Help Defeat 45 or Kiss Your Business Goodbye

45 by Leila Morris – Of all the legislation that Sacramento has come out with nothing has the potential to be as damaging to insurance agents as proposition 45 – not even single-payer legislation, said Allen Katz, executive vice president of SeeChange. He told insurance agents at the recent CAHU conference in Universal City, “I hope you are enjoying your lunch because if 45 passes, there won’t be a lunch next year.” The No on 45 Campaign is asking all agents to talk to friends, family, and clients about the dangers of this legislation. During mid-term elections, propositions can be lost by the slimmest of margins. That is why it is so important for every agent in California to get the message out about No on 45, Katz said. Under Prop 45, rates for individual and small group health insurance would need to be approved by the Insurance Commissioner before taking effect. John J. Nelson. CEO at Warner Pacific Insurance Services said, “When you are having a say in carriers’ premiums, it affects everything…Carriers would have to modify benefits and adjust rates. If you put a cap on premiums, there will be rationing and carriers will be leaving. One person could affect peoples’ ability to choose a plan.”

Peter V. Lee, the exchange’s executive director said that Covered California said he has concerns that the proposition could create roadblocks in the state exchange. Consumer Watchdog has fired back at Covered California’s resistance to 45, accusing it of being a captive of the insurance industry. Consumer Watchdog has gotten more ammunition for its attacks when news came out that the exchange had awarded $184 million in no-bid contracts. Consumer Watchdog’s tactics got really dirty yesterday when it delivered a pickup truck of steer manure to Blue Shield’s offices.

Katz said that the good news is that proposition 40 can be defeated, but everyone has to do their part. It is easier to defeat than pass an initiative. Unlikely allies, such as unions, the chamber of commerce, doctors, nurses and hospitals, oppose the legislation.  Neil Crosby, director of Sales at Warner Pacific Insurance Services said that many legislators on both sides did not support this legislation so they took it to the voters

Agents of Action is asking agents to “Share the video below with your clients, friends and family to explain how this flawed, deceptive measure will increase costs for consumers, reduce choice and harm the quality of our health care:”

Health Plan Report Card

The California Office of the Patient Advocate (OPA) is offering a health plan report card. Available in English, Spanish, and Chinese, the Report Cards allow consumers to compare the quality of care from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups.  For more information, visit


The State of Multi-Employer Pension Plans 

In 2013, strong investment performance buoyed multi-employer pension plans with a $45 billion reduction in the funding deficit. That’s a 9% improvement in funded status, according to a report by Milliman. Strong market performance helped plans return to similar funding levels to what they had before the financial crisis. More than half of all plans will need to earn an average of 8% or more per year over the next 10 years to reach 100% funding. Twenty-two percent of these plans were more than 100% funded at the end of 2013. At the other end of the spectrum, 15% were less than 65% funded.  Plan maturity is a major contributor to a plans’ ability to respond to poor funded status. Maturity can be measured by the ratio of active-to-total participants. From 2002 to 2012, the active participants in these plans fell from 48% to 37%.

To view the complete study, go to


Employers Reject Private Exchanges

In a departure from other industry polls, 55% of employers say they will never stop sponsoring employee health plans in favor of giving employees money to buy coverage through a private exchange The survey of more than 330 employers was conducted by National Business Coalition on Health and Benz Communications. Thirty-two percent are considering moving to a private exchange in three to five years; 8% are considering moving in the next three years, and just 5% said they already use a private exchange to provide employees’ health benefits.

Respondents are largely concentrated in the service and technology industries, mainly in the Southeast and West regions of the United States. Most respondents’ have 1,000 to 5,000 U.S.-based employees.

