IHIE I posted a snap shot of an option for the future of group health insurance could be through Health Insurance Exchange.
As, I learn more about this option of individual plans it could turn out be a strategy for companies in the future.
IndyStar.com publish a story on children with insurance will not be able to get vaccinations for the Indianapolis department of health.
From a coverage standpoint, all health insurance plans have to cover vaccinations at no cost to the insured. So should your child need $600 worth of immunizations it will cost you nothing. This was one of the few good things to come out of the health care reform laws.
There is some debate about people being on non grandfathered plan and not eligible for this benefit. Most carriers are not offering non grandfathered plans. The best way to see if you have wellness coverage is to call the number on the back of your insurance card and ask.
In the article there was a doctor quoted about the cost to the insured for these immunizations. This Doctor is not update on the current health insurance coverage. There are also state officials that are not up to date on mandated health insurance coverage.
If you are a parent it is your responsible to know your insurance coverage. You cannot count on doctors, elected officials or gov. employees, to be looking out for you.
The Internal Revenue Service has announced changes to the 2012 key amounts for Health Savings Accounts
(HSAs) and High Deductible Health Plans (HDHPs). HSA contribution limits and HDHP out-of-pocket
maximums will increase, while the HDHP minimum required deductibles will remain the same as 2011.
2012 Key Amounts
HSA Contribution Limit – Individual $3,100
HSA Contribution Limit – Family $6,250
HDHP Out-of-Pocket Maximums – Individual $6,050
HDHP Out-of-Pocket Maximums – Family $12,100
HDHP Minimum Deductibles – Individual Remains $1,200
HDHP Minimum Deductibles – Family Remains $2,400
Catch-Up Contribution Remains $1,000
National Journal reported on the McKinsey and Co. study on how 30% of employer could drop group health benefits in 2014.
The study predicts that employers that understand some of th health insurance law could find savings in dropping coverage. This all depends on how the each state sets up the exchange plan.
When you look at this study it shows that employers will drop that group health plan if the exchange plans make sense. There are industries that will have a very difficult time keeping employees on a companies health plan. When we look at the 9.5% rule. If more the 9.5% of house hold income goes towards group health insurance premium then that employee can take the employer contribution and use that towards a policy through the exchange. If an employee fall into this category why would they stay on the group health plan in the first place. They can go to the exchange with the employers money and be eligible for tax subsidies.
Right now there is a real fear that the health insurance exchange is going to be a high risk pool. This view is shared nation wide with all the exchanges.
Once the exchanges are developed then we will have a good idea what employers and employees will decide.
Washington Post Reported a large decrease in the PCIP health insurance program. HHS has funded the program with $5 billion dollars so that they can reduce premiums.
IBJ Reported that so far only 18,000 people have enrolled into the plan. HHS was expecting 375,000.
The reality is the premiums for any high risk pool are high. They are high because the program can not sustain the high claims.
For Indianapolis the premiums for the PCIP plans were already lower than the Indianapolis comprehensive health. So now with a premium reduction starting July 1st the new enrollment for the Comprehensive Health plan should stop. The only advantage now to the comprehensive plan is they will take anyone that has been declined. On the PCIP program you have to be without coverage for 6 months.
It will be interesting to see where the PCIP.gov rates go to.
Accountable care organization “refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with Original Medicare (that is, those who are not in a Medicare Advantage private plan). The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. The ACO would be a patient-centered organization where the patient and providers are true partners in care decisions.” This is the ideal goal of ACO through HHS
The reality of these organizations is now becoming known through pilot programs that have been established. POLITICO
On May 12, 10 medical groups participating in a Medicare pilot program that paved the way for the ACO program declared that none would participate if the rule were not substantially modified. This is a huge blow to the ACO model. The providers that have participated in these programs have declared the risk of financial loss is to high.
This is very bad for health care reform because this program was the only staple of trying to control health care costs.
Indianapolis has been awarded $6.8 Million from the Federal Government to Implement the key provision of the Affordable Health Care Act- Health Insurance Exchange.
And received a $1 million grant to look into setting up a state based exchange. So the $6.8 million must be an indicator that the DOI is going to move forward with a state based exchange.
The 4th circuit court of appeal heard oral arguments on the health care reform laws.
It has been reported that the Judges were leaning to uphold the law.
The challengers, the state of Virginia and Liberty University, have argued the decision to forgo insurance is not an economic activity that traditionally falls under Congress’ power to regulate interstate commerce. USA Today
Acting Solicitor General Neal Katyal argued no one truly abstains from the market for health care.
26 other states has challenged the insurance mandate in a separate case.
Most people have no clue what the long term effects of this law is going to have. This law is going to have a impact on every American.
Health insurance carrier profits seems to be an issue that is wildly misunderstood.
There is a big disconnect between the public and cost of health care. People do
not seem to understand that health insurance premiums are expensive because the
cost of health care is expensive and it is getting more expensive everyday (new
treatments, new medications coming to market, new technologies and our aging
population–just to name a few). Since many plans have copays ranging from
$20-$50 for doctor office visits (or Rx), people seem to think that equates to
the cost of the visit but that is not the case. The insurance carrier is paying
many multiples of the copay even after you have paid your “copay”. Since the
average insured consumer usually has little idea what health care costs, the
assumption is that because premiums are so expensive, the carriers must be wildly
According to Fortune Magazine in 2009, “Health Care: Insurance and Managed Care” ranked 35th
on the list of profitable industries (Top industries: Most profitable), and the
level of profit was only 2.2% margin. Note that is well behind “Pharmaceuticals”
(ranked 3rd at 19.3%), “Medical Products and Equipment” (ranked 4th at 16.3%)
even behind “Health Care: Medical Facilities” themselves (ranked 34th at 3.4%).
In the last year we have seen companies leave the market. Principal by has been the biggest
lost along with Unicare, American Community, & Humana pulling out of the
state of Indiana.
Indianapolis On Site Wellness
Inside Indianapolis Business reported on a story about a Dorel Juvenile Group attacking thier health care cost with an On Site wellness clinc. The company CEO stated that their health care costs were around $6 million a year. It sounds that this company has a Self Funded plan which requires them to pay the majority of the claims. This group decided that they would attack these claims but placing a FREE on site clinic to their employees.
We really don’t have a lot of details about how they set up this program but they did speak about a health risk assesment. From the health risk assement that must have given them more information on the health care needs of the employees. Groups over 100 lives should look at having a health risk assement of the group to provide information on the needs of the group.
With balloning health care cost companies are looking to take aggressive action to control and reduce the cost of health care.
Dorel Juvenile Group has taken a very active role with improving the health care of their employee’s. In today’s enviornment of a unhealthy work force company’s have to become involed with their employees over