I spent part of my morning comparing health insurance plans. Despite the fact that I’m not really interested in getting health insurance. I haven’t had health insurance for six years, nor have I felt any desire to get it. With the exception of an occasional cold, some muscle strains, chigger bites and wasp stings, I have no complaints.
The last time I went to a doctor was four years ago. My girlfriend thought I might have a kidney infection, so I went. It turned out to be a sore back muscle, but the doctor was nice enough to write me a prescription for Cipro anyway. You never know when you might need a broad spectrum antibiotic sometime on down the road.
I wouldn’t even be thinking about getting health insurance if Bob’s new position at Central Carolina Community College didn’t come with a plan for him and an option for me. After reviewing my CCCC options, we decided to ask the folks down at Farm Bureau for a quote. They insure our home and car, we thought, why not our kidneys, too?
So I find myself comparing health insurance plans this morning. It’s a distasteful business no matter how you slice it. First off, I’d rather be supporting a single payer national health-care-for-all plan than the health insurance industry. I don’t really want health insurance; I want affordable health care.
Personally, I think health insurance is a racket whose goal is making enough profits to keep their investors happy and their CEO’s in stock options and million dollar salaries. One third of every dollar paid into the for-profit Health Insurance companies goes towards administration, marketing, lawyers, CEO salaries and stock options while health care could easily be provided using only three cents out of every dollar to cover administrative costs.
To insure healthy profits, the health insurance plans come with yards of small print, loopholes designed to help them avoid paying claims. And then there’s all the stuff they plain refuse to insure from the get go. Click on “more” to see the impressive list of health care benefits excluded by the Blue Options HSA plan.
I think the recently passed H.R.3200 – America’s Affordable Health Choices Act of 2009 is really just a pre-emptive bailout for the health insurance companies. Since mandated insurance coverage doesn’t come into effect until 2014, I’m not sure I’m ready to stop wearing my black rubber “uninsured” bracelet.
Furthermore, I’m healthy and invested in keeping myself that way. My health care plan has been my local food diet, lots of sleep and a good balance between desk, yard work, friends and down-time. Putting money into good food and leisure time makes more sense to me than putting it into a Health Savings Account. Investing money into a plan designed to pay off if something terrible happens just feels wrong.
Sure, I realize most people will say that paying $175 a month to insure against something catastrophic is simply smart risk management. One bad car wreck could easily send us into bankruptcy and cost us our home. But every time I write that check, I’ll feel like I’ve just walked up to the betting window at the track and put my money on a horse to lose.
BlueCross BlueShield of North Carolina
Your plan for better health
Limitations and exclusions
Like most health care plans, Blue Advantage and Blue Options HSA has some limitations and exclusions. When your application is approved, and you become a member, you will have access to your benefit booklet online. It will contain detailed information about plan benefits, exclusions and limitations.
This is a partial list of benefits that are not payable.
- Not medically necessary
- Investigational in nature or obsolete, including any service, drugs, procedure or treatment directly related to an investigational treatment
- Any experimental drug or any drug not approved by the Food and Drug Administration (FDA) for the applicable diagnosis or treatment. However, this exclusion does not apply to prescription drugs used in covered phases II, III and IV clinical trials, or drugs approved by the FDA for treatment of cancer, if prescribed for the treatment of any type of cancer for which the drug has been approved as effective in any one of the three nationally recognized drug reference guides:
- The American Medical Association Drug Evaluations
- The American Hospital Formulary Service Drug Information
- The United States Pharmacopoeia Drug Information
- Side effects and complications of noncovered services, except for emergency services in the case of an emergency
- Not prescribed or performed by or upon the direction of a doctor or other provider
- For any condition, disease, illness or injury that occurs in the course of employment, if the employee, employer or carrier is liable or responsible for the specific medical charge (1) according to a final adjudication of the claim under a state’s workers’ compensation laws, or (2) by an order of a state Industrial Commission or other applicable regulatory agency approving a settlement agreement
- For a health care professional to administer injectable prescription drugs which can be self-administered, unless medical supervision is required
- For inpatient admissions primarily for the purpose of receiving diagnostic services or a physical examination. Inpatient admissions primarily for the purpose of receiving therapy services, except when the admission is a continuation of treatment following care at an inpatient facility for an illness or accident requiring therapy
- For care in a self-care unit, apartment or similar facility operated by or connected with a hospital
- For custodial care
- For domiciliary care or rest cures, care provided and billed for by a hotel, health resort, convalescent home, rest home, nursing home or other extended care facility, home for the aged, infirmary, school infirmary, institution providing education in special environments, in residential treatment facilities, except for substance abuse treatment, or any similar facility or institution
- For respite care, whether in the home or in a facility or inpatient setting, except as specifically covered by your health benefit plan
- Received prior to the member’s effective date
- Received on or after the coverage termination date, regardless of when the treated condition occurred, and regardless of whether the care is a continuation of care received prior to the termination
- For telephone consultations, charges for failure to keep a scheduled visit, charges for completion of a claim form, charges for obtaining medical records, and late payment charges
