Archive for the ‘health care reform’ Category

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Health Care Reform Overhaul Update

Wednesday, October 20th, 2010

Last week, Health & Human Services Secretary Kathleen Sebelius issued a letter to the National Association of Insurance Commissioners expressing concerns about the approach some carriers have considered for child-only health insurance coverage. In particular, while endorsing the idea of open enrollment periods, she rejected the idea of denying sick children outside the open enrollment period, but accepting healthy kids year-round.

While Congress is in recess until the upcoming elections, we continue to closely monitor activity in Washington, contributing comments on a variety of issues directly as well as through trade organizations. Regulators continue to issue guidance and seek industry input.

Carved-Out Plans

Some employers may have structured their benefit offerings so that one type of plan is available for one group of employees, but another plan for other groups. For example, management may be offered only a PPO, while hourly workers can only take HMO coverage. This is sometimes called a “carved-out plan.” In other cases, “executive medical” policies may provide benefits supplementing the underlying group health plan by covering deductibles, copayments, etc.

Beginning with plan years on or after Sept. 23, 2010, the Affordable Care Act prohibits nongrandfathered fully insured group health plans from discriminating in favor of highly compensated individuals. Specifically, the Affordable Care Act requires that such fully insured plans satisfy the requirements of and rules similar to those of Internal Revenue Code Section (“IRC”) 105(h). Historically, the nondiscrimination requirements of IRC Section 105(h) only applied to self-insured plans.

Recently, the Department of Treasury published Notice 2010-63 requesting comments in preparation for possibly issuing guidance on applying IRC Section 105(h) to fully insured plans. The Notice indicates that group health plans that fail to comply with the nondiscrimination requirements of IRC Section 105(h) are subject to an excise tax of $100 per day per individual discriminated against for each day a plan is noncompliant.

Depending on the facts and circumstances and the nondiscrimination tests applied, some fully insured carved-out and executive-medical type plans may be found to discriminate in favor of highly compensated individuals.

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Health Insurance Quotes for Children

Friday, October 15th, 2010

Health insurance companies are reluctant to offer child only health insurance policies under The Obama administration and new health law. The Affordable Care Act also know as Obama Care, states that all future plans in the individual health insurance market for children age 18 and younger cannot deny coverage to children who have pre-existing conditions.

Some insurers decided to stop quoting and writing new business in the child-only market because of concerns that parents would not quote and enroll children until they get sick. Insurers can charge higher rates for children, which is not prohibited by the Affordable Care Act but is permitted by state law.

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Health Care Reform Implementation Update

Thursday, September 30th, 2010

Sept. 23, 2010, marked the six-month anniversary of the enactment of the Affordable Care Act. There has been a lot of news coverage on this milestone during the past few days and it is likely that more will follow.

Certain provisions of the Affordable Care Act are effective starting with plan years (in the individual market, policy years) beginning on or after Sept. 23, 2010. We believe that some of our members or groups may not recognize or understand the plan/policy year concepts and mistakenly assume that certain Affordable Care Act provisions will immediately apply to their coverage on Sept. 23, 2010.

We ask that you call us with any questions regarding certain provisions of the Affordable Care Act that may not immediately apply to your coverage, but will apply starting with plan/policy years beginning on or after Sept. 23, 2010.

New EOBs and Language Notifications

Beginning Sept. 23, 2010, members and providers will see a new section in Explanation of Benefits (EOBs) and denial letters that is referred to as “Important Updates (not applicable to all policies or plans)”. The new section informs members that if their plan/policy is non-grandfathered, as defined in the Affordable Care Act, and if their plan/policy has renewed after Sept. 23, 2010, then the information in the new section may apply to them. This would also apply to new plans that are effective on or after Sept. 23, 2010.

These requirements do not apply to grandfathered plans. However, you should note that the new notification language will be included on all EOBs and denial letters, including those to members of grandfathered plans. Our call center Customer Advocates will be prepared to help members determine whether or not their plan is grandfathered or non-grandfathered.

Appeals and External Review

Concerning external review of denials, all non-grandfathered plans that are not required to follow an existing state external review law – for example, most self-insured plans – the option to choose to follow either the existing state external review process (when permitted by the state’s Department of Insurance) or to follow the new federal external review process, as of their effective date.

Non-grandfathered ASO self-funded plans to submit an External Review Election Form for their medical benefit plan(s) to their account representative at least 30 calendar days prior to their renewal date. If they do not make their own selection by completing the form at least 30 calendar days prior to renewal, the states external review process will review it. At this time there will be no additional charge for this new service.

