Mandatory health insurance – individual mandate

Mandatory health insurance is a requirement, under certain healthcare laws or proposals, that all citizens have health insurance. It is also known as the individual mandate. In many cases, people who do not buy or otherwise receive health insurance will be fined. The standards for the employer and the individual cover can vary in different cases. In the United States, compulsory health insurance is part of some state laws and the federal health insurance reform law of 2010.

All insurance, including health insurance, works on the principle that many people share the risk of certain events. In the United States, many people less than the age of 30 have chosen not to buy health insurance. This has led to an elderly population that is more widely insured, but also more prone to care for health problems. Also, as many choose not to buy insurance, the price of the individual’s health care plans has probably remained higher than it would otherwise. Proponents of compulsory health insurance argue that everyone requiring health insurance would therefore lower costs for everyone.

In addition to lower costs, an individual mandate can also extend coverage. The coverage will be extended because individuals may choose to purchase their own health insurance instead of paying fines. This could lower the cost of making those who need smaller insurance companies, especially young people, share in the cost of health insurance. Also, the uninsured tends to raise the price to health care for others because they cannot pay doctors and hospitals when they have health problems. It can force healthcare providers to close the gap by raising the prices of others.

There are many criticisms of compulsory health insurance. In the United States, a criticism is that the government should not or does not have the power to force people to buy something. Others say the law would be too difficult to implement. Affordable prices, penalties, and plans would qualify are also issues.

In the past, individual states in the United States have made mandatory health insurance part of state law. Hawaii state law has required employers to provide full-time health insurance since 1974. The effectiveness of the Hawaiian law has been the subject of debate. In 2009, as part of the Massachusetts health care reform, the state required all citizens to receive health insurance. Those who cannot be penalized unless they cannot afford it. Mandatory health insurance is less discussed in other Western countries, where the government provides basic health care for everyone.

Eligible

All states offer a kind of Medicaid program for pregnant women. Eligibility is determined by examining the applicant’s income, assets and those of other members of the household. However, it may differ in specific fitness guidelines between states. A pregnant woman is usually eligible for Medicaid if her income is at or below 133 percent of the federal poverty line. In several countries, a pregnant woman may be eligible for Medicaid if her income is at or below 200 percent of the federal poverty line. Go with your state’s Medicaid office to determine if you are eligible for Medicaid coverage during pregnancy.

The application of

In every state, you can apply for Medicaid by email or in person at your local Medicaid office. In some countries, you can apply online. After your application is reviewed, you must provide, among other things, proof of income and assets, proof of pregnancy and proof of citizenship. Ask your state’s Medicaid office if it requires any other document verification. You will usually be notified of Medicaid’s decision regarding your application within 30 days.

Benefits for Mother

A pregnant woman at Medicaid has access to a list of local healthcare providers and facilities accepted by Medicaid. These include traditional facilities, such as hospitals, and non-traditional facilities, such as birth centers. Provided that her medical providers accept Medicaid, Medicaid will typically cover all costs associated with her pregnancy: antenatal care, labor, delivery, pregnancy-related complications, and postpartum care for six to eight weeks. In some countries, Medicaid for pregnant women also covers dental and chiropractic care.

Medicaid coverage will ensure that you and your baby are well looked after.

Benefits for Baby

If a mother has Medicaid when her baby is born, the child is given by Medicaid for one year after birth. Coverage encourages steps to obtain all vaccinations and wellness exams for the baby in the year following the birth and ends with the month of the baby’s first birthday.

If a pregnant woman has Medicaid coverage when she delivers her baby, the baby will have Medicaid coverage for a year.

Using Medicaid

As a pregnant woman on Medicaid, you will receive a Medicaid insurance card for yourself from the time of approval up to eight weeks after delivery. You will receive a Medicaid insurance card for your baby every month from the first year after delivery. To receive Medicaid benefits, offer your Medicaid card or cards to your medical providers with each visit. If you have any questions about your application or coverage, please contact your state’s Medicaid office.

Nursing home paid

Nursing home costs can be outrageous. Sometimes the funds are just not available to cover the cost of the second round-the-clock nursing home. Fortunately, Medicaid is available to help with old-age spending for qualified low-income individuals. Even though Medicaid is a federally funded program, each state has its own eligibility and application requirements. Your application must be submitted in your state to the appropriate Medicaid office. If you need help getting the place, visit the US Department of Health and Social Services website.

