Wednesday, 18 November 2009

Florida Kid Care - Income Eligibility




Are you eligible for Florida Kidcare, Medicaid, or Healthy Kids?  In order to make that determination, you first need to know where your family income falls in the poverty guidelines. See the 2009 Federal Poverty Guidelines below:

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia
Persons in family
Poverty guideline
1
$10,830
2
14,570
3
18,310
4
22,050
5
25,790
6
29,530
7
33,270
8
37,010
For families with more than 8 persons, add $3,740 for each additional person.

To read more information about the Federal 2009 Poverty guildlines, click HERE.  Also, if you need to view the income amounts at the varying percentages over 100% of poverty level, please click HERE.  The next step is to look at the Florida KidCare Eligibility chart.  Below is a brief summary:

• Children ages 0 through one, up to 200% of the federal poverty level, are covered under Medicaid (Title XIX and Title XXI funded)

• Children ages one through five, up to 133% of the federal poverty level, are covered under Medicaid (Title XIX funded)

• Children ages one through five, at 134% to 200% of the federal poverty level, are covered under MediKids (Title XXI funded)

• Children ages one through five, above 200% of the federal poverty level, are covered under MediKids full pay

• Children ages 5 through 18, up to 100% of the federal poverty level, are covered under Medicaid (Title XIX funded)

• Children ages 5 through 18, at 101% to 200% of the federal poverty level, are covered under Healthy Kids (Title XXI funded)

• Children ages 5 through 18, above 200% of the federal poverty level, are covered under Healthy Kids full pay

To learn more or apply for Florida KidCare, please click HERE to visit their web site.


Monday, 9 November 2009

Prescription Drug Help






Programs which assist with prescription drugs and/or other medical expenses.

Partnership for Prescription Assistance- http://www.pparx.org
Florida Rx Card- http://www.floridarxcard.com/index.php
Sunshine Rx- http://www.emsmed.com/sunshine
Florida Prescription Drug Prices http://myfloridarx.com
Publix offers a 14 day supply of many common oral antibiotics for free http://www.publix.com/freeantibiotics
Walmart offers many generic prescriptions for $4 for a 30 day supply and $10 for a 90 day supply- http://www.walmart.com/catalog/catalog.gsp?cat=546834
NeedyMeds-non-profit which helps people who cannot afford medicine or healthcare-
http://www.needymeds.org/index.shtml
Pasco County Good Samaritan Clinic- http://www.goodsamclinic.org

How to control frauds in health insurance claims?

While we have been happy with growth of health insurance segment in the recent years, some of the negative points have started appearing. In the conferences recetly attended by me, I heard the following statements:

1. Insured getting policies issued from 3 insurance companies. Went for hospitalization, managed 3 original sets of bills, reports, receipts, discharge summaries. Lodged claims with all the 3 companies.

2. Hospital having 10 rooms had informed the different Insurance companies/TPA’s that 18 rooms are occupied or say 18 patients are being treated. Bogus names/patients/records are being maintained. Someone jokingly commented that even a software has been developed to handle the bogus accounting.

3. When a hospital was black listed by Insurance co or TPA then they shifted the hospital 4 buildings away with different name and again got listed with Insurance co's /TPA.

4. First floor of the hospital was being used for marriages as a Banquet Hall,with a view to take the benefit of heavy/busy marriage season.

Question before us is frauds have to be controlled as these are adding to the losses of the Insurance Companies and will ultimately result in increase in premium rates.

What are the alternatives before us?

Lodging of FIR with Police-question is then what next?Is it a piece of paper only?

Should these be referred to Economic Offences Wing of the Police Dep’t?

Do we have this specialised wing in all the states?

Should there be black list for those inividuals who are indulging in fraud so that for their life time they will not be able to get Health Insurance Policy? Imagine the data base size? Are all insurance companies ready to share the data?

Identification number to be issued by Authority under Nandan Nilekani should be made compulsory for all proposals /health insurance policies to be issued. As this will take time (may be 3 yrs to cover our population) Then why not start using PAN No as the controlling number.

Comments are invited.

Soon we will have SBI General Insurance Company becoming operational

We understand most of the approvals are through for setting up of JV between SBI and IAG of Australia and in the coming months this company will become operational.
In view of the recent good achievements of SBI Life it is foreseen the competition will increase in Non Life Insurance/General Insurance segment.

Extensive coverage of the branches of SBI all over the country will be a good feature of this company.