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by Leila Morris
• Why Brokers Must Get Up to Speed on HIPPA Rules Now
• Carriers May Be Declining More Individual Application
• WellPoint Sees a Jump in 4th quarter profits
• HMO-Like Plans May Be Poised for Comeback in Online Insurance Markets
• NAIC Leader Tied to Insurance Money
• The Public Supports Creating State Insurance Exchanges
• Health Net Offers Medi-Cal Plan in San Joaquin County
• Aetna Offers Individual Plans to Costco Members
• Health Reform Resource Center for Brokers
• A Look at So Cal Health Markets
• Health Net and Tenet Reach Agreements
• Governor Brown Calls Session to Implement Health Reform
• CAHU Needs Your Real Life Examples
LIFE AND HEALTH INDUSTRY UPDATE
• Study Highlights Industry Obstacles
• Vision Coverage
• Health Insurance Exchange 2013 Directory
Why Brokers Must Get Up to Speed on HIPPA Rules Now
If you are not protecting your clients’ health information according to HIPPA privacy rules, you could be in deep trouble. The Dept. of Health and Human Services (HHS) issued a rule to expand many HIPPA requirements to business associates that receive protected health information, such as contractors and subcontractors. Some of the largest breaches reported to HHS have involved business associates. HIPPA penalties for non-compliance are no laughing matter. Under this rule, they have been increased based on the level of negligence with a maximum penalty of $1.5 million per violation.
Another interesting provision is that, a patient who pays by cash can instruct their provider not to share information about their treatment with their health plan.
The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS.
“This final omnibus rule marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented. These changes not only greatly enhance a patient’s privacy rights and protections, but also strengthen the ability of my office to vigorously enforce the HIPAA privacy and security protections, regardless of whether the information is being held by a health plan, a health care provider, or one of their business associates,” said HHS Office for Civil Rights Director Leon Rodriguez.
In addition, patients can ask for a copy of their electronic medical record in an electronic form. The final omnibus rule sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individual’s health information without their permission.
The final rule also streamlines individuals’ ability to authorize the use of their health information for research purposes. The rule makes it easier for parents and others to give permission to share proof of a child’s immunization with a school and gives covered entities and business associates up to one year after the 180-day compliance date to modify contracts to comply with the rule.
The final omnibus rule is based on statutory changes under the HITECH Act, enacted as part of the American Recovery and Reinvestment Act of 2009, and the Genetic Information Nondiscrimination Act of 2008 (GINA) which clarifies that genetic information is protected under the HIPAA Privacy Rule and prohibits most health plans from using or disclosing genetic information for underwriting purposes.
The Rulemaking is in the Federal Register at https://www.federalregister.gov/public-inspection.
Carriers May Be Declining More Individual Application
Carriers are rejecting an average of 22% of applications for individual and family health plans, according to a study by HealthPocket. In comparison, a 2010 congressional study of the largest for-profit insurer found a decline rate of one in seven applications.
Kev Coleman, head of research & data at HealthPocket said, “Clearly there is great variability across states and within states, but nationally, it seems to be occurring more frequently than industry analysts had assumed. What is unclear is whether some insurers have increased their decline rate in order to improve risk pool health and profitability before 2014 when insurance companies can no longer reject applications based upon health status or pre-existing medical conditions.”
Some insurers decline more than 70% of applicants while others rarely decline applicants. There is also significant variability in different markets. For example, Kaiser Permanente plans have a decline rate of 34% in Georgia and a 22% in Hawaii. Some non-profit insurance companies have higher decline rates than do for-profit insurers.
For more information, visit http://www.healthpocket.com.
WellPoint Sees a Jump in 4th quarter profits
WellPoint reported stronger than expected fourth quarter results. John Cannon, interim president and CEO said “The results reflect ìimproved operating performance, solid expense management, and improving execution in our core operations. We are encouraged by this strong performance, and believe it positions us well for a solid 2013.”
Wayne DeVeydt, executive vice president and chief financial officer said, “Our fourth quarter results reflected lower than anticipated commercial medical costs and stability in our membership base. Our results were supported by the strength of our operating cash flow and year-end balance sheet metrics. We are encouraged by the performance of our associates and the business in the last six months, but we also want to retain an appropriately prudent stance in our outlook, in light of what we expect to be a fluid and dynamic market over the next 18 to 24 months. This is reflected in our initial expectation for 2013 EPS of at least $7.60.”
