SHOUTAmerica Warns Young Americans Of ObamaCare Cost Increase

WASHINGTON, Jan. 30, 2013 /PRNewswire-USNewswire/ — SHOUTAmerica, a non-profit organization focusing on the healthcare issues affecting young Americans, has unveiled a new calculator to help estimate costs of the looming health insurance rate hike that could soon hit many younger Americans.

The SHOUTAmerica calculator is now available online at

The new SHOUTAmerica calculator is designed to help young Americans who purchase individual policies estimate the cost of their health insurance in 2014 – based on their age, income, where they live, and other variables – and also identifies whether they are eligible for other coverage options in the individual market. The tool demonstrates potential increases in individual market insurance premiums, which could spike by as much as 42 percent or more. SHOUTAmerica believes this will discourage younger individuals from participating in the system.

Beginning on January 1, 2014, new federal rules on how health plans price their coverage, including changes in how policies are priced for younger and older people (i.e., the 3:1 age rating requirement),  broader benefit packages, health insurance taxes and other changes will cause insurance premiums to increase dramatically for younger, healthier Americans.

AMPS Achieves 100% Growth in 2012 – Touts Cost Plus Model

“The PPO replacement model has been a perfect line extension for AMPS because it takes advantage of all of our strengths as a company. Anyone can take a claim and re-price it at some equation of Medicare but doing so without first scrubbing the claim for errors and invalid charges still means the payer is taking a discount on a dirty billing. Our legal team’s technical acumen and employee support is the additional difference-maker in our Cost Plus model, as it allows us to provide complete protection services coupled with highly proactive member communication and advocacy. ” – Mike Dendy

Continue reading AMPS Achieves 100% Growth in 2012 – Touts Cost Plus Model

Are Minimum Premium Plans Making A Comeback?

In the late 80’s Minimum Premium plans were offered by carriers as a  method to entice plan sponsors from self-insuring their group medical plans. Self funding was becoming increasingly attractive to some employers and carriers were worried that they would lose the “float” generated by fully-insured cash cows. Competition brews innovation.

As a rep. for a large health insurance company at the time,  I remember going to a training session in Dallas and told “we are about to teach you all about self-funding, but we don’t want you to sell it. Only do so if you have to due to competition and instead try to offer a  Minimum Premium Plan as a last resort!”

My employer knew that a Minimum Premium Plan allowed full book value in year end financials, while ASO administration fees (self-funded plans) eroded corporate financials.

Minimum Premium Plans began to fade in the 90’s and eventually became extinct. Self-funding grew in market acceptance  because plan sponsors realized the difference.

But now we see a resurgence in Minimum Premium Plan offerings. It is our understanding that Humana,  Aetna and Cigna (Cigna Funding Alternatives) are actively marketing Minimum Premium Plans in select markets.

Could this be the “last gasp” for carriers under ObamaCare? Designs Innovative PPACA Plan


“TO AVOID OR NOT TO AVOID PPACA FINES, THAT IS THE QUESTION” – WILLIAM SHAKESPEAR JR. has designed a new and innovative group medical plan for those employers who wish avoid punishing PPACA fines and sanctions but are concerned about costs. The question employers have is “Are ObamaCare fines less or greater than the cost of providing health insurance?

This program is designed for groups with as few as 25 employees. For more information:

Don’t bother doing something unless your radically different from the competition” – Richard Branson

Editor’s Note: Taking Advantage of Loop Holes Is The Ultimate Sport For Non-Conformists. A 2,700+ page law is bound to have some serious loopholes one can seize upon. We love the challenge.

Insurance Brokers Prepare Clients For Armageddon

The real story in this article is step two of the demonization process: first it was the insurance companies that were demonized, step two is to demonize the medical care givers. Price controls are coming:

“To try and get a handle on rising costs, the Obama Administration will start to go after the healthcare providers. ” Medicare +40% (see article below this one) is going to begin to look damn good to the provider community.

Continue reading Insurance Brokers Prepare Clients For Armageddon

PPACA & Provider Reimbursement

“If Medicare reimbursement rates are good enough for the government, they should be good enough for private payers forced to carry the heavy yoke of PPACA (government) mandates. And besides, Medicare rates must be Ok, my doctor drives a Mercedes “- Don Pedro

Editor’s Note: Don Pedro is a renowned South Texas sage.

Don Pedro sounds like a liberal – Homer G. Farnsworth, M.D.

