What Kind of Coverage Will the Plans Sold Through the Health Insurance Exchanges Include?

The Affordable Care Act (ACA) requires that all health insurance plans sold on state exchanges beginning Jan. 1, 2014 cover ten essential 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 […]

How Does the Marketplace Verify Your Identity?

The Marketplace must ensure you’re eligible for a health insurance plan through the government program. To do so, several pieces of your personal information are pulled from federal agencies, as approved by the Department of Health and Human Services (HHS). The following sources, and perhaps several more, may be used to verify your identity: Social […]

Lipitor Goes Generic – What That Means for You

Lipitor, one of the most frequently prescribed medications for lowering cholesterol and preventing heart disease, is now available in generic form. Access to atorvastatin – the generic name for the drug – is going to save residents thousands of dollars. Here’s how: According to the American Heart Association, heart disease is the leading cause of […]

Indiana Level Funded Group Health Plan

Indianapolis has seen the introduction of several new group health products designed for companies with between 10 and 250 employees. What makes these plans intriguing is that they are self-funded health insurance vehicles. In a traditional self-funded plan, the employer pays for its own medical claims directly. Meanwhile, a third-party administrator administers the health plan […]

Why The Health Care Reform Employee Tax Subsidies Could Cost You More

The Hill Under the new health care reform law, if an employer’s group health insurance is considered unaffordable — a cost to the employee of more than 9.5% of household income —  the employee would be eligible for tax subsidies through a health insurance exchange.  As the law was originally interpreted, if the employee was […]

How Does the Loss of Five Insurance Carriers In Indiana Affect You?

IBJ The state of Indianapolis recently lost five individual health carriers from the market. For those working in the health insurance industry, this comes as no surprise. Below are the five companies that exited and the reasons for their departures: American Community Mutual Insurance Co. American Community left Indianapolis due to insolvency. The company had […]

Bad News for Children on Medicaid and Health Care Reform.

Forbes reported on the Government Accountability Office study children on Medicaid have lower access to health care and quality. The study showed that Medicaid patients are 13% more likely to die than uninsured patients in a hospital. 66% of children covered by Medicaid were denied appointment with a specialist for an urgent medical condition.  The physicians do not […]

Accountable Care Organizations

Chicago Tribune Accountable Care Organizations are starting gain traction.. Chicago looks like they have cut a deal with Anthem Blue Cross of Illinois to the ACO model in place. The ACO model is going to have physicians accountable for care. The physician will be rewarded for positive outcomes with patients. This is a huge jump […]

MLR’s Negative Effect

  The Medical Loss Ratio of the Health care Reform law is having a negative effect on carriers entering or staying in new markets. What has happen is a carrier will go into a new market and that block of business is profitable.  So let’s say they are operating at a 70% loss ratio. Under the […]

Health Insurance Mystery Shopper

The Hill Health and Human Services have canceled their “Mystery Shopper” program. This program was to give HHS information on getting Doctor Appointments. They wanted information on how long someone would have to wait to be seen. They would call a medical practice and state they had Medicare, Medicaid, & Private Insurance to see if waiting […]