Affordable insurance for full timer in S.D.

[Stickbender]

We received our letter requesting proof of residence today from South Dakota, Sanford Health plan, they request 2 forms of proof that we have been residence for 9 months. We do our banking , have drivers license , register 3 vehicles and still cant meet the 2 requirements, unless we basically move to South DAKOTA. Any suggestions on a affordable company we can go with in S.D.?

[was_butnotnow]

Fulltimer50 wrote:
No response from the S&M rep. I called Avera service today and was told that the PHCS,Multiplan Network was for emergency or situations where you need medical care and cant wait till you get back home. Like the flu. But NOT for routine care. I have sent an Email to service with the quote from RVerhealthinsurance.com
Will have to see who is right.

What they told is not what is stated in this article.
After reading this you I think should contact www.rverhealthinsurance.com
Again read this on RVerHealthInsurance.com
As this article states you have to ask and ask again to get to the bottom of your question to get a correct answer.

If you are a full time RVer domiciled in South Dakota and you qualify for a subsidy under The Affordable Care Act then you have probably been struggling to find a viable health insurance plan on the exchange in 2014. The three companies (Sanford, DakotaCare, Avera) on the healthcare exchange in SD have all said they are not a good fit for RVers–two of them (Sanford and DakotaCare) going so far as to say they will not allow RVers to sign up. One of them (Sanford) has actually dropped some RVers whom have enrolled in 2014 after discovering they did not have a physical address in SD. The third one, Avera Health, although it offers PPO plans has appeared to not actually have a network of providers outside of the SD region.
I spoke with Avera in January 2014 and confirmed what we suspected about Avera not allowing RVers to access a nationwide network outside of the SD region as well as not covering claims if members are traveling more then 3 months outside of SD. That had caused us to not recommend Avera for RVers in South Dakota in our State-by-State guide.

However, On February 17, 2014 I received a phone call from an Agency Manager with Avera in response to my inquiry about insuring RVers. She called me back to tell me that their policy has changed. Here are the two policy changes at Avera in regards to insuring RVers:
You can enroll in an Avera Health Plan with only a mail-forwarding address if SD is your legal domicile. You will not be asked to provide any further proof of physical residency.
You can utilize a PPO national network of providers while traveling outside of the SD region even in cases of non-emergency care.
The network that Avera PPO members will utilize outside of SD is called the PHCS MultiPlan network and is pretty big with over 900,000 healthcare providers. You can examine the network yourself by clicking here.

I pressed Avera to give me further confirmation of this change because sometimes when you call and talk to a sales representative you might be told that the PHCS MultiPlan network is for emergency care only. When I told the Manager this was happening her response was:
Sales reps are quoting rules for group plans and pre ACA individual. Everything I told you earlier is correct. Members can access PHCS for routine care.
This is great news for SD RVers whom qualify for a significant subsidy. If you have been considering changing your residency from SD to another state because of lack of carriers on the exchange that are RVer-friendly you might now reconsider staying in SD.

Avera still holds the position that they are not an ideal choice for RVers whom travel outside of the SD region extensively. Nevertheless, there is nothing in the Avera Health Plan Certificate of Coverage that prevents a full-time RVer domiciled in SD from enrolling in their plans and utilizing the MultiPlan network.

[Fulltimer50]

No response from the S&M rep. I called Avera service today and was told that the PHCS,Multiplan Network was for emergency or situations where you need medical care and cant wait till you get back home. Like the flu. But NOT for routine care. I have sent an Email to service with the quote from RVerhealthinsurance.com
Will have to see who is right.

[lbrjet]

True, a multi-state plan only means that different states offer the exact same plan. It does not mean that your insurance can be used in multiple states. The new HMO plans only cover emergencies when you are out of your home state. Find a state that offers a PPO plan with a good network like BCBS. Indiana is offering only HMO's now as our PPO plan went away. We just relocated to Arizona and got a much (much much) better PPO plan through the same provider, BCBS.

[Fulltimer50]

I am in discussions right now with the Avera sales reps. I started with the question about PHCS Multiplan Network to the sales rep in Yankton, who "just talked" to the sales and marketing manager for Avera who said that the network is for emergency care only. I am waiting for a call back from the S&M rep. The company moves very slowly to get the correct information to everyone even within their own company. Seems we have to our own work to get the correct information.

PS Sanford and DakotaCare are HMOs.

[Rice]

Old-Biscuit wrote:

Thanks for that info.
Seems Avera decided to go ahead and comply early........ALL states must have muti-state plans within 4 yrs. of ACA.
Avera is going to be the only game available for SD FTrs.

A clarification: a multi-state plan isn't necessarily what it sounds like.

Basically, a multi-state plan is one that is overseen by the Office of Personnel Management, presumably because the OPM has experience in managing health insurance for federal employees.

You can read about what multi-state plans really are here. (South Dakota currently does not offer any "multi-state" plans.)

