I'm pregnant. Can my health plan refuse maternity coverage?

Q. I thought I had completed my family, and was confident of never getting pregnant again because I had an IUD. So we bought an individual family plan from Blue Shield of California that excludes pregnancy. But I got pregnant anyway. I asked to be moved to a plan that covers pregnancy, and was denied because of my "pre-existing condition." Is this legit?

A. It sure is. In every health-plan underwriting manual I have ever seen, pregnancy is on the list of conditions that will get you turned down flat for new individual coverage.Moreover, the vast majority of health plans sold to individuals exclude maternity coverage. A recent study of some 3,300 individual policies by the National Women's Law Center, a Washington, D.C. advocacy group, found that only 12 percent included maternity coverage, and half of those were in the handful of states with laws that require it. In a few states, including Colorado, Connecticut, Nevada, and South Carolina, not a single plan available to a 30-year-old woman included maternity coverage.

In other states, you can get limited maternity coverage through an add-on rider that costs extra, but typically must wait a year or more before the benefits kick in, meanwhile paying an additional premium that may cost more than the basic policy itself.

"You can buy coverage in $1,000 or $2,000 increments, but by the time you've waited, you get back $100 or so if it's a normal delivery," says Judy Waxman, the center's vice president for health and reproductive rights. "It's just not worth it."This is one of many ways that individual health insurance is inferior to group coverage, which has included maternity care without exception for years.

But you, dear California resident, are in luck. Last year, California became the ninth state to pass a law requiring all individual health plans to cover maternity care. The new law takes effect July 1, 2012. According to a spokeswoman for Blue Shield of California, as of that date, the new benefit will automatically be added to all the company's individual plans, starting immediately. If your due date is any time after that, your remaining expenses for prenatal care and delivery will be covered.

The Affordable Care Act, aka Obamacare, will fix this problem for good. As of Jan. 1, 2014, all individual health plans sold in the U.S. must include maternity coverage. And you can sign up for a plan even if you're already pregnant, because insurers won't be able to turn you down for any pre-existing condition.

In a memo from Assurant health plans, agent were notified the direct bill option will no longer be available for new applicants. Existing policyholders will still have a direct bill option for now.

Formerly known as Time insurance company, Assurant health plans has long been uncompetitive in Georgia. At one time if you wanted health insurance and did not want to buy from BCBSGA, Time insurance company was a "go to" carrier.

Time was taken over by Fortis who later changed their name to Assurant health plans. Their limited major medical line is marketed by independent agents as well as direct writers employed by carriers like State Farm, Farm Bureau and USAA.

They only have one copay plan design (Core Med) and one HSA qualified plan. The HSA isn't a bad plan but not a great plan either. Their copay plan is fine until you get sick and really need it.

Assurant health plans is now specializing in child only health insurance in Georgia, short term medical, dental insurance, accident insurance and critical illness coverage.

Assurant health plans don't seem too interested in promoting major medical insurance and haven't in some time. Until 2 years ago, Assurant health plans had 3 health insurance plans with almost 200 options and combinations. They were also one of the few carriers offering maternity insurance.

They have eliminated maternity insurance (along with all the other carriers except for BCBSGA) and trimmed their plan options down from 200 to less than 50.

The few plans they still offer are not competitive with other carriers.

Assurant health plans has introduced a new heart attack and cancer plan in several states but Georgia is not one of them.

If you need a child only health insurance plan in Georgia, Assurant health plans is your only option, but if you want a major medical plan there are much better choices.

The short answer is, children's health insurance separate from their parents ceased to exist in Georgia in September, 2010 with the implementation of a new provision in Obamacare. The reason why child only health insurance in Georgia went away is not important. All you want to know is how do you buy a health insurance policy for your child.    

You can add your child(ren) on to your group health plan through your employer.

You can purchase a health insurance plan for yourself and add your child(ren) as a dependent.

Your child may be able to qualify for PeachCare or Medicaid.

You can purchase a child only health insurance plan from Assurant.

