Insurance World

In the time it takes you to read this sentence, the bills from a critical illness may have forced yet another American to file for bankruptcy. It could be as a result of their own illness or a loved one’s, but the result’s the same: Half of all bankruptcies are due to serious illness, according to a recent Harvard study, and-of those-75 percent were forced to file despite having health insurance.

One new option consumers have to help cover all expenses associated with critical illness is called, appropriately, Critical Illness Insurance. This specialized insurance provides a lump-sum payment should a subscriber suffer from certain specific critical conditions.

Right now, one of the few companies offering such insurance is Stonebridge Life Insurance Company. However, experts say that as Americans continue to survive critical ailments that were fatal only a few years ago, the need for the insurance is increasing. Stonebridge Life Insurance Company gives policyholders a one-time payment of up to $50,000 as soon as they’re diagnosed with a covered cancer, stroke, paralysis or a heart attack. The payment is intended to help people meet basic expenses, such as mortgage payments, car insurance, groceries, child care-even ballet lessons.

“Many people aren’t aware of the financial consequences of surviving a critical illness, especially if they’re unable to work for an extended period of time while they recover,” said Marlene Jupiter, author and expert on personal finance. “Now that medical progress and early detection are helping more people live through serious illnesses, people need to plan for how they’re going to financially survive the aftermath.”

For monthly premiums as low as $20, Critical Illness Insurance from Stonebridge Life is a direct-to-consumer product offering lump-sum payment options of $10,000, $20,000, $30,000 and $50,000. As an added benefit, the plan offers a return of premium option. Customers who sign up before the age of 50 and select this option may receive their paid premiums in full if they don’t make a claim before age 65.

“There is an increasing need for critical illness insurance because it helps close the gap that exists between health and disability plans, making sure that survivors are financially supported throughout their recovery process,” explained Lew Whalen, vice president of Stonebridge.

1. Health Savings Accounts (HSA)

This is a strategy where the employer buys a health plan with a large deductible. Typically, these are groups that are coming from a plan with a very low deductible. Since the higher deductible plans are usually much less money, the money saved is used to put into the employee’s “Health Savings Account.” The money in this account is used by the employee to pay qualified medical expenses. If it’s not used, the money rolls over to the next year. The money belongs to the employee, even if they leave the company.

2. Health Reimbursement Arrangements (HRA)

This is very similar to the HSA above but a portion of the qualified medical expenses not covered by the insurance is “pledged” by the employer, that is, the employer only spends the money, if there is a portion of the bill not paid by the insurance. This would be more favorable to the employer since on an HSA the money goes to the employee, whether there are claims or not. The problem with HRAs is that there are very few carriers that offer them right now.

3. Medical Reimbursement Accounts

This is very similar to HRAs above and extremely flexible. It’s otherwise known as partial self-funding. Employer buys a larger deductible and if the employee uses up that deductible, the employer pays all or a portion of it, depending on how a pre-arranged agreement is written. This goes for other expenses not paid by the insurance. The idea is that the employer self insures the typically smaller expenses with their own cash, (presumably, the savings in premium dollars from going to a higher deductible.) The downside to this is that many carriers prohibit the use of this strategy with their plans. It can be very effective but make sure you use an experienced third party administrator as there may be some legal and tax documentation required. Otherwise known as Section 105.

4. Kaiser.

More and more groups are moving to Kaiser. It is typically, benefit for benefit, less money than just about every other plan. Kaiser is spending billions on the future and their quality control is promising.

5. Offering Blue Cross and Kaiser side by side. Blue Cross has a new program where only five employees need to enroll with Blue Cross. The rest can be with Kaiser. This is a ground breaking opportunity in flexibility.

6. Blue Cross Elect. Blue Cross has a portfolio called Elect with 16 plans in it comprised of HMOs, PPOs, and an EPO plan. Each of these plans is priced from low premiums up to a much higher premium.

The beauty of this program is that Blue Cross allows the employer to “define” how much premium they are willing to pay towards an employee’s cost. For example, Blue Cross offers a $10, $20, $25, $30, $35, and a $40 copay PPO plan. The $10 plan is the most expensive of this group.

After viewing all of the premiums for the various plans, the employer can establish, arbitrarily, which plan they are willing to pay, say the employee only premium for. In this case, let’s say it’s the $25 copay plan. The employee can buy the $25 copay plan and it doesn’t cost them anything. However, if they want the more expensive $10 copay plan, the employer would payroll deduct the difference in premium costs.

Let’s say they have dependents they want to cover but the employer only wants to pay for the employee only. The employee could take the lesser expensive $40 copay plan, and use a little bit of the savings to help them with the costs of adding their dependents.

This has been a highly successful program because it gives the employees a greater number of choices, helping the employees be more definitive in their costs and needs, and at the same time, allows the employer to more efficiently define their costs.

This information is time sensitive and can change at anytime. If you have a question or need more information, please contact me at mail@thestrategyguide.com. –Todd Rich

Todd Rich is an expert on California Small Group Health Insurance Plans and has written four books on the subject. To learn more about Todd and his books, please visit www.TheStrategyGuide.com/ezines