LIFE & HEALTH INSURANCE

Coverage
- Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
- Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
- Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
- Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.

Costs
- Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.
- Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
- Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.

Care
- Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No copayment.
- Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
- Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.

For More Information
- Read the Full Law
- Find detailed technical and regulatory information on the Patient’s Bill of Rights.

Let Cornerstone Insurance Services, LLC help you choose a policy that will fit your individual needs. Protecting your assets, whether personal, business, or both, is our goal. A well-chosen policy can lessen the impact of some of life’s most common, yet unforeseen perils. We’re here to help when you are considering Health coverage.

Small employers don’t have to offer health insurance to their employees, but employers that do must make it equally available to all employees working 30 hours or more per week (not on a temporary or seasonal basis) and their dependents.
Let Cornerstone Insurance Services, LLC help you choose a policy that will fit your individual needs. Protecting your assets, whether personal, business, or both, is our goal. A well-chosen policy can lessen the impact of some of life’s most common, most states insurance law defines a small employer as a business with two to 100 employees, regardless of how much they work.
In general, insurance companies require at least 75 percent of a small employer’s eligible employees to participate in the health plan.
Companies must always round down to the nearest whole number when calculating the number of participating eligible employees. For example, a business with five employees would achieve 75 percent participation if three eligible employees participate. Seventy-five percent of five is 3.75, and 3.75 rounded down is three.
Insurance companies that offer small-employer coverage must make it available to any employer who applies year round. However, if the employer doesn’t meet the minimum participation requirements, availability may be limited to the federal open enrollment period running from November 15 through December 15 of each year.

Types of Plans
The Patient Protection and Affordable Care Act (PPACA) requires all individual and small-employer group plans to cover a standardized package of services. These services are known as essential health benefits.
The essential health benefits include the following items and services: ambulatory patient services (outpatient care you get without being admitted to a hospital)

- emergency services
- hospitalization (including surgery)
- maternity and newborn care
- mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
- prescription drugs
- rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- laboratory services
- preventive and wellness services and chronic disease management pediatric services, including oral and vision care.
Grandfathered plans (those that an employer bought before March 23, 2010) aren’t required to contain the essential health benefits, but they do need to comply with State laws. Also, some types of insurance, such as indemnity policies, aren’t subject to the ACA and don’t count as minimum essential coverage for tax purposes.

Providing Coverage
Employers must give new employees at least 31 days from their start date to enroll in a health plan. After this time, employees may be required to wait up to one year for the next open enrollment period to join. Insurance companies must offer a 31-day open enrollment period annually.
Employers may require newly eligible employees to wait up to 90 days before being eligible for benefits. This is the maximum allowable waiting period for new hires by Federal standards. However, the insurance company may not charge a premium during this period.
Beginning in January 2014, insurance companies won’t be able to impose coverage limits, exclusions, or waiting periods for employees with preexisting conditions who had a gap in coverage.

Continuing Coverage
State regulations and a federal law called COBRA (Consolidated Omnibus Budget Reconciliation Act) allow employees to maintain benefits for a time after leaving a job. COBRA doesn’t apply to all small employers with under 20 employees, but state continuation requirements do.
Employers are required to tell employees about their rights to continue coverage. Former employees who choose to continue their coverage through COBRA or state continuation must pay the full cost of the plan.
Employers aren’t required to contribute toward their premiums for former employees, even if they previously paid a share. Ask your carrier about your responsibilities regarding continuation notices.

Paying for Coverage

The law doesn’t require employers to contribute toward health benefit plan premiums. Many insurance companies, however, require employers to pay at least 50 percent of their employees’ plan premiums. Employers may choose to pay a higher percentage than the company requires.

Employers are usually not required to contribute toward the cost of dependent coverage.
Premiums may increase at each renewal term because of rising health care costs. State law also protects businesses who buy small-employer health insurance by prohibiting insurance companies from discontinuing coverage without a reason.
Businesses with 25 or fewer full-time equivalent employees that pay at least 50 percent of premiums and pay average annual wages below $50,000 may be eligible for a tax credit of up to 50 percent (35 percent for nonprofits) of the premiums the business pays if it buys coverage through the federal small-business health options program, called the Small Business Health Options Program (SHOP).
For more information, visit www.healthcare.gov/will-i-qualify-for-small-business-health-care-tax-credits.

