News 

Latest headlines for the Tennessee Health Insurance Marketplace

 
 

BCBST expects loss in 2016 on ACA individual policies

03/04/2016 -

After a moderately successful open enrollment period for 2016, BlueCross BlueShield of Tennessee did not see a significant change in demographics as they had hoped. The hope for insurance companies is the young, heatlhy individuals will sign up providing additional premium to pay for the older and sicker who are currently covered. Unfortunately even a 37% increase may not be enough to stem the losses. 

During the course of open enrollment, which ran from Nov. 1 to Jan. 31, federal officials with the U.S. Department of Health and Human Services said they were seeing more of the coveted "young invincibles" - people ages 18 to 34 - sign up. Younger members are generally healthier and less expensive to cover so insurers had hoped to see more in their membership pools.

For BCBST, however, the percentage is right around the 2015 number: 26 percent of enrollees account for these "young invincibles".

  • Fifty-one percent of enrollees are 45 or older.
  • The average age is 42. 
  • More than half, 53 percent, are female.

A similar mix of members mean the insurer is facing another year of losses, despite an average rate increase of 36.3 percent for 2016. The individual exchange has hit BCBST's bottom line. It's lost about $300 million in two years.

March 4, 2016

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HHS releases 2017 final regulations for the ACA

03/02/2016 -

On February 29, the Department of Health and Human Services (HHS) issued final regulations that address a wide range of benefit and payment parameters under the Affordable Care Act (ACA), effective for plan years beginning on or after January 1, 2017. The final regulations include some changes from the proposed rules that were issued in November 2015, and delayed a few provisions contained in the proposed rules until 2018.

On the same date:

  • The Centers for Medicare and Medicaid Services (CMS) issued an FAQ that clarified the suspension of the 2017 Health Insurance Industry Fee. The moratorium will apply to the Health Insurance Industry Fee that would have been due in the 2017 calendar year based on 2016 data.
  • CMS also issued a bulletin announcing that non-grandfathered individual policies and small group plans may extend their exemption from certain ACA provisions under the previously announced transitional relief.  If the applicable state permits, an extension may be granted through December 31, 2017. As of January 1, 2018, these policies and plans will need to comply with all ACA requirements. Earlier guidance had required these policies and plans to end by October 1, 2017.

Here is an overview of some key regulations in the final 2017 Benefit Payment and Parameters.

2017 Out-of-Pocket Maximums

The 2017 annual out-of-pocket maximums will be $7,150 for individual coverage and $14,300 for family coverage.

Marketplace Enrollment Period

The 2017 and 2018 open enrollment periods will follow the same timing as 2016 enrollment: November 1 through January 31 of the following year.

For 2019 and future years, the annual enrollment period will be November 1 through December 15.

Marketplace Automatic Reenrollment

If the plan in which an individual is currently enrolled is no longer available, Marketplaces may enroll consumers in a plan offered by another insurer if the current insurer does not have a plan available for reenrollment through the Marketplace.

2017 User Fee

The fee insurers pay to sell individual policies through the Federally Facilitated Marketplace (FFM) will remain at 3.5% of the monthly premium. Insurers transitioning to selling policies through State-Based Marketplaces on the Federal Platform (SBM-FPs) will pay a reduced user fee of 1.5% of premium for 2017 and 3% of premium in future years.

Network Adequacy Standards

The final rules have adopted several changes related to network adequacy requirements for plans sold on the Marketplace.

  • Transparency of network size - Beginning in 2017, HealthCare.gov plans to include a rating of each plan's relative network size compared to other plans available in the same geographic area.
  • Coverage when a provider leaves the network - New continuity-of-care requirements will apply in the Federal Marketplace. Insurers must provide 30 days' advance notice to patients receiving treatment from a provider who is leaving the network. Insurers will have to continue in-network coverage for individuals receiving active treatment, until the treatment is complete or for 90 days, whichever occurs first.
  • Treating certain out-of-network expenses as in-network - Beginning in 2018, cost-sharing amounts for certain services performed by out-of-network ancillary providers (e.g. anesthesiologists) at in-network facilities must be counted toward the in-network, annual out-of-pocket maximum. Only when the insurer provides written notice to the patient - at least 48 hours prior to the time of service - may the out-of-network service be billed at an additional cost. This is intended to help limit "surprise bills" for consumers.

Standardized Plan Options in the Individual Marketplace

The standardized plan system will remain in place to make it easier for consumers to compare costs for similar plans offered by different insurers in the Federal Marketplace. The current proposal includes four silver, one bronze and one gold plan. The standardized plans have:

  • Standard deductible amounts
  • Four-tier drug formularies
  • Only one in-network provider tier
  • Some services, such as office visits, urgent care and generic drugs, not subject to the deductible
  • A preference for copayments over coinsurance

Insurers can choose to offer standardized plans, non-standardized plans or both. Standardized plans will be displayed on HealthCare.gov in a manner intended to make them easy for consumers to find.

New Model for State/Federal Marketplace Partnerships

State Marketplaces that use HealthCare.gov's technology for eligibility and enrollment will be known as State-Based Marketplaces on the Federal Platform (SBM-FPs). States will retain primary responsibility for plan management and consumer assistance, and for ensuring all Marketplace requirements are met. States will use the Federal platform for eligibility determinations and enrollment processing. This model is intended to make the transition easier should additional states decide to move to this arrangement in the future.

Navigator Responsibilities Beyond Enrollment

Beginning in 2018, Navigators will be required to provide post-enrollment assistance for functions such as Marketplace eligibility appeals, application for exemptions through the Marketplace, and helping consumers understand how to use their benefits. Navigators will also be required to assist vulnerable and underserved populations, as identified by the state-based exchange in their area.

Marketplace Enrollment Directly on Broker and Insurer Websites Delayed until 2018

Beginning in 2018, individuals may enroll in Marketplace coverage directly through an insurer or broker's website. Further guidance and requirements will be issued. Until then, the current Marketplace enrollment process will continue.

Changes to Federally Facilitated SHOP Plans

As of January 1, 2017, a new employee choice option will be offered on the Federally facilitated Small Employer Health Options Program (SHOP). Currently, employers can offer employees a single plan or a choice of plans within a metal level. Under the new "vertical choice" model, employers will be able to offer employees a choice of all plans across all available levels of coverage from a single insurer. States can choose to opt out of offering vertical choice.

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Donald Trump wants to sell insurance across state lines - Will it help?

02/29/2016 -

While details are very limited, we do know the main plan for Donald Trump to control rising health care costs and insurance premiums is to allow carriers to sell health insurance across state lines. Currently, each state has their own set of rules and regulations for health insurance sold in their state. This would allow a Tennessean to buy a Kentucky or Georgia policy if the wanted. The allure to insurance companies would be to attract more people and companies to their policies. The real challenge is for those states with the most regulations will also have the highest cost policies and have the most to lose. 

Will it work? For some, yes because they will be able to buy are more watered down policy from another state. Unfortunately, this does nothing to stem the ever increasing cost of prescriptions and the direct to consumer advertising that pushes high cost drugs rather than older similarly effective treatments. What about waste, fraud duplicated testing and procedures? Electronic medical records were supposed to be fully online and working seamlessly to allow providers to share notes, tests and histories. Unfortunately, most don't communicate with each other creating another barrier to streamlined care and cost savings. 

Time will tell who wins the election and changes are actually possible to the current system. For me and our clients we continue to promote low cost, high deductible health plans (HDHP) paired with a Health Savings Account (HSA). When you let consumers know the true cost of care, they make much better decisions and ultimately reduce the cost of healthcare spending. 

David Moore 

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Employers get 1095 ACA reporting relief

02/26/2016 -

Employers have gotten an early New Year's gift from the IRS. On December 28, 2015, the IRS released Notice 2016-4 to extend due dates for the 2015 information reporting required by the Affordable Care Act (ACA). Employers will have an additional two months to furnish forms to individuals and an extra three months to file forms with the IRS.

Background

Applicable large employers (ALEs), who generally are entities that employed 50 or more full-time and full-time-equivalent employees in 2014, are required to report information about the health coverage they offered or did not offer to certain employees in 2015. To meet this reporting requirement, the ALE will furnish Form 1095-C to the employee or former employee and file copies, along with transmittal Form 1094-C, with the IRS.

Employers, regardless of size, that sponsored a self-funded (self-insured) health plan providing minimum essential coverage in 2015 are required to report coverage information about enrollees. To meet this reporting requirement, the employer will furnish Form 1095-B to the primary enrollee and file copies, along with transmittal Form 1094-B, with the IRS. Self-funded employers who also are ALEs may use Forms 1095-C and 1094-C in lieu of Forms 1095-B and 1094-B.

Extended Due Dates

Specifically, Notice 2016-4 extends the following due dates:

  • The deadline for furnishing 2015 Form 1095-C, or Form 1095-B, if applicable, to employees and individuals is March 31, 2016 (extended from February 1, 2016)
  • The deadline for filing the 2015 Forms 1095-C along with transmittal Form 1094-C, or Forms 1095-B with transmittal Form 1094-B, if applicable, with the IRS is:
    • If filing by paper, May 31, 2016 (extended from February 29, 2016).
    • If filing electronically, June 30, 2016 (extended from March 31, 2016).

The IRS previously provided a process for reporting entities to request extensions and some employers have already submitted their requests. Notice 2016-4 explains that the new extended due dates apply automatically (and are more generous than the prior process) so individual requests will not be granted formally.

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Community Health Alliance Tn Co-op goes out of business Dec 31st

10/15/2015 -

In a very unfortunate move for the 27,000 members, Community Health Alliance the Tennessee Health Co-op will officially close on December 31st. This was an experiment by the US Government to try and create new and competitive insurance options across the country. Many have already gone out of business and those remaining are struggling financially.,

Open enrollment is only a few weeks away, we received the 2016 BCBST rates and it's quite scary what a 35% rate increase looks like. We don't know who the completive players will be next year but it's obvious that guarantee issue and community rating is a very difficult place for insurance companies to price risk and make a profit.,

More to come,,

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Blue Cross cancels grandfathers plans - rates jump 37.5%

10/13/2015 -

Wow, that's all I can say to the increase my BlueCross BlueShield of Tennesse individual health clients are about to receive. I just got the advance copies of the letters going out to tell them of the new January 1 premiums. Our most popular plan, the Silver 16 is going up 37.5%. That's going to leave a mark for sure. On top of that, all those "grandfathered" health plans our President said you could keep are going away as well. You better not buy that new care just yet, you might need that extra money jingling in your pocket.,

What's going on you ask? Well, all those guarantee issue policies with no pre-existing conditions and the ability to drop them as soon as you have your procedure seem to be catching up with BCBST. I don't know exactly how much money they lost on the ACA plans but it must have been a boatload. As you can imagine paying a couple months of premiums to get a hundred thousand dollar surgery is going to cost someone and I think that statement is pointing and you and I.,

What are your options? We don't know just yet, the individual rates are supposed to be loaded into the systems on October 18th so we can see who wins the premium war for 2016. We will be updating our health insurance guidebooks as quickly as possible. If you would like a copy give us a call at 615-724-1701 or send me an email at dmoore@thebenefitbrokers.com,

Thanks much, we are all in this together and hopefully the pain is coming to an end.,

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Medicare premiums set for 50% increase in 2016

10/02/2015 -

It's strange this is not making bigger headlines as Social Security recipients won't see any increase in benefits, Medicare premiums are set to increase from $104.90 to $159.30 affecting an estimated 30% of Medicare recipients.,

Of course, if you are one of the "lucky ones" who planned and saved for retirement or continue to work and earn a higher income will pay higher rates still. As an example, each member of a married couple with household income ranging from $170,000 to $214,000 annually will pay $223.00 each. Part B premiums top out at $509.80 for those with an income of more than $428,000.,

More to come, better be saving your pennies.,

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UnitedHealthcare sends out $117 million in rebates

09/09/2015 -

UHC is getting ready to send out the Medical Loss Ratio rebate checks for 2014. While this sounds like a LOT of money, according to Employee Benefit Advisor they collected $12.8 BILLION in premium for 2014. UHC is the second largest group insurance carrier in the country second to Kaiser Permanente. These rebates are part of the ACA creating accountability and requiring carriers to spend 80-85% of all premium dollars on healthcare and not administration or overhead.,

As an insurance consultant what we experience from carriers trying to manage their loss ratios is how many fewer customer service employees there are. This is a direct shift back to us to assist with claims, billing, enrollment, education, communication and other areas to help customers navigate the healthcare system. While we are happy to do this, it is much more challenging for everyone involved.,

Where do we go from here? Great question. With the promise of much higher rates in 2016 I can only imagine we will see a new influx of middle class Americans unable to afford coverage while premium and benefit subsidies make coverage nearly free for those lower income individuals.,

,

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BCBST and HCA come to terms on out of network ER treatment

08/31/2015 -

After years of wrangling and employees struggling with possible huge emergency room bills BlueCross BlueShield of Tennessee and HCA/TriStar have come to an agreement on out of network emergency room claims. Beginning in May of 2013 BCBST began administering OON claims as their contract reads only paying the contractual prices for "in network" providers. This left nearly 11,000 people with very large out standing medical bills.,

As a health insurance consultant we have to instruct individuals to seek treatment from the nearest emergency room in a true emergency. The problem is/was that HCA/TriStar could charge any amount they wanted for these services and in the past BCBST would pay full billed charges. We always thought that was crazy and evidently BCBST did as well and said enough is enough. The problem is, members were left,with huge balance bills.,

While we don't know what the terms of the agreement are, those who needed emergency treatment will no longer be responsible for charges above their plans deductible and co-insurance.,

Here is a copy of the letter that will be mailed to those individuals with outstanding balances.

