This week I have been asked about this so many times that I wanted to address some confusion concerning federal COBRA.
Federal COBRA runs a standard 18 months, not 15 months. There are cases where it can be 29 months (disability extension) or 36 months (divorce, separation, death of the employee, state extension or dependent age-off of parent's plan). Generally it runs 18 months for most people.
The subsidy for COBRA (for those who qualify) runs 15 months. It was originally set up to run 9 months but was extended.
You do not exhaust or lose COBRA at 15 months. You only lose the subsidy at 15 months. You still have 3 more months of COBRA (or more if extended) after the subsidy goes away.
You are not eligible for HIPAA at 15 months. You have to complete the 18 months.
Sunday, May 23, 2010
Bintang Leo dlm Ramalan tahun 2010
Ramalan Bintang Leo
Kesibukan membuat kalian jarang bertemu. Karena kedewasaan Anda berdua, hal itu tidak mempengaruhi hubungan. Anda berdua saling merindu. Karier Anda akan melejit dengan cepat. Anda mempunyai sifat yang aktif dan selalu berusaha untuk maju. Bagi Anda waktu merupakan sesuatu yang berharga. Kesehatan Anda berpengaruh pada perjalanan panjang yang akan dilakukan. Sebaiknya Anda mempersiapkan obat-obatan untuk mengantisipasi hal yang tidak diinginkan.
Asmara : Cinta sejati bisa bertahan
Keuangan: Kegigihan bisa mendapatkan lebih
Kesehatan: Cepat ngantuk, jangan dianggap remeh
Jodoh dan Keuangan untuk Bintang Virgo
Thursday, May 20, 2010
Health Exchanges and Independent Agents
I am hearing and reading so much lately from the health insurance agent community about the future of agents under healthcare reform. Specifically as relates to the health insurance exchanges set for 2014. A minority believe that independent agents will have a place in the system while a majority, it seems, are suffering from "Chicken Little Syndrome". Truthfully, no one knows yet what place independent health agents will have in the new system. I do have some thoughts.
For those who know me and my business, I write a lot of HIPAA. HIPAA is guaranteed-issue health insurance, available kind of on an exchange (pick from available carriers and plans) and has no underwriting or medical screening component. Somewhat similar to the future exchanges (if you can get information which is generally only available on web sites like mine).
One would think that with the fairly small choice of guaranteed-issue plans (perhaps 25 at most in California) and fairly similar plan designs (HMO are similar and PPO/POS are similiar in deductible and general benefits) that choosing a HIPAA plan would be easy. Honestly, for every 10 people I help enroll under HIPAA, at least 9 of them need help in determining the most appropriate carrier and plan for their needs. And that is a good thing. Getting a coverage plan is important. Getting the best fit for coverage is more important.
There are a variety of factors that come into play during proper case development. Plan design and usage limitations are one area. Plan benefits and any exclusions or limitations is another. Then there is the network of participating providers and the prescription drug formulary to consider. All of these things before we really even look at the price of the plan. These services are easily and readily provided by independent agents who can compare multiple carriers and plans. The other option would be to call each carrier and then try to put it all together yourself. One of the problems with calling a carrier is...they only know their own plan. For example:
Blue Cross of California originated a plan in California called RightPlan PPO. It was the first no deductible non-maternity individuals-only PPO in California. It was subsequently copied by several other carriers and duplicated in their respective plan portfolios. Health Net has SimpleValue PPO (copy) and Blue Shield has ActiveStart PPO (copy).
Under the current market, you could call Anthem Blue Cross about the RightPlan PPO but they are not equipped to compare it against SimpleValue or ActiveStart. Each carrier only knows their own plans. You'd end up having to call three carriers, get whatever information you think is important, put it all together and try to decide which clone plan would work best. Or you could call an independent agent (for free by the way, there is no cost to have an agent) who can run that scenario for you.
Fast forward to the health insurance exchanges. Like HIPAA, the plans will all be similar but, like HIPAA, there will be differences between each insurance company's plans (network, formulary, benefits, tiers of drug coverage and so on).
Let's assume hypothetically that six companies in California offer plans to the exchange. The plans will be denoted as Gold, Silver, Bronze and Platinum. Benefit levels will be determined by mandates in the healthcare reform law. Seems simple enough, right?
Well, what if you take six medications and one of them is not in any drug formulary for the exchange plans? Which plans have tier 3 drug coverage and which don't. Are there restrictions on tier 3 benefits? How do I search their drug formulary? Are my doctors participating with this carrier's Gold plan? How about hospitals? Do the networks differ between Gold, Silver, Bronze and Platinum? Does this plan cover me locally only or can I use it in-network when I travel? Is this an HMO Gold, PPO Gold or POS Gold? What's the difference?