• Comply with eligibility requirement. No matter what condition you live in, you should be considered at least 65 years old or disabled or blind to Medicaid coverage for nursing homes.
• Meet the revenue requirements. There are certain guidelines that income Medicaid applicants must meet. For example, in Georgia a suitable person may not exceed $ 2022 per month. Most of your income will have to be applied towards old-age expenses. You are allowed to keep a small amount of your income each month. In Connecticut, old-age residents can keep $ 69 a month for personal needs.
• Meets the asset limits. Individuals cannot have more than $ 2000 in countable assets. A few starts from a nursing home are not allowed to exceed $ 3,000. Exempt assets include your home, primary vehicle and personal belongings. Most countries don’t allow you to “spend down” your assets if you exceed the acceptable amount.
• Choose an old age home approved by Medicaid. Before starting an old age home, check with Medicaid. Contact your local Medicaid office and name the old age home.
• Apply for Medicaid coverage. You will need to complete the application for Medicaid coverage. Many hospitals have Human Services caseworkers who take Medicaid applications. If you are currently in a retirement home, the staff will be able to assist you with the application process. Your finances must be verified before approving your application. Prepare to submit documents to show assets and income, such as bank account statements and mortgage deeds.
• Legal Aid Association of Central Tennessee and Cumberlands: To Medicaid to Pay for Nursing Home Services
• Georgia Department of Community Health: Eligible Criteria
• AXA Aquitable: Medicaid eligible for nursing home

That the world is digital and that today it is possible to do everything, or almost everything, by the screen of the cell phone, is nothing new for anyone. But did you know that it is possible to hire health insurance online?

That’s right, you can not only research but also hire an online health plan.

And, thinking about the importance that health plans have today in our lives, we separate a step by step how you can hire health insurance online. After all, you can do this with comfort, safety and without leaving home.

Hiring an online health plan can be easier and safer than you might think.

Regulation of hiring online

First of all it is important to reassure you. The contracting of an online health plan is a practice regulated by the National Supplementary Health Agency (ANS), in a resolution approved at the end of 2016 ( Normative Resolution No. 413 ).

That is, this resolution ensures that you are using a valid and standardized method by the agency that monitors and controls the activities of private plans in Brazil.

What to do to hire health insurance online?

In general, the procedures for hiring an online health plan, which includes all documentation delivery and choosing the best health plan for you, takes up to 25 business days. The plan may begin to be used on the date of the first monthly payment.

In order to sign the contract and guarantee the legitimacy of contracting your plan, the documents may be signed via a certified electronic signature, digital certification or biometric identification.

So, if you do not want to take all the signed documentation to the broker, you can print the sheets, sign and initial the pages and return the signed document via scanning.

It is worth remembering that, just like any online purchase, when you contract online health insurance you may have the right to repent and cancel the purchase for up to seven days. This is guaranteed by the Code of Consumer Protection.

How is the online agreement?

The online contract should contain the same information available in the contract that would be carried out in person. When you sign up for an online health plan, you should confirm the following information in addition to your data:

• Species of contracting and all its details, such as the type of accommodation contracted;
• Which assistance segmentation the contracted plan belongs to;
• Business name and registration number of the health plan in ANS;
• Lack ;
• Pricing of the service;
• Area of ​​action of the health plan;
• Geographical area of ​​service and coverage of the plan.

What types of health plans can be hired online?

If you want to hire an online health plan, know that hiring is available for all modalities:

• Individual or family plans ;
• Business plans: for SMEs, small and micro enterprises, and for Legal Entity (PJ) or Individual Microentrepreneur (MEI) ;
• Membership : model made via class entity by association.

How to choose an online health plan?

Here in Porthos you can request your quote online for health plans for both individuals and legal entities. Just tell us some details about your profile that Porthos compares prices of the main health care providers in the market.

But if you still have questions when choosing, look at some of the tips that we’ve separated so that you have more security to hire an online health plan without headaches:

What is your profile?

First of all you need to keep in mind what your profile is as a consumer of health services. That is because, many plans offer various services and treatments, which, perhaps, are not so necessary for you at the moment. One example is to have an air rescue available.

The tip is you think about how your life is today with health care. Also think about how you would like it to be, with the ease of having a health plan and your coverage of care available.

From there, consider other details, such as hiring accommodation in a single room or if for you it is okay to stay in shared ward. All this without forgetting that the more complete your health plan is, the more expensive it gets. So try to balance your personal profile with the financial one.

Consider your health history

Before hiring an online health plan, another point related to your profile is also to recover all of your health history. So you can gauge what the best coverage you need. And that means remembering what diseases, surgeries and hospitalizations you have lived from your childhood to the present moment.

