Health Insurance « Robert’s Insurance Blog

Posts Tagged ‘Health Insurance’

FAQ About Mental Health Parity and Addiction Equity Act

Friday, July 2nd, 2010

This comes from the Department of Labor and is an interim clarification on the Mental Health Parity act.

Since the interim final regulations were issued, some plans and issuers have stated that it is common with respect to outpatient benefits for plans and issuers to require a copayment for office visits (e.g., physician or psychologist visits) but coinsurance for other outpatient services (e.g., outpatient surgery, facility charges for day treatment centers, laboratory charges, or other medical items.)

For purposes of determining parity for outpatient benefits (whether in-network or out-of network), can a plan or issuer establish any sub-classifications, similar to the special rule for multi-tier prescription drugs?

Until the issuance of final regulations, the Agencies have determined that they will establish an enforcement safe harbor under which the Agencies will not take enforcement action against a plan or issuer that divides its benefits furnished on an outpatient basis into two sub-classifications for purposes of applying the financial requirement and treatment limitation rules under MHPAEA: (1) office visits, and (2) all other outpatient items and services. After the sub-classifications are established, the plan or issuer may not impose any financial requirement or treatment limitation on mental health or substance use disorder benefits in any sub-classification (i.e., office visits or non-office visits) that is more restrictive than the predominant financial requirement or treatment limitation that applies to substantially all medical/surgical benefits in the sub-classification using the methodology set forth in the interim final rules. Other than as permitted under this enforcement policy, and except as permitted under the interim final rules for multi-tier prescription drug formularies, sub-classifications are not permitted when applying the financial requirement and treatment limitation rules under MHPAEA. Accordingly, and as stated in the preamble to the interim final rules, separate sub-classifications for generalists and specialists are not permitted.

Here is the original link: http://www.dol.gov/ebsa/faqs/faq-mhpaea.html

Tweet This Post

Tags: benefits, Employee Benefits, employer benefits, group benefits, Health Insurance, large group, mental health parity, mental health parity and addiction equity act, self insured
Posted in Uncategorized | No Comments »

New Fact Sheet on COBRA State Continuation Stimulus for Illinois

Tuesday, December 29th, 2009

Please find the original at http://bit.ly/7b6Wlx

Illinois Insurance Facts

Illinois Department of Insurance

Federal Stimulus – Premium Reduction for Group Continuation Coverage

Updated December 23, 2009

Note: This information was developed to provide consumers with general information and guidance about insurance coverages and laws. It is not intended to provide a formal, definitive description or interpretation of Department policy. For specific Department policy on any issue, regulated entities (insurance industry) and interested parties should contact the Department.

On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act (“ARRA”), commonly called the Stimulus Plan. ARRA provides a subsidy that may reduce by 65% the cost of COBRA and other state group continuation coverage for workers who lose their jobs.

On December 19, 2009, President Obama signed Public Law 111-118 (the “ARRA Subsidy Extension”), which amended ARRA to increase the maximum duration of the subsidy from 9 to 15 months, and to extend the eligibility period from December 31, 2009, to February 28, 2010.

What Are Group Continuation Laws?

Group continuation laws require employers to offer employees who lose group coverage the opportunity to continue their employer-based health insurance.

•COBRA is the federal law that applies to employer groups with 20 or more full-time employees on more than 50% of the business days in the prior calendar year, and to group plans offered by state and local governments.

•State continuation law (“mini-COBRA”) applies to fully insured group plans of any size, including employers with 19 or fewer employees.

If you are uncertain about which law(s) applies to your group plan, contact your employer or the U.S. Department of Labor at 1-866-444-3272.

NOTE: This fact sheet focuses on the premium reductions provided under ARRA. For more detailed information about your rights under federal and state continuation laws, including recent changes to the State mini-COBRA law made by Public Act 096-0013 (signed into law by the Governor on June 18, 2009), please refer to the Department of Insurance consumer fact sheets titled “Health Insurance Continuation Rights – COBRA” and “Health Insurance Continuation Rights – Illinois Law.”

When an Employee Loses Group Coverage and Elects Continuation, Who Pays the Premium?

Normally it is the employee who lost group coverage, not the employer, who must pay the entire health insurance premium.

Who is Eligible for Premium Reductions Under ARRA?

Individuals who lose group health coverage because of an involuntary termination (“former employees”) between September 1, 2008, and February 28, 2010, may be eligible for a 65% reduction of their COBRA or mini-COBRA premiums for up to 15 months.

The premium reduction is not available to workers whose modified adjusted gross income in the year they receive the premium reduction exceeds $145,000 for individuals and $290,000 for couples filing joint tax returns. The premium reduction will be phased out for individuals whose modified adjusted gross income is between $125,000 and $145,000 and for couples between $250,000 and $290,000. If an individual takes advantage of the premium reduction and in the same year exceeds the income limit, he or she must repay the amount of the premium reduction. We encourage individuals and couples to confirm eligibility with a tax specialist.