How Insurers Calculate Small-Employer Plan Premiums
Insurance companies base the amount employers pay for insurance on the specific benefits package and cost-sharing levels chosen by the employer. The health status of employees won’t impact rates. Insurance companies will consider the following factors:
- Age of employees. Older people usually have more expensive and more frequent health-related claims. Generally, the older your workforce, the more your plan will cost.
However, federal law prevents insurers from charging more than three times more for older employees than they charge for younger employees. - Tobacco use. Federal law allows health plans to charge tobacco users up to 50 percent more. Texas law requires that rating factors related to health status be spread across the employer group.
A group with more tobacco users will pay higher rates than a group with fewer tobacco users.
- Geographic area. Health care costs vary by region because of differences in the cost of living and the number of providers in the area.
Most plans use either the county or ZIP code of the employer’s business address to base rates.

Federal Health Care Reform Requirements
Small businesses with fewer than 100 full-time plus full-time equivalent employees won’t face a penalty if they don’t provide health insurance to their employees.
Federal law defines a full-time employee as one who works at least 30 hours during a typical week. The law counts each 120 hours worked by part-time employees in a month as one full-time equivalent employee.
Consider a company that employs 30 full-time employees who work at least 120 hours each per month and 24 part-time workers who average 80 hours each per month.
To convert the part-time employees’ hours to full-time equivalent employees, multiply the number of part-time workers by the average number of hours they work each month: 24 x 80 = 1,920. Then divide the total number of hours worked by 120: 1,920/120 = 16. To get the total number of full-time equivalent employees, add this number to the number of full-time employees: 30 + 16 = 46. Thus, the employer in this example has 46 full-time equivalent employees and qualifies as a small employer under the law.

What are the principal types of life insurance?

There are two major types of life insurance—term and whole life. Whole life is sometimes called permanent life insurance, and it encompasses several subcategories, including traditional whole life, and universal life. In 2003, about 6.4 million individual life insurance policies bought were term and about 7.1 million were whole life.
Life insurance products for groups are different from life insurance sold to individuals. The information below focuses on life insurance sold to individuals.

Term

Term Insurance is the simplest form of life insurance. It pays only if death occurs during the term of the policy, which is usually from one to 30 years. Most term policies have no other benefit provisions.
There are two basic types of term life insurance policies—level term and decreasing term..
- Level term means that the death benefit stays the same throughout the duration of the policy..
- Decreasing term means that the death benefit drops, usually in one-year increments, over the course of the policy’s term.

Whole Life/Permanent Insurance

Whole life or permanent insurance pays a death benefit whenever you die—even if you live to 100!.

In the case of traditional whole life, both the death benefit and the premium are designed to stay the same (level) throughout the life of the policy. .
The cost per $1,000 of benefit increases as the insured person ages, and it obviously gets very high when the insured lives to 80 and beyond..
The insurance company could charge a premium that increases each year, but that would make it very hard for most people to afford life insurance at advanced ages..
So the company keeps the premium level by charging a premium that, in the early years, is higher than what’s needed to pay claims, investing that money, and then using it to supplement the level premium to help pay the cost of life insurance for older people.

By law, when these “overpayments” reach a certain amount, they must be available to the policyholder as a cash value if he or she decides not to continue with the original plan. The cash value is an alternative, not an additional, benefit under the policy.

Let Cornerstone Insurance Services, LLC help you choose a policy that will fit your individual needs. Protecting your assets, whether personal, business, or both, is our goal. A well-chosen policy can lessen the impact of some of life’s most common, yet unforeseen perils. We’re here to help when you are considering Life Insurance.

Long-term care (LTC) insurance pays for services to help individuals who are unable to perform certain activities of daily living without assistance or who require supervision due to a cognitive impairment such as Alzheimer’s disease. According to the U.S. Department of Health and Human Services, about 70 percent of individuals over age 65 will require at least some type of LTC services. There were 47.8 million people age 65 and older in 2015, accounting for 14.9 percent of the U.S. population, according to the U.S. Census Bureau. By 2030 the Census Bureau projects there will be about 74.1 million older people and about 88.0 million in 2050.

About 4.8 million people were covered by LTC insurance in 2014, according to LIMRA. In 2015 the average premium for a 55-year-old male ranged from $1,066 to $2,075, according to the 2015-2016 Long-Term Care Sourcebook published by the American Association for Long-Term Care Insurance. For a 55-year-old woman, the premium ranged from $1,400 to $2,411. Based on 2014 buyers, 38.6 percent of new LTC insurance policies were purchased by individuals under the age of 55, and 91.9 percent of buyers were under the age of 65, according to the study. The age of new buyers has been dropping slowly. A decade or so ago the age of the average buyer was between 66 and 67 years old, whereas now the average application age for coverage is 56 years old.