David Moore

Benefit Brokers, LLC,

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High drug / Rx costs are driving healthcare premiums

08/21/2015 -

Do you watch the nightly news? Or rather, the hour of prescription advertisements. Prescription costs are driving health insurance rates through the roof and FINALLY the Government may step in and actually begin negotiating with drug companies so we stop subsidizing the rest of the world.,

Google the cost of those prescriptions advertised on TV, you will be shocked and amazed at the cost. I saw an ad for Jublia the toenail fungus medicine, asked Google how much it cost and GoodRx.com says the lowest cost is $508 for a 4 ml dropper of the medicine. The low cost for Embrel that Phil Mickelson touts during the news is $3,256 per month, yep nearly $40,000 per year. Another little know fact is that we see the drug companies paying peoples deductibles to make it affordable for them and get insurance to begin paying the huge cost of these prescriptions. Doctors don't know how much these new, latest and greatest prescriptions cost, they know what the salesman told them. When a patient comes in wanting to try a new miracle medicine drug they don't have time to talk you out of it or explain why an older less expensive version will work just fine for you. Doctors have to see so many patients each day, many times it's easier to write the script and move on.,

Specialty drug spending is,expected to increase by 67% in 2015, this trend is crippling the health insurance industry and continues to drive rates even higher. Something has to be done and it looks like it will take Uncle Sam to finally put his foot down.,

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IRS updates 1094 & 1095 Health Insurance reporting for ALE's

08/12/2015 -

August 11, 2015

Draft Instructions and Revised Draft 2015 Forms for IRS Reporting Requirements

On August 7, the Internal Revenue Service (IRS) released draft instructions and revised draft 1095-B and 1095-C forms to be used for Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting in 2016. The IRS has posted the 2015 draft instructions and forms at IRS.gov/draftforms as information only, and will post final versions at a later date.

The revised 2015 draft forms are generally unchanged from the versions released on June 19, 2015. However, the IRS made several changes to the 2014 final instructions, including:

  • "B" form instructions for applicable large employers - The draft instructions for forms 1094-B and 1095-B now allow applicable large employers (ALEs) the option to use the "B" forms to report coverage of individuals who are not considered full-time employees for any month during the calendar year.
  • "C" form instructions for applicable large employers - The draft instructions for forms 1094-C and 1095-C require that ALEs continue to report all employees enrolled in self-insured coverage on the "C" forms - as part of MEC reporting.
  • 30-day extension for IRS filing - An automatic extension is granted if Form 8809 is submitted to the IRS on or before the filing due date.  
  • 30-day extension for providing forms to individuals - An extension may be granted by submitting a letter to the IRS on or before the due date for providing forms to individuals.
  • Details on how to file corrected forms - The draft instructions include details on filing corrected paper returns. Information on electronic filing corrections can be found on IRS Publication 5125.
  • Hand delivery - Both sets of reporting may be hand delivered to individuals.
  • Reporting supplemental coverage - The definition of a "plan sponsor" has been clarified for the purpose of reporting supplemental coverage by the same reporting entity as the health plan sponsor.
  • Reporting coverage offered under multiemployer plans - Simplified reporting now available for reporting offers of coverage for employers with multiemployer arrangements that qualify for relief.
  • Reporting on COBRA participants - Clarifications on how to report COBRA participants.

For more information on the final rules on this IRS information reporting, please read our Reporting Requirements Fact Sheet.

Draft Instructions and Forms

Instructions for Forms 1094-C and 1095-C

Form 1094-C - Transmittal/"cover sheet" for Large Employer and self-insured MEC reporting (applicable large employers)

Form 1095-C - Report to individuals and the IRS information on coverage offered and self-insured MEC (applicable large employers)

Instructions for Forms 1094-B and 1095-B

Form 1094-B - Transmittal/"cover sheet" for MEC reporting (insurance carriers and self-insured small group employers)

Form 1095-B - Report to individuals and the IRS information on MEC (insurance carriers and self-insured small group employers)

We will keep you informed when final instructions and forms are made available.

We encourage you to bookmark Cigna's health care reform website, InformedOnReform.com, where we will update information as future guidance and final rules are released. 

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Anthem buying/partnering with Cigna - Will it reduce rates?

07/29/2015 -

Ok, here we go again. Aetna is buying Humana, United HealthCare has bought all the little carriers and now Cigna goes away. Who will we buy our insurance from in two years? In Nashville this will leave BCBST, Aetna, United HealthCare and maybe Anthem.

Do you think this will help our medical premiums go down? I don't either. The bigger question is how or will BlueCross BlueShield of TN will stop Anthem from playing in their playground. This will be the interesting thing to watch with this transaction.

Anthem consists of 14 different BlueCross plans in 14 states. The BCBS Association won't let them use the Blue Cross logo but they are technically Blue Cross plans. Merging or buying Cigna and their 53 million combined members across the country and a presence in each state technically would give Anthem a foothold and more importantly provider contracts across the country. That gives them national pricing and presence. This is a very big deal indeed.

As I deliver 20-30% rate increases to my group customers on a weekly basis and each cries out in frustration, is fewer carriers the answer? Does this actually create more competition for reduced reimbursements to providers? Anthem, another Blue Cross subsidiary will now have access to Cigna's contracts as well as BlueCross BlueShield of Tennessee's giving them a somewhat unfair advantage when negotiating.

Just another day in the world of health insurance. My 20+ years in the business have never seen so much change without any real results to help control costs. 

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ACA penalties set to double on January 1, 2016

07/08/2015 -

The Trade Preferences Extension Act of 2015 ("Act"), signed into law by President Obama on June 29, significantly increases potential penalties for insurers and employers that fail to comply with the new Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting requirements first due in 2016.

As a refresher:

  • IRS Code 6055 requires insurers and self-insured plan sponsors to file reports with the IRS to verify whether an individual had MEC during a given calendar year to satisfy the Individual Mandate
  • IRS Code 6056 requires an "applicable large employer" to file reports with the IRS verifying whether it offered minimum value and affordable coverage to full-time employees and their dependents in a given calendar year to satisfy the Employer Mandate

The new penalties are effective for returns and statements required to be filed in 2016 for the 2015 calendar year:

 

Penalty

Old Amount

New Amount

Failure to file/furnish an annual IRS return or provide individual statements to all full-time employees

$100

$250

Annual cap on penalties

$1,500,000

$3,000,000

Failure to file/furnish when corrected within 30 days of the required filing date

$30

$50

Annual cap on penalties when corrected within 30 days of required filing date

$250,000

$500,000

Failure to file/furnish when corrected by August 1 of the year in which the required filing date occurs

$60

$100

Cap on penalties when corrected by August 1 of the year in which the required filing date occurs

$500,000

$1,500,000

Lesser cap for entities with gross receipts of not more than $5,000,000

$500,000

$1,000,000

Lesser cap for entities with gross receipts of not more than $5,000,000 when corrected within 30 days of required filing date

$75,000

$175,000

Lesser cap for entities with gross receipts of not more than $5,000,000 when corrected by August 1 of the year in which the required filing date occurs

$200,000

$500,000

Penalty per filing in case of intentional disregard. No cap applies in this case.

$250

$500

 

Click here to access the Act 

New Electronic Filing Steps

Additionally, this week the IRS provided more information on the process for electronic reporting to the IRS. The electronic filing system known as the ACA Information Return (AIR) system is significantly more complex than simply uploading a PDF file containing the pertinent information. Employers, insurers and third-party fulfillment or filing software developers are required to complete the following steps prior to being able to electronically submit any Reporting Forms:

  1. Register with the IRS's e-services website, including submission of personal information about the person registering for the Submitting Entity
  2. Obtain an AIR Transmitter Control Code (TCC), a unique identifier authorizing each Submitting Entity to submit the Reporting Forms, and
  3. Pass a series of technical/system tests to ensure that Reporting Forms will be properly submitted when due.

The first two steps can be completed now. The third step is anticipated to become available later this year.

Click here for more information on the AIR program 

We encourage you to bookmark Cigna's health care reform website, InformedOnReform.com, where we post the most recent guidance and regulatory information. 

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30% rate increase not enough? Appears so

07/01/2015 -

While it might sound crazy, a requested 36% average rate increase from BlueCross and BlueShield of Tennessee may not be enough to cover losses and high claimants. That is according to Julie McPeak the commissioner of the TN Dept. of Commerce and Insurance.,

As an insurance broker and consultant we knew the individual prices seemed much to good to be true (when compared with small group and other carriers rates). The new EHB plans are what most deem "very expensive" and the benefits overall "not great" for the prices. The challenge is guarantee issue with no pre-existing conditions limitations. This gives open access to a long list of delayed medical treatments for many who did not have access to health insurance or could not afford the premiums before the ACA took affect.

That has created a perfect storm of high claims resulting in BCBST and other carriers spending more in claims than they are receiving in premiums.,

BlueCross BlueShield of TN is not alone in the high rate increase requests. Community Health Alliance our new Health co-op is also seeking an average 32% increase as they under priced policies to gain market share. What happens on January 1st when the new rates take affect? Time will tell but there will certainlly be a resuffling of plan designs and possibly which carrier has the best pricing. United HealthCare is supposed to be entering the TN market and could cause a lot of disruption if they have the rates. 

Stay tuned, more excitement, frustration and high rates to come. 

David Moore

615-417-8102

,

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BCBST requests 36% rate increase for 2016

05/19/2015 -

Tennessee healthcare costs are going up

Tennessee individual health policies are going up in price on January 1, 2016. While each of the carriers selling individual policies in TN are asking for rate increases, none come close to the increase BlueCross BlueShield of TN who has had the lowest rates across the state.

As a broker and consultant we long wondered why the individual policies were so much less expensive than the EHB small group policies with nearly identical benefits. This will price the policies much closer and discourage small groups from cancelling their group policies and encouraging employees to buy individual instead, this is good news for the group health market.

Transitional Reinsurance Program

It is no secret that Blue Cross has taken a financial beating in the individual market and the risks to insurance carriers will increase dramatically when the Transitional Reinsurance Program expires the end of 2016. This little talked about program provides financial protection to insurers against large claims for the first three years of PPACA.

Under this program, HHS will reimburse insurance carriers for medical claims that exceed $60,000 in one year. Once a claim reaches that point, the reinsurance program begins paying 80% of the claim with a maximum payout of $250,000 per year. This offers protection due to the guarantee issue requirements of the new ACA compatible policies. The program is funded with fees collected with each policy sold.

There will not be much relief for those with individual policies staring down a very large increase in costs for policies many feel offer very little in terms of benefits. Most of our clients are choosing bronze and silver coverage with high deductibles and out of pockets with no first dollar benefits other than wellness. It will be interesting to see if a 2.5% penalty/tax for not having coverage will discourage the healthy from dropping policies and paying the "shared responsibility penalty".

More concerning to the broker community is that all the rates change on January 1st which is our busiest time of year making it challenging to help our group clients while advising individuals on their options. It's also important to note that BCBST commissions on individual renewals is $9 per person per month, this low amount will make it that much more difficult to devote the amount of time needed to properly advise people about their options. ACA has forced most of our small group policies to renew in the 4th quarter and the individual policies on January 1 puts a huge demand on our time.

Tennessee has some of the lowest cost health policies in America, unfortunately that will not do a lot to appease the frustration and financial anger a large increase will bring to policy holders.

Tennessean Article - BlueCross health premiums could grow sharply in 2016

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ACA model saves $400 million in Medicare costs - Does this matter?

05/04/2015 -

CMS recently announced a major cost savings of $400 million dollars over a two year test period using Accountable Care Organizations to improve care and reduce expenses. While this does sound like a lot of savings, consider that Medicare spent $492 BILLION last year. Medicare fraud on the other hand is estimated at $17-$57 billion (2012 numbers) with a recapture of $8 for every $1 spent combating this problem.,

I do think using ACAs will help reduce costs long-term but feel fraud and prescription costs are a much better target to reduce costs and increase the likelihood of this program lasting long-term.,

Here is a link to the Wall Street Journal article regarding the ACA savings.,

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Democrats beg to delay EHB above 50 employees.

03/24/2015 -

In what I think is a good thing, the Democratic leadership is "encouraging" HHS and Obama to delay expanding the Essential Health Benefit plan to groups with 50 to 100 employees. This is supposed to take affect on January 1, 2016 and based on my experience it will not be well received by those companies.,

The main reason I say that is the benefits in order to comply with the bronze, silver, gold and platinum packages are awful. The carriers are so limited by the tight constraints that employees are left with horrible insurance. If you do want a better plan the rates are so high it's completely unaffordable.,

While having guarantee issue would help some companies offer coverage without the hassle of underwriting, most will see their rates increase and participation potentially decrease.

Cross you fingers for a delay, those in lofty perches in Washington think they know what is best for America when the reality is they only want to serve those with the richest super PACs.,

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Breakfast with Governor Haslam

03/03/2015 -

I had breakfast with the Governor this morning and while he covered many areas of concern for our great state of Tennessee he spent a good amount of time talking about Insure Tennessee. This is his solution for Medicaid patients who earn too little for an ACA subsidy (138% of FPL) and too much for traditional Medicaid (100% of FPL). There are more than 200,000 Tennesseans who are in this insurance black hole.

As a health insurance professional I thought his plan not only made sense, it made a lot of sense. Medicaid traditionally has been a give-a-way program with few strings or requirements in place to incentivize the insured to manage their care and/or healthcare costs. They receive free insurance with pretty much 100% coverage.

The Governor's plan would provide very "affordable" insurance and would charge very "modest" copays to visit a physician, emergency room or hospital. This is a very important component of how insurance is supposed to work, without any personal responsibility why would you visit a doctor's office when could go to the emergency room? Why take a generic drug when you can get the brand name? With no difference in cost to the insured, there is no incentive to save money. I applaud the Governor for holding this group accountable just we who pay for our own policies are.

