health care – Susman

December 8, 2012

Health Care Exchange information

What will the Healthcare Exchange be? What does it mean?

The Pacific Business Group on Health yesterday released the third and final installment of its comprehensive report on how to ensure that the people joining a health benefit exchange end up with the plan that works best for them.

“The whole notion of the Affordable Care Act and the establishment of the exchange is to improve the overall health care marketplace,” said Ted von Glahn, a senior director at PBGH, a not-for-profit business coalition focused on health care issues.

“If you don’t get it right when people are making those choices,” von Glahn said, “that would defeat the whole purpose of it.”

That’s one of the points of yesterday’s report, that health officials need to make sure that the choice of a health plan for consumers in the exchange becomes both a simple and well-informed decision.

The report, done in three installments, is based on a series of 2,100 interviews overall, conducted in 2012 with low-income participants chosen to mirror the demographic makeup of expected enrollees in the exchange in 2014.

Outside of premium cost, one of the most important factors to increase enrollment among participants is to make the process a simple one. The first recommendation of the report is to offer shortcuts to the choice of a health plan. That simple approach — basically nudging participants to consider common concerns — must be balanced by the flexibility to also present consumers with more detailed and in-depth information about their choices, von Glahn said. Basically, the approach is to simplify choices, but to be able to lay out the more complex components to choosing a plan, such as the level of varying deductible levels a consumer would pay, for instance.

“Because we know there are half a dozen things that st and out, that matter to people, so you want to nudge them to consider certain aspects,” von Glahn said. “But you don’t want to curtail their opinions or needs. You have to give people choices of what they want to choose.”

The cost calculator, for instance, will be an important component of the health plan selection process, von Glahn said.

July 3, 2012

The New Health Care Reform Act Debunking Myths And Giving Facts

Unless you’ve been living in a cave, you’ve heard about the new health reform law, The Affordable Care Act, as the law now applies to all Americans. With so much political maneuvering, different political parties vying for the next presidency, and media hoopla, there is a lot of conflicting statements concerning this new Act. What is the truth? What are the myths?

Here is a straightforward breakdown of 5 myths you may have heard and the real facts concerning The Affordable Care Act.

Myth #1: The Affordable Care Act Will Raise The Cost Of Health Care

Fact: Most people are under the impression that this new reform act will cost Americans billions, if not trillions, of dollars. The truth is, The Affordable Care Act will reduce the national deficit by over $3 trillion over the next 10 years as a regular family of four will save over $2,300 on their insurance premiums.

Myth #2: The Affordable Care Act Will Hurt Small Businesses

Fact: The Affordable Care Act will instead lower health insurance premiums so that small businesses can offer health insurance to their employees. Small businesses could see a drop in insurance premiums of up to 4-percent, which saves employers $2,000 per person on health care costs.

Myth #3: Businesses Will Stop Offering Health Insurance To Employees

Fact: If businesses are saving anywhere from 3-to-4 percent on premiums per person on health insurance due to this health care reform act, then employers have no reason to take health insurance away from their employees. It is the hope of many economists that businesses that did not offer health insurance before will now find it affordable enough to offer it to their employees now.

Myth #4: Preventive Services Will Be Restricted On Many Health Care Plans

Fact: The Affordable Care Act will not restrict preventive care. Instead, many Americans have found that their preventive care coverage has improved, with seniors on Medicare obtaining several preventive care services for free.

Myth #5: The Affordable Care Act Will Have The Government Control My Choices For Healthcare

Fact: This has been the biggest fear in most Americans — that their freedom of choice will be taken away. But what this law does is give people more of a choice in their health care instead of having the insurance companies decide on who is covered. The Affordable Care Act allows more people who couldn’t afford health insurance before to obtain it now with the help of tax credits. It also increases consumer health care protections.

While there are still many myths and facts floating around, you now have a clearer picture concerning several debunked myths and the truths concerning the Affordable Care Act.

All of this information was taken directly from the White House web page.

October 1, 2010

Health Care Reform changes

Here are some changes that are now in effect:

· Require co-pays or co-insurance for preventive services.

· Cap lifetime benefits. (Caps of $1 million to $2 million are now common.)

· Cancel or rescind a policy, except in cases of fraud.

· Refuse to cover pre-existing conditions in children.

In addition, parents in many health plans can keep their young-adult children covered until the age of 26, unless the child gets a job that offers health coverage.