THE AGING U.S. POPULATION

The dependency ratio, or the number of people 65 and older to every 100 people of traditional working ages, is projected to climb rapidly from 22 in 2010 to 35 in 2030, according to the U.S. Census. The expected steep rise in the ratio over the next two decades reflects the projected proportion of people 65 and older climbing from 13 percent to 19 percent of the total population over the period, with the percentage in the 20 to 64 age range falling from 60 percent to 55 percent.

Let Cornerstone Insurance Services, LLC help you choose a policy that will fit your individual needs. Protecting your assets, whether personal, business, or both, is our goal. A well-chosen policy can lessen the impact of some of life’s most common, yet unforeseen perils. We’re here to help when you are considering Long Term Care insurance.

Medicare is a federal health insurance program for people age 65 and older, people of any age with permanent kidney failure, and certain disabled peope under age 65. Medicare is managed by thethe Centers for Medicare and Medicaid Services (CMS). This article summarizes Medicare covered services.

Medicare allows you to choose the way you receive your benefits. Newly eligible seniors who are drawing Social Security benefits are enrolled automatically in the Original Medicare Plan, which is the traditional payment-per-service arrangement. If you want to stay with the Original Medicare Plan, you don't have to do anything. The basic benefits of this plan are described below.

Your copy of Medicare & You will explain the Original Medicare Plan and other Medicare health plans in detail. It also will explain how to enroll in other health plan options, if you are interested. If you don't have a computer, your local public library or senior center may be able to help you find this information.
Medicare Part B pays 80 percent of approved charges for most covered services. You are responsible for payinga $183 deductible per calendar year and the remaining 20 percent of the Medicare approved charge. You will have to pay limited additional charges if the doctor who cares for you does not accept assignment. This means the doctor does not agree to accept the Medicare approved charge for services.

The Original Medicare Plan

This is the traditional payment-per-service arrangement. Newly eligible seniorswho are drawing Social Security benefits (need to add this text)are enrolled automatically in this option. This plan includes all Medicare covered services listed above.
The federal government does not sell these types of policies. You should read the publication called Guide to Health Insurance for People With Medicare before you buy a supplemental policy. For a free copy, call the Medicare hotline at 1-800-638-6833. Your state insurance department (See the Neighborhood Networks) also has information available to help you. ElderCare Online’s Insurance Coverage Channel includes several informative articles on the range of insurance coverage options.

Assistance for Low-Income Beneficiaries

If you have a low income and limited resources, your State may pay your Medicare costs, including premiums, deductibles, and coinsurance. Please review detailed guidelines on the government website. To qualify:

For More Information

Up-to-date information about Medicare is available on the Internet at the web site http://www.medicare.gov. If you don't have a computer, your local public library or senior center may be able to help you find this information.

If you have questions about how to enroll in Medicare, call Social Security's toll-free number, 1-800-772-1213, any business day from 7:00 a.m. to 7:00 p.m. The lines are busiest early in the week and early in the month, so it is best to call at other times. People who are deaf or hard of hearing may call a toll-free TTY number, 1-800-325-0778, between 7:00 a.m. and 7:00 p.m. on business days. When you call, have your Social Security number handy.
These calls are all treated confidentially. Some calls may be monitored by a second customer representative to make sure you are receiving accurate information and courteous service.
If you have any questions about what Medicare covers, call the Medicare carrier that processes Medicare claims in your area. The name and number are listed in Medicare & You.

There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):
1. Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
2. Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand.
1. Noncancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company.
However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.

In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:

Additional purchase options
Your insurance company gives you the right to buy additional insurance at a later time.

Coordination of benefits
The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.

Cost of living adjustment (COLA)
The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.

Residual or partial disability rider
This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.

Return of premium
This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.

Waiver of premium provision
This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.

Let Cornerstone Insurance Services, LLC help you choose a policy that will fit your individual needs. Protecting your assets, whether personal, business, or both, is our goal. A well-chosen policy can lessen the impact of some of life’s most common, yet unforeseen perils. We’re here to help when you are considering Disability insurance.