Seventy-three percent of employers say that the ACA will have the biggest effect on their benefit communication strategy in the year ahead. However, 39.4% are maintaining benefit plans and coverage levels without increasing employee costs, such like deductibles, coinsurance and copays. Slightly more than 32% will maintain benefit and coverage levels, but increase employee costs.  When asked how their company is preparing to comply with the ACA Cadillac tax in 2018, 26% say they are maintaining benefit plans and coverage levels without increasing employee costs; almost 20% are maintaining levels, but increasing employee costs and 15% are reducing benefit plans and coverage levels while increasing employee costs. For more information, visit

 Why Employees Should Consider Self Funding

Mid-sized employers should consider self-funding employee benefits, move to a private exchange or establish a defined contribution approach to control health care costs over the next decade, according to a new white paper by Barney & Barney, a Marsh & McLennan Agency LLC Company. Employers will bear an even bigger share of the cost

Shawn Pynes, Principal of Barney & Barney’s Employee Benefits division. Benchmarking data in white paper is based on responses from more than 330 employers and 1,084 benefit plans in the U.S. The following are key findings:

• PPO plans are the most costly to employers and employees. The employee-only premium is now more than $600 per month on average. Employees are responsible for $168 of that amount on average.
• Over the past three years, office visit copays have been creeping up for PPO and HMO plans. Copays have risen from an average of $19 to $21 for PPOs and from $20 to $22 for HMOs years.
• Employers are offering more low-cost options, including HMO plans and CDHPs. The number of HMO plans offered jumped 15% from 2013 to 2014. CDHP implementation grew by 13% over the same time period, compared to just 4% with PPO plans.
• The average copay for an emergency room visit has increased steadily over the past few years across PPO and HMO plans at $119 per visit.

For more information, visit

Two-thirds Will Change ACA Plans In 2015  

Competition among healthcare insurance companies is about to heat up as two-thirds of Americans covered via the Affordable Care Act (ACA) say they’ll change plans in 2015. A survey conducted by Radius Global Market Research (Radius GMR) shows that while most say they are satisfied with their coverage, that won’t stop them from shopping around when it is time to renew.

The vast majority of the 7 million households covered by a health insurance plan under ACA are satisfied with their coverage with only 20% saying they are not satisfied. But most of those same households think they can do even better.

“Consumers feel that there are opportunities to get more value from the health insurance market. Plans need…strategies to avoid significant customer churn in the coming months. Plans would also benefit from boosting efforts to educate their customers about the Affordable Care Act. Overall satisfaction was stronger among those enrollees who reported receiving adequate explanation of ACA coverage. Only 44% of Americans feel they are well informed,” says Kathleen Relias senior vice president of Radius GMR.

When asked what they’ll look for in a new healthcare plan, those surveyed named lower costs and improved access to doctors and care as their top priorities. More than half expect their healthcare premiums to increase in the next six months. More than one-third of those who switched primary doctors after joining ACA plans did so because their doctor was not on the new plan. And about 25% of households are visiting their doctor less frequently and/or experiencing longer office wait times. For more information, visit

Doctors Give ACA Improved Ratings

The number of doctors giving the ACA an F decreased from 30% in 2013, to 22% in 2014, according to a survey by The Medicus Firm. However, only 9% give the ACA the highest grade — up from 6.3% last year.  “Unfortunately, the grades, on the whole, are not very positive, so it’s good that there is some improvement in doctors’ perceptions of the effectiveness of the ACA,” said Jim Stone, president of The Medicus Firm. Doctors gave the following grades for specific areas:

• 23% gave the ACA an A for improving access to healthcare, up from 12% last year. 27% gave the ACA a B for improving healthcare access. Only 14% of respondents failed the ACA in this category, down from 24% who gave it an F last year for this objective.
• 7% gave the ACA an A for improving efficiency compared to 6% last year.
• 30% gave the ACA an F for improving efficiency compared to 35% last year.

This year’s survey was conducted after the ACA was in full effect for several months.

For more information, visit

LGBT Medicare Patients Face Discrimination at Hospitals 

LGBT Americans are facing an increasingly harsh choice between healthcare facilities that have policies that guarantee them equal care, and those that have consistently failed to take steps to ensure that all patients receive inclusive, compassionate and respectful care, according to a report by the Human Rights Campaign (HRC) Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization.

HRC is calling on the Centers for Medicare and Medicaid Services (CMS) to require that all healthcare facilities receiving federal reimbursement have in place uniform patient non-discrimination policies that specifically include sexual orientation and gender identity, and also protect LGBT patients from harassment and abuse. And he urged CMS to encourage healthcare facilities to also include such protections in their employment policies. “Pervasive discrimination divides this country into two Americas — one America that treats LGBT people fairly, and other that does not. It’s essential that the government take bold action to close this healthcare equality divide. Studies show that an alarmingly high number of LGBT people, especially transgender Americans, experience discrimination by healthcare professionals that undermines or prevents medically-necessary care,” said HRC President Chad Griffin.

