Category News

  As of June 1st 2010 the COBRA Subsidy has expired.

The program provided individuals who involuntarily lost their employer-sponsored health insurance benefits with a 15-month 65% subsidy of their COBRA health insurance premium.

Going forward all new COBRA Eligible people will have to pay the entire premium. All eligible individuals that are still in their 15  month period will still continue to receive the subsidy.Without the subsidy we should see a huge drop off of COBRA participants. The reason is most people will be able to go out to the individual market and pick up polices that have much lower premium. Some people will have to take the COBRA if they have major ongoing health conditions.  Even with ongoing conditions there are options available.
 

   
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Recently Wellpoint took some really bad press on the treatment of Breast Cancer. Some of that bad press was wrong. Anthem was accused of purposely rescinding policies of women diagnosed with breast cancer. This accusation was really way out of bounds. Wellpoint has paid for the treatment 10 of  thousands of women who have suffered from Breast Cancer.  So I think its appropriate that Anthem is implementing the key provisions of this new act.

WellPoint, Inc. (NYSE: WLP), the nation’s largest health insurer by medical membership, announced today it will unilaterally implement key provisions of the Breast Cancer Patient Protection Act introduced by U.S. Rep. Rosa DeLauro. These new provisions include more transparent benefit language including clear explanations of benefits to members with breast cancer, and the provisions standardize minimum recovery times in the hospital for women recovering from mastectomy.

The adoption of these provisions builds on WellPoint’s existing leadership in breast cancer treatment. While variability exists within clinical guidelines and state regulations, the vast majority of WellPoint’s members already receive the standard of care indicated in the legislation. However, WellPoint believes that applying this universal minimum standard will both benefit our members, as well as encourage others in the industry to follow and adopt this standard. Beginning July 1, 2010, WellPoint will standardize clinical guidelines for women recovering from mastectomy to offer a voluntary 48-hour minimum in-hospital stay.

“Women recovering from breast cancer surgery will decide, in consultation with their physicians, whether hospitalization for 48 hours is required,” said Sam Nussbaum, Chief Medical Officer, WellPoint. “We are committed to making medical coverage decisions for women with breast cancer that are in accord with the latest scientific evidence and clinical research. It’s important for us and our members that WellPoint continues to lead in this area,” he added.

“We continue to work with the American Cancer Society and academic thought leaders to gain real-world knowledge of breast cancer treatments to shape improvements in care for women with breast cancer,” said Nussbaum. “Our goal is to ensure that our members receive optimal care.”

WellPoint also champions effective member communication and transparency regarding breast cancer diagnosis and treatment options. More than 3,000 nurses and clinical associates work with members daily, to encourage detection of breast cancer at its earliest stages and to ensure that members are receiving the best breast cancer treatments available. Toward that end, WellPoint is taking steps to provide comprehensible, straight-forward explanations of benefits so that members more clearly understand their treatment options.

“WellPoint works to ensure that all of our members are getting best practice care,” said Dijuana Lewis, Chief Executive Officer of WellPoint’s Comprehensive Health Solutions business unit. “We are especially proud of our record in improving care for women with breast cancer in this country and believe these added measures will increase the quality of care that our members receive.”

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Congress is poised yet again to consider another extension of the current May 31, 2010, eligibility deadline for the COBRA subsidy program provided under the American Recovery and Reinvestment Act (ARRA).

Eligibility for the Federal COBRA premium subsidies would be extended through year-end and employers would have more time to fund their pension liabilities under a tax bill that the House could vote on this week.

Under the measure, the “American Jobs and Closing Tax Loopholes Act”, the 65 percent, 15-month COBRA premium subsidy program would be extended to involuntarily terminated employees through December 31, 2010.

Without congressional action, employees who lose their jobs after May 31 will not be eligible for the subsidy.

If passed by the House, the act would move to the Senate for another vote. It remains uncertain when the proposed act will be reconciled in a final bill and seems unlikely that this will come before Congress breaks for its recess May 29 through June 6, 2010.