WellPoint reports the following results:
• Membership: Medical enrollment totaled 36.1 million members on December 31, 2012, an increase of 5.5% from December 31, 2011. The acquisition of Amerigroup added nearly 2.7 million state-sponsored members during the fourth quarter of 2012. Membership also grew by 74,000 in the senior business, primarily due to expansion into new Medicare Advantage service areas during 2012. The increases in state sponsored and senior membership were offset by a 578,000 decline in local group members and a 321,000 decline in national businesses and members. These declines reflected the company’s small group product repositioning in New York and changes to its administrative fee structure for certain national accounts. Enrollment was also impacted by economy-related in-group membership attrition and competitive situations in certain local group markets.
• Operating Revenue: Operating revenue totaled about $15.3 billion in the fourth quarter of 2012, an increase of $95.8 million, or 0.6%, compared to the prior year quarter. This increase included revenue of about $316.8 million related to the Amerigroup and 1-800 CONTACTS acquisitions.
• Benefit Expense Ratio: The benefit expense ratio was 87.3% in the fourth quarter of 2012 compared to 87.6% in the fourth quarter of 2011. The decline reflects increases in senior and state sponsored businesses in the commercial market.
• Medical Cost Trend: For the full year 2012, the underlying local group medical cost trends was near the low end of 7%. Unit cost increases continue to be the primary driver of medical trend while utilization moderated over the second half of 2012. The company expects the underlying local group medical cost trends to increase during 2013 and be within the range of 7% for the full year.
• Commercial Business: Operating gain in the Commercial segment increased 22% in the fourth quarter of 2011 — driven by an improvement in the benefit expense ratio for local group business. This was offset partially by the reduction in fully insured Local Group membership and increased SG&A expense.
• Consumer Business: The company has experienced an operating loss of $173.3 million in the consumer segment during the fourth quarter of 2012, compared to an operating loss of $4.6 million in the fourth quarter of 2011. The majority of the decline in consumer segment results was driven by closing costs with the Amerigroup acquisition as well as other severance and impairment expense items. The company also saw a decline in the results of its senior and state sponsored programs and has taken steps to improve the future performance of these businesses.
WellPoint expects the following for the full year of 2013:
• Net income is expected to be at least $7.60 per share, including integration costs related to the Amerigroup acquisition. Year-end medical enrollment is expected to be in the range of 35.3 million to 35.5 million.
• Operating revenue is expected to be from $71.5 billion to $73.0 billion.
• The benefit expense ratio is expected to be 86%.
• The SG&A expense ratio is expected to be 13.5%.
• Operating cash flow is expected to be at least $2.6 billion.
For more information, visit www.wellpoint.com.
HMO-Like Plans May Be Poised for Comeback in Online Insurance Markets
by Julie Appleby KHN Staff Writer
Reprinted with permission by www.kaiserhealthnews.org.
It’s back to the future for insurers, which plan to sharply limit the choice of doctors and hospitals in some policies marketed to consumers under the health law, starting next fall.
Such plans, similar to the HMOs of old, fell into disfavor with consumers in the 1980s and 1990s, when they rebelled against a lack of choice.
But limited network plans – which have begun a comeback among employers looking to slow rising premiums – are expected to play a prominent role in new online markets, called exchanges, where individuals and small businesses will shop for coverage starting Oct. 1. That trend worries consumer advocates, who fear skimpy networks could translate into inadequate care or big bills for those who develop complicated health problems.
Because such policies can offer lower premiums, insurers are betting they will appeal to some consumers, especially younger and healthier people who might see little need for more expensive policies.
“Insurers, who are designing their plans for next fall, will start with as tight a network control as they can,” says Ana Gupte, a managed care analyst with Sanford Bernstein.
Plans may also benefit from offering such policies because they are less attractive to those with medical problems, who can no longer be turned away beginning in January 2014.
“Plans will basically say they can minimize their risk by creating narrow networks,” says John Weis, president of Quest Analytics, an Appleton, Wis., firm that analyzes provider networks for insurers.