Who Will Benefit from the ARRA Subsidy Extension?

P.L. 111-118, enacted on December 19, 2009, extended the maximum duration of the premium reduction from 9 to 15 months. Even those individuals who, prior to the enactment of P.L. 111-118, lost eligibility for the premium reduction due to the end of the 9-month period may be eligible for the additional 6 months of subsidized premiums.

•Eligible individuals who chose to continue coverage after the 9-month premium reduction period must receive a refund or credit for premiums paid in excess of the reduced premium rate.

•Eligible individuals who did not pay the premium for a period of coverage beginning after the 9-month premium reduction period must be allowed to continue their coverage by making a retroactive payment. Such payment must be made by February 17, 2010, or within 30 days of receiving the notice described below, whichever is later.

How Do Individuals Sign Up for the Premium Reduction?

Eligible individuals will receive a notice with general information about the premium reduction under ARRA and a form to request the premium reduction.

For group plans subject to federal COBRA requirements, written notice must be provided by the former employer.

•Former employees who lose group health coverage will receive notification and enrollment forms allowing them to continue their group coverage and to request the premium reduction.

For group plans subject only to state mini-COBRA requirements (i.e., employers with 19 or fewer employees), written notice must be provided by the insurer providing coverage under the group plan.

•Former employees who lose group health coverage will receive written notice allowing them to request the premium reduction. This notice must be provided within 10 days of the involuntary termination.

The ARRA Subsidy Extension (P.L. 111-118) requires insurers and employers to provide additional information to former employees about the changes made by the new law, including the extension of the premium reduction period and the option for eligible individuals to make retroactive premium payments. Guidance for insurers and employers on these new notification requirements can be found on the Department’s website at http://insurance.illinois.gov/ModelNotices/COBRA.

If you have questions about the notices described above, you can contact your former employer or the insurer providing coverage under your group health plan. For plans subject to federal COBRA requirements, you may also contact the federal Department of Labor at 1-866-444-3272 or visit the agency’s website (http://www.dol.gov/ebsa/COBRA.html). For plans subject only to state mini-COBRA requirements, you may contact the Illinois Department of Insurance (“Department”) at 1-877-527-9431 or visit our website at http://insurance.illinois.gov/ModelNotices/COBRA.

MODEL NOTICES:

•The Department of Labor (DOL) has published Model Notices for employers to use when providing the notifications required by ARRA. Employers can download copies of these Model Notices from the DOL website at http://www.dol.gov/ebsa/COBRAmodelnotice.html.

•The Department of Insurance has created a state-specific Model Notice for use by insurers providing coverage subject only to state mini-COBRA requirements. These model notices are available on the Department’s website at http://insurance.illinois.gov/ModelNotices/COBRA/.

How will the Premium Reduction be Applied to Group Continuation Coverage?

Former employees who qualify for the premium reduction will only be required to pay 35% of the group coverage continuation premium. The remaining 65% will initially be paid by:

• the former employer, if the employer had 20 or more employees on more than 50% of the business days in the prior calendar year and is subject to federal COBRA provisions; or

• the insurer providing coverage under the group health plan, for those employers with fewer than 20 employees subject solely to mini-COBRA requirements.

The former employer or the insurer will then be reimbursed by the federal government through a reduction in payroll taxes.

What if an Employer or Insurer Refuses to Provide the Premium Reduction?

ARRA provides for expedited reviews if an employer or insurer denies an individual’s application for the premium reduction. Once the denied individual submits an appeal for review, the Department of Labor or the Center for Medicare and Medicaid Services (CMS) will make an eligibility determination within 15 business days.

DOL will handle appeals related to private sector employers subject to federal COBRA provisions (i.e., employers with 20 or more employees). For more information or to submit an appeal, please visit the DOL’s website at http://www.dol.gov/ebsa/COBRA/main.html or call a DOL benefits advisor toll-free at (866) 444-3272.

CMS will handle appeals related to state mini-COBRA plans, as well as appeals for Federal, State, or local governmental employees. For more information or to submit an appeal, please contact the CMS-sponsored help desk toll-free at (866) 400-6689 or via e-mail at continuationcoverage@maximus.com.

Will Individuals be Eligible for the Premium Reduction for as Long as They Are Eligible for Group Continuation Coverage?

The premium reduction will not necessarily last as long as your group continuation coverage. For example, former employees typically qualify for up to 18 months of federal COBRA coverage. The premium reduction lasts only up to 15 months. Therefore, an eligible individual who chooses to pay for 18 months of COBRA coverage would still have to pay 3 months of unsubsidized premiums.

Can an Individual Lose Eligibility for the Premium Reduction?

