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by Leila Morris
HEALTHCARE
? Most Small Businesses Don?t Understand Health Reform Requirements
??Doogie Howser Would Beat Marcus Welby in Patient Care Spending
IN CALIFORNIA
??Insurance Commissioner Urges Consumers to Challenge Treatment Denials
??Her Zumba Class Was a Dead Giveaway for Disability Fraud
??VSP Stays in California Due to Favorable Ruling
LIFE, DISABILITY, LTC
??Get Recognized for Your Service to Clients
EMPLOYEE BENEFITS
??Voluntary Sales by Employee Size
EVENTS
??Webinar on Winning the Small Business Marketplace
MOVERS AND SHAKERS
??Bernard J. Tyson Named Chairman and CEO of Kaiser
??Becky Patel Named Chairman of the Board of Delta Dental of California
??Christopher Hilger Elected To Securian Board of Directors
??American General Names Victoria Noel vice president, senior strategic account manager
NEW PRODUCTS
??Group Voluntary Products
??GSI Supplemental Disability Plans
??FSA Reimbursement
??CDHPs
??Automated Enrollment
HEALTHCARE
Most Small Businesses Don?t Understand Health Reform Requirements
Beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (ACA) requires businesses with the equivalent of 50 or more full-time employees to provide health insurance coverage for their workers. Businesses with fewer than 50 employees are exempt from this requirement, although employees may be required to purchase their own coverage.
Based on their size (fewer than 50 employees), only two of the businesses surveyed would be required by the ACA to offer health insurance coverage to employees in 2014. However, 34% believed incorrectly that they were required to buy insurance for employees in 2014 while 35% weren?t sure. Nearly 70% believed incorrectly or were not sure whether they would be required to pay a tax for not providing health insurance in 2014. Only 31% knew that the reform law does not require them to a pay tax if they don?t offer insurance. The survey also revels the following about small employers:
? 83% review company health plan benefits once a year.
??78% don?t know how health insurance exchanges could affect their business beginning in 2014.
??77% are not doing any long-term planning based on their expectations of how health care reform might affect their business.
??68% have no plans to drop coverage for employees in 2014.
??61% are most concerned about the cost and budgetary implications of health care reform.
??59% ask their employees for input when reviewing their company?s health insurance benefits.
??51% would consider increasing an employee?s share of premiums while 39% would consider increasing an employee?s deductible.
??44% said it would be fair to impose penalties on employees who don?t participate in wellness programs. More than 40% of the employers that are willing to penalize employees consider the following to be acceptable: reduce the contribution to an employee?s health insurance benefits; reduce benefits like dental and vision coverage; and reduce 401k contributions, stock options, or bonuses. For more information, visit www.eHealthMedicare.com.
Doogie Howser Would Beat Marcus Welby in Patient Care Spending
Doctors with the least experience spend significantly more money treating patients, according to a RAND study. Recently trained doctors may be more familiar with expensive new treatments. Also, their uncertainty and lack of experience may translate into more-aggressive medical care. Less-experienced doctors may also attract patients with problems that are harder to address. As newer doctors gain more experience and have longer relationships with patients, their practice patterns may become less costly. But, it is also possible that the cost differences remain throughout their careers.
Researchers looked at commercial health plan claims for more than 1 million Massachusetts residents from 2004 and 2005 to construct cost profiles for more than 12,000 doctors in the state. Doctors with less than 10 years of experience had 13.2% higher costs than doctors with 40 or more years of experience. Doctors with 10 to 19 years of experience had 10% higher costs; those with 20 to 29 years of experience had 6.5% higher costs; and those with 30 to 39 years of experience had 2.5% higher costs. Factors that did not affect costs include whether the doctor had a malpractice claim or disciplinary action, whether a doctor was board certified, or the size of the medical practice.
The cost difference does not suggest that less-experienced doctors provide better medical care. Previous research has found only a weak relationship between quality and spending. Researchers say that post-graduate training programs and specialty medical boards need to educate doctors about their responsibility to be good stewards of health care resources.
Researchers also say that the findings could have significant implications for less-experienced doctors who might be excluded from contracting networks or face lower payments as both private insurers and government programs look to reward health care providers who deliver quality care at a lower cost. For more information, visit http://www.rand.org/newsletters.html
IN CALIFORNIA
Insurance Commissioner Urges Consumers to Challenge Treatment Denials
Insurance Commissioner, Dave Jones, issued a statement urging policyholders to challenge their insurer if the company denies their claims for treatment. He reminds policyholders they have a right to appeal to the company and ask CDI to review the denial. There is also a fair chance a review of the decision could go in their favor.
