parameters
  • Provisions and Parameters for the Permanent Risk Adjustment Program
  • Provisions and Parameters for the Transitional Reinsurance Program
  • Provisions for the Temporary Risk Corridors Program
  • Provisions for the Advance Payments of the Premium Tax Credit and Cost-Sharing Reduction Programs
  • Provisions on User Fees for a Federally Facilitated Exchange (FFE)
  • Distributed Data Collection for the HHS-Operated Risk Adjustment and Reinsurance Programs
  • Small Business Health Options Program
  • Medical Loss Ratio Requirements under the Affordable Care Act;
• An interim final rule on the Amendments to the HHS Notice of Benefit and Payment Parameters;
• A final rule from the Office of Personnel Management on the Multi-State Plan Program for the exchanges;
• A proposed rule from HHS on exchanges, qualified health plans and the Small Business Health Options Program (SHOP); and
• A proposed rule from the Internal Revenue Service that imposes an annual fee on health insurers.

We are currently reviewing the final and proposed rules and we will provide more information as it becomes available.

 

Lay and Williams Health Insurance

 

The Pre-Existing Condition Plan (PCIP) – Stops issuing New Business Effective 02/16/2013

The Pre-Existing Condition Plan (PCIP) – Stops issuing New Business Effective 02/16/2013

Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. We encourage you to visit http://finder.healthcare.gov to explore your other health care options.

The Pre-Existing Condition Plan (PCIP) – passed as part of Affordable HealthCare Act  (PPACA) as a stopgap measure until January, 2014 rolled around – was originally projected to serve almost 400,000 people. It’s ended up enrolling just about 100,000, but at a cost far, far beyond that which was initially projected.

The average cost for an enrollee in 2012 was over  $32,000…

The administration announced it would close enrollment in the program effective immediately (on Friday 02/15/2013) to preserve remaining funds so as to be able to treat existing enrollees until January 1, 2014. (At that point those enrolled will, in theory, be able to obtain insurance on the PPACA’s new health exchanges.)

The Obama administration on Friday stated it would stop enrolling new beneficiaries in a special $5 billion insurance program for people with pre-existing medical conditions, because of rising costs and limited funding…

The U.S. Department of Health and Human Services issued a notice on Friday saying it would suspend new enrollments beginning on Saturday to “help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.”

The PCIP plan allowed those with pre-existing conditions who could afford the premiums (varying from some $200 to $600+ a month depending on age and state), and who had been without insurance for six months, to obtain health insurance when private insurers either refused coverage or charged incredibly high premiums.

The PCIP has been given great coverage for some – a number of lives have have been saved due to the program, while for others it was an unattainable form of relief; either people could not afford the premiums or they were locked into an existing, high-cost insurance policy which they didn’t dare go off of for six months in order to qualify.

In January 2013 PCIP changed their plan options for the public to select from.  PCIP no longer offered $2000 Deductible with 80% Coinsurance, $1000 Deductible 80% Coinsurance or HSA with 80% Coinsurance.  As of January 2013 in Texas PCIP only offered a $2000 Deductible 70% plan, and this plan is managed by United HealthCare.  The current PCIP plan provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a $2,000 in-network medical deductible and a $500 prescription deductible before PCIP pays for a percentage of the covered services. After you have met the deductible, you will pay 30% of medical costs for in-network services.

Let us Help with Your Health Insurance Needs

 

 

Texas Medicaid Vendor Drug Program – Payment Update

Texas Medicaid Vendor Drug Program – Payment Update

There will be a one-day delay in payments to fee-for-service pharmacy providers for Medicaid because of President’s Day on Monday, February 18, 2013.  Claims submitted February 8-14 will have a payment date of February 19, with deposits available February 21, 2013.

Claims submitted after February 14,2013 will resume on the regular cycle.

Please visit the Vendor Drug website for more information about vendor payment.

 

 

BAYLOR HEALTHCARE SYSTEM & SCOTT & WHITE HEALTHCARE – JOINING FORCES

The Baylor Health Care System and Scott & White Healthcare will announce Friday afternoon that they are joining forces to become “the largest not-for-profit health care system in the state of Texas.” 

The Waco Tribune-Herald reported in March that there were serious negotiations in the works between Dallas-based Baylor and Temple-based Scott & White, but both systems have been mum in recent months.

The $5.2 billion Baylor Health Care System owns or operates 30 hospitals statewide and employs nearly 20,000 people. It has 2.8 million patient encounters annually, according to its website.

The Scott & White system, with employs 12,000 people, has 12 hospitals and more than 65 clinics across a 29,000-square-mile service area in Central Texas.

Officials from both systems will announce the details of the partnership at 4 p.m.   How’s this effect you?

Read More:

 

 

IRS Issues Final Regulations on Comparative Effectiveness Research Fee – Affordable HealthCare Act

IRS Issues Final Regulations on Comparative Effectiveness Research Fee

On December 5, 2012, the Internal Revenue Service (IRS) issued final regulations on the Comparative Effectiveness Research Fee (CERF). This is a Final Rule, so there is no comment period.

CERF is an annual fee on insured and self-insured health plans that will be used to fund the Patient Centered Outcomes Research Institute (PCORI), which will conduct research designed to determine which of two or more treatments works best when applied to actual patients.

The fee applies for plan years beginning on or after 10/2/11 and continues through 2019. Insurers pay the fee for insured plans and employers pay the fee for self-insured plans. The first payments are due for some plans on 7/31/13. The annual fee begins at $1 per participant and will increase in future years.

The final regulations included the following changes and clarifications:

• The fee does not apply to an insurance policy providing for an employee assistance plan, disease management or wellness program as long as it does not provide significant benefits in the nature of medical care/treatment.
• The fee applies to individuals on a temporary U.S. Visa who live in the U.S.
• The fee does not apply to U.S.-based “trailing dependents” of expatriate employees who live overseas.
• An employer sponsoring a plan with self-insured and insured coverage options can disregard individuals covered under the insured option. The insurer will pay the fee for the insured participants.
• The third-party administrator or carrier is NOT allowed to pay or calculate the fee for self-insured plans.
• Since Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) are considered self-funded plans, employers are required to pay any tax applicable to HRAs and FSAs that are not “excepted benefits” even if their HRA or FSA is offered with an insured group health plan. (Note: Multiple self-insured plans with the same plan year can be treated as a single self-insured plan so that only one assessment applies.)

We encourage you to contact us for future updates.

PCIP – FEDERAL RISK POOL RATES EFF 1/1/2013

Here are the 2013 monthly PCIP premium rates for Texas by the age of an enrollee, effective January 1, 2013.

PCIP Coverage In Texas

PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there is no waiting period.

PCIP has a $2,000 annual medical deductible, and a $500 annual drug deductible.

The monthly premiums for your Texas are:

Standard Plan Age Monthly Premium Cost 00-18 $139 19-34 $207 35-44 $249 45-54 $319 55+ $444

In a calendar year, all covered services — both in-network and out-of-network — will count toward your catastrophic maximum. This means the maximum you’ll pay for covered benefits (not including your monthly premium) is $7,000. The maximum is even less if you use only in-network providers. There is no lifetime maximum or cap on the amount the plan pays for your care.

As a community service Lay and Williams is happy to help anyone with their application for the PCIP ( Federal Risk Pool) plan.  Contact us today we have helped over 20 people get approved with the PCIP in 2012.  In 2012 you could pick from 3 different plans for Individual Health Insurance; the PCIP has changed the options for 2013, the PCIP will only offer 1 plan with one Deductible ($2,000).

Let us Help with Your Health Insurance Needs