This information about your history is very relevant. It will also influence in hiring your plan, which will need to have all these references recorded on a form.

You, as the contractor of the plan, can not omit this information, as it may also be subject to a check-up requested by the plan itself. This request is made to confirm that you do not, in fact, have a pre-existing condition.

That is, be clear and true in your statements about your health so as not to generate any conflict. This also applies to members who will be dependent on you in the plan.

Keep an eye on the accredited network offered

You need to check which network accredited available by the health plan in question before hiring. It may not always happen to have that doctor in your family that you have been going to for years, or not to have that hospital that you already know and that is close to your home..

Having the assurance that you have affordable and quality medical coverage for your profile, without a doubt, your plan will be much better taken advantage of.

Another tip when hiring online health insurance plan is to evaluate the coverage of the plan. That is, which cities you can use your plan without worry. This is an important aspect, especially for those who travel a lot for work or a trip with friends and family. Plans with national coverage are ideal for this type of client.

Invest in your health

The costs with health plans can seem very expensive or out of your reality at first. But remember that it is an investment for your health and the ones you love.

With all these tips on how to hire health insurance plan online you have realized that you can compare the prices offered by different carriers. Thus, you put at the tip of the pencil at your disposal at this cost, and can find the best way for you to hire.

There are simpler plans, such as outpatient or hospital, with coparticipation and other details. They can be a good choice for anyone who wants to ensure a quality service while spending little.

The important thing is not to let go of your health. Search, make a quotation and take care!

The readjustment of health plan usually gives headache for many that contract this type of service.

Every year, the National Agency of Supplementary Health, ANS, announces the index for authorization of price adjustments of health insurance plans. They may or may not also include dental coverage.

ANS is the body responsible for controlling the price adjustments of health insurance plans.

Once the price adjustments of health plans are defined, they begin to be valid only after the operators receive ANS authorization.

Control of readjustments

The responsibility to control the amounts of health insurance monthly payments, as well as the increase in prices, is attributed to ANS by Law 9.961 / 2000. The measures change according to the type of contract.

If you have an individual or family contract, be aware that the maximum annual adjustment limit for 2018 is 10%. This amount was recently defined by the National Supplementary Health Agency, ANS, and is valid for plans contracted as of January 1999 or adapted to Law 9,656 / 98.

Therefore, the operators that are authorized by the ANS (only those authorized!) Can apply the health plan readjustment, as determined by Normative Resolution nº 171/2008.

But if you have a collective plan by membership or business, that maximum percentage has almost doubled. Many contracts of adhesion health plans or business had increase of up to 19% this year.

A very relevant information that deserves to be taken into account is: on what date was your plan hired?

If you have contracted the health plan before 02/01/1999, it has not entered this new Law, it has not changed. Therefore, it is part of the category entitled “Old Plans”.

Plans belonging to this group follow only what determines their contracts. Therefore, these new measures provided for in more recent laws do not apply to you.

Differences in individual and collective health plan readjustment

To begin to understand how the readjustment of collective health plan works, it must be known that the decision on the increases that are applied in these types of plans does not belong to ANS.

Well, who comes on the scene in these cases are the operators of the plans. Therefore, the negotiations are made with the administrators, without any limit of value.

Another question that may surround your mind right now is whether it is worth having a collective health plan. This is because the main differential or call for their hiring is precisely the economy that is made at the cost of an individual plan.

To evaluate this question, it is important to know some rules followed by the plans.

We already know that the readjustment of the collective health plan is not the responsibility of the ANS. In addition, another difference that exists and that must be of public knowledge concerns the cancellation of the contract.

ANS does not allow operators to cancel the contract on an individual basis unilaterally. It is necessary for both parties to reach an agreement for the contract to be terminated.

Already in the collective plans, the operators can rather cancel the contract after the first year of service.

For these and others, experts recommend hiring individual plans for those who want to be more protected.

Another suggestion of the professionals of the segment for those who are in the process of hiring a plan or even for those who have and are dissatisfied, is to do accounts.

In general, collective plans are cheaper at the outset, but when the first readjustments occur, that advantage falls apart.

It is also important to consider that the readjustment of the individual plans authorized by the ANS is the highest. However, operators can apply lower rates or even keep monthly amounts, without adopting the adjustment.

Business Plans

Another possibility is that your health plan, as is very common, has been contracted by the company in which you work. In this case, it is important to know that price adjustments of health plans do not go through the definition of the Agency.

What happens is this. The ANS will monitor the readjustment of the values, that is, the negotiation between the interested parties – company and operators. They must notify the agency one month before the adjustment begins.

