Need Some Health-splaining?

Need Some Health-splaining?

The Council for Affordable Health Coverage (CAHC) and Partnership for Employer-Sponsored Coverage (P4ESC) hosted a crowd of more than 150 health policy influencers recently at the Price of Good Health  summit located at the Newseum in Washington, D.C. One great thing that came out of it was a free CAHC whitepaper titled: “Health Cost Primer: Explaining the Medical Cost Trend.” Download it at

Number of Uninsured Adults Hits Four-Year High

More adults than ever since the Affordable Care Act took effect in 2014 now say they don’t have health insurance. About 13.7 percent of U.S. adults went without medical insurance in the fourth quarter of 2018, a new Gallup poll found. An estimated 7 million more adults are without health insurance now versus 2016 when the rate of uninsured dropped to a new low of 10.9 percent.

Yellow capsules omega 3, fatty acid, fish oil on dollar banknote at wooden table.

Let’s Be Clear: Drug Prices Really Aren’t Skyrocketing

Adam J. Fein at Drug Channels, a site where he blogs about the prescription drug business, wants the world to know that too many politicians and journalists are repeating the false narrative of “skyrocketing” and “soaring” drug prices. He notes that hot-off-the-presses IQVIA data show that list prices for brand-name drugs grew by less than 6 percent in 2018. Net prices (after rebates and discounts) increased by a mere 1.5 percent. The 2018 figures mark the fourth consecutive year that net drug prices have grown by low-single-digit amounts, writes Fein. So that’s not really so bad, right? 

Voya Financial Launches Suite of HSAs and Spending Accounts

Voya Financial announced the launch of its new suite of Voya Health Savings and Spending Account solutions as optional employee benefits.

The suite of solutions will initially include the following tax-advantaged accounts: a Health Savings Account to be used in combination with high deductible health plans; a Health Flexible Spending Account (Health FSA); a Limited Purpose FSA; a Dependent Care FSA; and a Commuter Benefit Account Voya’s solutions will include several key features:

  • Easy access to accounts: Employees can access and manage all of their Voya Health Savings and Spending Accounts — when, where and how they need to — through one user-friendly web portal or mobile app.
  • One debit card to manage all accounts: Account holders only need one debit card to access funds from any of their Voya Health Savings and Spending Accounts to pay qualified expenses.
  • Employer flexibility: Access one administration portal to review reports and activity on all of their Voya Health Savings and Spending Accounts.

In addition to the savings and spending features of all of the Voya Health Savings and Spending Accounts, HSA account holders with $2,000 or more in their HSA may choose to actively manage their account and select their investment options within their HSA. More at 

Limelight Gets Big $

Limelight Health , a quoting, underwriting, and proposal platform for the employee benefits industry, announced it has secured $33.5 Million in Series C funding. The financing round was led by Principal Life, with participation from AXA Venture Partners, MassMutual Ventures, Aflac Ventures, Transamerica Ventures, Wells Fargo Strategic Capital (a division of Wells Fargo Commercial Capital), LaunchPad Digital Health, and Wanxiang America Healthcare Investments. Limelight Health will use the funds for product development, customer acquisition, global expansion and hiring efforts. The company says it will enhance product features to include more automation, enhanced workflow, an underwriter certification program and risk scores based on data sets for better underwriting. More at 

Mason Finance Publishes White Paper

Mason Finance has recently published a free white paper on life settlements for the 65+ crowd. Download the paper at

 Aflac Recognized for Diversity

Aflac is once again listed on Black Enterprise’s prestigious list of the 50 Best Companies for Diversity.  This marks the 12th time that Aflac has appeared on this annual list. Aflac’s workforce is comprised of 34 percent African-Americans and 45 percent ethnic minorities, while African-Americans make up 12 percent of Aflac’s officers, with 27 percent of officers being ethnic minorities. Of Aflac’s entire workforce, 67 percent are women.

According to Black Enterprise, to compile the list, Black Enterprise’s editorial research team, in partnership with the Executive Leadership Council, sends surveys to the nation’s top 1,000 publicly traded companies to get an in-depth look at the ethnic and gender composition, as well as their programs designed to foster an inclusive working environment. The annual survey focuses on African-Americans but includes other ethnic minority groups as defined by the U.S. Census Bureau. Any information provided by companies on diversity efforts targeted toward women, LGBT, the disabled and veterans is used as secondary, supporting data.

