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The Future of Employer Based Coverage
by Leila Morris

Employers are likely to continue providing health coverage as long as they get a federal tax incentive. They will also provide coverage as long as it remains a competitive advantage to do so, since workers want group health coverage, said Chris Jennings, president of Jennings Policy Strategies. He addressed a recent a May forum in Washington, D.C., sponsored by the Employee Benefits Research Institute. Noam Levey, who covers national healthcare policy for The Los Angeles Times said, “It is interesting to hear what people in Washington think is going to happen with employer-provided coverage, and then you talk to people in the benefits world, and you get a very different picture. The simple fact of the matter is that employer-provided health coverage clearly has a value for employers.” Levey said that employers are working to tier their benefits, at different levels for different workers. He said that he real wild card with health benefits is the federal tax treatment of health coverage and how Congress may change it. “The Cadillac tax obviously is going to be something that’s going to get a lot of debate here, and when it actually goes into effect, I’ll guarantee you we’re going to have some fireworks in Washington,” he said. A recent EBRI survey reveals how much employees value health benefits. Seventy percent of workers rate health coverage as the most important benefit and another 10% rate it as second most important. Of the 60% of workers who report rising health care costs, one-third reduced their retirement plan contributions, which means trading off retirement benefits to maintain health benefits. When considering a specific job, 77% of workers say health benefits are the most important benefit while only 11% say retirement savings plans are most important. Ninety percent of workers are confident that their benefits are less expensive than what they could purchase on their own, and 80% are confident that their employer had picked the best plan for them. Ninety percent are satisfied with their health coverage, and 75% are satisfied with the mix of health coverage and wages. Ninety percent want in more choice in their health plans, which may explain the interest in health care exchanges. EBRI found that 45% of employees prefer something along the lines of a defined contribution health offering. Fronstin added, “It’s going to be interesting to see what happens down the road as workers understand more about the benefits of public exchanges and as employers introduce private exchanges. We’ll see what kind of shift there is and whether it’s employer-driven or worker-driven.” Jennings predicts that many employers will go into private exchanges. The most likely candidates are small businesses, retailers, and employers with part-time, low-income work forces. While many employers are considering private health exchanges, Americans who work for larger employers will probably not see that change immediately, he said. Jennings said, “It’s going to take a few years for all that to shake out. Employers are slow to react…They want to see how the exchanges are operating. They want to see satisfaction rates.” However, Jennings said that employers will have more incentive to look at alternatives if there is a major resurgence in healthcare-cost inflation. Jennings doesn’t anticipate an abrupt reduction in benefits among employers since larger employers are already preparing for the Cadillac tax and high-cost plan assessment. George Washington University professor Joe Antos cited an Aon Hewitt study of workers in its own private exchange, which found that 58% selected a different level of coverage from one year to the next. “What that says is that having somebody else decide what your coverage should be probably isn’t going to suit a lot of people. A private exchange gives people more choices. It’s an opportunity to find out what people really want and not pour more money into something that may not be of such great value.” Antos said that the Affordable Care Act’s (ACA) coverage mandate primarily affects lower-wage workers. Higher-income workers generally work for companies that already offer coverage. Antos said, “If you’re a part-time worker and you’re working 32 hours a week, you might drop to 29 hours because your employer doesn’t want to get caught in all of this. Are you going to be able to make up those hours? Are you going to be able to get another job?” He cited a recent study by the Urban Institute that calls for eliminating the employer mandate since relatively few people will not have insurance. Antos said that it’s highly unlikely that the federal government will enforce the unpopular employer mandate. He also said that a shift to defined contribution health plans is inevitable. For more information, visit The Growing Interest in Private Exchanges Interest in private exchanges has sharply increased as the Affordable Care Act is officially underway, according to a report by the Decision Resources Group. The number of patients in consumer-driven health plans is likely to increase as private exchanges become more prevalent, which could have a negative effect on pharmaceutical sales, especially for branded drugs. Decision Resources Group Analyst, AnnJeanette Colwell said, “Although there has not been mass movement towards these private exchanges, employers are interested in exploring these options. The increased interest in private exchanges provides an opportunity for managed care organizations to gain commercial enrollment, especially if employers begin moving their groups into single carrier exchanges.” She said that when employer groups shift their workers into exchanges and use a defined contribution benefit model, employers will be more cost-conscious. Consumers are less likely to choose plans that significantly exceed their employers’ contributions. They are likely to choose a high-deductible option that has lower monthly premiums. For more information, visit A Preliminary Look At 2015 Individual Rates A picture of the 2015 insurance landscape is beginning to emerge months after the close of the 2014 exchange open enrollment period, according to a report by PWC. Publicly released premium increases across about 29 states and the District of Columbia vary widely, ranging from a low of -23% in Arizona to a high of 50% in Arkansas. The average rate increase across states reporting data is 8.2% while the average monthly premium (without subsidies) is around $385.Year two of the exchanges is expected to see an upswing in participation from several major commercial insurers. The bellwether Blue Cross Blue Shield plans have submitted increase requests across the country typically above 9%. New healthcare CO-OPs, nonprofit insurers created under the ACA, are priced comparably to or lower than competitors in Arizona, Colorado, Connecticut, Kentucky, Maine, Maryland, Nevada, and Tennessee. Arizona’s CO-OP is the lowest-priced plan in the state, with a 23% proposed rate decrease from 2014. Competitive premiums may not always result in higher enrollment as some CO-OPs have found. For more information, visit Federal Drug Discount Program Faces Challenges A federal program that provides billions in drug discounts to safety net hospitals and other health care providers is expanding under health care reform. The 340B program faces a number of critical issues, such as whether to better define eligibility, strengthen compliance efforts, and provide greater transparency about the discounts provided, according to new analysis by the RAND Corporation. The federal Health Resources and Services Administration is developing new regulations to address these and other issues. “Policymakers need a clear, objective description of the 340B program and the challenges it faces on the road ahead. There are increasingly divergent views on the program’s purpose and the role it should play in supporting safety net providers,” said Andrew Mulcahy of RAND. The federal 340B program began in 1992 to help health care providers extend services to the indigent and uninsured. The program allows some hospitals, clinics, and health centers to buy outpatient prescription drugs at discounted prices. The program covers more than 7,800 entities as a result of expanding eligibility rules. Hospitals that participate in the program account for more than one-third of all U.S. outpatient hospital visits. Federal officials estimate that the 340B program accounts for $6 billion in outpatient drug spending, about 2% of all U.S. prescription drug spending in 2011. This translates into savings of $1.6 billion for eligible safety net providers. RAND researchers say that these savings are small compared to the disproportionate share hospital payments and primary health care grants that play a large role in financing care in the safety net. However, some estimates suggest that the size of the program could double under provisions in the federal Affordable Care Act. Formulas used to calculate drug prices are based partly on proprietary information, which can make it difficult for health care providers to know whether they can negotiate a lower price for drugs through another source. For more information, visit Some Medicare Advantage Companies Fail At Customer Service Using government data, HealthPocket analyzed customer service in the call centers of Medicare Advantage companies. Hold times, dropped calls, accuracy of information provided, and customer satisfaction metrics were all included in the analysis of every Medicare Advantage plan that operates in multiple states. HealthPocket found low customer service scores among several large Medicare Advantage companies. While the top five companies are regional brands with lower brand recognition nationally, several of the bottom five companies are popular insurance brands. UnitedHealth Group includes the familiar AARP-branded Medicare Advantage products, and Health Net and WellCare are also Medicare Advantage brands with considerable enrollee populations. More than15% of the Medicare Advantage companies failed to meet the government standards for customer service through a call center. The following companies had the highest customer service scores: 1. HealthPartners 2. Gundersen Lutheran Health System Inc. 3. Cambia Health Solutions 4. Health Plan of the Upper Ohio Valley 5. University of Pittsburgh Medical Center The bottom five companies were: 1. Universal Health Care Group 2. Health Net 3. UnitedHealth Group 4. WellCare Health Plans 5. Munich American Holding Corporation The complete findings and methodology can be reviewed here State Spending on Employees’ Health Insurance Varies Significantly Spending on health insurance for state employees was up slightly in 2013 over the previous two years, with the cost varying widely from state to state, according to a report from the State Health Care Spending Project. Paying for employee health insurance is second only to Medicaid as a portion of states’ health care spending. Monthly premiums averaged $963 per employee, with the state covering 84% of the premium. In California, the average is $1,092 with the state covering 77% of the premium. State plans, using premium contributions from states and employees, paid for 92% of the average enrollee’s health care costs in 2013. To provide some context, these plans would be designated as platinum in the health insurance exchanges.Nineteen states offered employees at least one health plan with an annual deductible of at least $1,500 in 2013, up from 16 states in 2011. Among the 19 states, 7% of state employees enrolled in the high-deductible plans in 2013. Nationwide, 4% of state employees enrolled in such a plan, and 45% enrolled in plans with no deductible. After controlling for plan richness and household size, there is a substantial range in premiums across the states. This suggests that other factors have an important effect on premiums, such as variation in physician treatment approaches, service utilization, and age and health status of employees. For more information, visit Obesity, Language, And Affordability Pose Barriers To Latino Health Latinos face barriers to maintaining their health including affordability, immigration status, and language, according to a study by National Council of La Raza (NCLR). Twenty-five percent of those surveyed had visited an emergency room in the past year — a costly option that cannot replace regular medical visits for people with chronic conditions. Latinos are among the fastest-growing segments of the American population and will represent nearly one-third of U.S. workers by 2050. “Our nation’s ability to meet economic demands is tied to the health of this community. Affordable health insurance and access to high-quality medical care and information is vital,” said Delia Pompa, senior vice president, Programs, NCLR. The following are key findings: • 60% of survey respondents have been diagnosed with a chronic disease. Comorbidities are highly prevalent. • About 75% are overweight/obese. • About one-third had difficulty in getting health information in Spanish, the preferred language among 74% of those surveyed. Focus group participants perceived that the fear of unintended immigration consequences is a deterrent for health care access in their communities. “To take on these critical challenges, we need a major public health initiative that includes using promotores de salud, community health workers, who are trusted sources of information and who provide culturally and linguistically appropriate education,” said Manuela McDonough, Associate Director, Institute for Hispanic Health, NCLR. For more information, visit   IN CALIFORNIA Kaiser Is the Only Exchange Plan to Lower its Rates The Los Angeles times reports that Kaiser is lowering its rates for Obamacare coverage in California by 1.4% next year.California’s health insurance exchange recently announced that premiums were rising 4.2%, on average, statewide for 2015 policies. A new analysis by Citigroup healthcare analyst Carl McDonald offers new details on what consumers can expect by company. Kaiser was among the most expensive health plans in 2014 and staggered to a fourth-place finish in exchange enrollment. Anthem Blue Cross was the leader statewide, followed by Blue Shield of California and Health Net Inc. Kaiser doesn’t seem particularly happy with its exchange market share, as it is the only company reducing exchange premiums in 2015, McDonald told the LA Times. Rates for Anthem Blue Cross, a unit of industry giant WellPoint Inc., are going up 4.6%, on average, according to Citigroup.Blue Shield’s increases are 6% statewide and Health Net is raising premiums by 4.9%. Despite those 2015 rates going in different directions, McDonald and other industry analysts are skeptical that Kaiser will gain much ground on its rivals. Even with the slight decrease, Kaiser’s HMO remains one of the more expensive options. Next year, Health Net’s HMO remains the cheapest coverage on the silver tier in L.A. at $231 a month for a 40-year-old, up $7 from this year’s premium. Those low rates made Health Net the market leader in L.A. with 33% market share, beating out Blue Shield and Anthem. Those three insurers and Kaiser together accounted for 94% of Covered California’s initial enrollment of 1.4 million people under the Affordable Care Act. About 1.2 million actually completed the sign-up process and started paying their premiums, according to state estimates. These rates are still subject to review by regulators before open enrollment for 2015 starts Nov. 15. The changes in premiums for each company also vary by region and the type of health plan. Among the smaller, regional health plans, L.A. Care is boosting its HMO premiums by 11.3%, according to Citigroup research. That’s the biggest percentage change for any insurer in the state. Medi-Cal Is Bracing for an Enrollment Boom By the end of 2015, the Affordable Care Act will add more than two million enrollees to Medi-Cal, according to a report by the California Health Care Foundation. However, Californians are likely to have a hard time getting health care through Medi-Cal unless the number of participating physicians grows or California finds other ways to deliver services. Medi-Cal enrollees face significant challenges due to statewide variations in physician availability. The survey also finds the following: • Their are 35 to 49 Medi-Cal primary care doctors to 100,000 enrollees, which is well short of the 60 to 80 that the federal government says are needed. There are 68 to 102  non-primary physicians Medi-Cal to 100,000 enrollees, which is within the federal estimate of need (85 to 105 per 100,000). • 69% of all physicians have Medi-Cal patients; 77% have Medicare patients; and 92% have privately insured patients. • Physicians in community health centers and public clinics have the highest rate of Medi-Cal participation at 92%, and those in solo practice have the lowest at 54%. To get the report, visit   NEW PRODUCTS Integrated Disability & Absence Management Services Broadspire is adding short-term disability, long-term disability, family medical and state Leave management to its global portfolio of products. The new suite of products will be available in the fourth quarter of 2014. Broadspire is a global third-party administrator of worker’s comp claims, liability claims, medical management services, and risk management information services. For more information, visit Best Practices in RFPs. Visit the following link to get DMEC’s report, “Best Practices in Conducting an RFP and Selecting an Implementing a New Vendor”: Video Highlights the Need for Disability Coverage Heath Care professionals share their experiences in videos from Unum that underscore the benefits of disability coverage and return-to-work programs. For more information, visit Self Funded Solution Collective Health is offering a fully integrated health self-insurance platform to employers of all sizes as a software-as-a-service (SaaS) solution with a flat-fee pricing structure. It includes actuarial analysis, customized health plan design, legal and regulatory compliance, plan funding, claims administration, health provider network access, and real time data analytics in one seamless package. For more information, visit 403(b)(7) Opportunities The new Pacific Life 403(b)(7) program, which is designed for K-12 public school employees, combines investment options offered through Pacific Life Funds and dedicated service from a leading retirement-plan service provider, Aspire. For more information, visit or talk to a Pacific Life consultative wholesaler at 800-722-2333. LIFE SETTLEMENTS “Worthless” Life Policy Brings a Windfall Melville Capital, LLC brokered the sale of a life insurance policy that was initially undisclosed by the debtor and then, once discovered, was thought to be worthless because the policy had zero cash surrender. The Hubert Moore Lumber Company filed for bankruptcy with what appeared to be little if any assets. However, several unscheduled life insurance policies were discovered after a thorough investigation. One policy was sold for $460,000. The trustee was able to liquidate what appeared to be a worthless asset for a very significant amount of money for the benefit of the estate. For more information, visit ... Continue Reading →