Needless to say, this list could go on forever.
Another factor that I believe may come into play are deviations from basic design. With Medicare Supplement plans, there are some carriers who offer the Medicare mandated benefits but also create enhanced plans with other options above the Medicare minimum standard. Could we see this in the exchange as well? I believe it is very possible. So instead of six carriers offer six Gold plans, you might see something like this:
Carrier A - Gold
Carrier B - Gold, Gold Preferred, Gold Plus, Gold Enhanced
Carrier C - Gold, Gold Preferred
Carrier D - Gold, Gold Select
Carrier E - Gold, Gold Select
Carrier F - Gold, Gold HMO
Gold = Standard Gold design based on reform rules for plan minimum standard
Gold Select = Gold plan benefits with a select network of providers (smaller)
Gold Preferred = Gold plan health benefits plus a long-term care rider
Gold Plus = Gold plan benefits with a dental HMO plan
Gold Enhanced = Gold Plus plan design (with dental) plus additional vision and chiropractic coverage
Gold HMO = HMO plan adhering to Gold plan design rules
Under this scenario, as many as 13 Gold plans could be available (or more, or less) from the six insurance companies. It could get really confusing really quickly. And what if they do the same with Silver and Bronze? Or Platinum?
The bottom line is that a person should not have to match their medical needs to a health plan. All of my case development for HIPAA plans is directed at matching the plan to meet the medical needs, not the other way around. While no plan is always absolutely perfect, good case development should find the one plan that, given overall medical needs, is the "best" fit for each client.
I would think, given these variables, that the role of the independent agent would be extremely important in matching people's medical needs with the appropriate health plan, whether through the exchange or privately outside of the exchange.
Certainly the states, or insurance companies, or federal government could set up "call centers" staffed by non-agents who would be available to review coverage options and answer questions. Would it be less expensive? Probably not. But more to the point, there comes a time in this business when experienced, veteran independent agents really get a feel for the way certain insurance companies operate with regard to networks, formulary and benefits. I have found that EOC (Evidence of Coverage) booklets are often sorely lacking in certain areas when it comes to benefit utilization or the way a claim is "really" processed. Just because something is written in a booklet or spreadsheet or benefit summary does not mean that is exactly how it works, or in all situations.
We learn from experience. I write mostly HIPAA. Claims for HIPAA tend to be much greater and much more varied than underwritten coverage. That is the nature of guaranteed-issue coverage. I have seen situations which absolutely contradict what was written in the benefit summary, spreadsheet or EOC. I have also learned over the years many of the little nuances of the plans and insurance carriers that can be very critical when a prospective client brings their medical needs to me.
I hope that our leadership understands the value that we independent health agents provide.
On a side note:
I was a bit saddened to read an article recently in an industry publication in which President Obama told a health agent who expressed concern about her career that she was "the one who has to tell her clients about the insurance company's rate increase". While that is part of our job, I'd like to think we do a bit more than just pass on rate increase information. I certainly hope this is not how our leadership sees us and perceives our value to our clients.
I don't always have time to tell people about rate increases since the carrier will tell them anyway. I am often quite busy running drug formularies, trying to find which network doctor X is actually in and trying to help my clients get the plan that will best cover their immediate needs like chemotherapy, heart surgery, infusion therapy, transplant surgery or self-injectible life saving medication.
For those who know me and my business, I write a lot of HIPAA. HIPAA is guaranteed-issue health insurance, available kind of on an exchange (pick from available carriers and plans) and has no underwriting or medical screening component. Somewhat similar to the future exchanges (if you can get information which is generally only available on web sites like mine).
One would think that with the fairly small choice of guaranteed-issue plans (perhaps 25 at most in California) and fairly similar plan designs (HMO are similar and PPO/POS are similiar in deductible and general benefits) that choosing a HIPAA plan would be easy. Honestly, for every 10 people I help enroll under HIPAA, at least 9 of them need help in determining the most appropriate carrier and plan for their needs. And that is a good thing. Getting a coverage plan is important. Getting the best fit for coverage is more important.