 A.M. Best: Health Insurers Doing Well

Who hoo! AM Best says it’s maintaining a stable market segment outlook for the U.S. health insurance industry in 2019, citing positive earnings in all major lines of business, growth of industry capital and surplus and reduced near-term regulatory uncertainty. The new Best’s Market Segment Report, titled, “Market Segment Outlook: U.S. Health,” contends that positive fundamentals continued in 2018 driven by favorable medical cost trend, stable performance of the commercial group market, profitable growth in government programs and sustained improvement in the commercial individual segment. AM Best expects underwriting results to be strong in 2018, though down slightly compared with 2017 (when the industry reported its highest earnings in five years!). Best says carriers are pricing closer to medical cost trends in the current year, especially in the individual business where profitability exceeded projections for many carriers in 2017. Strong earnings are expected to contribute to further growth of capital and surplus, which — similar to 2017– outpaced premium growth. Government programs remain the industry’s primary source of premium growth, driven by Medicare Advantage and Medicaid managed care. Want to know more? Go to to access a copy of the full report.

5 Tips for Clients looking to help reduce health care costs

Robert Falkenberg, CEO, UnitedHealthcare California, says now is the ideal time to teach your clients how health plans work and how they can use them to their economic and health advantage. Here are Falkenberg’s five top tips:

  1. Understand the health plan

It sounds basic, but understanding the health plan before clients need to use benefits can save you a lot of time, stress and money. They need to learn what their health plan covers – including medical, pharmacy and preventive benefits. When in doubt, tell them they can call the number on the health plan ID card to get the most up-to-date information. Also, it’s a good time to make sure they understand health plan terms such as deductible, copay, coinsurance and out-of-pocket limit. If they need a refresher, there are resources online such as the Just Plain Clear Glossary to help them learn and understand these terms.

  1. Ask about lower-cost prescriptions

If clients are worried about the cost of a medication, mention those concerns to their doctor who might be able to find a more affordable option. Many doctors are now using technology that enables them to view precise medication costs in real time before leaving the exam room. In addition, some pharmacy benefit plans now offer discounts at the point of sale by providing savings from pharmacy manufacturer rebates directly to consumers. These discounts could potentially lower your out-of-pocket costs on select medications.

  1. Stay “in network”

Make sure clients understand that one way to help keep costs down is to stay in a health plan’s care provider network, which consists of the doctors, specialists, hospitals and other care facilities.

  1. Consider alternatives – even online docs

For nonemergency issues, clients might be able to receive fast, professional and lower-cost care at an urgent care center, a convenience care clinic or an online doctor visit. Online doctor visits are a great option for treating conditions such as colds, migraines and allergies. Online visits often can cost as low as $40 or $50 per visit, much less than a trip to urgent care or an emergency room.

  1. Take advantage of wellness discounts and incentives

Encourage clients to explore employer and health plan incentives for taking healthier actions such as completing a health survey, exercising or meeting nationally recommended health benchmarks for cholesterol, blood pressure, body mass index, and no nicotine.

Walmart and CVS Reunited

Walmart and CVS announced a split in January, but it looks like the two are now reunited for a long-term commitment. CVS Health and Walmart announced the companies have reached a multi-year agreement on terms under which Walmart will continue participating in the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid retail pharmacy networks. The companies are not disclosing the financial terms of the new contract.

About Medicare Fraud

Walgreens Boots Alliance, Inc. has agreed to pay $269.2 million to settle U.S. claims that the drugstore chain defrauded Medicare and Medicaid over insulin drugs and a consumer-discount initiative. The two settlements, announced this week, are a result of allegations over improper billing. In the first, Walgreens agreed to pay $209.2 million to resolve claims it billed Medicare, Medicaid and other programs for hundreds of thousands of insulin pens it distributed to people who didn’t need them. In the second, Walgreens said it would pay $60 million for overbilling Medicaid by not disclosing lower drug prices it offered in a discount program. By the way, If you’re interested in Medicare fraud look up “The Personal Toll of Whistle Blowing” by Sheelah Kolhatkar in the February 4 issue of The New Yorker. It’s eye opening! And don’t miss this month’s Medicare Insider on page XX.