Insurance Giants Creating Massive Database of Patient Records

Two of California’s largest health insurers are partnering to create a massive database of patient medical records. With just a few strokes of a keyboard, doctors and nurses will be able to access the medical histories of about one in four California residents. Supporters say the effort by Anthem Blue Cross and Blue Shield of California could mean faster, cheaper and better healthcare. But the system faces significant technological challenges and privacy concerns The benefits could prove useful in emergency rooms, where doctors would be able to review patients’ histories instantly. It’s expected to go online by the end of the year. “We need to bring healthcare into the digital age, and by doing so you can really improve the quality and cost of care,” said Paul Markovich, chief executive of Blue Shield of California according to a recent post in the Los Angeles Times. ... Continue Reading →
CC Cal Broker ad 2

For Many People, Covered California Is Still Open for Enrollment

After months of planning, promotion and outreach, Covered California successfully completed its first open enrollment period of the historic Patient Protection and Affordable Care Act—helping more than a million consumers gain health insurance coverage. Some people, however, may have had a change in life circumstances since open enrollment ended on Mach 31, and suddenly, they have a new need for coverage. If so, the door is not closed. They can still gain coverage through Covered California’s special-enrollment option. “We continue to remind people that we still are open for business,” said Covered California executive director Peter V. Lee in a recent post at CV Independent. ... Continue Reading →

