HHS (Health and Human Services) loosens electronic health records standards.  This relaxation of healthcare regulations is a push to create jobs without waiting for Congress.  The U.S. Government believes the best use of health information technology will help doctors and hospitals in delivering the right care to the right patient at the right time.  Northeast Ohio is home to one of the strongest networks of electronic medical records in the nation.  

Healthcare reform is said to be benefitting West Virginia Medicare Members.  More than 25,000 West Virginia Medicare members have saved more than $13 million in Rx drugs in 2011 as a result of the Affordable Care Act.  The infamous “doughnut hole” in the Medicare Part D Rx drug benefit is being eliminated over the next few years which is helping save Rx drug cost.

This is not just happening in West Virginia but also throughout the country as stated by many officials in each state.  They are echoing that “Medicare’s prescription coverage gap is getting noticeably smaller and easier to manage this year for millions of older and disabled people with high drug costs.”  The “doughnut hole,” an anxiety-inducing catch in an otherwise popular benefit, will shrink about 40 percent for those unlucky enough to land in it, according to new Medicare figures provided in response to a request from The Associated Press.

Group medical benefit rates still are on a rise but the increases have moderated.  Eighteen months after passage of the Patient Protection and Affordable Care Act (PPACA) group medical benefits costs rose one again according to a recent survey.  The survey finds that the largest accounts – groups with more than 500 employees, benefitted most from the new law.  Most of the group increases ranged from one percent to ten percent. 

Many employers state that the rate increase was lower but that was due to many employers moving to higher deductibles and copays to offset rate increases, which means passing the cost to the employee when using medical insurance.  However, one big emerging development since the passage of the PPACA in 2010 is that carriers and employers are offering fewer options compared to pre PPACA.  As health care costs continue to rise, employers are looking for new ways to promote and maintain a healthy workforce. Demand for wellness tools among employees is also increasing.

California is trying to make its Pre-Existing Condition Insurance Plan (PCIP) go in the black.   The PCIP will morph into California’s exchange program in 2014.  The number of enrollees is still much lower than expected and the average amount of claims per enrollees much higher than expected. PCIP is supposed to provide comprehensive health coverage for people with health problems for a price similar to the price of ordinary individual commercial health coverage.  Eligibility is not base on income and the risk pools cannot charge higher rates for people with more sever health problems.  Congress let states choose between running PCIP risk pools themselves or letting HHS provide PCIP risk pool services for their residents.  To avoid crowding out existing commercial health coverage and government-provided coverage, including existing state-funded risk pools, PPACA drafters required that PCIP enrollees have gone without any form of health coverage, including state risk pool coverage, for at least 6 months.  

Currently only 23,000 people have enrolled into the PCIP program.  The enrollees have been averaging claim cost of $3,100 per member per month, officials say.  The high cost means that, unless more funding surfaces, the program can afford to serve only about 6,800 enrollees at a time, not 23,000, officials say.  The state has found that 19% of the enrollees are ages 29 or under, 41% are ages 30 to 49, and 39% are ages 50 to 64.  The plan administrator is processing 91.5% of clean clams within 10 business days, compared with a goal of 90%.

Seniors go to social sites in droves to share their feeling and opinions on Medicare. They are the fastest growing group of users on sites like Facebook, LinkedIn, and Twitter. They have expanded their share of the social networking areas by more than 150 percent over the past two years.  One of the things seniors want is education.  They often go online to see advice about a program that is constantly changing, like Medicare.  A senior mentioned on one of the post “Who can explain and make all these rules and restrictions easy to read.”  Next to education seniors also want to make sure that the information is trustworthy and not just a sales pitch for a special Medicare benefit.

Seniors spend a lot of time talking about Medicare plans types and supplements.  Medicare Part D comes first as the hot topic then a close second is about Medicare supplements.  Seniors are constantly confused by changes to private plans and so vent their frustrations on the insurance companies handling the Medicare advantage or supplement plans.  However, as the insurance companies explain, a majority of the new rules and changes have come down the U.S. government and they must comply with all these added rules.   The new PPACA health rules signed into law in March 2010 is why most of the changes and new rules have come from. 

