Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
DECEMBER 2001 NICA NEWS
GOLD RECORDS
Record 9/01 (G. Gummere): Client didn't receive check from insurance company for a bill in April of 2001. She received a notice from the hospital to pay the bill. When called, the insurance company checked and found out the check was sent and it was lost in the mail. The insurance company will send the beneficiary a new check for the bill amount, $362.61, in approximately ten to fourteen days.Good work. NICA Volunteers can help save beneficiaries money. The NICA program and the Volunteers helped older Nebraskans save $639,575.00 in 2001, or an average of $88.80 per client.
Record 7/01 (J. Van Mark): Client was planning to buy a supplement, although he planned to continue working, and wanted information. NICA Volunteer suggested he visit with his employer before purchasing. The beneficiary and employer worked something out with the insurance benefit, so beneficiary would pay half of the employer supplement. This would save the beneficiary $600 annually.
Another success story of a NICA Volunteer who helps a beneficiary save money.
Record 9/01 (L. Kruse): Client called asking for advice on help with prescription drugs. Health & Human Services had informed client that she was a little over the income guidelines to be eligible for Medicaid. Later she received a letter from HHS indicating that if she bought a life insurance policy, her spend down would qualify her for Medicaid.
An individual must have an income total of less than $716 to qualify for Medicaid prescription assistance. A life insurance policy with a face value of less than $1500 cannot be counted as an income resource.
Record 9/01 (J. Barry): Client couldn't understand why amount charged and amount paid were different. Volunteer showed him how to read the Medicare Summary Notice form to determine why the bill wasn't paid. Volunteer explained that the clinic would send it through again and they would get paid. I told him Medicare would pay, but it might take time.
Medicare usually takes between four to six weeks to pay bills.
Record 10/01 (C. Howe): Eighty-seven-year-old client requested a review of a long-term care policy purchased in 1995. No apparent problems and policy remains in force.
This client would have purchased the policy at age 81. A few companies market to this age range and they are generally quite expensive policies. Some companies sell only one year of coverage to those 80 and older and very few companies sell to people older than 84. Policies issued in Nebraska can increase premiums based solely on age after age 65. In addition, premiums for everyone insured under the same policy form may increase when the group, as a whole, incurs significant claims. All Nebraska policies are guaranteed renewable which means the policies cannot be canceled, nonrenewed, or dropped by anyone except the policyholder, as long as the premiums are paid on a timely basis. All rights rest with the client as to whether he/she wishes to keep the policy or to discontinue it.
Record 8/01 (E. Humlicek): Caregiver's father is age 70 with no savings, a small pension and social security of $716 per month. He lives alone and needs financial help with medical problems. NICA Volunteer referred caregiver to Health & Human Services' Aged, Blind & Disabled Division.
This person may be dual eligible for Medicare and Medicaid assistance. HHS will determine eligibility.