Insurance Insider News
Bundled Payment Experiment Fails
by Leila Morris

      California hospitals faced disappointing results in a recent experiment with bundled payments. Researchers at Rand evaluated a pilot program, coordinated by the Integrated Healthcare Association, to adopt bundled payments for orthopedic procedures among commercially insured people under 65. The three-year study began in 2010. Under bundled payments, doctors, hospitals, and other health providers share a fixed payment, which covers the average cost of a bundle of services, such as all aspects of caring for a person undergoing a hip replacement. At the outset, participants included six of the state’s largest health plans, eight hospitals, and an independent practice physicians’ association. Two insurers dropped out, saying that the bundled payment model would not lead to a redesign of care or lower costs. Another said that bundled payment was incompatible with its primary business – HMOs that use capitation payments. Just two hospitals signed contracts with health plans to use bundled payments. However, two ambulatory surgery centers signed contracts with one health plan. The project was hurt by delays in regulatory approval of contracts and a lack of consensus on the types of cases and services to include. Most stakeholders agreed that the bundle definitions were probably too narrow to capture enough procedures to make bundled payment viable. The project had such a low volume of cases that there was not enough information to draw conclusions about how bundled payments affect health care quality or costs, according to researchers. Susan Ridgely of Rand said, “Despite the many challenges, participants continue to be interested in making bundled payments work.” For more information, visit Covered California Expects Low Rate Increases The vast majority of Covered California consumers will see low increases in their health insurance premiums for 2015, and many consumers will see no increase or even a decrease. The average premium for health plans offered on the exchange will increase an average of 4.2% for the coming year. Executive Director Peter V. Lee said that Covered California’s role as an active purchaser brought in low rate increases while maintaining high quality. Additionally, 90% of enrollees get federal subsidies. In most areas of the state, the subsidy will increase or remain very close to 2014 amounts. For many consumers, any premium increase will be offset by an increase in subsidy. All 10 insurance companies that were in the exchange for 2014 submitted bids to return for 2015. The following portfolio reflects a wide mix of large nonprofit and commercial leaders in the individual health insurance market: • Anthem Blue Cross of California. • Blue Shield of California. • Chinese Community Health Plan. • Health Net. • Kaiser Permanente. • L.A. Care Health Plan. • Molina Healthcare. • Sharp Health Plan. • Valley Health Plan. • Western Health Advantage. In response to customer feedback, some health insurance plans will offer expanded provider networks. For more information, visit Insurers Spend Big on Anti-Prop 45 Campaign Six health insurance companies have donated $37.3 million, through June 30, to fight Proposition 45. The ballot measure would require health insurance companies to get permission before raising rates, as is the rule in 35 other states. Prop 45 would also give the insurance commissioner the right to prevent health insurance companies from passing on lobbying costs, civil fines, bad faith judgments, campaign contributions, or excessive executive compensation. Top contributors were the three health insurance companies controlling 75% of the private insurance market in California. Kaiser gave $14.3 million; WellPoint gave $12.5 million; and Blue Shield gave $9.5 million, according to a report by Consumer Watchdog. The No on 45 campaign has hired consultant Rick Claussen, creator of the 1994 Harry and Louise advertising campaign against federal health care reform. The $37 million advertising campaign is set to begin as early as mid August according to media buyers. Annuity Agent Arrested John Paul Lewinski, 59, was arrested at his home in Palm Desert on July 29. Lewinski is charged with five felony counts of financial elder abuse and five counts of burglary for allegedly ripping off five senior citizens for more than $2 million through the sale and surrender of investment annuity products. Bail is set at $2 million. Investigators allege that Lewinski, a licensed insurance agent, convinced some victims to surrender annuities and investment products with the promise of higher returns through new investments. He allegedly conned other victims into giving him money to invest for them. Lewinski did not purchase annuities or investment products or refund the victims’ money. Lewinski allegedly gave victims fraudulent financial statements and minimum investment payments to trick them into believing that their insurance investment and life savings were secure. The Department of Insurance encourages anyone who has done business with Lewinski and/or JPS Insurance Services to contact the Rancho Cucamonga Regional Office at 909-919-2200. FINANCIAL PLANNING A Look At Matching Contributions A survey by TIAA-CREF shows that 78% of Americans who contribute to an employer-sponsored retirement plan get matching contributions from their employer, and 77% of those who have matching contributions save enough to get the full employer match. However, only 72% of women contribute enough to get the full employer match, compared to 82% of men. Only 64% of those earning less than $35,000 a year get the full match. Forty percent of employees who are not contributing enough to get the maximum matching funds get reminders to do so and are happy to get them. An additional 32% do not get reminders from their employer, but wish they did. Teresa Hassara, executive vice president of TIAA-CREF’s Institutional Business said, “An employer match is a very compelling factor in determining whether employees contribute to a defined-contribution retirement plan but just offering it is not enough. Plan sponsors must ensure they are communicating the benefits of the match to employees, particularly those who are not currently reaching the full match. Their communications should be targeted to various groups’ unique financial needs.” For low earners, plan sponsors can explain the benefits of saving for retirement and position the matching contribution as part of a larger focus on long-term financial well-being. For women, more information about the match may be effective: Of those not receiving the full match, 17% of women (compared to 10% of men) said that more information about how the match works would make them consider increasing contributions. For more information, visit HEALTHCARE Consumers Who Don’t Get Subsidies Pay Substantially More Health insurance consumers without subsidies who shopped through eHealth paid average premiums of $189 a month or $2,268 a year. Those without subsidies are also more likely to chose lower-tier plans, resulting in deductibles that may be over $4,000 a year. Carrie McLean, eHealth director of Customer Care said, “As many as 40% of Americans shopping for coverage on their own will not be eligible for government subsidies. And if you do get a subsidy, unexpected increases in your household income or court challenges to the Affordable Care Act may still call your subsidy dollars into question. Without subsidies, the…cost of health insurance could increase substantially for many Americans.” eHealth used health plan selection and cost data from its May 2014 Health Insurance Price Index report. The study found the following: • The average premium for an individual plan, across all metal levels, was $346 a month before subsidies were applied and $82 a month after subsidies were applied. • The average premium for an individual plan was $271 a month across all metal levels. • Individual consumers with bronze plans paid an average of $68 (after subsidies) toward their monthly premiums; those with silver plans paid an average of $69; those with gold plans paid an average of $208; and those with platinum plans paid an average of $220. • Individual consumers with bronze plans paid an average of $259 toward their monthly premiums; those with silver plans paid an average of $328; those with gold plans paid and average of $353; and those with platinum plans paid an average of $411. • Sixty-nine percent of individual consumers chose plans with premiums of $100 or less a month after subsidies were applied. Forty-six percent had premiums of $50 or less. • Sixty-one percent of individual consumers chose health insurance plans with monthly premiums of $200 or more. For more information, visit The ACA Boosts Mental Health Services After implementation of the ACA, mental health treatment increased 5% for 18- to 25-year olds who have possible mental health disorders  The study, published in Health Affairs, found smaller, but consistent, effects among all young adults, not only those with possible illnesses. For people getting mental health treatment, uninsured visits declined 12%, and visits paid by private insurance increased 13%. For more information, visit Spending on Mental Health and Substance Abuse Grows Slower Spending on mental and substance use disorders is likely to grow at a slower pace than all health spending through 2020, according to a study by Truven Health. Spending will fall from 7.4% in to 6.5% in 2020. The study was published in the August journal Health Affairs. A major factor contributing to slower growth is that several major mental health medications are set to expire. Prescription medications accounted for 28% of  mental health spending compared to 11% of all health care spending in 2009. Also, spending for mental health treatment in state-operated psychiatric hospitals has slowed as a result of the recession and a slow economic recovery. “That growth in behavioral health expenditures is projected to slow relative to overall health spending even as recent health reform and parity legislation helps to increase behavioral health coverage and access is good news for consumers and their families,” said Tami Mark, lead author from Truven Health Analytics. For more information, visit Americans Are Worried That the Exchanges Will Fail Fifty-six percent of Americans are not confident that the health exchanges will operate smoothly during this fall’s open enrollment, according to a report. Fewer than two in five people are confident in the technical capabilities of the exchanges. Americans fear much higher prices for health plans during the upcoming enrollment season; 46% say this could be a major problem. Only one in 12 Americans report lower monthly health care spending compared to a year ago while almost half report higher spending. Thirty-seven percent of Americans say they are more negative about the Affordable Care Act’s effect on their own health care than they were a year ago while only 16% are more positive. The negative sentiment is up 9% from August 2013. insurance analyst Doug Whiteman said, “The Obama Administration is still having trouble getting Americans to believe in affordable health care, despite the Department of Health and Human Services’ recent report that nearly half the people buying subsidized plans on are paying $50 a month or less for their health plans.” For more information, visit MERGERS AND ACQUISITIONS Guardian Acquires Premier Access Guardian Life acquired Sacramento-based Premier Access Insurance Company. The dental coverage provider serves more than 5,000 employers and 630,000 members. The addition of Premier Access strengthens Guardian’s Dental PPO and HMO networks in several states including California, Utah, and Nevada. It also extends Guardian’s reach in state-run Medicaid and Children’s Health Insurance Program (CHIP) markets, which are expected to grow significantly due to expanded eligibility under the Affordable Care Act (ACA). Guardian will also gain a presence on six state exchanges, complementing its existing offering on 48 of the small business health (SHOP) exchanges. For more information, visit Agency Mergers and Acquisitions Rise 40% In the first six months of 2014, 165 insurance agency mergers and acquisitions were announced in the U.S. and Canada , according to a survey by OPTIS Partners. That’s a nearly 40% jump over the same period in 2013 and the most active first half since the firm began tracking transactions in 2008. It’s also the second most-active six-month period OPTIS has ever recorded. The report covers property/casualty agencies, agencies selling P/C and employee benefits, and employee benefit agencies. Private-equity-backed firms accounted for 67 agency purchases; privately owned brokers accounted for 54; publicly held brokers accounted for 27; banks accounted for nine; and insurance companies/others accounted for eight. Timothy Cunningham, managing director of OPTIS said, “We predict there will be robust M&A activity…as more agencies owned by retiring Baby Boomers…go to market. It looks like the first half of 2014 is the start of a prolonged active period for agent-broker M&A transactions. The agency-brokerage business is awash with Baby Boomer principals. It’s estimated that they own more than 30% of all the equity in the system. The industry has not adequately addressed perpetuation/succession planning. Without a sound perpetuation plan in place, the only option for many of aging principals will be to sell to a third party — often PE-backed and public brokers.” The full report is online at NEW PRODUCTS Wellness App HumanaVitality released its first mobile application, providing a new wellness tool to members using smartphones to manage their health and fitness progress. With the easy-to-use custom dashboard, members with employer-sponsored insurance plans can create and track personal wellness goals and milestones. For more information, visit EyeMed Vision Care Contact Center Gets Accolades For the fifth consecutive year, BenchmarkPortal named the EyeMed Vision Care Contact Center a Center of Excellence. The evaluation takes into account factors such as first call resolution, the cost a call, call waiting time, customer satisfaction, agent satisfaction, and utilization of human resources. For more information, visit Dental Discount Plan DentalPlans added the CVS iSave plan, which offers discounts on the MinuteClinic, vision, pharmacy, fitness facility memberships, hearing, chiropractic and alternative medicine, prepaid diagnostic imaging, prepaid lab, a 24-hour nurse hotline, and more. For more information, visit HR Tool Suite SuiteHR launched a payroll, HR, and benefit technology solution for small to mid-sized employers. It offers employers a single technology platform and services delivered through local employee benefit brokerage firms and HR consulting firms throughout the U.S. For more information, e-mail EVENTS Medicare Supplement Insurance Virtual Conference Four leading insurers have signed on as platinum sponsors for a virtual insurance conference broadcast from the 2015 Medicare Supplement Insurance Summit. The program will take place April 14 as part of the national Med Supp industry conference in Orlando. Only the special sessions for agents and brokers will be streamed live online. United HealthCare, Mutual of Omaha, Aetna, and Medico Insurance have agreed to underwrite the cost of broadcasting the sessions. For more information, visit ... Continue Reading →
Older Couple Walking Along Beach