Your missing the dynamics here Homer! Don Pedro is a conservative proving a point! – Molly Mulebriar

ObamaCare Officials Too Busy To Return Calls

Recently we posted an article entitled “How Minimum Value Mandate Will Affect Cost Plus Health Plans.” The accuracy of the article depended upon verification from the Office of the Division Counsel/Associate Chief Counsel (Tax Exempt & Government Entities) at the Internal Revenue Service, 1111 Constitution Avenue, Washington, DC.

As directed in IRS Notice 2012-31 we called them at 202-927-9639. An answering machine verified we reached the right office, but since there was a backlog of calls to return, the machine voice said that our call would be returned in the order it was received. We have been waiting for a return call since.

Is this any indication of what is in store for us when ObamaCare kicks in at full strength in 11 months?

Business Owner Adapts To ObongoCare

First owner George Burnett charged liberals a dollar more than conservatives at his Vernal, Utah smoothie shop. Now, another Utah business owner — evidently inspired by that political stand — has fired two employees for supporting President Obama. And it’s all completely legal.
nOwner George Burnett charges liberals a dollar more than conservatives at his Vernal, Utah smoothie shop

Continue reading Business Owner Adapts To ObongoCare

Boon-Chapman Partners With Kelsey-Seybold

Kelsey-Seybold Clinic, the nation’s first accountable care organization accredited by the National Committee for Quality Assurance, and Boon-Chapman, a Texas-based third-party administrator of employee benefits, announced a partnership to deliver Kelsey-Seybold’s “KelseyCare” health benefits plan to partially self-funded employers in the Greater Houston area with 50 or more covered employees.

Continue reading Boon-Chapman Partners With Kelsey-Seybold

11 Months Until ObamaCare Is Fully Enacted – Do You Know What To Expect?

As the full enactment of Obamacare approaches, there are many factors that business owners know to look out for.

  • Do I need to provide health insurance to my employees?
  • Should I go to an exchange?
  • How will the mandate impact my business and profitability?
  • How much are my health insurance premiums going to go up?

These are all questions that many business owners are starting to look. Below are some points that you may not have thought of that should go into your business planning.

Continue reading 11 Months Until ObamaCare Is Fully Enacted – Do You Know What To Expect?

McAllen Independent School District Seeks Health Insurance Proposals

Attention Bidders: McAllen ISD INVITES your bid on RFP No. 2012-096 – Self-Insured and Fully Insured Health Plan and Related Services.

BIDS three (one copy should be hard copy, and the other two copies are to be submitted on CD or FLASH DRIVE in one (1) single file) SHALL BE RECEIVED at Purchasing Services, 4309 Warrior Drive, Bldg. C, McAllen, Texas NO LATER THAN: 3:00:00 PM local time, Wednesday, February 13, 2013.  Bids received after this deadline shall be considered void and unacceptable and will be returned upon written request at bidder’s expense. McAllen ISD will not be responsible for mis-sent or misplaced proposals.  Unsigned bids shall not be considered.  FACSIMILE TRANSMITTALS SHALL NOT BE ACCEPTED. (digital signatures will be acceptable).

The specifications will be available to interested parties on or after January 16, 2013. The Request for Proposal package will ONLY be available online. To obtain a copy of this RFP, please register at

Any questions regarding this RFP must be emailed through the “Questions” option located within the solicitation posted on The Public Purchase website,tx no later than 10:00 AM, Wednesday, February 6, 2013.  Questions/clarifications regarding this bid will not be answered by phone.

Julie Hernandez, MISD Senior Buyer

McAllen ISD is on Facebook. You can also follow us on Twitter by texting “follow McAllenISD” to 40404.

Editor’s Note: Placing a bet on Aetna may bring odds of 20 to 1.

Aetna Announces New Health Plan For Texas Political Subdivisions

The Texas Health Affiliate Plan offered through collaboration between Aetna and Michigan Employee Benefits Services (MEBS), the VEBA  Trust  Administrator.

The Texas Health Affiliate Plan is a Voluntary Employee Beneficiary Association, VEBA plan.  As a Trust, its members realize purchasing power to buy benefits without losing their organization’s autonomy and ability to make benefit decisions.

