Tag Indianapolis Group Health Insurance


Skyline of Indianpolis. This photo was also ta...

Indianapolis Delays Essential Health Benefits

The Essential health benefits must include items and services within the following 10 categories: Ambulance, Emergency Services, Hospitalization, Maternity, New Born Car, Mental health and substance abuse, behavioral health, Prescriptions, Rehabilitative, Laboratory, Preventive, Disease management, Pediatric with oral and vision.

This is a very big part to the Affordable Care Act. These coverage’s will have a huge impact on both cost and quality of care. At first, the federal government was to establish the benefits. They decided to pass the responsibility down to the state level.

The essential benefits is one of the main aspects that will impact health insurance premiums. If a gastric bypass surgery was to consider an essential benefit. Every Hoosier that needed this surgery would have it covered. Does not matter if you are on a private insurance plan, Medicaid, or Medicare it would have to be covered. Having this one benefit covered could increase the premium for everyone by 1%. 1% does not sound that bad! Now think about more than a hundred different procedures or services that have to be covered. Now we are talking about 100% increase in premium cost! This is the impact the essential benefit will have on every Hoosier and US citizen.

Indianapolis Department of Insurance is delaying the establishment of the essential benefits. They are listing the lack of clarity from the federal government as the reason why. They also list 16 questions that the federal government has not answered.

The questions range from clear deadline for establishing the benefits to premium tax credits for individual dental plans. To most Hoosiers this is boring insurance law but this is so very important to every one of us. This will impact cost and care to all of us.

To have 16 big questions unanswered at this time is very concerning.

Read More

Senate Passes Insurance Industry Aid Bill

NY Times reported a interesting view on health care reform.  They are reporting a glitch in the health care law.

Under the Affordable Care Act, if an employee has access to group health benefits, then their dependents are not eligible for subsidies through the exchange. This is basically the short version of the argument. This aspect of the law have been interpreted by both the IRS and Congressional Joint Committee on Taxation.

The so called “glitch” is that a employee may be able to afford their portion of the premium, on a employer sponsored health plan but not the dependent portion.  In Indianapolis, an employee only contribution, maybe below $1,000 a year. Now if we add the dependents to the plan the cost may very well jump to $7,000 year. A lot of Indianapolis small group and mid size companies, the employer has gone with the philosophy to pay the for the employee. The lower pay employees, then are unable to afford to put their families on the plan. This is 100% a legit issue.

These dependents will not qualify for subsidies under the health care reform. The reason the law was written this way is to keep some type of retention on employer sponsored plans.

In Indianapolis, we are going to see a lot of employers with under 50 employees consider dropping group health coverage in 2014.  There is going to be many health insurance and legal factors a decisions maker will consider. If the employee base are low wage earners, then the employer may be doing the employees a favor by dropping coverage. This will give the low paid employees full access to subsidies. So the argument could be made that if this is not fixed then it will lead to groups dropping coverage.

This is just one of many issues we are going to face in Indianapolis when it comes to health care reform

Read More

Mike Pence recently sent his letter to Gov. Daniels regarding the development of  a state based exchange.

Governor Elect Mike Pence, has choose not to establish a state based exchange.  He stresses the lack of clarity coming out of the federal government. Indianapolis developed the health Indianapolis plan that has been very successful, form a cost stand point while keeping insureds satisfied. There are over 40,000 Indianapolis residents on this plan. The state of Indianapolis wanted to be able to offer this plan in a state based exchange. At this time, that plan is not an option with in the exchange.

The letter also points out the tax increase that will impact Indianapolis residents and businesses.  We are going to see tax increases for medical devices manufacturers, individual mandate, employer mandate, Medicare tax, & tax on investment properties.  Every Indianapolis resident is going to feel the impact of these tax increases.  There is a new 3.8% tax on investment property income. No one except Mike Pence is talking about this tax increase.

Mike Pence states in the letter that the health care law is going to lead to more dependence on federal subsidies for Hoosiers. This could happen as individual health insurance premiums almost double.  Under the health care law there will be subsidies available and a majority of people could qualify for this assistance.