The scope and timing of the changes, however, depends on the type of plan. Some of these changes don’t take effect until Jan. 1, 2011. Other plans are gr andfathered, and exempt from the changes. For up-to-date information on the new reforms, go to www.insurance.wa.gov and click on the health reform icon.

October 1, 2010

Gov Schwarzenegger signs health care bill

The governor signed a bill on Thursday that will establish a web-based insurance exchange that will allow consumers to comparison shop for health insurance coverage. This legislation makes California the first state to implement an oversight board for insurance exchange marketplaces since the federal health care laws were approved.

“For national reform to succeed, it will be up to the states to make it work, and California is moving forward on reforms that will provide affordable and quality health care insurance,” Schwarzenegger said in a statement.

The two bills, SB900 and AB1602 are said to promote competition in the health insurance marketplace, according to Assembly speaker John Perez of Los Angeles.

Edwin Garcia, a spokesman for Kaiser Permanente, called the exchange “a promising and important part of health care reform” that would make coverage more affordable for millions of low- and middle-income Californians and small business owners. Kaiser insures about 6.5 million people in the state, Garcia said.

The exchange is said to be active by 2014.

August 20, 2010

Health Care Update – August 20th, 2010

Removing lifetime and annual dollar limits for essential health benefits

As part of the health care reform law, health insurance companies must remove lifetime and annual dollar limits on covered services (in network and out of network) that the U.S. Department of Health and Human Services (HHS) considers “essential health benefits.” This change goes into effect September 23, 2010, although certain annual limits can be removed in phases over the next four years.

HHS has not given us the final definition of “essential health benefits” yet, but based on the information and examples it has released, as well as our own research of current state and federal m andates, we have come up with a list of approximately 26 services we believe will be affected. There may be variations in certain states. The services still may be subject to copays and other cost shares.

This provision of the health care reform law also restricts annual or lifetime dollar limits at the plan level except transitional annual dollar limits as defined in the legislation.

A waiver program will be available for certain types of plans like mini-med and limited benefit plans so they can retain annual plan limits. We are waiting for more information on this program from HHS.

Administrative services only (ASO) plans also are required to comply with the health care reform law lifetime and annual limits provision for plan years that start on or after September 23, 2010. We will provide guidance to ASO clients, but the final decision on how they choose to comply is theirs.

August 13, 2010

Update on Health Care Reform

Here are some updates on Health Care Reform and how it can affect you or your business. Remember, you can also visit http://www.healthcare.gov/ to get information.

Unions/collectively bargained plans

Whether fully insured or self-insured, unions must implement the same provisions as other gr andfathered plans for plan years beginning on or after September 23, 2010. However, fully insured plans get some special treatment in the interim final gr andfathering rules. The following allowances are given to collectively bargained agreements (for the life of the agreement) that were ratified before March 23, 2010:

· The plans may change carriers and remain gr andfathered.

· The plans may make benefit plan changes (such as plan design) or change employer/employee organization contribution amounts and remain gr andfathered.

· The interim final rules on gr andfathering are silent as to whether gr andfathered health insurance coverage is exempt from the anti-abuse rules.

When the last of the collectively bargained agreements expires, the special allowances end as well. From that point on, the gr andfathered status of fully insured plans will be determined as it is for any other health plan.

Self-funded plans that are kept as collectively bargained agreements are treated like any other plan. For self-funded plans, whether or not they are kept as collectively bargained agreements, a change in third-party administrators will not result in the loss of gr andfathered status.

If a group customer requests that we implement health care reform changes earlier or later than its renewal date because its ERISA plan year differs from the renewal date, we will honor the request.

60-day notice of plan changes

Another health care reform law provision requires plans to create a uniform summary of benefits. And any material modifications to the terms of the plan must be communicated to members 60 days before those changes go into effect. Based on our review, we believe that the 60-day notice provision will not go into effect right away; however, it must be implemented before March 23, 2012 (two years after the law was enacted). The U.S. Department of Health and Human Services will be giving us more guidance on this provision. When it does, we will let you know.

No discrimination based on compensation

Benefits cannot be based on wages

The health care reform law notes that, effective September 23, 2010, plans may not discriminate in favor of highly compensated employees. This means that group health plans cannot base eligibility or the level of benefits on an employee’s wage. The group can offer different levels of benefits as long as they comply with ERISA and are not tied to the amount an employee makes. The legislation defines a highly compensated employee is someone who is:

· One of the five highest paid officers.