“State or federal regulators, who must review the plans sold in the online markets, are unlikely to permit them to exclude an entire class of doctors, such as cancer or diabetes specialists. But there might be more subtle ways to discourage consumers with medical problems. They might have too few oncologists, or only general oncologists, for example,” says Stephen Finan, senior director of policy with the American Cancer Society Cancer Action Network, an advocacy group in Washington.
Cost Vs. Choice
“Narrow networks may be more than adequate 90% of the time,” Finan says, “but are not well-suited to deal with complicated medical conditions and chronic diseases.”
That’s because there may be few or no specialists available for certain complex conditions, so patients may have to seek care outside of the networks. If the policy doesn’t cover non-network care, they may end up footing the bill themselves. Even if policies allow for outside the network coverage, patients can incur large copays or other costs. Your (financial) exposure could be high, Finan says.
The federal health law requires the policies to include a standard set of essential benefits, from emergency room and hospital care to prescription drugs, but the law is less prescriptive about the size of the policies’ networks of participating doctors and hospitals.
In March, the Obama administration issued rules stating that insurers must maintain a network of a sufficient number and type of providers, including providers that specialize in mental health and substance abuse, to assure that all services will be available without unreasonable delay. That fell short of the standards sought by some consumer advocates, but pleased other groups that say insurers should have broad discretion to shape their networks to meet regional needs.
The administration noted that nothing in the final rule limits an exchange’s ability to establish more rigorous standards.
Insurers contend that by limiting network size, they can offer plans with higher quality or more efficient doctors and hospitals, which might slow spending or improve care.
Networks are already part of most health plans. For doctors and hospitals, joining a network brings in business. In exchange, they agree to negotiate their prices with insurers.
Driven by consumer and employer demand for lower-cost plans, insurers are already rolling out narrow network policies that have shaved premiums 10% or more. A recent survey by benefit firm Mercer found that 23% of large employers offered such plans this year, usually among a choice of plans, up from 14% in 2011. In Massachusetts, insurer Harvard Pilgrim launched its Focus Network in April, touting 10% lower premiums. While it includes 50 hospitals and 16,000 physicians, it excludes some of the state’s highest-cost systems.
In California, Blue Shield has a number of SaveNet HMO plans that contract with select doctor and hospital groups, creating networks averaging a little more than half the size of its standard ones. Next year, for example, one serving Marin and Sonoma counties will offer a network of about 100 primary care doctors and 325 specialists.
Still, narrow network plans are a hard sell to employers, particularly the large ones, which don’t want to hear gripes from workers about limited choice of doctors simply to save 10% on premium costs.
But small businesses and individuals buying their own coverage in the online markets might regard that tradeoff differently. “If my doctor is in the network and cheaper, it might work,” says Wall Street analyst Carl McDonald at Citi Research, a division of Citigroup Global Markets.
Competing On Price
“To stand out from competitors, some plans may choose to offer the lowest possible rates, and would narrow their networks to do so,” says Chet Burrell, CEO of insurer CareFirst in Maryland. He acknowledged that narrow networks could be a subtle but powerful way to discourage less-than-healthy applicants. The question will be what degree of tolerance will a state have to permit narrow networks?
State rules on what makes an adequate insurance network vary. Some states, including California, specify that specialists must be available within a certain driving time or distance. Others simply say insurers must have sufficient numbers of providers. Some states don’t have any requirements.
“State rules are very, very loose,” says Weis at Quest, who says that states should consider adopting the rules that now apply to Medicare Advantage, the private market alternative to Medicare. In that program, the federal government requires networks to include primary care physicians and more than 25 types of specialists, and sets county-level requirements on the minimum number of doctors required in each category and how far patients might have to travel to see one.
Even though state rules vary, regulators say plans that are too skimpy will be called out by regulators, or consumers. “We will look very closely at how plans put their packages together,” says Sandy Praeger, the elected insurance commissioner in Kansas. “If you have a crummy network, no one will buy the plan,” says consultant Robert Laszewski, a former insurance executive, adding that the law also includes programs that financially reward insurers that get a large share of sicker patients and penalize those that get a healthier and more profitable bunch.
Many policies that offer a limited network of doctors and hospitals generally allow patients to go to out-of-network providers, with whom they do not have negotiated prices. But patients who seek such care face significant co-payments, which often start at 30% of the bill and can go as high as 50%.
