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RE: Affordable Healthcare Coverage

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I thought that I would mention something that might be useful with regards
to pre-existing conditions.  While I am not 100% sure it passed, I am at
least 99.99999% sure that Congress recently passed a law that requires
health insurance companies to cover pre-existing conditions IF you are
covered by another health insurance plan.  For example, if you have a
heart condition and you are covered by a health insurance plan, but then
you are forced (for some reason...change jobs, etc) to change health
insurance companies, the new company is required to cover your
pre-existing condition.  If on the other hand, you have been "cheap" and
not maintained health insurance and then attempt to get health insurance
AFTER something has been discovered, they are not obligated to cover it.
Thus, since it seems that you currently have health insurance coverage,
any other health insurance coverage is required to offer you similar

Now, the obvious catch is that they can charge you what they want.
Therefore, another company could offer you a similar plan at an outragous

With regard to your raising costs, that is to be expected.  The cost of
health insurance, as I am sure that you are aware, is a function of how
much it is used (ie how often are you and/or the "group" sick), the
deductible, the amount of coverage (ie maximum amounts), and what is
covered.  Since you are now in the "older" age groups, it is more likely
that you will have more health related problems, so the health insurance
company is going to charge you more.  That is where the benefits of a
group insurance plan can come into play.  I believe that is typical group
plans everyone pays the same rate.  Depending on each individual's
situation, this can either be great (ie you are sick quite a bit, but pay
a low premium but get a lot of bills save quite a bit) or it
can be unfair (ie you are rarely sick, but pay more in premims that you
get covered in "lose" money).

With regards to HMO's vs Traditional vs. PPO plans...

I have been exposed to all three.  Each has it strengths and weaknesses.
All are highly dependant on quality of the health insurance company.  I
have been exposed to three different HMO plans.  I had very little
problems with either.  Both HMO plans were through good quality companies.
Granted, I was not exposed to too many "odd ball" medical situations with

The adavantages of an HMO are typically lower premiums for broader
coverage (including alot of "preventative" stuff).  However, this is
changing slightly as a lot of HMOs are discovering the cost of doing
business.  Typically, though, it is easier to get much broader coverage
for less money.  Also, there are fewer "hidden" costs (i.e. you tend to 
pay your premiums and your co-pay and maybe your part of the deductible)
The disadvantages are fairly well know. You are limited
on the doctors (and hospitals...since only have "privaledges" at certain
hospitals) you can select from.  Some procedures are subject to approval
from the health insurance company.  Unless it is a "life threatening
emergency", you are supposed to get approval to go the emergency room.
You must get a referral from your general practicioner to see a

Traditional plans have the advantage of flexibility.  You can see any
doctor that you want.  You don't have to get a referral to see a
specialist.  The disadvantage tends to be out of pocket expenses.
Tranditional plans tend to have higher premiums and then they will cover
only certain percentages of some procedures (subject to deductibles etc).
Traditional plans also tend to not cover some "preventative" type

PPOs are kind of the middle ground.  They are basically Traditional plans
with a built-in financial incentive to see certain doctors.  Kind of the
mix of a HMO and Tranditional plan.

So far, I have had more problems with PPOs and Tranditional plans than
HMOs.  But nothing really that significant.  I am currently covered by a

Hope that helps.


On Fri, 19 Jan 2001, Structuralist wrote:

> >From what our agent mentioned, the MSA may no longer be in affect. The agent
> indicated that the MSA idea (which requires you to place money into a
> savings account where it must remain AND at the same time purchase a
> healthcare policy) was not very popular among those he proposed it to.
> Unless there is a wide acceptance of the plan, the individual may still end
> up going into heavy debt for a catastrophic ailment.
> I think one of the problems with healthcare in this country is that it is
> more of a business than a humanitarian ideology compared to, say, the
> government supported health plans in Canada. Possibly one our Canadian peers
> can address this more accurately, but a close friend of mine whose wife is
> Canadian returned to Canada just so she could have her last child. She
> firmly believed the quality of care was much better than in the US. Mothers
> weren't kicked out of hospitals before they were ready (generally 24 hours
> maximum in the US, unless it is a C-section in which case, my wife informs
> me that it is up to four days).
> So far, from the comments I received, the best choice is to increase the
> deductible and make sure it is covered in an interest bearing account - to
> keep the premium lower. Of the plans we looked at, Blue-Cross appears to be
> better at this time than Blue Shield. It offers the same services for a much
> lower premium and a comparatively lower deductible.
> I have not heard of the Golden Rule plan? Tell me more if you can. What
> about others in different regions of the country. How many of you are on
> HMO's and how are they performing? Do you find that if there is an illness
> or existing condition that an HMO is still delivering for you in a timely
> fashion or are you willing to spend more for a private or preferred
> physician plan?
> Does NCSEA or ASCE have a group plan that we can take advantage of?
> Dennis
> -----Original Message-----
> From: Mark D. Anderson PE [mailto:mark(--nospam--at)]
> Sent: Friday, January 19, 2001 12:37 PM
> To: seaint(--nospam--at)
> Subject: Re: Affordable Healthcare Coverage
> I don't quite meet the over 50 criteria, but, ....have you thought about
> Golden Rule and the MSA option?  The legislation authorizing MSA may have
> "sunset" at the end of 2000, I haven't kept up with the latest.
> Mark D. Anderson PE
> ----- Original Message -----
> From: "Structuralist" <dennis.wish(--nospam--at)>
> To: <aec-residential(--nospam--at)>; "SEAINT Listservice" <seaint(--nospam--at)>;
> "se-practice Listservice" <se-practice(--nospam--at)>
> Sent: Thursday, January 18, 2001 1:15 PM
> Subject: Re: Affordable Healthcare Coverage
> > For some reason, I have not received much e-mail in the last 24-hours. I
> > received only 5 posts from the SEAINT List, 3 from the AEC-Residential and
> 2
> > from the SE-Practice list. This is unusually low. Only one post was a
> > response to this subject.
> >
> > If you replied to this subject, would you please send a copy of your
> > response to me directly at admin(--nospam--at) so I can find out your
> > opinions on the National Association of the Self-Employed health coverage?
> >
> > My wife called the Blue Shield Agent today and was told to expect a rate
> > increase every six months. As I explained in my original post, our rate
> went
> > up last May as I turned 50-years old. The rate went up about 40%. In July,
> > there was another 20% scheduled increase, another 20% increase in December
> > and another expected in March. How does Blue Shield justify so many cost
> > increases and how are others dealing with it?
> >
> > We already ruled out Health Net as an unacceptable plan from references
> and
> > are now considering having to stay with Blue Shield and try to lower our
> > premiums by raising our deductible. We can move to Blue-Cross since we
> have
> > had no major illness in the last five years (although we do have existing
> > conditions).
> >
> > I would be interested in hearing from other self-employed who are over 50
> > and dealing with rising health coverage costs.
> >
> > Regards,
> > Dennis S. Wish, PE
> > The Structuralist Administrator for:
> >
> > AEC-Residential Listservice
> > admin(--nospam--at)
> >
> >
> >