There are a variety of factors that come into play during proper case development. Plan design and usage limitations are one area. Plan benefits and any exclusions or limitations is another. Then there is the network of participating providers and the prescription drug formulary to consider. All of these things before we really even look at the price of the plan. These services are easily and readily provided by independent agents who can compare multiple carriers and plans. The other option would be to call each carrier and then try to put it all together yourself. One of the problems with calling a carrier is...they only know their own plan. For example:
Blue Cross of California originated a plan in California called RightPlan PPO. It was the first no deductible non-maternity individuals-only PPO in California. It was subsequently copied by several other carriers and duplicated in their respective plan portfolios. Health Net has SimpleValue PPO (copy) and Blue Shield has ActiveStart PPO (copy).
Under the current market, you could call Anthem Blue Cross about the RightPlan PPO but they are not equipped to compare it against SimpleValue or ActiveStart. Each carrier only knows their own plans. You'd end up having to call three carriers, get whatever information you think is important, put it all together and try to decide which clone plan would work best. Or you could call an independent agent (for free by the way, there is no cost to have an agent) who can run that scenario for you.
Fast forward to the health insurance exchanges. Like HIPAA, the plans will all be similar but, like HIPAA, there will be differences between each insurance company's plans (network, formulary, benefits, tiers of drug coverage and so on).
Let's assume hypothetically that six companies in California offer plans to the exchange. The plans will be denoted as Gold, Silver, Bronze and Platinum. Benefit levels will be determined by mandates in the healthcare reform law. Seems simple enough, right?
Well, what if you take six medications and one of them is not in any drug formulary for the exchange plans? Which plans have tier 3 drug coverage and which don't. Are there restrictions on tier 3 benefits? How do I search their drug formulary? Are my doctors participating with this carrier's Gold plan? How about hospitals? Do the networks differ between Gold, Silver, Bronze and Platinum? Does this plan cover me locally only or can I use it in-network when I travel? Is this an HMO Gold, PPO Gold or POS Gold? What's the difference?
Needless to say, this list could go on forever.
Another factor that I believe may come into play are deviations from basic design. With Medicare Supplement plans, there are some carriers who offer the Medicare mandated benefits but also create enhanced plans with other options above the Medicare minimum standard. Could we see this in the exchange as well? I believe it is very possible. So instead of six carriers offer six Gold plans, you might see something like this:
Carrier A - Gold
Carrier B - Gold, Gold Preferred, Gold Plus, Gold Enhanced
Carrier C - Gold, Gold Preferred
Carrier D - Gold, Gold Select
Carrier E - Gold, Gold Select
Carrier F - Gold, Gold HMO
Gold = Standard Gold design based on reform rules for plan minimum standard
Gold Select = Gold plan benefits with a select network of providers (smaller)
Gold Preferred = Gold plan health benefits plus a long-term care rider
Gold Plus = Gold plan benefits with a dental HMO plan
Gold Enhanced = Gold Plus plan design (with dental) plus additional vision and chiropractic coverage
Gold HMO = HMO plan adhering to Gold plan design rules
Under this scenario, as many as 13 Gold plans could be available (or more, or less) from the six insurance companies. It could get really confusing really quickly. And what if they do the same with Silver and Bronze? Or Platinum?
The bottom line is that a person should not have to match their medical needs to a health plan. All of my case development for HIPAA plans is directed at matching the plan to meet the medical needs, not the other way around. While no plan is always absolutely perfect, good case development should find the one plan that, given overall medical needs, is the "best" fit for each client.
I would think, given these variables, that the role of the independent agent would be extremely important in matching people's medical needs with the appropriate health plan, whether through the exchange or privately outside of the exchange.
Certainly the states, or insurance companies, or federal government could set up "call centers" staffed by non-agents who would be available to review coverage options and answer questions. Would it be less expensive? Probably not. But more to the point, there comes a time in this business when experienced, veteran independent agents really get a feel for the way certain insurance companies operate with regard to networks, formulary and benefits. I have found that EOC (Evidence of Coverage) booklets are often sorely lacking in certain areas when it comes to benefit utilization or the way a claim is "really" processed. Just because something is written in a booklet or spreadsheet or benefit summary does not mean that is exactly how it works, or in all situations.
We learn from experience. I write mostly HIPAA. Claims for HIPAA tend to be much greater and much more varied than underwritten coverage. That is the nature of guaranteed-issue coverage. I have seen situations which absolutely contradict what was written in the benefit summary, spreadsheet or EOC. I have also learned over the years many of the little nuances of the plans and insurance carriers that can be very critical when a prospective client brings their medical needs to me.
I hope that our leadership understands the value that we independent health agents provide.
