Archive for November 16th, 2010

Paying Cash For Dental Expenses May Be Less Expensive Than Insurance

Tuesday, November 16th, 2010
Dental, Vision & Hearing Plan

UCT - Where Community and Compassion Unite
50% Commission*

8% Lifetime Renewals

 9 Month Advance

*SC, TN, KY, CO, SD call for comp.
Issue Ages:  18-84
10% Household Discount

If two or more people, living in the same household at the same address, apply for coverage at the same time, then each may receive a 10% discount.

Call Western Marketing for more information: 

800-852-7152 

Ask for Doug, Justin, Robin or Russ 
Western Marketing
Western Marketing
www.wmacorp.com
800-852-7152

Benefits
 Dental Vision Hearing

The client may choose between a $0 or $100 Policy Year Deductible.  After the Policy Year Deductible is satisfied, UCT will pay the following percentages of actual charges up to the Policy Year Maximum Benefit:
  • 60% in the 1st Policy Year;
  • 70% in the 2nd Policy Year;
  • 80% in the 3rd Policy Year;
  • 90% thereafter.
  • Client chooses $750, $1,000, $1,500 or $2,000 Policy Year Maximum Benefit.

Guaranteed Renewable for Life
DentalUCT doesn’t charge a policy fee and, although some limitations do apply, your acceptance for this insurance is guaranteed.  This Policy is renewable as long as you live, provided you continue to pay premiums when due. 

Covered Expenses
  • Dental services, performed by a licensed dentist, including one annual examination and cleaning, x-rays, fillings, prophylaxis, bridges, crowns, dentures and outpatient dental surgery prescribed as Medically Necessary.
  • Hearing examinations performed by a physician or audiologist, including the cost of the hearing aid and any necessary repairs.
  • Visits to a physician for a basic eye examination or eye refraction, including the cost of eyeglasses or contact lenses prescribed by the physician, up to a maximum benefit of $150 in any one Policy Year.

Curacao 2012 Incentive Trip
Curacao 2012Don’t Forget: Your production counts towards Western Marketing’s Curacao 2012 Incentive Trip! 

CLICK HERE for details.

 
 

Editor’s Note: Posting this does not mean we are endorsing the product. We are simply showing that the cost of delivery through an insurance product is comprised of certain cost components.

Fred Hunt Opines

Tuesday, November 16th, 2010


TPA Forecast & Industry Trends for 2011 by SPBA President Fred Hunt

MyHealthGuide Source: Fred Hunt, President, Society of Professional Benefit Administrators (SPBA), 11/10/2010, www.SPBATPA.org

Preface by Mr. Hunt: For 30 years, I have been providing these very candid insights & prognosis. They are provided to all SPBA members as well as available for the outside world to read. To my own surprise, the accuracy rate of the forecasts has been extremely high. This time, I think the forecast will again be accurate, but the outcome more circuitous, with so many specific issues in flux right now. Flux will remain for about 4 years.

Health Reform is Entrenched, But …

In politics, 2011 will be a hectic gridlock prelude and staging ground for the 2012 elections. Both parties are facing internal civil war, so Democrat and Republican are no longer predictable cohesive categories, and neither side can achieve what they are promising to do with health reform.

Balance-of-power provisions in the legislative system prevent the new Republican House majority from achieving their stated goal of totally repealing health reform or even applying major “de-funding” to aspects already in the law. Only new requests for funding can be stopped by non-action by the House.

By Inauguration in 2013, too much will be entrenched to simply repeal. Consequently, wisely, most employers, TPAs, and plans are proceeding as if there will be no legislative changes and focusing on regulatory developments. They will be prepared no matter what. Any significant change to the employee benefits provisions will come via regulatory not legislative action.

Health Reform is Still Evolving

Health Reform is still evolving in terms of the rules of the game (regulations), and then what pieces will be changed or eased, and how will the various players (insurers, medical providers, employers, etc.) adjust to the new realities.