The VEBA offers Public Sector Employers , with at least 350 employees, a number of unique benefits, including:

  • A three-year self-insured maximum liability  contract that improves your ability to budget and provides risk protection with budget certain level funding
  • Unique Mini-Aggregate program removes risk  and overall stop loss coverage includes a no lasering guarantee
  • Both immediate and long-term savings, as well as reduced pricing volatility and tax savings, by moving from fully insured to self-insured plans
  • The ability to build protected reserves, for benefit spend, with discipline
  • Product and service stability, including the ability to retain your individual plan designs  and unique network strategies
  • Consultative data-driven solutions to help mitigate trend and improve health outcomes

Unlike many VEBA plans, the Health Affiliate Plan provides access all of these benefits without losing autonomy.  The Entity continues their own unique plan design and individualized reporting from a designated analytics professional, who can also help benchmark  with other VEBA participants. This level of data and information transparency is simply not offered by other Trusts or Pools.

In addition, the Health Affiliate Plan offers access to enhanced services, including:

  • Network discounts through Aetna’s broad national provider network
  • Disease Management programs
  • Case and Care Management programs
  • Pharmacy benefits
  • Basic term life insurance included

Summary of  the 3 year offering

  • Guaranteed cost for three years – Fixed Cost, Claim Cost and reserves.
  • Max liability protection and predictability for 3 years / budget ability
  • Elimination of Fully Insured State Mandate, Premium and HIF taxes ( Health Care Reform Taxes)
  • Flexibility of plan design within VEBA pool, while benefiting from economies of scale in pricing
  • Maintain control , flexibility & reporting


For more information contact Louie Heerwagen at


Health Care Provider Intrigued By Dr. Hummer’s Business Model

Below is a redacted email we received from one of our readers. We had posted an article on Gregg Hummer, M.D. and his approach to paying health care providers fairly, quickly and efficiently:

Bill, I was intrigued by simplicity health plan, and asked for feedback from one of my clients who was formerly a hospital administrator, and now runs a physician group of pathologists. I wanted to pass his input on to you… Cathy

George, If you have a second, take a look at the links below. I am curious how this would appeal to 1) a hospital and 2) a physician group. I would assume that knowing what you will get paid, and getting paid quickly appeals to both, but not sure about pricing based on cost plus Medicare rates.

Cathy – This model is very intriguing.  Providers spend tremendous amounts of money trying to collect payments from insurance companies, in large part because many insurance companies in the healthcare sector, including the large influential carriers in my experience, are highly creative and aggressive in crafting reasons to deny or delay claims reimbursement without regard to the accuracy, legitimacy, or timeliness of the claim submission. If that process and the associated costs can be eliminated, or at least mitigated, thereby allowing providers to expend fewer dollars on collections efforts, providers could obviously afford to accept a lower fee for each service.  The success of the model clearly hinges heavily on the claims authorization/payment process and a mutually-acceptable fee schedule, but this model has the potential to bring about real savings, unlike the “fixes” we are seeing come out of Washington and the alleged cost savings we will reportedly experience with the AFA.


ObamaCare’s Health-Insurance Sticker Shock


Health-insurance premiums have been rising—and consumers will experience another series of price shocks later this year when some see their premiums skyrocket thanks to the Affordable Care Act, aka ObamaCare.

The reason: The congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing. Premiums will soon reflect that disregard—indeed, premiums are already reflecting it.

IRS To Employers: Pay ObamaCare Share Responsibility Or Else!

As if concerns about the fiscal cliff, debt ceiling, higher taxes and a potential recession weren’t enough to scare employers, the Obama administration has just handed them one more headache: an IRS warning that any efforts to avoid the ObamaCare mandate to provide coverage or pay a penalty (or is it a tax?) will not go unpunished.

Continue reading IRS To Employers: Pay ObamaCare Share Responsibility Or Else!

Do Hospitals Lose Money On Medicare Patients?

Do hospitals, as they are quick to point out, lose money on Medicare patients? According to information available at , some do and some don’t. Some hospitals are more effecient than others.

But, what is the overall truth?

A 2010 Report To Congress: Medicaree Payment Policy is an interesting read. To answer the question posed here, go to page 51 and view Tables 2A-5 & 6.

Hospitals who lose money on some patients must make it up on others. That is common sense business logic. Yet if the overall margin is -8% on Medicare business, paying hospitals on the commercial side at 120% of Medicare seems fair. Or should that be 125%? Or 135%. Or, as we find in the managed care contracting world, 200% and more, sometimes much more.