On a side note:
I was a bit saddened to read an article recently in an industry publication in which President Obama told a health agent who expressed concern about her career that she was "the one who has to tell her clients about the insurance company's rate increase". While that is part of our job, I'd like to think we do a bit more than just pass on rate increase information. I certainly hope this is not how our leadership sees us and perceives our value to our clients.
I don't always have time to tell people about rate increases since the carrier will tell them anyway. I am often quite busy running drug formularies, trying to find which network doctor X is actually in and trying to help my clients get the plan that will best cover their immediate needs like chemotherapy, heart surgery, infusion therapy, transplant surgery or self-injectible life saving medication.
Wednesday, May 19, 2010
MRMIP Clears Backlog (No Enrollment Waiting Period)
The California MRMIP (Major Risk Medical Insurance Program) has apparently received some additional funding and has cleared the backlog of applications.
As of today (5/19/10) there is no waiting list for MRMIP enrollments.
I am working on obtaining specific information regarding the federal temporary risk pool which is scheduled to open July 1. In the meantime eligible uninsurables may enroll in the MRMIP without an enrollment waiting period.
More MRMIP information here
As of today (5/19/10) there is no waiting list for MRMIP enrollments.
I am working on obtaining specific information regarding the federal temporary risk pool which is scheduled to open July 1. In the meantime eligible uninsurables may enroll in the MRMIP without an enrollment waiting period.
More MRMIP information here
Monday, May 10, 2010
Large Companies Contemplate Dropping Employee Health Coverage
The Dallas Morning News is reporting that several very large companies "have concluded that they might be financially better off canceling their health care coverage and moving their workers to government-subsidized exchanges that will be available in four years".
At least four companies have investigated to varying degrees the impact of dropping health care coverage and pushing their workers onto the new exchanges, where they will be able to buy their own insurance.
While doing this would subject companies to fines, the size of the fines would be substantially less than the cost of providing health insurance to their workers.
The four companies identified so far are:
*AT&T
*Verizon Communications, Inc.
*Caterpillar, Inc.
*Deere and Co.
If these four are looking at this option, it is a pretty safe bet that other large employers are doing the same.
At least four companies have investigated to varying degrees the impact of dropping health care coverage and pushing their workers onto the new exchanges, where they will be able to buy their own insurance.
While doing this would subject companies to fines, the size of the fines would be substantially less than the cost of providing health insurance to their workers.
The four companies identified so far are:
*AT&T
*Verizon Communications, Inc.
*Caterpillar, Inc.
*Deere and Co.
If these four are looking at this option, it is a pretty safe bet that other large employers are doing the same.
Sunday, May 9, 2010
HIPAA Enrollment Change (Yet Again) - Anthem
Anthem Blue Cross (CA) has made another enrollment change to the HIPAA plans.
Under the prior change, all enrollments in HIPAA were subject to approval followed by a premium notice. The notice would allow payments in two 15-day periods (1-15th, 16-31st paid or postmarked) to start on the first of the following month. Example:
*Premium paid or postmarked 1-15 June would start July 1 (30-day gap)
*Premium paid or postmarked 16-30 June would start August 1 (60-day gap)
Under the latest change, the premium payment period has changed as follows:
*Premium paid or postmarked 1-15 June would start June 1 (slightly retroactive)
*Premium paid or postmarked 16-30 June would start July 1
Also, Anthem Blue Cross CA has indicated that it will accept certain "substitute" documents in lieu of the Certificate of Creditable Coverage which is not issued until after the expiration of continuation coverage.
Under the prior change, all enrollments in HIPAA were subject to approval followed by a premium notice. The notice would allow payments in two 15-day periods (1-15th, 16-31st paid or postmarked) to start on the first of the following month. Example:
*Premium paid or postmarked 1-15 June would start July 1 (30-day gap)
*Premium paid or postmarked 16-30 June would start August 1 (60-day gap)
Under the latest change, the premium payment period has changed as follows:
*Premium paid or postmarked 1-15 June would start June 1 (slightly retroactive)
*Premium paid or postmarked 16-30 June would start July 1
Also, Anthem Blue Cross CA has indicated that it will accept certain "substitute" documents in lieu of the Certificate of Creditable Coverage which is not issued until after the expiration of continuation coverage.
Wednesday, May 5, 2010
A Good Story (sadly not health insurance but life insurance)
Every day it seems the health insurance companies are making mistakes, denying claims, rescinding coverage and all of the rest. They pay claims grudgingly (if at all) and, according to many media sources, try to get out of paying as many as they can.