Assurant offers two different child only health insurance plans. You can purchase a basic benefit plan (Health Access) or a temporary (Short Term Medical) plan for up to 6 months.

Review plans options, rates and apply for child only health insurance from Assurant.

Politicians think because you can drive to North Carolina and buy cheap cigarettes the same principle should apply to health insurance.                        

Problem is, health insurance doesn't work that way, and our Georgia politicians are scratching their heads. The AJC reported on new legislation that was supposed to make it easier for Georgian's to purchase health insurance across state lines.

Nobody has even asked to be approved to sell across state lines,” Georgia Insurance Commissioner Ralph Hudgens said. “We’re dumbfounded. We are absolutely dumbfounded.”

Dumbfounded. That's a good word.

Do you suppose anyone under the gold dome has heard of Obamacare?

With all the massive changes that will affect health insurance in 2014 (assuming Obamacare survives the Supreme Court and the November elections) carriers are not making any major moves involving health insurance, especially those that involve huge sums of money in filing fees.

Hudgens, a conservative Republican who strongly supports free-market ideas, said he expected policies sold in states such as Alabama, which have fewer requirements for health plans, to be offered in Georgia after enactment of the law.

Under the new law, health plans approved under the rules of other states could be sold in Georgia, even if they don’t meet Georgia requirements.

However, the companies still would have to be registered in Georgia and prove they are financially solid. And any complaints from policy holders would be resolved in Georgia, instead of forcing customers to go to the state that approved the plan to resolve a dispute.

The health insurance policies and rates would also have to be filed in GA and approved by the Department of Insurance. This is expensive and time consuming.

Any savings that may be achieved due to fewer mandates in Alabama would be offset, at least in part, by network discounts and overall cost of health care in Georgia.

And Alabama is a poor example in this case. Blue Cross of Alabama dominates the state when it comes to health insurance. They control so much of the market very few health insurance carriers even offer their product there. If Alabama Blue were to try and compete for health insurance here they would lose the advantage of their deep network discounts making it impossible to compete against home grown BCBSGA or other health insurance carriers such as Humana, Cigna and other health insurance carriers.

Kyle Jackson, Georgia state director for the National Federation of Independent Business, had high hopes that the new law would help small business operators who buy their own health plans.

“It’s frustrating,” Jackson said. “You can’t force the insurance companies to write these policies. But I know in talking to folks in my membership that there is a real demand … especially if you are talking about the possibility of some lower-cost health insurance plans that do not have the mandates we have.”

No doubt, mandates add an average of 30% to the cost of health insurance, but the only way to significantly reduce health insurance premiums in most cases is to totally obliterate all mandates.

That won't happen.

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Dental insurance from Cigna allows you to use any dentist. Additional discounts and lower out of pocket apply when you use a Cigna participating dentist. Cigna dental plans offer the following:

• Low annual per person deductible applies to Basic and Major services
• Cigna dental preventive services covered at 100%, deductible does not apply
• Fillings, non-routine X-rays, emergency services and simple extractions, Cigna dental pays 80% of allowed charges after deductible
• Crowns, inlays, root canal, periodontics and anesthetic, your Cigna dental plan pays 80% of allowed charges after deductible.

Dental insurance from Cigna is not available as a stand alone policy, it must be purchased as an add-on to a Cigna major medical health insurance plan. 

If you are looking for a superior dental insurance plan without major medical, consider one of the Humana dental insurance plans. Humana Preventive Plus is an excellent value, and allows you to use any dentist.

Cigna dental insurance plans require a 6 month waiting period before you can access Basic services and a 12 month waiting period before Major services are available for use. Your Cigna dental plan has a $1000 annual maximum on covered services.

Coinsurance applies to Basic and Major services. The amount paid by Cigna dental plan is a percent of their internal fee schedule for participating dentists. This is NOT the same as paying 80% or 50% of actual billed charges. If you use a Cigna participating dentist your out of pocket will be less than using a non-par dentist. 

Cigna dental plans and dentists are available in Atlanta and Athens. Coming soon to other areas of the state.

As with most dental insurance plans, benefit restrictions and policy limitations apply. Ask for a Cigna dental insurance plan summary of benefits for full details.

