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With the the Patient Protection and Affordable Care Act (PPACA) upheld by the U.S. Supreme Court, half of the states in the nation now face a federally run health care exchange, the default for states that haven’t made progress or declined involvement in setting up a state run marketplace for health insurance coverage.
See also: State-Based Exchange Status Map
Absent massive extensions which some say could still be granted by the Administration, the landscape for health insurance could be a federally-run system for administration, enforcement and assessment of insurers for at least half the nation.
National Association of Insurance Commissioner (NAIC) officials have said it is too late to start a state-based exchange if work has not already been underway for a while, and still meet the deadlines imposed by the U.S. Department of Health and Human Services (HHS), with open enrollment beginning in October 2013.
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President Barack Obama’s healthcare law could sharply exceed its cost-savings targets and add up to $530 billion to the federal budget deficit, a leading authority on U.S. government benefit programs said on Tuesday.
A study by Charles Blahous, a George Mason University research fellow and the Republican trustee for the Medicare and Social Security entitlement programs for the elderly, challenges the administration’s contention that the 2010 law would better keep healthcare costs in line.
Known as the “Affordable Care Act,” or “Obamacare,” the measure to expand health insurance for millions of Americans is considered Obama’s signature domestic policy achievement.
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Group health benefit administrators and managers can make their employees aware of some money saving tips when using their health insurance.
It may be a good idea to do a seminar or send out a refresher to employees so they remember how their plan can help their wallet, not hurt it.
Here are the biggest tips to save:
Use in-network doctors. Doctors, hospitals, outpatient testing, treatment, and surgery centers that are in-network will save a lot of money. Most insurers offer online and telephone directories to target in-network providers that will equal cost savings.
Ask your doctor about the best care for the best price. Doctors often have more than one drug to treat medical conditions and illnesses. When you chat with your doctor about benefits, see if there are generic options that will help you the same, but cost less. Many plans also offer mail order pharmacy options that have discounts on prescriptions. And with many drugs now available in similar formulas over the counter, see if your doctor recommends any of these more affordable medications.
Call before you run to the doctor. You can sometimes avoid the expense and hassle of going to the doctor if you need a medication or consultation on a lab follow up. Many doctors will fax a prescription refill to your pharmacy and they or their nurses will discuss the results of lab tests over the phone. Both can save patients money on copays and time.
Go to the most appropriate doctor for medical concerns. Retail clings in department, grocery, and drug stores have convenient, quick, and even weekend care in some stores. But patients should check their benefits coverage to see if the costs are on par with their primary doctor. Equally as important is deciding on whether or not to go to the emergency room. Patients should call their health plan’s nurse line or doctor’s office to see if a trip to the ER is going to worth the big cost and potential wait time. Many people go to the ER for back pain, fevers, and nausea that are slowing down the staff’s ability to address more serious illness and injuries. So if a hospital visit is necessary, be sure to check that the hospital is in-network. Just because your doctors works at that hospital or has admitting privileges does not mean that the hospital is covered under your plan. So check coverage and even estimate costs on many of the provider’s web calculators before you go if possible.
Read medical bills and invoices. Billing errors do happen, so review the cost when checking out at the doctor and when the invoice comes in the mail. Adjustments after you have visited the doctor will affect your wallet, so keep a file and call your insurer to double check that you are paying the correct amount.
Seek out the best provider when it comes to specialized exams. Services at labs can cost dramatically less than those done at hospital facilities. Same goes for pathology tests, MRIs and CT scans, as well as colonoscopy, endoscopy, and arthroscopy tests. An insurer will have online cost calculators and provider listings that will give greater value than a hospital visit.
Focus on preventive health, not just current problems. Regular physicals, screenings, and immunizations will help ward off problems before they start. Providers oftentimes list recommended tests and schedules for children and adults. Patients save a lot of money taking care of the health versus ending up with a chronic condition that can affect their lifestyle and wallet dramatically.
Reviewing your insurance provider and their benefits will help employers know that they have the best plan for their employees. This means a lot of savings for their workers and confidence in their benefits package.
Bradley Palmer is with Grouphealthflorida.com offering Florida Group Health Insurance. To learn more about group health insurance, visit http://www.grouphealthflorida.com.
Tampa, FL – Grants are now being awarded for small businesses to assist in providing comprehensive workplace wellness programs. The Patient Protection and Affordable Care Act (PPACA) will award $200 million over the next five-year period to businesses that did not offer these programs as of March 23, 2010 and employ fewer than 100 employees that work 25 hours or more per week.
