Federal
To keep the government operating for fiscal year 2011 (September 2010 through September 2011), Congress has been passing a series of continuing resolutions (CR) that continue the funding for a set period of time. The current CR runs out the first week in March, so the House last week passed yet another CR, shipped it off to the Senate and headed out of town for a President’s Day recess. Included in the just-passed CR are provisions that would de-fund parts of the 2010 individual health insurance reform law, such as prohibiting the use of federal funds to pay government employees to work on or to implement the PPACA.  The Senate will surely reject this CR because of both the de-funding provisions and the $61 billion in spending cuts for the current fiscal year. Congress will once again confront a looming funding deadline when it returns from recess in a week.

While there is increasing health-related “action” in Congress, such as the de-funding effort and the soon-to-be successful effort to repeal the 1099 requirement, the implementation process within the agencies continues unabated. This is where the real action is, with post-regulation guidance likely to be issued on several fronts in the very near future. Sub-regulatory guidance is expected to touch on the following areas or answer certain questions: 1) Whether group plans, as of 2012, will be allowed to offer a Medicare Advantage-only plan alongside a stand-alone PDP;  2) whether and how insurers have to report PBM administrative costs for medical loss ratio (MLR) purposes;  3) FAQs on the parameters (e.g., national vs. state-by-state reporting) of an insurer’s MLR requirement for ex-pat business;  4) revised rules on already-issued claims and appeals rules; and  5) clarification of the length and breadth of the types of “new business’ that can be sold under a limited benefits plan or mini-med waiver. All of these items will have a bearing on operations at Aetna health insurance and Golden Rule insurance.

States
The Obama administration has awarded $241 million in grants to seven states to develop a health insurance exchange. Developing the technology to make such a virtual marketplace work is expected to be costly, however. Administration officials hope the grants awarded last week will allow a few states to build systems as “early innovators” that others will be able to adopt. The states receiving grants, which were appropriated by the law last year, are: Kansas ($31.5 million), Maryland ($6.2 million), Massachusetts ($35.6 million), New York ($27.4 million), Oklahoma ($54.6 million), Oregon ($48.1 million) and Wisconsin ($37.8 million). A sign of the sometimes odd nature of health care politics, Kansas, Oklahoma and Wisconsin have Republican governors who have complained bitterly about the new law and are challenging its constitutionality in federal court.

Arizona health insurance Governor Jan Brewer was advised by HHS Secretary Kathleen Sebelius that the maintenance of effort provision of the PPACA does not preclude the state from removing childless adults from the Arizona Health Care Cost Containment System (Medicaid) because the expansion was part of a demonstration project. The Governor and many legislators support this reduction as a means to help address the state’s significant budget deficit. While many view the development as a positive, a legal challenge at the state level is possible because the coverage expansion resulted from a ballot initiative. Also, the health insurance exchange bill was voted out of the House Banking and Insurance Committee by a 4-2-1 margin. Discussion was robust, with Republican members questioning the need to take any action in light of pending litigation against the PPACA. The view that the bill should continue to move to the floor for a full vote prevailed.

The Connecticut health insurance Committee held a hearing last week on a bill that would require public hearings on rate increases. The bill would compel hearings in some cases, and would give the state attorney general and health care advocate the right to argue on behalf of consumers at the hearings and call witnesses. In addition, the bill would change existing law, which states that rates can’t be “excessive”, by defining excessive as “unreasonably high.” Industry representatives said the legislation would conflict with federal reform laws, add administrative burden on the Insurance Department and, ultimately, increase costs. Keith Stover, lobbyist for the Connecticut Association of Health Plans, testified that rates already have to be actuarially sound and that medical insurance costs are, in fact, increasing. The Insurance Department said lawmakers should hold off on changes until incoming Commissioner Thomas Leonardi reviews the plan.

The Public Health and Insurance committees held a joint hearing on the SustiNet public option bill, the insurance exchange bill, the “pooling” of all public employees bill (to be known as the Connecticut Health Partnership) and a bill to allow the state to pool state employee and Medicaid pharmaceutical purchasing. The most important development of the day was the Malloy Administration’s written testimony. The state’s Budget Director Ben Barnes was not only tepid toward SustiNet as a whole, he was quite clear that the SustiNet bill gives too much budgetary power to a quasi-public agency (almost $8 billion in state health spending) and raises questions about SustiNet’s cost and savings projections. He pointed out that certain Medicaid concepts in the bill are against federal law, including allowing the agency to set Medicaid rates.. Speaker of the House Chris Donovan sat with Hartford Mayor Segarra, and they advocated strongly for the Speaker’s “pooling” bill to allow cities and towns to buy into the state’s health insurance plan. It eventually would allow small businesses and nonprofit organizations to buy in (also part of the SustiNet plan). This bill was vetoed in 2008.