Essential Health Benefits

Starting with plan years beginning on or after Sept. 23, 2010, the Affordable Care Act generally prohibits group health insurance coverage from having annual limits on the dollar amount of essential health benefits.

However, for plan years beginning prior to Jan. 1, 2014, group health insurance coverage may have certain restricted annual limits on the dollar amount of essential health benefits in accordance with federal regulations.

Federal regulations and guidance also provide for the waiver of the restricted annual limit requirements under certain circumstances.

Pre-existing Under 19

Starting with plan years beginning on or after Sept. 23, 2010, the Affordable Care Act prohibits group health insurance coverage from imposing pre-existing condition exclusions on enrollees under age 19. If you missed this announcement earlier, you should note that we have now aligned our benefits with the Affordable Care Act by not allowing pre-existing exclusion only for enrollees up to age 19. This is for our fully insured and individual business – ASO/custom accounts may still vary their coverage to provide richer benefits.

Child-only Policies

We are awaiting state Department of Insurance approvals for our new child-only policy. Our target date to begin enrolling members is May 2011.

Special Open Enrollments

Some groups may be having their open enrollment now for plans starting Oct. 1, 2010. Included in open enrollment for these groups is a special open enrollment for adding dependents under the provision of the Affordable Care Act that extends adult child dependent coverage up to age 26. Those individuals who also reached a plan’s lifetime limit are also eligible for the special open enrollment.

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Health Insurance Quotes for Children Don’t Exist

Friday, September 24th, 2010

All insurance carriers are halting sales of individual health insurance for children policies based on confusion over a federal reform provision that takes effect today.

The health insurance reform act that was passed in March requires that policies starting now or in the future cannot exclude, limit, or deny medical coverage to children under 19 based on any health problems that developed before seeking medical coverage. Therefore, there will be no more exclusions for children with pre-existing conditions.

Premiums could double for everyone by mid 2011. Your best choice is to buy health insurance now and lock in a low rate for several years. Many carriers allow you to lock in rates for more than a year at a very small cost per month.

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Losing Cobra or Group health insurance coverage?

Thursday, September 2nd, 2010

Are you going to be losing your cobra or group health insurance coverage?

Many people today are losing their cobra coverage as the government extensions and subsidies are finally going away. To make things worse, with the new health care reform laws, employers are cutting coverage benefits as well. Some employers are even erasing the group health plans completely.

All in all this may be a benefit to you. Individual health insurance is affordable and anyone can apply for coverage. The best part is that if you have serious pre existing conditions and cannot be approved on a health plan that you can get a guaranteed issue plan.  The plan is guaranteed to offer you health insurance coverage if you have had creditable group or cobra coverage in the past 63 days. So take a look at the health insurance quotes and see which plan is going to be best for you and your family.

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Revive the Public Health Insurance Option

Thursday, July 29th, 2010

Progressive Democrats Attempt to Revive the Public Health Insurance Option

A group of 129 progressive House of Representatives Democrats, seeking to revive the public option, introduced legislation on July 22 to establish a public health insurance plan that would compete with private health insurers. It is highly unlikely that the House will vote on the legislation this year. Republicans and some moderate Democrats remain strongly opposed to the public option, and Democratic leaders have little interest in reigniting the divisive health care reform debate before the November elections.

Supporters of the Public Option Act (H.R. 5808) claim that the legislation would sharply reduce the federal deficit. The non-partisan Congressional Budget Office (CBO) estimates that the bill would reduce the federal deficit by approximately $68 billion from 2014 to 2020.

The public plan would be administered by the Secretary of Health and Human Services and would be offered through the new health insurance exchange beginning in 2014.  The bill would require the public plan to charge premiums that fully cover its costs for benefit payments and administrative expenses. The plan’s provider payment rates would be based on Medicare reimbursement rates. The legislation has been referred to the House Energy and Commerce Committee.

President Obama Signs Unemployment Insurance Extension Bill into Law

President Barack Obama signed H.R. 4213, the Unemployment Compensation Extension Act of 2010, into law on Thursday, July 22, ending months of partisan squabbling over the measure. Moments after the late Senator Robert Byrd’s (D-WV) replacement, Carte P. Goodwin, was sworn into office, the Senate quickly voted to invoke cloture on the legislation, sending it back to the House, which then passed the measure by a vote of 272-152.