“Prevention and wellness programs will help retain and attract employees,” said Thomas Kaspar of Grouphealthflorida.com. “Your employees will be more healthy and an employer can tout cutting edge benefits.”
Kaspar’s group health agency helps businesses find what insurer offers the best health awareness and prevention initiatives. Grants from the PPACA will most often be awarded to companies that sign up with plans that offer health education, risk assessments, and screenings as well as seminars to encourage participation from all employees to modify unhealthy behaviors and lifestyle patterns.
“Many insurers offer tailored programs to keep employees well, rather than just covering illness or injuries,” Kaspar said. “The wellness services will cover women, men, and children’s wellbeing and strive to help employees and their families live longer, healthier lives.”
Health plans now abound with options for personal and online coaching to help achieve healthier lifestyle goals, from reducing stress and sleeping better, losing weight and improving fitness and energy levels, stop smoking, and improving the work/life balance. Paired with health care tax credits and insurance exchanges, small businesses will have many incentives to offer insurance and wellness programs that they otherwise might not have thought about or allocated monies for in their business plan.
With more than 20 years experience, Group Health Florida assists benefit managers and companies through the detailed process of finding the best insurance and wellness programs for their employees. They pride themselves on providing a high quality of service, dependability, knowledge, value, and clarity.
To learn more visit: Grouphealthflorida.com
http://newsroom.cigna.com/images/56/839403_ChoiceFundExecSummary_v8HR.pdf
Grouphealthflorida.com offers Florida Group Health
Insurance. To learn more about group health insurance,
visit http://www.grouphealthflorida.com.
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1-800-873-5713 EXT 101
On September 3, 2010, the Department of Health & Human Services issued guidance on the process for obtaining a waiver of the requirement to eliminate annual dollar limits on medical plans.
Organizations that offer limited benefit plans will need the waiver to continue offering plans with their current annual dollar limits between now and 2014.
Plans may apply for a waiver if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. For insured plans, either the plan or the insurer can apply for the waiver.
To be eligible to apply for a waiver:
The plan or policy must have been in effect before September 23, 2010
The application must be submitted at least 30 days before the first day of the plan year for which a waiver is being requested. Applications will be processed within 30 days after they are received.
For plan years beginning before November 2, 2010, the waiver request must be submitted at least 10 days before the first day of the plan year and HHS will process the application at least 5 days before the first day of the plan year.
The application must include all of the following:
The terms of the plan or policy
The number of individuals covered
The annual dollar limits and the rates
Documentation supporting anticipated premium increases and/or decreased access
Attestation statement signed by the plan administrator or the CEO of the insurer that elimination of annual limits would result in significant premium increase and/or decrease in access to coverage.
A waiver is valid for one plan year only. A separate application must be submitted for each plan year until 2014. For plan years beginning on or after January 1, 2014, waivers will no longer be allowed.
Grouphealthflorida.com offers Florida Group Health
Insurance. To learn more about group health insurance,
visit http://www.grouphealthflorida.com.
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Floridas #1 Group Health Agency
We would like to share with you a summary of wellness and prevention initiatives as a result of the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reform Act.
Elimination of Co-Payments for Screenings and Preventive Care
Starting in September of 2010, employer-sponsored (and other) group health plans and health insurance issuers are prohibited from requiring co-pays for all preventive services recommended by an independent expert panel, the United States Preventive Services Task Force. Co-pays are also eliminated for certain recommended immunizations, breast cancer screenings and other preventive care/screenings for women and children. However, this requirement does not apply to “grandfathered” health plans, which are defined in PPACA as any plan in which at least one individual was enrolled as of March 23, 2010.
Note: Pay careful attention to the cost-sharing requirements for office visits under this rule.
Employee Wellness Discounts
Starting January 1, 2014, PPACA enhances such wellness discounts by permitting group health plans to give reductions of up to 30 percent of the cost of premiums to employees who participate in such wellness programs. This may be expanded to 50 percent subject to the discretion of the Secretary of Health and Human Services (HHS).
Break Time for Nursing Mothers
Effective immediately, the PPACA also provides that employers covered by the Fair Labor Standards Act must provide reasonable break time and a private space – other than a restroom – for nursing mothers for up to one year after the birth of a child. Employers are not required to compensate employees during such break times. Additionally, employers with less than 50 employees may qualify for exceptions if it can be proven that the requirement would impose an undue hardship on the employer.