Here are a few items from the FAQ:

Why should I choose a Multi-State Plan?
A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.

Note that it doesn't say anything about a person being covered when he is out of his home state.

If I move to a different State, can I keep my Multi-State Plan coverage?
A few MSP options have a nationwide network. In future years, our goal is to expand reciprocity in plan options across State lines.

This shows that a multi-state plan might have a nationwide provider network, but it is not required to.

In fact, it's not even required to have a state-wide network:

If a Multi-State Plan is offered in a particular State, will it be available everywhere in the State or might it be available in only certain parts of the State?
It depends. While OPM is encouraging statewide coverage in the Multi-State Plan (MSP) Program, it is not required of MSP insurers at this time. OPM is, however, requiring MSP insurers that offer partial coverage in a State to submit a plan for extending coverage throughout the State.

What Avera has done has nothing to do with multi-state plans. Instead, it has made available a network that extends outside South Dakota, and evidently is the only one that has done so.

On another part of the site, I found this:

The U.S. Office of Personnel Management (OPM) has entered into a contract with the Blue Cross and Blue Shield Association to offer more than 150 Multi-State Plan (MSP) options in 30 States and the District of Columbia on the Health Insurance Marketplace.

This indicates that currently, all actual multi-state plans are through Blue Cross. Blue Cross is known for having an extensive nationwide network, so it might be a good choice for a fulltimer, but that's independent of its classification as a "multi-state" plan. And it would be imperative for a fulltimer to verify the network associated with a particular plan before signing up because Blue Cross does offer some HMO plans, which usually have very limited provider networks.

For fulltimers, in particular, classification as a multi-state plan doesn't mean anything; it's the provider network that is key.

[TechWriter]

Bohemian wrote:
My understanding is that this is completely settled law. As always, that does not stop someone from trying to refuse your right of residency. It just gives you the legal standing to demand your rights.

Oh joy, spend thousands in court.

[Old-Biscuit]

was_butnotnow wrote:
Just read this on RVerHealthInsurance.com

If you are a full time RVer domiciled in South Dakota and you qualify for a subsidy under The Affordable Care Act then you have probably been struggling to find a viable health insurance plan on the exchange in 2014. The three companies (Sanford, DakotaCare, Avera) on the healthcare exchange in SD have all said they are not a good fit for RVers–two of them (Sanford and DakotaCare) going so far as to say they will not allow RVers to sign up. One of them (Sanford) has actually dropped some RVers whom have enrolled in 2014 after discovering they did not have a physical address in SD. The third one, Avera Health, although it offers PPO plans has appeared to not actually have a network of providers outside of the SD region.
I spoke with Avera in January 2014 and confirmed what we suspected about Avera not allowing RVers to access a nationwide network outside of the SD region as well as not covering claims if members are traveling more then 3 months outside of SD. That had caused us to not recommend Avera for RVers in South Dakota in our State-by-State guide.

However, On February 17, 2014 I received a phone call from an Agency Manager with Avera in response to my inquiry about insuring RVers. She called me back to tell me that their policy has changed. Here are the two policy changes at Avera in regards to insuring RVers:
You can enroll in an Avera Health Plan with only a mail-forwarding address if SD is your legal domicile. You will not be asked to provide any further proof of physical residency.
You can utilize a PPO national network of providers while traveling outside of the SD region even in cases of non-emergency care.
The network that Avera PPO members will utilize outside of SD is called the PHCS MultiPlan network and is pretty big with over 900,000 healthcare providers. You can examine the network yourself by clicking here.

I pressed Avera to give me further confirmation of this change because sometimes when you call and talk to a sales representative you might be told that the PHCS MultiPlan network is for emergency care only. When I told the Manager this was happening her response was:
Sales reps are quoting rules for group plans and pre ACA individual. Everything I told you earlier is correct. Members can access PHCS for routine care.
This is great news for SD RVers whom qualify for a significant subsidy. If you have been considering changing your residency from SD to another state because of lack of carriers on the exchange that are RVer-friendly you might now reconsider staying in SD.

Avera still holds the position that they are not an ideal choice for RVers whom travel outside of the SD region extensively. Nevertheless, there is nothing in the Avera Health Plan Certificate of Coverage that prevents a full-time RVer domiciled in SD from enrolling in their plans and utilizing the MultiPlan network.

Thanks for that info.
Seems Avera decided to go ahead and comply early........ALL states must have muti-state plans within 4 yrs. of ACA.
Avera is going to be the only game available for SD FTrs.

[phyllen]

In answer to was_butnotnow. We have been domiciled in SD since 2010. We are now both on Medicare. We have our Medicare supplement through Gerber Life and our Medicare Part D through the Humana WalMart plan. Have not had issues. YET!

As far as I can determine, the changes in insurance have only affected those under 65 who now go under the ACA.