For example, will insurance companies withdraw from the health insurance market in the US because of the many limits and unsustainable rules and requirements imposed on them throughout health reform? The health insurance business will be unprofitable by 2014, and insurance companies need to make money.

Even if insurance companies try to branch out into new services in their own name, the term “insurance company” will probably trigger the punitive treatments. (Insurers that have had independent-named and independent-thinking/operating TPA subsidiaries should be fine.)

I had noticed in recent years that insurers had been searching for and found profitable new markets in parts of Europe and Asia to replace their US health insurance market. If insurers withdraw from the US health insurance market, there is a large vacuum in the market for TPAs and self-funding to fill. Meanwhile, doctors, hospitals, employers and individuals will all be adjusting their actions, from who they serve, how they practice, “gaming” the system, ACOs, etc.

Those new approaches will, in turn, cause other changes. For example, if insurers exit the market, what happens to state exchanges which the government sees as the key to the future health payment system? Exchanges rely on insurance companies. Similarly, doctors and hospitals may find it uneconomic to take Medicare and Medicaid patients at a time when both programs are expected to grow tremendously. So, health reform is like reshuffling the cards and dealing a new hand to each of the players.

Prediction:  Health Reform Boost TPA Business

For those and other reasons, TPAs and self-funding will find health reform a net boost to their business. Why? The punitive and suffocating aspects were applied to insurance companies, not self-funding and TPAs. In some cases, new requirements that do apply are simply factors similar to ERISA fiduciary and reporting self-funded plans have always had.

Employer Defection?

Health reform also deals employers a new hand.

Employers have sometimes resented the hassle of employee health plans because they have been considered a “fringe benefit”. However, as health reform unfolds, the market offerings from state exchanges and elsewhere become more cookie-cutter and bureaucratic.

Self-funding with TPAs becomes the only place to find personalized service and plan design flexibility. Those two factors have been the drivers of the many-thousands-percent growth of the TPA self-funding market over the past 30 years. The giant new importance for employers, is that employee health benefits become a tool of corporate profitability and survival. How? Why?

 The doctor shortage and regimented health plans means that promptly getting a valuable employee medical care and back to work is vital. A worker off the job waiting weeks for diagnosis and treatment (as happens in virtually all government-designed plans around the world) drains money and productivity from the employer. Unless the employer sponsors his own plan which is designed and administered for the maximum efficiency of that employer and workers, the employer is helpless.

Sponsoring a Heath Benefits Plan As Important As Any Company Decision

Sponsoring a heath benefits plan will soon become as important as having a service contract for valuable machinery the company needs. Most people have not yet seen this coming, but the reality will hit suddenly and quickly, and within just a couple of years. So, what will become vital to employers is the personalization, flexibility and cost-efficiency that has always been the greatest advantage of TPAs and self-funding.

Dont get me wrong. In pursuing a profitable post-health-reform future, TPAs will have many headaches, obstacles, and mazes to endure. TPAs will look and think differently from a pre-2010 TPA. The evolving new TPA will need to be alert and pro-active to opportunities for many new services which employers will want to hire TPAs to do. SPBA meetings in recent years have provided case studies and new profit centers which proactive TPAs are already preparing and discussing with clients. Those sessions and sharing will continue, so TPAs will have nationwide perspective and brain trust. Health reform and other factors are generating more services and requirements employers and plans will want handled, so TPAs will find the menu of services and profit centers they offer growing.

TPA Future Optimistic

In summary, the future outlook for TPAs and their main market of self-funding is optimistic. It will take dedicated brain power to envision as well as energy and patience to bring into reality, and to explain to clients the evolving new menu of available services for sale. Health reform will be a case of TPAs turning lemons into lemonade.

TPAs Must be Pro-Active

The best news of this report is that there has been a wonderful change in TPAs attitude this year! For several years, a main theme of my industry forecasts has been that TPAs need to maintain the pro-active attentive energy and focus on government rules, regulations, industry trends and interacting with other TPAs. I saw too many TPAs getting lazy and just coasting along. They were becoming a risk to themselves and to the whole TPA self-funding concept.

