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- Presented by Janet Trautwein
- Executive Vice President and CEO
- National Association of Health Underwriters
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- Everyone needs medical care sometime, and the most common way to pay=
for
it in this country is through private health insurance.
- While most Americans have some type of private health insurance
coverage, the different types of health insurance coverage and how t=
hey
work can be confusing and difficult to understand.
- This briefing is designed to explain health insurance basics in laym=
an's
terms, and also provide you with contact information for resources t=
hat
can provide you with additional information and help.
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- You may be wondering exactly who are the National Association of Hea=
lth
Underwriters, or why we are qualified to give this briefing.
- Our association represents over 20,000 health insurance agents, brok=
ers
and employee benefit specialists nationally.
- Our members sell health insurance and employee benefit products. Annually we assist millions=
of
Americans with their insurance needs.
- Our members help both individuals and also employers purchase health
insurance products. Our
employer clients range from fortune 500 companies to sole proprietor=
s.
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- In addition to selling the insurance products, producers often help
their clients, particularly the small employers, with all sorts of
employee benefit issues, including assistance with claims processing,
COBRA administration, privacy issues, and more.
- Most of our members are independent health insurance agents or
consultants, and many are small-business owners themselves.
- As an association, our two top public policy goals are:
- Reducing the number of uninsured Americans through private-market
solutions; and
- Making sure that state-level private health insurance markets are as
vibrant and competitive as possible.
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- In the United States, this is the breakdown of how people receive th=
eir
health insurance coverage:
- 54% through their employer or the employer of a family member
- 5% purchase individual insurance coverage
- 13% receive Medicaid
- 12% receive Medicare
- 16% are uninsured
- Source: Kaiser Family Foundation
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- In Illinois, this is how the breakdown of how people receive their
health insurance coverage:
- 58% through their employer or the employer of a family member
- 5% purchase individual insurance coverage
- 9% receive Medicaid
- 12% receive Medicare
- 1% receive other public coverage
- 14% are uninsured
- Source: Kaiser Family Foundation
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- The majority of Americans have group health insurance coverage throu=
gh
either their employer or the employer of a family member.
- Many people don’t realize that health insurance is issued
differently for different types of employers, and that since insuran=
ce
is regulated at the state level, health insurance requirements for t=
he
different types of employers can vary significantly from state to st=
ate.
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- Millions of Americans work for small employers, which for health plan
purposes, are generally those with 50 employees or less.
- Millions of other Americans get their health employer-sponsored heal=
th
insurance coverage through large employers. Generally, for health plan
purposes, those are business with more than 50 employees.
- The requirements for the issuance of coverage to large groups are
different than for small groups, and the way that rates are determin=
ed
is also different.
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- In addition to employed people who have group health insurance, mill=
ions
of people who lose their group health insurance coverage, due to a j=
ob
change, a divorce, job loss or other reason are able to keep their g=
roup
coverage, at least temporarily.
- Most people who are able to continue their group health insurance
benefits are eligible to do so according to federal Consolidated Omn=
ibus
Budget Reconciliation Act of 1985 (COBRA) legislation.
- However COBRA does not apply to all employers, and many states have
mandated continuation =
of
coverage options for people who are not covered by COBRA.
- Also, many people leaving group insurance for the individual market =
have
federally mandated group-to-individual health insurance portability
benefits.
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- The federal Health Insurance Portability and Accountability Act of 1=
996
(HIPAA) requires that all small-group health plans:
- Be issued on a guaranteed basis, no matter what health conditions
members of the group have.
- Be guarantee-renewable, unless there is non-payment of premium, the
employer has committed fraud or intentional misrepresentation or the
employer has not complied with the terms of the health insurance
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