Interested In Campaign Against Insuring Coal?

When we first heard about the campaign against insurers who insure coal and/or invest in the coal industry, we thought it might be a passing thing. Nope. These people are serious and diligent. Take a look at the latest email we received…

Dear colleague,

The Unfriend Coal campaign calls on insurance companies to stop underwriting and investing in climate-destroying coal projects. Our electronic newsletter, Insuring Coal No More, shares brief updates and campaign highlights on climate, coal, and the insurance industry on a monthly basis. The January issue, which will appear tomorrow, will focus on the role of insurance brokers in facilitating coal projects, on initial movement on coal among US insurers, and on the manifold impacts of the California wildfires on insurers. You can sign up at to subscribe to this free monthly newsletter.


Peter Bosshard
Director, Finance Program
The Sunrise Project
Coordinator, Unfriend Coal campaign

By the way, check out our guest editorial this month on page XX.  We gave them a little more space to express themselves. 

Life Agents Win: Qualified Biz Deduction

Listen up, life insurance folks. The IRS has released final regulations that should help life agents get a new federal income tax deduction. The IRS says it generally will exclude sales of commission-based insurance policies when deciding whether a business owner can qualify for the “qualified business income deduction.”  So that’s a win.

More Employees Than Ever Test Positive for Pot

Recent research by Quest Diagnostics shows plenty of employees are availing themselves of marijuana: there’s been a 33 percent increase in positive drug tests on employees. According to Rob Wilson, president of Employco USA, a national employment-solutions firm, the increase in employee usage of marijuana is in industries across the board. In California and nine other states it’s legal to use marijuana for recreation, and in 33 states it’s legal to use medically. With this in mind, employers may wonder what rights they have when taking a hard line on drug use.

An employer’s ability to monitor employee drug use depends on whether or not the organization is unionized. In a non-union environment, a supervisor or human resources team member can help determine if an employee is under the influence of marijuana. “If your suspicions are backed up by other leaders in your company, you can discipline and even terminate your employee,” says Wilson.

If you work in a collective-bargaining workplace, Wilson says that you should have a series of steps laid out in your handbook that will help everyone understand what the outcome of marijuana use on the job will be. Even though marijuana law are changing, employers can still have a zero-tolerance policy about drug use on the job — even if the employee has the legal right to use marijuana. However employers can’t, for example, discriminate against someone simply because they have a medical marijuana card.

Hodges-Mace Launches SmartBen® Bridge Program to Enhance the Customer Experience

Hodges-Mace announced the launch of the SmartBen Bridge program for benefit partners and vendors. Bridge offers a partnership where stakeholders involved in the lifecycle of a client can connect to provide a better benefits delivery experience for their mutual clients.  The company says Bridge is the culmination of extensive research and analysis into how Hodges-Mace, with the help of its partners and vendors, can best serve the growing needs of its customers and brokers. The new program is designed to educate the market about the software and services that Hodges-Mace brings to the table and how the organization interfaces with various providers to deliver smarter benefit solutions. Hodges-Mace currently has an extensive network of partners including brokers, carriers (both medical, and group/VB), payroll/HRIS firms, and value-added companies (i.e. FSA / COBRA / telemedicine, etc.).  The company also works with a variety of vendors to help employers and their employees maximize their benefits coverage.  Bridge takes all the disparate pieces of information from stakeholders and packages them into a smart, online tool to improve the employer/employee experience.

Online Searches Steered Customers Wrong

It seems people who used search terms like “Obamacare” or “ACA”  last fall were most often directed to websites that promote individual health plans that didn’t meet consumer protections of the Affordable Care Act, according to a new study by Georgetown University’s Center on Health Insurance Reforms. Pros warn that some consumers may not even realize the limitations of the plans they purchased. 

Covered Cal Unveils Report

Covered California presented an extensive report, “Options to Improve Affordability in California’s Individual Health Insurance Market,” to state leaders recently. The report is the result of months of work with leading economists and stakeholders as California looks to continue to lead the way on implementing the Patient Protection and Affordable Care Act and improving access to quality care for its residents. The report was prepared pursuant to California’s 2018-19 budget trailer bill, which required Covered California to, in consultation with stakeholders and the Legislature, develop and submit to the Legislature by Feb. 1, 2019, options to improve affordability for low- and middle-income consumers. Covered California developed two approaches, with each approach containing different options for implementation. The approaches include expanding the amount of premium and cost-sharing support for consumers, reinstituting a state-based individual mandate penalty and establishing a state reinsurance program.