In 2010, when things seemed scariest, I have seen TPAs rise to the challenge. Whether from just plain anger or a determination to master the new challenge, I have seen a big jump in the pro-active professionalism of TPAs and SPBAs Stop-Loss Partners. That is the best news in years, and makes my prediction, about a bright future for TPAs and self-funding all the more certain. This is a reinvigorated industry! SPBA members have taken the leadership role of becoming resources of insight for clients and their communities on the big, small and unseen agenda aspects of health reform. TPAs and Stop-Loss Partners are instantly digesting every new batch of insider insights and analysis on how the laws will be applied. They have actively submitted real-world insights to the reg-writers, and been rewarded with many regulatory decisions that recognize and accommodate those real-world needs. More than in past years, SPBAs TPAs and Stop-Loss are acting like a team determined to build an active role in whatever evolves.

About SPBA

SPBA is the national association of Third Party Administration (TPA) firms who provide comprehensive ongoing administrative services to client employee benefit plans. SPBA also has a Stop-Loss Service Partner category for carriers, MGUs, and re-insurers of self-funded health plans.  Visit www.SPBATPA.org.

ING Gears Up For Insurance Sale

Tuesday, November 16th, 2010

ING will probably spin-off its insurance arm in two separate stock market listings in Amsterdam and New York, says chief executive Jan Hommen.

ING would have a Europe-focused listing for its Asian insurance business, while a US initial public offering would have a strong position in retirement services. The Europe flotation would probably include its UK general insurance arm, ING Direct.

However, Hommen said the Dutch bankassurance giant was still in talks with many interested parties over the insurance units. Aviva has already cast the slide rule over the business to see if it is worth buying.

Hommen was speaking after the insurance business posted a €656m third quarter loss due to writedowns in the US. ING Group’s third-quarter net profits, fell to €371m from €499m last year, reports the Financial Times.

Editor’s Note: ING is a major stop loss writer in the United States. Who will buy this block?

Evil Health Insurance Company Exposed

Tuesday, November 16th, 2010

http://www.youtube.com/watch?v=vKI9be55N00

Do You Still Believe That Network Discounts Are Saving You Money?

Tuesday, November 16th, 2010

MyHealthGuide Source:  Jim Farley, J. P. Farley Corporation, 11/10/2010, www.jpfarley.comUSA Today (10/22/2010) featured a front page article (below) about a small physical therapy firm in Michigan who has successfully sued Blue Cross and Blue Shield of Michigan for tactics that would put the small firm out of business for offering Ford, GM and Chrysler an alternative that would have saved them millions of dollars per year on physical therapy claims. This is the same Blue Cross plan that has had suit filed against it by the U.S. Department of Justice for paying hospitals higher prices in exchange for bigger discounts. (It should be noted, others are being investigated by the feds and states for similar practices.)Basically, the Physical Therapy firm came up with a better and less expensive way to handle physical therapy for the automaker’s self insured plans which were administered by Blue Cross and Blue Shield of Michigan. Blue Cross then refused to administer the therapy claims submitted for reimbursement by the small firm. Blue Cross then appears to have encouraged hospitals to revoke ‘discounts’ on all other services the hospitals rendered to participants of the automaker’s plans. When that did not work, Blue Cross then kicked the small firm out of its provider network in an attempt to deny the small firm customers.What really needs to be asked in this situation is why did this occur?

The payments involved were payments to providers of physical therapy, not payments to Blue Cross. The automaker customers reported that the small firm cut their physical therapy costs by 40%.

Carriers who are constantly push their big discounts say they are trying to save plans money. However, when their customers make moves that actually do save them money, the carriers suddenly step in and threaten to stop the practices put in place to achieve plan savings. The network discounts will save a plan money as long as the measurement used to determine savings is limited to the discount. If you consider costs, what a plan actually spends in health claim costs, the savings quickly disappear.

Which is more important to you, the amount of the discount or the total cost of the plan? If it’s the latter, network discounts are not the answer.