That is if the contract is intended to cover at least 30 beneficiaries. Otherwise, the adjustment works quite differently. It enters into the so-called “Contract Grouping” (or Risk Pool), in which the readjustment that your contract will receive will be the same as other contracts with less than 30 beneficiaries.

The same adjustment will be applied for all contracts belonging to that grouping. The information will be disclosed by the operator of your health plan, on her website. The amount can be applied to the contract in his birthday months.

Therefore, it is good to keep an eye on the price adjustments of health insurance annually. It is also worth looking at the number of related beneficiaries. It is a way of planning whether or not your contract enters into this “risk pool” in the following year.

Exceptions

There are still some exceptions, so write them down as well. It may be that even when the collective bargaining agreement involves less than 30 beneficiaries, it falls within any of these exceptions. Are they:

• Plan signed before January 1, 1999, and is not adapted to Law 9,656 / 1998;
• It is a dental contract only;
• It is a contract that only covers former employees who have been dismissed without just cause or retired, or even exonerated;
• It is a contract signed before 01/01/2013 and not added by RN 309/2012 by the contracting company.

The readjustment of collective plans, therefore, is not regulated by the ANS, even though these are the majority in the market.

The choice is yours – health plan portability

It is worth remembering that the consumer can always choose the plan that, in addition to better serving the needs, also fit comfortably in the pocket. Despite having a plan for years, nowadays everyone can opt for portability for other operators.

But to know the options available in the market, to make the hiring or even the exchange via portability of deficiencies, it is valid to make comparisons. For this, the ANS Guide, which can be accessed on the Agency’s website, is a real ally.

Currently, this guide presents 458 operators that market individual health plans in our country. Worth consulting!

Attention to the readjustment modalities

Okay, the health plan readjustment has already been established. Everyone already knows the percentage. But what are the situations in which it can be applied?

There are some adjustment modalities authorized by the ANS: annual, via the change of age range of the consumer, by accident or technical review.

Annual readjustment

In this case, as the name implies, the health plan readjustment is applied once a year when the anniversary of the contracting of the health plan occurs.

Readjustment due to age change

Here the health plan readjustment occurs according to the change of the age of the health plan user. The old plans present in contract the age groups foreseen for the adjustment, as well as the percentages.

But since 2004, due to the Statute of the Elderly, it was prohibited to readjust by age group for those who are over 60 years of age. The date of hiring directly influences the values ​​and corrections undergo changes depending on the age group. Thus, in addition to the annual adjustment, whenever the age group established in contract is extrapolated, the price of the health plan increases.

The new price applies to the initial age of the established age group, including the direct beneficiary and dependents. If the dates between the anniversary of the plan contract and age change coincide, the beneficiary of this health plan will have two monthly adjustments.

Adjustment for claims

Increase determined by the operator due to the large number of procedures and covered services that were performed in a given period, being larger than expected.

Technical review

This model of price adjustments of health insurance plans was suspended. It was realized when an operator was in financial trouble, in such a way that the economic imbalance would jeopardize the continuity of the services to its clients.

It is mandatory to offer the client two monthly payment alternatives that aim to rebalance the plan economically. One of these alternatives is the monthly price increase itself. But, remembering that they must be approved in advance by the ANS.

In addition, it is important to know that such price increases and adjustments should be presented to customers as options, not obligation.

Keep an eye on the ticket!

Users of individual health plans should be aware of payment tickets. They must verify that the percentage used by the operator is equal to or lower than that determined by the ANS. They should also check whether this increase is being made in the contract’s anniversary month.

Therefore, it is important to know that retroactive amounts are allowed for the months of lag between the application of the adjustment and the anniversary date of the contract.

In conclusion: the payment slip must clearly show the following items:

• Index of readjustment authorized by ANS;
• Authorization number of the ANS;
• Name, code and registration number of the health plan, as well as the month foreseen to apply the next adjustment.

In any case, before choosing or changing health plans, it is important to know about values, coverage and accredited network. Make an online health insurance quote and compare.

children

Medicaid coverage is available to South Carolina children under the age of 19 and whose family income is at or below 200 percent of the federal poverty level. Children must be US citizens and state residents and all applicants must have a valid social security number. Medicaid coverage is also available for disabled children 18 and among whom are still living at home between ages. Parental resources and income are not considered for disabled applicants.

women

South Carolina offers Medicaid coverage to low-income pregnant women and women diagnosed with breast cancer or cervical cancer. Pregnant women should be state residents and US citizens with a valid social security number. The income limit for pregnant women is 185 percent of the Federal level of poverty. Breast and cervical cancer patients should be between the ages of 40-64, diagnosed by the South Carolina best chance network and within the income guidelines to qualify for Medicaid services.