The letter also state the uncertainty of how a state based or federal exchange is going to operate. There is a fear of the Federal Government is going to micro managing a state based exchange.  If  Indianapolis does not have the flexibility to add the Health Indianapolis Plan that is a huge red flag.

The cost of operating the exchange is a huge unknown. There have been estimates from $44-$88 million a year. The current state administration does not know where that funding is going to come from.

If Mike Pence becomes the next Governor of Indianapolis, you can expect to have a Federal Facilitated Exchange. At this time we do not know how the exchange will operate.  In the next few months more details should come out on how the Federal Exchange will operate.

Read More
The Indianapolis State House
The Indianapolis State House

The next Governor of Indianapolis is going to have a huge impact on health insurance in the state.

The first decision the Governor will have to make is on the Essential Benefits. It is the responsibility of each state to form the Essential Benefits.  The essential benefits are a set of health care service categories that must be covered by health insurance plan in 2014. The essential benefits will have a huge impact on health insurance premiums.   For example, if the state decided one of the essential benefits is that fertility treatment must be covered.  This would be a great benefit for Hoosiers that needed that coverage but everyone would pay a higher premium.

The 2nd big decision by the Governor is on establishing a state based exchange. Under the new health care law, a state based exchange can be established for people to buy health insurance policies from.  This is a very big decision. The cost of running a state based exchange is anywhere from $66-$88 Million a year.  The Department of Insurance has not clarified where this money would come from. If the state chooses  not set up a state based exchange then the federal exchange will operate in Indianapolis. The Federal Government has not released a lot of information on how that exchange will operate. It is fair to say the department of insurance will have little control over the federal exchange.

The next Governor of Indianapolis, will make health insurance decisions that will effect every Indianapolis resident.

Read More

Under the Health Care Reform there are new preventive care benefits that every Non Grandfathered policy will have to cover. Some of these benefits will be covered at no cost to the insured. It’s very important that you consult your current coverage to determine if these new benefits will be covered. There will be some plan that do not cover these benefits.

Some Indianapolis based insurance companies will not have grandfathered plans. Each health insurance carrier operating locally will determine if they can administer grandfathered and non grandfathered plans. Self Funded plans my also be exempt.

It’s very important to know your current benefits. When seek wellness visits it extremely important to know what is covered and what could end up not covered.  Some times our medical providers may not be well versed on coverage changes. Check with your health insurance carrier.


A pregnant woman
A pregnant woman (Photo credit: Wikipedia)


From Healthcare.gov, the federal government’s site providing basic information on health care reform, including PPACA:


Preventive Services for Adults – Including Senior Citizens

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

Alcohol Misuse screening and counseling

Aspirin use for men and women of certain ages

Blood Pressure screening for all adults

Cholesterol screening for adults of certain ages or at higher risk

Colorectal Cancer screening for adults over 50

Depression screening for adults

Type 2 Diabetes screening for adults with high blood pressure

Diet counseling for adults at higher risk for chronic disease

HIV screening for all adults at higher risk

Immunization vaccines for adults- -doses, recommended ages, and recommended populations vary:

Hepatitis A

Hepatitis B

Herpes Zoster

Human Papillomavirus

Influenza (Flu Shot)

Measles, Mumps, Rubella



Tetanus, Diphtheria, Pertussis


Learn more about immunizations and see the latest vaccine schedules.

Obesity screening and counseling for all adults

Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

Tobacco Use screening for all adults and cessation interventions for tobacco users

Syphilis screening for all adults at

Covered Preventive Services for Women, Including Pregnant Women

Note: Services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012. See Affordable Care Act Rules on Expanding Access to Preventive Services for Women.