I asked my doctor during a recent checkup if it was true what 'Dr. Dean' says about doctor spending 1/2 their time working on patient files. He told me "not anymore", most of his time is spent fighting with health insurance companies. Sigh!
So, I wanted to share the following true story. It is not a health insurance story, but a life insurance story. I dream of the day even one California health insurance company could tell a story like this. I doubt any of them could..........
In 1999 I attended the annual agents meeting of Northwestern Mutual Life in Milwaukee, WI. This is an annual "must" for NML agents and it is both educational and a lot of fun.
Then-CEO Jim Ericson opened the first morning session with the following story (and yes it has stuck with me 11 years now).
In early 1999 an agent's client applied for a life insurance policy for his young teenage daughter. Something for the future I guess. Well, for some reason the case got hung up in underwriting and they didn't get what they wanted with medical records and never completed the underwriting.
The client called his agent in late spring to inquire as to whether or not the life insurance policy on his daughter was ever issued. The agent checked and told his client that it had not completed underwriting and was never issued.
The client told his agent, "well, I guess it doesn't matter anyway, my daughter has passed away".
The agent took the case to NML where it ended up on the desk of Mr. Ericson. He directed his underwriting department to complete the underwriting on the young girl's application and report to him whether or not the policy would have been issued at that time (given the missing information).
Underwriting reviewed the application, received the missing information and reported to Mr. Ericson that, indeed, a policy would have been issued at that time had they received all of the information they required.
Mr. Ericson directed Northwestern Mutual Life to issue the life insurance policy posthumously on the young girl, waive premium payments, and immediately pay the benefit to the beneficiary.
Northwestern Mutual did not have to do this. They could have simply said that the policy was never issued due to missing medical information. But they didn't.
This story never made the press, was never published in any newspaper. Quietly, as their nickname "The Quiet Company" suggests, they made a decision to do the right thing, or more to the point, to do the honorable thing.
It's about honor and being honorable. That's what it really means to be an insurance company!
I asked my doctor during a recent checkup if it was true what 'Dr. Dean' says about doctor spending 1/2 their time working on patient files. He told me "not anymore", most of his time is spent fighting with health insurance companies. Sigh!
So, I wanted to share the following true story. It is not a health insurance story, but a life insurance story. I dream of the day even one California health insurance company could tell a story like this. I doubt any of them could..........
In 1999 I attended the annual agents meeting of Northwestern Mutual Life in Milwaukee, WI. This is an annual "must" for NML agents and it is both educational and a lot of fun.
Then-CEO Jim Ericson opened the first morning session with the following story (and yes it has stuck with me 11 years now).
In early 1999 an agent's client applied for a life insurance policy for his young teenage daughter. Something for the future I guess. Well, for some reason the case got hung up in underwriting and they didn't get what they wanted with medical records and never completed the underwriting.
The client called his agent in late spring to inquire as to whether or not the life insurance policy on his daughter was ever issued. The agent checked and told his client that it had not completed underwriting and was never issued.
The client told his agent, "well, I guess it doesn't matter anyway, my daughter has passed away".
The agent took the case to NML where it ended up on the desk of Mr. Ericson. He directed his underwriting department to complete the underwriting on the young girl's application and report to him whether or not the policy would have been issued at that time (given the missing information).
Underwriting reviewed the application, received the missing information and reported to Mr. Ericson that, indeed, a policy would have been issued at that time had they received all of the information they required.
Mr. Ericson directed Northwestern Mutual Life to issue the life insurance policy posthumously on the young girl, waive premium payments, and immediately pay the benefit to the beneficiary.
Northwestern Mutual did not have to do this. They could have simply said that the policy was never issued due to missing medical information. But they didn't.
This story never made the press, was never published in any newspaper. Quietly, as their nickname "The Quiet Company" suggests, they made a decision to do the right thing, or more to the point, to do the honorable thing.
It's about honor and being honorable. That's what it really means to be an insurance company!
Monday, May 3, 2010
Blue Shield CA Adds 5th HIPAA Policy
Effective May 1, 2010, Blue Shield of California has added a 5th policy to the HIPAA guaranteed-issue individual & family portfolio.
The new addition, Access+ Value HMO, is a lower-priced HMO option than the Access+ HMO that was made available 3/2/10.
This is the first time I have seen a carrier offer three plans under one plan registration for HIPAA.
The new addition, Access+ Value HMO, is a lower-priced HMO option than the Access+ HMO that was made available 3/2/10.
This is the first time I have seen a carrier offer three plans under one plan registration for HIPAA.
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