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Sevier Health Insurance

Facts and Figures

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Breakdown of Insureds

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Insurance Carriers

State Government Insurance Programs Offered

Medicaid Covers Inpatient hospital, Outpatient hospital services, Prenatal care, Vaccines for children, Physician, Nursing facility services, Family planning, Rural health clinic services, Home health care for persons eligible for skilled nursing services, Laboratory and x-ray services, Pediatric and family nurse practitioner services, Nurse-midwife services and more. Eligibility: Income limits: Aged, blind or disabled: 100% FPL for singles and couples with asset limit of $2,000 for singles and $3,000 for couples. Pregnant women and children ages 0–5: 133% FPL. Children ages 6–18: 100% FPL. Parents/caretakers living with their children ages 0–18: 4% to 60% FPL.

Children's Health Insurance Program (CHIP)

CHIP: Well-child exams, Immunizations, Health care provider visits, Prescriptions, Hearing and eye exams, Mental health services, Dental services for prevention and treatment of tooth decay. Must be a U.S. citizen or legal alien and Utah resident, under 19 years old, not covered by health insurance (including Medicaid), with income up to 200% FPL

Primary Care Network

PCN: Primary care services, Prescriptions drugs, Dental benefits, Immunizations, Eye exams (no glasses or contact lenses), Lab and x-rays services, Emergency room visits, (restrictions apply), Emergency medical transportation, Birth control, Insulin, Lancets, Test strips, Syringes (for diabetes control and management) PCN: Must be 19–64 years old, uninsured, ineligible for Medicaid, not have access to student health insurance, Medicare or Veterans’ Benefits. Income limit of 150% FPL.

Premium Partnership For Health Insurance

UPP is a program for adults and children who do not currently have health insurance or COBRA coverage. UPP will help pay for monthly insurance premiums for individuals enrolled in their employer’s health insurance plan or COBRA

Utah Medicare

Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Heath Care Reform

" Immediate Benefits for Utah

Small business tax credits. 40,500 small businesses in Utah could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 22,400 Medicare beneficiaries in Utah hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Utah who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.

Support for health coverage for early retirees. An estimated 38,500 people from Utah retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 1.6 million Utah residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 186,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Utah peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 1.5 million residents of Utah with health insurance from their employer, along with anyone who signs up with a new insurance plan in Utah.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 11,600 individuals in Utah who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $40.1 million federal dollars are available to Utah starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 47 Community Health Centers in Utah but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 11% of Utah’s population who live in an underserved area.

New Medicaid options for states. For the first time, Utah has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status."

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