New Annuity Disclosure Requirements
by Leila Morris

Governor Brown signed into law AB 2347 (Gonzalez), which extends important consumer protection on annuity products that are commonly marketed to seniors. The new law requires disclosure language on the front of the policy jacket or on the coversheet for an immediate annuity. This disclosure is already required for the more common deferred annuity products. Those getting immediate annuities are guaranteed a 30-day free look period. Don Goldmann Named President-Elect of NAHU The Word & Brown Companies’ Don Goldmann was named president-elect of the National Association of Health Underwriters (NAHU) at the insurance trade association’s recent 84th Annual Convention in Scottsdale, Ariz. A vice president at Word & Brown since 2006, Goldman has served on the NAHU Financial Committee five times. He helped write five annual budgets and was deeply involved in debates about issues facing NAHU members. As secretary of the organization, Goldmann oversaw the review of 34 important sun-setting policies and procedures.  “Don is a frequent contributor to national, state, and local journals for the health industry, CPA and financial planner societies, and employee benefit associations, as well as being a highly sought-after speaker at conferences,” said Edward J. “Rusty” Brown, Jr., co-founder of The Word & Brown Companies. CDI Imposes Record Penalties Against United California Department of Insurance (DOI) Commissioner Dave Jones issued more than $173 million in penalties of against United Healthcare for violating the insurance code from 2005 to 2008. It’s the largest administrative penalty ever assessed against a California health insurer or plan. Jones says that the fine is warranted because no other insurer has violated the insurance laws hundreds of thousands of times. And no other insurer has repeatedly misrepresented its business practices, failed to correct the root causes of its violations, or ignored its statutory obligations to the extent found in the case. The administrative proceeding arises from problems that surfaced after United Healthcare’s acquisition of PacifiCare in 2005. Shortly after the transaction, the California Medical Association (CMA) saw a spike in complaints from its  members about the way PacifiCare was processing claims and contracts. After conducting its own investigation, the DOI filed an administrative proceeding against United Healthcare, charging PacifiCare with violations that included the following: ● Failing to give providers notice of their appeal rights and members notice of their right to an independent medical review. | ● Failing to pay claims and interest on late-paid claims in a correct and timely manner. ● Failing to acknowledge receipt of claims. ● Failing to respond to provider disputes in a timely manner. ● Closing claims files illegally ● Sending untimely collection notices for overpayment. Commissioner Jones sustained the findings of the administrative judge that PacifiCare committed over than 900,000 violations of the law. United Healthcare has appealed Jones’ decision to a California superior court. HEALTHCARE HHS Says That MLR Rules Have Saved Consumers $9 billion on Premiums HHS secretary Sylvia M. Burwell announced that consumers have saved $9 billion on their health insurance premiums since 2011 as a result of the Affordable Care Act. The Medical Loss Ratio (MLR) rule requires insurers to spend at least 80% of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers. The report shows that, since the rule took effect, more insurers year over year are meeting the 80/20 standard by spending more of the premium dollars they collect on patient care and quality, and not red tape and bonuses. For more information, visit Bill Would Eliminate Congressional Health Insurance Subsidy Representative John Barrow (GA-12) is leading an effort in the House with Congressman Dan Maffei (NY-24) to eliminate the health insurance subsidy available to members of Congress. The legislation would do the following: ● Prohibit Members of Congress from receiving a taxpayer-funded subsidy to pay forhealth insurance if that Member served on or after the day the Affordable Care Act was signed into law. ● Require that if a member of Congress purchases health care through the exchange set up by the Affordable Care Act, they must purchase through their home state’s exchange. ● Apply these changes to members of the House and Senate. How CDHPs Save Money People who are enrolled in consumer-directed health plans (CDHPs) utilize health care services more efficiently, long after switching from their traditional insurance plans, according to a study by Health Care Service Corporation (HCSC), operator of the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. The study, which tracked more than 316,000 Blue Cross and Blue Shield members, found that those migrating to a CDHP plan saw cost savings in the first year and continued to experience even lower health costs years later. This study measured and tracked the claims experience of members previously enrolled in traditional plans who switched to a CDHP. CDHP members increasingly use generic prescriptions. BlueEdge CDHP members saw a three-year average reduction in the following: ● Medical expenses fell 11.8% ● Overall spending, combined medical and pharmacy costs fell 10.5% ● Inpatient care costs fell 23.5% ● Outpatient care costs fell 5.1% ● Professional services costs fell 14% For more information, visit An Encouraging Report on Medicare Solvency The trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report, according the The Medicare Trustees. The improved outlook is due, in part, to cost controls implemented in the Affordable Care Act. Per capita spending is projected to continue to grow slower than the economy for the next several years. There was lower-than-expected spending in 2013 and lower projected utilization in the types of health care needed by Medicare patients. Medicare spending, per beneficiary, has grown quite slowly over the past few years and is projected to continue to grow slowly over the next several years. During the past four years, per capita Medicare spending growth has averaged 0.8% annually. That is a much slower growth rate than the average 3.1% annual increase in per capita GDP and national health expenditures. The report is available at: Reporting Medicare Fraud Can Pay Off The Corporate Whistleblower Center is urging home health care industry managers or executives to call them anytime at 866-714-6466 if they have proof a home healthcare company is overbilling Medicare. In a recent example of fraud, Amedisys and its affiliates agreed to pay $150 million to the federal government to resolve allegations that they submitted false home healthcare billings to the Medicare program. Amedisys allegedly billed Medicare for nursing and therapy services that were medically unnecessary or provided to patients who were not homebound, and otherwise misrepresented patients’ conditions to increase its Medicare payments. In this instance, the whistleblowers will split over $26 million. For more information, visit http://CorporateWhistleblowerCenter.Com How HSAs Could Beat 401(k)s For Savings For some employees, using an HSA for health care expenses in retirement may be better than saving in a 401(k) plan, according to a report by the Employee Benefit Research Institute (EBRI). Contributions to an HSA reduce taxable income; earnings on the assets in the HSA build up tax free; and distributions from the HSA for qualified expenses are not subject to taxation. “Depending on the rate of return in an HSA, these accounts could generate significant assets,” said Paul Fronstin of EBRI. If you contribute the maximum allowable amounts for 40 years to an HSA without making withdrawals, you could accumulate up to $360,000 if the rate of return is 2.5%, $600,000 if the rate of return is 5%, and nearly $1.1 million if the rate of return is 7.5%. However, he added that many people aren’t able to save in an HSA and pay their out-of-pocket health care expenses. Also, HSA balances may not be enough to pay all medical expenses in retirement even if maximum contributions are made for 40 years. For more information, visit   EMPLOYEE BENEFITS Dental Coverage Rate Is Increasing for Young Adults Some young adults are enjoying extended dental coverage under their parents’ health care policies, according to a study by the American Dental Assn. The ACA increased access to dental care for young adults ages 19 to 25 by 6.9%. Utilization of dental services had also increased 3.3%. This is a significant increase since the pre-reform coverage rate for this group was 38%. Although the Affordable Care Act (ACA) allows parents to keep their children on their medical plans up to age 26, there is no similar requirement for dental coverage. However, some employers are expanding dental coverage voluntarily along with expanded medical coverage.For more information, visit A Snapshot of Employee Benefits in the U.S. In March 2014, 86% of full-time private industry workers in the United States had employer-provided medical care, according to a report by the Bureau of Labor Statistics. In contrast, only 23% of part-time workers had medical care benefits. Access also varied by establishment size: 57% for workers in small establishments (fewer than 100 employees) compared to 84% in medium and large establishments (100 employees or more). Seventy-four percent of full-time workers had access to a retirement plan compared to 37% of part-time workers. Retirement benefits were available to 50% of workers in small establishments and 82% of workers in medium and large establishments. Private industry employers paid 70% of the single coverage medical plan premium for employees in the lowest 10% of average earnings and 81% for employees in the highest 10% of average earnings. For family coverage, the employer share of the premium was 57% for employees in the lowest 10% of earnings and 72% for employees in the highest 10% of earnings. In private industry, 72% of full-time workers had access to life insurance benefits. In local government, 90% of full-time workers and 22% of part-time workers had access. Most workers who had access participated in life insurance benefits. For more information visit Majority of Workers Feel Responsible To Save for Their Retirement Seventy-eight percent of workers say it’s their responsibility to save for their retirement. Also, 84% of defined contribution plan participants say it’s their responsibility to save for their retirement, according to a LIMRA survey. The survey also found the following: 77% say that all workers should have access to a retirement savings plan at work and that these plans offer an effective way to save for retirement. 60% say that those who save in a defined contribution retirement plan are likely to achieve a secure retirement. 85% of defined contribution plan participants say these plans provide an effective way to save for retirement. Thirty percent say that their defined contribution plan savings will represent the primary source of retirement income. 50%  of defined contribution plan participants and nearly 40% of plan participants under 45 say that savings in their defined contribution plans will be their primary source of retirement income. 45% of workers who participate in their defined contribution retirement plan are more confident that they will realize their chosen retirement lifestyle compared to 32% of non-participating workers. NEW PRODUCTS Private Exchange Platform Maxwell Health released an operating system for employee benefits. It can support a wide variety of product and service integrations, including all health, dental, vision, life, disability, and other insurance offerings. The mobile-enabled platform provides a central place to access health and benefit services. Employers can access data from those services to provide more informed health solutions. For more information, call 860-716-9475 or visit Simplified Enrollment Assurant Employee Benefits is offering a suite of services and tools to ease the pain of annual enrollment. Assurant Works includes professional benefit communication and enrollment and electronic data exchange capabilities. Now employees can easily choose from dental, vision, disability coverage, cancer, and critical illness insurance. For more information visit Variable Annuities Securian Financial Group introduced higher single and joint withdrawal rates for MyPath optional living benefits on MultiOption variable annuities issued by Minnesota Life. Annuity owners can withdraw a higher percentage of their annuity assets than when the products were introduced. Single and joint withdrawal rates increased by the following amounts for applications signed on or after July 21: ● .10% on all MyPath benefits (single life) ● .25% for MyPath Ascend and MyPath Summit (joint life) ● .35% for MyPath Core Flex and MyPath Value (joint life) For more information, visit www. Vision App EyeMed Vision Care launched a mobile member app that makes it easy for plan members to access vision plan information and get a digital copy of their member ID card or locate network eye care providers using an iPhone or iPad. Enrollment Options Transamerica’s TransApp enrollment system now offers complete integration with PlanSource. Using a streamlined enrollment process, employers can offer insurance products from Transamerica Life Insurance Company and its affiliates including hospital indemnity, short-term disability, cancer, critical illness, accident, universal life, interest-sensitive whole life, and term life. For more information, visit or ... Continue Reading →