“It is often hard for consumers to figure out how much they might be charged if they go out of network,” says Lynn Quincy, senior policy analyst at Consumers Union, publisher of Consumer Reports magazine. In addition to meeting separate annual deductibles for out-of-network care, patients can be balance-billed by doctors or hospitals for the difference between what the insurer pays them and their total charges.
That doesn’t change under the federal health law, so consumers could be left on the hook for tens of thousands of dollars. There’s no escaping that we’re going to see insurance policies that include networks wide and narrow,” says Quincy.
NAIC Leader Tied to Insurance Money
New NAIC CEO Ben Nelson’s Senate campaigns were financed largely by the insurance industry, according to a report by SNL Financial. His personal wealth is also tied to the insurance and financial services sectors, according to disclosure forms. Meanwhile, Nelson has taken a second new job with a Washington, D.C., public affairs firm. A 2012 examination of congressional wealth conducted by The Washington Post identified Nelson as having $1.7 million in insurance policies and annuities. That examination pegged Nelson’s net worth at $10.2 million in 2010. Read the full report here:
The Public Supports Creating State Insurance Exchanges
Fifty-five percent of American say that creating state-based health insurance exchanges is their state’s top of the health priority this year, according to a survey by the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the Harvard School of Public Health. Drew Altman, president and CEO of the Kaiser Family Foundation said, “Governors are largely splitting along partisan lines on the exchanges, but the public is not. People like the idea.”
While some Republican governors are balking at the optional expansion of Medicaid under the ACA, 52% of Americans say their state should expand its Medicaid program. Sixty-six percent of Republicans prefer to keep their state Medicaid program as is; 75% of Democrats are seeking a state expansion; and Independents are evenly divided.
So far, 18 states and the District of Columbia plan to create their own state-based exchanges; seven other states will establish exchanges in partnership with the federal government; and 25 will default to a federally-run exchange.
Fifty-two percent of Americans (including 78% of Republicans) say that opponents of the ACA should continue trying to change it so that the law has less impact on taxpayers, employers, and health care providers. Forty percent say that those opposed to the health care law should accept that it is now the law of the land and stop trying to block its implementation.
Policy makers involved in budget deficit negotiations face a conundrum. Sixty-five percent of Americans say that Washington should act quickly to bring down the deficit, but there is little public appetite for major reductions in federal health care spending. “In a climate heavily focused on reducing the federal budget deficit, the public still places a high priority on federal spending on veterans’ health care, medical research, health-related responses to disasters, and preventing chronic and infectious diseases,” said Robert Blendon of the Harvard School of Public Health. Fifty-eight percent oppose any cuts to Medicare and 46% oppose any cuts to Medicaid.
Americans support only two of six proposals to trim Medicare. Eighty-five percent say drug companies should be required to give the federal government a better deal on medications for low-income people on Medicare. Fifty-nine percent say that high-income seniors should have to pay higher Medicare premiums. Fifty-one percent oppose gradually raising the age of Medicare eligibility for from 65 to 67 – an idea that’s making the rounds in Washington. Sixty-one percent strongly oppose requiring all seniors to pay higher Medicare premiums. The poll also found a widespread view that Medicare cuts are not really needed; the public believes that there are better ways to reduce the deficit, such a reducing funding for foreign aid and reducing spending in Afghanistan.
For more information, visit http://www.kff.org/kaiserpolls/8405.cfm.
Health Net Offers Medi-Cal Plan in San Joaquin County
Through Health Net Community Solutions Medi-Cal plan, San Joaquin County residents now have access to physicians, specialists, hospitals, emergency rooms, pharmacies and a 24-hour nurse advice telephone line. Health Net’s Medi-Cal plan – as well as its commercial HMO, POS, PPO and Healthy Families Program lines of business – have been awarded the Multicultural Health Care distinction by the National Committee for Quality Assurance. For more information, visit www.healthnet.com.
Aetna Offers Individual Plans to Costco Members
Aetna is now offering individual health insurance plans to Costco members in California. The Costco Personal Health Insurance program includes five plans. It offers broad major medical benefits; dental options; an extensive network of doctors and hospitals. In addition to California, the Costco Personal Health Insurance program is also available to Costco members in Arizona; Connecticut; Georgia; Illinois; Michigan; Nevada; Pennsylvania; Texas; and Virginia. Aetna plans to expand the program to other markets in the coming months. Costco is providing lower copays on prescriptions at Costco pharmacies. In addition, all plans include special features and lower monthly premiums negotiated only for Costco members. For more information, visit www.costcopersonalhealth.com.