Incentives for good behavior and wellness programs

Better yet, there are incentives where these individuals can earn dollars to pay for their premium and cover out of pocket costs by doing things to make or keep them healthy. They will have a choice of plans where if their employer offers group coverage they can choose that policy just like their peers, if they decide the TennCare program is better for their needs, they would choose it.

New payer model to reduce costs and improve care

Governor Haslam also introduced a new payer program that would reward doctors and hospitals for high qualify outcomes through coordinated care and management. By working together to reduce costs, the providers can actually earn more than they do today in our "fee for service" healthcare world. Of course they are treating this group of patients for free today so they should be excited to try a new payer model that if successful can spread into other areas of healthcare.

Not today!

Unfortunately the General Assembly did not think this new health plan was best for the 200,000 uninsured Tennesseans who are gasping for health insurance. What was their reasoning? While I don't know for sure, the easy scapegoat is ObamaCare and the negative press surrounding it. While I am very proud of our Republican, conservative state and legislators we must also think of the hospitals, physicians, labs and others who are treating these uninsured and taking the financial hit. There is continuing work and hopefully the fears will be alleviated and soon we can reduce our uninsured population significantly and help those rural hospitals that so greatly need the additional revenue.

These are of course my opinions.

David Moore

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60 day open enrollment for qualified events

03/02/2015 -

Special Open Enrollment Provisions for Individual Health Insurance in Tn

Outside of the open enrollment period, you can enroll in an individual policy directly or through the Marketplace only if you qualify for a special enrollment period. Most special enrollment periods last 60 days from the date of the qualifying life event. 

Qualifying life events that create a special enrollment period include:

  • Getting married.
  • Having, adopting or placement of a child.
  • Permanently moving to a new area that offers different health plan options.
  • Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.

For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.

 

You may also qualify for a special enrollment period if you have certain complex situations. Some cases and examples that may also give you a special enrollment period include:

Exceptional circumstance-You faced a serious medical condition or natural disaster that kept you from enrolling. For example:

  • An unexpected hospitalization or temporary cognitive disability.
  • A natural disaster, such as an earthquake, massive flooding or hurricane.
  • A planned Marketplace system outage, such as Social Security Administration system outage.

Misinformation or misrepresentation-Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:

  • Not getting enrolled in a plan.
  • Being enrolled in the wrong plan.
  • Not getting the premium tax credit or cost-sharing reduction you were eligible for.
  • Enrollment error-Your application may have been rejected by the insurance company's system because of errors in reading the data, or some of the data was missing or inaccurate.
  • System errors related to immigration status-An error in the processing of applications or system caused you to get an incorrect immigration eligibility result when you tried to apply for coverage.
  • Display errors on HealthCare.gov-Incorrect plan data was displayed at the time that you selected your health plan, such as benefit or cost-sharing information. This includes issues where some consumers were allowed to enroll in plans offered in a different area, or enroll in plans that don't allow certain categories of family relationships to enroll together.
  • Medicaid/Marketplace transfers-
  • ​If you applied for Medicaid through your state or were sent to Medicaid from the Marketplace, but you weren't eligible for Medicaid.
  • Your state transferred your information to the Marketplace but you didn't get an answer about your eligibility and/or didn't get enrolled before the end of the open enrollment period.
  • Error messages-Your application was stopped due to specific error messages. For example, you received a "data sources down" error message or another error message that didn't allow you to enroll.
  • Unresolved casework-You're working with a caseworker on an enrollment issue that didn't get resolved before the end of the open enrollment period. 
  • Victims of domestic abuse-You're a victim of domestic abuse and weren't previously allowed to enroll and receive advance payments of the premium tax credit separately from your spouse. You'll be able to do so now.
  • Other system errors-Other system errors that kept you from enrolling, as determined by the Centers for Medicare & Medicaid Services.

If you have questions or need help applying for coverage feel free to call us at 615-724-1701. I hope this informaiton has been helpful to you. 

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How much does that procedure cost? Guroo.com

02/26/2015 -

Guroo.com an online tool that went live on Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. That's the real cost - not "charges" that often get marked down - based on a giant database of what insurance companies actually pay.

OK, this isn't like Priceline.com for knee replacements. What Guroo hopes to do for consumers is limited so far.

It won't reflect costs for particular hospitals or doctors, although officials say that's coming for some. And it doesn't have much to say initially about the quality of care.

Still, Guroo should shed new light on the country's opaque, complex and maddening medical bazaar, say consumer advocates.

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CMS announces "another" special enrollment for 2015

02/25/2015 -

Deadlines, they are deadlines in my world

If you don't do something by the deadline you missed it. Seems that is not what the CMS really meant with the February 15th deadline to enroll in medical insurance for 2015. The Centers for Medicare & Medicaid (CMS) announced today another special enrollment for those who did not have health insurance in 2014 and are subject to a "shared responsibility payment" "fee" or tax as I like to call it.

This new enrollment period is for those who were unaware or didn't understand that the IRS really meant it when they said you would have to pay a tax or fee for not having qualified coverage. Surprise! Perhaps the enrollment numbers did not actually reach the quotas and they thought another month might help. Either way, there is another opportunity to buy health insurance. As an agent/broker/consultant it does not help us as you must purchase through healthcare.gov.

Eligibility rules for March 15 - April 30th special enrollment

You must live in a Federally-facilitated Marketplace and;

  • Currently not enrolled through the FFM for 2015
  • Attest that when you filed your 2014 tax return you paid a fee for not having coverage and
  • Attest that you were not aware of this "fee" "penalty" or TAX before you did your taxes.

If you meet these criteria you will have coverage beginning the next month if you sign up by the 15th of the previous month.

Exemptions from the shared responsiblity tax

Here is another interesting fact, the CMS estimates that 10 to 20 percent of all taxpayers were uninsured in 2014, most will qualify for an exemption while only 2 to 4 percent of those uninsured will have to pay the tax or fee.

If you have questions you can call the Marketplace call center at 800-318-2596

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Insure Tennessee fails to provide health insurance to 280,000

02/04/2015 -

I must say I am disappointed the Senate failed to help Medicaid expansion move forward for those who earn too little to receive health insurance subsidies in Tennessee. While I am not a fan of many ACA provisions, the fact that we have some receiving subsidized health insurance while others earning less are somehow not qualified.

Governor Haslam did not settle for the status quo Medicaid expansion and fought for something better while hundreds of thousands waited for health insurance. There are flaws with just about any way you look at health insurance in Tennessee and America, is that a reason to deny coverage to those in need. I see the Affordable Care Act giving huge subsidies to many who need it but there are many more on the sidelines who don't qualify. At the same time many hard working Tennesseans are seeing their insurance policies cancelled forcing them into new "compliant" plans that cost twice as much in many cases.

I read that less than 5% of Americans received a premium subsidy last year but the nearly 50% of us on individual and group policies are paying higher rates to subsidize these few and still we have hundreds of thousands without access to affordable coverage.

What is the future of healthcare? I know it will continue to change and hopefully improve. One thing is for sure, we are on a collision course with unaffordable coverage for the working person and their families. I see it every day when doing enrollment meetings and talking with employees who pay too much for a policy that covers too little unless they have a catastrophic claim.

Health insurance is one of the most important policies a person can buy but what happens when it becomes unaffordable to the middle class while the lower income individuals have heavily subsidized rich policies with low co-pays and out of pockets. That does not seem a sustainable solution. I don't have the answers, there sure are a lot of questions. 

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Plan ahead when filing taxes if you receive a health insurance subsidy in Tennessee

01/13/2015 -

1095-a forms are coming to show your subsidy dollars

Tennesseans will begin receiving their W2s soon and will be anxious to file for their tax refund checks. It's important to know that if you received any Obamacare subsidies there is a new form you will need to file and you will receive a 1095-a form from the IRS showing how much you received in subsidy dollars. You will need this form before you file your 2014 tax return. 

Did not have insurance in 2014?

Get ready to pay your new penalty (tax) for not having a qualified health insurance policy. The calculation is tricky but the basic rule is $95 per adult or 1% of your adjusted gross income. It jumps to $395 or 2% of AGI for 2014 and open enrollment closes in just 4 short weeks so don't delay in getting health coverage. 

Click here for more information

 

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Taxpayers may be surprised how ObamaCare affects their tax return

01/05/2015 -

We have heard the warnings for several  years now and finally the time has come to file the first tax returns that will include premium subsidies and the individual mandate penalty "tax" that says you must  have qualified health insurance. While the penalty is not too steep in the first year, those who underestimated their incomes for a higher premium subsidy are in for an unpleasant surprise. 

Premium subsidies are based on your household income, the number of dependents and everyones ages. It's very difficult to predict your income for the next  year and if things changed or you underestimated you probably received more subsidy money than you should have. The IRS wants that money back and they have a great way of collecting it. 

Here is a story that CBS News ran over the weekend talking in more detail about some of the challenges Americans will face. ObamaCare and Taxes

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Big deductibles and lack of HSA options hurts consumers

01/02/2015 -

As the Affordable Care Act moves forward, many consumers feel they are being led down a very slippery slope with higher premiums and deductibles. With that is a harder way to use tax free dollars to pay for your medical care. One of my biggest complaints is how the government treats deductibles when it comes to HSA eligibility. They use a "shared" deductible which means the minimum single person deductible we can offer is $2,700. The law says to have a qualified High Deductible Health Plan (HDHP) you must have a deductible higher than $1,300 (two per family), that two per family line actually equates to $2,600 for a single and $5,200 for family coverage because they don't recognize an "embedded" deductible as credible. This is one simple thing they could change that would help millions of middle class Americans better afford High Deductible Health Plans.

Speaking of high deductibles, while it's true a higher deductible and no co-pays reduces premiums substantially, many are afraid to seek medical treatment because they don't have the money to pay for services. Wellness visits are covered at 100% and that's a great thing but the cost to treat the flu or a doctor's visit can easily run $100 or $150 and Labwork sometimes runs close to $1,000.

What is the solution? In my opinion transparency and a simpler way to price healthcare and prescriptions would make a tremendous difference in how and where people receive medical care. When you can comparison shop for a prescription like you do copier ink or a new camera pricing will come down and consumers will save money. Then throw in showing alternative prescriptions or generics alongside that price comparison and a real market shift will occur.

Here is an article that ran today in USA Today about the deductible dilemma

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87% of healthcare.gov enrolles receive financial assistance. Are you getting help or paying for it?

12/30/2014 -

Open enrollment in Tennessee

Tennessee along with many other states use the healthcare.gov website to enroll and receive premium and benefit subsidies for the new ACA health plans. Of course we only recommend those who qualify for a subsidy use the healthcare.gov website because if you don't get a subsidy there is NO reason to deal with the complexities of the website. Many who don't qualify for a subsidy are finding premiums to be much higher than pre-ACA days and plan designs with higher deductibles and out of pocket maximums.

In middle Tennessee BlueCross and BlueShield of TN are the dominant player with network options and the lowest prices for their medical plans. We have helped many individuals choose and apply for the best coverage based on their situation. We strongly recommend HDHPs in conjunction with Health Savings Accounts (HSAs). We are here to help and answer questions, call us at 615-724-1701.

 

Healthcare.gov 2015 statistics about enrollment and subsidies

A report released by the Department of Health and Human Services today provides the first detailed analysis of enrollment in the Marketplaces for the first month of the 2015 open enrollment period.   About 87 percent of people who selected health insurance plans through HealthCare.gov for coverage beginning Jan. 1, 2015 were determined eligible for financial assistance to lower their monthly premiums, compared to 80 percent of enrollees who selected plans over a similar period last year. In addition, more than 4 million people in both the state and federal Marketplaces signed up for the first time or reenrolled in coverage for 2015 during the first month of open enrollment. That includes more than 3.4 million people who selected a plan in the 37 states that are using the HealthCare.gov platform for 2015, and more than 600,000 consumers who selected plans in the 14 states that are operating their own Marketplace platform for 2015. 


Today's report includes data through December 15 for the 37 states using the HealthCare.gov platform, and through December 13 for 12 states and the District of Columbia that are using their own Marketplace platforms. Data for California are through December 14.  Data for automatic reenrollments are not yet available in the vast majority of states, so today's report does not fully capture the number of people who selected plans leading up to the deadline for Jan. 1, 2015 coverage. In particular, the automatic reenrollment process for the 37 states using the HealthCare.gov platform began on December 16 and was completed for the vast majority of consumers on December 18.

HHS also released a Weekly Enrollment Snapshot that captures more recent enrollment activity in the 37 states using the HealthCare.gov platform. The Weekly Snapshot shows that from November 15 to December 26, nearly 6.5 million consumers selected a plan or were automatically reenrolled. 

"We're pleased that nationwide, millions of people signed up for Marketplace coverage starting January 1. The vast majority were able to lower their costs even further by getting tax credits, making a difference in the bottom lines of so many families," HHS Secretary Sylvia M. Burwell said. "Interest in the Marketplace has been strong during the first month of open enrollment. We still have a ways to go and a lot of work to do before February 15, but this is an encouraging start."

Detailed findings for HealthCare.gov states through December 15:

More than 3.4 million people selected a plan through December 15 in the 37 states that are using the HealthCare.gov platform for 2015, including Oregon and Nevada.  Of those:

87 percent selected a plan with financial assistance compared to 80 percent in the early months of the first open enrollment period. 

33 percent were under 35 years of age compared to 29 percent in the early months of the first open enrollment period. 

Nearly 1 million consumers selected a plan in the three days leading up to December 15. That is almost one third (28 percent) of total plan selections from November 15 through December 15.

Of the 3.4 million plan selections, 48 percent (1.6 million) reenrolled in a Marketplace plan and 52 percent (1.8 million) signed up for the first time.

The most recent Weekly Enrollment Snapshot with data available through December 26 can be found here.

The information contained in this report provides the most systematic summary of enrollment-related activity in the Marketplaces to date. Data for the various metrics are counted using comparable definitions for data elements across states and Marketplace types. But because many states extended their plan selection deadlines for January 1 coverage, the report does not include the full count of consumers who will have selected coverage that begins Jan. 1, 2015.

