Attention Ruggers in: KS, SC, FL, WY, NE, SD, LA, TX, WI, AR, ME, IN, IA, GA, and OH

If your state was listed in the title, in 2014, you'll be getting your health insurance directly from the Federal Gov't.  Be grateful that your State Gov't has a clue....[hat tip:  Insureblog.com]

These states have REFUSED to implement the health insurance exchanges, thus utilizing their refusal to be a part of the expanded Medicaid program offered within Obamacare.   This was the genius of Roberts Ruling on Obamacare. The States, who basically run and pay for Medicaid, get to keep their Fed Money, without the Feds using a "carrot and stick" to get them to accept Obamacare.  Love it!

Here, I'll list 'em again:

KS, SC, FL, WY, NE, SD, LA, TX, WI, AR, ME, IN, IA, GA, and OH

All of you playing Rugby need this as a supplement (You got $3-5,000 laying around in case a prop falls on you?). 

And, for the states listed above, you're employer will NOT be faced any penalties for not providing health insurance, but yet, you'll have access to Federally subsidized and guarantee issue plans... My guess, your health insurance premiums will remain stable, and as more Kaiser's come online (and they will, only way to control costs is to control the Docs, Nurses and Hospitals) you'll see employers FLYING to these states.  (Please note:  All of these states are right-to-work states, except WI, ME, and OH... that'll change...)

If your Boss is smart (Or, if you're the Boss), what she'll do is offer each employe $XXX.XX per month, and let them buy their own insurance.  Less for singles, more for families... Those with state-based exchanges, she'll just pay the $2,000 per employee, or drop your hours down below 40/week, or both.

Employers are NOT stupid.  They want to make profit.  Figure that out.  Also, they know that a company with benefits will attract better employees.  Benefits are good, for everybody.

Now, if you're a Rugby player NOT listed above... You'll be paying a penalty to the IRS, or forced to purchase shit health insurance which, and this will happen, will EXCLUDE sports... Trust me.  It's gonna get nasty.

So, congrats to the States who told the Feds to GFY....

CA Health Insurance: A New Hope...

People are losing health insurance in CA.  21% of the population, or 1 in 5.

Why?

It's too expensive, doesn't seem to have any value, and too many people can skirt by without it, burdening those who do have insurance.  (Similar example is Auto Insurance in CA:  25% according to this study.)

Luckily, a new company call See Change Health is working to reversing that trend.

Simply, See Change will PAY YOU to go to the doctor, and to take steps to be healthy. 

They understand that catching something early helps everybody, you, your employer, and the bottom line of money.

They create a personalized "Health Action Plan" for each employee, and provide CASH incentives to take the necessary steps to get or stay healthy.

Interested?  Call us.

Now, for Rugby Players, imagine getting PAID to go the Chiropractor, or Massage Therapist.  How about help with your gym membership, or supplements?

More interested?  Call us.

Stupid Broker Trick: Selling a Group Plan where the Main Local Hospital is OUT of network

So, S. Mart rides his bike to work.  Everyday.

BOOM!  A car smashes into S. and he's whisked to the local emergency room by ambulance.  S. had no CHOICE as to the ER since, um, well, HE JUST GOT HIT BY A CAR!!!!!!!! 

His group insurance carrier informed him that since the hospital was Out-of-Network, he'll have to pay the difference.  (This typically doubles to quadruples your out of pocket...)

Technically, since it was an emergency, and S. had no choice, the out-of-network rates should not be applied.  In fact, the carrier did agree, and is reviewing the submitted bills from the hospital.  Good on them.

Here's the Stupid Broker Trick:  Selling a group plan where the Area's MAJOR ER was Out-of-Network.  "I'll bet it was the cheapest," interjected my friend in HR, KRE.  So, this guy made the sale, but failed to inform a rather key piece of info.

Luckily, S. is okay, and will pedaling again soon.  I wish I could say the opposite for the broker.

Fitness: Wins 80% of Matches, and could lower your Insurance Premiums

Fitness is the key to most matches....I don't know how many times a Rugby coach stated that the All Blacks score 80% of their tries in the last 20 minutes of a match.

Well, Obamacare actually makes it EASIER to charge smokers and those who are over-weight MORE for their health insurance.  In a classic Gov't Boondoggle, not only can your employer make you pay more for health insurance, but also for the Wellness program they decided that you need.  Lovely...