- Incurred more than 18 months prior to the member’s submission of a claim to BCBSNC, except in the absence of legal capacity of the member
- For cosmetic purposes except as specifically covered by your health benefit plan
- For any services that would not be necessary if a non-covered service had not been received, except for emergency services in the case of an emergency
- For benefits that are provided by any governmental unit except as required by law
- For services that are ordered by a court that are otherwise excluded from benefits under this health benefit plan
- For care that the provider cannot legally provide or legally charge or is outside the scope of license or certification
- Provided and billed by a licensed health care professional who is in training
- Available to a member without charge
- For care given to a member by a provider who is in a member’s immediate family
- For any condition suffered as a result of any act of war or while on active or reserve military duty
- In excess of the allowed amount for services usually provided by one doctor, when those services are provided by multiple doctors
- For palliative, cosmetic or routine foot care
- For dental care, dentures, oral orthotic devices, palatal expanders and orthodontics except as specifically covered by your health benefit plan
- For dental implants
- Dental services provided in a hospital, except when a hazardous condition exists at the same time or covered oral surgery services are required at the same time as a result of a bodily injury
- For any treatment or regimen, medical or surgical, for the purpose of reducing or controlling the weight of a member or for treatment of obesity, except for surgical treatment of morbid obesity
- Wigs, hair pieces and hair implants for any reason
- Received from a dental or medical department maintained by or on behalf of an employer, a mutual benefit association, labor union, trust or similar person or group
- For sexual dysfunction unrelated to organic disease
- Treatment or studies leading to or in connection with sex changes or modifications and related care
- Music therapy, remedial reading, recreational or activity therapy, all forms of special education and supplies or equipment used similarly
- Hypnosis except when used for control of acute or chronic pain
- Acupuncture and acupressure
- Surgery for psychological or emotional reasons
- Travel, whether or not recommended or prescribed by a doctor or other licensed health care professional, except as specifically covered by your health benefit plan
- Heating pads, hot water bottles, ice packs and personal hygiene and convenience items such as, but not limited to, devices and equipment used for environmental control
- Devices and equipment used for environmental accommodation requiring vehicle and/or building modifications such as, but not limited to, chair lifts, stair lifts, home elevators, and ramps
- Air conditioners, furnaces, humidifiers, dehumidifiers, vacuum cleaners, electronic air filters and similar equipment
- Physical fitness equipment, hot tubs, Jacuzzis, heated spas, pool or memberships to health clubs
- Eyeglasses or contact lenses
- Orthoptics, vision training, and low vision aids
- Fitting for eyewear, radial keratotomy and other refractive eye surgery, and related services to correct vision except for surgical correction of an eye injury. Also excluded are premium intraocular lenses and services related to their insertion beyond what is required for insertion of conventional intraocular lenses
- Routine hearing examinations and hearing aids or examinations for the fitting of hearing aids except as specifically covered by your health benefit plan
- Routine hearing examinations except as specifically covered by your health benefit plan
- Evaluation and treatment of developmental dysfunction and/or learning differences
- For routine eye examinations, except as specifically covered by your health benefit plan
- Medical care provided by more than one doctor for treatment of the same condition
- Clomiphene (e.g., Clomid), menotropins (e.g., Repronex) or other drugs associated with conception by artificial means
- For maintenance therapy. Maintenance therapy includes services that preserve your present level of function or condition and prevent regression
- For massage therapy services
- For holistic medicine services
- For services primarily for educational purposes including, but not limited to, books, tapes, pamphlets, seminars, classroom, Web or computer programs, individual or group instruction and counseling, except as specifically covered by your health benefit plan
- For genetic testing, except for high risk patients when the therapeutic or diagnostic course would be determined by the outcome of the testing
- Services whose efficacy has not been established by controlled clinical trials, or are not recommended as a preventive service by the US Public Health Service, except as specifically covered by your health benefit plan
- Shoes of any type, unless part of a brace
- For any condition, disease, ailment, injury or diagnostic service to the extent that benefits are provided or persons are eligible for coverage under Title XVIII of the Social Security Act of 1965, including amendments, except as otherwise provided by federal law
- For conditions that federal, state or local law requires to be treated in a public facility
- For vitamins, food supplements or replacements, nutritional or dietary supplements, formulas or special foods of any kind, except for prescription pre-natal vitamins or prescription vitamin B-12 injections for anemias, neuropathies or dementias secondary to a vitamin B-12 deficiency
Your coverage may be canceled by BCBSNC for failure to pay premiums and for false statements on your application, among other reasons. Coverage for dependent children ends at age 26. Members will be notified 30 days in advance of any change in coverage. A waiting period for coverage of pre-existing conditions may apply to your coverage.1 These pages contain available benefits only. They are not your insurance policy. Your policy is your insurance contract. If there is any difference between these pages and the policy, the provisions of the policy will control.
1 – Pre-existing conditions are defined as those for which medical advice, diagnosis, care or treatment was received or recommended within the 12 months prior to the date that this coverage begins. You may receive credit toward the 12-month waiting period, if we receive your completed application within 63 days of the termination of your previous creditable health coverage.