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Business Insider offers this information about their health insurance, including maternity insurance.

In partnership with Aetna, Costco will dole out the Costco Personal Health plan in several states, according to a company press release – Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas, and Virginia, with more to be added later in the year.

Costco is following the path of Wal-Mart by offering health insurance to their members but do you really get a good deal?

The short answer is, no.

A quick check on Georgia health insurance from Costco including maternity insurance resulted in this finding.

They only offer health insurance through Aetna.

Aetna does not offer maternity insurance coverage. In fact, they never have included maternity insurance as an option.

They only offer 5 plans in Georgia. If you really wanted health insurance from Aetna you can buy it through Georgia Insurance Shop and have access to 10 different plans.

The rates for the Costco health insurance plan are slightly less but the coverage has been stripped. In other words, you get less coverage for a lower premium.

Well duh!

The less expensive plans (read higher deductible) do not cover ANY brand name drugs. One plan covers brand Rx only after a $4,000 deductible.

-There is NO maternity care, unless you incur "pregnancy complications." This could be a major deterrent for many consumers, especially considering how important families must be to business.

-Deductibles are sky-high, which is unfortunately a growing trend for private health care plans. For individuals, they range from $3,000 to $7,500 for in-network care and $6,000 to $10,000 for out-of-network care. For families, deductibles start from $6,000 to $15,000 for in-network and $12,000 to $20,000 for out-of-network care. 

Here's a clue to the folks at Business Insider. After Obamacare was signed all Georgia carriers stopped offering maternity insurance except one (BCBSGA). And don't forget that Aetna NEVER offered maternity insurance as an option.

Costco consumers who apply for insurance with Aetna will have to go through medical underwriting which means your premium can increase or you can be turned down.

Costco is a great place to shop for toilet paper but you can do much better on health insurance and we can show you maternity insurance options as well.
 

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If you're looking for a dental insurance plan, C550 includes preventive care and offers copay's on other dental procedures. After a small copayment, you'll be 100 percent covered for many preventive services such as cleanings, X-rays and oral exams. The plan also offers fixed dollar copayment's on other procedures.

• No Waiting Periods

• No Deductibles

• No Annual Limit

• No Lifetime Maximum

View HumanaOne Dental plans and apply for plan C550 now.

NEW Dental Preventive Care Plus plan from HumanaOne.

Dental PPO plans are quite popular in Georgia.  Dental Preventive Care Plus is low-cost and provides coverage for preventive care, such as cleanings and X-rays, and offers discounts on basic and major services. Plus, there are no copayments for office visits.

• Freedom to visit any dentist you like.
• Most in-network preventive services covered at 100%.
• Additional discounts for visiting in-network dentists.

View HumanaOne Dental Preventive Plus plan and apply now.

NEW Vision Insurance Plan from HumanaOne

Vision insurance plans in Georgia from less than $16 per month. Got eyes? Need a vision insurance plan? Can't afford an eye exam, glasses or contact lenses? Buy a vision insurance plan.

Most major medical plans do not cover ROUTINE eye exams, eyeglasses or contacts but there are items that a good vision insurance plan will cover.

Affordable premiums. Easy  "one click" application. No deductible plans.

​Many Georgia citizens buy a vision insurance plan to offset the cost of routine care not covered by major medical. A quality vision insurance plan is now available in Georgia for less than $16 per month.

This vision insurance plan allows you to see any eye care professional but has the added benefit of a lower copay if you use a network provider.

Eye exams (including dilation if necessary) from participating providers are covered with a $10 copay. The plan also covers lenses, frames and contact lenses.

Discounts on Lasik.

A routine eye exam can detect changes not only in your vision but your overall health. A professional eye exam can detect other disease such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis and rheumatoid arthritis. With more than 35,000 participating eye care providers there is almost certain to be one in your area.

Click here for full details on this vision insurance plan. Click, review, quote and apply direct online.

Dental and vision insurance in Georgia is now affordable for almost every budget.