A new trend is happening in the U.S., “doctors do not do old.” A looming shortage of geriatricians adds another wrinkle to dealing with long-term medical care issues.  Older people tend to need more medical care than younger people, and the average age of a U.S. resident is going up.  But because the U.S. government reimburses doctors less money through Medicare than what the going rate is for private practice less and less doctors want to venture into this profession.  It comes down to dollars and cents says many doctors.  “We have to follow extra government laws handed down by the PPACA, Congress, and the department of Health and Human Services.  And to top it off we get paid less on the dollar for Medicare patients, since the government reimburses us most of the time we see those who are 65 and over, than through private insurance.”  Medicare primarily covers those who are age 65 and over in the U.S.  So more work for Medicare clients and getting paid less by the government is causing a shortage of geriatricians in the U.S.   

One of the ways to counter this trend is for the government to improve the state of geriatric education by requiring hat every medical school it helps have an affiliation with a nursing home as well as with a teaching hospital.  Currently there is only around 3% of medical schools that have required classes in geriatrics.  Some say that that must increase because “out of sight out of mind” sets in.   Having geriatrics more front-and-center in medical school will help bring more doctors into this field.  However, again, many if not most decisions are based on income potential.  As an official at a local medical teaching hospital stated “as long as Medicare reimbursement to doctors is less than the open market there will always be a shortage of geriatric doctors.”  Many things change but math calculations never change. 

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gnazhealth.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on US and international health care.

Mark was born in Southern California and moved to Phoenix, AZ to become Communications Director for a non-profit agency. His background is in languages and intercultural studies as well as design and marketing. After 6 years in the not-for-profit world, Mark joined the Tribune for 11 years as their Senior Graphic Designer and then started his own studio/consulting business, MJAStudios, marketing and graphic design.

Mark loves to travel and has spent a number of summers overseas studying as well as doing relief work and business development in Pakistan, Russia, Thailand, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, the Caucasus, Malaysia, Belgium, Finland and England. He loves his work, art, reading, his wife of 19 years and his four home-schooled kids.

We are very excited to have Mark head up Good Neighbor Insurance’s (GNI’s) marketing division.  You may view all of our agents and associates bio by going to www.gninsurance.com/aboutGNI.asp.   GNI provides our clients with many international medical and travel insurance as well as international property and casualty insurance including kidnap & ransom insurance, directors and officers insurance, and other specialty insurance benefits.  GNI also provides our Arizona clients, www.gnazhealth.com, health care plans, Medicare plans, dental plans, local personal property and casualty coverage, and other specialty benefits.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gnazhealth.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on US and international health care.

LTC is not health insurance or medical care.  Individuals who require LTC are usually not sick in the traditional sense but instead are unable to perform the daily activities.  Activities of Daily living (ADL) is what health professionals call the routine ability of feeding, bathing, dressing, grooming, work, homemaking, and leisure.   There are several evaluation tools that the medical profession uses such as the Katz ADL scale, the Lawton IADL scale, the Roper-Logan Tierney model of nursing, and the program of all-inclusive care for the elderly (PACE).  

Good Neighbor Insurance, www.gnazhealth.com, provides different LTC options for our clients.  Good Neighbor Insurance (GNI) also provides individual and family health insurance, Medicare Supplement plans, dental plans, personal property and casualty cover, and other benefits such as short term travel insurance.  You may reach any of GNI’s agents by calling their toll free number at 866-636-9100 or Phoenix Arizona number at 480-633-9500 or email them at info@gninsurance.com.

Why do U.S. citizens purchase LTC cover?

• Protect assets
• Avoid becoming a burden to their family
• Ensure they receive care in a quality facility
• Ensure they have options for care
• Be able to maintain personal dignity and independence
• Have peace of mind.

Why U.S. citizens do not purchase LTC cover?