You can lose eligibility for the premium reduction in two ways. First, the premium reduction lasts only as long as you are eligible for group continuation coverage, but in no event longer than 15 months. Second, you become ineligible for the premium reduction when you become eligible for new group health coverage or Medicare.

•Beneficiaries must notify their former employer when they become eligible for new group health coverage.

•Beneficiaries who willfully neglect to notify their former employer of their eligibility for a new group health plan must repay 110% of the amount of the premium reduction to the federal government. No such penalty shall be imposed if the beneficiary demonstrates “reasonable cause” for the failure.

NOTE: Eligibility rules for the premium reduction differ from rules governing eligibility for COBRA coverage generally. Eligibility for COBRA continuation coverage ends only when a beneficiary enrolls in new group coverage or Medicare. However, simply being eligible for new group health coverage disqualifies an individual from receiving the premium reduction.

Does the Premium Reduction Apply to Group Continuation Coverage other than COBRA?

The premium reduction under ARRA applies to both federal COBRA continuation coverage and to comparable state continuation coverage known as “mini-COBRA” (215 ILCS 5/367e). ARRA does not apply to the state’s spousal continuation law or dependent continuation law. For more information about these laws, please refer to the Department of Insurance consumer fact sheet titled “Health Insurance Continuation Rights – Illinois Law.”

Does ARRA Extend the Length of Available Group Continuation Coverage?

ARRA itself does not change the length of time that group continuation coverage must be provided to eligible individuals: COBRA typically provides for up to 18 months of coverage, while mini-COBRA had provided for up to 9 months of coverage.

The period of coverage required under the state mini-COBRA law, however, was recently increased from 9 months to 12 months by Public Act 96-0013. All group plans subject to the law that are issued, delivered, amended or renewed after June 18, 2009, must provide for up to 12 months of continuation coverage. If an individual is currently receiving mini-COBRA coverage and the employer’s policy is renewed after June 18, 2009, the individual would be entitled to the additional 3 months of coverage, regardless of the date the individual first elected mini-COBRA coverage.

Who is Eligible for a Second Opportunity to Continue Group Coverage and Receive the Premium Reduction?

ARRA required a “second election period” so that former employees who lost group coverage prior to ARRA’s enactment and who initially chose not to continue their coverage, or chose to continue coverage and later stopped paying premiums, were given a second chance to continue their group coverage and receive the premium reduction. Individuals whose former employer is subject to federal COBRA provisions (i.e., employers with 20 or more employees) and who lost group coverage due to an involuntary termination that took place between September 1, 2008 and February 16, 2009, should have received notice of this second election period from their former employer by April 18, 2009. Former employees then had 60 days after receiving this notice to elect continuation coverage and request the premium reduction.

After the enactment of ARRA, Illinois passed a law (Public Act 096-0013) providing a similar second election period for Illinois employees of small businesses (i.e., employers with 19 or fewer employees). Former employees who lost group coverage due to an involuntary termination that took place after September 1, 2008, and who did not have continuation coverage in effect as of June 18, 2009, were eligible for this second election period. These individuals should have received notice from the insurer providing group coverage by July 18, 2009, and would then have 60 days after receiving notice to elect continuation coverage and request the premium reduction.

If you believe you were eligible for the second election period and did not receive notice, you can contact your former employer or the insurer providing coverage under your group health plan. For plans subject to federal COBRA requirements, you may also contact the federal Department of Labor at 1-866-444-3272 or visit the agency’s website (http://www.dol.gov/ebsa/COBRA.html). For plans subject only to state mini-COBRA requirements, you may contact the Illinois Department of Insurance (“Department”) at 1-877-527-9431 or visit our website at http://insurance.illinois.gov.

Does the Premium Reduction Affect Eligibility for other Income-Based Government Programs?

The amount of the premium reduction will not be counted as income in determining eligibility for, or assistance provided under, any other federal or state program.

Does ARRA Affect Individuals Who Qualify for COBRA Due to Eligibility for Trade Adjustment Assistance or Eligibility for Benefits from the Pension Benefit Guaranty Corporation?

ARRA provides significant extensions of COBRA coverage periods for individuals who receive benefits directly from the Pension Benefit Guaranty Corporation or are eligible for Trade Adjustment Assistance. If you have additional questions about these extensions, contact the federal Department of Labor at 1-866-444-3272 or visit the agency’s website (http://www.dol.gov/ebsa/COBRA.html).

For More Information

Call the Department of Insurance Consumer Services Section at (866) 445-5364 or our Office of Consumer Health Insurance at (877) 527-9431 or visit our website at http://insurance.illinois.gov

Tweet This Post

Tags: American Recovery and Reinvestment Act, ARRA, COBRA, COBRA Stimulus, continuation, Health Insurance, illinois stimulus, state continuation
Posted in COBRA, Employee Benefits, Health Insurance, Legislative, Uninsured, health savings account, hsa | 2 Comments »

COBRA Stimulus payments and eligibility extended

Tuesday, December 22nd, 2009

This is from the Department of Labor’s website. The original can be found at http://bit.ly/6fcZNC.