HRC Foundation’s 2014 Healthcare Equality Index (HEI) found that too many hospitals continue to fall short in providing vital patient non-discrimination protections.

This year, HRC independently researched hundreds of hospitals that declined to participate in the HEI, which for seven years has assessed how well health care facilities are treating LGBT patients and employees. It found most fell far short of full LGBT patient equality — yet still collect taxpayer money through healthcare reimbursements.

The research revealed the following:
• Only half had employment non-discrimination policies that included sexual orientation and gender identity.
• Of those with patient non-discrimination policies, 72% contained sexual orientation protections, but only 52% included protections for gender identity, leaving transgender patients particularly vulnerable to inequitable treatment
• More than 20% failed to incorporate patient non-discrimination and equal visitation information on the facility’s website

The good news is that the number of survey participants continues to grow, and their leaders are striving to meet Arc’s criteria for equal treatment of LGBT patients and employees. For more information, visit

The Student Health Insurance Industry Is Growing

The U.S. student health insurance industry and the two insurers that dominate the market saw their largest growth in five years in 2013, according to a survey by SNL Financial. Aetna grew its premiums by 11.12% in 2013, while UnitedHealth Group Inc. grew the business 21.20%. The two companies hold 60.34% market share in this segment. Overall industry premiums earned grew 20.58% to $1.74 billion from $1.44 billion in 2012. During 2013, the overall industry reported loss ratio came in at 79.13%, compared to 76.34% in 2012.

Aetna serves more than 200 colleges and universities with over 500,000 medical plan student members and their dependents. Aetna ranked first in the 2013 U.S. student health insurance market share rankings with 35.79% market share. The company reported earned premiums of $623.5 million in 2013, up from $561.1 million in 2012. The loss ratio for this segment was reported at 82.05% in 2013, up from 78.52% in 2012. Aetna writes its student business through subsidiary Aetna Life Insurance Co.  Student health plans are reported annually on the Accident and Health Policy Experience Exhibit of NAIC statutory filings. These exhibits are reported by entities filing under P&C, life and health sectors under individual and group policy sections. SNL aggregates the premium amounts reported in the individual and group sections of these exhibits to calculate the total premiums and loss data. For more information, visit


More Options for Breast Cancer Survivors

Breast cancer survivors who feel that life insurance is out of reach should take a second look. Life insurance is widely available at competitive prices for recovering breast cancer patients, according to a study by “We conducted a fresh survey in honor of Breast Cancer Awareness Month, and the results show that a robust, competitive life insurance marketplace for breast cancer survivors,” said founder and CEO, Robert Bland. The best possible monthly prices for a 20 year, medically underwritten, level term life policy that covers death by any cause, at any time, in any place, except for suicide in the first two policy years (one year in some states). The sample 20-year term life policy is also renewable, without evidence of insurability, to age 90+ and convertible to permanent insurance without having to undergo any further underwriting. The 20-year level term policy is the most popular customer choice at and so we felt that exhibiting available premiums for this policy would be informative. Rates on a ten year policy would cost less, while rates for policies with 25, 30 or lifetime rate guarantees would cost more,” said Robert Goss, executive vice president of LifeQuotes. For more information, visit


MS Guide

The Multiple Sclerosis Association of America (MSAA) is offering comprehensive, easy-to-follow information and resources for the MS community about the health insurance marketplace under the Affordable Care Act (ACA), Medicare, Medicare Advantage, and Medicaid. Visit and click on Health Insurance Guide.

White Paper on Reducing Medicare Surcharges 

HealthView Services is offering a white paper on Medicare Surcharges and a Calculator to help Americans better understand, manage and reduce Medicare surcharges in retirement. For more information, visit

WellPoint Affiliates Offer Wide Medicare Options

WellPoint’s affiliated Medicare offerings for the 2014 enrollment season will include new plans, new provider collaborations, enhanced benefits and online doctor visits.