· A shareholder who owns more than 10% in value of the employer’s stock.

· Among the highest paid 25% of all employees (exceptions apply).

Waiting periods

We do not believe we will need to change our approach to allowing groups to offer different waiting periods to different employee levels. The health care reform law "nondiscrimination by compensation" provision is specific to the benefit offerings of a medical plan and not the waiting periods established by a company.

Gr andfathered vs. non-gr andfathered plans

No matter how a plan is structured, in order for it to be a gr andfathered plan, it must have been in effect when the health care reform law was passed on March 23, 2010, and no changes are made to the benefits or the benefit plan. For non-gr andfathered plans, the plan sponsor of a group health plan (other than a self-insured plan) may not set up rules about health insurance coverage eligibility (including continued eligibility) for any full-time employees based on the total hourly or annual salary of the employees. Nor can the sponsor set up rules that in any way favor employees who receive more compensation.

Offering benefits only to currently eligible employees

A group can retain gr andfathering status by continuing to offer benefits only to currently eligible employees (instead of all employees), as long as the benefits are not tied to how much those employees make. In addition, the health care reform law notes that the plan sponsor of a group health plan (other than a self-insured plan) may not set up rules about health insurance coverage eligibility (including continued eligibility) for any full-time employees based on the total hourly or annual salary of the employees. Nor can the sponsor set up rules that in any way favor employees who receive more compensation.

Executive physicals

Because this health care reform law provision is specific to plans and not to benefits, executive physicals ( and similar benefits) are not affected.

Getting to the bottom of your health care costs

Did you know: Health care fraud and abuse accounts for 3% of health care spending?

The National Health Care Anti-fraud Association estimates conservatively that 3% of all health care spending, or $68 billion, is lost to health care fraud each year – that’s more than $180 million per day.

This content is provided solely for informational purposes: it is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers. We’re just passing along information we are getting in hopes of assisting you in navigating the new rules and regulations as they come.

March 19, 2010

In this issue of the Insurance Reporter we focus on health care reform

So, health care reform is finally here, however, real change is going to happen slowly. In fact, the real transformation of America’s health insurance system won’t take place until 2014, when four major changes will happen simultaneously:

1. Insurers will be required to take all applicants; 2. States will set up new insurance supermarkets for small businesses and people buying their own coverage; 3. Most Americans will be required to carry health insurance, and;
4. Tax credits to help pay for premiums will start flowing to middle-class working families, and Medicaid will be exp anded to cover more low income people.

There’s a lot to underst and, so read on for a quick overview of the present day facts and feel free connect with us if you want some clarification as to how it affects your health insurance.

The President’s Proposal

The President’s Proposal puts American families and small business owners in control of their own health care.

Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs, guarantees choices, and enhances quality health care for all Americans. Building on that year-long effort, the President has put forth a proposal that incorporates the work the House and the Senate have done and adds additional ideas from Republican members of Congress. The President has long said he is open to any good ideas for reforming our health care system, and the final proposal includes the best ideas from both sides of the aisle offered in the course of the debate, including some from the day-long bipartisan meeting held in February of 2010. The proposal posted here reflects the version that is being vote on in Congress.

What Will The President’s Proposal Mean For You?

Take a few minutes to find out what health insurance reform would mean for you and your family. To begin, select which one describes your situation:

“I own a small business.”

“I have Medicare.”

“I do not have insurance.”

“I buy my own insurance.

Key Provisions Of The President’s Health Care Bill

The President’s Bill puts American families and small business owners in control of their own health care.

It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 32 million Americans afford health care who do not get it today – and makes coverage more affordable for many more. Under the plan, 95% of Americans will be insured.

It sets up a new competitive health insurance market giving tens of millions of Americans the same choices of insurance that members of Congress will have.

It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.

It will end discrimination against Americans with pre-existing conditions.

It puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Health Insurance Reform & Your State

Click on this map to see the report on the current status of health care and the benefit of reform.

Quick Links

The White House Blog: Health Care

H.R. 3590 – Patient Protection and Affordable Care Act as passed in the Senate

H.R. 4872 – Health Care and Education Affordability Reconciliation Act of 2010

Health Care Exchange information

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