Posts Tagged ‘aetna health insurance’

Thursday, June 3rd, 2010

Congress has once again left town for a recess, until June 7, allowing two key health benefit items to expire at the end of May. One is the “doc fix,” which is needed to stave off a pending 21 percent cut in Medicare physician reimbursements. Aetna favors a multiple-year change to bring stability and certainty to the Medicare Advantage market. While the House passed a bill to extend the fix for 19 months until the end of 2011, the Senate left town without addressing the issue. Although the current short-term fix lapsed on Monday, CMS has alerted its contractors to “hold” claims for the first 10 days of June in the hopes that the “fix” will be fixed by June 10.

Similarly, the House approved, but the Senate did not, a jobs and extenders bill dealing with other expiring items. However, the House-approved package does not contain an extension of the enhanced Medicaid FMAP formula desired by the states, nor does it include an extension of eligibility for the COBRA 65 percent-subsidy program. It also expired at the end of May.

The issue of whether a non-federal government has the authority to tell an employer how to administer a self-funded health plan has been heading to the U.S. Supreme Court for well over a year. The case comes from California where the 9th Circuit ruled in 2008 in favor of the City of San Francisco by deciding that ERISA was not a barrier to San Francisco’s “play or pay” law.  Since the 4th Circuit had ruled just the opposite a few years before in a Maryland case, the conflicting outcomes makes this case ripe for resolution by the Supreme Court. Late last week, the Solicitor General’s office recommended that the Supreme Court not take up the case because, in part, the new health care reform law may dramatically reduce the number of state or local governments following San Francisco’s lead. The SG’s position is unfortunately influential, but it is not determinative. Aetna prefers that the Court take up the case as the ERISA preemption question presented is so fundamental to the employer-sponsored marketplace. Aetna also believe ERISA preemption would be re-affirmed.

Wednesday, May 19th, 2010

The legislature adjourned for 2010 after a number of negative Georgia health insurance bills were defeated, including a proposed tax on health plans and restrictions on rental networks. Among the legislation that did pass was, most significantly, a bill that would apply state prompt-pay laws to self-funded plans. The bill also contains an extension of time for payment of paper claims and a compliance threshold of 95 percent before any fines are imposed. Several interested parties, including Aetna, are working with the Governor’s office to encourage a veto of the bill, but this is unlikely.

Wednesday, May 19th, 2010

The legislature adjourned for 2010 with no significant Florida health insurance bills passing. The only exception was in the area of Medicaid, where Aetna helped pass legislation regarding provider-sponsored networks. Legislation that was defeated includes mandates for coverage of Down’s Syndrome and other developmental disabilities, and problematic pharmacy legislation.

Wednesday, May 19th, 2010

Delaware health insurance debate resumed last week on a bill that would prohibit health insurers from denying coverage for medically necessary procedures and tests. The bill was voted out of committee with the understanding that significant changes are needed before a full vote occurs. The Department of Insurance presented testimony applauding the intent of the sponsor but reserving full support, indicating there is benefit in allowing preauthorization to limit unnecessary medical testing. Additionally the Comptroller General provided testimony on the potential cost impact to the state health benefits plan.  An actual dollar figure has not yet been quantified. Aetna, along with the other plans, and Med Solutions continue to express serious concerns with the bill.  The legislature will be in recess for the next two weeks, returning June 1.

Wednesday, May 19th, 2010

The General Assembly in Colorado health insurance recently adjourned a 2010 session that was focused heavily on health care issues. Outgoing Governor Bill Ritter succeeded in his goal of leaving a health care reform legacy with the passage of unisex rating in the individual market, a plain language requirement for insurance forms and contracts, an all-payer database and the creation of a task force to develop standard coding and edits for claims. Although the oral chemotherapy mandate passed, the industry was successful in helping to defeat a bill that would have prohibited carriers from setting rates for non-covered services and one making the wrongful denial of a claim an unfair claim practice. Aetna took a lead role in reaching a compromise on a bill that would have prohibited subrogation.

Wednesday, May 19th, 2010

As the comment period ended with respect to medical loss ratio (MLR) regulations, a flurry of letters were sent last week to both the National Association of Insurance Commissioners and the U.S. Department of Health and Human Services. In addition to Aetna health insurance and other insurers, several employer groups have written with comments and concerns, including the American Benefits Council, the National Coalition on Benefits and the National Retail Federation. In all cases, the comments point out that it’s important to assure that positive, quality-oriented elements of health care, such as health information technology, disease management and wellness programs, fraud and abuse regimens, all should count as quality measures when calculating a company’s MLR. The National Retail Federation in particular noted the need for a national MLR for large employer business, a position well embraced by Aetna.