Somewhere in the  commercial payer market is a magical hospital reimbursement percentage that is forever elusive.


HHS Issues Guidance On Essential Health Benefits & Actuarial Value

HHS问题的指导基本卫生福利及精算价值 卫生和人类服务部(HHS)发布规则的建议 确定基本卫生福利(EHB),以及如何分担费用的限制,适用于 这些好处。该指南还提供重要信息的精算和 团体健康计划必须符合最低值的要求,在2014年开始。 在这篇文章中:背景基本卫生福利成本分担要求精算值|健康储蓄账户(HSAs) 健康的报销帐户(HRAS)|最小值|单机牙科计划 背景 根据病人的保护和支付得起的医疗法(ACA)在2014年开始,所有非原状的健康计划 在个人和小团体市场销售(包括内部和外部ACA交易)必须: 量10 EHB 达到每年的成本分摊限额EHB 符合精算值限制EHB 雇主的健康计划还必须满足“最低值”的要求,以避免某些惩罚ACA。 2012年11月26日,HHS发布了针对这些领域所建议的规则。这些建议的意见 规则是2012年12月26日到期。虽然自我保险和大型团体健康计划将不会提供通过 ACA交易,这些拟议中的规则,这些计划具有重要的意义。 基本卫生福利 该的EHB指导一般情况下的监管方式包括在早期HHS指导。 (请参阅我们的 2011年12月22号供您参考。)允许每个状态之中选择一个基准健康计划 这些四: 2 36 | 02 | 2013年1月8日 任何三个最大的小团体保险产品, 入学,在国家 最大的三个国家雇员的任何计划招生 任何的三个最大的联邦雇员计划 注册 最大的被保险人提供的HMO计划在该州的商业 市场招生 基准的健康计划将作为一个参考平面的状态, 这既反映的范围和限制的承保服务。 “ 基准健康计划必须涵盖所有10个ACA的法定 类的好处,包括门诊门诊服务, 住院,生育,和其他服务。在一定程度上, 基准的计划不能覆盖任何这些十大类,他们必须 覆盖的基础上提供的好处在另一个基准 选项​​。在婴幼儿口头或视觉服务的情况下,计划必须 辅以包括根据(1)的联邦所提供的好处 牙科及视力计划选项,最大的报名,或(2)国家的 独立的牙齿或视力儿童健康保险计划下 计划,如果一个国家计划的存在。 直到2012年12月26日,选择一个基准计划。为 国家没有做出选择的,默认的基准计划是 登记在自己的小团体保险市场最大的产品。 拟议的规则提供了重要的指导,在几个方面: 需要10个EHB小儿牙科和视力服务。该指南的定义,“儿童 服务“为19岁以下的个人,包括服务。 ,EHB不能包括常规非儿童牙科和视力服务,美容牙齿矫正,或长期/ 监护护理家庭护理。 由于许多计划目前没有覆盖habilitative的服务,指导,允许各国确定 什么样的服务,包括在habilitative服务类。另外,国家可以允许保险公司 一种定义habilitative好处。 对于处方药福利计划必须至少包括:(1)一种药物在每个 类别或类,或(2)相同数量的药物作为基准计划在每个类别或类别。 巴克发表评论。本指南不解决的应用程序的的EHB要求,自被保险人或 大组健康计划。虽然自我保险和大型团体健康计划不要求提供EHB, 的ACA EHB盖: 日间门诊服务 紧急服务 住院 孕产妇和新生儿护理 心理健康和药物使用 紊乱的服务,包括 行为健康治疗 处方药 康复和habilitative 服务和设备 实验室服务 预防和保健服务 慢性疾病管理 儿科服务,包括口腔 和视力保健 3 36 | 02 | 2013年1月8日 禁止的年度和寿命限制美元EHB适用于那些计划。在早些时候发布的一个公告 在2012年,HHS表示,这些计划将允许使用EHB“的定义,如果定义是一个 授权HHS的秘书。此外,该部门打算使用他们的执法 自由裁量权和工作计划,作出真诚的努力,申请授权的定义EHB 确保有限制EHB没有年度或终生美元。