10 Million Americans Sought Help to Enroll in Obamacare

While the complexities of health insurance may have boosted sales for some brokers, many got out of the business last year figuring they won’t be able to compete with  Unlike the advent of consumer-friendly shopping sites like Amazon or the myriad airline ticket sites, uninsured people didn’t cut out the middle man when looking for health coverage because they needed help figuring out what plan was best for them, brokers said.“It’s hard to believe that I sold more insurance in six months than I did in five years,” said Insurance Agent Bob Nelson, referring to the October-March open enrollment period on, according to a recent story at ... Continue Reading →

Employees Unhappy with Benefits and Employers

When asked how they like their benefits, employees gave the lowest rating in six years, according to a survey from Unum. Only 47% say their benefits are excellent or very good. Only 33% say that the benefit education their employer provides is excellent or very good, and 28% say their benefit education is fair or poor. This is a reversal to the upward trend in ratings since 2009. Only 49% say their workplace is excellent or very good. Seventy-seven percent of workers who say their benefit package is excellent or very good also say the same of their employer. In contrast, only 17% of employees who say their benefit package is fair or poor also say that their workplace is excellent or very good. And 79% who say their employer’s benefit education is excellent or very good say the same of  their employer — compared to only 30% of those who say their benefit education is fair or poor. Bill Dalicandro, vice president of the consumer solutions group at Unum said, “This research underscores the value of an effective benefit education plan because when an employee understands their benefits, they tend to value them more and…may value their employers more for providing access to them.” For more information, visit Voluntary Sales by Employer Size A survey by the Eastbridge Consulting finds that employers with over 2,500 employees accounted for the largest volume of voluntary sales again last year. This segment accounted for 36% of all voluntary sales, up from 33% in 2012. The following are voluntary sales broken by employer size: • Less than 10 employees 4% • 10 to 25 employees 7% • 26 to 99 employees 12% • 100 to 499 employees 17% • 500 to 999 employees 11% • 1,000 to 2,500 employees 13% • Less than 2,500 employees 36% Gil Lowerre, president, Eastbridge, said, “For 2013, the 500 to 999 segment continues to have the highest sales, followed closely by the 1,000 to 2,500 segment, indicating both have good penetration. The least penetrated segments are the two smallest ones — under 10 lives and 10 to 25 lives. “This comes as no surprise since many carriers and brokers do not write in these smaller segments. However, it is interesting that the 2,500 or more employee segment had the third lowest [sales]. This segment is obviously still under-penetrated despite having the highest sales,” said Bonnie Brazzell, Eastbridge vice president. For more information, visit 401(K) Plans Put Retirement Readiness Within Reach Americans who have access to 401(k) plans can achieve a more secure retirement if they start early and save consistently, according to new research sponsored by Prudential Financial. “This latest research shows if saving starts earlier and retirement occurs a few years later, the required savings rate becomes even more achievable,” says George Castineiras, senior vice president, Total Retirement Solutions at Prudential Retirement and one of the authors of the Prudential paper. For people with a workplace-based retirement plan an average of 35% of their retirement income should come from a 401(k) or other retirement savings plan. And the average required savings rate to achieve that level of targeted income is 14% — if savings starts at age 35 and retirement occurs at age 65. “What’s particularly compelling is that this research helps to highlight the strength of the existing retirement system. Modern plan design allows individuals to get tax-advantaged savings and the ease of payroll deduction as well as investment education, advice and institutionally priced products,” said James McInnes, senior vice president of product management and development at Prudential Retirement, the paper’s co-author.  The research finds that the required savings rate for an average wage earner in a single income household drops from 15% to 10% if the individual starts saving at age 25, instead of age 35. When the target retirement age is changed to age 67 — the retirement age of Social Security for those born after 1959 — the average required savings rate (starting at age 35) is lowered from 15% to 12%. When the retirement age is further delayed to age 70, the average rate drops to 6%. If savings start at age 25 and retirement occurs at age 70, the required savings rate drops to 4%. For more information, visit ANNUITIES New Regulations Boost Annuities The Treasury Dept. has enacted new rules allowing employees to convert a portion of their IRA or 401k retirement funds into a qualifying deferred income annuity. The value of longevity annuities can now be excluded from calculations of required minimum distributions. Ken Nuss, founder of AnnuityAdvantage, sees this as an opportunity for near-retirees to hedge against the possibility of outliving their retirement savings. As the name implies, deferred income annuity payouts begin at a later date — at age 80 or 85. Deferred income annuities function much like an individual pension plan, creating a lifelong and predictable income stream. The final rules allow for a return of premium option for heirs. Since insurance companies introduced these annuity products three years ago, growth has been strong. For more information, visit or call 1-800-239-0356. Americans Are Interested in Annuities Seventy-one percent of Americans would consider buying an annuity to meet a variety of needs, including having predictable monthly income, being able to provide an inheritance, meeting chronic care expenses, and achieving asset accumulation. However, 53% are not familiar with annuities, and only 20% plan to use an annuity to convert their retirement savings into an income stream, according to a survey by the Phoenix Companies. “The majority of Americans don’t have a deep understanding of today’s annuities. They don’t necessarily understand the basic income protection traditionally offered on all annuities; and they are not aware of the range of benefits available on newer products, such as accumulation and chronic care features. At the same time, when these newer types of features are described, a lot of people say they would consider buying the product,” said Mark Fitzgerald, national sales manager for Saybrus Partners, Phoenix’s distribution subsidiary. Consumers would purchase an annuity to get these benefits: • 49% having predictable monthly income in retirement. • 41% being able leave money for a spouse or heirs. • 36% having money for chronic healthcare expenses. • 31% having asset accumulation opportunities. For more information, visit IN CALIFORNIA Burnham Benefits Hires Senior Account Exec Burnham Benefits Insurance Services hired Helen Vits as a senior account executive. Vits’ career in employee benefits first began at Baker, Thomsen Associates, where she climbed the ranks and remained with the firm as it was acquired by Brown & Brown and exhibited adaptability to the changing tides of the industry. In addition to consultation, Vits launched and led a webinar series at Brown & Brown, managed partner relationships, served as a technical lead and pursued new business opportunities. For more information, visit EPIC purchases Jenkins Insurance Services The shareholders of Jenkins Insurance Services (Jenkins), a Leavitt Group agency, have sold 100% of their shares in Jenkins to Edgewood Partners Insurance Center (EPIC). Jenkins, which has offices in Concord, Sacramento, San Jose, Orange County, and in Reno, Nevada, employs 160 and has about $34 million in annual revenue. While the terms of the deal were not disclosed, Jenkins shareholders Curt Perata, John Connell, and Mark Karpenko became shareholders of EPIC. Leavitt Group Enterprises, the Leavitt Group’s parent company, received cash for its majority ownership in Jenkins. Eric Leavitt, the Leavitt Group’s CEO said, “EPIC’s offer made all four Jenkins shareholders interested in doing a transaction we did not anticipate or previously desire. The deal was compelling and will open new vistas for all four Jenkins shareholders. We are in a very unique time in the market cycle and we expect this transaction, as it pertains to the Leavitt Group, to be just that — unique. The Leavitt Group has been built through acquiring, forming, and fostering independent insurance agencies. We remain committed to this course. However, in this instance, it just made good sense to sell.” For more information, visit HEALTHCARE HSAs Provide Financial Flexibility Fifty-two percent of HSA account holders spent more than 80% of their HSA funds for health care expenses during 2012, according to a survey by America’s Health Insurance Plans (AHIP) and the American Bankers Assn. Since Congress authorized HSA plans in 2004, AHIP has conducted three surveys on HSA banking activity. This latest report measuring the financial activity of more than 1.4 million HSAs, shows consumers taking an active role in managing their health care dollars. Fifty-five percent of HSAs received personal contributions during 2012. While end of the year account balances varied, roughly 80% of accounts had a positive balance that could be carried over to the next year to help pay for future expenses. Fifty-eight percent of accounts had withdrawals during the year. Of those accounts, the average withdrawal during 2012 was $2,081. For more information, visit Latinos Benefitted Most from In-Person Enrollment Assistance During the first open enrollment period for plans under the Affordable Care Act, Latinos benefitted most from free in-person enrollment assistance, according to a survey by PerryUndem, a health care research firm. Thirty-four percent used enrollment experts compared to 12% of non-Latino whites. Seventy percent of Latino enrollees plan to get a check-up in the next few months thanks to their new health plans compared to only half of non-Latino whites. The survey found the following about Latino consumers who remained uninsured: • 41% thought they could not afford health insurance. • 26% thought that they would not be eligible. • 78% did not know about financial assistance or subsidies, underscoring the need for continued education in this community. • 66% did not know that free in-person enrollment assistance is available. • 66% did not know that they could not be denied because of a pre-existing condition. • 20% found the enrollment process to be confusing compared to 9% of non-Latino whites. For more information, visit Appeals Court “Cuts the Heart Out of the ACA” In the case, Halbig v. Burwell, The U.S. Court of Appeals for the District of Columbia Circuit ruled that the Affordable Care Act’s (ACA) tax credits are only available to persons in state-run marketplaces. Elizabeth Taylor, executive director of The National Health Law Program (NHeLP) said, “Today’s ruling is misguided and, if not corrected, will cut the heart out of the ACA. Only 14 states established their own Marketplace.” As noted in the amicus brief filed by AARP Foundation Litigation and NHeLP, tax credits are crucial to achieving the law’s mission of providing near universal health care coverage. According to analysis by the Urban Institute, 7.3 million people could lose their subsidies. Jane Perkins, NHeLP legal director said, “If today’s decision stands…older adults, the chronically ill, and those with low to moderate incomes would feel the brunt. Without the financial help required by the ACA, quality coverage will be out of reach. These Americans will be too poor for private coverage, but not eligible for public programs — the very situation the ACA was designed to avoid.” The ruling does not immediately affect the availability of financial assistance in the federal Marketplace. The government is likely to petition the appeals court for review by the full 11 judge panel. More Patients Are Visiting Retail Clinics Retail clinics are playing a growing role in health care delivery, according to a study from Walgreens. Patients are relying more on nurse practitioners at retail clinics to provide chronic and preventive health services. The study also reveals marked increases in the number of patients who are making return visits to clinics. Visits to healthcare clinics for preventive services, screening, and chronic care increased from 4% in 2007 to 17% in 2013. The annual percentage of return patient visits to Healthcare Clinic climbed from 15% in 2007 to more than 50% in 2012 and 2013. For patients age 17 and under, visits for preventive services and vaccinations increased 180% For patients ages 18 to 64, visits for health testing increased 90% while preventive health service visits increased 66%. Acute visits increased 84% for patients 65 and older. The Convenient Care Association estimates that 33% of Americans live within 10 minutes of a retail healthcare clinic. Walgreens has increased the variety of services at select Walgreens clinics from providing vaccinations to diagnosing and treating a number of chronic conditions. Clinics at select locations are open seven days a week, with extended evening and weekend hours, and offer walk-in service. Healthcare Clinics accept most major insurance plans and Medicare and Medicaid, and offer affordable, transparent pricing for those without insurance coverage. Healthcare Clinic’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90%. For more information, visit Most Medicare Beneficiaries Have Modest Means A small share of the 52.4 million elderly and people with disabilities on Medicare have relatively high incomes, but most are of modest means, according to a survey by the Kaiser Family Foundation. Half live on less than $23,500 last year. Although the majority of beneficiaries have some savings, the value of their assets varies dramatically, and is much lower for black and Hispanics, widows, younger Medicare beneficiaries with disabilities, and seniors over 85. For more information, visit NEW PRODUCTS Retirement Plan Monitoring Tools The companies of OneAmerica introduced OneCheck, a set of plan health monitoring tools and reports for participants and sponsors. OneCheck analyzes an employee group’s average income replacement ratio. This can help indicate how successful the plan is and whether employees are on track for adequate retirement savings. For more information, visit FSRI Designation The LOMA Secure Retirement Institute launched the third course of the Fellow, Secure Retirement Institute (FSRI) designation program, Planning for a Secure Retirement (SRI 131). For more information, visit About LIMRA LOMA Secure Retirement Institute Affordable Long Term Care Insurance Genworth introduced affordable long-term care insurance that addresses the primary barriers to purchasing long term care insurance – price and complexity. The FlexFit Premium package starts at $1,000 annually. The FlexFit Coverage package starts at $100,000 of initial coverage to protect a certain amount of income and/or assets. Both packages include the following: • 3% compound inflation to protect against rising costs of long term care services. • First day home care so you don’t have to satisfy a waiting period for care received in your home (90 day waiting period for covered facility care). • Privileged Care Coordination services with a registered nurse who can help the insured find appropriate care services from local home care agencies. • Caregiver support services offering information and referral services available to non-insured immediate family members For more information, visit INSURANCE SALES Many Americans Say They Don’t Have the Right Level of Insurance A survey by PolicyGenius reveals that 50% of Americans say don’t have the right level of insurance. The survey also reveals the following: • Women are less comfortable than men about their protection against financial risks, with 41% of women not too confident and 61% of men pretty confident. • Most respondents take an online, DIY approach to getting their insurance questions answered and associate a negative shopping experience to feeling underinsured. • Fifty-nine percent conduct online research as their first step when shopping for insurance • Forty-eight percent who say they have less insurance than they need also said that their latest experience dealing with insurance was negative. • 25- to 34 year olds are the least confident in their insurance decisions (54% said too much or not enough insurance. The group is six times more likely to turn to online sources for insurance information than consulting family or friends For more information, visit     ... Continue Reading →