US Sues Michigan Blue Cross Blue Shield
MyHealthGuide Source: Pete Yost  with contributions from Mike Householder, 10/18/2010, U.S. sues Michigan Blue Cross Blue Shield – is this happening with your insurance carrier? WASHINGTON (AP)  —  The Justice Department alleged Monday in a lawsuit that Michigan Blue Cross Blue Shield is discouraging competition by engaging in practices that raise hospital prices  —  conduct an assistant attorney general vowed to challenge anywhere it is found in the United States.The suit targets “most favored nation” clauses between Michigan Blue Cross Blue Shield and health care providers which, according to the government, essentially guarantee that no competing health care plan can obtain a better rate.Michigan Blue Cross Blue Shield has most-favored-nation clauses or similar language in contracts with at least 70 of 131 general acute care hospitals in the state, the government alleges.The lawsuit said that Michigan Blue Cross Blue Shield intended to raise hospital costs for competing health care plans and reduce competition for the sale of health insurance.

“As a result, consumers in Michigan are paying more for their health care services and health insurance,” Assistant Attorney General Christine Varney, who runs the Justice Departments antitrust division, told reporters.

In response, Michigan Blue Cross Blue Shield said the lawsuit is seeking to restrict the nonprofit companys ability to provide the most deeply discounted rates from Michigan hospitals. The company said that negotiated hospital discounts are a tool that Blue Cross uses to protect the affordability of health insurance for millions of Michigan residents.

“Our hospital discounts are a vital part of our statutory mission to provide Michigan residents with statewide access to health care at a reasonable cost,” the company said.

In some instances, the lawsuit states, Blue Cross has negotiated most-favored-nation clauses in exchange for increases in the prices it pays for the hospitals services. In those instances, says the suit, Blue Cross has bought protection from competition by causing hospitals to raise the minimum prices they can charge to Blue Cross competitors.

“Blue Cross has not sought or used MFNs to lower its own cost of obtaining hospital services,” says the lawsuit.

The state of Michigan joined the Justice Department in the case filed in federal court in Detroit.

The lawsuit outlines two types of most-favored-nation clauses requiring a hospital to provide services to Blue Cross competitors either at higher prices than Blue Cross pays or at prices no less than Blue Cross pays.

In alleging violations of the Sherman Act and the Michigan Antitrust Reform Act, the government said that under the “MFN-plus” clause, Blue Cross negotiated agreements requiring more than 20 hospitals  —  including Sparrow Hospital in Lansing, St. John Hospital in Detroit and Munson Medical Center in Traverse City  —  to charge some or all other commercial insurers more than the hospital charges Blue Cross. Under the other clause, Blue Cross has agreements requiring more than 40 small, community hospitals to charge other commercial health insurers at least as much as they charge Blue Cross, the lawsuit alleges.

Sparrow Health System spokeswoman Rose Tantraphol said Sparrow was not a party to the lawsuit, has not seen it and could not comment on the particulars of it.

She did say, though, that Sparrow “has a similar contractual arrangement with Blue Cross Blue Shield of Michigan as most other larger Michigan hospitals,” and “as is common practice throughout the nation, contracted rates are determined, in part, based on volume.”

In a statement, Munson said it was monitoring the situation “with interest,” but had “no basis to know if the allegations in this lawsuit are true.”

St. John Providence Health System spokeswoman Maureen Petrella said she had no comment.

Varney declined to say whether the Justice Department has open inquiries in other states of most-favored-nation clauses, which are not illegal unless they stifle competition.

About J.P. Farley Corporation

J.P. Farley Corporation founded in 1979 by Jim Farley, current President and CEO, is a privately-held third-party administration and consultation firm. The company was founded to deliver added value to employee benefit Plans that are self-funded for medical, prescription, dental, vision, short-term and long-term disability benefits. Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA), and Health Savings Accounts (HSA) administration are also part of the portfolio of service offerings.  Visit www.jpfarley.com.
 

 
 

Shindler’s List

Tuesday, November 16th, 2010

oved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711 as of November 1, 2010