“(见我们2012年3月1日提供的信息。) 成本分担要求 ACA参保人分摊费用或外的自付费用的金额限制在个人和小 团体健康计划。成本分担免赔额,共同保险和共付额。它不包括 保险费,不给付的服务,结算帐单金额,或分担费用的网络供应商。 在2014年,这个参保费用分摊限额将根据允许的金额为高抵扣健康计划 (HDHPs)与HSA的协调。 (在2013年,这些款项是6250美元的自我只覆盖和其他12,500元 超越自我的。)2014年限制将在未来几年被编入索引。 小团体健康计划也有限制量的免赔额。在2014年,这些限制将 自我只覆盖2,000元及4,000元以外的自我只覆盖在未来几年将被索引。 这些扣除限额并不适用于个别市场的政策。 $ 2,000 / $ 4,000可抵扣的限制规定,并不适用于自被保险人的序言 计划或覆盖在大组市场。然而,序言是无声的应用在百忙中 口袋限制的要求,这些计划。 巴克发表评论。由于共享对ACA的目的,包括成本,除了免赔额和共付额 共同保险的口袋限制有显着影响团体健康保险和大 作为最常见的设计计划没有信用的共付额的口袋限制。这将需要 计划重新设计的覆盖范围规定,符合ACA。 精算值 在2014年开始,所有非贴现窗在个人和小团体市场(包括内部和健康计划 ACA交易外)必须提供的覆盖范围,以满足某些不同程度的覆盖。的水平 覆盖是基于该计划的精算价值(AV) – 俗称“金属含量。” 健康计划 金属水平 精算 值 铜奖60% 银70% 黄金80% 铂金90% 4 36 | 02 | 2013年1月8日 AV是预期计划的比例报销医疗费用的标准人口为EHB: 精算 值 = EHB费用报销的计划 成本计划所涵盖的总EHB 例如,如果一个健康计划,预计偿还,平均80%的合资格EHB范围之内 计划,AV为80%。计划所涵盖的人士,平均支付,其余20%通过 的功能,如免赔额,共付额和共保额。 ,AV可以考虑常规措施 慷慨 – 较高的AV,计划提供更慷慨的覆盖面。 ACA要求所有非的日子个人和小团体计划提供覆盖在这些“金属之一 水平“帮助”增加消费者的健康计划比较,作出明智的选择。“对于 例如,所有的银计划将有70%的AV,这意味着预期的计划报销EHB 所有这些计划的70%。因此,在选择计划,消费者可以将精力集中在其他因素,如溢价, 网络,以及保险公司的服务,知道所有银计划将提供水平相当的利益 偿还网络EHB相同的。 要确定一个健康计划的AV,HHS已经开发出一种AV计算器使用一组理赔数据反映 的人口预计将在2014年注册的个人和小团体市场。为了确保一致的 确定AV的方法,所有的健康计划将2014年使用HHS AV的计算器。 (适用于 年后,2014年,国家可能会使用一个国家的特定数据的基础上确定AV,但使用HHS AV计算器 逻辑将仍然是必需的。) HHS预计,“绝大多数的计划将在2014年及以后,可以使用计算器。”不过, 指导提供了两个备选方案,确定为不兼容的AV计算器的计划,AV。 这两种选择都需要美国精算师学会的成员证明的方法。 “ 选择的选项如下: 该计划的好处的设计将调整(仅供AV计算),以适合的参数 AV计算器。 AV计算器可以用于规划设计规定,符合它的参数,并精算师 计算的AV计算器AV确定适当的调整。 提供一定程度的灵活性,在设计健康计划,以满足金属级AV的要求,指导 允许一个“微不足道的变化”加/减2个百分点,在确定的覆盖水平。为 例如,可以有一个AV介乎68%至72%,而不是被限制到70%的银计划。 健康储蓄账户(HSAs)和医疗报销账户(HRAS) HHS认识的指导,与HSA或HRA HDHP集成的价值被低估 如果该帐户的雇主的贡献是不包括在该AV。因此,每年的雇主供款 一个HRA下新做的,在本年度的HSA和金额,将被计入总 预期的医疗支出“的决定AV。但是,该帐户的贡献将被“调整,以反映 5 36 | 02 | 2013年1月8日 预期支出的福利年度的医疗费用。“雇员供款,以HSA为小团体 计划,在个别市场的HSA和个人捐款,将不被计入的AV。 