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Monday April 21st 2014



Covered California Launches Self-Service SHOP Website

• Covered California Launches Self-Service SHOP Website
• Exchange Reaches Out To Lesbian, Bisexual And Transgender Consumers
• Group Actually Claims that ObamaCare Will Increase Cancer
• Millennials Not Likely To Enroll In Exchanges
• Bypassing Would be Positive for U.S. Insurers
• Employers Take a Dim View of the Health-Care System
• Preferred Pharmacy Networks Are Not Always Cheaper
• ACA Has Helped Seniors Save $8.9 Billion On Prescription Drugs
• Long Term Care Insurance Options For Those With Existing Health Conditions
• Workers Find Retirement Income Projections Helpful
• Carriers Continue to Improve Voluntary Billing Practices
• Plaintiffs Dismiss Lawsuit Against Life Partners
• Guardian VP Chris Swanker Named 2014 Board Chairman for the National Association of Dental Plans
• New President of Anthem Blue Cross
• Workplace Workout Videos
• HealthCare Visa Cards


Covered California Launches Self-Service SHOP Website

SmallBusinessCovered California officially launched the full self-enrollment function of the Small Business Health Options (SHOP) online marketplace. It will enable small businesses to fully enroll for coverage that may begin as early as Jan. 1, 2014. Previously, small business employers have been able to register online, check their eligibility and work with a certified insurance agent to get a quote. The new system enhancements now allow online enrollment functionality for SHOP, including online quoting, the ability to submit an online application at in real-time, and the ability for employers to initiate electronic open enrollment for their employees.

Since registration opened in August, more than 22,000 licensed agents have signed up to become certified to sell Covered California products, with more than 7,000 agents certified and available to help individual consumers and small employers in the Covered California marketplace. The increased website functionality also includes a number of new features available for the certified insurance agent community, such as the ability to create an online profile for an individual consumer or small employer, the ability to start and submit an application on behalf of an individual or small employer, and, the ability to process and manage employer online enrollment applications for SHOP.

Exchange Reaches Out To Lesbian, Bisexual And Transgender Consumers

Covered California has launched billboard and print advertising to reach the Lesbian, Gay, Bisexual, and Transgender (LGBT) community throughout the state. LGBT focused billboards have been placed in the Bay Area, San Diego, and Los Angele. Print ads are also running in the largest LGBT focused publications. The LGBT campaign will complement Covered California’s general advertising effort that is already serving California’s diverse communities. For more information, visit


Group Actually Claims that ObamaCare Will Increase Cancer

There have been all kinds of complaints about the Affordable Care Act, but here’s a new one. The Association of American Physicians and Surgeons (AAPS) is claiming that the Affordable Care Act will increase breast cancer rates because health plans will be required to pay for abortions under the law. The group cites a Chinese study, which found a 44% increase in breast-cancer risk in women with at least one induced abortion. There was a “dose-dependent” effect, which supports a causal relationship. With two or three abortions, the risk was increased by 76% and 89%, respectively. The group warns that the “morning after” pill contains a high dose of hormones like those in hormonal contraceptives. Birth control pills are considered class-1 carcinogens by the World Health Organization (WHO).

“Kathleen Sebelius might call contraception and abortion ‘preventive’ measures, but does her opinion justify imposing a duty on Americans to fund measures they believe could increase cancer?” asked AAPS executive director Jane M. Orient, M.D.

The group did not cite any U.S.-based research to support its claim. In February 2003, the National Cancer Institute convened a workshop of over 100 of the world’s leading experts who study pregnancy and breast cancer risk. Workshop participants reviewed existing population-based, clinical, and animal studies on the relationship between pregnancy and breast cancer risk, including studies of induced and spontaneous abortions. They concluded that having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer. A summary of their findings can be found in the Summary Report: Early Reproductive Events and Breast Cancer Workshop.

