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 https://www.publicpurchase.com/gems/register/vendor/register.

Any questions regarding this RFP must be emailed through the “Questions” option located within the solicitation posted on The Public Purchase website http://www.publicpurchase.com/mcallenisd,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 Heerwagenl@aetna.com

 

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. http://blog.riskmanagers.us/?p=10126

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.