Open Enrollment in the Marketplace runs from Nov. 15, 2014, through Feb. 15, 2015.  Consumers should visit HealthCare.gov to review and compare health plan options. Consumers shopping for health insurance coverage should sign up by Jan. 15, 2015, in order to have coverage effective on Feb. 1, 2015.  If consumers who were automatically reenrolled decide in the coming weeks that a better plan exists for their families, they can make that change at any time before the end of open enrollment on February 15.

To read the monthly enrollment report visit: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment.pdf

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Medicaid expansion in Tennessee? Today could be the day.

12/15/2014 -

Tennessee Governor May Announce Breakthrough On Medicaid Expansion Monday.

The Memphis (TN) Commercial Appeal Share to FacebookShare to Twitter (12/15) reports that Tennessee Gov. Bill Haslam (R) "has scheduled a news conference for Monday morning amid speculation that he will announce a tentative agreement with the Obama administration on an alternative Medicaid expansion plan for Tennessee." Haslam's office "spread word Sunday of the previously unscheduled news conference" but did not disclose the subject. The governor's office "also hurriedly scheduled a series of meetings with newspaper editorial boards across the state during the rest of the week, bolstering the speculation of either a breakthrough with Washington or a decision against pursuing an agreement any further." According to the article, Haslam has been in negotiation with the Administration for over two years regarding his efforts to develop a "hybrid plan" that would use Federal funding to buy private health insurance for low-income Tennesseans

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Insure Tennessee | Will this replace TennCare?

12/15/2014 -

After 17 months of working on a unique plan for the state, Gov. Bill Haslam this morning announced plans to expand Medicaid in Tennessee.

Haslam unveiled a new plan called Insure Tennessee. It includes two options. Through the first, called the Volunteer Plan, working Tennesseans that earn 138 percent of the poverty level or less, can obtain vouchers to cover the cost of employer-offered insurance.

"It is our belief that over half the participants that would be covered ... are currently working," but just cannot afford their employer-sponsored option, Haslam said.

The second option will reimburse TennCare recipients for health care costs based on healthy choices they make.

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How much is my penalty "tax" for not having health insurance?

12/04/2014 -

We have been getting a lot of questions about the penalty (tax) for not having qualified health insurance in 2014 and 2015. This is a new era in mandates and is supposed to combat the uninsured running up healthcare costs the rest of us get to pay for.,

Calculating your actual penalty can be tricky. The easiest way to look at is you will owe the greater of 2% of your annual income or $325 per person in your household ($162.50 per child under age 18). Fortunately, the penalties have maximums. In the case of a "high income" person or family they are limited to paying a penalty equal to the national average premium for a bronze plan on the health insurance marketplace. That of course will be a different number for each person. In the instance of paying the per person amount, the maximum penalty "tax" is $975.,

How do I pay the penalty?

You will pay the penalty "tax" on your federal income tax return that you file for the tax year that you don't have qualified health insurance. If you do not pay the penalty, the IRS will withhold it form any future tax refund.,

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Child only policies save money in Tennessee

11/07/2014 -

Affordable health insurance for your children.

The Affordable Care Act has opened the door to saving money with "child only" health insurance policies. Where this really works well is when you have just one child but are paying employee and child(ren) pricing for your group insurance at work. These policies charge the same regardless if you have just one child or ten.

By buying a health policy for just your child you not only save money, you can get the coverage you want or need. Plus, each of the new policies include comprehensive dental and vision benefits with the health insurance at no additional charge.

Have healthy children? Save money by buying a basic very inexpensive policy. If your child has medical problems or requires expensive medicines you can get a very rich policy for not much money. You are in charge of the cost and benefits.

For example a child only policy from BlueCross Blue Shield of Tennessee can cost less than $100 per month for a very basic high deductible plan. Have a child with high medical or prescription claims, for as little as $170 per month for the best policy with a $2,100 deductible then 100% plan. That means if your child has high claims once you have paid out $2,100 in total expense, everything is covered at 100%.

Want more information? We have a great individual health insurance buyer's guide. Call us at 615-724-1701 or email dmoore@thebenefitbrokers.com

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2015 BCBST rates are out - Yes they are going up!

11/06/2014 -

Now I understand why CMS waited until the mid-term elections ended to approve and allow the 2015 health insurance rates to be released, there would have been higher voter turnout for sure. It's a solid 20% increase which we expected. To see it in print and comparing costs for my family is quite a shock to the system.,

Fortunately we are a healthy family of four living in middle Tennessee. Of course the new EHB plans and the "affordable care act" don't distinguish between healthy or unhealthy individual any longer. Rates for me an my family on a very basic $3,500 deductible plan using a limited physician network are going from $980 per month to $1,193. Ouch!

What are my options? Not sure yet but group insurance now looks like a much better option with the ability to pre-tax premiums. As an insurance broker/consultant this is a bit of a relief as we ,had no explanation why individual rates were so much less than the same plan in a small group.,

Is this a tax increase? Can't say for sure but it sure feels like one.,

We will see where United Healthcare, Cigna, Humana, Community Health Systems set their prices for 2015. Truth is I expect these new rates to still be competitive and for many their best "Affordable" health care option.,

These are very interesting times in the health insurance business. We have guidebooks that show what we consider the best individual and group insurance options in Tennessee comparing benefits and rates. Would you like a copy? Give us a call 615-724-1701 or send an email dmoore@thebenefitbrokers.com we are happy to show you your options for 2015.,

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BlueCross BlueShield of Tn and Mission Point create network M

11/02/2014 -

Accountable care organizations are showing up across the country but have been relatively unseen in Tennessee until the recent announcement of this new partnership. Mission Point has built their business with the ACO model which rely on a "patient centered home" where healthcare is coordinated between doctors and facilities. It only makes sense to share information and work together but many in the healthcare continue to work independently and EMRs do not transfer easily.,

The new network M will only be available to large employers with 1,000 or more employees. They will of course have access to the Mission Point network as well as Blue Cross's largest network P. While the P network includes the HCA Tri-Star hospitals, the primary benefits of network M will come from St. Thomas and Vanderbilt's Monroe Carrell Jr. Childrens Hospital.,

BlueCross Blue Shield of Tennessee estimates that this new network will result in cost savings of 10%. That of course would be a wonderful thing as bending the healthcare cost curve down has proven difficult and ACO's could finally be the solution everyone has been looking for.,

Need help with your insurance? Benefit Brokers has been helping employers build and manage group insurance programs for more than 20 years. Find out today how we make our clients live easier and more affordable.

David Moore - 615-724-1699

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Change Healthcare changes the way we buy healthcare

11/02/2014 -

Transparency is coming, slowly but it's coming.

Change Healthcare has found a way to show and compare costs for 81% of medical services and 75% of prescriptions. Soon we will will hopefully know how much it costs when our child needs to see a Pediatrician for an ear ache and a prescription to treat it. Imagine your doctor telling you to schedule and MRI for an injury and actually making that decision based on are report card of customer satisfaction, wait times and cost. It will change the way we purchase healthcare and actually create competition in the marketplace.

Education is another key aspect of how Change Healthcare is bending the cost curve down. As an insurance consultant/broker we hold employee meetings and create benefit communication tools for our clients. We try to make such terms as deductibles, co-insurance, non-formulary and limitations understandable but at the end of the day most don't really understand until they have claims and start seeing these items on their EOB. Insurance is frustrating and expensive.

It's exciting to see what is becoming available and some promising tools to help consumers in one of the most expensive areas of their lives. My hope is insurance carriers will get on the bandwagon and use these transparency tools to let consumers vote with their pocketbooks rather than go blindly into another medical procedure.

Benefit Brokers, LLC and it's staff have been helping employers and their employees design and implement creative benefit plans that work and are affordable for more than 20 years. If you have questions or need help call today, 615-724-1699.

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Cigna introduces Private Health Ins. Exchange in Tn

09/26/2014 -

I attended a broker event this week to learn more about the Private Health Insurance Exchange Cigna will be offering to groups with more than 50 employees in 2015. They have contracted with B-Swift to do the administration and provide back office support. The insurance industry is predicting growth in private exchanges to be incredible in the coming years. Many compare this to the 401-k revolution when companies switched from pension plans to a more defined contribution model.

Many in the industry are talking about defined contribution in healthcare and all the money that will save employers, the reality is that companies already pay premiums that way. A company that pays all or part of the employee premium for medical insurance pays a "defined contribution" for his staff. A private exchange does not change that, the big difference is the ability to offer more benefit choices, use online enrollment and hopefully streamline the process.

There are challenges as this is a new technology and platform in the small and mid-sized group market. One of the biggest things to consider is the plan design and pricing build out that has to be done before the first employees can be enrolled. Many times it takes a month or more to set up the system and groups tend to make decisions on insurance options at the last minute. Cost is another factor and many employees are not computer savvy and will still need to have help.

I do think this model will streamline and simplify benefits in the future. California has CalChoice a private exchange with more than 10,000 businesses participating. It offers different carriers and many products to choose from giving employees true choice. It's just a matter of time before we have options like this in Tennessee. At Benefit Brokers, LLC we try to stay abreast of the new technology, tax strategies and options for our clients. Do you have questions or need help with your group insurance plan? Give us a call, we have helped many companies just like yours over the past 20 years. David Moore 615-724-1699

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Key dates for 2015 Health Insurance Marketplace

09/16/2014 -

Are you ready for the upcomingHealth Insurance Marketplace Open Enrollment Period? Open Enrollment is the time when you can apply for a new Marketplace plan, keep your current plan, or pick a new one.

4 key dates you should know:

November 15, 2014. Open Enrollment begins. Apply for, keep, or change your coverage.

December 15, 2014. Enroll by the 15th if you want new coverage that begins on January 1, 2015. If your plan is changing or you want to change plans, enroll by the 15th to avoid a lapse in coverage.

December 31, 2014. Coverage ends for 2014 plans. Coverage for 2015 plans can start as soon as January 1st.

February 15, 2015. This is the last day you can apply for 2015 coverage before the end of Open Enrollment.

To buy Marketplace insurance outside of Open Enrollment, you must qualify for a Special Enrollment Period due to a qualifying life event like marriage, birth or adoption of a child, or loss of other health coverage.

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Employers required to provide "Creditable Coverage" letters to all Medicare eligible employees by October 15th.

09/11/2014 -

If you offer group health insurance to your employees you are required to provide a "Creditable Coverage" letter to each employee/dependent who is Medicare eligible. You are to determine if your policies prescription benefits are as good or better than Medicare's Part D coverage. If it is deemed your policy is not as good, any Medicare eligible persons covered on your policy are subject to a 1% per month penalty on their future Part D premiums.,

Letters must be sent by October 15th which is when open enrollment begins for Medicare.,

Read more here

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Why does my insurance cost so much? Watch the nightly news.

09/08/2014 -

We help thousands of people with their health insurance plans and always get the question about costs. Prescriptions are just one factor but the costs can be staggering and in most cases the insured does not fully understand the true cost of many prescriptions. When you have a co-pay for your prescription you really don't care what the cost is as long as you feel better.

Ever wonder why so many prescriptions are advertised on the nightly news? Direct to consumer advertising works and when you ask your doctor for a specific drug, he generally does not know the cost and may not have time to fully explain your options. Most of the drugs you see advertising are extremely expensive and advertising works.,

Ever wonder what the cost is of those drugs?

While this is not a full blow study, I did take claims data from some of our clients to see what the cost is for some better know prescriptions, here are some examples;,

Embrel to treat arthritis $1,800 - $2,200 per month

Androgel - Hormone Replacement $525 - $750 per month

Ambilify - Psychosis $500 - $840 per month

Cymbalta - Depression $900 - $1,200 per month

Celebrex $147 - $182 per month

Why the variance? Most don't realize that each pharmacy has a different contract with the insurer and prices can vary widely even with stores across the street from each other. With real time pricing tools virtually non-existent it's difficult to compare costs between pharmacies. It never hurts call or shop around and in most cases generics can and will save you money.,

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Health Insurance cancelled? Here's what you need to know

08/19/2014 -

Help! I'm losing my health insurance policy

BlueCross BlueShield of Tennessee has announced they will require all non-grandfathered individual health plans to renew to an Essential Health Benefits "EHB" plan beginning on October 2nd.,

A few key things you need to know;,

  • You MUST reapply for these policies online, you will not be transitioned automatically
  • You Must apply by the 15th of the month prior to your renewal date. Ex. If your policy renews on November 1st, you must apply online by October 15th for a November 1st effective date.,
  • The new policies are based on your age at the effective date
  • Children under age 19 receive comprehensive dental and vision benefits with their health insurance policy
  • There are NO pre-existing conditions or waiting periods, even if you did not have prior coverage
  • The E Network is very skinny - In most circumstances we recommend the S or P Networks
  • You should check to see if you qualify for a subsidy, there are billions of dollars waiting to help low and middle income Americans pay their premiums Check here,
  • HSA limits have increased and a $2,500 deductible plan is no longer qualified for an HSA in 2015.,

The new policies are a little different than what you currently have. We are happy to help and have put together an Individual Health Insurance Guidebook to help you find the right policy at the right price.,

Give us a call at 615-724-1701 for assistance.,

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"Trust but verify" Ronald Regan -- Still applies to ObamaCare

07/18/2014 -

House Hearing Highlights Exchange Subsidy Verification Shortfalls

President Ronald Reagan made an old Russian proverb -- trust but verify -- one of his mottos. Unfortunately, even though the Department of Health and Human Services (HHS) promised last Fall to make it their motto too when it came to exchange-based subsidies, this week the House Energy and Commerce Subcommittee on Health revealed their promise to be a fairly empty one so far.  