The legislation did not include an extension of the COBRA health insurance subsidies and other safety-net programs that had also expired earlier this year. The legislation will provide unemployment insurance for those who have already exhausted their normal six months of benefits through Nov. 30, 2010; it is retroactive to June 2, 2010. The Congressional Budget Office estimates this extension will add $33.9 billion to the federal deficit over 10 years.

House Republicans Criticize New Rules for $27 Billion Electronic Health Records Program

House Ways and Means Health Subcommittee Republicans alleged during a July 20 hearing that eligibility criteria for the new $27 billion federal electronic health records (EHR) program are too lenient. The EHR program will provide additional Medicare and Medicaid payments, beginning in 2011, to health professionals and hospitals that adopt certified EHRs. The additional payments, which were enacted in 2009 as part of the American Recovery and Reinvestment Act, will likely encourage many physicians and hospitals to purchase and implement EHR systems.

In order to be eligible for additional Medicare and Medicaid payments, hospitals and health care professionals must adopt and make “meaningful use” of certified EHR technology. Dr. David Blumenthal, the National Coordinator for Health Information Technology (IT), testified that the eligibility criteria were designed to accommodate diverse providers, while appropriately encouraging the adoption of EHRs. The Obama Administration had originally proposed more strict eligibility requirements that were denounced by the health care industry as unrealistic.

The new qualification standards are the first in a series of rules, and they apply only to additional payments before 2013. Dr. Blumenthal stated that HHS will place higher demands on providers in the future.

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Health Insurance Reform Schedule

Wednesday, July 21st, 2010

2010
New programs:

  • Temporary retiree reinsurance program.
  • National risk pool, small business tax credit.
  • $250 rebate for Medicare members who reach the “doughnut hole”.

Health Insurance Reforms:

  • No lifetime benefit limits based on dollar amounts.
  • Allowed restricted yearly limits on the dollar value of certain benefits.
  • No coverage rescissions/cancellations (except for fraud or internal misrepresentation).
  • No cost-sharing obligations for preventive services.
  • Must have dependent coverage up to age 26.
  • New internal and external appeal process.
  • No pre-existing condition exclusions for dependent children (under 19 years of age).
  • New health plan disclosure and transparency requirements.

2011
Insurance Reforms:

  • New uniform coverage documents and standard definitions are developed.
  • Must have minimum medical loss ratios.

Medicare Reforms:

  • Start of Medicare Advantage cost-sharing limits.
  • Medicare beneficiaries who reach the doughnut hole to get a 50% discount on brand name drugs.
  • Primary care doctors and general surgeons practicing in underserved areas, such as inner city and rural communities to get a 10% bonus.
  • Medicare Advantage plans begin having payments frozen.

Other:

  • Yearly fee for brand-name drug manufacturers.
  • Start of voluntary long-term care insurance program giving a cash benefit to help those with disabilities stay in their homes or pay nursing home cost: benefit starts 5 years after paying coverage fee.
  • Increased funding for community health centers to provide care for many low-income and uninsured people.

2012

  • Hospitals, doctors and payers encouraged to join forces in “accountable care organizations”.
  • Hospitals with high rates of preventable readmissions facing reduced Medicare payments.

2013

  • Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned income – up from the current 1.45%. A new 3.8% tax on unearned income, such as dividends and interest, also added.
  • Contributions to flexible spending accounts (FSAs) limited to $2,500 a year – indexed for inflation. And the threshold for deducting medical expenses on taxes goes from 7.5% to 10% income.
  • Medical device manufacturers have a 2.9% sales tax on medical devices; with exemptions for some, like eyeglasses, contact lens, and hearing aids.
  • No more deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D-eligible retirees.

2014
Coverage Mandates & Subsidies:

  • New Individual and employer coverage responsibilities.
  • New Individual affordability tax credit and expanded small business tax credits.

Health Insurance Exchange & Insurance Reforms:

  • State individual and small group health insurance exchanges operational.
  • Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective.
  • No more lifetime and yearly dollar limits for essential benefits.
  • New taxes on health insurers.

2018

  • New tax (“Cadillac tax”) on employer-sponsored health plans that offer policies with generous coverage levels.

2020

  • Doughnut hole coverage gap in Medicare prescription benefits is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

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Health Insurance Reform News July 2010

Friday, July 9th, 2010

Health insurance reform will inevitably add to the already unsustainable federal deficit. In addition, it will prove impossible for the government to create and establish a more efficient system than the one now in place.

These are some of the arguments of more than a dozen states that have filed lawsuits. The lawsuits challenge the constitutionality of the reform. Their arguments also include that the government should not force citizens to buy health insurance.