• Is it affordable?
• Is it the best way to protect my assets?
• How do I make sense of this complicated product?
• What is in the fine print?
• When is the best time to buy?
• Will the benefit level be enough when the time comes?
• Am I not covered already?
• What if I never need it?
• Why has no one approached me about it?

What do our clients expect from one of our LTC agents?

• Life experience – an older agent because of a greater life experience
• Low pressure, easygoing manner – no hard sale
• The ability to explain the benefits in easy terms
• Specific knowledge of the senior market
• Agent should have a LTC policy too

Who typically desires to purchase a Long Term Care policy?

• Female, Caucasian, age 55-64
• Married with adult children
• Working in a white-collar profession; not yet retired
• College educated
• Living in a metropolitan area with a population of at least 250,000
• A homeowner with 11 or more years in a the current resident
• Affluent; upper middle class with a household income of $100,000 or more
• A “planner” who is interested in financial issues; owns life insurance and other conservative investment products
• Family oriented
• Exposed to LTC issues; knows someone (a family member or friend) who has needed LTC services
• Research oriented; an online user; self-educated about LTC
• Generally skeptical and mistrusting of financial advisors and insurance companies

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gnazhealth.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on US and international health care.

It is not a US. Federal requirement to have student insurance for your students but it can be and should be a financial requirement.  Not having international student coverage for your students here in the U.S. not only is a moral obligation but also keeps the college and university from possible liability concerns;  especially when your international student does not have financial pockets to pay for possible medical bills.   

Today, most colleges and universities either require international students to carry medical insurance, or they are in the process of implementing a mandatory medical insurance requirement. When asked why, the schools have responded with the following reasons:

1.   It reinforces the federal policy requiring international students to be financially responsible.   A medical insurance requirement is a logical and legal extension of this government requirement.

2.   The school must protect itself from medical providers that might look to the host school for payment of medical bills on uninsured or underinsured students, especially for those schools who have an insurance requirement that is not being properly enforced. 

3.   The college has a moral obligation to the community, the medical profession, and its students to make sure the international students can afford the high cost of medical care. Host families require coverage with Major Medical Benefits for liability reasons. 

4.   International students come from countries with some form of socialized medicine and don’t understand how the health care system in the United States works. 

5.   International students are not insured under a parental policy nor are they eligible for public assistance in the United States.  Travel insurance is short-term coverage and inadequate.

Doug Gulleson is one of the two principles of Good Neighbor Insurance, Inc and does enjoy traveling the world to scuba dive.  He travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.  Doug never forgets to have his travel medical insurance,  www.overseashealthinsurance.com/short-term.asp, with him at all times.

Health Savings Accounts (HSAs) were created in 2003 so that individuals covered by high-deductible health plans could receive tax-preferred treatment of money saved for medical expenses.  Medical Saving Account (MSA) plans were the grandfather of high-deductible health plans with tax-preferred saving options but no longer provided. 

Since the HSA is a tax advantaged account it is subject to contribution limits similar to Individual Retirement Accounts. The money you contribute to your HSA through your employer is not subject to federal tax at the time of deposit (Pre-Tax Dollars).  If you are self-employed the dollars contributed are an “above the line” deduction on your taxes.

2012 HSA Contribution Limits

Each year the HSA Contribution Limits are revised (or remain unchanged) based on the inflation rate of the previous year.  This year the HSA Contribution Limits were raised about 1.63% based on the rise of the Consumer Price Index (CPI) in the previous year.  This means that the contribution limit for an individual increased $50 to $3,100 and the limit for families increased $100 to $6,250.  The catch-up provision for those age 55+ remains at $1000. 

You must have your HSA-qualified health insurance in place by December 1st in order to qualify for that same year’s tax break.   You may make direct contributions to your HSA bank account until April 15^th of the following year to the last year’s contribution limit.

Here is another chart to show the past HSA’s year contributions  

2013 Contribution Limits

At this time the contribution limits for Flexible Spending Accounts (FSA) will be changing.  FSAs is one of the number of tax advantage options that employers (groups) in the U.S. may use to help save on premiums and taxation.  The new PPACA (the new health care law signed into law by President Obama in March of 2010) will limit the amount employees can contribute to a FSA  account.  Note that FSA plans are for those who work for a company.  