Even though former HHS Secretary Kathleen Sebelius testified before Congress last Fall multiple times that the HHS subsidy verification process was ready and working, and certified its viability this past January, the House Committee has identified at least four million unverified subsidy cases. At the beginning of this month, the U.S. inspector general released a report that documented subsidy verification shortcomings. Findings of the report include:

HHS has been unable to resolve nearly 90% of application inconsistencies, even if the applicant submitted appropriate documentation.

Most inconsistencies are related to citizenship and income, the first and most basic qualification criteria.

Without the ability to resolve inconsistencies in an applicant's data, the marketplace cannot determine if the applicant is eligible for enrollment. This should be step one in the enrollment process, but there is no confidence that this is being done properly.

Both federal and state-based marketplace websites continue to have problems, resulting in applicants not being able to enroll online. These problems generated a backlog of paper applications for several states.

The Federal Data Hub created additional problems for states who attempted to appropriately process applications.

The Data Hub was frequently inoperable, which meant states could not verify applicant data.

Federal data sources accessed through the Hub were frequently inaccurate, thus creating more inconsistencies.

One state marketplace reported that the Data Hub identified a set of infants and children as incarcerated, according to federal data sources.

The Center for Medicare and Medicaid Services (CMS) has concurred with the Office of the Inspector General's (OIG) findings and recommendations. However, CMS placed part of the blame for these failures on consumers who are inexperienced with the enrollment process.  

During this week's House hearing, Republicans asserted their concern for people who could least afford to pay back subsidies and noted that many cases of incorrect determination are likely not the result of fraud, but rather consumer misinformation and honest mistakes. Democrats retorted that health reform is working for millions of people and called Republicans to work with them to make changes to the law that will actually improve verification, rather than merely holding hearings outlining problems.  
 
Unlike enforcement of the individual mandate, where IRS authority and collection methods are limited, the Treasury Department has full authority to reclaim subsidy dollars from consumers who took premium tax credit dollars for which they were not eligible. If an individual misstated his or her income and actual income still fell below 400% of the federal poverty level (FPL) and the individual met all other exchange eligibility criteria, then the amount of subsidy recapture is capped by income. However, if a consumer was never eligible to purchase subsidized exchange coverage to begin with (for example because he or she had been offered affordable and minimum value employer coverage) or if the individual's income exceeded 400% of the FPL, then he or she is on the hook to repay the total subsidy amount received, which can easily run in the thousands of dollars.

NAHU has been raising the subsidy verification issue with the Administration, members of Congress and the media for months. One area we have particularly highlighted is employer coverage verification, which has been poor at best. When members of Congress asked during the hearing if any employer had been notified about an employee requesting a subsidy, the witnesses were unaware of any cases where employer verification had truly occurred. Government witnesses also admitted that the verification system is still not fully operational. It is uncertain if the verification system will be ready in time for enrollment scheduled to begin in November.

http://newsmanager.commpartners.com/nahuw/issues/2014-07-18/1.html

 

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BlueCross BlueShield of Tn asking for 19% increase on health insurance policies

07/17/2014 -

Affordable Care Act -

That's what they call it but for many the new health plans are anything but affordable. As you know we work primarily in the group health insurance marketplace and many are seeing big increases there as well. That's not to say everyone is getting hurt by the new plans, many are seeing better benefits at lower costs. While lower income Tennesseans are seeing the greatest benefit from the new Essential Benefit Plans (EHBs), many who had pre-existing conditions or were on expensive COBRA policies have been able to get better coverage for substantially lower costs.,

We have many group clients who have seen lower costs as well. This is due to how insurance policies are rated with healthy people getting the lowest rates and those with higher risks or medical conditions paying much higher costs. The new plans are "community rated" with guarantee issue. That means there is one set cost for a health insurance policy and each person that age pays the same cost regardless of their health status. Healthy people pay more, unhealthy pay less. The carriers get the same amount of premium dollars in the end, it's who is paying what that has changed.,

Early group insurance renewals

September 1st is where we are seeing our first healthy groups who did an "early renewal" get their EHB pricing. It's going to be a real shocker when they see 25-50% increases on the new plans. Carriers are allowing companies to keep their current plans for another year with a "grand mothered" program. Our early look at these have been 20-25% increases. What to do? Better have a good broker on your side to show you all the options and help you design the right plan for your situation. We are happy to help, call us 615-724-1699.,

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PCORI fee for Health Reimbursement Arrangements (HRAs) due by July 31.

06/24/2014 -

Reminder: PCORI Fee Payment Due by July 31

The Affordable Care Act[1] amends the Social Security Act by creating the Patient-Centered Outcomes Research Institute (PCORI). The Institute will be responsible for setting national research priorities and establishing an agenda to carry out such research.

 

The provision also amends the Internal Revenue Code creating the Patient-Centered Outcomes Research Trust Fund (PCORTF) that will be used to support the PCORI. In addition to specified appropriations and transfers from the Medicare Trust Fund, the Affordable Care Act also imposes a fee on fully-insured health insurance policies (individual and group) and self-funded health plans that together will fund the PCORTF. This fee is commonly referred to as the PCORI fee.[2]

 

This article is provided for general use. Employers and other plan sponsors with specific questions about the PCORI fee are urged to contact their legal counsel or tax professional.

 

Resources

In addition to a plan sponsor's legal counsel or tax professional, the Internal Revenue Service (IRS) provides several resources through its PCORI web page. Information includes:

 

  • Final Rule - provides the details for calculating the fee, among other pertinent information
  • Questions and Answers - addresses common questions about the fee and its payment
  • Summary Chart - a chart of common types of insurance coverage or arrangements, and the party responsible for paying the fee
  • Form 720 - the form to be used to report and pay the fee.

 

Payment is Due by July 31

For fully-insured group plans and individual policies, BlueCross is responsible and liable for calculating, reporting and paying the fee to the IRS.

 

For self-funded plans - including Health Reimbursement Arrangements (HRAs) - the plan sponsor is responsible and liable for calculating, reporting and paying the fee. The final rule provides guidance to determine the plan sponsor and methods for calculating the number of members on which the fee is based.

 

Fees are due by July 31, 2014. The amount of the fee is based on plan year timing:

  • For plan years ending Jan. 1, 2013 through Sept. 30, 2013, the fee is $1 per member per year
  • For plan years ending Oct. 1, 2013 through Dec. 31, 2013, the fee is $2 per member per year

 

Please refer to the IRS website for other information about reporting and paying the fee, especially if you have to file Form 720 for other purposes.

 

The PCORI fee and HRAs

Several questions have been asked about the application of the PCORI fee to HRAs, particularly for groups with a fully-insured medical plan. As mentioned above, BlueCross is responsible for paying the fee for our insured business. However, the plan sponsor of the HRA plan will also be responsible for paying a fee on the self-funded portion of the plan.

 

The following excerpt from the IRS chart summary may provide clarity:

"Special rule for coverage under multiple applicable self-insured health plans:

·         Generally, separate fees apply for lives covered by each specified health insurance policy or applicable self-insured health plan.

·         However, two or more applicable self-insured health plans may be combined and treated as a single applicable self-insured health plan for purposes of calculating the PCORI fee but only if the plans have:

§  The same plan sponsor; and

§  The same plan year.

"For example, if amounts in an HRA may be used to pay deductibles and copays under a specified health insurance policy, the HRA (an applicable self-insured health plan) and the policy would be subject to separate PCORI fees. However, an HRA that may be used to pay deductibles and copays under the applicable self-insured health plan is not subject to a separate fee (and the fee will apply only to the applicable self-insured health plan) if both the HRA and the applicable self-insured health plan have the same plan sponsor and the same plan year.

·      There is no similar rule for lives covered by more than one insurance policy subject to the PCORI fee.

"Special counting rule for HRAs [ ]:

·         Plan sponsors are permitted to assume one covered life for each employee with an HRA."

 

Available Reporting for Self-funded Plans

While BlueCross cannot report or pay the PCORI fee on behalf of self-funded plans, we are providing a variety of resources that may assist plan sponsors. BlueCross provides information to self-funded plans for Form 5500 reporting, including the number of participants at the beginning and end of the year for plans that we administer.

 

In addition, BlueCross has reports available through Interactive Reporting on BlueAccess that may be of assistance if the plan sponsor determines it to be appropriate. Two reports are available:

 

  1. Demographic Breakdown of Members Report - This report provides the number of members by month. For each complete month, the membership information returned is as of the last day of the month.

To access the report:

  • Log-on to BlueAccess
  • Select Interactive Reports
  • Select Launch - Enter Client (group) name
  • Select Demographic breakdown option listed under the Member Information section

 

The current reporting date is the default. If you are looking for the most recent information, select Run. This will return all member demographics for the group. Run the report for the month you need. Print or download the results for your records.

 

  1. Enrollment Report - This report provides the number of subscribers by month. For each complete month, the enrollment information returned is as of the last day of the month.

To access the report:

  • Follow the first three steps for accessing the Demographic Breakdown of Members report as outlined above
  • Select Enrollment by Group by Month option listed under the Member Information section

 

The current reporting date is the default. Run the report for the period that you wish to see. The results will be separated for each month within the time period specified. You can print or download the results for your records. These tools can be found on BlueAccess.

These reports provide information about all subscribers or members enrolled under a group number based on the information in our database at the time the report is compiled. The reports will not reflect any additions or terminations that have not yet been reported and/or processed by BlueCross.

 

This information is provided for general use. If you are an employer or self-funded plan sponsor and have specific questions regarding the calculation, reporting, or payment of the PCORI Fee, please consult with your attorney or tax professional.

 

[1] The Patient Protection and Affordable Care Act, Public Law 111-148, was enacted on March 23, 2010. The Health Care and Education Reconciliation Act, Public Law 111-152, was enacted on March 30, 2010. They are collectively known as the Affordable Care Act.

[2] For additional general information about the PCORI fee, please refer to the Feb. 4, 2013 and July 1, 2013 Health Care Reform Update articles available on BlueAccess.

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2014 Long-term disability insurance annual review

06/17/2014 -

Long term disability insurance is the most under rated benefit offered by employers but in my opinion, it's second in importance to health insurance. Most think life insurance is critical to a financial plan but the truth is, you are much more likely to become disabled than you are to die. What happens to your family and lifestyle when your income stops for an extended period of time? This is where LTD insurance comes in.,

The following is a fascinating look at LTD statistics and more importantly the Federal Governments Social Security Disability Insurance (SSDI) program. Do you realize it is going to run out of money by 2016? There are 8.8 million Americans receiving benefits and the money is nearly gone, what happens next will be interesting to see.,

Since 2005, the Council for Disability Awareness (CDA) has conducted an exclusive annual review of long term disability claims among the U.S. working population. The 2014 CDA Long Term Disability Claims Review summarizes quantitative and qualitative long term disability insurance claims data from 2009 through 2013, gathered from the annual CDA member Long Term Disability Claims Survey. The report identifies continuing or emerging trends for the purposes of education, evaluation and use by interested audiences. Also included is selected worker disability data from the Social Security Disability Insurance (SSDI) program. Nineteen CDA member companies, representing more than 75 percent of the commercial disability insurance marketplace, contributed disability claim data for this year's study, making this edition of the review the largest and most comprehensive to date. ,Download the report here

,

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Why does the BCBST P network cost more? Based on this report, HCA charges much higher costs then the other Nashville hospitals.

06/03/2014 -

The federal government has been releasing hospital charges across the country showing the differing costs for the same medical procedures. The prices vary widely even between hospitals across the street from each other with most of the HCA/Tri-Star facilities charging more than 100% of the average Medicare reimbursement rates. Not only is this article interesting there is an interactive map that shows all the hospitals based on a zip code and how the rates differ. See what your favorite hospital charges compared with the others in your area. 

Tennessee business owners have long seen double digit increases in their group medical insurance premiums while Medicare continually freezes or reduces reimbursements. It seems even Medicare can't slow down the inflation and medical trend challenge as charges are increasing for most of the common procedures. This is offset by fewer people being admitted which is what allows the federal government the right to say Medicare costs are stable.,

Read more here

.,

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IRS fines employers $100 per day for dumping workers into Tn health exchange

05/27/2014 -

Employers who thought they had found a way to shift the cost and responsibility of providing health insurance to the government are learning that door has been closed for good. At least if they want to give employees "tax free money" to pay the premiums. We thought HRAs and FSAs would provide a great tool to help employees purchase less expensive individual policies when the ACA was first being rolled out, it's clear now this is not an option. 

Christopher E Condeluci, a former tax and benefits counsel to the Senate Finance committee says "if employers want to help employees buy insurance eon their own, it can give them higher pay, in the form of taxable wages. But in such cases, he said, the employer and employee would owe payroll taxes on those wages, and the change could be viewed by workers as reducing a valuable benefit." 

Read more

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$5.5 Billion bailout, just in case.......

05/23/2014 -

The Obama administration released a 435 page regulator update on Friday May 16th providing clarity around a number of different issues. One of which that has been denied for months is that there is a  "bailout program" for insurance companies if they lose money under the new health insurance program. It appears the White House has authorized as much as 5.5 billion dollars from "other sources of funding" in the "unlikely event" that ObamaCare costs more  than expected. 

Many of course think this is a political issue to try and keep rate increases at a minimum level until the next round of elections in the fall. It is of course a necessary thing to do if you want to keep the markets competitive until enough new people are in the risk pool, everyone understands who is enrolled, how much the premiums are and what the risk/claims look like. 

Read more here 

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ObamaCare subsidies may be wrong for 1 million Americans or Illegals

05/19/2014 -

The Washington Post is reporting this morning that more than 1 million people may be receiving too much or too little premium subsidies and they are having to verify the information by hand. The newest problem reveals that the IRS has found hundreds of thousands who listed incomes significantly from the income the IRS has on file. The problem is the next step is consumers are asked to upload or mail in payroll documentation as proof of income. While only a fraction have done so, the federal computer is unable to match the documentation because the capability has not yet been built. 