Millennials Not Likely To Enroll In Exchanges

Less than three-in-ten uninsured Millennials say they will definitely or probably enroll in insurance through the exchange, according to a national poll of America’s 18- to 29- year-olds by Harvard’s Institute of Politics. Among the 22% of Millennials who do not have health insurance, 29% say they definitely or probably will enroll. Less than 10% of Republicans plan to enroll in an exchange; less than 20% of Independents plan to enroll; and 35% to 40% of Democrats plan to enroll. Fifty-two percent of Millennials would support recalling all members of Congress if it were possible. For President Obama, 47% support a recall and 46% oppose it. The poll also finds President Obama’s job approval rating at the lowest level (41%) since the beginning of his presidency. America’s 18- to 29- year-olds were critical in the election and reelection of Barack Obama. But they now rate the President’s job performance closer to that of Congress – and at the lowest level since he took office in 2009. For more information, visit

Bypassing Would be Positive for U.S. Insurers

Allowing U.S. health insurers to build interfaces that bypass portions of the federal insurance website would be a positive for the industry, according to a report by Fitch Ratings. While the alternative websites are unlikely to be developed, the ability to bypass could improve the quality and timeliness of the data that insurers receive regarding new exchange-sourced policyholders.

The government website has been plagued by technical problems since its launch two months ago, making it challenging for health insurers to get accurate information about enrollees. The complexity of the website could contribute to misinformation and lead to lower profitability in health insurers’ exchange-sourced businesses.

With that said, Fitch says that its questionable that insurers would be interested in committing the resources to build their own sites or get  in the middle of the website controversy. In addition, the government would probably be very hesitant to allow the interfaces. They could be viewed as limiting the marketplace by reducing consumers’ ability to comparison shop.

Fitch Ratings says that geographically concentrated health insurance companies are likely to add the most enrollees from state-sponsored health insurance exchanges formed under the Affordable Care Act, particularly Blue Cross/Blue Shield plans. Fitch attributes this to the single-state focus of many of these insurers, typical large market shares in their respective states, and a common focus on providing consistent health insurance coverage. For more information, visit

Employers Take a Dim View of the Health-Care System

Employers view the health-care system as wasteful and expensive. They see the keys to improving the system to be in pricing and performance transparency, according to a survey by Deloitte. Also, three years into the implementation of the Affordable Care Act (ACA), many companies do not fully understand the law’s features.

Researchers surveyed 500 randomly selected U.S. employers offering health benefits during May and June of 2013 with 50 or more workers. Only 33% give the system an A or B grade while 38% give it a C, and 29% give it D or F. Only 22% say the ACA will reduce costs by 2019, and 19% say it will improve quality of care by that time. About half of respondents say it will widen access to health insurance.

When asked what is likely to improve the system, the leading response was increased price transparency around of specific medical products, services, and procedures (52%) followed by clear, accessible information about the performance of care provided by doctors (46%).

Bill Copeland of Deloitte said employers are frustrated over a lack of value compared to what they pay into the system, and they don’t think that the ACA is addressing this gap. He said, “Employers feel they lack the data and tools to manage their concerns around cost and quality. I think in the coming year, they will join the front lines of the effort to improve the system by demanding more visibility and by strengthening the use of incentives and penalties to motivate employees toward healthful behaviors.”

Employers expect to shift 26% of cost increases to their workers. In fact, the top costs-containment strategies are having employee cost-sharing (54%), having wellness programs (36%), changing plan designs (28%), reducing benefits (20%), managing networks (19%), limiting worker hours (18%), and using defined contribution plans (17%).

Rick Wald of Deloitte said that employers “are dissatisfied with the health system and feel a need to take more action. On the other side they are watching to see if the health-reform measures gain traction. One way or another, corporate America is likely to make significant moves around health care because the status quo isn’t sustainable.”

The survey also reveals the following:
* Employers expect their health costs to be 19% higher in 2014.
* 49% share cost and quality information with employees about health-care providers, common procedures, and medications.
* 26% invest in rewards/penalties, technologies, and coaching to motivate employees toward healthful behaviors, and 39% measure their return on investment.
* Employers lack trusted sources to help them make value-based purchasing decisions. Those identified as the most trusted resources include independent consultants (24%); physicians (22%); and health insurance plans and third-party benefits managers (each 21%).
* 23% analyze their claims data to identify providers that do unnecessary testing or procedures or to see if providers are complying with evidence-based standards. Slightly more than one third use claims data to analyze employee use and costs regarding treatments, medications and other services.
* Employers point to hospital costs (75%), prescription drug costs (67%) and waste and inefficiency in clinical/administrative/billing processes (67%) as the chief drivers of health costs. Such factors as insufficient competition in insurance market, insufficient employee awareness and responsibility for costs and new technologies and equipment rated lower.
For more information, visit