Georgia health insurance John Price, an Aetna insurance local market head, Southeast Region, has been appointed to Commissioner Hudgens health insurance advisory group to help provide the Commissioner with expertise on health insurance issues. Also, the Commissioner of the Department of Community Health announced Friday that the current Managed Medicaid contracts (Wellcare, Amerigroup, Centene) will be extended for 12 months while the new Governor reviews the program.

Ohio health insurance Pooling of Ohio public school district employee health plans will be considered by the General Assembly. A study found that there is the potential for $138 million in savings if the state leverages the greater buying power of pooling 191,000 employees enrolled in 613 public school district health plans. Seventy-two percent of Ohio school districts purchase employee health insurance through consortia, but they are typically composed of 10 or fewer districts and do not result in savings, the study found. The report also calls for the state to find ways to encourage school districts to pursue lower-cost, high-deductible health insurance plans that could reduce district costs up to another 37 percent over current employee health care plans.  As Ohio struggles with the economic downturn and an $8 billion budget deficit, limiting collective bargaining rights is also front and center in the Statehouse so that the Administration ultimately may change the structure of pensions and health care benefits.

Texas health insurance Lt. Gov. David Dewhurst and Sen. Jane Nelson have reintroduced two health care-related bills that died in the House in 2009. One would bring “outcomes-based payments” to Texas’ Medicaid and the Children’s Health Insurance Programs. The other would allow private insurers, major employers and government employees’ insurance plans to experiment with new financial approaches, such as accountable care organizations (ACO). ACOs are an arrangement in which doctors and hospitals share risk, and potential savings, for bringing care costs below targeted levels. The legislation would begin rewarding the state’s health care industry for preventive care and treatments that are coordinated to prevent duplication and waste. The bills will be referred to a committee and debated by both the Senate and House during the current legislative session, ending in late May.

Senators tasked with taking a close look at the Medicaid program got a dose of the difficulties involved in trimming services in a state where services considered optional turn out to be not so optional. They heard testimony on multiple examples of how Medicaid cuts would affect people in the system. Because of the restrictions contained in the federal health care reform law, budget planners have less latitude in where to look for cuts in the Medicaid program. The Senate subcommittee will eventually pass on its recommended budget solutions to the Finance Committee charged with approving an overall budget that makes up a shortfall of more than $20 billion this session.

• Coverage summaries
• Claim information
• Premium and billing details
• Network providers
• And more!

Golden Rule Insurance members can access My UH One .com once they receive their “New Member” packet.  United Health One members will also learn more about this new website through the monthly
“Health-e-News” email newsletter.

For most existing UnitedHealthOne members to access their personalized account, they will need to register on the website.  Registration is simple and the site is easy to navigate.

Deductible
Individuals think that the only thing that matters in individual health insurance is the deductible.  Sure, deductibles are very important, but looking further into the plans is necessary.  For example, is a $3500 deductible plan at 20% coinsurance better than a $5000 deductible plan at 0% coinsurance?  Ask that question to the normal individual and they will say yes.  The correct answer is sometimes.  The reason is, the 3500 plan in most situations has a higher out of pocket maximum, where the 5000 plan has the lower out of pocket maximum.  Sure some individuals  have the time to go read about it and figure it out for themselves, but the average person will just simply go with the lowest deductible.

Price
The price for individual health insurance is not the most important thing.  Understanding the plan is.  If an individual health plan is a lot cheaper then all of the other compared plans there is always something wrong with it.  For example, Aetna insurance has what is called a value plan.  They are great, but you can only go see your doctor 5 times a year.  That may be fine for a lot of individuals , but what about a 50 year old.  Brokers are so important for these situations.  Aetna and most companies have this option, to spend less but also get less.  It is great, but people should know the difference.

Providers
Most individuals have a family doctor or someone in mind that they would like to see on a regular basis when purchasing individual health insurance.   The thing is most people think that their doctor will be in network no matter what, because they are purchasing a PPO plan where they can go wherever they would like to go.  The word “in- network” is very important, because it is the difference in being able to pay around $35 for a doctor’s visit or having to meet your deductible to see your regular doctor.  All the big insurance companies, Golden Rule, Aetna, Coventry, Humana, and Cigna all have a physician look up tool on their web pages.  So why not use them to your advantage.  I make sure that every one of my clients can use that free resource before they purchase an individual health insurance plan.  Imagine if a person is on vacation and they need to find a doctor fast, most people will panic. My clients will know that they can go to a computer and find an address and a number quicker than calling the back of their card.