What'll suck for most male Rugby players:  We are usually "Obese" by the Definition via Body-Mass Index, or BMI.  I'm 5'10", 195#, which puts me at 29 BMI, over-weight.  Bullshit.

There's hope:  SeaChangeHealth.com is a company that will help you pay LESS for health care while you get healthier. 

Fitness.  Should work in your favor, unless you work at Walmart.

Obamacare Fails: UTAH and Humana part ways

A major insurer just simply won't play... The Feds can nothing.  Fascinating.

COBRA vs. G.I. Joe!!! (Loved that cartoon...)

Some may know, I sucked it up at Starbucks for 16 months to rebuild RuckingInsurance.com nationwide. (2008-2009 Divorce + Economy = Ass Kicking...)

I've quit, and I got my COBRA paperwork.

Remember, I mentioned that Starbucks self-insures, meaning, they pay an insurance company to administer the benefits, but keep the cash reserves to pay claims unto themselves. Most big corporations do this.

(IMHO: If Obamacare stays, they'll stop, bc it's cheaper to do so...) If I were to purchase the same level of benefits on the open market, $660/month.

My end date is 2.28.11. I have until 5.5.11 to call Starbucks and elect COBRA. My cost would be $307/month. That's less than half of the open market rate.

(Self Insuring allows Starbucks to pick and choose benefits, and control costs, better than an insurance company can, because they're not pinned down to specific state laws....nice, huh?)

Now, that's over 60 days to make a decision. If I get hurt/sick before then, I just elect COBRA, pay the monthly, and boom, I have insurance.

If nothing happens for that time period, I do....Nothing.

Nothing...It's like having free insurance, I only have to pay if I get hurt/sick.

(This is EXACTLY what will happen if insurance companies are forced to take all comers. People will wait to be hurt/sick BEFORE they buy insurance.)

I'm a freaking insurance agent/broker. I recco this strategy to clients, and I do it myself.

Remember, "Knowing is half the battle..."

G.I. Joe!!!!

CA Rugby Players have been OBSTRUCTED from paying true health insurance costs...

CA Rugby players are in for a rude awakening, especially if they depend on Employer sponsored health insurance.

We've had good for a while. Expect that to change, and for you to pick up more share of the load.

Ever try to avoid penalties on the Pitch?

Any decent Rugby player bends the laws. Penalties are costly turnovers, and can lead to 3 or even 7 points.

That doesn't stop us from playing the ball on the ground in a ruck. (A boot would though...)

Anyway, Obamacare has a penalty for those who don't buy health insurance, starting 2014. This especially affects business owner's with employees.

Here's how to get around that: (By the by, this isn't tax advice. Verify this with your payroll guy or CPA)

The employer can set up a POP, or premium only plan. The boss dumps X dollars into each paycheck on a pre-tax basis, and it's up to the employee to purchase health insurance.

This prevents the company from paying a penalty, avoids COBRA hassles, and each employee now has portable health insurance. (Ever get hit with a COBRA rate?)

Another advantage is that it gets the Boss OUT of the health insurance business. IMHO, you should own your own HI, and never let someone control your health care dollars.

You're a Rugby player. The ball is safest in your hands, right?

Even in the bottom of a ruck...

Tax-Free Individual Health Insurance

Clarifying Health of Zane Benefits has an interesting take on the tax code in CA and employee benefits.

I'm researching now...

Employer dropping Benes? Here's what you do...

Your employer will drop his benefits.  Why?  Because the Obamacare penalty is cheaper, and/or, the Boss will go to an Health Reimbursement Arrangement, avoiding both the hassle of group health, and the penalty.

Here's what you need to do if you have pre-existing condition that prevents you from getting individual traditional health insurance.

Now, other plans exist that could help with Rugby injuries, so don't fret.  And, remember, in 2014, and if Obamacare is not repealed or de-funded, you can buy health insurance AFTER a prop falls on you.

Doesn't make sense, but that's how it is...

The Future of your Health Insurance...You're gonna own like you own your Boots

Your Employer will drop you health insurance, and shove an extra $X into your paycheck through a Health Reimbursement Arrangement, HRA, and expect you to buy health insurance and track health expenses.

Just like I've been telling you to do for over 4 years...

Don't believe me?

Texas is leading...California will follow soon. 

I love my Boots.  Especially, when I'm stomping on some handsy open-side.