News Statement

Release Date: December 21, 2009
Contact Name: Gloria Della or Joseph De Wolk
Phone Number: 202.725.8422/202.579.4681

Statement of Phyllis C. Borzi on COBRA subsidy extension

Washington, DC – Phyllis C. Borzi, Assistant Secretary of the Employee Benefits Security Administration (EBSA) today released the following statement regarding the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the recent extension of the premium reduction under the COBRA subsidy:

“I am pleased Congress has acted and the President has signed the Fiscal Year 2010 Defense Appropriations Act. The act extends the eligibility period for the COBRA premium reduction for an additional two months (through Feb. 28, 2010) and the maximum period for receiving the subsidy for an additional six months (from nine to 15 months). Millions of unemployed Americans and their families will be better able to afford and keep their health benefit coverage because of this new law.

“Individuals who had reached the end of the reduced premium period before the legislation extended it to 15 months will have additional time to pay the reduced premiums related to the extension. To continue their coverage they must pay the 35% of premium costs by (60 days after date of enactment) or, if later, 30 days after notice of the extension is provided by their plan administrator.

“We encourage you to subscribe to our COBRA Web site, www.dol.gov/cobra, to get information on new notice requirements, updated guidance, fact sheets, and frequently asked questions as they become available.

“Individuals should contact their plan or health insurance provider for information regarding the extension under their health plan. If you need further assistance contact an EBSA Benefits Advisor toll-free at 1-866-444-3272.”

U.S. Department of Labor news releases are accessible on the Department’s Newsroom page. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at 202.693.7828 or TTY 202.693.7755. The Labor Department is committed to providing America’s employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit the Department’s Compliance Assistance page.

Tweet This Post

Tags: ARRA, COBRA Stimulus, cobra subsidy, Employee Benefits, Health Insurance
Posted in COBRA, Employee Benefits, Health Insurance, Legislative, Uninsured | 4 Comments »

More Information on UniCare Exiting Illinois and what will happen

Thursday, October 29th, 2009

IF YOU ARE ON AN INDIVIDUAL UNICARE HEALTH INSURANCE POLICY

If you are currently on an Individual UniCare policy, they will give you an option of moving onto a “comparable” plan on Blue Cross Blue Shield of Illinois with no underwriting. This is actually a great thing. The only problem is that the premium will probably be higher than what you are paying now as they don’t seem to be giving “new business rates” (as if you were healthy and signing up for a new plan). If you are not eligible for a new plan, then at least you have continuity. If you are healthy and have been on UniCare for more than a year, you can transition to BCBS, then reapply for new business rates. If they accept you, then they will give you the cheaper rate and you won’t be stuck with the 1 year pre-existing condition clause. If you do not accept to change, you can keep your policy until 6/1/2010 when it will terminate.

IF YOU ARE ON A SMALL GROUP UNICARE POLICY

If you are currently on a UniCare small group policy, they give you the option of transitioning to a comparable plan on BCBS while keeping the SAME TOTAL premium until your next renewal date. As BCBS uses “composite” rates (averages everyone together for one rate for each classification of employee, employee only, employee/spouse, etc.), the rates will be different. If you choose NOT to accept the transition offer, then your coverage expires at your renewal date.

If anyone has questions, please feel free to post them here or email me directly.

Tweet This Post

Tags: Employee Benefits, guaranteed issue, Health Insurance, small group, unicare, unicare to blue cross blue shield of illinois, unicare transition
Posted in Employee Benefits, Health Insurance, Uninsured, health savings account, hsa | 1 Comment »

UniCare is Pulling out of Illinois

Wednesday, October 28th, 2009

UniCare announced today that they will be pulling out of the Illinois markets. This comes as a shock to everyone, including the hundreds of employees that will lose their jobs. NOTE: Details as they become available, will be forthcoming.

INDIVIDUAL HEALTH INSURANCE

If you are on individual health insurance via UniCare, you will be transitioned to Blue Cross Blue Shield of Illinois. This will be guaranteed issue, meaning they will accept you. Details have not been worked out, but my best guess is that there will be no underwriting and they will place you on a similar plan.

If you choose not to accept this, then your plan will end, probably around 12/31/2009.

GROUP HEALTH INSURANCE

If you are on a small group health insurance plan with UniCare, it looks like you have a choice between staying on your plan until your renewal date or transitioning to Blue Cross Blue Shield of Illinois. When this option is presented, I will evaluate whether it makes sense to move the group at this time.

Billing and claims should not change during this time.