Preferred Pharmacy Networks Are Not Always Cheaper

Negotiated prices at preferred retail pharmacies are sometimes higher. In a recent study, CMS compared the negotiated prices at non-preferred retail pharmacies for Part D sponsors with both preferred and non-preferred networks. CMS looked at a one-month sample of negotiated pricing for the top 25 brands and 25 generics in the Part D program. Pricing at preferred retail pharmacies is lower than at non-preferred network pharmacies, but when mail and retail pharmacy costs are included, some sponsors’ preferred network pharmacies offer somewhat higher negotiated prices compared to their non-preferred network pharmacies.

In March 2012, only about 11% of the beneficiaries in standalone Part D plans were enrolled in contracts that CMS identified as having higher preferred than non-preferred prices. In its report CMS added, “From 2012 to 2013, the enrolled population in PDPs with a preferred network has doubled. Thus, we believe the impact of higher preferred network prices on the program, as a whole is likely to become increasingly significant. Since we believe higher negotiated prices in network pharmacies violate the intent of § §1860D-4 (b)(1)(B), we are considering options for clarifying our requirements in future rulemaking.”

ACA Has Helped Seniors Save $8.9 Billion On Prescription Drugs

Seniors and people with disabilities with Medicare prescription drug plan coverage have saved $8.9 billion on their prescription drugs thanks to the Affordable Care Act, according to new data by the Centers for Medicare & Medicaid Services (CMS). At the same time, these seniors will be free to use more of their Social Security benefit cost of living adjustment on what they choose because the Medicare Part B premium will not increase in 2014, thanks to the health care law’s successful efforts to keep cost growth low.

Since the Affordable Care Act was enacted, more than 7.3 million seniors and people with disabilities who reached the “donut hole” in their Medicare Part D (Medicare Prescription Drug Coverage) plans have saved $8.9 billion on their prescription drugs, an average of $1,209 per person since the program began. During the first 10 months of 2013, nearly 3.4 million people nationwide who reached the coverage gap — known as the donut hole. This year they have saved $2.9 billion, an average of $866 per beneficiary. These figures are higher than at this same point last year, when 2.8 million beneficiaries had saved $1.8 billion for an average of $677 per beneficiary. CMS recently announced that the Medicare’s Part B premium will not increase in 2014, and that the last five years have been among the slowest periods of average Part B premium growth in the program’s history. The Part B deductible will also not increase, having decreased in 2014. The Part B premium and deductible for 2014 are 15% below what was projected in 2010, the year the Affordable Care Act was enacted.

Also as a result of the Affordable Care Act, Medicare Advantage and Prescription Drug Plans remain stable and strong. Earlier this year, CMS announced that the average Medicare Advantage (MA) premium in 2014 is projected to be $32.60. CMS also estimated that the average basic Medicare prescription drug plan premium in 2014 is projected to be $31 per month, holding steady for 4 years in a row. The deductible for standard Part D plans will decline by $15 in 2014, to $310. Since the passage of the Affordable Care Act, average MA premiums are down by 9.8%.

Since enactment of the Affordable Care Act, the life of the Medicare trust fund has been extended by nearly ten years, till 2026.
For state-by-state information on savings in the donut hole, please visit:


Long Term Care Insurance Options For Those With Existing Health Conditions

An increasing number of consumers are exploring long term care insurance options that accept people with existing health conditions including diabetes, cancer, Parkinson’s, Multiple Sclerosis and even osteoporosis with breaks and fractures. “There are millions of Americans who will not health qualify for long term care insurance and each year insurers turn down a percentage of applicants who apply. As a result we are seeing increased interest in innovative products that can address some or all of an individual’s long term care risk,” explains Jesse Slome, director of the American Association for Long Term Care Insurance. According to the Association, 25% of long term care insurance applications from people 60 to 69 were declined in 2012. For applicants from 70 to 79, the decline rate grew to 44% last year, AALTCI reports. Contrary to what many consumers believe, long term care insurance was not affected by the Affordable Care Act (Obamacare). People must health qualify in order to get coverage, Slome notes. For more information, visit