Blind and disabled

You can also qualify for Medicaid services if you are blind or disabled. As of 2011, the income limits for the blind and / or disabled applicants in South Carolina were $ 908 for individuals and $ 1226 for couples. Cover is available to individuals who meet the standard of the Social Security Administration’s disability but are still busy. Disabled individuals participating in Medicare Part A may also apply for Medicaid coverage.

Senior citizens

residents state 65 years of age, may also apply for South Carolina Medicaid coverage. As of 2011, senior applicants may have a gross monthly income of no more than $ 908 for individuals or $ 1226 for couples. The income limit increases to $ 2022 for applicants looking for long-term care coverage. If you and / or your spouse are applying for long-term care coverage, your total countable resources should not exceed $ 10,000.

Low-income families

Families with low or no income can also qualify for South Carolina Medicaid benefits. To qualify, you need to have at least one dependent child living at home and meet monthly income requirements. As of 2011, the net limit income for a family of four was $ 920. All applicants must also be US citizens, state residents and a valid social security number.

Are you staying in Australia? Then it depends on your personal situation or how you are insured for medical expenses.

We compile this information with care. But the rules are complicated and often change. We can therefore not guarantee that this information is accurate and complete. That is why we recommend that you always know which rules apply to you.

How is healthcare arranged in Australia?

Australia has a government-paid medical care system under the name Medicare. The insurance is paid from a tax allowance ( medicare levy) and the general resources of the Australian federal government.

Low incomes do not have to pay a tax allowance. People with a high income who do not have private insurance pay a higher supplement.

In addition to Medicare, there is coverage for the costs of most medicines ( Pharmaceutical Benefits Scheme ).

How can foreigners take out insurance?

Are you staying in Australia with a permanent residence permit ? Then you fall under Medicare.

Medicare is also accessible to Dutch students who come to Australia with a student visa. In addition, they must take out an OSHC ( Overseas Student Health Cover ). This is possible, for example, via the educational institution in Australia. For more information, visit the Australian Ministry of Health website.

Travelers from a limited number of countries – including the Netherlands – also have limited eligibility for Medicare for short stays in Australia.

How can I apply for Medicare?

If you have a permanent residence permit, you must report to a Medicare office upon arrival in Australia. Processing your application takes approximately ten days.

Are you only staying in Australia temporarily? Then you need a European Health Insurance Card (EHIC) to qualify for limited eligibility for Medicare. You can request this card from EHIC or your Dutch health insurance company. Even then you must report to a Medicare office upon arrival.

What does Medicare reimburse?

Foreigners in Australia with a permanent residence permit are eligible for:

full or partial reimbursement of the costs of medical care by, for example, a general practitioner or specialist;

free treatment and stay in a public hospital;

partial contribution towards the costs for certain medicines.

Are you only staying in Australia temporarily? Then you are only eligible for Medicare if there is a medically necessary treatment. This means that your ailment or complaint originated in Australia and the treatment cannot be postponed until you are back in the Netherlands.

What should I look out for?

Medicare is not a substitute for travel insurance with medical coverage (or additional healthcare insurance). The coverage is particularly limited for travelers who are staying in Australia without a permanent residence permit. In addition, it is wise to take the following into account:

You receive no reimbursement for treatment and stay in a private hospital, or as a private patient in a public hospital;

Excluded from Medicare are: maternity care, ambulance transport, dentist, physiotherapy, prostheses, glasses, contact lenses and hearing aids.

Medicare only reimburses medical care in Australia and a limited number of countries outside; If you are traveling outside of Australia, there is a good chance that you are not insured.

What does the Dutch basic insurance cover?

It depends on your personal situation whether you are obliged to remain insured on your Dutch basic insurance during your stay in Australia.

Dutch basic insurance reimburses emergency care throughout the world. But you will never be reimbursed more than what the treatment costs in the Netherlands. You may therefore have to pay extra if you are staying in a country where medical care is expensive, such as Australia.

Repatriation (return to the Netherlands) or evacuation due to an illness or accident is not covered by Dutch basic insurance.

Which solution does Pat Vergos offer?

Pat Vergos is a specialist in the field of medical insurance for long-term stays abroad. Our insurance policies offer a solution if you are no longer eligible for Dutch basic insurance. Our insurance policies can also be a supplement, for example for costs that are not covered by Dutch basic insurance or Medicare.