巴克发表评论。拟议的规则反映了早期HHS的指导,不提供的全部价值 HSA考试和HRAS的雇主供款。 HHS的立场是,由于雇主HSA或全额 HRA的贡献将不会被使用的所有员工在今年用人单位缴费,信用 只在AV计算给定预期可使用的量的,平均来说,在一年的 的贡献。被设置在该AV的雇主帐户贡献的金额没有信用 结转,并在未来数年使用。 虽然这是一个令人失望的决定,计划发起人与HSA的,降压的分析HHS AV 计算器显示,几乎所有的HDHP / HSA设计的计划,在个人和小团体市场 今天的青铜计划将满足60%的AV要求,即使没有雇主HSA的贡献。 最低值 在2014年开始,如果雇主不提供健康保险,至少有一个“最低值”(MV) 60%,其雇员可能有资格接受联邦保费补贴或参加交流计划 为降低成本,共享资格。在ACA的“共同责任”的规定,用人单位可能会受到 3000元的处罚为每个全职雇员接受资助交易所覆盖。今年早些时候, 国内收入署(IRS)发出的通知中,提出了几种方法来确定MV。 (见5月15日,2012年你的信息。HHS)建议的规则在很大程度上如下,IRS指导。 用于确定的MV的规则通常将与上面讨论的对AV HHS的指导是一致的。 然而,他们将被修改,以反映不同的利益和人口覆盖在大 雇主计划。确定的MV也反映了一个事实,即这些计划不要求提供EHB。 有三个选项可用于确定MV: MV计算器 –  HHS和国税局将通过类似的设计,这将是一个MV计算器 到AV计算器上面讨论。但是,它会根据典型的自筹资金的索赔数据 雇主计划。 设计为基础的安全港清单 –  HHS和国税局将发布一系列基于设计的安全 港口检查表的形式,以确定是否有计划提供MV。 精算认证 – 如果计划包含非标准的计划功能,无论是MV计算器 也不是安全港清单可以使用,那么美国精算师学会的成员可以 提供认证,该计划符合MV要求。 雇主供款HSA或HRA也可以考虑在确定MV,使用相同的 上面所讨论的原理的AV。 巴克发表评论。由于一大群计划不要求提供EHB,它是不明确的选项 上述确定的MV将适用于计划不涵盖所有10个类别的EHB。不 6 36 | 02 | 2013年1月8日 与HSA的雇主提供的全部学分,雇主HSA的贡献值也是一个关注点 计划。然而,如果MV计算器方法论是符合的AV计算器,它会出现 大多数雇主HSA计划MV将满足60%的要求,即使没有雇主HSA的贡献。 独立的牙科计划 作为一种替代被列入在交易所的医疗计划,ACA使小儿牙齿的组成部分, EHB提供一个独立的牙科计划在Exchange。一个独立的儿童牙科计划 需要说明的交易平台,它有一个合理的年度费用分摊的限制。独立的 牙科计划将需要提供低75%(AV)或85%(AV)的覆盖水平。 巴克发表评论。由于大型团体健康计划不要求提供EHB,小儿牙齿 视野覆盖率的要求并不适用于那些计划。但是,如果一大群计划涵盖了这些 儿科服务,年度收入和终生禁止对美元的限制将适用于19岁以下的参与者。 牙齿和视力的计划被认为是例外的好处,一般不向ACA(包括 EHB要求),如果它们被单独提供,并且不是一个医疗计划的一个不可分割的一部分。但是,如果 牙科或眼科医疗保险相结合的医疗大选中,ACA的需求,包括EHB,可 申请,该计划可能需要删除年度和寿命限制美元小儿牙科和视力 服务。 在关闭 虽然大多数本指导意见的状态交易所提供的方案,他们确实有 大雇主计划的重要意义。这些雇主将需要定义EHB对他们的健康计划 确保课程符合适用ACA要求。 作者 理查德·D·秸秆,FSA,MAAA 玛丽·哈里森,JD 公司生产的降压顾问的知识资源中心 知识资源中心负责降压的国家多实行法律分析和出版物, 政府之间的关系,研究,调查,培训和知识管理。欲了解更多信息,请联系您的 巴克顾问或电子邮件fyi@buckconsultants.com的。 本出版物仅作参考,并不构成法律意见,法律,税务及其他顾问咨询之前 应用此信息您的具体情况。 版权所有©2013年降压顾问有限责任公司。保留所有权利。