Anemia screening on a routine basis for pregnant women

Bacteriuria urinary tract or other infection screening for pregnant women

BRCA counseling about genetic testing for women at higher risk

Breast Cancer Mammography screenings every 1 to 2 years for women over 40

Breast Cancer Chemoprevention counseling for women at higher risk

Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*

Cervical Cancer screening for sexually active women

Chlamydia Infection screening for younger women and other women at higher risk

Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*

Domestic and interpersonal violence screening and counseling for all women*

Folic Acid supplements for women who may become pregnant

Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*

Gonorrhea screening for all women at higher risk

Hepatitis B screening for pregnant women at their first prenatal visit

Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*

Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*l Osteoporosis screening for women over age 60 depending on risk factors

 Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

 Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

 Sexually Transmitted Infections (STI) counseling for sexually active women*

 Syphilis screening for all pregnant women or other women at increased risk

 Well-woman visits to obtain recommended preventive services for women under 65*

 Behavioral assessments for children of all ages

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

Blood Pressure screening for children

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

Cervical Dysplasia screening for sexually active females

Congenital Hypothyroidism screening for newborns

Depression screening for adolescents

Developmental screening for children under age 3, and surveillance throughout childhood

Dyslipidemia screening for children at higher risk of lipid disorders

Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

Fluoride Chemoprevention supplements for children without fluoride in their water source

Gonorrhea preventive medication for the eyes of all newborns

Hearing screening for all newborns

Height, Weight and Body Mass Index measurements for children

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

Hematocrit or Hemoglobin screening for children

Hemoglobinopathies or sickle cell screening for newborns

HIV screening for adolescents at higher risk

Immunizationvaccines for children from birth to age 18 -doses, recommended ages, and recommended populations vary:

Diphtheria, Tetanus, Pertussis

Haemophilus influenzae type b

Hepatitis A

Hepatitis B

Human Papillomavirus

Inactivated Poliovirus

Influenza (Flu Shot)

Measles, Mumps, Rubella






Learn more about immunizations and see the latest vaccine schedules.

Iron supplements for children ages 6 to 12 months at risk for anemia

Lead screening for children at risk of exposure

Medical History for all children throughout development

Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.

Obesity screening and counseling

Read More

Wellness Video

Above is a video that address some of the new changes for women’s preventive services covered under the new health care law.  In the past there has been coverage for these procedures but it was at a shared cost to the insured. Under PPAC these coverage are now covered at 100% with no cost to the insured as long as they stay in network.  For health insurance most providers are participating in the national networks like UHC and Anthem. Finding a network provider to perform these services should not be an problem, but it is always important to ask  the attending physician if they are participating in your network.  If  you are on a health plan that was established prior to 2010 you may want to check to see if these benefit are covered.


Women’s health

The following guidelines for women were effective for plan years beginning on or after Sept. 23, 2010:

  • Mammography screening (film and digital) for all adult women*
  • Genetic screening and evaluation for the BRCA breast cancer gene
  • Cervical cancer screening including Pap smears
  • Sexually transmitted diseases screening including gonorrhea, Chlamydia, syphilis and HIV
  • Iron-deficiency anemia, bacteriuria, hepatitis B virus and Rh incompatibility screening in pregnant women
  • Breast-feeding counseling and promotion
  • Osteoporosis screening (age 60 and older)*
  • Counseling women at high risk of breast cancer for chemoprevention

Expanded women’s preventive care services on or after Aug. 1, 2012

New coverage guidelines under the Patient Protection and Affordable Care Act (PPACA) require health plans to cover an expanded list of women’s preventive care services with no cost-share (copayment, coinsurance or deductible) as long as services are received in the health plan’s network. Coverage for the following expanded women’s preventive care services becomes effective the first plan year beginning on or after Aug. 1, 2012:

Read More


Walgreen’s rejoins Anthems Network

Anthem just announced that Express scripts and Walgreen’s have reached an agreement.  Anthem members can use the Walgreen’s pharmacy as they will be considered a in network provider.

Walgreen’s is a great provider of pharmacy benefit in the area. It is important to remember to check local pharmacies for the most competitive prices on medications.  The large pharmacies can sometime have the most expensive prices. If you are on a Health Savings Account it makes sense to be a consumer shopper for RX.  Comparing prices of local pharmacies might bring large savings to you.

Read More


2005 US cent, obverse side]

Healthcare.org has released the medical loss ratio for all health insurance companies operating in Indianapolis. It is interesting to see just how close the carrier are to the 80% or 85% loss ratio. With all of the tools the carriers use to keep cost down it is surprising that the loss ratios are not lower.  This is just another indicator how expensive medical care is.