According to the California Insurance Code, when insurers deny requested treatment as not a covered benefit they are required to give policyholders the specific provisions in their policy that exclude coverage. In addition, if companies deny coverage for a treatment as not medically necessary, they are required to outline the facts and law on which they based their denial.
Jones said, ?If your health insurer won?t initially cover your treatment, that?s not the end of it. As a consumer, you have options. You may file a request for assistance with my department whenever you have problems with an insurer involving a claim. Denial by an insurance company is not the final word. If your claim was denied because the insurer determined the treatment is not medically necessary or was experimental, you may request an independent medical review (IMR) from the Department at no cost to you. However, you must first file an appeal of the denial with your insurance company, using the company?s internal appeals/grievance process.?? For more information, visit http://www.insurance.ca.gov/0100-consumers/0020-health-related/0020-imr/upload/
HCB002IMR.pdf
Her Zumba Class Was a Dead Giveaway for Disability Fraud
Adure Renee Velazquez, 35, of Sacramento was arrested by detectives from the California Department of Insurance (CDI) Fraud Division. She was charged with three felony counts of disability insurance fraud. If convicted, she could face up to three years in state prison and a fine of $20,000. The estimated loss to the State of California is $29,788. The following is a timeline of her actions in 2011:
? January 21 ? was in a car accident.
? April???notified her employer she was receiving medical treatment for injuries from the accident.
? May???became a certified Zumba dance instructor.
? June 16???filed a non-industrial disability Insurance (NDI) claim through her employer.
? June 23???began receiving benefits.
? June 28???began receiving payments from the fitness center owner for her services as a Zumba dance instructor. Velazquez continued receiving treatment for her injuries while allegedly teaching and participating in Zumba dance exercises. She continued to receive NDI benefits until September 8, 2011.
VSP Stays in California Due to Favorable Ruling
The Sacramento Bee reports that Vision Service Plan isn?t going anywhere. In fact, a favorable decision by a state agency Tuesday prompted the Rancho Cordova insurer to green-light a plan to add 400 jobs in the area. The state agreed to rewrite the rules governing California?s fledgling online insurance market, a crucial piece of President Barack Obama?s overhaul of the health care system.
The revision gives companies like VSP ? which insure eye care only ? much greater access to sell coverage in the online market. VSP and other eye-care insurers can now take aim at the full range of Californians who will buy coverage through the market, which begins operations in January 2014.
VSP, which employs 2,100 Sacramentans, had hinted it might leave the state. A slew of government and business leaders, led by Senate President Pro Tem Darrell Steinberg, D-Sacramento, urged the agency to change its mind. Read more here.
LIFE, DISABILITY, LTC
Get Recognized for Your Service to Clients
The LIFE Foundation is accepting entries for the 2013 realLIFEstories Client Service Recognition Program. The annual program publicizeS compelling stories of the role insurance has played in helping families and businesses in times of great financial need. Insurance agents have until January 14, 2013 to share their life, disability or long-term care insurance success stories. Four winning stories, chosen by an independent judging panel, will be featured nationally in the fall of 2013. For more information, visit www.lifehappens.org/reallife
EMPLOYEE BENEFITS
Voluntary Sales by Employee Size
Employers with over 2,500 employees account for almost one-third of all voluntary sales, according to a recent Eastbridge Study. However, Gil Lowerre, president of? Eastbridge said, ?Sales numbers, alone, can be deceiving. If you look at the sales divided by the employee population (ESI) for each employer size, it becomes clear that some segments are underpenetrated while others are more penetrated. Specifically, the very large market (2,500 and over) is underpenetrated even though it accounted for the largest portion of sales given that there was such a significant difference between the sales mix and actual mix of employees for that size.?
The most penetrated market for 2011 was the 500 to 999 segment. While sales were just $587 million, the segment had the highest ESI. Bonnie Brazzell, vice president at Eastbridge said, ?The percentage of sales coming from any particular segment tends to change a great deal from year to year. For example, in the 2010 report, sales from the under-100-lives segment exceeded the percentage of employees in that segment (41% compared to 36 %), but the 2011 numbers show a sales mix of just 24% compared to 36% of the total employees. So the under-100 lives-segment went from contributing a proportionally higher than expected percent of sales to lower than expected.?
Voluntary Sales by Employer Size
Employer Size Segment Estimated 2011 Sales (millions)
<10 employees $179
10-25 employees $392
26-99 employees $781
100-499 employees $1,120
500-999 employees $587
1,000-2,500 employees $662
>2,500 employees $1,752
Total $5,478
For more information, visit www.eastbridge.com.
