St. Clair Health Insurance

Facts and Figures

  • Insurance
    Carriers
    13
  • Number of
    General Doctors
    65
  • Number of
    Hospitals
    2

Insurance Carriers

State Government Insurance Programs Offered

AHIP


AHIP - Alabama Health Insurance Plan www.alseib.org There are two plan options under this program: Indemnity and Managed Care plans. This plan is designed for those who have exhausted their group plan coverage and are not eligible to apply for another group coverage. This is in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Eligibility requirements: - must be a resident of Alabama - the plan you previously had must also be a group plan, government plan, church plan or COBRA - must have continuous coverage of at least 18 months - your previous coverage must not have lapsed for more than 62 days

COBRA


Consolidated Omnibus Budget Reconciliation Act (COBRA) ensures that employees who have reduced work hours or those who are losing their jobs can keep their health care coverage for up to 18 months. Under COBRA, the coverage will be more expensive since the member now has to pay for 100% of the coverage cost.

Pre-Existing Condition Insurance Plan (PCIP)


www.PCIP.gov A federal program focused on providing coverage to people who have a pre-existing condition. Eligibility requirements: - must be a US citizen and should be able to show proof of citizenship or residency - must be without coverage for at least 6 months - must be having a problem getting approved because of a condition

Medicaid


Medicaid - SOBRA and MLIF MLIF - Medicaid for Low Income Families insurealabama.adph.state.al.us SOBRA Medicaid is a program designed for children and pregnant women. Eligibility requirements: - must be a US citizen and a resident of Alabama or a legal alien - must not be eligible for ALL Kids Income limits: - Pregnant Women: 133% FPL. - Children (ages 0–5): 133% FPL. - Children (ages 6–18): 100% FPL. - Parents/caretakers living with children ages 0–18: 24% FPL. - Aged, blind and disabled: Singles with incomes up to 75% FPL and asset limit of $2,000, and couples with incomes up to 83% FPL with asset limit of $3,000. (source: coverageforall.com)

ALL Kids


insurealabama.adph.state.al.us or www.adph.org/allkids ALL Kids is a state program that provides coverage to low-income families with children below the age of 18 who are uninsured. Coverage can start on the 1st day of the month right after application. Duration of coverage is 12 months. Benefits include doctor visits, check-ups, hospital care, immunizations, prescription drugs, dental and vision care, emergency services, and mental health/substance abuse services. Eligibility requirements: - Must be a US citizen or legal immigrant - Must be below 19 years old - Must be ineligible for Medicaid - Cannot acquire coverage - For children 5 years old and below, income must be between 133%–300% of the federal poverty level (FPL) - For children between 6-18 years old, income must be 100% - 300% FPL

AL Child Caring Program


insurealabama.adph.state.al.us Gives outpatient coverage only. Eligibility requirements: - must not be eligible for ALL Kids program and other plans - must be enrolled in school (if the child is of school age)

Breast and Cervical Cancer Prevention


www.adph.org/earlydetection Gives coverage for Pelvic exam, Pap smear, clinical breast exam, mammogram, ultrasound, colonoscopy, or biopsy, if necessary. Eligibility requirements: - women aged between 40–64 - must be uninsured or underinsured - income must not be higher than 200% of the FPL - women below the age of 40 can avail of free breast cancer screening provided that they undergo a clinical breast exam.

Medicare


A federal health care system that provides coverage to America's seniors (aged 65 or older) or those under 65 but with a disability or end-stage renal disease. Medicare has 4 parts: Part A which covers hospital care is free of charge; Part B covers medical care. Members need to pay for Part B coverage at a minimal cost. Part c is a combination of the coverage of Parts A and B which members can purchase from Medicare-approved private insurers. Part D covers prescription drugs which are also purchased through private insurance companies.

Health Coverage Tax Credit


www.irs.gov (keyword: HCTC) Covers inpatient care, outpatient care (lab tests, x-rays, etc.), doctor visits, preventive care, major medical care (surgery, physical therapy, durable medical equipment, etc.), mental health and substance abuse care, and prescription drugs. Eligibility requirements: - Must be receiving TAA (Trade Adjustment Assistance) - Must be 55 years or older and receiving pension from the Pension Benefit Guaranty Corporation (PBGC). - Must not be enrolled in other state plans, or in prison - Must not be receiving 65% COBRA premium reduction - Must not be a dependent in tax returns - Must be enrolled in qualified health plans where you pay more than 50% of the premiums. - Individuals who are eligible for the federal Health Coverage Tax Credit can also use their credit funds to purchase a private health insurance product developed by Blue Cross Blue Shield of Alabama.

VA Medical Benefits Package


www.va.gov Provides comprehensive preventive and primary care, outpatient and inpatient services. Covers pre-existing condition. Eligibility requirement: ”Veteran status” = active duty in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions.Certain veterans must have completed 24 continuous months of service.

Heath Care Reform

Through tax credits, small business owners can provide their employees with health insurance coverage without needing to spend so much on their premiums.
Medicare members who fell to the Medicare gap can expect to receive a rebate check of $250.
Early retirees who are waiting to be eligible for Medicare can be assured of continued coverage because of a $5 billion support for health plans providing early retirement coverage.
Alabama now has the option to choose to get funding from the federal Medicaid program.
The health care reform gives a $1.5 billion fund for scholarships for health care providers working in areas where there is a scarcity of medical professionals.
Funding is also provided for Community Health Centers in Alabama as well as for creation of new ones. This should make available health care to more residents.
Uninsured residents with pre-existing condition can now have coverage through a transitional high-risk pool. This is in preparation for 2014 when the health care reform’s provision that will prohibit insurers from denying coverage to applicants with a pre-existing condition.
Children until the age of 26 can stay on their parent’s policy as dependents regardless if they are still students, working (for as long as their employer doesn’t offer health insurance benefits) or still living with their parents.
No more liftetime limits on health plans. Annual limits will also be strictly regulated.
Patients will have easier access to physicians and emergency care. Women no longer need to get an approval from their primary care physician to see their gynecologist.

Pregnancy is considered a pre-existing condition.

The maximum look back period is 5 years.This means that the health insurance carrier can look at your medical record for the past 5 years and if you have a condition or have been treated for an illness in the past 5 years, the insurer considers it a pre-existing condition.

Health insurance carriers in Alabama have the right to reject application because of an applicant’s medical condition. But once you are already enrolled and you get sick, insurers cannot take away your coverage. Members have the right to re-enroll or renew their coverage no matter how many times they want through their guaranteed renewability provision.

Insurance carriers determine the premium rate and coverage an applicant will have. In this regard, it is very important for applicants to understand the policy before signing it.

Small businesses (those with 2-50 employees)is eligible to apply for group plans. The same rules as mentioned above apply when signing up for group plans which means they’ll have guaranteed issue.

Premium rates are determined by factors like (but not limited to) applicant’s health condition, sex and age.

Self employed individuals can have tax credits for a portion of what is paid for premiums.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email [email protected]