However, at this time, HSAs are not set to change to a lower contribution limit.  Good Neighbor Insurance, www.gnazhealth.com, will keep you informed as soon as anything is mentioned on the 2013 annual contributions for HSAs.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care information with him at all times when he travels (check out his diving travels at www.douggulleson.com).  Keep our blog close by you, www.gntravelinsurance.com , for continual updates on the changes with the US health care system.

On the other side of the spectrum is Term life insurance.  This type of life insurance is set for a set amount of years usually between 10-30 years.  This type of insurance is primarily used for younger individuals and families to help the surviving spouse support the family for a few years if the other spouse passes on.  Most families have term life coverage until the kids finish college and/or once most of major bills have been paid like a home mortgage.    Term life insurance premiums are usually around 25 to 35 percent of a whole life insurance policy premium.

Then in the “middle” of the life insurance options is what is call universal life or also variable universal life.  This is the “hybrid” of whole life and term life insurance.  Many in the U.S. wanted a stronger life insurance policy than the term life plan but did not want to pay the high premium of a whole life insurance plan.  Thus, the universal life insurance option was born.  Universal life insurance allows you, the policyholder to place an age to have the policy end such as age 70. 

Good Neighbor Insurance provides many Life insurance options and the Term life and Universal life insurance options are the most popular.  Below is a graph of Universal Life insurance plans that  United of Omaha provides.   To request a Term life or Universal life insurance quote please go to our web page at www.gnazhealth.com.

Universal life offers the following advantages:

• Lower-cost life insurance (compared to Whole Life insurance)
• No-lapse protection
• A tax-advantaged savings element that provides a cash value with a guaranteed minimum interest rate
• Flexibility to adjust premium payment and death benefit as needs change
• Favorable loan features

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gnazhealth.com , information with him at all times when he travels Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the US health care system.

There are a couple plans that include these sports activities already packaged into your travel insurance and there are other travel plans where you can add their sports rider for an added premium.  Good Neighbor Insurance provides both types of plans and you may view our adventure sports web page by going to www.gninsurance.com/extreme-sports. 

We provide four travel plans that include adventure sports coverage:

Atlas international with sports rider:

• Add the sports rider for 20% of your travel premium
• No height restrictions on mountaineering and rope climbing

Travel Guard trip insurance:

• All adventure sports is covered except participation in contest of speed, motor sport or motor racing including training or practice for the same
• This plan is used as your primary insurance
• Coverage also can be in the U.S. only or outside the U.S.

BUPA adventure sports travel insurance:

• Full contact sports covered plus no restrictions on hazardous sports or occupations (except motorsports).
• No deductible
• Unlimited medical and evacuation coverage
• Amateur and Professional sports covered

Patriot adventure sports insurance:

• Non U.S. citizens traveling outside their country of citizenship with coverage to also include the U.S.
• May include trip cancellation coverage as an added benefit
• Coverage period from 30 days to 6 months for non-contact sports

Check out Good Neighbor’s Insurance You Tube channel on sports insurance coverage at  http://www.youtube.com/user/gninsurance#p/u/6/TU2xFPuAFp4 or go to our You Tube channel at http://www.youtube.com/user/gninsurance#p/a.

Doug Gulleson is one of the two principles of Good Neighbor Insurance, Inc and does enjoy traveling the world to scuba dive.  He travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other but Doug never forgets to have his travel medical insurance with him at all times.  Good Neighbor Insurance provides many different types of international insurance including medical and evacuation coverage outside the U.S.  Visit Good Neighbor Insurance’s corporate site at www.gninsurance.com  and www.overseashealthinsurance.com/trip-protection.asp for different travel medical insurance options that may fit your needs.

Dad, my bonus mom Gloria, I, and many other friends witnessed this family become American citizens a few years back. Yes, this guy can cry and I was misty eyed knowing how amazingly wonderful we are to be Americans. For sure we have our struggles but what country doesn’t. I was born and raised in Indonesia for 19 years and there is nothing like our wonderful country, the United States of America! Now this year, in November 2011, the Putrasahan family has made another dream come true; they opened up their own dental office.