Health Carriers Thriving Under Stress

The health insurance industry has been going through a number of challenges including legislative and regulatory reform, demands from more price- and service-conscious consumers, fierce competition, shift of customer mix, and uncertain economic conditions in the United Stats and abroad. Yet the industry is thriving under stress, according to a report by Zacks Investment Research. Big players, such as CIGNA, WellPoint, Humana, UnitedHealth, Molina Healthcare and others, have reported unfaltering growth in premium as well as fees and other income over the years. In the first quarter of 2014, these insurers had a combined 14% increase in revenues. So far, the carriers have handled some of the less onerous provisions of health care reform fairly well including MLR requirements, a ban on denial of coverage due to pre-existing ailments, dependent coverage up to the age of 26, and the annual rate review. The question is how provisions of the law will affect the industry, such as those relating to insurance exchanges, the individual mandate, ICD-10 requirements, pre-existing conditions, Medicaid expansion, and an annual insurance industry assessment of $8 billion for 2014 with increasing annual amounts thereafter. Investor sentiment toward the reform this year and beyond will be the driving factor for managed care stocks. Several health reform provisions are likely to increase insurers’ medical costs, such as the excise tax on medical devices, annual fees on prescription drug manufacturers, enhanced coverage requirements, and the prohibition of pre-existing condition exclusions. Also, the annual insurance industry assessment will increase insurers’ operating costs. Confined to national boundaries until recently, the industry is flocking to international markets with fewer regulations, higher margins, greater demand, and lower competition. With a wide overseas presence, Cigna and Aetna view their international business as a positive differentiator and key driver of growth. Both companies intend to penetrate deeper into the emerging economies of Asia and the Middle East. In April 2014, Aetna bought U.K.-based InterGlobal, which offers private medical insurance to groups and individuals in the Middle East, Asia, Africa and Europe. UnitedHealth expanded its reach from Australia, the Middle East, and U.K. to Brazil with its buyout of AmilParticipacoes. Data from Kaiser Family Foundation and the Congressional Budget Office indicates rapid growth in individual exchange markets, with approximately 22 million purchasing coverage online by 2016 and 24 million by 2023. The exchanges seem to have been well received. Moreover, 35% of new exchange insurers below age 35 led to a favorable mix. Insurers that were initially averse to participating on exchanges are planning to jump on the bandwagon for 2015 and beyond. However, with comparative shopping options and easy access to consumer information, the exchanges are likely to heighten competition among private insurers. For more information, visit AMAC Applauds the SAVE Medicare Home Healthcare Act The Association of Mature American Citizens (AMAC) is applauding the Securing Access Via Excellence (SAVE) Medicare Home Health Act, which was introduced in the House. It provides relief to American seniors who are at risk due to Medicare cuts of 14% to home health services. The Act achieves the same level of Medicare savings as the Obamacare cuts by creating a program to reduce hospital readmissions through incentives for positive patient outcomes. The goals is to allow mature Americans to remain in their homes. AMAC says that Obamacare’s Medicare home health cut will force thousands of small businesses to close, costing nearly 500,000 home health professionals to lose their jobs. AMAC says these cuts affect the Medicare population’s most vulnerable demographic — older, sicker and poorer mature Americans.  Some will be forced to seek care in an institutional setting, driving up patient and Medicare costs and putting patients at risk for poorer health outcomes. For more information, visit The Uninsured Remain Underserved by Health Exchanges Despite the goals of the Affordable Care Act, many U.S. citizens still are uninsured and underserved due to technical problems and lack of information from health insurance companies and health exchanges, according to a study by J.D. Power. However, cost is the key reason that shoppers wanted health insurance, but were unable to get it (89%). Other reasons include having pre-existing conditions (26%) and not knowing where to buy insurance (10%). (Shoppers were able to select multiple reasons during the survey.) Many shoppers had problems enrolling because of technical problems (40%); the application process taking too long (19%); and the website not having enough information about the plans (18%). Additionally, 49% of shoppers who did not complete enrollment had not decided on a plan. Rick Johnson, senior director of the healthcare practice at J.D. Power said, “For health insurance providers to thrive in this new environment, they will need to retool their marketing, information and enrollment efforts toward a new generation of uninsured to serve their needs.” Fifty-nine percent of enrollees cite monthly premiums as an important reason for their plan selection; 36% cite doctor visit co-pays, 32% cite out-of-pocket maximums, and 32% cite annual deductibles. The study does not find a significant difference in the enrollment experience for federal and state exchanges. Fifty percent of consumers say their top reason for shopping through an exchange is to comply with the law while 40% shop because they want health insurance but haven’t been able to get it. Fifty-five percent of shoppers first heard about the Marketplace through the news media while only 4% learned about it in a notification from a state or federal agency. For more information, visit 2015 Obamacare Rate Filings Reveal Out-of-Pocket Cost Changes A recent HealthPocket study finds that deductibles and other out-of-pocket costs are changing inconsistently among the four categories of Obamacare plans: bronze, silver, gold, and platinum plans. Bronze plans had a decrease in deductible with an increase in specialist copayments, and a higher maximum for annual out-of-pocket costs. Silver plans had decreases in deductibles, doctor copayments, specialist copayments, and maximum annual out-of-pocket costs. Gold plans had decreases in deductible, doctor copayments, and specialist copayments, but an increase in maximum for annual out-of-pocket costs. Platinum plans had increases in deductible, doctor copayments, and specialist copayments, but a decrease in maximum annual out-of-pocket costs. Actuarial values requirements for the different categories plans have not simplified the health plan shopping process as originally intended. While the actuarial value changes evenly among the different categories of Obamacare plans, the resulting changes in deductibles and physician copayments did not change proportionally with the actuarial value changes. “Early media attention of the 2015 Obamacare plans has focused on premiums, but out-of-pocket costs are just as important…they can represent thousands of dollars in annual expenses for a consumer who uses healthcare services regularly,” said Kev Coleman, Head of Research & Data at HealthPocket For more information, visit HSA Accounts Provide Financial Flexibility An HSA plan is a valuable financial tool for consumers, providing flexibility to cover immediate medical expenses and save for health care costs, according to a study by the American Bankers Association (ABA) and America’s Health Insurance Plans (AHIP.) Fifty-five percent of HSAs received personal contributions during 2012. Roughly 80% of accounts had a positive balance that could be carried over to the next year. “This study confirms that HSAs are being used as they were designed: to pay for routine health care needs and to save towards future medical expenses. HSAs have the advantage of offering consumers greater choice and control over their health care,” said Kevin McKechnie of the ABA. The study also reveals the following: • 44% of the accounts received employer contributions. Of those accounts, the average personal contribution was $2,337, and the average contribution from employers was $1,142. • 58% of accounts had withdrawals during the year. Of those accounts, the average withdrawal during 2012 was $2,081. • 19% of accounts had $0 available at the end of the year; 31% had $1 to $499; 11% had $500 to $999; 12% had $1,000 to $1,999; 14% had $2,000 to $4,999; and 12% had at least $5,000. For more information, visit The Uninsured State-by-State A report by WalletHub projects uninsured rates by state post-Obamacare. The following are these states with the   States with Lowest Uninsured Rate Post-Obamacare: Uninsured Rank State Name Uninsured Rate Pre-Obamacare Projected Uninsured Rate Post-Obamacare Difference Before and After 1 Massachusetts 4.35% 1.20% -3.16% 2 Rhode Island 14.34% 5.60% -8.73% 3 District of Columbia 9.09% 6.29% -2.80% 4 Hawaii 9.11% 6.35% -2.75% 5 Oregon 16.91% 6.38% -10.54% 6 West Virginia 17.34% 6.59% -10.74% 7 Minnesota 10.07% 6.61% -3.47% 8 Iowa 11.58% 7.47% -4.11% 9 Washington 16.01% 8.27% -7.73% 10 Kentucky 17.30% 8.95% -8.35% 11 Colorado 16.54% 9.02% -7.52% 12 Maryland 14.91% 9.13% -5.77% 13 Wisconsin 11.64% 9.75% -1.89% 14 New York 13.39% 10.16% -3.23% 15 Pennsylvania 13.27% 11.05% -2.22% 16 Ohio 15.19% 11.27% -3.92% 17 Virginia 14.91% 12.45% -2.46% 18 Tennessee 15.70% 12.46% -3.24% 19 Indiana 14.80% 12.78% -2.02% 20 Kansas 15.46% 12.91% -2.55% 21 Missouri 16.49% 12.95% -3.55% 22 New Jersey 16.83% 13.54% -3.29% 23 Utah 15.96% 13.57% -2.38% 24 Nebraska 14.71% 13.69% -1.02% 25 Arkansas 20.87% 13.77% -7.10% 26 South Carolina 19.25% 13.97% -5.28% 27 Illinois 16.16% 14.16% -2.01% 28 California 21.00% 14.26% -6.74% 29 Idaho 19.12% 14.41% -4.72% 30 South Dakota 15.88% 14.71% -1.17% 31 Alabama 15.97% 15.44% -0.53% 32 Arizona 20.13% 16.38% -3.74% 33 North Carolina 19.64% 16.68% -2.96% 34 Montana 21.98% 17.65% -4.34% 35 Georgia 21.66% 18.16% -3.50% 36 Wyoming 18.92% 18.29% -0.63% 37 Oklahoma 19.76% 18.33% -1.43% 38 Alaska 20.48% 18.96% -1.52% 39 Nevada 26.52% 19.58% -6.94% 40 New Mexico 24.29% 19.59% -4.69% 41 Florida 24.73% 19.61% -5.12% 42 Louisiana 22.41% 20.91% -1.50% 43 Mississippi 18.11% 21.46% 3.34% 44 Texas 