Wellpoint (one of the largest insurers in the United States) is not going out of business, they are just packing their bags and exiting the Illinois market.

If you have questions, please contact me. More details as they become available.

Tweet This Post

Tags: blue cross blue shield of illinois, Employee Benefits, Health Insurance, illinois, insurance, Texas, unicare, wellpoint
Posted in COBRA, Employee Benefits, Health Insurance, Uninsured | No Comments »

How Health Reform will Impact HSAs

Wednesday, October 7th, 2009

By Roy Ramthun, “Mr. HSA”

Many of you have emailed me asking about the status of HSAs in health reform. This email is an attempt to try to answer most of those questions. However, things could change at any time, so I will try to update you when they do.

First, none of the bills (so far) outright repeal HSAs. Sen. Rockefeller (D-WV) filed but did not offer an amendment to repeal HSAs completely in the Senate Finance Committee. Other amendments that would have improved HSAs were defeated.

Some of the bills do make some modifications to HSAs that you should be aware of, in case they become law. For example, the House Ways & Means Committee passed its version of health reform which included a proposal that would not allow HSA funds (or HRA or FSA funds) to be used to purchase over-the-counter medicines and products. The Senate Finance Committee has a similar provision in its version of health reform legislation as well as a provision that would increase the penalty for HSA withdrawals for non-medical expenses from 10 percent to 20 percent. Other amendments that have less of an impact on HSAs were also adopted by the Finance Committee and can be found here è http://finance.senate.gov/sitepages/legislation.htm.

However, my biggest concern comes from the insurance reform and mandated coverage requirements in the bills. The House and Senate bills say that in the “reformed” world, you will not be in compliance with the individual mandate unless you have the minimum required health insurance coverage. In comparing the overall benefit levels of different health plans, Congress is planning to use a yardstick known as “actuarial value” which measures the share of health care expenses paid by insurance. Consumers pay the remainder, in deductibles, co-payments and other charges.

The four levels of coverage allowed by the Finance Committee have actuarial values ranging from 65 percent for the “bronze plan” to 90 percent for the “platinum plan.” The Senate Health, Education, Labor and Pensions (HELP) Committee prescribes three levels of coverage, with actuarial values from 76 percent to 93 percent. The House bill also calls for three levels of coverage — basic, enhanced and premium — with values from 70 percent to 95 percent. By contrast, the actuarial value of policies in Massachusetts (the only state where the purchase of health insurance is mandatory, and the model Congress is supposedly copying) can be as low as 56 percent.

The Congressional Budget Office (CBO) says the actuarial value of policies bought in the individual (non-employer) insurance market now averages 55 percent to 60 percent. For insurance plans provided by employers, CBO says the average value is 80 percent to 85 percent. And according to the Congressional Research Service, the value is slightly higher, 87 percent, for the standard Blue Cross and Blue Shield plan available to federal employees, including members of Congress. Unfortunately, not everyone can afford that level of coverage.

If the minimum required coverage has an actuarial value of 70 percent, it leaves only 30 percent for all out-of-pocket expenses — including deductibles, copays and coinsurance. My concern is that many of the HSA plans on the market today cannot meet this standard because of the higher deductibles included in these plans. That means deductibles and other out-of-pocket expenses for copays and coinsurance will have to come down, which means premiums for HSA plans will go up. And that is on top of the likelihood that premiums will already go up due to other provisions in the bills that eliminate annual and lifetime limits on benefits, among other things.

There is one way that current HSA plans might be able to meet the 70 percent (or other minimum) standard – if the plan can include the HSA contributions made by you or your employer when determining the actuarial value of the plan. I believe reasonable actuaries would do this, and a paper released by the American Academy of Actuaries in May says it is appropriate to do so. While the federal legislation pending in Congress is silent on the issue, I remain concerned that the Secretary of Health and Human Services will use her regulatory authority to preclude actuaries from including the HSA contributions in the actuarial value.

My other concern is that the Secretary of HHS will require HSA plans to cover benefits below the deductible. Currently, HSA plans are only allowed to cover preventive care benefits below the deductible. But if the Secretary decides that all plans must now cover prescription drugs below the deductible, for example, that would create a conflict between the HSA law and the new reform requirements. This could effectively preclude HSA plans from being offered in the future. To date, amendments to limit the Secretary’s authority and clarify the actuarial value issue have not been accepted.

Neither of these actions by the Secretary would make any policy sense to someone who wants to keep their HSA, but remember this is more about politics than logic. Congress and the White House want to win any way possible. I believe you can no longer sit on the sidelines and wait to see what happens. Please consider calling, writing or emailing your elected representatives in Washington, DC and let them know that you want to be able to keep your HSA in the future.

