Southeast Joe - Insurance and Related Services

02/22/2013

Employers still in ‘shock mode’ with PPACA

As published in the Employee Benefit Advisor
By Gillian Roberts
February 19, 2013

More than half of employers have not calculated the costs of the Patient Protection and Affordable Care Act, but of those that have, 61% say PPACA has increased their expenses. According to a survey of 1,200 employers by Willis Human Capital Practice, a majority (60%) of employers would like to avoid increases in spending on their group plans. However, only 20% of respondents plan to adjust benefits outside of health care — including retirement, dental, vision, salaries and vacation.

“Employers continue to recognize the value of providing medical benefits, how important those benefits are to their employees and that providing benefits allows them to attract and retain the employees they need,” says Jay Kirschbaum, practice leader at Willis.

Other findings include:
Of the employers who say PPACA has increased their costs, 17% say those increases are more than 5%.
34% of employers say they will shift benefits costs to employees, while 55% feel that competitors should do so.
39% are choosing to voluntarily forego grandfathered status, due to a desire to control plan design and other elements such as co-pays and premiums; last year, only 13% of employers made this decision. Willis says this increase drastically exceeds the Department of Health and Human Services predictions.
Most employers are intending to play under the pay or play mandate

As for the future, Kirschbaum says: “While few employers consciously manage their group medical benefits as a component of their total rewards perspective, survey responses indicate the very beginning of an employer trend in this direction.”

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02/20/2013

As published in Talent Management written by David L. Barron

As Health Care Changes Loom, Is HR Ready?
David L. Barron - 2/19/13

The sweeping health care reform passed in 2010 finally takes full form in 2014. Here’s what HR needs to know.

The countdown to 2014 — when the entirety of the health care legislation passed in 2010 is set to take effect — has begun.

Three major changes will happen next year as a result of the Affordable Care Act, and each poses challenges for employers.

First, all taxpayers will be required to show proof of health insurance when paying their taxes or pay a penalty. Second, employers with more than 50 full-time employees will be required to provide health insurance or pay a penalty.
Finally, employees will have a choice between purchasing health insurance at work — and receiving the employer contributions — or purchasing it in an exchange and receiving federal subsidies to lower the cost of premiums.
Here’s a more detailed look into what employers need to know to prepare.

The Mandate
Every man, woman and child will be required to have health coverage starting in 2014. This means large numbers of the uninsured will join exchanges and take advantage of this new low-cost avenue to purchase health insurance — without exclusions for pre-existing conditions or history.
Many experts, however, believe that only the sick will purchase insurance immediately since they cannot be turned away or charged higher rates. Millions of young, healthy people may simply pay the penalty for at least the first few years — in 2014, the penalty will only be $95 — or wait until they get sick to sign up for insurance.
This is good news if you’re an uninsurable sick person. But for employers, it’s likely to mean higher rates to cover the increased costs to the system.

Pay or Play
Starting in 2014, employers with more than 50 full-time employees are required to provide health insurance or else they will have to pay a penalty if at least one employee joins the exchange and receives a subsidy.
The penalty is $2,000 per full-time employee minus 30. In other words, if an employer has 60 full-time employees, it would pay a penalty on 30 employees.

For some businesses, however, paying a penalty may be cheaper than offering insurance. Many companies are considering their options, weighing the impact of dropping insurance on recruitment and its effect on their ability to attract talent.

Furthermore, companies can be subject to penalties if the cost of “self only” insurance is more than 9.5 percent of an employee’s income and the employee enters the exchange. If the cost is higher than the 9.5 percent threshold, the insurance is deemed “unaffordable,” and the employer is penalized at $3,000 per full-time employee who opts for the exchange.

The Exchange
Each state is supposed to establish a health care exchange by 2014, where its citizens can shop for health insurance among plans offered by various private insurers. Most states, however, have refused to implement the exchange. This in turn will place the burden on the federal government to pick up the expense. At this point, no one knows what the exchanges will look like or how they will work, but most experts envision a website that will function like a traditional e-commerce website.

Starting in March, employers will be required to provide a written notice to employees explaining how the exchanges will work, and the employee’s option to decline the employer’s insurance in favor of the exchange. If the employee purchases coverage through the exchange, the federal government will provide premium assistance in the form of an “advanceable” tax credit based upon income level and number of dependents.