26.80% 24.81% -1.99% N/A Connecticut 9.50% N/A N/A N/A Delaware 12.22% N/A N/A N/A Maine 11.53% N/A N/A N/A Michigan 13.46% N/A N/A N/A New Hampshire 14.16% N/A N/A N/A North Dakota 11.80% N/A N/A N/A Vermont 9.28% N/A N/A NATIONAL 17.87% 14.22% -3.66% For more information, visit   IN CALIFORNIA PacifiCare Files Suit to Overturn A Huge Fine PacifiCare sued California Insurance Commissioner Dave Jones, seeking to overturn what it says is an egregious, overreaching action stemming from a series of long-resolved administrative errors. The lawsuit, filed by PacifiCare in Orange County Superior Court, seeks judicial review of the Commissioner’s decision to impose a fine of $173.6 million against the company. That decision ignored the state administrative law judge’s August 2013 finding that  the penalty should be $11.5 million, sharply lower than the Commissioner’s proposal. Stephen Scheneman, president of PacifiCare said, “By treating errors in standard health insurance paperwork more severely than errors directly affecting patient health or the integrity of their policies, the Commissioner threatens to make California’s health care system slower, less efficient, more bureaucratic and more expensive. PacifiCare says that the case involved largely technical and administrative issues that arose in 2007, which PacifiCare self-disclosed to the CDI. These issues caused no harm to members or providers, and were resolved within months. The Commissioner’s unprecedented decision to pursue an enforcement action even though all of the issues had been resolved resulted in more than three years of hearings on the matter, hearings that included hundreds of hours of testimony, the review of thousands of pages of exhibits, and more than $10 million in Californians’ tax money spent by CDI on outside lawyers. After all that, even the Commissioner acknowledged there is no basis for paying restitution to members or providers, according to PacifiCare. The Commissioner, who did not attend one day of the three-year hearing, has not explained why he waited nearly a year – until June 9, 2014 – to issue a fine fifteen times what the California administrative law judge determined. This ruling threatens to paralyze the health care system in the state, resulting in more costs and bureaucracy for Californians. We are taking this action to protect the interests of our customers who depend on the availability of affordable health insurance. Access to affordable health care depends on balanced regulation that does not impose irrational costs [and is not] potentially disruptive to the market. As we have done since 2008, we plan to continue to vigorously defend ourselves and our members in this matter.” For more information, visit Covered California to Offer Grants for Navigator Program Covered California will award up to $16.9 million in grants for the launch of its Navigator Program, the next phase in the agency’s outreach, education, and enrollment efforts. Covered California will award grants for programs that educate consumers about Covered California health insurance plans and about how to get financial assistance to help pay for them. Navigator activities will also include informing consumers about the benefits of getting health care coverage, motivating consumers to act, helping consumers shop for and compare plans, and helping consumers in enrollment and renewals. The goal of the Navigator Program is to enroll more than 130,000 subsidy-eligible consumers during the second open-enrollment period from November 15, 2014 to February 15, 2015. Navigators also will help enrollees renew their health insurance coverage. Covered California is seeking proposals from grant applicants with a statewide and regional scope. Covered California seeks organizations that have experience providing outreach to California’s diverse populations and proven success enrolling consumers in health care programs. As many as 135 organizations could get grants, which will be based on recipients enrolling a predetermined number of consumers. Grants will cover the period of Oct. 1, 2014, through June 30, 2015.  The grant application deadline is July 28, 2014. Awards will be made starting August 27, 2014. Organizations will be selected through a competitive grant application process. Applications will be evaluated based on the best value and most effective enrollment strategies. Grant applicants must comply with the Enrollment Assistance Program regulations. For more information, visit CAHU Health Care Summit CAHU’s Health Care Summit will be held in Universal City on October 7 and 8. For more information, visit Covered California Hires Blue Shield Exec Covered California appointed Anne Price as director of the Plan Management Division and James D. Lombard as chief financial officer. Price recently joined Covered California from Blue Shield of California. She has more than 20 years of financial and management experience in the health care industry, including commercial insurance, Medicare and Medicaid. At Blue Shield, she was director of finance and strategic partnerships with the California Public Employees’ Retirement System. Lombard has 20 years of public finance experience, including budgeting and policy analysis, administration and program operations. He most recently was chief administrative officer in the California State Controller’s Office, where he supervised human resources, budgets, accounting, facilities and information technology. He will start his new job in the coming weeks. For more information, visit Heffernan Insurance Brokers Hires Assistant Vice President Heffernan Insurance Brokers, one of the largest full-service, independent insurance brokerage firms in the United States, recently hired Lawrence Thomas as assistant vice president for its Orange County branch. Thomas will focus on building the nonprofit, entertainment and fashion apparel manufacturing niches for Heffernan in Southern California. Thomas has spent over seven years in major market development throughout southern California, including direct sales for a multi-national document management corporation.  His duties at Heffernan will include new business development and client service. Heffernan provides insurance and financial services products to a range of businesses and individuals. Headquartered in Walnut Creek, Calif., Heffernan has offices in San Francisco, Petaluma, Menlo Park, Los Angeles and Orange County, CA; Portland, OR; St. Louis, MO and New York, NY. For more information, visit or call 800-234-6787.   NEW PRODUCTS Fixed Deferred Annuity Guardian Life introduced the Guardian Fixed Target Annuity. It allows customers to select from multiple guaranteed interest periods and provides flexible renewal and withdrawal options to help generate income for retirement. Unlike many fixed annuities, it does not have market value adjustments on withdrawals made before maturity. This lets customers know what to expect from their retirement income stream. For more information, visit   LIFE INSURANCE Life Insurance Sales Were Flat in June Year-over-year, applications for individually underwritten life insurance were flat at 0.3% in June, according to the MIB Life Index. The first six months of 2014 have shown progressively lower monthly losses. U.S. life insurance application activity was flat (0%) in the second quarter copared to a negative first quarter, which was down 5.4%. At the close of second quarter 2014, applications were down 2.7%. However, in June the number of applications increases 1.2% from the previous May, which is consistent with seasonal averages. Applications by age group were mixed in June. Applications ages birth to 44 were down 1.7%; ages 45 to 59 were flat at 0.3%; and ages 60 plus were up 2.8%. Second quarter activity, by age group, mirrored the improvements in the composite index: ages birth to 44 were down 1.2%; ages 45 to 59 were down 0.5%; and ages 60 plus were up 2.9%. For the first six months of 2014, ages birth to 44 are down 3.8%; ages 45-59 are down 2.8%; and ages 60 plus are up 0.6%, compared to the same period last year. For more information, visit   EMPLOYEE BENEFITS Study Unveils Small Businesses’ Approach to Benefits Small-business are concerned about taking care of employees and continuing their benefit options, according to a recent Aflac study. Businesses with to 99 employees took these actions in 2013: • 45% of small businesses hired full-time workers, compared to 71% of mid-sized companies, and 60% of large organizations. • 12% changed employee hours from full-time to part-time. • 34% gave employees smaller raises than in previous years, but only 24% plan to do the same this year, and only 18% plan to eliminate or delay raises in 2014. Only 12% of employees at small businesses are extremely satisfied with their benefits, and only 14% say their benefit package meets their family needs extremely well. Fifty percent of employees at small companies saying they’re likely to look for new jobs in the next 12 months; 57% say they’re likely to accept jobs with slightly lower compensation, but better benefits; and 47% say improving their benefit packages is one thing their employers could do to keep them in their job. Thirty-eight percent of small-business employees say that maintaining their health care benefits is their most important benefit concern. Eighty-five percent of small-business employees consider voluntary benefits to be part of a comprehensive benefit program. In fact, 62% of workers at small companies see a growing need for voluntary insurance benefits compared to year’s past, driven by these trends: • Rising medical costs (71%). • Increasing price of medical coverage (63%). • Increasing deductibles and copays (58%). • Reduced number of benefits and/or amount of coverage by their employers (29%). For more information, visit Videos Are Highly Effective Enrollment A report by Flimp Media finds that employee benefit video communication campaigns had exceptionally high employee engagement and response rates. Seventy-nine percent of employee recipients watched the digital video postcard content. The average employee spent 3.5 minutes engaged with their video postcard message. For more information, visit   EVENTS Webcast on Annuity Sales The National Association for Fixed Annuities is holding a Webcast on Thursday, July 24 on annuity sales secrets. It will be held 8:30 a.m. PT. For more information, visit ... Continue Reading →