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As it stands as of June 1st  the Medicare Reimbursement rate for Medicare is going to be reduced 21%. This means the Doctors and Hospitals are going to be paid 21% less for treating Medicare patients. This is going to have a huge impact on physicians practices.

What could happen is Doctors will not be able to take on any new Medicare patients. Thus we could see rationing.

It’s very important if you or your family member are on Medicare that you contact your Doctor to make sure they know you. You want to build a relationship with the Doctor so that you are not treated as a number. Also prepare yourself for longer waiting times for treatment.

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The House prepares for action on a physician payment fix while the administration trudges through early implementation steps for a new health coverage law.” Notably, “this week marks the two-month anniversary of its enactment on March 23.” The law’s “implementation gets slower as the wheels of regulatory agencies churn through new rule making…prior to a September 23 benchmark deadline, six months after enactment of the law. Two reports released this month documented some expected market forces that will affect the law’s cost and effectiveness,” including a “report on an AARP study that drug prices have spiked over the past 12 months

The physician payment fix is a very big issue of healthcare. As of June 1st the reinbursment rate for Doctors treating medicare patients will be reduced 21%. This is going to have a huge impact on doctors and hospitals.

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This is interesting that the house speaker would criticizes the Governor on the Healthy Indiana Plan.  When responsible leaders makes a decision to limit the enrollment into a subsidized health plan it usually comes down to math.  There are actuaries that can  predict what its going to cost to fund claims on a large group of people. Then we add into the equation a large group of people that are unable to get coverage elsewhere. So now we have a group of people that are high utilization which mean very high healthcare cost.  If you continue to add people to that plan how do you fund it?

INDIANAPOLIS — House Speaker Pat Bauer say Gov. Mitch Daniels has “obliterated” the state’s Healthy Indiana Plan by limiting new enrollment in the program.

Bauer said Tuesday that the action Daniels took in March after Congress passed the health care overhaul has hurt about 30,000 Hoosiers who he said cannot get health care coverage though other means.

Daniels ordered the Family and Social Services Administration to freeze enrollment for childless adults in the state’s medical saving accounts, saying the federal legislation will put 500,000 more residents on Medicaid and lead to higher state taxes.

Agency spokesman Marcus Barlow says no one has been removed from this plan, but enrollment is capped.

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The small group tax credit, which will benefit millions of small businesses, has just become more attractive. That’s because the IRS has just released new details clarifying that the tax credit also applies to premiums for dental and vision benefits – not just health benefits. And there’s more good news:

  •  Eligible companies that already get state tax breaks to help pay premiums can also claim the federal assistance.
  • A business owner’s salary won’t be taken into account when figuring out the company’s average wages – helping more firms stay below the cutoff for the federal credit. To qualify for the credit, companies must not employ more than 25 employees and the average annual compensation of those employees cannot exceed $50,000.
  • Nonprofits – including churches and other religious congregations – are eligible to claim a partial credit.

See the latest information at irs.gov.

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The excise tax was included in the Patient Protection and Affordable Care Act (PPACA) passed into law on March 23, 2010. The provision levies a 40% nondeductible tax on the annual value of health plan costs for employees that exceed $10,200 for single coverage or $27,500 for family coverage in 2018. Data reveals that the average 2010 cost of medical coverage for active single and family plans is $5,184 and $14,988, respectively. When these figures are projected out to 2018 with reasonable estimates of future health care inflation, the excise tax is often triggered.

As a result of the excise tax provision, a plan with single coverage costs of $11,200 in 2018 would exceed the limit by $1,000 and be assessed a tax of $400. If 10,000 employees were enrolled in that plan, the total tax bill would be $4,000,000. The tax is paid by the employer either through increased premiums on an insured plan or a surcharge levied by the administrator of a self-funded health plan. Employers will be forced to either absorb the additional tax or pass some, or all, of it back to employees in the form of higher premiums.

Health care reform’s so-called “Cadillac plan” excise tax will affect more than 60% of large employers’ active health plans by the provision’s 2018 effective date.