  • Medical Loss Ratio: Insurers must, in general, spend 80% or 85% of the premium dollars they take in on health care costs and health care improvement activities. If they do not, they must provide refunds to policy owners.


Advantage Health Solutions, Inc.http://www.advantageplan.com

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: Not Applicable Not Applicable Not Applicable
Small Group Market: 95.8% 80.0% Not Applicable
Large Group Market: 93.5% 85.0% Not Applicable


Anthem Ins Companies Inc(Anthem BCBS)http://www.anthem.com

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: 81.8% 80.0% Not Applicable
Small Group Market: 79.2% 80.0% $61.00
Large Group Market: 92.4% 85.0% Not Applicable


Golden Rule Insurance Companyhttp://www.goldenrule.com/hhs

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: 76.4% 80.0% $130.00
Small Group Market: Not Applicable Not Applicable Not Applicable
Large Group Market: Not Applicable Not Applicable Not Applicable


Medical Mutual of Ohio www.medmutual.com

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: 82.1% 80.0% Not Applicable
Small Group Market: 81.5% 80.0% Not Applicable
Large Group Market: 115.5% 85.0% Not Applicable



Time Insurance Company http://www.assuranthealth.com

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: 77.7% 80.0% $121.00
Small Group Market: Not Applicable Not Applicable Not Applicable
Large Group Market: Not Applicable Not Applicable Not Applicable


UnitedHealthcare Insurance Company http://www.uhc.com

Insurer’s MLR MLR Standard Average Rebate Per Subscriber (If MLR Standard Not Met)
Individual Market: Not Applicable Not Applicable Not Applicable
Small Group Market: 82.5% 80.0% Not Applicable
Large Group Market: 87.6% 85.0% Not Applicable
Read More


English: President Barack Obama discusses his ...

In Indianapolis, the health care law will have a huge impact on Hoosiers health insurance along with the rest of the country. Thursday the Supreme Court is expected to rule on the health care reform law. Many residents are questioning the true impact of the health care.

A famous quote was “We have to pass the bill so that you find out what’s in it” House Speaker Nancy Pelosi. People are starting to realize the health care reform is not living up to expectations.

The main selling points of the law.

1st It would bring down the cost of health care. The President said families would save on average $2,500 a year on their premiums.

According to the Kaiser Family Foundation, The health care law has already increased the cost of health insurance and most of the law in will not go into effect until 2014.  6 out of 10 Americans have seen premiums rise for families on average of $1,300 a year. So the costs are going up and the bill is not even in full force.

2nd  President Obama said “If you like your doctor, you will be able to keep your doctor, period. If you like your health plan, you will be able to keep your health plan, period. No one will take it away, no matter what.” This is not the case. The latest report from The Congressional Budget Office says up to 20 million American could lose their employer- provided health insurance as a direct result of the health care reform. 

3rd The President stated that that cost of the health care reform was under a Trillion dollars. The CBO say the health care will cost $1.76+ Trillion over the next decade.  That is a $800 billion mistake.

When we look at the few positive aspects of the law they are really overshadowed by the negative.

Every resident should be paying attention to the Supreme Court Ruling.

Read More


US truck - California 2007
Long Ways to Go Short Time to get There

Indianapolis small trucking companies can face difficulties providing a group health insurance. There is variety of reason why this is. The biggest obstacle is participation. Many truck drivers will not pay large portions of their premium. This industry can sometimes have higher claims utilization than which lead to higher premiums. The higher premium then will reduce the participation in a company sponsored health plan.

There are a few ways to overcome the participation issue.

The first one is for the employer to pay the majority of the premium.  I know that might not be a feasible option but there are plan designs to offset the cost. Why not entertain a multi choice or dual option plan. The base plan would be the plan that employer pays the largest percentage of. Then buy up option for any employee that would like richer benefits.

A group health plan for a trucking company is an investment into the employees. So why not treat it that way.  If you are able to recruit the best drivers with the lowest infraction why not reward them with benefits.  These divers are making your company successful which increase the companies rating which could lead to more jobs.  Why not pay the majority of their premiums? View the health insurance plan as a way to recruit and retain the best drivers.

There is other option available other than these two.

Contact us and let’s have a conversation.

Read More