Aetna Settles Up

California Attorney General Xavier Becerra announced Aetna has agreed to pay $935,000 as a result of a settlement involving negligently disclosing patients’ HIV status. A contractor working for Aetna sent nearly 2,000 Californians letters displaying their HIV status. The information was visible to anyone who cared to look through windows in the envelopes. Aetna sent letters to 12,000 people across the U.S. The company has agreed to implement new protocols to prevent future breaches of patient confidentiality. Aetna patients who were affected have received an additional $17 million in compensation through a private class action lawsuit. 

Good Things for SCAN

Looks like SCAN is doing things right. The not-for-profit Medicare Advantage provider announced that it has surpassed the 200,000 membership mark in California, representing a near 20 percent five-year increase. SCAN has maintained for two years in a row its 4.5-star rating out of a possible five stars from the Centers for Medicare and Medicaid Services (CMS). SCAN was also named one of the best insurance companies for Medicare Advantage for 2019 by U.S. News & World Report, and received a 90 percent member satisfaction rating as reported in the 2019 Medicare & You Handbook. 

Women in Insurance & Financial Services Announces 2019 Partners

Women in Insurance & Financial Services (WIFS) has announced that five industry corporations have partnered with the organization to support the advancement of women in the insurance and financial services profession in 2019. The partners include: Prudential, Executive Partner Penn Mutual, and Ambassador Partners Ameritas, Lincoln Financial Network – The WISE Group, and National Life Group.

The collective contributions from Partners for Excellence enable WIFS to provide its membership with robust educational programming, an annual conference, online resources and media exposure, as well as groundbreaking demographic and industry-wide research on what drives women to be successful. 

Life Activity Dips

U.S. life insurance application activity was relatively stable across the first three quarters of 2018, but  did a bit of a dive in the fourth quarter. The decline was 3.5 percent in the fourth quarter, year-over-year, according to the MIB Life Index. The Index lost ground in all but three months of 2018 with the most significant declines observed in the year’s final quarter.

Fidelity Says Wait on Social Security If You Can

Fidelity has some great consumer education info up on the “viewpoints” section of their site.  For example, when should you start taking social security benefits? If you claim Social Security at age 62 rather than wait until your full retirement age, you can expect up to a 30 percent reduction in monthly benefits. Read more at

CVS Health Pledges $100 M to Community Health

CVS Health announced a $100 million commitment to its Building Healthier Communities initiative. CVS-Aetna maintains the combined company is committed to making community health and wellness central. The new initiative, which will be funded over five years through the combined company as well as the CVS Health Foundation and Aetna Foundation, builds upon the tradition of community investment by both organizations. Building Healthier Communities will focus on the following three areas: improving local access to affordable care, partnering with local communities and impacting public health challenges. 

Way to Go, Humana

Humana took the No. 1 spot among Health Care Providers for its corporate citizenship, according to Forbes and JUST Capital in their new “JUST 100.” The JUST 100 ranks publicly traded companies in the United States based on how they perform against the American public’s definition of “just” corporate behavior.

NAFA Intros Board of Directors and Committee Leadership

NAFA recently welcomed new blood to its Board of Directors and committee leadership for 2019. Those joining the ranks include:

Board of Directors
Kevin Mechtley of North American Company for Life and Health Insurance
Jodi Hyde of Fidelity & Guaranty Life
Tim Minard of Great American Insurance Group
Andrew Payne of CreativeOne
Craig Rudesill of Nationwide
David Schliesman of Allianz Life
David Wolfe of Advisors Excel

Membership Committee
Shannon Compton, The Annuity Source — Chair
Tony Compton, Great American Insurance Group — Vice Chair

Government & Legal Affairs Committee
Andrew Payne, CreativeOne — Chair
Ryan Lex, Athene — Vice Chair

Education Committee
Matt Tarkenton, Tarkenton Financial — Chair
Tiya Stanley, North American Company for Life and Health Insurance — Vice Chair