Workers Find Retirement Income Projections Helpful

Ninety percent of U.S. workers say retirement income projections are helpful, according to a LIMRA study. “The study suggests that workers are interested in a clear explanation of how the estimates were calculated and need additional information to provide context to the projections,” said Alison Salka of LIMRA. Forty-five percent of workers who found the retirement income estimates less than very helpful did not understand the calculations or were not confident in the accuracy of the results. Two in five said the information was too hypothetical, and 17% said the projections didn’t capture all of their retirement savings. Salka added, “Many consumers do not have a good idea what their monthly income or expenses are. A prior SRI study found that nearly a quarter felt they needed help with basic budgeting skills. This coupled with unknowns like inflation and taxes can make any retirement projections seem abstract.”

Only half of U.S. workers have seen a monthly retirement income projection. Women and workers with incomes under $75,000 were less likely to have seen an estimate of their monthly income in retirement than men or workers making $75,000 or more. Workers contributing to a defined contribution plan are nearly twice as likely as those who are not contributing to have seen a retirement income projection (67% vs. 35%). For more information, visit


Carriers Continue to Improve Voluntary Billing Practices

Carriers that want to be successful in the worksite market know they need to pay close attention to billing and administrative practices in order to meet the demands of employers and brokers. One way carriers are making that happen is by offering electronic and consolidated billing, at least for some product types, according to a report by Eastbridge Consulting. The report also finds that most carriers are now offering individual and group voluntary products. They are incorporating existing individual expertise or adopting individual practices in the billing process. This has allowed for more options and greater flexibility for brokers and employers. For more information, visit


Plaintiffs Dismiss Lawsuit Against Life Partners

Plaintiffs recently dismissed a lawsuit filed against Life Partners. The United States District Court for the Northern District of Texas denied a motion for class certification in the lawsuit. Life Partners provides purchasing agent services for life settlement transactions. The plaintiffs claimed that Life Partners’ medical consultant used an unreasonable method of estimating life expectancies. However, this allegation was criticized by the Court as part of its 34-page order denying certification as a class action. Life Partners CEO Brian Pardo said, “This is yet another example of attorney-driven litigation which damages the entire economy, not to mention the companies that are the targets of such litigation. We are very pleased that the plaintiffs decided to walk away from this case and we hope to see other similar cases end the same way.”


Guardian Vice President Chris Swanker Named 2014 Board Chairman for the National Association of Dental Plans

Chris Swanker, vice president of Worksite & Specialty Markets, has been elected 2014 Board Chairman for the National Association of Dental Plans (NADP). The NADP is the largest non-profit, national trade association focused exclusively on the dental benefits industry. As NADP Board Chairman, Swanker will be responsible for helping determine the Board agenda and areas in which the association should focus, and providing leadership in meeting the challenges confronting the dental industry.

New President of Anthem Blue Cross

Mark Morgan has been named president of Anthem Blue Cross. Morgan will oversee the management of Anthem’s commercial business and strategy in California. Morgan has more than two decades of experience in the industry, having held senior leadership positions with significant strategic and profit and loss responsibility at Health Net and Anthem Blue Cross. In his new role, Morgan served as Anthem Blue Cross’s chief operating officer managing the day-to-day operations of Anthem’s commercial business since June 2013, and as Vice President and General Manager of California’s Individual and Small Group business before that. Before joining Anthem Blue Cross, Morgan began his career at Health Net, where he had leadership roles across all lines of business to include Large Group, Small Group, and Individual and Family Plans as well as product development, marketing, sales and underwriting.


Workplace Workout Videos

Wellness company, Voom is offering 10-minute workplace workout videos developed by fitness expert, Sean Foy. The Fast Fitness videos are the product of Sean’s book, “The 10 Minute Total Body Breakthrough.” For more information, visit

HealthCare Visa Cards

The new MyDoc Visa HealthCards are designed to deliver healthcare to employees in smaller bites, which are more digestible and controllable, by employers. The cards are also intended to be great gifts for customers, clients, family and friends. Available at, cards may be purchased in values from $20 to $1,000. Recipients use the card to pay for care at any office or clinic where Visa is accepted. We add value by providing live call center e-Nurses to assist patients and physicians. The cards include a personalized ‘QR Code’ for each user, to be scanned using the attending care-provider’s smartphone, taking the health professional directly to each patient’s medical record.
For more information, visit