That leaves piles of unprocessed "proof" sitting in a federal contractors desk in Kentucky while the government continues to pay undocumented subsidies. The white house agrees this is a problem that needs to be resolved "as soon as possible". But it seems there is a more pressing issue they must first address. 

It seems there are another roughly 1 million cases where people enrolled - or tried to enroll - in health plans and ran into questions about their citizenship status. Throughout the signup period the HealthCare.gov website blocked many unnaturalized citizens or permanent legal residents, requiring them to submit immigration documents that are, like the income verification information, caught in a backlog. 

Read more 

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I just had a High Speed HeartVue Scan

05/08/2014 -

I am 52 years old, very healthy, exersize regularly, don't smoke, have no family history or heart or other medical problems, take no medicines and eat a pretty good diet. Sound like a great health risk, that's what I think. The problem is I have a good friend who can say the same thing and is actually in better shape than I am who just had a very bad heart attack. 

He is ok, he made it to hospital just in time but this would have been fatal if he had been further from the hospital. While he had no risk signs, he had nearly 100% blockage in a main artery (called the widow maker) and substantial blockage in another. I did a long bike ride with him just a few weeks before. 

Needless to say, I began to question how healthy I really am. There is a fast, easy and inexpensive test that will look inside your heart and blood vessels to see if there is any artery buildup or plaque. The cost is only $69 and it took me a total of 45 minutes from door to door, including all the check in stuff. I don't have my results yet but feel better for being proactive about this. Getting an annual physical is very important, this inexpensive test seems equally important. 

To learn more you can call the Tennessee Heart and Vascular Institute Imaging Center at 615-620-0083. 

Remember, if you need help with your health insurance or employee benefits in Nashville Tn, we are here to help. 

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Details on ACA enrollment with statistics

05/05/2014 -

Feds Release Enrollment Statistics, No Payment Details Yet

On Thursday, May 1, the Center for Medicaid and Medicare Services (CMS) released the most comprehensive analysis to-date of health coverage enrollments made through the new health insurance marketplaces between October 1, 2013, and March 31, 2014. The data also includes enrollments made via special election periods through April 19, 2014.

Here are some key takeaways:

  • 8,019,763 people selected marketplace plans from October 1, 2013, through April 19. 
  • Nearly 2.6 million signed up via state-based exchanges and there were over 5.4 million plan selections via the federally facilitated and partnership marketplaces.
  • About 3.8 million people were procrastinators and enrolled between March 2 and April 19.
  • Of the more than 8 million:
    • 54 percent are female and 46 percent are male;
    • 34 percent are under the age of 35;
    • 28 percent are between the ages of 18 and 34;
    • 65 percent selected a Silver plan
    • 20 percent selected a Bronze plan; and,
    • 85 percent were eligible for a premium tax credit
  • Being a red state or a blue state didn’t really matter. More than a third of the sign-ups came from three states with large numbers of uninsured residents. Bright blue California had 1.4 million people sign up and fire-truck red Florida and Texas brought in 980,000 and 730,000 sign ups respectively. The next closest states were New York and North Carolina, which each signed up more than 350,000 residents.
  • The states that enrolled the smallest percentage of their uninsured populations were purple Iowa, red South Dakota and blue Massachusetts.
  • The report contains the first glimpse of the demographics of the newly signed-up population. About 63 percent were white, compared to 17 percent African American, 11 percent Latino and 8 percent Asian.

The report also shed some light on the question of how many of the 8 million were previously uninsured and how many of them were just switching to new exchange-based individual coverage. The report extrapolated data to predict about 5.18 million people who applied for exchange-based coverage were getting coverage for the first time. This number is based on data showing that just 13 percent of new enrollees told the federal exchange that they had coverage at the time of the application. However, even HHS officials cautioned that the sample used to make this calculation was small, the data is “not very reliable” and people may have underreported their coverage. Data for all the state exchanges wasn’t available.

One key piece of data not contained in the report — how many people enrolled in private qualified health plans have paid their first premiums. Obviously, this is the final step to truly being covered. Industry trends suggest that 85 percent will pay and 15 percent will not, and that an additional number will drop their coverage or simply will stop paying premiums at some point during the coverage year. How many new exchange enrollees will ultimately drop-off of their coverage plans is right now an unknown, but a recent study shows that only about half of individual market purchasers pre-health reform remained in their individual policy for a year or more. Will this new 8 million people behave similarly? Only time will tell!

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HHS Releases detailed ACA enrollment - Claims 8 million signed up for coverage.

05/05/2014 -

HHS on Thursday released the most comprehensive Affordable Care Act enrollment data Share to FacebookShare to Twitter to date, providing a wealth of information from which national outlets, websites, wire services, cable news programs, and countless local papers drew reports and analyses. The biggest takeaway, that over eight million Americans have signed up for private coverage on the law’s online marketplaces, dominated the headlines of most large-circulation sources, but other information, like demographic breakdowns and state-by-state figures, made up the bulk of the accounts.

        Beyond that, many of the reports focus on the late surge in enrollment, with more than five million individuals signing up since February. Populating the less positive assessments, though, were two key points: the relatively low number of Latino enrollees, as well as the proportion of enrollees ages 18-35, which, while higher than in previous updates, is still cast as lower than needed to sustain the cost of the law. Finally, a few point out that with all the information released Thursday, the Administration still hasn’t said what percentage of those who signed up have paid their premiums.  

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BlueCross vs. TriStar in the emergency room

04/15/2014 -

Blue Cross Blue Shield of Tn announced several months ago that they would no longer pay for the higher cost of "out of network" care charged by providers not in their PPO networks. For years we informed those with the S Network that they could visit the nearest facility in a true emergency and it would be treated as if they were "in network" from BCBST. We are finding that this is no longer true. Under this new payment strategy, BCBST is paying "out of network" facilities what they would have paid an "in network" facility for the same procedures. The problem is, facilities can charge any amount they want for each service as they don't have negotiated rates. 

This change is putting hard working employees who have what they deemed good health insurance in the cross hairs of a corporate battle between BlueCross BlueShield of Tennessee and HCA TriStar. So far there are only losers who are the insureds that are now facing huge bills with what appears nowhere to turn for help. 

We have been helping several of our groups employees in this situation by working through the system and BlueCross dispute channels but we are running in brick walls. Who is the bad guy in this situation? It seems the system but one would think these two powerhouses could take off the gloves and work together to help these unfortunate few who are now left with thousands of dollars in medical bills for following the rules. 

A recent article from Shelly DuBois in the Tennessean highlights this problem and the lethal fight that is now occurring over one mans $44,000 unpaid medical bill. Read more here

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Want health insurance after April 1st? Sorry we can't do that any longer. Fallout continues...

04/04/2014 -

Many Tennesseans and others around the country who did not sign up for insurance during open enrollment will be in for a rude awakening if they want or need coverage for the rest of the year. Because of the guarantee issue and no pre-existing condtions limitations carriers needed the protection of not allowing someone to buy insurance only when they need it. There has to be protection for the carriers and I personally think this is a good thing. Another option would be to offer coverage with pre-x if you don't buy the policy during open enrollment. 

You can, of course buy coverage if you have a qualifying event (marriage, divorce, birth or adoption, loss of group coverage, etc.) within 30 days of the event. It's very important to understand how these rules work and we are happy to help, feel free to call us at 615-724-1701. 

By Associated Press, Updated: Friday, April 4, 2:57 AM

WASHINGTON — Here’s more fallout from the health care law: Until now, customers could walk into an insurance office or go online to buy standard health care coverage any time of year. Not anymore.

Many people who didn’t sign up during the government’s open enrollment period that ended Monday will soon find it difficult or impossible to get insured this year, even if they go directly to a private company and money is no object. For some it’s already too late.

With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for HealthCare.gov and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.

It’s a little-noted consequence of President Barack Obama’s health care overhaul, which requires nearly all Americans to be insured or pay a fine and requires insurers to accept people with health problems.

“I have people that can buy insurance, but the companies shut them down. They won’t take the applications,” insurance broker Steve Bobiak of Frackville, Pa., said. “We’re a free country. You should be able to buy anything anytime you want.”

Those who act now may still be able to get in, depending on where they live. Following the lead of the government marketplaces, some companies are extending off-marketplace sales for a week or a month to help people who hit snags trying to enroll by this week’s deadline. Rules vary from state to state.

After those extensions, eligibility for coverage during 2014 is guaranteed only for people who experience certain qualifying life events, such as losing a job that provided insurance, moving to a new state, getting married, having a baby or losing coverage under a parent’s health plan.

The federal law doesn’t prevent companies from selling policies to everyone all year. But insurers consider it too risky now that the law prohibits them from rejecting people in poor health.

“If you didn’t have an open enrollment period, you would have people who would potentially enroll when they get sick and dis-enroll when they get better,” said Chris Stenrud, spokesman for insurer Kaiser Permanente. “The only insured people would be sick people, which would make insurance unaffordable for everyone.”

Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies.

“It’s lousy communication out there,” he said. “If we don’t know, my God, how do they expect other people to know? It’s terrible.”

A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren’t aware of the marketplace deadline on March 31. The Obama administration, insurance companies and nonprofit groups scrambled to spread the word, often with messages that focused on the cost savings available to many people through the government marketplaces.

There wasn’t much public discussion about people who prefer to buy policies outside the marketplaces, sometimes finding better deals or options more to their liking.

Health and Human Services spokesman Aaron Albright pointed to a cryptic note on the HealthCare.gov website: It says “in some limited cases some insurance companies may sell private health plans outside the marketplace and outside open enrollment” that satisfy the law’s coverage mandate. It doesn’t say how to find any companies doing that. Albright had no further comment.

Gary Claxton, a health law expert at the Kaiser Family Foundation, said it’s “highly unlikely” that companies will offer such coverage after the deadline window fully closes. Some do still offer temporary plans, lasting from a month to a year. But those plans don’t cover pre-existing conditions and don’t get buyers off the hook for the law’s tax penalty.

Nate Purpura, spokesman for eHealthInsurance.com, which sells policies from 200 companies across the nation, said at this point he knows of none planning to offer major medical insurance after this month, except to people with qualifying life events.

For people trying to get an off-marketplace plan through an open enrollment extension, some insurers are selling them through April 15, and others through the end of the month. Purpura said eHealth will offer such plans in at least some areas of these states: Arizona, California, Georgia, Hawaii, Louisiana, Maryland, Michigan, Nevada, New Mexico, Ohio, Oregon, Utah, Virginia and Washington state.

Kaiser Permanente will offer extensions that mirror the state or federal marketplace in the area where a plan is sold, Stenrud said. The federal marketplace extension for online enrollment is April 15. But Oregon, for example, is giving marketplace buyers until April 30.

After that, Stenrud said, without a qualifying life event, the door closes until Nov. 15.

By Associated Press, Updated: Friday, April 4, 2:57 AM

WASHINGTON — Here’s more fallout from the health care law: Until now, customers could walk into an insurance office or go online to buy standard health care coverage any time of year. Not anymore.

Many people who didn’t sign up during the government’s open enrollment period that ended Monday will soon find it difficult or impossible to get insured this year, even if they go directly to a private company and money is no object. For some it’s already too late.

With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for HealthCare.gov and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.

It’s a little-noted consequence of President Barack Obama’s health care overhaul, which requires nearly all Americans to be insured or pay a fine and requires insurers to accept people with health problems.

“I have people that can buy insurance, but the companies shut them down. They won’t take the applications,” insurance broker Steve Bobiak of Frackville, Pa., said. “We’re a free country. You should be able to buy anything anytime you want.”

Those who act now may still be able to get in, depending on where they live. Following the lead of the government marketplaces, some companies are extending off-marketplace sales for a week or a month to help people who hit snags trying to enroll by this week’s deadline. Rules vary from state to state.

After those extensions, eligibility for coverage during 2014 is guaranteed only for people who experience certain qualifying life events, such as losing a job that provided insurance, moving to a new state, getting married, having a baby or losing coverage under a parent’s health plan.

The federal law doesn’t prevent companies from selling policies to everyone all year. But insurers consider it too risky now that the law prohibits them from rejecting people in poor health.

“If you didn’t have an open enrollment period, you would have people who would potentially enroll when they get sick and dis-enroll when they get better,” said Chris Stenrud, spokesman for insurer Kaiser Permanente. “The only insured people would be sick people, which would make insurance unaffordable for everyone.”

Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies.

“It’s lousy communication out there,” he said. “If we don’t know, my God, how do they expect other people to know? It’s terrible.”

A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren’t aware of the marketplace deadline on March 31. The Obama administration, insurance companies and nonprofit groups scrambled to spread the word, often with messages that focused on the cost savings available to many people through the government marketplaces.

There wasn’t much public discussion about people who prefer to buy policies outside the marketplaces, sometimes finding better deals or options more to their liking.

Health and Human Services spokesman Aaron Albright pointed to a cryptic note on the HealthCare.gov website: It says “in some limited cases some insurance companies may sell private health plans outside the marketplace and outside open enrollment” that satisfy the law’s coverage mandate. It doesn’t say how to find any companies doing that. Albright had no further comment.

Gary Claxton, a health law expert at the Kaiser Family Foundation, said it’s “highly unlikely” that companies will offer such coverage after the deadline window fully closes. Some do still offer temporary plans, lasting from a month to a year. But those plans don’t cover pre-existing conditions and don’t get buyers off the hook for the law’s tax penalty.

Nate Purpura, spokesman for eHealthInsurance.com, which sells policies from 200 companies across the nation, said at this point he knows of none planning to offer major medical insurance after this month, except to people with qualifying life events.

For people trying to get an off-marketplace plan through an open enrollment extension, some insurers are selling them through April 15, and others through the end of the month. Purpura said eHealth will offer such plans in at least some areas of these states: Arizona, California, Georgia, Hawaii, Louisiana, Maryland, Michigan, Nevada, New Mexico, Ohio, Oregon, Utah, Virginia and Washington state.