Roy Ramthun, “Mr. HSA”

HSA Consulting Services, LLC

202-747-4467

roy@hsaconsultingservices.com

www.hsaconsultingservices.com

Tweet This Post

Tags: Employee Benefits, health, health care, health care reform, Health Insurance, health insurance reform, health savings account, high deductible health plan, hsa
Posted in Employee Benefits, Health Insurance, Legislative, health savings account, hsa | No Comments »

Legislative Update on Health Care Reform from NAHU

Friday, July 31st, 2009

Robert Slayton Associates Insurance believes the comprehensive health reform legislation working its way through Congress would have a profound impact on our clients. Working through our professional trade association, the National Association of Health Underwriters, we bring you this update on the latest happenings and means to contact your legislators on this critical issue.

Legislative Action in the House of Representatives

It was quite a busy week for health care reform negotiations in Washington. After a week of intense talks between the House Democratic leadership and the conservative Blue Dog Democrats Coalition, a deal appears to have been struck between the two groups of Democrats, and the Energy & Commerce Committee is expected to report a bill out of Committee with unified Democratic support on July 31. The bill will include what is being billed as the “Unity Amendment,” which includes concessions from both sides of the Caucus.

The other two committees of jurisdiction, the Ways & Means Committee and the Education and Labor Committees finished their versions of H.R. 3200 two weeks ago, and the initial goal was to report the measure out of Energy & Commerce last week and pass the entire measure on the House floor this week. However, the dispute with the Blue Dogs delayed the Energy & Commerce Committee mark-up, and now the House floor vote is delayed until Congress reconvenes in September.

The fate of H.R. 3200 and the efforts of the Blue Dogs when the three committee bills are merged together still remain under debate. There is some concern that agreements made with the Blue Dogs in the Energy & Commerce Committee will not be honored when the bill reaches the House Rules Committee in September. Over 57 progressive Democrats have signed a letter stating that they will not support earlier concessions promised to the Blue Dogs if they are brought the House floor, and Speaker Pelosi has indicated her support for the Progressive Caucus. The deal struck today is intended to alleviate this concern, but in reality the political climate after the August recess will have much to do with how the bills are “married” together as well.

Senate Finance Committee Will Not Mark Up Bill Until September

Over in the Senate, the bipartisan negotiation between Republican Senators Enzi, Grassley and Snowe and Committee Democrats has slowed, and Finance Committee Chairman Max Baucus (D-MT) announced on July 30 that the committee will not be able to mark up their version of health care reform legislation before the Senate adjourns for its August recess on August 7. The Finance Committee legislation, which is still being drafted, may not even be available for public release before the Senate adjourns next week. This delay, particularly when coupled with the deal reached in the Energy & Commerce Committee, raises the question of how long the Democrats will continue to allow the bipartisan negotiations to continue.

Brining Health Care Messaging to the Public Will be the Focus of the August Congressional Recess

With the August congressional recess set to begin, it is clear that Republicans and Democrats alike view the recess as the high water mark for health care reform. Sliding personal poll numbers for President Obama are a factor, as is a decline in public support for Democratic health care efforts. A Pew Research Center poll released Thursday that found that 44 percent oppose “health care plans currently before Congress,” while just 38 percent favor the plans. In a NBC/Wall Street Journal Poll, 42 percent now say that the president’s plan is a bad idea, a 10-point increase since last month.

Republicans and some conservative Democrats are interpreting those declining numbers as lack of public support for overwhelming change. Instead, they believe that the public favors more deliberative and targeted reform, perhaps on an incremental basis. Their strategy for the August recess is mammoth public education on the realities of a government-run public plan option and other costly and intrusive elements of the Democratic bills, as well as the need to “get health reform right.”

But Democratic leaders are interpreting these polls as only a failure of messaging, and plan to ramp up their campaign efforts into as high as gear as possible during the August recess. Their focus seems to be on targeting insurance companies as the villains, beginning with a pronouncement from House Speaker Pelosi earlier in the week. “It’s almost immoral what they are doing,” she told reporters. “They are the villains. They have been part of the problem in a major way.”

They also want to use the time clear up what they view as public misconception about their work. This week House Majority Leader Steny H. Hoyer (D-MD), conceded that Democrats have much ground to make up in August and need to focus on how their ideas would benefit the public if the party is to succeed on health reform. “We’re responsible for putting together a plan, and so we’ve been focused on that,” he said. “Republicans have been somewhat free to conjure up whatever they want.”

Grassroots Call to Action: Make Sure Health Reform is Done Right

Health reform is needed, but it needs to be both affordable and responsible, and it also should be crafted in a bipartisan way. This measure is the most consequential to be considered by Congress in decades—it will impact all citizens and change the scope of one-sixth of our nation’s economy. It’s crucial that we don’t let our congressional leaders rush to judgment on this measure. Instead, we need to urge them to spend August discussing the bill with their constituents, and then make changes to their bills when they reconvene in September to reflect the will of American employers and health care consumers. Click here to send a message to your legislators to let them know that you would like them to take the time to craft bipartisan comprehensive health care reform that will work for all Americans. Also, consider joining this coalition of concerned Americans dedicated to “getting health care reform right!”