Don’t Expect Clients to “Sleepwalk” Retirement

It is not enough for retirement funds to set default investment options and then expect employees to “sleepwalk” to a financially secure retirement, Alexander Forbes said this week, when it released its annual Benefits Barometer research report on retirement funds and other employee benefits. Fund members should be involved in retirement planning to ensure that it is suitable for their needs, senior executives of Alexander Forbes say.  And they say your employee benefits should provide you with protection to ensure that your journey to retirement is not jeopardised by events, such as disability, that could affect your ability to save. he key issue is not to maximise retirement savings, but to optimise the allocation of your resources across short-term consumption, long-term savings and income protection, Anne Cabot-Alletzhauser, the head of the Alexander Forbes Research Institute, and John Anderson, the managing director of research and product development at Alexander Forbes, says in a recent post at ... Continue Reading →

California Cuts Number of Uninsured

Quietly, while the drought and immigration grab the headlines, and while commentators decry health care reform’s rocky start, California has done something remarkable. It has cut the number of residents without heath insurance in half since last summer, from 22 percent to 11 percent of the population. And, despite the myriad problems with the system, the percentage of uninsured Americans has dropped from 18 to 13.4 percent in the same time. It would have dropped even more if all the states were taking advantage of the Affordable Care Act’s health exchange programs. Even better, health care analysts are nearly unanimous in expecting the trend to continue, especially after the employer mandate kicks in. The United States still has a huge amount of work to do if it wants to catch up to other countries on health care. The Commonwealth Fund reported last month that the U.S. ranked last among 11 major, industrialized countries in 2011 on measures of health system quality, efficiency, access to care, equity and healthy lives according to a recent Op-Ed piece in the San Jose Mercury News. ... Continue Reading →