Why (MOST) Insurance Agents don't want your business...

When I was asked to move into the forwards, hooker specifically, I was quickly told that I was too small...

"So, how do I get bigger?"  Tarzan taught me the BFS system, and I worked hard.  Very Hard.

(These days, I use crossfit.com)

With Insurance Agents, they'd like for you to work really hard, get BIG, then buy the policies they are hocking.  They don't want to "waste their time" on the small guy.  Instead, they all troll for the same dissatisfied guy looking for a new agent.  Problem is, if the client is dissatisfied now, chances are that he's normally pissed, and you're just the next to get the abuse.

Pricks.

To me, no business is too small.  I starting this gig making about $6/month on policies.  A Hundred customers wouldn't cover my rent.

But I kept going.  I worked hard.  I built and grew with Rugby.

I was small, health insurance only.  Now, I write health, accident, employee benefits, life, disability, business, sports leagues, sports teams, travel insurance, professional athletics, and professional liability.

I'm so grateful for this Sport and this business.  I'll talk to any Rugby player about any kind of insurance.

Nothing is too small... except me at Hooker.

This is Bullshit... Solution: OWN your insurance...

We Californians...so good at telling people how they should live their lives, but, of course, we discriminate like the rest of them.

We don't even have the courtesy of being frank about it.  Lip service to an ideal...

Solution:  OWN your health insurance.  Don't take Employer sponsored benefits.  CA laws allow domestic partnerships on individual/family health insurance. 

Take control.  No one else will do it for you...even in California.

Explaing Group Health Insurance Rules is similar to Explaing Rugby to your Grandmother...

Group Health Insurance...funny that I'm explaining something that'll probably disappear this year...

...Anyway, it's difficult.  Like explaining what a scrum half does to your Grandmother...

"Well, Grandma, I put the ball in the scrum, and the hooker..."

"Hooker!?!?!  I should wash your mouth out with soap!!!"

Well, you get it.

Lots of rules/laws with group health insurance.  Start dates, enrollment periods, open enrollments, adding spouses and kids, dental or no dental.  Plus, "Life Changing Event" rules about making changes.

Oh, and the money you spend buying a High-Deductible HSA Qualifed plan DOES NOT GO TO FUNDING YOUR HSA.... silly bastards.

So, Grandma, enjoy your $250 check from PresBO and we'll talk rugby later.

In the meantime, be very clear in your questions to the agent trying to sell you a group policy:

1.  How do you make changes?
2.  What is considered a "life changing" event?  (Affects #1)
3.  How do I protest an unpaid claim?
4.  How do I fight a rate increase?
5.  How do I get my utilization report?  (How much money they spent on claims for you or your group.)

This info will guide you through who's interested in helping you, and who's gonna bail at the first sign of trouble.

Make Sense, Grandma?

More for College and under 27 Rugby Players: Call Mommy and Daddy

Yep, you can probably get back on Mom and Dad's insurance.  Call 'em, see what they think.  If it's cheaper, do it.

Remember, once you hit 27 (adulthood now?), you're on your own.

I don't believe your Employer will keep a group plan.  They'll probably go to an HRA, Health Reimbursement Arrangement, and you'll find insurance on your own.  So, go shopping.  See who's cheaper, and go.  If Mom and Dad live out of state, with better rates, that's a no-brainer.  However, my guess it'll be a wash, with no major differences.

Bigger Group, Bigger Discount

You get a discount at most Rugby Tourney's if you enter more than one side.

With Group Health, I've recently discovered, you get a discount with 10 or more enrollees.

Now, Obamacare ignores companies under 50 employees.  Interesting, because I wonder what percentage of the workforce is at places this size.  More, how many businesses will SCALE BACK to under 50 to avoid Obamacare?

I'm not a big fan of Group Health Insurance.  And, if trends continue, we'll all be buying individual health plans to avoid going to the post office for stitches...

From Zane Benefits: zaneben.com/ruckinginsurance

The Entrepreneurial Challenge - Thursday, Mar 25

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Health Care Reform - The Impact on U.S. Employers and Employees

By Paul Zane Pilzer
Posted on Wednesday, Mar 24 at 5:30 pm

"While I personally did not support President Obama on U.S. Health Care Reform, such reform is already proving very good for my business (Zane Benefits) and for many entrepreneurs in health care and wellness. I feel today like an arms manufacturer on December 7, 1941."                                                                                         Paul Zane Pilzer, March 23, 2010

Note: Zane Benefits has posted a technical article summarizing the impact of health care reform on insurance agents, employers, and employees, including which changes take place in 2010, 2011, and 2014.