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EVENTS
Webinar on Winning the Small Business Marketplace
The Hartford is offering a free one-hour Webinar to share benefit-buying trends to brokers and agents. LIMRA?s Pat Cronin will explain how to win in the small business marketplace. It will be held Wednesday, Nov. 14 at 1:oo p.m. EDT. Cronin will also share LIMRA?s survey results showing the life and disability insurance purchasing trends of the small business segment by industry, size and geographic location. Register here?https://thehartford.webex.com/thehartford/k2/j.php?ED=206150942&UID=0&H
MOVERS AND SHAKERS
Bernard J. Tyson Named Chairman and CEO of Kaiser
The board of directors of Kaiser Foundation Hospitals and Health Plan named Bernard J. Tyson as the next chairman and chief executive officer of the organization. Tyson will succeed George Halvorson, who has served in the role since 2002 and recently announced that he will retire next year. To support a seamless transition process, Bernard Tyson, current president and chief operating officer of Kaiser Permanente, will join the board of directors next month. He will assume the role of CEO after a six-month transition period. Halvorson will remain chairman through the end of 2013, at which time Tyson will assume the role of chairman and CEO. Tyson, who lives in the Bay Area, has held his current position as president and COO for almost two years. Before that, he served as executive vice president of health plan and hospital operations for Kaiser Permanente as well as senior vice president and COO for the organization?s regions outside of California. Tyson was instrumental in the creation of Kaiser?s successful ?Thrive? media campaign.
Becky Patel Named Chairman of the Board of Delta Dental of California
Becky Patel, CEO of LISI Inc. has been named Chairman of the Board of Delta Dental of California. Patel has served on the Board of Directors for Delta Dental of California since 2007. She has been CEO of LISI since 2010. In this role, Ms. Patel has guided the development of new solutions for brokers, ranging from unique products and services, special events, and educational opportunities, to customized sales support, and more.
American General Names Victoria Noel Vice President, Senior Strategic Account?Manager
American General Life Companies named Victoria Noel vice president, senior strategic account manager. Previously, she was president of National Financial Partners (NFP) Life Brokerage and Senior Vice President for NFP Insurance Services.
Christopher Hilger Elected To Securian Board Of Directors
Securian Financial Group president Christopher M. Hilger was elected to the company?s board of directors at its October 15 meeting. Hilger, 47, became president of Securian in January. He is the 16th president in Securian?s 132-year history and reports to Chairman and CEO Robert L. Senkler. Hilger oversees all of Securian?s insurance businesses and its IT division and also serves as CEO of Allied Solutions, LLC, a Securian subsidiary. A 25-year veteran of the insurance industry, Hilger joined Securian in 2004 when the company purchased Allied Solutions.
NEW PRODUCTS
Group Voluntary Products
Cigna?s group voluntary product suite now includes accidental injury and critical illness coverage. The products are available for employers with 250 to 5,000 employees in most states. Cigna?s full suite of group voluntary products includes group universal and term life, accidental death and dismemberment, disability, accidental injury, critical illness, dental and vision. For more information, visit www.cigna.com.
GSI Supplemental Disability Plans
Petersen International Underwriters increased the maximum participation limit for employer paid disability insurance plans from 75% to 80%. When the benefits become taxed as ordinary income due to the employer paid plan, the additional 5% adjustment to the top participation limit becomes very valuable, according to Petersen. For more information visit www.piu.org or call 800.345.8816 or email piu@piu.org.
FSA Reimbursement
FlexMinder is partnering with Flex-Plan Services Inc. to make it easy for consumers to save on out-of-pocket health care expenses. Flexi-Crawler will identify out-of-pocket expenses associated with the deductible, co-pay, or co-insurance and prepare the claims and required documentation to submit for reimbursement automatically. Flexi-Crawler gathers and prepares carrier EOB data directly, making the reimbursement process easier and more efficient. For more information visit www.flexminder.com.
CDHPs
Flex Service Corporation has reduced prices on its consumer-driven health plans and tax-advantaged products for 2013 new business. Flex has dropped standard prices by as much as 15% its flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), and transit/parking reimbursement accounts (TRAs). For more information, visit http://www.flexiblebenefit.com or call 888-353-9178.
Automated Enrollment
BeneTrac, a Paychex company, and Assurant are partnering to help brokers and human resources clients streamline online enrollment and benefit administration. BeneTrac?s management platform offers real-time access to information, online enrollment tools, a presentation of consolidated bills, payroll/carrier integration, and automated eligibility tracking. When offering new lines of coverage, such as disability, dental, voluntary insurance and other products, brokers and employers have the potential for lower costs and greater efficiency in managing benefits. For more information, visit www.benetrac.com.
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