Doctor Kris is a general dentist practicing in the Valley for over 15 years. Their business is called Logos Dentistry PLLC and they can be found on Facebook. Their business web site is at www.logosdentistry.com. You may email Doctor Kris at drkris@logosdentistry.com. You may email the front desk for an appointment at frontdesk@logosdentistry.com or call them at 480-788-3627. Their office is located on the SW corner of Price Road and Ray Road.

I personally am not fond of dentist offices since my childhood dental experiences came from Indonesian dental work done. Growing up in Indonesia we had to travel all day to another island to get a dentist to look at our teeth. The travel was not the hard part. What was the toughest part was keeping from choking those cotton balls stuffed down our throats to keep our mouth dry as the dentist worked on our cavity filled teeth. Modern dentist equipment was not common in those far corners of the earth. But I will tell you now I am so very happy to sit down in Dr. Kris dentist chair because this doctor really knows the art of his business. He not is only great but, in layman’s terms, awesome! I will never ever go to another dentist, so help me God!!

We are excited for Doctor Kris and his wonderful wife and family for their lives in and out of work. They are a true example of what an American family is and should look like. I am thankful to not only say that Pak (Mr. in Indonesian) Kris is my dentist but also an awesome friend!

Well, with that said, I better get my call into their office, Logos Dentistry, so I can make sure I have no cavities to fret about.

Doug Gulleson loves to scuba dive overseas.  He makes sure he has his U.S. health care and overseas health care information with him at all times when he travels (check out his diving travels at www.douggulleson.com). Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the US health care system.

“Massachusetts has made great strides in securing insurance coverage for its citizens” says Dr. Alice Coombs, president of the Massachusetts Medical Society.  “But insurance coverage does not equal access to care” she continued.  In fact, recent statistics from the American College of Emergency Physicians show that more than 80 percent of ER doctors said emergency room visits were increasing in their departments; most reporting “significant” rises.

Here are some interesting finds from this 2011 report since the Massachusetts universal state health insurance law was passed in 2006 (836 primary care and specially doctors in Massachusetts were asked to provide their findings to this report).

Good Neighbor Insurance, www.gnazhealth.com and www.gnhealthplan.com,  provides individual and family health insurance to its clients in Arizona.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gnazhealth.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on US and international health care.

These six major coverage options are:

(1) Individual or family coverage (private health care plans)

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Issue:  

On December 1, 2010, the Department of Health and Human Services (HHS) published an Interim Final Rule implementing medical loss ratio (MLR) requirements pursuant to the Affordable Care Act (ACA).  Beginning in 2011, these regulations would:  impose a medical loss ratio of 80 percent on individual and small group plans, and 85 percent on large group plans, meaning that insurers are required to spend 80-85 percent of each premium dollar on claims and other government-approved activities.  MLR standards would be measured on a state-by-state basis.

Recommendations:  

Insurance carriers, in general, are concerned that a minimum MLR will have the counterproductive effect of raising premiums for consumers and causing unintended market disruptions.

The federal MLR regulation will penalize investment in fraud prevention, utilization management, and development of connectivity or administrative simplification systems.  It also will hinder the development of more affordable insurance options, such as high-deductible health plans.  Moreover, the new MLR rules will reduce competition in both the individual and large group market.  All of these issues could lead to higher premiums for consumers.

The MLR also may result in fewer product choices.  The creation of an unlevel playing field that favors HMOs over plans that offer open access to providers may drive the market towards closed networks – the opposite of the product selected by the majority of consumers.

Further, the implementation costs of the MLR regulation itself will be significant, especially with respect to mandatory data collection and reporting, not only of an insurer’s own data, but also extensive new information to be collected from employers, vendors, and providers (none of which, incidentally, have significant inducement to facilitate such data collection). 

