Tag Indianapolis Group Health Insurance

You know social media has caught on when the health insurance industry has embrace it. It’s amazing to see so many people communicating about health insurance through facebook and tweeter.

www.healthcare.gov   Set the tone with health insurance when they created a facebook page to  communicate their message about the new health care law. Then on a opposing view point http://www.healthactionnetwork.com/  also uses facebook to talk about the health care law.  This is just two examples there are many more companies both for profit and non profit using the social media plat form to talk about health insurance.

These out lets are also being used to bring people to health insurance websites either to sell them or to inform them.

We are seeing some possible content problems with posted information.

Nefouse and Associates has been online providing Indianapolis health Insurance for over 11 years and the social media movement is changing how health insurance topics are communicated.

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HHS has commissioned the Institute of Medicine to conduct  a study on the Essential health Benefits of the health care law.  They are to recommendations will lead to how Essential health benefits are determined. This is a huge aspect of the law. Right now we have an idea of what these essential benefits are.  Anthem Essential Health Benefits   There is real concern on transparency with the HHS on this topic. When these benefits are determined it will have a huge impact on Health Insurance. 

1. Elimination of lifetime limits on essential health benefits (effective for plan years starting on or after September 23, 2010)

2. Restricted annual limits on essential health benefits (effective for plan years starting on or after September 23, 2010)

3. Requirement that employers of 50 or more employees provide minimum essential coverage that includes the essential health benefits package (effective in 2014)

4. Requirement that qualified health plans offered in exchanges include the essential health benefits package (effective in 2014)

Allergy injections and/or testing


Ambulatory surgical services

Asthma education

Bariatric surgery

Cardiac rehab

Chiropractic manipulation services and/or osteopathic manipulation

Diabetic supplies and glucometers

Diagnostic services

Dialysis and kidney disease treatment

Durable medical equipment, medical equipment and supplies, oxygen

Emergency room services

Enteral formula and modified low protein food products

Hearing aid

Home health care


Infusion therapy, home infusion therapy

Inpatient or outpatient facility services

Inpatient rehab/physical therapy


Mental health/substance abuse inpatient and/or outpatient

Office visits

Ostomy supplies

Outpatient occupational therapy

Outpatient physical therapy

Outpatient speech therapy

Pharmacy and prescription drugs/injections

Preventive care and preventive screenings

Prosthetic devices or limbs

Pulmonary or respiratory rehab/therapy

Skilled nursing

Surgical and anesthesia services

Transplant service

Treatment of TMJ


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The Administration of the new health law sent a memo out giving  Flexibility for State Run Exchanges. This is in response to the Governor’s Letter to HHS early this week.

The memo is stating that the states already have the power to set up the exchanges as they see fit. The Governors letter points out some serious issue and there need to be more than just memo addressing them.

The exchanges are going to change the way people purchase health insurance and what option they have available. There is real concerns that the exchanges will not be competitively priced. There is also some fear that the carriers could decide not to participate in the exchanges but compete against it.

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Most universities offer some type of health insurance plan to the students. Most of these plans would be consider Limited liability health plans. The usually are guaranteed issue. Well now under the new health care law all of these plans will have to adapt to the new health care laws. College Students Health Insurance

This will create some very interesting situations. The first impact will be a huge increase in premium.  Once these plans become true health insurance products they will no longer be able to offer low premiums.  There are many college student groups that are praising this measure but will they still be happy when they see the new premiums?

It will be very interesting to see what kind of changes these plans adopt.

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Right now there is a lot of confusion on how the health insurance exchanges are going to be set up. There are states like South Carolina that have told the Federal Gov. they will not set up an exchange because they do not believe the law is constitutional. Then there are states like California that are on the fast track to set up an exchange. State Health Exchange

Then we here from conservative states that they want full control over how the exchanges are set up. They want waivers to the health care law so they can make plans affordable.Governor’s Letter to HHS

Now all of sudden we hear politicians talking about removing funding for the health care law so that implementation has to stop. Defund Health Law

Next the white house is stating that they are not backing down from the individual mandate. White House Supports Mandate

It’s very hard at this time to get a clear picture of where health insurance and health care is going.

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Governor’s Letter to HHS

Here is the Governor’s letter to  Kathleen Sebelius Secretary U.S. Department of Health and Human Services.

This letter is stating that the states should have the right to setup the health exchange without the federal governments mandates.  This is a huge statement!  These governors realize that the federal mandates will make the plans in the exchange unaffordable. So the states want to develop the plans with cost in the equation. Not everyone needs or wants the same level of benefits.

The other major factor here is the medicaid. The states cannot afford the expansion of medicaid either in enrollment or increased benefits.