Impact of ObamaCare on Business – Lessons From France

By Filed under New Health Care Law on January 7, 2013 with 8 comments

Beginning this time next year…the Affordable Care Act will put new requirements on businesses with 50 or more full-time employees, whereas businesses with 49 or fewer employees will be exempt…[Similarly,]  French companies employing 50 or more workers are, among other things, obligated “to establish a committee on health, safety and working conditions and train its members,” whereas companies with 49 employees are not…

The chart below, reproduced from their paper using data on employers in France, shows the number of employers of various sizes…

Luis Garicano, Claire Lelarge and John Van Reenen, “Firm Size Distortions and the Productivity Distribution: Evidence From France.”

The chart shows a couple of odd patterns at the 50-employee mark. First, there are sharply fewer employers (by more than a factor of two) with exactly 50 employees than with exactly 49 employees. Second, although the number of companies usually falls with the number of employees, there are actually more employers with 49 employees than with 45 employees.

Texas State Senator Considers Managed Care Bill

State Sen. Juan Hinojosa will file legislation to carve pharmacies out of Medicaid managed care. He said turning the state’s Medicaid prescription drug program over to for-profit managed care companies has devastated independent pharmacies in Texas.

Under managed care the state contracts the coverage for its 3.2 million Medicaid beneficiaries to heath maintenence organizations. Pharmacists complain that they can’t make money at $1.35 per prescription, down from $6.35 they were earning under the prior Medicaid contracts.

The Jenga Game of Pay or Play

So what should employers be doing to prepare for 2014? In a nutshell:

  1. Determine if the requirement to offer affordable health coverage applies. If the answer is yes, then:
  2. Become knowledgeable about state exchanges.
  3. Calculate the minimum value of employer-provided coverage.
  4. Calculate the threshold for exceeding affordable employee contributions to the plan.
  5. Prepare employee communications about the existence of the exchange.
  6. Decide whether and how long to offer employer health benefits (pay or play).

Continue reading The Jenga Game of Pay or Play

Wellpoint To Cover Virtual Office Visits

The chance that patients can virtually see a doctor–and have that visit paid for by their insurance company–has just dramatically increased. WellPoint, the second largest health insurer in the country, plans to include coverage for such telemedicine services in all of its employer and individual plans, reported The Wall Street Journal.

WellPoint’s telehealth program, LiveHealth Online, will allow its members to connect with their doctors using a webcam, video-enabled tablet or smartphone beginning in 2014. It plans to launch the program in California and Ohio early next year and then roll the service out to its remaining 12 states by the end of the year.

The virtual doctor visits should appeal to employers and individuals looking for “convenience and accessibility of care,” WellPoint’s Executive Vice President Ken Goulet told the WSJ.

Initially, members can consult with their doctors using only webcam video, but WellPoint plans to add smartphone and tablet capabilities soon thereafter. Members will have access to these virtual visits every day between 7 a.m. and 11 p.m. and will owe roughly the same copayment as for the live in-person visit.

WellPoint’s virtual doctor visit program is the latest and most significant sign that payers are moving toward telehealth, albeit slowly. Some payers, such as Aetna and UnitedHealth, provide virtual-visit services only as an option for certain employers. And Highmark launched a virtual physician visit pilot program in April for about 10,000 of its members at three Western Pennsylvania companies and one company in West Virginia, FierceHealthIT previously reported.

Aetna Fined $1 Million For Unapproved Policies

Aetna has been fined $1 million by the Washington state insurance department because it has issued more than 7,000 health, disability and life insurance policies that failed to meet state requirements.

Insurance Commissioner Mike Kreidler said Aetna sold many of its policies to out-of-state employers or through out-of-state trusts. Others didn’t include certain coverage mandated by state law, didn’t refer to the state appeals and grievance process or failed to obtain approval for rates and benefits, The Seattle Times reported.

Because these policies didn’t comply with state law, Kreidler’s office asserted they were never official and even introduced significant risk to consumers of these health plans, reported Live Insurance News.

“All insurers must comply with state law, and most of them do,” Kreidler said in a statement. “I hope that this fine and compliance plan resolves these problems with Aetna.”

Aetna agreed to the fine and said it will work to resolve the identified problems.


Form W-2, Box 12D

January 31, 2013 is right around the corner. This is the last day employers can supply 2012 W-2s to employees or–in the least–have the W-2s postmarked. Generally, employers filing more than 250 W-2s for the 2012 tax year are required to report the “aggregate cost of applicable employer-sponsored coverage” in box 12D on the W-2. The provision is currently optional for businesses who filed fewer than 250 W-2 forms in the previous tax year. Certain employers are exempt from this requirement in 2012.