July 2024 – Risk Managers

It’s Impossible To Keep Up

Health insurance has become a heavily regulated government utility managed by government bureaucrats in far away places. Every day we are reminded how busy they are.

Why Is Individual Health Insurance Better Than Group Insurance?

SOURCE: Individual vs Group Health Plans

Because the ACA requires minimum levels of coverage and prohibits insurance companies from denying people coverage because of pre-existing conditions, individual plans are better and easier to get. Plus, they’re often more affordable than comparable group plans.

Former Self-Funded Employer Touts The ICHRA

We received the following unsolicited email this morning from a client we have worked with for more than 20 years who moved his plan to ICHRA’s last year. He’s happy he did.

Amazing $372 ACA Compliant Group Health Insurance Plan For Groups of 50+

Announcing an amazing ACA qualified group health plan special to large employers. It is so good that to refuse the offer requires cognitive testing.

Funerals Cost More Than $895

If only Mr. Garcia had taken the $895 Shield test things might have turned out differently. It works by detecting tumor DNA in blood samples.

Jerry

“Jerry Hodge had an opportunity and the vision it took to recognize it’s potential but he didn’t have the credit or the money to seize upon it. He talked his mother into co-signing the note. That was the beginning of an adventure that brought opportunities to many others in his community and beyond, bringing him fame and fortune.”

Food Has Become A Poison

50% of American children are fat. That’s a problem………….

Are Political Subdivisions Exempt From ACA Federal Tax Penalties?

Robin, a seasoned loophole technocrat from Sherwood Forest and his jolly band of renegades, makes the argument political subdivisions are exempt from all federal taxation. If so then it must follow all political subdivisions such as school districts, cities and counties are exempt from Affordable Care Act (ACA) federal tax penalties.

Employer ACA Shared Responsibility Provisions

The American health care finance system is a government controlled utility requiring strict adherence to hundreds of onerous government mandates policed by an army of over 85,000 armed IRS agents. Failure to abide whether intentional or not subjects plan sponsors to punishing government sanctions.

SOURCE: Internal Revenue Service

2024 Rate for ACA Affordability Calculations

SOURCE: Keenan Blog

The Internal Revenue Service (IRS) has announced the 2024 indexing adjustment for the percentage used under the Affordability Safe Harbors under the Affordable Care Act (ACA) for plan years beginning in 2024. The percentage that should be used for 2024 plan years is 8.39% (which is down from 9.12% in 2023).

Atlantic Mutual Insurance Company

As the largest marine insurance firm in the United States for many years, Atlantic Mutual Insurance Company became involved in some of the most famous shipwrecks in American history.

Does Your School District’s Health Plan Meet The ACA Affordability Mandate?

“In 2021, TRS districts’ contributions towards health coverage varied significantly across the state. Overall, the weighted average district contribution is approximately $330. The state contribution of $75 has remained in effect since 2001 as well as the required public employer minimum contribution of $150, neither which has been increased in the last 20 years.” – Segal – TRS ActiveCare Benefits Study

Cold Calling

Tomorrow I plan to make a cold call on Elon Musk and will post the video here.

Can Federal Funding Save Teachers’ Healthcare Insurance?

“ICHRAs represent a way for school districts to reclaim some of their operating expenses while benefiting their employees. “

Hospital Prices Are ‘Unreasonable’ And ‘Indefensible’, Say Employers

“Employers are frustrated that the health care system is designed to enrich the middlemen and is not delivering improvements in affordability, access or quality for purchasers or employees and their families,”

Can Federal Funding Save Teachers’ Healthcare Insurance?

“It’s a matter of time before ICHRAs become more widespread among school districts.”

Why ICHRAs Make Sense – The 60/40 Rule

In any given population a minority drives costs for the majority. All are not equally sick.

Group Health Plan vs ICHRA

Let’s compare what your employer is paying for your group health insurance plan vs a Blue Cross Blue Shield individual plan.

Parametric Insurance

SALAAM TAKAFUL INSURANCE

“Buyers pay into a pool to offset each other’s losses and, if there’s a surplus after service fees and other costs, are eligible to get some of their money back.”

For Employers Unafraid of Change

For employers afraid of change Cary Simon has a special song just for you………

Theme Song For Plan Sponsor Refuseniks

This song is dedicated to plan sponsor refuseniks who avoid the pain of change at all costs by continuing self-flagellation strategies clinging to status quo health plans.

Who Are We To Believe?

One court says NSA arbitration decisions are enforceable and another court says they are not.

Hospital Turns Away Patient

A tax supported community hospital has refused to accept 120% of Medicare for an elective surgical procedure needed by a Texas school teacher. Instead they have quoted a cash price exceeding 900% of Medicare, far more than they routinely accept from Medicare and Medicaid patients.

The Medical Industrial Complex Poised To Steal More Of Your Money

PLAN SPONSOR HAS HAD ENOUGH

Medical cost growth will rise to highest level in 13 years; a renewed call to action to address affordability

SOURCE: PWC

Commercial health care spending growth is estimated to grow to its highest level in 13 years, according to PwC’s newest research into annual medical cost trend. PwC’s Health Research Institute (HRI) is projecting an 8% year-on-year medical cost trend in 2025 for the Group market and 7.5% for the Individual market. This near-record trend is driven by inflationary pressure, prescription drug spending and behavioral health utilization.

Reason For Our Health Care Crisis: Government

“All of our major health care programs (Medicare, Medicaid, Obamacare, etc.) came into existence primarily to solve problems created by previous government interventions. And, the reason why there is a continuing push for further reform is because all the programs that are supposed to be solving problems are creating new ones.”