The list of Governor’s that signed
Governor Rick Perry of Texas
Governor Gary R. Herbert of Utah
Governor Scott Walker of Wisconsin
Governor Dennis Daugaard of South Dakota
Governor Bill Haslam of Tennessee
Governor Tom Corbett of Pennsylvania
Governor Nikki Haley of South Carolina
Governor Terry E. Branstad of Iowa
Governor Sam Brownback of Kansas
Governor Bobby Jindal of Louisiana
Governor Paul R. LePage of Maine
Governor Haley Barbour of Mississippi
Governor David Heineman of Nebraska
Governor Brian Sandoval of Nevada
Governor Susana Martinez of New Mexico
Governor John R. Kasich of Ohio
Governor Mary Fallin of Oklahoma
Governor Robert J. Bentley of Alabama
Governor Nathan Deal of Georgia
Governor C.L. “Butch” Otter of Idaho
Governor Mitch Daniels of Indianapolis

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If you are a small business owner or a controller of a small group then you have had to deal with participation on the group health plan. The particapation issue commes up with groups that have high premiums. The high prmiums could be the result of many different things. This post is about how you tackle the problem of particapation so the group stays compliant.

 If a group is running rich benefits then some of the employee are unable to afford their portion of premium.  This can happen when small group owners are more concerned about their families benefits than the entire group. There are a couple of fixes that might help here and the first one is to have the employer pick up a larger portion of the premium.  This is not a popular fix with owners! The 2nd is to look at changing the plan design to make premiums more affordable. This comes in the form of cost shifting.

Another issue that can add to lack of participation is employer contribution. If the employer pay 50% of the employee portion that might work for most of the company but if there are lower compensated employees this could be a problem. It’s important to look at contribution levels to see if they are realistic for all of the employees.

Aging population can add to a decline in participation. If a group is running age base premium rates then it can be difficult for older employees to afford them. A easy fix to this is composite rates where all the employees pay the same rate. Now composite rates can all have a negative impact on younger employees. If the premium is averaged out then some of the younger employee could go out to market and pick up individual plans. These type of situations one really has to look at the demographics of the group.

High claims can be the big obstaclefor a small group or any group for that matter. High claims can increase the premiums very quickly and then all of your healthy people come off the plan because of high premiums. This is a form of adverse selection. When high claims become obviously a owner or controller has to get to work. Tough decisions have to be made about plan design, wellness programs, and disease management.  If high claims are not addressed the group health plan can go into a death spiral with in a couple of years and then you have no more group health plan.

We have seen all of these situations and more when it comes to participation. Carriers do have the ability to audit your group for participation and they can drop you if you do not get compliant.

Keep an eye on your participation!

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I listened very closely to the speech given by our president on the State of the Union. I concentrated very closely on the small portion dedicated to  health insurance.  The speech was very broad and in a sense contradictory to the Presidents actions for the last two years.

The fact the President stated that he is open to idea to fix the current law is a huge stepping point. There is so much in the  law that is wrong. We are still waiting for clarification on about 1000+ of the law.  Right not politicians are only speaking about a handful of things that are good for the individual in the law from a coverage standpoint.  When the President spoke about removing the 1099 aspect of the law for small business I thought that was great.  From a Math if you remove those taxes what is the Gov. going to tax next?  The health care law created 149 new gov. agencies. So it was difficult for me to hear the President talking about making Gov. more efficient.

When the true cost of this law comes to light I think most people are going to be in for a huge shock.  There is major concerns with the states and how they are going to pay for the expansion of medicaid. This year a lone we have seen premiums go up and not down and this came from the health care law and the essential benefits.  This health care law could implode our entire medical system because of cost.

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If you are the controller or an owner of a small business there are  major decision you will have to make on an employee health insurance. The one that I will focus on here is age based vs composite premium calculations. These will impact your employees.

Age base premium is exactly what they sound like. The premium is calculated by your age. So the younger employee benefit with this because they pay less in premium. The older employee pays much more.

Composite rates are an average of the employee ages. So every employee pays the same amount.

There are pros and cons to both approaches. Composite is much easier to administer because everyone pays the same price. The age based makes it much cheaper for younger employees which can help with retaining young health people on the plan.

Each case is different but these are things to think about when establishing a plan or renewing a group health plan.

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It’s very important that we continue to talk about health care reform. Ask people that are in the health care equation. Speak to your Doctor, Nurse, Pharmacist, and Insurance broker.  It’s important for everyone to know what the people in the health care field think about the current reform laws. Right now there is a lot of debate going on with politicians using examples of both pro and con that might not really be truthful.  Speak to the people you receive health services from.

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