These two forms of group insurance are in some ways the same and yet are different.  They are both the form of Health Insurance an employee can access in order to continue coverage when they leave the employment of a company that has group health insurance and where employee was enrolled in and did meet the minimum participation requirements.  For Texas Continuation  you have to have been enrolled and participated in the plan for a minimum of 3 months.

COBRA governs groups over 20 people (and is ruled by Federal law (ERISA))
&
State Continuation is for less than 20 people. (Is ruled by the individual states, IE Texas)

COBRA lasts for up to 18 months (when exhausted you can apply Texas Continuation for 6 mo)
State Continuation last for up to 6 months

COBRA offers even more generous time limits for spouses and dependent children.

If the employee is terminated for “cause” the company does “not” have to allow the ex employee to enroll in the continuation of coverage whether COBRA or State Continuation.

I have learned this week from a client that State Continuation Coverage in this persons case (Aug 2010) can go for an extra three months or a total of 9 months. This individual was looking for options thinking his state continuation of group health insurance was going to end. He did look for individual coverage but could not pass the underwriting and so went to the Texas Health Insurance Pool for coverage.

He now has learned he can put this off for the group plan can keep him, as long as he pays the monthly premium to his former employer for an additional three (3) months. So now he can put off enrolling in the Texas Health Insurance Pool coverage and will save a few hundred dollars every month he can keep his previous coverage. If He had qualified for individual coverage he could have saved some money on his monthly premium as well, but he did not pass the underwriting.

We shall all see what happens with the GI (Guaranteed Issued) that the new “Health Care Reform” law will do to premiums for Health Insurance.

TDI notes on Texas Continuation and COBRA

The first has to do with the so called Grandfathered plans this is any health plan interred in to and in effect prior to March 23 2010. This two paged document gives some food for thought on this topic.

This sounds simple but there is a lot more to it if you look and stop and think. It will have to be looked at by each individual and group to see what is best.

The second document is titled Health Care Reform Law (what is Means for you) this is an eight page document with some clear information and stating on page 5 there is a timeline spelled out by Humana as to what changes are coming and when. The time line starts in 2010 and runs year by year out to 2014.

The State of Texas Insurance web site has a section on Health Care Reform that should be a good resource in working to see what all the changes will be for all of US.

In a Health Insurance policy, once you have met your deductible, if you do not have a 100 percent plan then you are in the part of the policy of Co-insurance. That is where the insured and the insurance co share in the costs. Then when you have spent your full Co-insurance amount then the insured is 100 percent covered for the remaining period of time in the plan year.

Co-insurance – the percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member’s co-insurance is 20 %.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan’s stop loss amount.

Stop-loss – the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

I was certain that because Texas has had The Texas Pool Insurance plan in place (was known as the Texas Risk Pool in the past) then Texas would not have any part of any federal risk pool insurance, or insurance for individuals of last resort because Texas had a program in place. It has always been an expensive program and I am sure there are many Texans who would like to be on the Texas Pool plan but just cannot afford to do so?

In speaking with people at the Texas Heath Insurance Pool (888-398-3927) this program will be here for now to cover people who have no place to go with commercial insurance and do not want to have a break of coverage. They will continue to cover any Texas resident who cannot get individual coverage (and is declined by at least one Insurance company).

What will happen to this plan when all the new rules are put in place will remain to be seen, so stay tuned!

The Federal Pre-existing Condition Insurance Plan (or PCIP) will go into effect soon. The target date for rates in July 15th and they are taking applications even now without any rates? I would not advise submitting an application until we can see the rates and all the particulars.

The main thing to know about this program is that you must be un-insured for a minimum of six months. This is the first thing. As the name implies you must have some pre-existing condition that other insurance would turn you down for.

Again if we are to have a new world with Guaranteed Issued (GI) individual Health insurance what is the long term purpose of this plan? Again stay tuned!

For now I know I can be of help with the Tex Health Pool and If this is something you know or think may be of help for you please contact me at caseyl@texasfamilybenefits.com or call me 713-481-6501. I will help look at your situation to see what may be the best option for you. And after the PCIP plan is more public I can then help people look into this plan as well.

I will start with the basic terms needed to look at Health Insurance.

Deductible – the dollar amount an insured individual must pay for covered expenses during a calendar year before the plan begins paying claims (if a 100% plan) or co-insurance benefits.

The Deductible is generally the first item that people ask about in Health Insurance. What is the Plan Deductible?

Social Security Disability Insurance benefits are available for the US Government, but in 2005 (the most recent data available) only 39% of the applicants were approved and the process is long and frustrating.

Our most important asset is not our home, car, or other possessions. It’s your ability to earn a living. All of your plans for the future—from purchasing a home, to putting your kids through college, to saving for retirement —are based on the assumption you can continue to earn a paycheck until you retire.

But what would happen if the paychecks stopped? That’s where disability insurance comes in. This form of Insurance gives you some income if you become unable to work.

So what are People to do? Explore options. If your employer offers disability coverage, take the time to explore the coverage that would be sufficient to meet your income replacement needs in the event of a disabling accident or illness. If it’s insufficient, your employer may offer you the option to increase your disability benefit, often through a voluntary payroll deduction. Another option is to purchase coverage on your own.

If your company does not provide DI today, call on me and I will be happy to meet and discuss options and solutions with company managers. I will be happy to talk to individuals to examine one on one and help you examine and find options and solutions for your future.

The microsite www.protectyourpaycheck.org is homebase for DIAM—this is great web site to examine objective, third-party information about disability insurance.

TexasFamilyBenefits.com is the web presence for John CASEY Lowery. I am an insurance agent licensed in Texas that works in the Health, Life, DI, and LTC for (Individuals and Groups). I will work to stay up to date in the markets I serve for my clients and potential clients. I only work in the Texas market.

Information on the new Health Insurance Reform Law is slowly coming out to us from the powers that be in the nation’s capital. I will use my Insurance resources and work to use my site and blog to put our useful information as I can.

Along with the “new look” of the web site the biggest change is in the Individual Health Quote Engine that I use. This is the “tool” that can give multiple quotes from all the Health Insurance companies J. Casey Lowery works with. I believe this is the best system I have seen yet for my clients and is easy for us to use in the office to better serve the client.

Please see the resource tab on the web site for this has good information on a verity of Insurance and Health topics and plan to grow this resource and keep it as user friendly as we can.

I plan on having post on Individual and Group Insurance topics and will work to make the web site a useful resource and tool for Health and Life (personal lines) Insurance needs in Texas.