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New study show a large increase of Health Savings Account plans. These type of major medical plans are becoming popular because they create a reduction in premium. Consumers are starting to look at health insurance for major medical events and then small claims fall on to them. When the consumer now pays the first $2,500 in claims in a plan year they are more likely to shop out a minor procedure. If one needs an MRI on your knee its amazing to see the different charges for the same procedure. It very common to a $2,000 difference in price from the cheapest to the highest charge.  Looking at the HSA in another  way is you have your deductible to meet and that is it. So you know as a policy holder your worst case scenario in claims in one year is your deductible. Consumers have an easier time budgeting for just the deductible. The last reason we are seeing a large increase in HSA plans is the tax benefit side. Now all of your medical expense are tax deductible. So if you fund you HSA custodial account you can write off your contributions.Ten million Americans are covered by Health Savings Account (HSA)-eligible insurance plans, an increase of 25 percent since last year, a new census released today by America’s Health Insurance Plans (AHIP) finds.  Health Savings Accounts were authorized starting in January 2004.  Since then, AHIP has conducted a periodic census of health plans participating in the HSA/high-deductible health plan (HDHP) market.“HSA plans continue to be an important coverage option for families and small businesses across the country,” said Karen Ignagni, President and CEO of AHIP.

Key findings from the census include:

•           As of January 2010, approximately 10 million people were covered by HSA/HDHP products, an increase of 25 percent since last year.

•           Between January 2009 and January 2010, the fastest growing market for HSA/HDHP products was large-group coverage, which rose by 33 percent, followed by small-group coverage, which grew by 22 percent.

•           Thirty percent of individuals covered by an HSA plan were in the small group market, 50 percent of individuals covered by an HSA plan were in the large-group market, and the remaining 20 percent were in the individual market.

•           In the individual market, 2.1 million covered lives are enrolled in HSA plans, while nearly 3 million lives were enrolled in HSA/HDHP coverage in the small-group market and almost 5 million lives were covered in the large-group market.

•           States with the highest levels of HSA/HDHP enrollment were California (1,018,000), Ohio (651,000), Florida (639,000), Texas (637,000), Illinois (575,000), and Minnesota (361,000).

For more information about the 2010 HSA/HDHP census, please visit www.AHIPResearch.org.

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The Medical Loss Ratio is very critical to the health insurance industry. This MLR is going to have a huge effect on carriers profits and how they operate. In fact we could see some carriers drop out of certain markets reducing the already limited choices of carriers. The HHS has to clarify the laws on  the MLR. These laws going into effect as of Jan1st 2010 so we are getting down to the wire on explantions.

The National Association of Insurance and Financial Advisors (NAIFA) has again partnered with The Council of Insurance Agents & Brokers (CIAB), the Independent Insurance Agents & Brokers of America (IIABA), and the National Association of Health Underwriters to provide comments to the Department of Health and Human Services regarding the development of Medical Loss Ratios (MLRs) in section 2718 of the Public Health Service Act.

The groups are concerned that the narrow MLR definitions would adversely impact spending on such important health plan activities as case management, wellness, disease management, and fraud and abuse prevention programs, among others.

The group asserts, “It is important to spend time clearly defining clinical series and administrative costs to allow insurance carriers to provide an array of services that will improve the health of Americans and provide them the health care they deserve – effectively and efficiently – including the important services provided by licensed health insurance agents, brokers, and benefits consultants.”

Read the group’s full comment letter on the development of Medical Loss Ratios at www.naifa.org/advocacy/documents/05172010_2718.pdf.

About NAIFA: The National Association of Insurance and Financial Advisors comprises more than 700 state and local associations representing the interests of approximately 200,000 agents and their associates nationwide. NAIFA members focus their practices on one or more of the following: life insurance and annuities, health insurance and employee benefits, multiline, and financial advising and investments. The Association’s mission is to advocate for a positive legislative and regulatory environment, enhance business and professional skills, and promote the ethical conduct of its members

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