Category News

Unitedhealthcare has a non profit called UnitedHealthcare Children’s Foundation. This organization gave out 800+ grants in 2010 to families that had children with ongoing health conditions. Families can qualify to receive up to $5,000 to help pay for medical services and equipment. Some of these services could be occupational & speech therapy, counseling services,surgeries, RX and durable medical equipment.

For the last couple of years we have heard so much about how terrible the insurance industry is and some of it is justified but here is a situation where the carrier is giving back. 




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The budget agreement that was reached last week has defund Free Choice Vouchers of the new health care law. Most people have no clue what these are.

A free choice voucher gave the employee the right to take a employer contribution for a group health care plan and apply that to a the exchange plan. The employee would be eligible for this benefit if they were spending more than 8% of house hold income on health premiums.

Here are a few issues with having this type of voucher system. How would the house hold income of an employee be tracked? Who would track it? What would it cost to track this information? There are a lot more issues with these vouchers.

Now that this aspect of the health care law is defund what impact will it have?

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The 1099 provision of the health care reform, which would have raised $19 billion to help pay for the law is on it’s way to being repealed. This aspect of the law would have required all businesses to file tax reporting for all vendors from which they purchased $600 worth of goods or services. Politico

This have been a hot topic issue since the law was passed. This type of reporting would take valuable resources away from small business.

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Concierge medicine is where you pay your doctor a retainer fee so that you may see then with very short notice. The avg fee is around $1,500 but can be as high as $5,000. This type of services is all so called boutique medical, retainer-based medicine, and innovative medical practice design.

There are some real Medicare worries about this type of program. If a medicare doctor is willing to put this type of program in place this could be a crushing blow to health care reform.

With health care reform we will see a huge increase in insured people who know utilize  medical services. If Doctors go with this type of Concierge Medicine then the people that can pay will not see a rationing of care.  This could have a major impact on health care reform and rationed care.  If a doctor has 500 patients willing to pay that might be in the ball park of $750,000 a year.

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This is a really informative website on the health of each state. It even goes in dept to how healthy each county  is. It’s ranking the counties for healthy behaviors, clinical care , social & econmic, and physical enviorment. There is a serious relationship between and wealth of a county and how healthy they are.

If you are a controller of a  health plan then using these rankings could help with employee wellness programs.  If your employee base is located in a unhealthy county then you know these employees might  need more education on wellness and life style changes.

A site like this is really bringing awarness about health.

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In the small group health insurance industry there has been a huge increase in carriers auditing their clients.  The audit consists of the carrier requiring the client to provide up today wage n tax information. The carrier is looking to see if the group is still compliant form a participation standpoint.

In the past very few customers would receive an audit. In 2011 there has been a much higher increase from national carries like Anthem and UnitedHealthcare calling for audits on renewing groups. I think the high increase of audits might have something to do with the Medical Loss Ratio in the new health care law.  It is my belief that high claims groups might be targeted for these audits.  My view on this is pure speculation but I am seeing a trend.

In the past we would only see an audit if there was a large decrease in participation in the plan.

If you are the owner or a controller of a small group health plan be very aware of the audit. If your group is not meeting participation it might be time to address that issue before you are forced to.

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With the health care reform we have seen an exodus of stand alone children’s policies in the Indianapolis market.

Here at Nefouse & Associates we have found a short term solution to the problem. There is a company with A+ rating that will except children age 2-18 on a short term basis. The policy is good for up to 6 months so it’s not a long term solution but it is a short term.

Please contact us for more information.

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Agencies Postpone Claims and Appeals Enforcement

The Employee Benefits Security Administration (EBSA), U.S. Department of Health and Human Services (HHS), the U.S. Treasury Department,   Treasury Department agencies and the Labor Department have postpone the claims appeal process of the health care reform. They are stating they are having problems form a technical standpoint.  If you look at all of these agencies that are involved there is no wonder why they are having problems with this aspect of the new law.

The appeal process in a nut shell is the ability for an insured to appeal a claim that was declined in person with some type of board.  So an good example of this would be on experimental therapy. The insurance company could decline the claim because its considered experimental. With the new health care law anyone could appeal a denied claim and the law is suppose to set up the process for that appeal to happen.

Grandfather plans are exempt from the appeal process.

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