On March 23, 2010 President Obama signed into law H.R. 3590 - the Patient Protection and Affordable Care Act (the "Senate Bill") which mandates sweeping changes in U.S. health care and health insurance. The U.S. Senate is currently debating the Health Care and Education Reconciliation Act H.R. 4872 (the "Reconciliation Bill") which makes modifications to the Senate Bill as described herein.
Here's how this already-passed legislation will impact small (2-50), medium (51-200), and large (>200) size employers and their employees.
Changes in the Individual / Family ("Personal") Health Insurance MarketFirst and foremost, new insurance regulations prevent health insurers from denying coverage to individuals or charging more based on their health status or gender. These regulations also mandate that health plans provide a very generous list of services (i.e. a federal government formulary), cap annual out-of-pocket spending for participants, impose no annual or lifetime limits on coverage, and, beginning September 23, 2010, offer preventive (wellness) services with no copays or deductibles.
These new mandates, while laudable in their intent for consumers, will significantly increase the cost of health insurance (before federal subsidies) for the majority of U.S. taxpayers. If you are among the 25% of U.S. households earning more than $88,250 a year, your current cost for health care will potentially double. Below $88,250 a year in income, the new legislation caps your health care cost at 2% - 9.5% of your income for premiums and $0 - $5,950/person/year for out-of-pocket expenses.
The net effect of these federal subsidies for employers is that when you switch from group to personal policies the federal government is insuring that each of your employees can afford health insurance at widely varying cost based on their income.
Small Employers (2-50 employees)Small employers in the U.S. employ more than 50% of American workers and are responsible for the overwhelming majority of new jobs. More than 55% of small employers today do not offer health insurance-because of cost. Both the Senate Bill and the Reconciliation Bill impose no penalties or mandates on small employers to offer health insurance. Congress seemed to recognize that any increase in employer mandates would cause small employers to hire less workers and/or substitute more technology for labor in the workplace.
Most importantly for this sector, health care reform is dramatically accelerating the switch of small employers from group to personal (individual or family) health insurance. While personal health insurance has grown from covering 12 million people in 2002 to 35 million people in 2009, the reason 45% of small employers still offer group plans is because, in 45 states, employees with pre-existing medical conditions were unable to obtain personal insurance.
This is no longer the case. Beginning 2014, insurance carriers must accept all applicants at the same price regardless of health status, and beginning 2010, there is a new federal "risk pool" to guarantee coverage to people who do not have health insurance and cannot medically qualify or are charged more for traditional medically-underwritten personal policies.
Moreover, recent federal legislation allows employers to pay for personal policies with pre-tax dollars, and new Treasury regulations allow employees to use pre-tax salary to reimburse themselves tax-free for personal policy premiums. These two changes have the practical effect of reducing by 20%-50% the after-tax cost of personal policies for employees and employers.
Thanks to health care reform, small employers with group plans in all states can now cancel their group plans and switch to giving each employee a pre-tax allowance to purchase their own personal policy-while being assured that all their employees can get and afford personal health insurance.
A company I founded, Zane Benefits, is the leading supplier of software administration platforms that allow employees to pay for their own personal health insurance with pre-tax employer and/or payroll-deducted funds. Thanks to health care reform, we have experienced a significant increase in business from employers (and their agents) seeking to switch employees from their group plan to personal policies, or at least offer employees the opportunity to save 20%-40% on health insurance by paying for their personal policies through pre-tax salary reductions.
Medium Employers (51-200 employees)Medium-size employers were not as lucky as small employers when it comes to health care reform. For employers with 51-200 employees, the health care reform bill signed into law on March 23, 2010 mandates a $750 per employee annual penalty for employers that do not offer (and substantially pay for) health insurance. The Reconciliation Bill would raise this $750 per employee penalty to $2,000 per employee (less an exemption for the first 30 employees).
Most medium-size employers who currently do not offer health insurance will simply pay this penalty rather than increase their operating costs by approximately $10,000 per employee for health insurance. Medium-size employers who do currently offer health insurance face an expected doubling of their health insurance costs, from $5,000 to $10,000 per person per year, due to the new federal mandates on coverage.
This creates a choice for all medium-size employers of either paying the penalty or paying a much greater cost for health insurance. The penalty along with new health insurance mandates could have a devastating effect on new U.S. job creation and employment at a time our economy can least afford it. A $750-$2,000 per employee penalty, and/or a doubling of employer health insurance costs, will force many medium-size employers to move jobs overseas, create less new U.S. jobs, and/or substitute more technology for labor in the workplace.
Additionally, think about employers with 49-50 employees seeking to expand. The addition of a single employee could cause their company to incur a penalty of up to $100,000.
Large Employers (>200 employees)Large employers fared the worst in health care reform. Those large employers who cannot  afford to offer health insurance face the same ($750-$2,000) per employee penalty as medium size employers. And those large employers who currently offer health insurance will face an expected doubling of their health care costs due to the new federal mandates on what must be covered and no lifetime limits on coverage.
Moreover, large employers are required to automatically enroll employees in their lowest cost health plan if the employee does not choose coverage or does not specifically opt out of coverage. For each employee who chooses to opt out of employer coverage, employers are charged a $3,000 annual fee up to a maximum penalty of $750 ($2,000 with the Reconciliation Bill) times their total number of employees.
Among the new federal mandates for coverage, I am troubled by the potential cost of the mandate requiring no lifetime limit on coverage. Prior to health care reform, most states already mandated a per-person minimum lifetime maximum on health insurance benefits ranging from $3 million in Texas to $6 million in California. States typically required insurers operating in their state to re-insure their catastrophic risks, and Wall Street practically required large employers to purchase re-insurance on their catastrophic risks. Re-insurers, such as Lloyds of London, were only able to re-insure carriers and large employers because there was a defined maximum amount of lifetime benefits.
From a practical standpoint, very few people could ever come close today to utilizing $3 or $6 million of medical costs. The new federal mandate for no lifetime limit may cost Americans hundreds of billions for very little benefit, and may even be unobtainable in the re-insurance marketplace. The federal government should move now to either change lifetime maximum benefits to a practical $3-$6 million amount, or offer carriers and large employers the re-insurance they need to comply from the U.S. Treasury at minimal cost.
SummaryHealth insurance reform is here to stay. I do not expect this legislation to be repealed, or successfully challenged in the courts.
Like most government programs of the past, health care reform will create enormous opportunities for entrepreneurs. I plan on exploring these opportunities in future articles and perhaps an entire book. As always with change, those entrepreneurs who get there first will reap the greatest rewards.
While I personally did not support President Obama on U.S. Health Care Reform, such reform is already proving very good for my business (Zane Benefits) and for many entrepreneurs in health care and wellness.
As a businessperson, I feel today like an arms manufacturer on December 7, 1941. Only time will tell us as a nation whether health care reform was worth the financial cost. To quote Tiny Tim (Charles Dickens), "God bless us, every one!"