Kaiser Permanente will offer extensions that mirror the state or federal marketplace in the area where a plan is sold, Stenrud said. The federal marketplace extension for online enrollment is April 15. But Oregon, for example, is giving marketplace buyers until April 30.

After that, Stenrud said, without a qualifying life event, the door closes until Nov. 15.

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78,000 sign up for health insurance in February

03/12/2014 -

Across our beautiful state nearly 78,000 have signed up in February for a health insurance policy under the federal health insurance exchange. Nationwide over four million have signed up since the October 1st open enrollment began. 

In Tennessee 56 of those who signed up were women. Adults aged 55 - 64 made up 32% of the February enrollment while the younger and presumably healthier (under age 35) residents only accounted for 28% of the enrollees. 

The middle level silver plans were chosen by 72% of enrollees, while 16% chose the least expensive bronze options. 

In January, 60,000 Tennesseans had signed up. Please remember that open enrollment closes on March 31st and you CAN NOT buy an individual policy unless you have a credible event. That means if you have a loss of coverage due to: divorce, death, termination of an employer based plan, a dependent aging off a parents plan, marriage, birth/adoption or a permanent move across state lines you are not allowed to buy a health policy. 

Cancelling an individual policy you don't like does NOT qualify for a loss of coverage. 

Additionally, if you have not signed up for a policy by March 31st, you will be subject to the tax penalty. 

If you have questions about this or need help with your insurance plans give us a call today. 615-724-1701

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New day, new ObamaCare rules

03/06/2014 -

The Obama administration on Wednesday released a broad set of regulatory changes to the health law that would give some consumers additional time to stay in plans that do not comply with all its coverage requirements and all consumers more time to enroll in coverage come 2015.

In response to reporters’ questions, an administration official said repeatedly that March 31 remains the enrollment deadline for consumers who want to get coverage on the health insurance exchanges this year.  After problems with the rollout of the health law’s web site and lower-than-expected enrollment, there had been speculation that the deadline would be extended.

The rules changes, released jointly by the Department of Health and Human Services and the Treasury Department, were published now to provide certainty and clarity for consumers, employers and insurers, officials said.  “Unlike last year, we’re putting out the policies early, they’re clear, people can rely on them,” an administration official said.

Administration documents also said the provisions were developed “in close consultation” with several members of Congress, including Senate Democrats Mary Landrieu of Louisiana and Jeanne Shaheen of New Hampshire. Both lawmakers are facing tough re-election campaigns this fall.

The changes include:

  • Allowing consumers who hold individual policies purchased before the health law went into effect and that do not meet the law requirements to stay in those plans for another two years if their state allows it and the insurer continues the plan. In November, President Obama had given individuals a one-year extension.
  • Extending the enrollment period for 2015 coverage from Nov. 15, 2014 until Feb. 15, 2015, one month longer than previously scheduled.
  • Changing the law’s reinsurance and risk corridor provisions, which are designed to help insurers manage the financial risk of taking all comers while keeping premiums affordable. The cap at which “reinsurance” kicks in would be lowered for 2014 from $60,000 to $45,000 in claims per person, then rise to $70,000 next year, with a reinsurance cap of $250,000 per person. Administration officials also said they would implement the risk corridors provision, which has been criticized by Republicans as a “bailout” for insurers, in a budget neutral fashion, with payments in equaling payments out.
  • Giving states until June 15 to determine if they want to operate their own health exchanges in 2015. Fourteen states and the District of Columbia currently operate their own exchanges, with the federal government operating them everywhere else.
  • Increasing annual limits for cost-sharing – deductibles, copays and coinsurance -- limits for exchange policies in 2015. For individuals, those limits would rise to $6,600 from the current $6,400 and for families to $13,200 from the current $12,700.

In a statement, America’s Health Insurance Plans president and chief executive officer Karen Ignagni said her group was still reviewing the series of changes.

“There is broad agreement that if more young and healthy individuals choose not to participate in the new marketplaces, it could lead to higher premiums for those consumers that remain in the exchanges,” she said “That is why it is crucial that sufficient steps be taken to stabilize the market…”

Republicans criticized the decision to allow people to remain longer in plans that do not comply with the health law.

“Once again, the Obama administration has shown it will do whatever it takes to hide the true impact of ObamaCare from the American people – at least until after the next election,” said Sen. Orrin Hatch, R-Utah, ranking member of the Senate Finance Committee.  “The fact is Americans should be able to keep the insurance – and the doctors and hospitals – of their choosing, as the president promised. Pushing this off for two more years isn’t a solution at all.”

Robert Laszewski, a consultant and former insurance industry executive, said in a note to his clients that allowing people to keep policies that don’t meet the law’s standards doesn’t bode well for insurers.  Those policyholders need to sign up for new coverage – often at higher rates – to offset the costs of enrollees who are older or sicker, he said.

Brian Haile, senior vice president for health policy at tax service Jackson Hewitt, said adding a month to what was previously planned for the open enrollment period next year is a good idea. “Given that so many Americans are cash-strapped during Christmas,” he said, “the extension … to Feb. 15, 2015 is hugely beneficial to them – and the overall enrollment effort.”

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Forbes reports: Obamacare to increase employer sponsored health insurance premiums for millions.

03/02/2014 -

There are many reports and rumors of increased health insurance costs due to "ObamaCare". This one is a little different because it's actually provided by The Centers for Medicare and Medicaid. They predict costs will increase for two out of three small and medium sized businesses in 2014. 

As a professional who works with small and medium sized companies. I agree with this study and the coming shock that will affect many employers and employees. One thing we are not seeing mentioned is how high the costs are for people over age 50. Rates are now based on age and the difference between a 25 year old and 50 year is $214 vs $383 per month for a basic HDHP. The scary part, is the cost for a 60 year old is $582 for that same plan. While I have not seen anyone writing about it, age discrimination becomes real factor when you have that type of premium disparity. 

Back to the CMS report, many feel the prediction that 2/3 will see higher costs is conservative  as the CMS report is only based on one factor, community rating. There are of course many things that change with the new "essential health benefit" plan designs. Another challenge we are facing is that individual insurance policies (in middle Tn) are priced about 25% less than a similar group policy. This is giving employers another reason to consider dropping their group coverage and just sending employees to buy their own coverage in the individual market. 

To read the full article and see the CMS report click here 

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Tennessee's uninsured not enrolling in health plans. Time is running out.

02/24/2014 -

The health insurance marketplace was supposed to be the solution to Tennessee and Americas uninsured population. After four months of open enrollment it does not appear they are actually that interested in getting health insurance regardless of the low price tag. 

As of February 1st, only 59,705 applications have been received according to the US Department of HHS. Of those who have enrolled 78% have qualified some some type of premium subsidy. 

We here at Benefit Brokers, LLC have been doing our part to help enroll individuals in both subsidized and non-subsidized plans outside of the Marketplace. We have had several employers drop their group coverage sending employees out to find their own policies. There have been some employees who benefited due to their age and low income but many employees have not been happy with the results they are seeing. 

Those who have benefited the most in our opinion are individuals who have been able to move their children to a lower cost health/dental/vision plan from the group policy they have been using. Most companies don't subsidize dependents and group policies cost for children generally charge the same regardless of the number of kids. For those with just one child, they can save a substantial amount of money and choose the type of coverage they want. 

Needless to say, there is much work to be done prior to the March 31st deadline to enroll and receive subsidies. If you have questions feel free to call us at 615-724-1701. 

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Top 10 ObamaCare questions from "The Fiscal Times"

02/18/2014 -

After counceling with dozens of indviduals and small busienss owners, we concur with this story.

A new poll from the Urban Institute found that about a third of Americans are still unfamiliar with the health care law, and a Bankrate poll shows the majority have no idea what the deadline is to enroll. Since the law is aimed at only 15 percent of the adult population in the U.S. (85 percent of Americans have health care insurance through their employers or individually), these statistics are not out of line. On top of that, the administration has made numerous changes in the rules and deadlines, adding to consumer confusion. To help consumers get a better understanding of the Affordable Care Act, The Fiscal Times has assembled a user guide to Obamacare (Ehley, 2/17).

Read the full story here

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Final Regulations Ease 2015 Employer Mandate Requirements

02/15/2014 -

The Treasury Department issued final regulations for implementing the employer mandate under Healthcare Reform. The mandate requires that starting in 2015, large employers must offer full-time employees health coverage that is both affordable and provides minimum value or pay a penalty if at least one full-time employee enrolls in subsidized coverage on the Exchange. These final regulations provide some transition relief:

 Mandate Delayed Until 2016 for Employers with 50 to 99 Employees

​For a medium-sized employer—defined as 50 to 99 full-time equivalent employees, the penalty for not providing health insurance has been delayed until 2016. This delay is implemented to give smaller employers more time to adjust, and for businesses to reconsider cutting employees' hours. Firms wanting to use this new "phase in" period, however, must certify that they haven't shrunk employee numbers to qualify as a medium-sized business.

 Percentage of Covered Employees Reduced

​The original proposed regulations required large employers to offer coverage to at least 95% of their full-time employees in order to avoid a penalty. With these new final regulations, the requirement has been reduced to 70% for the 2015 plan year. It increases back to 95% in the 2016 plan year.

 Other 2015 Transition Relief

​As we expected, but were waiting on regulations to confirm, the transition rules that were to go into effect for 2014 have been extended to 2015. These include:

Six-month measurement period: Employers can use a six-month measurement period with a twelve-month stability period for 2015

Non-calendar year plans: Employers with plans that do not start on January 1, 2015 do not have to comply until the start of their 2015 plan year if they meet certain conditions. Generally, management carve-out plans that do not currently offer coverage to most all employees will have to comply on January 1, 2015.

Dependent coverage: If a plan doesn't offer dependent coverage in 2014, then the plan will have until 2016 to arrange for coverage. Also, stepchildren and foster children do not have to be included in the definition of dependent. Plans are not required to offer coverage to spouses. 

Determining large employer status: Employers can use six consecutive months of 2014, instead of twelve months, to determine whether they have 100 full-time equivalent employees for 2015.

 Various Employee Categories

​The final regulations provide clarity on determining whether certain employees are considered full-time. These clarifications address volunteers, educational employees, seasonal employees, students under work programs and adjunct faculty.

 What is a Full-Time Equivalent?

A full-time employee is defined by law as one who works 30 or more hours per week. The final regulations provide for two methods to determine full-time employee status. The first is the look-back measurement period described in the earlier proposed regulations. The second is the monthly measurement period. The final regulations clarify this alternate method that allows employers to use hours of service for each calendar month to determine the status.

 

Key Points:

Employers now have the rules needed to finish their compliance strategy for 2015

Medium-sized employers (50-100 full-time employees) will not be penalized in 2015

Large employers (100 or more full-time employees) will still be subject to the penalty in 2015

To avoid the penalty in 2015, employers who are subject to the mandate must offer coverage to at least 70% of their full-time employees

In 2016, employers over 50 employees must offer coverage to at least 95% of full-time employees to avoid the penalty

 

Do you have questions about how this will impact your company and employees? Give us a call, we are happy to review your current benefit strategy and make recommendations to help you reach your goals. 615-724-1699.

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New fees, taxes and rules under PPACA

02/06/2014 -

Just a brief reminder in case you have forgotten a few of the reasons our health insurance costs are going up this year. Being a group insurance specialist, we help a lot of companies and their employees design and manage their insurance programs. While the rate increases we had seen last year did seem reasonable (averaging 10-11%) this year we are off to the races. Smaller companies with 50 or less employees are all forced to have an Essential Health Benefits (EHB) plan which has many requirements and fixed pricing based on a persons age. Those groups with over 50 employees are still underwritten and rates can vary widely based on many factors. 

These over 50 companies are the groups we see getting big increases so far in 2014. Some of our best clients have seen increases from 20% to over 40% based on their risk factors, demographics, medical inflation and of course the new fees and taxes. While the fees and taxes are computed at 3.4% for these groups, we are seeing overall base rates increase by 4-8% and medical inflation adding another 8%. It's very painful and in a lot of cases the options are very limited to try and keep the increase at a moderate level. 

Just in case you have forgotten about these new fees and taxes, here's a refresher. 

Transitional reinsurance fee: This fee will be imposed on employers for the next three years and will go toward helping the state-based insurance exchanges pay for large claims. The fee will be $63 per insured member in 2014, but is expected to decrease in the latter two years.

Patient Centered Outcomes Research Institute fee: This charge will go to pay for a new agency tasked with giving patients a better understanding of the prevention, treatment and care options available, and the science that supports those options. Employers were charged $1 per insured person in 2013 and will pay $2 in 2014. The fee then increases with inflation in health care spending for the next five years.

Health insurer fee: This annual fee is aimed at helping pay for the implementation of ACA. It will be about 2.5% of total premiums in 2014 and is expected to go up to 4% by 2017. Beyond that, it will rise with the growth in premiums. Insurers are expected to pass this fee through to employers.

'Cadillac' tax: Starting in 2018, employers who offer rich benefit plans -- where the total premium will cost more than $10,200 for an individual plan or $27,500 for family coverage -- will have to pay the so-called Cadillac tax, a 40% tax on the amount over the threshold. This tax is prompting companies to shift more medical expenses onto employees, which not only brings down the price of the premiums, but also pushes employees and their spouses to consider other options available to them.

Individual mandate: Also adding to employer costs is the ObamaCare requirement that Americans obtain insurance or face a penalty starting in this year. That will prompt many employees who had opted out of their company's coverage to sign up.

Aside from new ObamaCare fees and taxes, the growth of health care costs has been at record low levels for several years. Annual premiums -- including both employers' and employees' shares -- rose only 4% in 2013, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits 

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Nine million people signed up for ObamaCare, Really?