Health Reform Resource Center for Brokers
Word & Brown General Agency has launched a Health Reform Resource Center designed to provide insurance brokers easy access to the information they need to help consumers and small business owners understand and comply with the new requirements contained in the Affordable Care Act (healthcare reform). Included in the online resource center are tools and information about eligibility, enrollment and tax credits. The center also provides information on health insurance exchanges including the California Health Benefit Exchange’s Small Business Health Option Program (SHOP), which will offer health insurance to groups with 50 or fewer employees. Brokers need to login to access the Resource Center. For more information, visit www.wordandbrowncompanies.com.
A Look at So Cal Health Markets
Center for Studying Health System Change (HSC) offers the following snapshot of the Los Angeles and San Diego Health Markets:
• Physician organizations, hospitals, and others are seeking tighter affiliations with physicians to gain patients, compete with Kaiser Permanente, and prepare for health reform.
• Hospitals considering affiliating or even merging with each other to help adjust capacity, expand referral bases, organize service-line strategies, and improve care coordination.
• LA physician organizations are developing accountable care organizations (ACOs). The two largest physician organizations, HealthCare Partners and Heritage Provider Network, are participating in Medicare ACOs, and HealthCare Partners is working with Anthem Blue Cross in a commercial ACO.
• Private hospitals are working with community health centers to help public and private safety net providers remain financially viable, use existing capacity to serve more patients, and improve patient care as the county prepares for health reform.
• Unlike in other markets, there has been substantial Medi-Cal ACO activity, with two ACOs under development that include safety-net hospitals, community health centers and Medi-Cal health plans.
The Los Angeles report is available at
• There has been substantial hospital construction to meet state seismic requirements and improve competitive positions. As health reform moves forward, there are some concerns that the market may be moving toward excess capacity for some services and in some geographic markets.
• Hospitals are investing in lucrative service lines, including cardiovascular care, cancer care, and women’s and children’s services, particularly in more affluent markets in the northern region of the county. Physician organizations that are tightly aligned with hospitals are buying practices in the service areas of competing hospitals to shift patient referrals to their aligned hospitals.
• Plans and providers are developing lower-premium commercial products featuring limited-provider networks. This is due to the pressure to offer more affordable insurance products and competition from Kaiser. Low-cost provider, Sharp HealthCare, is at the center of many collaborations. Collaborations include ACOs formed with Sharp-affiliated physician organizations. Sharp uses capitation, or fixed per-member, per-month payment.
• Many safety net providers have expanded capacity to meet increased demand for outpatient services as a result of the economic downturn. San Diego’s extensive, well-established federally qualified health centers (FQHCs) have been able to use new federal grants to finance expansions and upgrades of existing facilities. Hospitals that provide substantial safety net care in economically struggling areas of the county have expanded some services, particularly emergency department capacity.
• Long regarded as having a weak commitment to the safety net, county officials have made health and health care a higher priority in recent years. They approved a 10-year strategic plan to improve care for low-income people, including efforts to establish patient-centered medical homes, integrate mental health care with primary care, and coordinate health care with other social services.
The San Diego Fresno report is available at
Health Net and Tenet Reach Agreements
New, multi-year agreements give Health Net members access to medical care at all 11 Tenet Healthcare hospitals in California. In addition to covering Tenet Healthcareís 11 facilities statewide, the two-year agreements reinstate and retroactively cover Tenet Healthcare’s six Southern California hospitals that were terminated from Health Net’s network on December 22, 2012, as if there was no termination.
The six Southern California Tenet Healthcare hospitals are: Desert Regional Medical Center in Palm Springs, Fountain Valley Hospital and Medical Center, JFK Memorial Hospital in Indio, Lakewood Regional Medical Center, Los Alamitos Medical Center, and Placentia-Linda Hospital.
The Northern California Tenet Healthcare hospitals are: Doctors Hospital of Manteca, Doctors Medical Center of Modesto, San Ramon Regional Medical Center, Sierra Vista Regional Medical Center in San Luis Obispo, and Twin Cities Community Hospital in Templeton.