Why Change Fails – People Don’t Like Change

Short 1:56 minute Video Explains Why People Don’t Like Change

I often say to audiences “I can’t sell a health plan that removes all financial barriers to health care, gives plan members greater freedom to choose, and is half the cost of traditional status quo health plans. No one will buy it. But I can sell a health plan with a high deductible most can’t afford, with fewer provider choices, with rates double the cost and guaranteed to go up year after year after year.”

Drink The Water Damn It!

Moving away from 40 years of managed care to something different is one of the hardest things to do. That’s why most don’t. Those who do find the pain of doing the same is far greater than the pain of change.

Texas Low-Mileage Drivers Pay Less In July

SOURCE: Texas Low-Mileage Drivers

Texas’s top insurance providers are fighting a massive turf war and good drivers are cashing in. Drivers who are currently insured, drive less than 50 miles/day, and have no tickets in 3 years can grab deep discounts on car insurance.

Dog & Cat Insurance Quotes In Seconds

Get your dog or cat insured in seconds with an A rated insurance company.

Workers Compensation

Named one of the Top Workers’ Compensation Providers in the U.S., AllComp Solutions has been agents’ go-to insurance partner for 25+ years. We provide convenient access to low-cost coverage from a robust network of top-rated carriers — enabling you to get winning workers’ comp solutions for your clients across a wide variety of industries, all in one place.

Chris Deacon

By Chris Deacon

It was an honor to give testimony before the Senate Committee on Aging on the critical issue of transparency in healthcare.

I started with an analogy: Imagine being the CFO of a company where you hand over the company credit card to your vendors and supplies, and at the end of the month you are given a bill—no receipts, no details, just one lump sum. This is the reality in our healthcare system today, where employers are forced by their TPA’s to pledge their dollars and their employees’ to an unaccountable and unaffordable healthcare system with ZERO accountability or oversight. Abuse of the company credit card must stop.

Negative Selling

We sold a group health plan but we tried our hardest not to………….

Confidential Health Insurance

You’ve heard of Confidential Life Insurance. That’s when you purchase a life insurance policy on a living being without their knowledge as long as you have an insurable interest.

The Largest U.S. Commercial Health Insurance Risk Pool

SOURCE: Oscar Health

“Growth of the Affordable Care Act (ACA) market has created a larger risk pool than any employer, state, or subdivision of the economy, which has resulted in a more stable cost trend than the rest of the industry.”

School Teacher Blown Away

By Patrick Moore

Dow Jones is nearing 40,000… will family health insurance premiums match it?

Deaf Mute Patient Receives Terrible News

Brad O’Neill Opines On ICHRA

Just like our morning coffee, we all have a different appetite for health care.

Congress Must Pass AHA

Pre-existing conditions are covered under the Affordable Care Act (ACA) so why can’t pre-existing conditions be covered under property & casualty policies covering life threatening perils?

THE FUTURE OF THE COMMERCIAL HEALTH INSURANCE INDUSTRY

HMOs Rise From The American Health Care Rubble

The analysis found that “particularly health maintenance organization (HMO) plans and exclusive provider organization (EPO) plans—have grown steadily since 2014 and now account for 82 percent of plan type offerings.” – Lewis & Ellis, LLC

ACA Subsidies on Average are Worth $6,312 Per Year

SOURCE: ACA Subsidy Calculator: Could You Get Thousands? – Family Benefit Support

The Affordable Care Act (ACA) sets a limit on how much you have to pay for health insurance based on your income. If your income is high, you won’t pay more than 8.5% of it on health insurance. If it’s lower, you might not have to pay anything at all. For instance, a family of three making $37,290 could qualify for free health insurance.

To Disarm BUCA’s You Need To Eliminate Employer Based Insurance

Traditional Group Health Insurance vs Individual Health Insurance

Comments By Joe Markland on Linkedin

If individual’s get to choose plans in local markets you will see that the BUCA’s do not have the same power. Individuals will not mind smaller networks in exchange for cost savings. They don’t care about brand, though in their local markets local HMO’s do carry weight. Individuals will buy different from an employer who needs “BIG” to cover a broad population often across State lines. Most don’t need to “pre-pay” for oil changes.

Tip On Negotiating Direct Agreements

Frustrated with dealing with the less than willing towards gaining a direct agreement? Tired of the run around? Endless meetings? Disappointing outcomes?

Texas School District Believes In Magic

The Eagle Pass Independent School District is paying more for health insurance than most school districts in Texas. In addition to regular pay all full-time employees are gifted an additional $11,328 per year just to pay for health insurance.

Texas Company Sues +70 Insurance Companies

Texas COVID-19 Testing Provider Sues Insurance Companies Over Reimbursement Denial | Law Street Media

COVID-19 testing company Diagnostic Affiliates of Northeast Hou LLC filed a complaint on Monday against health plan companies Entrust LLC, operating under the name 90 Degree Benefits, and Texas School Health Benefits Program for allegedly violating federal requirements to cover COVID-19 testing services.

Cool Video By Bryn Elise

Awesome video by Bryn Elise. She gets first class medical treatment for pennies on the dollar. Short video – watch to the end to see what she paid for all of this.

Boudreaux Wilson III

Mr. Wilson joins staff at RiskManagers.us.

Direct Primary Care Is So Good It’s Bad

The following article attempts to underscore how truly awful Direct Primary Care really is because only rich people benefit while poor people end up having to seek primary care from fewer providers in dingy germ filled offices after waiting hours before seeing a doctor for a scant 5 minutes. How dare the rich do this to us!

Air Ambulance Ruling Severely Undermines No Surprises Act

“The decision in Guardian Flight makes the IDR process illusory, thus leaving providers with no means to collect unpaid charges for services rendered…….the plaintiffs failed to state a cause of action under the NSA, because the statute lacks provisions establishing a private cause of action to enforce an IDR award.”