Employees making up to 400 percent of the federal poverty level are eligible for the subsidy. That equals roughly $90,000 for a family of four.

In all, some employers may find little impact on participation in their plans, while others may see a mass exodus to the exchange. If the latter happens, the employer group will be smaller, likely driving up costs further. It’s therefore incumbent on employers to be prepared and model out a worst-case scenario — and sooner rather than later.

David L. Barron is a member in the Houston office of law firm Cozen O’Connor, with a focus on litigation practice on labor and employment law. He can be reached at [email protected].

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02/11/2013

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02/09/2013

Interesting news .....
'Sticker Shock' Ahead on Health Insurance
By David Pittman, Washington Correspondent, MedPage Today
Published: February 05, 2013

WASHINGTON -- Separate surveys released this week give dramatically different outlooks for two groups of people under the Affordable Care Act (ACA): the young, healthy worker and the part-time worker.

Premiums for a healthy, nonsmoking, 27-year-old in a "bronze" -- or relatively inexpensive -- small-group or individual policy would increase on average by 169% in five markets in 2014, a survey of major health insurers by the conservative American Action Forum (AAF) found.

Meanwhile, premiums for an unhealthy, 55-year-old smoker in a more generous gold-rated policy would decrease by 22%, on average, in those same five markets in 2014.

"The results surveyed above indicate that there will be massive sticker shock to the relatively young and healthy in both the small group and individual markets," the AAF report said. Those increases essentially subsidize the ACA mandated coverage of sicker individuals and limits on variations in premiums between groups of insured such as men and women, the report noted.

ACA mandates coming in 2014 include the mandate for individuals to purchase insurance; minimal coverage requirements for insurers; coverage of pre-existing conditions for adults; limits on premium variation based on age, gender, health status, or group size; new fees and taxes; and other new rules.

The AAF sought to understand how these changes would play out in different markets. It sent a survey to an unspecified number of major insurers and asked them to forecast the ACA's impact on small-group and individual plans in six cities.

Results showed premiums would increase for young, healthy individuals by an average of 190% in Milwaukee and 157% in Phoenix -- the city with the lowest increase for the group.

To put a dollar amount on that, the average current monthly premium in Chicago, Phoenix, Atlanta, Austin, and Milwaukee is $2,047 for young, healthy workers in a small-group plan. The AAF survey found it will jump to around $5,124 in 2014 with the ACA changes.

However, premiums would drop 32% for older, less healthy individuals in Austin, Texas, the largest drop for the surveyed cities, and by 15% in Milwaukee, the smallest drop for a city.

Premiums for older, less healthy workers in a small-group plan in those same five cities would drop from $14,534 today to $10,706 next year, the AAF survey found.

Both groups of enrollees would be helped economically in some cases by federal tax credits available for those making between 100% and 400% of the federal poverty level, if they purchased insurance through a health insurance exchange.

"By eliminating or constraining these 'rating factors' that result in the variation in today's market, the ACA in 2014 increases the premium for the young and healthier and lowers the premium for the older and sicker," the AAF survey said. "The same would be true if there were a law reforming automobile insurance."

The AAF survey didn't specify which health insurers participated in its survey but did say it wouldn't have published results without at least four respondents for each city. Albany, N.Y., was the only city it asked about whose results weren't published.

A separate survey from the ADP Research Institute, also released this week, says the ACA's penalties for employers to offer coverage to employees could result in more of today's part-time workers receiving coverage.

"The shared responsibility provision of the ACA may result in employees who are currently classified as part-time being reclassified as full-time, meaning the employer must offer coverage to those employees or face a potential penalty," ADP's 2012 Study of Large Employer Health Benefits said.

In 2012, 23% of all employee positions were classified as part-time and only 15% of those were eligible for benefits, the survey found. The survey was based on roughly 300 companies with at least 1,000 employees.

The ACA mandates that any employee working at least 30 hours per week, or 130 hours per month, must be offered employer-sponsored health coverage that meets certain requirements if the business employs 50 or more full-time workers.

"The ACA will require employers to extend health coverage to more part-time employees, and employers need to carefully consider the best approach for their organization," the report stated.

On Monday -- the same morning the AAF released its survey -- Health and Human Services Secretary Kathleen Sebelius said the government must reach out to young people currently uninsured who may not know they can gain federal assistance to buy coverage through a health insurance exchange or marketplace. Young people are particularly tough to reach, she noted.