It will be several years before the reforms take effect, and opponents are trying to ensure that they never will.

But significant improvements have already been made and insurers are also moving into compliance ahead of schedule. New rules forbid insurance companies from denying coverage to children, young adults can now stay on their guardians’ policies until age 26, and setting a lifetime limit on benefits will be banned soon.

Let’s not forget the true objective and that is to reduce costs. The Obama administration  must demonstrate that reforms will eventually bring down costs. This is the true test.

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Republican Attempt To Repeal Individual Mandate

Wednesday, June 23rd, 2010

The United States House of Representatives voted 187 to 230 to defeat a Republican proposal to repeal the individual health insurance mandate in the new health reform law, the PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (PPACA). Twenty-one Democrats joined 166 House Republicans in voting against the requirement that most Americans purchase health care coverage beginning in 2014.

Representative Dave Camp (R-MI) – the senior ranking Republican on the powerful House Ways and Means Committee – offered the proposal as a procedural motion to an unrelated bill. Despite the proposal’s failure, some Republican members believe they scored political points by forcing a vote on the new health reform law. However, House Ways and Means Committee Chairman Sander Levin (D-MI) stated that the vote displayed increased support among House Democrats for the health reform law, because only 21 Democrats voted in support of the Republican proposal, whereas 34 Democrats voted against the health care reform bill in March.

SENATE PASSES DOC FIX LEGISLATION
The Senate passed legislation on June 18 that would avert a 21.3 percent reduction in Medicare physician payment rates that became effective June 1. Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY) took to the floor and passed a six-month delay in reimbursement cuts by unanimous consent, after extracting it from a larger tax and benefits package, H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010. The $6.5 billion bill was offset with spending reductions that appeased both Republicans and Democrats.

The House, which is not scheduled to return until the evening of June 22, still must pass the “doc fix” legislation. Earlier this week, a procedural vote to end debate on the legislation failed 52 to 45 (60 votes were necessary for passage). Eleven Democrats broke with their party leaders to vote no. Many Republicans and moderate Democrats believed that the more than $50 billion net cost of the bill should be offset by spending cuts and/or federal revenue increases. The fate of the full tax-extenders legislation, H.R. 4213, remains up in the air.

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This Week in Health Care Reform

Friday, June 11th, 2010

Primary elections were held in 11 states this week as lawmakers returned to Washington, D.C., to face a growing list of unfinished legislative business including a jobs bill and environmental issues stemming from the Gulf crisis. Meanwhile, President Barack Obama launched a public relations campaign to combat skepticism around his new health insurance reform legislation and to promote the early implementation of certain provisions of the law.

Health Care Reform
Health Care Reform Debate Alive and Well: Democrats continue to sell their plan for health care reform to Americans in the face of mixed public opinion, simultaneously battling Republicans pushing for its repeal.

Congressional lawmakers address concerns about the new health care reform legislation, particularly among senior citizens , who make up a disproportionate share of voters in midterm elections. Democrats and the administration are eager to publicize certain provisions of the bill, like retaining young adults on their parents’ plans until age 26, as a way to gain support and to turn voters away from Republicans who called for its repeal.

On Tuesday, President Obama held a nationally televised town hall meeting at a senior center in Maryland to highlight the distribution of $250 rebate checks for senior citizens who hit the so-called “doughnut hole ” in Medicare’s prescription drug coverage. The first round of checks was mailed yesterday and serves as the law’s first monetary benefit.

State Battle Against Health Care Reform Law Continues: On Monday, Virginia Attorney General Ken Cuccinelli disputed the administration’s claim that the state lacks standing to challenge the new federal health care reform law. The lawsuit filed by Cuccinelli in the Eastern District Court cites a Virginia law that exempts state residents from being required to have health care coverage. Sebelius argued that states cannot simply pass a statute that would nullify a federal law. A hearing to determine next steps is set for July 1.

Public Opinion
Americans Want Repeal of Health Care Reform: A recently released Rasmussen report suggests that Americans are strongly in favor of repealing President Obama’s health care reform law. Fifty-eight percent of those polled favor repeal, while 62 percent believe the new legislation will increase the budget deficit. In addition, 57 percent predict health care costs will increase, while 51 percent feel the quality of care will decrease as a result of the new health care reform law.

Looking Ahead
Democrat lawmakers are expecting to pass the jobs bill next week but will need Republican support in order to get the 60 votes needed for passage. One provision of the bill, a 21 percent cut in Medicare payments to doctors, is being delayed as the bill moves through Congress and would ultimately be blocked if the legislation passes.

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