Here are ideas to avoid some anticipated negative effects of the MLR regulation:

1) Rebates should be provided to employers:   Rebate administration should be simplified to provide greater clarity to employers and to insurers.  In group markets, where the insurer contracts with an employer, the insurer generally does not have access to enrollee information specific enough to permit accurate rebate payments directly to the enrollee. In such cases, rebate payments should be permitted to the employer.  Alternatively, insurers should be permitted to apply a good faith effort standard in calculating individual enrollee rebate amounts.

2) Small employer should be defined as 1-100 employees for MLR:   The conforming amendments to ACA clearly require a small employer definition of 1-100.  These provisions do not provide flexibility for states to have lower definitions.  If HHS continues to allow states to define employer as 1-50, states should be required to provide 12 months advance notice before such definition could go into effect.  Otherwise, states could modify the employer definition after rates already have been filed and products have been sold.  And finally, the state where the headquarters of the employer is located should determine whether the employer is small or large in all states.  Otherwise, employees of the same employer could alternatively find themselves located in both a small and large employer.

3) Employee counts should be based on “eligible” employees. The IFR does not address how an employer or insurer calculates the number of employees for purposes of determining group size in the MLR context. For consistent application, the regulation should clarify that group size is to be determined by measuring the number of employees who are eligible for plan benefits, which would track most consistently with the predominant current practice and with the standard in most states.  Insurers do not have total employee information and have been unsuccessful in collecting this in the past.

4) The special adjustments for limited benefit (‘mini-med’) and expatriate plans should be continued beyond 2011. The unique characteristics of these kinds of plans will continue to pose MLR reporting and calculation challenges beyond the current one-year adjusted application period. Uncertainty about future MLR applications may hurt employer decisions in this area.  Therefore, an announced extension of this treatment would be helpful. 

5) ICD-10 expenses should be included as “quality improvement activities.” Conversion to ICD-10 will improve quality in numerous ways, including enhanced clinical research and improved disease management.  Therefore, implementation costs associated with ICD-10 should be classified as a “quality improvement activity” with respect to MLR calculation.

6) Vendors should be required to report administrative expenses in the aggregate.  Rather than requiring vendors to provide a detailed breakdown of administrative costs on a claim-by-claim basis, which in many cases is infeasible, the regulation should require vendors to report their administrative charges in aggregate to an insurer, which the insurer should then be permitted to rely upon for purposes of MLR calculation.

7) HHS should clarify that state-based MLR standards are pre-empted by the new federal standards.  The regulation should clarify that the ACA requires full federal pre-emption of state MLR methodologies.  States are limited to modifying the percentage only.  Otherwise, administration of two MLR methodologies would be infeasible and create unnecessary administrative costs. 

8) Student health plans should not be subject to the federal MLR.  Student health plans (SHPs) provide coverage for between 1.5 and 3 million students.  Many of these students are 26 or older, foreign or cannot use their parent’s policies because of network restrictions.  Access to affordable student policies is critical for students.  Historically, student health plans have been considered short term limited duration policies and therefore should not be subject to the federal MLR.  If HHS does apply an MLR, it should be a lower percentage to account for the higher volatility of this group and should be done on a total book of business basis – not state by state. 

9) The playing field should be leveled between HMOs and Open Access Insurers:  The MLR creates an unlevel playing field between HMOs and the more popular open access plans. To mitigate this problem, insurers should be allowed to include in their quality definition key functions such as fraud prevention, concurrent review and utilization management, and expenses incurred as a result of federal or state requests for data to improve quality and efficiency.

10) The regulation should permit national aggregation in the large group market. Requiring insurers to disaggregate their large group market into state MLRs, and to disaggregate MLRs to the legal entity level, would erode the normally vibrant competition, consumer value, and wide choice of products currently available to consumers in the nation’s large group markets.  Specifically, such MLR disaggregation would hurt employers that offer multiple products or coverage across state lines, reduce choice of coverage, increase prices for groups, decrease competition, and increase administrative costs.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, http://onlineglobalhealthinsurance.com/my-travel-guard.asp , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the US health care system.