"If we're going to fulfill the full promise of the Affordable Care Act and insure millions of Americans, we need to reach these people," Sebelius said Monday.

David Pittman

David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.

02/07/2013

An interesting article from NBC News follows -
Alzheimer's numbers to triple by 2050, report says

By Robert Bazell, Chief Science and Health Correspondent – NBC News

The number of Americans living with Alzheimer’s will triple in the next 40 years, which means that 13.8 million will have the mind-robbing disease by 2050, researchers projected Wednesday.

Previous estimates of what many call “the tsunami of Alzheimer’s” hitting our society as the population ages have come up with similar numbers. This latest projection is notable because it is based on an analysis of more than 10,000 people 65 and older enrolled in the Chicago Health and Aging Project since 1993.

Researchers interview the volunteers every three years to monitor the number who develop Alzheimer’s as they grow older. Census data project that as the baby boom generation ages, the number of Americans ages 65 to 84 will approximately double by 2050. At the same time, the number of those 85 and older will increase almost four-fold to a total of nearly 14 million. The study estimates that 36.6 per cent of that population will suffer Alzheimer’s.

Currently an estimated 4.7 million Americans have Alzheimer's, the most common cause of dementia.

“These projections emphasize the need to find either prevention or treatment for Alzheimer’s disease dementia in order to decrease the burden of future disease on individuals, families and the medical care system,” the team at Rush Hospital in Chicago writes in the journal Neurology.

What are the chances of better treatments any time soon? In a few words: not great. Drug companies and academic researchers are carrying out many trials and we can hope for an unexpected great success. But none is apparent

The FDA has approved five drugs to treat Alzheimer’s. Most physicians say that in a minority of patients they relieve symptoms for a few months. But none stops the inevitable brain destruction.

Still, the drugs generated sales of $2.9 billion in 2011, according to IMS Health, a healthcare technology and information company. The best selling, Aricept from Pfizer, brought in $1.5 billion. Doctors admit that all too often they will give the patient the pills long after it is clear they have no benefit because they want to help, and families expect them to do something even if it affords no improvement.

Early diagnosis will be playing an increasing role in the effort to stop or slow down Alzheimer’s. Recent studies of people who carry gene variants that bring on Alzheimer’s at an early age found that brain changes leading to the disease began as early as 25 years before memory loss or other symptoms set in. Drug trials are now looking at people with the gene variant that predisposes them to Alzheimer’s, trying experimental drugs decades in advance to see if they can slow the process.

As part of the push for early detection, drug company Eli Lilly won approval from the FDA last April for a radioactive tracer that, used with a PET brain scan, measures the build-up of a substance called amyloid plaque that many experts believe is either the cause of Alzheimer’s or a critical marker for its progression.

The company says the product, called Amylin, can help doctors diagnose Alzheimer’s and rule out other possible, mostly rare, causes of dementia. There is no evidence to date that it can help predict what will happen to people who do not have symptoms. The price of Amylin, the PET scan and the doctors’ time adds up to $4,000 and federal advisers say Medicare and Medicaid should not pay for it.

So what can a person do to reduce the risk of dementia later in life? Dozens of studies have shown that exercise is very helpful.

One of the strongest pieces of research came out Monday from the Cooper Institute in Dallas. Looking at 25 years worth of records for more than 19,000 people who visited the institute, which specializes in preventive care through fitness, it found that those most fit in their late 40s were 36 per cent less likely to develop dementia in their 70s and 80s. Exercise is neither new nor glamorous. But for much disease, including Alzheimer's, it remains a strong defense.

Contact me if you would like information on a Critical Illness coverage that pays a lump sum between $10,000 and $60,000. Restrictions apply. You must not have been treated for the critical illnesses covered, not diagnosed fo rthem and not diagnosed for them for the first thirty days of coverage.

01/24/2013

UnitedHealthcare Launches Innovation Contest to Battle Chronic Illness

By Brian T. Horowitz eWeek electronic newsletter

UnitedHealthcare is offering a $60,000 prize for developing products that solve challenges in health care and aid people with chronic conditions.
UnitedHealthcare has launched an open initiative to encourage the development of products that help people live healthier lives and manage chronic conditions.

Announced on Jan. 11 at the International Consumer Electronics Show, the "Breakthrough Health Tech Challenge" will award a $60,000 prize to the winning health care innovator. UnitedHealthcare is the health benefits unit of UnitedHealth Group.