In the never-ending roll-out of proposed health care reform regulations, the Administration last week published yet another set of Interim Final Regulations. This set deals with coverage for dependent children up to age 26 pursuant to the requirement that insurers and group plans allow kids to stay on their parents’ policies or coverage until age 26.  Comments are due by August 11, but the rule is effective July 12, 2010. Many insurers have already announced that they will implement this provision early (e.g., May 31 for Aetna) to cover graduating college students who may have otherwise faced the summer without insurance. Whether self-funded employers follow suit is not as clear. Also, with the temporary fix of Medicare physician reimbursement rates set to run out the end of May, the House is expected to take up a more lasting fix sometime this week. If the House proceeds as expected it will attempt to install a five-year suspension of any physician rate cuts. Aetna supports the change, as it will give this market predictability.

Tuesday, May 4th, 2010

While the underlying cost of health insurance services remains an under-reported issue, there are signs that this may be changing. The California legislature, for example, is beginning to turn its attention to rising hospital and provider costs, and not just the rising cost of premiums. Just in time, the U.S. Justice Department announced last week that California’s largest health care purchasers can proceed with an extensive study of the costs of care at more than 300 hospitals statewide. The California Hospital Association tried to block the project claiming antitrust concerns, but the Justice Department rejected the claim. Only by addressing costs throughout the health care system will the nation begin to slow the overall cost of health care and truly deliver on the promise of health care reform. Transparency remains a very important part of the equation.

Federal
In January, the U.S. Supreme Court ruled in the Citizens United case that the First Amendment protects the right of corporations, as citizens, to spend corporate funds on political advertising advocating the election or defeat of a particular candidate. In an effort to stave off an anticipated onslaught of corporate money infusion in this year’s elections, the Democratic majority introduced legislation last week to curb any such corporate activity. The core component of the legislation would require corporations (and unions) in the name of transparency to disclose their spending on political advertisement. This legislation is very likely to be a key subject of debate for the rest of the legislative year as Democrats seek to rally consumers and other groups in favor of the bill, and Republicans use the measure as a rallying cry against what they view as an infringement on the First Amendment.  It is not at all clear, at this stage, whether this bill has legs or whether corporations will even take advantage of the Supreme Court’s ruling. What is clear is that the issue will further drive a wedge between the two parties.

In response to WellPoint’s proposed rate increase in the California individual health insurance market in January (now rescinded), Senator Dianne Feinstein (D-CA) had proposed legislation to establish a Federal Rate Authority to both review “potentially unreasonable” increases in health insurance rates (in conjunction with the states) and to endow the federal government with new regulatory powers with respect to the Authority’s findings. Although this provision was not included in health care reform, Senator Feinstein now is poised to offer her bill as an amendment to other legislation moving through the Senate — starting with the financial regulatory reform measure currently before the Senate. The Feinstein proposal would further erode the traditional role of the states with respect to insurance matters and was opposed by Aetna and the insurance industry. Aetna will oppose this new tactic as well.

Wednesday, April 28th, 2010

We know many families are worried about their dependents losing health insurance coverage when they graduate from high school or college or otherwise age out of coverage. Health care reform will address this issue nationwide later this year, when new regulations will go into effect. However, some plan sponsors may want to make changes earlier, to help these dependents remain insured without a gap in coverage.

In keeping with the spirit of health care reform, Aetna health insurance and Easy To Insure ME will work with clients to extend coverage to their medical plans’ current dependents ahead of schedule. This means current dependents under the age of 26 would not have to leave their plans when they would otherwise age out or are no longer full-time students (including those who would have lost eligibility effective May 31, 2010). Note that this would not include reinstatement of dependents who previously aged out of their plan. It also does not affect dental, vision, standalone pharmacy or other benefits.

For individual and small group medical plans (as defined in state law), Aetna health insurance will continue coverage effective June 1, 2010 for dependents under age 26 currently covered on a parent’s medical plan. Aetna health insurance will not change the plan’s premium until renewal.

For fully insured larger groups, and for all self-funded medical plans, Aetna health insurance will offer the option of expanding medical coverage for dependents under the age of 26 currently covered on a parent’s medical plan, effective on or after June 1, 2010. This would include dependents who would have aged out on May 31, 2010. Aetna will provide pricing for this plan design change, as appropriate, for plans that choose this option.

Regardless of whether a plan makes this change ahead of schedule, health care reform is bringing changes to all plans soon. On the next renewal date on or after September 23, 2010, all health insurance plans must cover all dependents up to age 26 (and older for insured plans in states that mandate coverage above age 26). This may include dependents who are not currently enrolled in the plan, in accordance with regulations. We will be able to tell you more when the federal government issues regulations telling insurers and employers how this must be administered.

Aetna is pleased to offer our plan members the ability to keep their dependents insured. This is one step toward the goal of health care coverage for all Americans.

Wednesday, April 21st, 2010

Aetna is implementing a rate action for Aetna health insurance plans for individual, family, and the self employed in Maryland health insurance.

The new rates are effective July 1, 2010

Wednesday, April 21st, 2010

Aetna is implementing a rate action for Aetna health insurance plans for individual, family, and the self employed in North Carolina health insurance.

The new rates are effective July 1, 2010