Beginning July 1, a new law in South Dakota will expand the South Dakota High Risk Pool to children with preexisting conditions that may not be able to get coverage any other way.

The law will help to cover approximately 455 children that are under the age of 19 who are considered medically uninsurable.  Governor Mike Rounds explains that “Every child in South Dakota should have health insurance, and now every child can. The South Dakota High Risk Pool will begin taking applications today for children who have been without health care coverage.”

The open enrollment period is from July 1 through August 29 and allows any child who has been without health insurance coverage for 12 months or longer can enroll without a pre-existing condition waiting period. Other requirements include:

Younger than 19
U.S. citizens
South Dakota residents

Monthly premiums range from $125 to $240 a month for children who qualify for the South Dakota Risk Pool. Deductibles range from $1,000 to $10,000 a year.

Though 455 children does not seem like a lot, especially compared to the 200,000 uninsured children in the state of South Dakota, but it’s a start and South Dakota is definitely making a positive stand for uninsured children.

According to a press release last week, Governor David Patterson (NY) submitted a bill to ensure that New Yorkers laid off by small business can qualify for federal benefits that pay up to 65% of COBRA health insurance premiums. COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985 gives workers and their families who lose their health benefits the right to choose to continue coverage provided by their group health plan for a limited period of time.

“The need to pass this bill is urgent because we must ensure as many people as possible retain their health coverage. One of the greatest challenges facing the State as a result of the current economic crisis is how we help unemployed New Yorkers retain access to their health insurance. Given the record levels of unemployment announced just last week, we need to move quickly to amend State law to make this subsidy available to as many New Yorkers as possible,” states Governor Paterson.

Unfortunately, COBRA is very expensive. Workers may be charged up to 102% of the full insurance premium. The American Recovery and reinvestment Act (ARRA), signed into law in February, makes a subsidy of 65% available to help cover the cost of COBRA health insurance premiums. Income limitations apply and no subsidies are available to individuals making annual incomes greater than $125,000 and couples making more than $250,000 annually.

Under the new economic stimulus plan, the federal government will subsidize 65% of the cost of health insurance under COBRA for workers who have lost or may lose their jobs between September 1, 2008 and December 31, 2009. The stimulus package was signed into law on February 17.

COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, allows individuals who have been laid off to stay on employer-based health plans for up to 18 months after termination. Individuals who elect COBRA coverage must pay the share of the premium that they paid while working, as well as their employer’s share plus a 2% administrative charge. COBRA, for most, is too expensive and individuals usually elect to go without health insurance or buy an individual health insurance plan through a private health insurance carrier.

COBRA’s revision under the economic stimulus plan only allows individuals to stay on COBRA up to 9 months. So, what happens in 9 months when you no longer can benefit from COBRA coverage and your new job, if any, doesn’t provide employer based coverage? Individual health insurance plans from private health insurance brokers or carriers, such as Health Plan One, can help in providing affordable health insurance.

High deductible plans offer low premiums and work best for healthy people who don’t go to the doctor that often. Now why would you need insurance if you’re healthy? One reason, life is unpredictable. Sudden illnesses can occur as well as tragic accidents and there is no better way to prepare for what may or may not happen with a health insurance plan.

But were too afraid to ask!

According to Lesson 16 from CNN’s Money 101, there are a few things to know about health insurance:

A lot of people who think they are healthy may believe that having no insurance saves them a lot more money than having insurance. But what if there’s a catastrophe? You may get into a car accident and get hurt or get hurt on your yearly skiing trip. You may be a healthy person but no one can avoid accidents or unexpected illnesses. A major illness can even push you to bankruptcy.

Make sure you compare plans. Benefits vary from plan to plan and comparing plans can help you find the plan that fits your specific needs.  Also know that a low premium doesn’t always mean cheaper health coverage. A low premium usually means a higher deductible. This means that you must reach this deductible before the insurance starts paying.

In the event you lose your job, COBRA can protect you from losing your health coverage. COBRA usually has higher premium costs but expensive health insurance is better than none at all. COBRA fills the gap while you are looking for an individual plan, getting on your spouse’s insurance, or finding another job.

Indemnity plans v. Managed Care plans

Indemnity plans allow you to go to any primary care doctor, specialist or hospital. You or your employer pays the premium and there is a deductible that needs to be met before insurance kicks in. After your deductible is met, your health plan pays for a percentage of your health care expenses, usually 80%.  Indemnity plans offer the best choice of a provider but usually have more expensive premiums, deductibles, and coinsurance.

Managed Care plans consist of Health Maintenance Organizations (HMO), Preferred Provider Organization (PPO), and Point of Service plans (POS). HMOs have the least expensive monthly premiums but offer the least choice of a provider.  HMOs manage both the financing and delivery of a broad range of healthcare services. HMOs focus on prevention and primary care. You usually pay a small copayment for each doctor’s visit instead of a deductible and coinsurance.

PPOs allow you to go to out of network providers but you receive better benefits if you stay in network. You usually have direct access to specialists but some PPO plans require you to obtain a referral from your primary care physician (PCP) before seeing a specialist.

POS plans are a combination between HMOs and PPOs. You can choose how to access the plan each time you need treatment. You can stay in network or go out of network but will have to pay deductible and coinsurance charges if you choose to go outside the HMO network.

To make an informed decision, compare many plans before diving into a health plan that looks good. Check out providers; compare deductibles and premiums, and the benefits associated with the health plan.  A good health insurance policy covers hospital expenses, surgical expenses, and physician’s expenses. Some additional benefits are prescription drugs, preventive care, vision care, and maternity care. The best health insurance plan gives you flexibility at a low cost. Make sure you know the health services that you need because you want your plan to cover the health services you need.