Tweet This Post

Tags: COBRA, Employee Benefits, health care, health care reform, Health Insurance, health insurance reform, Legislative, Uninsured
Posted in COBRA, Employee Benefits, Health Insurance, Legislative, Uninsured, health savings account, hsa | 2 Comments »

How Can I find Affordable Health Insurance?

Monday, July 6th, 2009

BACKGROUND

This is a respond I wrote to a family who purchases their own health insurance because the company the husband works for does not provide health insurance. I didn’t know which state they were in, so the reply is fairly general.

RESPONSE

What quality insurance is available depends mostly on which state you live in. Insurance companies pick which states they want to be competitive in by their pricing. If everyone is healthy, consider a high deductible health plan that is HSA compatible (the insurance company will tell you whether it is compatible). Choose one that pays 100% after you reach the deductible. What I have found is that sometimes the cost savings more than makes up for the design of the plan. With HSA compatible plans, you pay everything (using the network negotiated rate) up to the deductible, then the insurance company pays 100% thereafter (as long as you choose a plan with 100% cosinsurance). There is one deductible for the family versus 2 or three on traditional plans. Here is an example of savings: Currently a family pays $700/month for a $1500 deductible plan that includes doctors’ visits, etc. Moving to a $3500 deductible HSA plan costs $400/month. Monthly savings is $300; annual savings is $3600. You can’t not save money. Even if you saved just $2000/year, you’d still be ahead. As for choosing a reputable company, go to my website: http://www.robertslayton.com, click on “Free Articles” then choose tips for evaluating individual/family health insurance. I do recommend using an Insurance Agent who knows the individual health insurance market for your state. There is no charge to you and the rates are typically the same as if you went directly to an insurance carrier (in Illinois, they are always exactly the same). If you are in Illinois or Wisconsin, feel free to call me. If you are in a different state, go to www.nahu.org and click the “Find an Agent” button (currently on the right side of the page).

If you have questions/comments, please write me back.

Tweet This Post

Tags: affordable health insurance, benefits, family coverage, Health Insurance, health savings account, high deductible health plan, hsa, Uninsured
Posted in Health Insurance, Uninsured, health savings account, hsa | 1 Comment »

New Law Impacts Small Illinois Employers who offer Health Insurance

Thursday, June 25th, 2009

House Bill 2325 was signed into law on June 18,2009. It does two things that will impact you as an employer.

CHANGES

1. State Continuation has been expanded for 3 additional months to 12 months of total coverage.This change will go into effect at your renewal date (from 7/1/2009 renewals on).

2. New notification laws. You have 10 days to give an terminated employee notice of their rights to continue coverage and they now have 30 days within which to respond (they are required to respond in writing). Lack of timely notification can result in a $500 fine.

If you use a service, they should already know about these changes. If this terminated employee is eligible for the subsidy, then the insurance company is required to handle the notifications. If you fall into this category, I recommend taking the following action (as I’ve seen insurance companies screw up this part):

DOCUMENTATION OF TIMELY NOTICE

Print out a sheet stating that the employee/family is eligible for either 9 or 12 months of coverage (depending upon whether your group plan renewal has happened after 6/18/2009) and that this person has 30 days to elect this coverage in writing. Use the “Model ARRA Notice” and modify it for state continuation and the notification guidelines. Find it here: http://www.dol.gov/ebsa/COBRA.html. You can also request a copy of what your current COBRA service uses and provide it yourself.

TWO COPIES – ONE FOR YOU, ONE FOR THEM

Furnish two copies of this notice. One that the terminated employee must sign and date at the time of termination. The second copy they bring home. This will help you avoid the new $500 penalty.

NOTE: I am not an attorney or an expert on these notifications. To be perfectly compliant, check with your COBRA/State Continuation provider or attorney for specific language.

Tweet This Post

Tags: COBRA, COBRA Stimulus, cobra subsidy, Employee Benefits, HB2325, Health Insurance, illinois, Legislative, Mini-Med, state continuation
Posted in COBRA, Employee Benefits, Health Insurance, Legislative | No Comments »

I Will Deliver Letters to Your Legislators on 7/15/2009

Monday, June 15th, 2009

If you’ve been following my tweets, you probably know that I will be flying into Washington DC next month for one day of lobbying on behalf of Insurance Agents around the country. It is a joint effort between NAHU, NAIFA, AHIA, IIABA, and CIAB.