Posting of Nutritional Requirements
By March of 2011, the Secretary of HHS must publish regulations requiring all chain restaurants (defined as any establishment that has 20 or more locations operating under the same name) to disclose the nutritional content of all menu items. Specifically, the number of calories for each item must be disclosed on menus, menu boards and drive through menu boards, and such menus must also feature “a succinct statement concerning suggested daily caloric intake.” This requirement also extends to buffet items, and vending machines maintained by companies that operate 20 or more machines.
Government Funding for Wellness Programs
In addition to the specific provisions outlined above, PPACA also creates a “Prevention and Public Health Fund” which will be administered through HHS and will support prevention and public health programs. Beginning with the fiscal year 2010, $500 million will be appropriated to various programs within HHS, with the amount of appropriations increasing each year to $2 billion in the fiscal year 2015 and each year thereafter. Under PPACA, the funds are to be used for activities such as prevention research and health screenings, the Community Transformation grant program (designed to fund state and municipal wellness programs by creating walking paths, nutrition awareness programs, etc.), Education and Outreach Campaign for Preventive Benefits (a planned public-private partnership to raise awareness on preventive care), and immunization programs.
Additionally, school-based health centers (facilities that provide primary health care to students on school campuses) will receive $50 million per year in grant funding through 2013. These grant monies are to be used only for expenditures on facilities and equipment, not for hiring personnel.
Small Business Grants for Wellness Programs
The PPACA includes a grant program to assist small businesses in providing comprehensive workplace wellness programs. Grants will be awarded to eligible employers to provide their employees with access to new workplace wellness initiatives. The grants will be awarded beginning in 2011 with $200 million appropriated for a five year period.
An eligible employer is an employer that:
Employs fewer than 100 employees who work 25 hours or more per week; and
Did NOT have a workplace wellness program in place as of March 23, 2010 (date of PPACA enactment)
The PPACA requires the Secretary of HHS to develop program criteria that are based on research and best practices. A comprehensive workplace wellness program must be made available to all employees and include:
Health awareness initiatives (including health education, preventive screenings and health risk assessments)
Efforts to maximize employee engagement (including mechanisms to encourage employee participation)
Initiatives to change unhealthy behaviors and lifestyle choices (including counseling, seminars, online programs and self-help materials)
Supportive environment efforts (including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health)
Note: The money will likely go quickly. Small businesses need to be prepared with a wellness program which meets the criteria and requirements as described in the PPACA and developed by the Secretary of HHS.
While there are still many unanswered questions regarding the implementation of the above mentioned programs, especially the small business wellness grant funding, adding provisions for wellness and prevention under PPACA is one small step for a healthier workforce.
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Insurance. To learn more about
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Floridas #1 Group Health Agency
Background
The new IRS Small Business Health Care Tax Credit opportunity may enable eligible employers to expand their benefit plans to include specialty benefits and potentially offer a richer plan to their employees.
The tax credit program helps small businesses and small tax-exempt organizations afford the cost of covering their employees’ health care benefits. Visit the IRS site for additional support materials, including a video and frequently asked questions about the program. For more information please contact your UnitedHealthcare account executive.
http://www.brainshark.com/brainshark/vu/view.asp?pi=599859779
Grouphealthflorida.com offers Florida Group Health
Insurance. To learn more about group health insurance,
visit http://www.grouphealthflorida.com.
Call us now for a quote .
1-800-873-5713 X 101
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Floridas #1 Group Health Agency
From Humana
September 23 marks the six-month anniversary of the enactment of health reform. As a result, some key changes take effect.
The following changes take place for all health plans:
Lifetime limits. Plans may not impose lifetime dollar-limits on essential benefits.
Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
Coverage for adult children. Children may stay on their parents’ policies until age 26 if coverage isn’t available through their work, regardless of their marital status.
Pre-existing conditions. Group plans and new individual plans may not impose pre-existing condition exclusions for children under 19 (does not apply to grandfathered individual plans).
http://apps.humana.com/marketing/documents.asp?file=1428206
Grouphealthflorida.com offers Florida Group Health
Insurance. To learn more about group health insurance,
visit http://www.grouphealthflorida.com.
Call us now for a quote .
1-800-873-5713 X 101
www.grouphealthflorida.com
Floridas #1 Group Health Agency
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