Starbucks U.S. Benefits Plan Description

Just got the 1/2 inch thick Benefits Plan Description from Starbucks.

Damn.

I'll read it over the next couple of days.  Of course, Health Insurance issues only, as I don't deal with 401(k)'s and other retirement stuff.

Here's a quick hit:  ER deductible for the plan I chose is $100.  Add that to the $300 yearly deductible, and the $3,000 Out of Pocket Max, I'm keeping my Accident Medical Plan for $5,000 per year benefit.

Why doesn't SBUX cover Chiro?

Because of Worker's Comp...

Back injuries cost employers money.  Chiropractic is STILL not respected as a therapy.  Sucks.

SIDE NOTE:  Still no word on the COBRA amount for my health insurance.

Corporate vs. Individually Owned Health Insurance

The reason you own your health insurance:

Nobody can take it away from you.

I have had cases where an employer has switched health insurance companies, during a month where an employee or dependent gets sick, and both the new and the old deny the claim.

Also, I've had cases where the company just dropped coverage altogether, for ALL employees.  No COBRA in this instance, since the benefit plan no longer exists.

Is it cheaper to go through your employer?  Yes, usually.

Why?  Because the business is picking up a strong portion of the premium.  You do NOT see the real costs of the benefits.

[That's why Americans believe health insurance is so cheap.  They haven't been paying for it for YEARS!]

If you own, you can't lose it.  (As long as you pay the premium...)