The 2012 session of the GA legislature approved a bill that will allow parents to once again purchase a child only health insurance plan. 

On April 3, 2012 GA House Bill 1166 was sent to Gov. Deal and is awaiting his signature.

Once the bill becomes law, parents will once again be able to purchase a child only health insurance plan in Georgia, beginning in 2013. The law is due to sunset on 12/31/2013 based on the assumption that Obamacare will replace this law on 1/1/2014.

Currently the only way to purchase a child only health insurance plan in GA is to apply for a STM (short term plan) or a fixed benefit basic health insurance plan such as Health Access.

In 2013 that will change.

But wait, there's more . . .

Obamacare denies health insurance carriers the ability to reject children's health insurance due to pre-existing medical conditions. Children's health insurance policies cannot have exclusion riders because of pre-existing health. Premium surcharges are allowed without an upper limit.

Each GA health insurance carrier handle's child health insurance differently. Some apply rate up's to the child's premium only while others will spread the premium surcharge over other family members. Some premiums are surcharged as much as 500% of the standard premium.

The good news is, the Georgia DOI does have to approve rates for children's health insurance and we can expect carriers to soon begin filing new rates for 2013.

We won't know what the new rates will be until late 2012, probably in December.

At this point I would not be surprised to see base rates for children's health insurance under the age of 19 by at least 100%, perhaps more. This will also impact family rates, possibly making health insurance unaffordable.

Which is contrary to what Obama promised when promoting the Affordable Care Act . . . .

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Most major medical plans do not cover ROUTINE eye exams, eyeglasses or contacts but there are items that a good vision insurance plan will cover.

Affordable premiums. Easy  "one click" application. No deductible plans.

​Many Georgia citizens buy a vision insurance plan to offset the cost of routine care not covered by major medical. A quality vision insurance plan is now available in Georgia for less than $16 per month.

This vision insurance plan allows you to see any eye care professional but has the added benefit of a lower copay if you use a network provider.

Eye exams (including dilation if necessary) from participating providers are covered with a $10 copay. The plan also covers lenses, frames and contact lenses.

​Discounts on Lasik.

A routine eye exam can detect changes not only in your vision but your overall health. A professional eye exam can detect other disease such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis and rheumatoid arthritis. With more than 35,000 participating eye care providers there is almost certain to be one in your area.

Click here for full details on this vision insurance plan. Click, review, quote and apply direct online.

But mostly worse.

A recent health care symposium hosted by Buck Consultants, BCBSGA, Piedmont Healthcare and others had these observations about the future of health care.

Employers that offer health insurance are feeling the pinch of these costs –- and are, in turn, squeezing workers for more out-of-pocket payments. Medical providers are battling increased costs of their own, and at the same time are being pressured on pricing and quality from insurers and employers.

Sounds bleak huh?

It get's worse.

Providers have scrambled recently to form ‘‘accountable care organizations’’ — groupings of hospitals and doctors that seek to coordinate medical services for patients.

Hospital systems, meanwhile, are consolidating at a rapid pace. Dr. Ira Horowitz of Emory University School of Medicine said the metro Atlanta market could end up with four or five large hospital systems at the end of this wave of mergers and new partnerships.

Assembly line health care is the future.

Health Care in the Work Place

The panelists said employers will continue to provide financial incentives for workers to improve their health, and in some cases will use higher surcharges to penalize workers for unhealthy practices such as smoking.

Burgess said one Las Vegas employer, by offering a hefty financial incentive, induced more than 90 percent of its employees to switch to a new set of primary care physicians.

Employers are also charging workers more for brand-name prescriptions when a generic drug is available.

If you expect to receive health insurance from your employer, expect your employer to demand from you.

Health Insurance Will Change

WellPoint, parent company of Blue Cross, which is paying more to primary care physicians who operate a ‘‘medical home’’ for patients. That means one doctor coordinates services for all the patient’s needs, including managing chronic diseases.

Other insurers, including Aetna and UnitedHealthcare, have launched similar medical home programs.

If your insurance company is paying the bills they feel they have a right to direct your health care.

Welcome to the future.