Governor Brown Calls Session to Implement Health Reform
In his recent state of the state address, Governor Jerry Brown called for a special legislative session on healthcare to further implement the Federal Patient Protection and Affordable Care Act. “I am calling for a special session to deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January The broader expansion of Medi-Cal that the Act calls for is incredibly complex and will take more time. Working out the right relationship with the counties will test our ingenuity and will not be achieved overnight. Given the costs involved, great prudence should guide every step of the way,” he said.
The legislative session will cover the following:
• Rules and regulations governing the individual and small group health markets related to guaranteed issue coverage, pre-existing condition exclusions, rating restrictions, and any other requirements necessary to conform state law to federal rules.
• Requirements for Medi-Cal eligibility, enrollment, and retention.
• Low-cost health coverage options in the California Health Benefit Exchange, for individuals with incomes up to 200% of the federal poverty level.
CAHU Needs Your Real Life Examples
CAHU is asking brokers to submit real stories of how the combination of self-insurance and stop-loss coverage helped a small business provide health coverage. The names of the company and agents will not be used. CAHU explains that the legislature is already gearing up to revisit the issue of stop loss insurance. Last year, CAHU worked with NAIFA California and the Independent Insurance Agents and Brokers of California, to put the passage of SB 1431 on hold.
An example that CAHU used last year was the story of a small business with an employee who has a baby with Down’s Syndrome. Off-the-shelf insurance coverage wouldn’t address the family’s special needs, so the company self-insured for health care, including expanded benefits for speech therapy and orthotics for the child. The self-insurance plan also included stop loss coverage to protect against large catastrophic claims. This customized health insurance package made the premiums affordable for the employer and the employees. CAHU said that this story resonated with legislators, making it possible to show how real people would be negatively affected if stop loss insurance was taken out of the health agent’s tool box. You can e-mail stories to Juli Broyles at firstname.lastname@example.org.
Study Highlights Industry Obstacles
Economic uncertainty is making it hard for life insurers to expand their customer base. In fact, insurers are struggling even to retain clientele. High unemployment and huge credit card debt are making it hard for Americans to invest in retirement products such as life insurance, according to Zacks Industry Outlook.
Also, the low interest rate environment is a major risk to life insurers at this point. Investment income remains weak as life insurers experience low returns on fixed-income instruments. Also, low rates are spoiling life insurers’ efforts to grow fixed annuities and universal life insurance sales.
In December, Fitch Ratings has affirmed the credit outlook for the U.S. life insurance industry as stable for 2013. Insurers are expected to have improved liquidity and balance sheet strength. The rating agency also expects the low interest rate environment to restrict earnings growth of the sector.
There is growing interest in cheaper products to cover only basic risks. As a result some life insurers have already gone back to the basics in order to escape financial and regulatory hardship.
Life insurers with favorable Zacks Ranks are Aviva with a Zacks Rank #1 (Strong Buy); Genworth Financial and ING Groep NV with a Zacks Rank #2 (Buy).
Health insurers depend on using a pre-existing condition exemption clause to control costs and maximize profits. But, they will no longer be able to do so under the ACA. While the legislative overhaul brings more regulatory scrutiny on private insurance companies, the net negative effect is far softer than was initially feared. Also, the removal of this uncertainty is a positive. For more information, visit Zacks.com.
Colonial Life has teamed up with Superior Vision to offer vision benefits nationwide. The vision insurance includes comprehensive eye exams, eyeglass frames and lenses, contact lenses, and a contact lens fitting exam and discounts on additional glasses and contacts. Employer groups can choose a full benefit package or a plan that includes glasses and contacts without the exam. Superior Vision has a provider network of more than 48,000 ophthalmologists, optometrists, opticians, and regional and national retail chain locations, including LensCrafters, Pearle Vision, Wal-Mart Vision Centers, Target Optical, Sam’s Club, America’s Best, and Visionworks. Employees can sign up for the vision plan as part of their regular enrollment and can pay premiums through convenient payroll deduction. For more information, visit www.superiorvision.com.
Health Insurance Exchange 2013 Directory
Healthquest publishers is offering its 2013 health insurance exchange directory as a PDF document with a supplementary excel spreadsheet for $95. For more information, visit www.healthquestpublishers.com or call 209-577-4888.