WHY I’M GOING TO WASHINGTON – TO FIGHT FOR MY LIVELIHOOD

You probably aren’t aware, but there have been bills circulating around Congress that will essentially kill part of my livelihood. The main reason is that they see our jobs as “overhead” instead of what we really do, which is take care of our clients through being experts in our field. The latest bill put forth last week by Senator Kennedy establishes what is known as Navigators. These will be organizations that will impartially help people to choose and apply for medical coverage. The kicker is that insurance agents are barred from establishing or being a part of one of these Navigators.

Picture yourself going into your doctor only to be seen by a clerical person with no medical training. They take down your symptoms, check their database, and then prescribe a treatment. Would you feel good about this? I know I wouldn’t, but this is what is happening to insurance agents. Most insurance agents have studied for years and have an intimate knowledge of which plan design would work best with your needs and wants, which health insurance carriers handle which conditions best, which carriers pay their bills, which carriers jack up rates, and which carriers doctors like the best. Personally, I DON’T want an impartial person, I want a person who’s lived in the trenches and can tell me the real story.

Here’s a booklet that lists many of our stories of how we’ve helped our clients: http://tr.im/agentstories

I’m on page 37.

SEND YOUR LETTERS TO ME – I will deliver them for you

Someone responded to my tweet about going to Washington and asked if I would be willing to deliver a personal letter for her. I said, sure.

This got me to thinking that why don’t I open it up to everyone. If you want your letter (in this case an email) hand delivered to your Legislator, email it to me at letters@robertslayton.com. I will drop it off at their office. If you want a snail mail letter delivered, then mail it to your congress person’s name, C/O Robert Slayton, P.O. Box 62, Naperville, IL 60566. I will deliver these too. I must receive it by the 13^th or else it won’t go with me. Snail mail letters must only include paper, nothing else (as the airline might object).

Please note: I won’t deliver pure negativity (e.g. you’re a jerk). But will deliver all other letters. Please note in your subject line which representative you’d like it to go to. If you don’t know, then use the following website to find out: http://www.votesmart.org. Just put in your zip code and it will pull up your Congressional representatives. Make sure you choose your Federal legislators (listed at the top).

Most legislators want you to list your home address at the bottom (to make sure you are in their district). I would recommend doing this (many will send you a response). I will not keep, sell, or otherwise use any of these emails/letters and will delete all messages (and the mailbox) after the 15^th of July.

If you have questions, please leave a comment or tweet me at @rcslayton.

Tweet This Post

Tags: ahia, ciab, Employee Benefits, Health Insurance, iiaba, insurance agent, legislation, nahu, naifa, navigators, senator kennedy
Posted in Employee Benefits, Health Insurance, Legislative, Uninsured | No Comments »

Robert’s Insurance Blog

Posts Tagged ‘Health Insurance’

New Fact Sheet on COBRA State Continuation Stimulus for Illinois

Illinois Insurance Facts

Illinois Department of Insurance

Federal Stimulus – Premium Reduction for Group Continuation Coverage

What Are Group Continuation Laws?

When an Employee Loses Group Coverage and Elects Continuation, Who Pays the Premium?

Who is Eligible for Premium Reductions Under ARRA?

Who Will Benefit from the ARRA Subsidy Extension?

How Do Individuals Sign Up for the Premium Reduction?

For group plans subject only to state mini-COBRA requirements (i.e., employers with 19 or fewer employees), written notice must be provided by the insurer providing coverage under the group plan.

MODEL NOTICES:

How will the Premium Reduction be Applied to Group Continuation Coverage?

What if an Employer or Insurer Refuses to Provide the Premium Reduction?

Will Individuals be Eligible for the Premium Reduction for as Long as They Are Eligible for Group Continuation Coverage?

Can an Individual Lose Eligibility for the Premium Reduction?

Does the Premium Reduction Apply to Group Continuation Coverage other than COBRA?

Does ARRA Extend the Length of Available Group Continuation Coverage?

Who is Eligible for a Second Opportunity to Continue Group Coverage and Receive the Premium Reduction?

Does the Premium Reduction Affect Eligibility for other Income-Based Government Programs?

For More Information

COBRA Stimulus payments and eligibility extended

More Information on UniCare Exiting Illinois and what will happen

UniCare is Pulling out of Illinois

How Health Reform will Impact HSAs

Legislative Update on Health Care Reform from NAHU

How Can I find Affordable Health Insurance?

RESPONSE

New Law Impacts Small Illinois Employers who offer Health Insurance

CHANGES

DOCUMENTATION OF TIMELY NOTICE

TWO COPIES – ONE FOR YOU, ONE FOR THEM

I Will Deliver Letters to Your Legislators on 7/15/2009

WHY I’M GOING TO WASHINGTON – TO FIGHT FOR MY LIVELIHOOD

SEND YOUR LETTERS TO ME – I will deliver them for you

Pages

Archives

Categories