[was_butnotnow]

Just read this on RVerHealthInsurance.com

If you are a full time RVer domiciled in South Dakota and you qualify for a subsidy under The Affordable Care Act then you have probably been struggling to find a viable health insurance plan on the exchange in 2014. The three companies (Sanford, DakotaCare, Avera) on the healthcare exchange in SD have all said they are not a good fit for RVers–two of them (Sanford and DakotaCare) going so far as to say they will not allow RVers to sign up. One of them (Sanford) has actually dropped some RVers whom have enrolled in 2014 after discovering they did not have a physical address in SD. The third one, Avera Health, although it offers PPO plans has appeared to not actually have a network of providers outside of the SD region.
I spoke with Avera in January 2014 and confirmed what we suspected about Avera not allowing RVers to access a nationwide network outside of the SD region as well as not covering claims if members are traveling more then 3 months outside of SD. That had caused us to not recommend Avera for RVers in South Dakota in our State-by-State guide.

However, On February 17, 2014 I received a phone call from an Agency Manager with Avera in response to my inquiry about insuring RVers. She called me back to tell me that their policy has changed. Here are the two policy changes at Avera in regards to insuring RVers:
You can enroll in an Avera Health Plan with only a mail-forwarding address if SD is your legal domicile. You will not be asked to provide any further proof of physical residency.
You can utilize a PPO national network of providers while traveling outside of the SD region even in cases of non-emergency care.
The network that Avera PPO members will utilize outside of SD is called the PHCS MultiPlan network and is pretty big with over 900,000 healthcare providers. You can examine the network yourself by clicking
here.
I pressed Avera to give me further confirmation of this change because sometimes when you call and talk to a sales representative you might be told that the PHCS MultiPlan network is for emergency care only. When I told the Manager this was happening her response was:
Sales reps are quoting rules for group plans and pre ACA individual. Everything I told you earlier is correct. Members can access PHCS for routine care.
This is great news for SD RVers whom qualify for a significant subsidy. If you have been considering changing your residency from SD to another state because of lack of carriers on the exchange that are RVer-friendly you might now reconsider staying in SD.

Avera still holds the position that they are not an ideal choice for RVers whom travel outside of the SD region extensively. Nevertheless, there is nothing in the Avera Health Plan Certificate of Coverage that prevents a full-time RVer domiciled in SD from enrolling in their plans and utilizing the MultiPlan network.

[Greyghost]

Bohemian wrote:
The Supreme Court of the United States has ruled that you have the right to maintain "legal residency" in your town, county, and state forever once it has been established as long as you do not declared residency elsewhere.

You do NOT need to maintain a home or rental or real mailing address once residency has been established. You may not be refused anything that requires residency by the government or by a private company. Once residency has been established all that other "at least 6 months per year stuff" has no legal standing.

Could you please provide the explicit statute that addresses this?

[EsoxLucius]

Bohemian wrote:
Just a note on one special consideration for residency when you are not actively "In-state".

The Supreme Court of the United States has ruled that you have the right to maintain "legal residency" in your town, county, and state forever once it has been established as long as you do not declared residency elsewhere.

You do NOT need to maintain a home or rental or real mailing address once residency has been established. You may not be refused anything that requires residency by the government or by a private company. Once residency has been established all that other "at least 6 months per year stuff" has no legal standing.

In other words, once you have had a real physical presence in a town, met and established real physical residency you may retail your legal residency in that town forever.

My understanding is that this is completely settled law. As always, that does not stop someone from trying to refuse your right of residency. It just gives you the legal standing to demand your rights.

Tell that to Sanford and Dakota Care.

[Greyghost]

I sent you a PM.

[was_butnotnow]

Is the problem with health insurance ins SD just with ACA?
Is anyone having a problem getting Medicare Medigap or Medicare Part D in SD as fulltimers?

[Bohemian]

Just a note on one special consideration for residency when you are not actively "In-state".

The Supreme Court of the United States has ruled that you have the right to maintain "legal residency" in your town, county, and state forever once it has been established as long as you do not declared residency elsewhere.

You do NOT need to maintain a home or rental or real mailing address once residency has been established. You may not be refused anything that requires residency by the government or by a private company. Once residency has been established all that other "at least 6 months per year stuff" has no legal standing.

In other words, once you have had a real physical presence in a town, met and established real physical residency you may retail your legal residency in that town forever.

My understanding is that this is completely settled law. As always, that does not stop someone from trying to refuse your right of residency. It just gives you the legal standing to demand your rights.

[mpierce]

Clay L wrote:
For what it is worth we had no problem getting private health insurance in SD as full timers before we went on Medicare. The company we used was Assurant.
BC/BS on the other hand would not continue our policy in either NH or SD unless we had a real address and spent more than six months continuously in the state each year.
That was about 7 years ago.

But, EVERYTHING has changed with Obama care. Need to recheck, and check carefully.