Category Archives: Uncategorized

Premiums Continue to Increase

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Rate Increases – the New Norm?
Across the U.S., insurers have filed their 2017 rate requests. Many people are asking, “Why are healthcare premiums for individual plans on the rise?” As noted in previous alerts, there are many factors that go into calculating rates, including the amount of services used, as detailed in this recent article from The Motley Fool.

Since the start of the Affordable Care Act (ACA), those with insurance are using more services than premiums cover. Although insurance companies nationwide expected an influx of people who would require additional care, the volume far exceeded expectations. In addition, fewer younger, healthier individuals enrolled than anticipated to counter these costs. In 2014, consumers used $2.5 billion more in services than premiums covered, according to ModernHealthcare. In the last two years, Blue Cross Blue Shield of Arizona (BCBSAZ) has lost more than $185 million offering plans associated with the ACA.

Watch for additional articles and information to be posted at the media center on azblue.com. You may also want to join our Twitter feed and LinkedIn community if you haven’t already.

Information from Blue Cross/Blue Shield of Arizona

New Guidance for Preventive Services and Wellness Programs

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On Oct. 23, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released frequently asked questions (FAQ)that provided clarification on the implementation of coverage of preventive services, non-financial incentives given to wellness program participants, and disclosure requirements under the Mental Health Parity provision.

UnitedHealthcare is currently reviewing the FAQ and will be communicating at a future date any updates to coverage once determined.  Below is a summary of the questions addressed in the FAQ Part XXIX.

Coverage of Preventive Services
Health reform law requires non-grandfathered group health plans and health insurance coverage offered in the individual or group market to cover certain preventive care services without cost-sharing. The FAQ Part XXIX provides clarity on the standards used to determine which services are required to be covered in network without cost-sharing.

  • Question 1 – Plans and issuers are required to provide a list of the lactation counseling providers available within the network under the plan or coverage.
  • Question 2 –If a non-grandfathered health plan’s network does not have network options for lactation counseling services, the plan cannot impose cost-sharing on the member if services are received out-of-network.
  • Question 3 – If a member’s state does not license lactation counseling providers and a plan only covers services received from providers licensed by the state, the lactation counseling must be covered without cost sharing when it is performed by any provider acting within the scope of his or her license or certification under state law.
  • Question 4 – Plans cannot limit coverage for lactation counseling without cost-sharing to services provided on an inpatient basis, while imposing cost-sharing for lactation counseling on an outpatient basis. Additionally, coverage for lactation support services without cost-sharing must extend for the duration of the breastfeeding.
  • Question 5 – The requirement to cover the rental or purchase of breastfeeding equipment without cost-sharing extends for the duration of breastfeeding and cannot be limited to a set number of months, provided the individual remains continuously enrolled in the plan or coverage.
  • Question 6 – Non-grandfathered health plans cannot impose general exclusions that would encompass recommended preventive services. For example, non-grandfathered health plans cannot contain a general exclusion for weight management services for adult obesity. Non-grandfathered health plans must cover without cost-sharing, screening for obesity in adults, in addition to behavioral interventions for weight management for certain populations.
  • Question 7 – If a colonoscopy is scheduled and performed as a screening procedure based on USPSTF recommendation, a plan or issuer may not impose cost-sharing with respect to a required consultation prior to the colonoscopy, if the provider determines that the pre-procedure consultation would be medically appropriate.
  • Question 8 – After colonoscopy is performed as a screening procedure based on USPSTF recommendation, the plan or issuer must cover any pathology exam on a polyp biopsy without cost-sharing.

 

For more information about Preventive Care Services, Wellness Programs, and Mental Health Parity, visit the United for Reform Resource Center or contact your UnitedHealthcare representative.

Affordable Care Act Rules Finalized

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After five years of interim rules governing implementation of the Affordable Care Act, along with repeated modifications through guidance and clarification documents, HHS and the Labor and Treasury departments have finalized the regulations. The final rules cement existing policy related to coverage of adult children up to age 26, pre-existing conditions and other central tenets of the ACA.

 

Harry Reid exempts Senate staff from exchanges

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The biggest public supporter of the Affordable Care Act (ACA) has reportedly decided that some of his staff should be exempted from the new law.  CNN reports that Senate Majority Leader Harry Reid is the only congressional leader to exempt some of his staff from having to buy insurance through the ACA exchange.  While our country leaders have been exempted, the law specifically says that Congressional staff must purchase coverage through the exchange.

Easiest Way To Access The Exchange

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With difficulty is accessing the Affordable Care Act’s website, many are choosing to use Paper Applications.  Whether Paper of internet your best solution may be to contact a licensed Insurance Agent to assist.  Whether it is a Small Group or an Individual need, the Covered California or the ACA options are not easily understood.  Call your insurance agent and ask to be directed to a “Licensed health Insurance Agent” .

Will Policy Cancellations Be Reversed?

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WILL YOU BE ABLE TO KEEP YOU CURRENT HEALTH PLAN?  Even though the President announced the government would allow health insurers to continue to offer coverage that doesn’t comply with the Affordable Care Act (ACT) requirements, the issue is far from resolved.  State regulators  must decide whether of not to allow plans to be implemented that violate Federal law.  Most states are still deciding how to proceed.

The Washington Post (tiered subscription model)/WonkBlog (11/18),

Woops! Hold It – Additional Guidance on Individual Health Plans

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It looks like the Health and Human Services (HHS)  has changed it’s mind and will verify income for individuals and families applying for subsidies.  Sources of information will include tax filings, Internal Revenue Services (IRS) and Social Security (SSA) data.

http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/income-verification-8-5-2013.pdf