mairagency.com

mairagency.com

About THE MAIR AGENCY Our entrance into the marketplace offering insurance and financial services began in 1988. The background of education and ongoing continued education prepared and continues to keep us prepared to serve the market in a broad range of insurance services. Helping families, individuals and small businesses with the protection of health insurance before age 65 and after, accident, sickness, critical care coverage, life insurance protection for small net worth as well as large net worth individuals and long term care needs has and will continue to be our well rounded approach to provide total protection for our clients and prospects. While a well-rounded approach to all these areas of protection is our motto, beginning in 1996 our focus to provide the very best healthcare protection for our client’s became our primary focus as we met new prospects. Determined that our consultation be the very best we could make for our prospects and clients, our research revealed to us that we could offer nothing but the very best coverage available by the very best provider available in NC. That research revealed no other but that Blue Cross and Blue Shield of North Carolina® would be our provider. One of the most valuable benefits of a quality healthcare plan is one that not only guarantees value financially, but provides quality care of its subscribers. BCBSNC, being the oldest and largest provider in all fifty states and over 200 foreign countries, guarantees our clients the most flexible network of doctors and hospitals worldwide. Realizing this, with the fact BCBSNC offers more flexible choices of plans thereby the ability to service a broader range of subscribers, which left our agency the obvious choice of becoming an exclusive agency to BCBSNC. Our motto to provide the best bears no correlation with who will pay our agency the most. You the client is first and foremost. While being exclusive to BCBSNC as our provider for healthcare protection, we do represent many major life insurance carriers so that we can indeed provide not only the very best protection for your personal needs, we can guarantee the very best value here as well. The years have evolved for our agency and growth so that now more than ever we are able to provide our clients not only quick response to evaluate your needs with a very qualified agent in person, we are also able to help and assist with your customer service needs promptly. Our clients are not just an income stream, we believe the way we were taught many years ago… this is a service industry. You drop everything to assist a client’s needs. If you grant our agency the opportunity to serve your needs and you ever feel you have become a number in line, I ask you to call me directly. That will never occur twice. It starts today….
919-459-2683
1-855-ITS-BLUE(855-487-2583)

Authorized Agency

In the Spotlight: Health Care Reform and
Essential Health Benefits


Today, health insurance covers a wide range of benefits but exactly what is included can vary based on where someone lives and the policy they purchase. Beginning January 2014, the Affordable Care Act (ACA) will create a more uniform standard, requiring that all health insurance coverage for individuals and small groups includes certain treatments and procedures deemed “essential health benefits.” Large groups are not required to comply with the essential health benefits requirements. The underlying idea is that the
“essential benefits package” be equal to the coverage offered under a “typical employer plan.” Ten general categories were identified as essential health benefits:


  • Ambulatory patient services;
  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care;
  • Mental health and substance use disorder services, including behavioral health treatment;
  • Prescription drugs;
  • Rehabilitative and habilitative services and devices;
  • Laboratory services;
  • Preventive and wellness and chronic disease management; and
  • Pediatric services, including oral and vision care.


Defining Essential Benefits


At the direction of the ACA, the Institute of Medicine (IOM) developed the criteria and methods that the Department of Health and Human Services (HHS) will use to evaluate and update essential benefits packages.
HHS announced in December that states would choose essential health benefits from four options:


  • One of the three largest small group plans in the state by enrollment;
  • One of the three largest state employee health plans by enrollment;
  • One of the three largest federal employee health plan options by enrollment; or
  • The largest HMO plan offered in the state’s commercial market by enrollment.


States have the flexibility to increase the level of coverage by adding more services and benefits that must
be covered. This means that all plans in the individual and small group markets inside or outside of the
exchanges - will provide a specific set of benefits, which, by law, will be modeled after what a typical
employer currently provides today in the private sector.​


Levels of Coverage


The ACA outlines four levels of coverage that insurers may offer, with varying levels of cost sharing. Each level (bronze, silver, gold, and platinum) reflects the actuarial value of that plan (the total amount the plan is worth in terms of percentage of total services paid by the insurer). All individual and small group plans at every level will be required to cover the determined essential health benefits.


BCBSNC Views


Jonathan Gruber, an economics professor at Massachusetts Institute of Technology, has cautioned that mandating coverage that is too generous could have the opposite effect desired, meaning this could lead to more individuals being priced out of the market altogether. Blue Cross® and Blue Shield® of North Carolina (BCBSNC) believes all individuals should have access to affordable, meaningful insurance coverage. BCBSNC appreciates that HHS recognizes that providing state flexibility is important in their transitional strategy for the implementation of EHBs, given all of the other reform elements that need to be put into place by late summer 2013 in order to have products available for exchanges for open enrollment in 2013. 

919-459-2683

855-ITS-BLUE

(855-487-2583)


Fax: 919-459-2660


Clientcare@MairAgency.com


Office Hours:

  1. Mon-Thurs: 8:30am-5pm
    Fri: 8:30am-3pm
    Sat-Sun: Closed

The Affordable Care Act