Students
Another place where individuals are getting taken advantage of are in the school plans.  Sure something is better than not having anything at all.  However, college kids aren’t reading into these policies and how much coverage they really have.  Some of these health plans only allow a person to use $50,000 at the hospital.  That’s just not enough.  Especially when you can purchase a health plan with unlimited coverage for the same price by getting individual health insurance though Easy To Insure ME.  It is very hard for people to understand why they should seek advice from a professional. This is the exact reason why they should.

Easy To Insure ME
Individual health insurance plans are similar in many ways, finding the right one is the challenge.  So when trying to find the best plan for you at the best price, seeking a professional is key. Finding a good broker is as easy as clicking the link to EasyToInsureME.com.  All you will have to do is put in your basic information in the top right hand corner of the home page, and a professional will contact you within 24 hours. It is that easy.  Easy to insure me on the web.

In most cases it is helpful to speak to a broker when searching for an Indiana health insurance plan. You might have questions about preventive care benefits, office copays, or prescription drug coverage.

Most consumers are in search of affordable Indiana health insurance coverage. In addittion, all carriers offer high deductible, catastrophic coverages for shoppers operating on tight budgets. Many of the plans will offer health care benefits without having to meet a deductible first.

Easy To Insure ME represents carriers that are only the best of the best. If we wouldn’t recommend it to our families, then we won’t recommend it to you. Each Illinois health insurance visitor receives a custom proposal of four recommended plans that are picked from a list of about 300 options. These plans are sent directly to your email instantly after you have received Illinois health insurance quotes on the website.

The best carriers in Illinois health insurance are Aetna, Coventry Health Care, United Health One, Golden Rule Insurance, Humana, Blue Cross, Blue Shield, and Celtic.

With North Carolina health insurance copay plans it is  important to know what the copay covers. Some carriers doctor copays cover only the consultation. While others cover lab work and x-rays. During annual exams some carriers pay for lab and x-rays. Two examples of carriers that do this are Golden Rule Insurance and Aetna health insurance.

The final feature in North Carolina health insurance to pay close attention to is the out of pocket maximum. This is the total sum of the deductible plus your chosen coinsurance. The usual and customary out of pocket maximum is around $5,000 per individual. This means that in the very worst case scenario you will expend five thousand dollars for $5,000,0000 worth of North Carolina health insurance coverage. This feature is actually a safety net for you and is called a stop loss. It caps your maximum expense at a certain limit to save you from paying to much for health care.  To lower your out of pocket maximum a lower deductible and better coinsurance must be chosen.

Community Health Network is a not-for-profit health system that includes Community Hospitals East, North and South in Indianapolis and Community Hospital Anderson; The Indiana Heart Hospital; Indiana Surgery Centers; Indianapolis Endoscopy Center; Community Center for Digestive Care; Community Physicians of Indiana; and Community Employed Specialists.
United Healthcare Golden Rule health insurance’s  provider network in Indiana health insurance includes more than 10,500 physicians and 140 hospitals and medical facilities.

Tenet’s hospitals had received 73 quality designations for cardiac care under the United Healthcare Golden Rule insurance Premium Designation Program in 2009. Tenet Healthcare Corporation is a health care services company whose subsidiaries and affiliates own and operate acute care hospitals, ambulatory surgery centers and diagnostic imaging centers.

Accreditations reflect a health insurance plan’s ability to work with physicians to improve the quality of clinical care to enhance customer service. NCQA Health Plan Accreditation is a nationally recognized evaluation that employers, regulators and consumers can use to assess health plans. The accreditation process evaluates all parts of a health insurance plan’s delivery system, from physicians and hospitals to other health care providers and administrative services. The review also includes onsite and offsite evaluations by a team of physicians and managed-care experts.

Effective December 11, 2009 new underwriting guidelines will allow Golden Rule insurance to cover more ongoing prescription costs with a slight increase in premium with most cases.

The most popular Golden Rule insurance plan at EasyToInsureME.com is the Copay Select series. The changes in prescription coverage for Copay Select are as follows:

• Tier 1, Generic prescriptions will fall into the category of a 0-10% increase in premium. Most cases will not include any action being taken.
• Tier 2-4, Brand Name prescriptions will fall into the category of a 0-40% increase in premium. Cases with simple Brand Name medication for high blood pressure, cholesterol, thyroid, and more will only receive a slight increase.

Consumers that have been taking medication for longer than a two year period will see minor increases in premium as the condition is considered controlled. United Health One and Golden Rule health insurance quotes are available at Easy To Insure ME.