The traditional Medicare Advantage and Part D enrollment season begins on Oct. 15 with the opening of the Annual Election Period (AEP) and continues through Dec. 7. This is when most people eligible for Medicare, including those 65 and older and those with certain disabilities, buy or change their Medicare plans. WellPoint affiliates in 21 states will offer a host of plans this year, including Medicare Advantage (MA), Prescription Drug Plans (PDPs), Medicare Advantage Prescription Drug Plans (MAPD), group plans and Medicare Supplement products.

“We recognize that no two Medicare beneficiaries are the same so we are offering an expanded continuum of products with the goal of having something for every beneficiary to consider. “This year, in particular, we’ve focused on developing products that are a good value and easy to use with benefits that help members get and stay healthy,” said Marc Russo, president of Medicare programs for WellPoint.

WellPoint has developed new, value-based contracting partnerships with high-quality providers across the country in an effort to coordinate health care and improve the quality of care for its members while working to ensure appropriate services are provided. “Through these new types of relationships, we are working more closely with health care providers than ever before,” Russo said.

WellPoint affiliates are adding Dual-Eligible Special Needs Plans (DSNPs) in 145 counties in 12 states this year. DSNPs are MA plans that provide enhanced benefits to people eligible for Medicare and Medicaid. DSNPs are the largest and fastest growing type of the special needs plans1. These plans are $0 premium plans with $0 copays. All include dental and vision coverage, many feature some transportation to doctor’s appointments, and some include over-the-counter drug coverage. HMOs are being introduced in 67 new counties in nine states.

Vision and dental benefits are being added in most WellPoint-affiliated MA plans this year where they didn’t exist Most WellPoint-affiliated MA plans will now also include a program to help members with advanced illness planning. The Vital Decisions program provides counseling by telephone to help members with certain advanced illnesses identify their goals, share them with loved ones and take steps toward meeting them.

More preferred pharmacies. Members of all of WellPoint’s affiliated Part D standalone Prescription Drug Plans (PDPs) and most of its affiliated Medicare Advantage Prescription Drug Plans (MAPD) can save on their drug copays by using a preferred pharmacy. The number of preferred pharmacies is increasing by almost 50 percent this year.  For more information, visit

Innovations In Healthcare Website

The AARP announced the launch of “The Longevity Network” to promote innovations in health care that will improve the quality of people’s lives as they age. The two organizations unveiled at the 2014 HealthTech

Benefit Engagement Software

Navera announced its latest release of Benefits Engagement software, a cloud-based service that enables employees and consumers to select the healthcare and voluntary benefits that most closely match their needs. The 2014 Fall Release includes major enhancements to the consumer experience and to profile-driven and context-sensitive plan recommendations.  It also offers first-time functionality to support a portfolio approach to benefits enrollment.  Steve L. Adams, CEO of Navera said, “This is a major release driven primarily by client and partner feedback and lessons learned from multiple deployments. The release delivers a first-class consumer experience that is people centric and communications focused.  The release also builds upon the animation and storytelling that have served our clients well.  Consistent with our mantra that ‘voluntary benefits are the new core benefits,’ we’re also providing more extensive decision support for healthcare and voluntary benefits. And, finally, our portfolio approach is based upon the premise that consumers need to learn more about how healthcare and voluntary benefits work together to provide the most complete and cost-effective coverage.”  For more information, visit

Virtual Health Concierge

PlushCare, the virtual healthcare concierge, announced that it has emerged from beta to virtually connect any patient with online doctors educated at world-class medical schools Stanford and UCSF. Available on a pay-per-visit basis or through an ongoing workplace benefit plan, PlushCare offers same-day diagnosis, treatment, and as-needed prescriptions for urgent care, chronic illnesses or health advice all from a patient’s computer or smart phone. All-inclusive, a PlushCare examination is available for a $45 flat rate regardless of a patient’s health insurance status. PlushCare will start in California before rolling out across the United States. PlushCare appointments are available for $45 per visit. For more information, visit

Private Exchange Solution

Connecture introduced On Ramp, a full-service, private health insurance exchange solution and benefit portal. For more information, visit OnRamp.



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