Through its crowdsourcing challenge, UnitedHealthcare aims for innovators worldwide to address the greatest challenges facing the health system. Crowdsourcing involves outsourcing a task to a large group of people.

UnitedHealthcare is looking for ideas on how to use consumer devices such as video-game systems and mobile phones to aid people with chronic conditions, including diabetes, heart disease and obesity. The innovations should be able to prevent the onset of chronic conditions, said Martin Nyman, director of innovation at UnitedHealthcare.
"The goal of the challenge is to identify new solutions that will enhance the health of people living with chronic conditions, facilitate the prevention of these conditions and help people lead healthier lives," Nyman told eWEEK in an email. "By engaging people from around the globe, we will be able to identify new ideas that focus on solutions that contribute to improving people's health and the overall health system."

Through the challenge, UnitedHealthcare is also looking for "exergaming" innovations that combine exercise and games, said Nyman. Exergaming is a form of consumer engagement, he noted. UnitedHealth Group combines exercise and social challenges in its OptumizeMe mobile app. Available on Windows Phone 7, iOS and Android, OptumizeMe allows people to track their health behaviors. Through the app, they can also challenge friends to meet fitness, nutrition and lifestyle goals.

UnitedHealthcare will accept submissions through April 8. A team of health care experts will evaluate the submissions based on "creativity, viability and the potential to improve people's health," Nyman said. "We believe this groundbreaking challenge will inspire new ideas and concepts that could serve as breakthrough solutions to improving people's health and the health care system," Gail Boudreaux, CEO of UnitedHealthcare, said in a statement. "By engaging people from around the globe, we will be able to identify new thinking that focuses on solutions that promote health, prevent disease and improve medical care."

The company has launched a number of health care challenges since mid-2012. The new challenge is geared toward the public while previous challenges focused on engaging UnitedHealth Group employees, the company reported.
UnitedHealthcare launched the challenge because of a convergence occurring in consumer, Nyman said in a company video.

The "common person" can now develop these consumer technology products in a cost-effective way and apply them to a certain application, according to Nyman. For the challenge, UnitedHealthcare is open to ideas from outside the health care industry, according to Boudreaux. "Innovative ideas can come from anywhere, including from people outside the health system," Boudreaux said.

After the challenge has concluded, UnitedHealthcare will draw on its industry expertise, including data analytics and clinical insight, to help market the innovations and benefit the health system, Nyman said.
In addition to announcing the innovation challenge at CES, UnitedHealthcare also demonstrated its MyHealthcare Cost Estimator, which is Web-based and mobile. MyHealthCare helps users understand their health care costs for doctors and hospitals as well as compare the costs and quality of alternative treatments, the company reported.
"It's bringing transparency to health care, which all consumers deserve," Dr. Reed Tuckson, executive vice president and chief medical officer at UnitedHealth Group, said in a company video at CES.

Brian T. Horowitz is a freelance technology and health writer as well as a copy editor. Brian has worked on the tech beat since 1996 and covered health care IT and rugged mobile computing for eWEEK since 2010. He has contributed to more than 20 publications, including Computer Shopper, Fast Company, FOXNews.com, More, NYSE Magazine, Parents, ScientificAmerican.com, USA Weekend and Womansday.com, as well as other consumer and trade publications. Brian holds a B.A. from Hofstra University in New York.
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01/22/2013

Important news for United Healthcare members in Florida with respect to Baycare

BAYCARE HEALTH SYSTEM & UNITEDHEALTHCARE FINALIZE MULTI-YEAR AGREEMENT

UnitedHealthcare and BayCare Health System have signed a five-year agreement, providing our members renewed in-network access to BayCare’s 10 hospitals, ancillary facilities and nearly 400 hospital-employed physicians. The agreement covers UnitedHealthcare members participating in Medicare, Medicaid, Florida Healthy Kids, individual and employer-sponsored programs.

The new arrangement is effective Nov. 26, 2012, ensuring uninterrupted in-network benefits coverage for all UnitedHealthcare plan participants who may have visited a BayCare hospital, ancillary facility or physician during this interim period. Claims received for services on or after November 26, 2012 will be processed using the updated participation status. UHC members do not need to take any action in this regard.

01/21/2013

Do you need a review of your health insurance and live in Florida? Let me know.