01/29/2014 -

Hmmmm, that number seems much higher than every other statistic and report I have seen anywhere on the internet. Is it true? what does it really represent?

I am not saying I don't trust everything they say out of Washington but sometimes they do stretch the truth just a little bit. I do have confidence in the Kaiser Family Foundation when it comes to facts about healthcare and here is what they have to say. 

Here’s the breakdown supplied by the administration: 3 million have signed up for private plans through the federal and state health exchanges since they opened for enrollment in October. Another 6.3 million have been deemed eligible for Medicaid in the past three months of 2013.  In addition, the administration had previously said that 3 million young adults under age 26 have been able to stay on their parents’ plans under the law.

Let’s parse those numbers a bit:

1) The 3 million enrolled in private coverage

A surge in late December and early January helped push enrollment totals to about 3 million despite the troubled rollout of the federal exchange and some state marketplaces. It puts sign-ups almost halfway to meeting the Congressional Budget Office projection that 7 million  would sign up the first year with another two months left to go in open enrollment.

What’s not known is how many of those 3 million have actually paid their first premiums, which is a requirement to become covered.  So the number could be less. On the flip side, it also isn’t known how many people bypassed the federal and state marketplaces and signed up directly with insurers, so the number could be higher.

And the administration has released only limited information on enrollees. Are they mainly the sick, who are clearly more motivated to enroll despite the difficulties with the websites? Or is it a good mix of the healthy and the sick?

Data released by the administration earlier this month showed that 33 percent of enrollees were ages 55 to 64, while 24 percent were 18 to 34.

While advancing age is generally associated with more health problems — and higher costs — there is no way to tell the health status of enrollees. The law bars insurers from denying applicants with health problems, so no questions about past issues are asked. As a result, whether insurers have correctly calculated the costs — and set their premiums accordingly — won’t be known until well into the year when actual claims costs can be analyzed.

Is the law reducing the number of uninsured, which was one of its main goals?

Some reports, including a McKinsey study cited by the Wall Street Journal, have said few of those enrolling were previously uninsured.

Using an online survey of 4,500 people who were uninsured, bought their own coverage or said they were losing job-based plans, McKinsey estimated that most people who have enrolled were renewing or replacing existing policies. This follows a spate of news stories about people who sought to buy coverage only after learning that their existing individual policies were not being renewed because they failed to meet some of the law’s requirements.  Only 11 percent in the McKinsey survey reported they were uninsured in 2013.

No one knows if the sample used by McKinsey accurately reflects those who have signed up.

Still, the McKinsey report offered some cause for optimism for the law’s backers, noting that of those who had not yet enrolled, 26 percent said they intended to do so. The majority of those respondents said they were uninsured. “This suggests a higher percent of prospective market growth from those previously uninsured” if issues such as cost and website problems can be addressed, the report said.

The most telling tabulation of whether the law reduced the number of uninsured won’t come until well into 2015 when the Census Bureau releases figures for 2014.

But remember those under-26-year-olds? The provision allowing them to stay on their parents’ plans went into effect in 2010. The census has reported a drop in the uninsured rate among 19-25-year-olds since then, even as the rate for 26-34-year olds remained stable.

2) The 6 million enrolled  in Medicaid

What’s not clear from the Medicaid sign-ups cited by the administration is how many of those were renewing coverage or were qualified under the old rules, compared with how many are new under the federal law’s expansion.  Under the law, states can expand coverage to all those under 138 percent of the federal poverty level, about $26,951 for a family of three, with the federal government picking up 100 percent of the cost for the first three years.

Half the states and the District of Columbia have expanded their Medicaid programs to cover more people. Many states are keeping the old rules for Medicaid, which often do not cover adults without dependent children, no matter what their income level.

So, 9 million Americans may well have signed up, but a lot remains unknown about who they are. Supporters and critics alike will use the figures anyway, but it will be a while before a full assessment of the law’s effect can be reliably made.

Here is the whole story

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Open enrollment countdown - March 31st is your last chance to sign up this year.

01/28/2014 -

We are well into our first month of enrollment with the new Essential Health Benefit (EHB) health plans and overall the new policies and premiums seem to be well received (by most). While there have been many hiccups and challenges as you would expect, I can report the customer service I have received from the Healthcare.gov people and BCBST have been very positive. Millions have enrolled across the country and most are experiencing functioning websites and information that is being transmitted to the appropriate carriers accurately. 

That said, we are now just over two month from the close of open enrollment. If you have an older policy that costs too much, does not cover your pre-existing condition, or has a deductible and out of pocket higher than you would like, there is no reason to wait. Take a few minutes, learn about your new options and sign up - get a new comprehensive policy and move forward. 

March 31st will be the last day of open enrollment for a May 1st effective date. After that you must have a "qualifying event" to sign up or change your policy. The next open enrollment will open again on November 15th for a January 1st, 2015 effective date. If you want coverage sooner you must sign up by February 15th for a March 1st policy and March 15th for April 1st.

An important point to remember is, if you don't qualify for a premium subsidy, there is no reason to use the healthcare.gov website and the process of applying through that complicated system. If your income is too high, you and your broker/agent can go straight to the insurance carriers website, choose your plan and sign up for your policy. It is very simple once you know what plan is right for you and your family. 

Do you need help finding that "right" policy? A great place to start is our "Health Insurance Marketplace Guide" that can be found on the home page of our website. Visit www.thebenefitbrokers.com where we have information to simplify your search. Of course you can always call and set up an appointment for a one on one meeting in person or over the internet/web chat to choose and apply for your policy. Our phone number is 615-724-1701. 

 

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Benefit Brokers moves to Goodlettsville Tn.

01/19/2014 -

Benefit Brokers, LLC moved their corporate offices from west Nashville to Goodlettsville on January 17th. The move comes after being based their Nashville locations for many years to primarily ease the commute of it's staff and provide room for expansion. After concerns that ObamaCare and health reform would drastically change our business, it appears all the chaos and confusion will help many see the value a professional health insurance broker can provide. Many don't realize there is no cost to access our knowledge and expertise, we are paid by the carrier and the price is the same if you do everything your self or have a professional help you. Why not use a professional?

We feel a more retail setting with good street visibility and easy access will allow those in the local community a comfortable place to learn about their health insurance options and we can help them select and apply for the right policy. Benefit Broker's continues to support the small and mid sized marketplace for group insurance and employee benefits. Many agencies have abandoned companies with fewer than 50 employees choosing the larger more profitable companies instead. We started out serving these employers more than 20 years ago and will continue to do so, The individual market is new for us and we are working hard to help those needing individual policies for their families or apply for coverage and subsidies. 

We expect many changes to the Tennessee health insurance marketplace in the coming years and look forward to educating and serving our customers long into the future. Please stop in and see us if your in the are, you'll love the new office. 

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BlueCross Blue Shield of Tennessee extends premium payment deadline until January 31st.

01/14/2014 -

I HAVE JUST BEEN INFORMED BY BC THAT THE PAYMENT DEADLINE FOR 1/1/14 EFF DATE POLICIES HAS BEEN EXTENDED TO 1/31. 

This is for ON Marketplace policies.

I have also just been informed that NON-Marketplace policies have 30 days from the eff date of coverage to pay their premium.  And this will be the policy for the NON-Marketplace plans going forward.  A NON-marketplace policy with a 2/1 eff date has 30 days to pay – or till the end of the month.  So BC must receive payment on these by the end of the month that coverage begins.  Same system we are used to with BC. 

BUT ON MARKETPLACE POLICIES MUST PAY BY THE EFF DATE OF COVERAGE.  This is in the law.  We got these extensions for January due to the problems with the website.  As it stands today, a 2/1 Marketplace policy must pay by 2/1. 

Hope this helps those customers who have frantically been trying to pay their premium today and Billing has had a 3 hour wait time.  Let me know if you have questions.  And to avoid some of these issues, good idea to encourage your client to pay the first premium at the time of application.  

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50% of Tennessee Health Insurance Marketplace enrollees qualify for Medicaid

01/14/2014 -

36,250 Tennesseans enrolled in health insurance to be effective on January 1, 2014 during the first open enrollment period. We know this is much lower than initial estimates but still with the Marketplace not really working until late November it's a very good start. What I find surprising is that nearly 50% of those enrolling qualify for Medicaid and 67% qualify for some type of premium subsidy. 

We have helped many with BlueCross Blue Shield of Tennessee policies as they seem to be the most competitively priced and plan designs are reasonable. Most we have helped did not qualify for subsidies though several did and many received benefit subsidies reducing their deductible and out of pocket limits. 

One thing that is certain, using the Marketplace is complicated and confusing, then once you complete that step choosing a policy can be equally confusing. If you are reading this beware of the E Network from BCBST, it is what the call a "skinny" network and they are not kidding. When searching in my hometown of Hendersonville for a medical facility (hospital, outpatient center, etc.) there were 36 showing under the P network, 34 under the S network and just 1 under E network. That one facility was the county health department. Not my first choice if I am paying for a qualify insurance product. 

Need help choosing a policy? we have been helping Tennesseans for more than 20 years and can assist you in finding and signing up for the right policy for your situation. Give us a call at 615-724-1701 or check out the website www.thebenefitbrokers.com 

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Tennessee democrats not giving up on Medicaid expansion in the state.

01/13/2014 -

Many states across the country have expanded Medicaid eligibility to individuals and families making under 139% of the Federal Poverty Level (FPL). These states have seen their Medicaid roles grow exponentially with the ease of signing up for the free coverage through www.healthcare.gov. That allows an individual with an an annual income up to $15,971 or a family of four at $32,745 to gain free medical care through the Medicaid program. 

Tennessee has not agreed to expand the eligibility even though the Federal Government will cover the cost of expansion for the early years. There is a great cost to the state in terms or cost of coverage though a greater concern is the reduced reimbursements doctors and hospitals would receive on these newly eligible patients. This would cause financial hardship on many rural hospitals putting them out of business. 

Governor Haslam wants the expansion to allow these lower income Tennesseans to buy into the same health plans other Tennesseans have access to. These Essential Health Benefit "EHB" plans are more comprehensive with great reimbursements to providers and a much broader provider network. This same strategy has been adopted by Arkansas and appears to be working successfully, hopefully the same with in the Tennessee health care system. 

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BlueCross Blue Shield prescription benefits not working? Many are having problems, here is what to do.

01/09/2014 -

If you recently purchased a health insurance policy from BlueCross Blue Shield of Tennessee directly or through the Health Insurance Marketplace some policies are not being loaded with the correct pharmacy information. There has been so many application so quickly we expect glitches and want to help you fix them quickly and easily. If you are having any problems you can call the Blue Cross of Tennessee Customer Service number at 888-924-2271 and tell them the drug benefit is not showing active and your policy needs to be corrected. 

Have you been wanting to get prices, compare benefits, ask questions or want to know anything about the new health plans? We have answers and have been helping countless individuals and companies not only learn and understand their healthcare options but sign up and enroll in the right policy. 

Learn more and download our marketplace guide at www.thebenefitbrokers.com 

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Is Government run healthcare more efficient than private insurance? The Government claims lower expenses to run the program - funny math - you decide.

01/06/2014 -

We have long been told that private insurance companies expenses are way out of line in comparison to what the Government spends to run Medicare and Medicaid. As one who often questions how my hard earned tax dollars are spent I questioned this logic but figured since they had such huge volumes it must be true. In fact, as part of the ACA they have reduced the amount private insurers can spend on administration to 15% or 20% of premium depending on the size of the group. This caused carriers to slash customer service jobs to reduce expenses of course this hurt the consumer who had claim issues or questions and the brokers involved in helping resolve them as well.

Myth vs. Fact: Administrative Costs in Medicare & Private Health Plans

Posted on January 3, 2014 by AHIP Coverage

It’s a familiar refrain, one we’ve blogged about multiple times -  comparing Medicare’s administrative costs to those of private health plans is inaccurate.

As Avik Roy noted in a blog post, “A more accurate measure of overhead would therefore be the administrative cost per patient, than per dollar of medical expenses. And by that measure, even with all the administrative advantages Medicare has over private coverage, the program’s administrative costs are actually significantly higher than those of private insurers.”

According to a study in Health Affairs,  “Ironically, Medicare’s low administrative costs — about 3 percent compared with 17 percent in the private sector — may be to blame for the high spending.  The private sector uses these funds to do a better job controlling excessive use. Tomas Philipson and colleagues have shown that the variation in Medicare hospital use is four times larger than the private sector when it comes to heart disease. Because it can rely on its monopsony power to control overall spending, Medicare has a weaker incentive to limit overuse.  Meanwhile private insurers have become more efficient, employing tools such as utilization review and case management (which count as administrative costs) to assess patient needs and then either restrict services or steer patients towards more cost-effective care. In a world without private insurance, we would likely see more money wasted on care that produces no benefit for patients.”

“In addition, administrative spending protects against fraud.  By some estimates, the Medicare program loses a staggering $60 billion to fraud each year. This amounts to 11 percent of the Medicare budget and would be enough to double Federal spending on primary and secondary education.  No private company would ever tolerate this abuse.  Imagine the fraud if Medicare covered 300 million Americans.”

These findings have been echoed elsewhere. A Heritage Foundation report found that from 2000-2005, Medicare’s administrative costs per beneficiary were consistently higher than those for private insurance, ranging from 5 to 48 percent higher, depending on the year.

And according to a BNA study, “Popular comparisons of Medicare and private group health plan ‘overhead’ costs wrongly compare only a part of administrative expenses related to the Medicare program to the whole of private sector administrative expenses for comparable large group health plans.” The report also says that Medicare’s costs for claims administration “are really about the same as claims administration costs in the private large group health plan market.” Moreover, some of Medicare’s general administration costs are expensed elsewhere in the federal budget, and others, like premium taxes, do not apply to the Medicare program.

As Ezra Klein noted on the Wonk Blog, “It’s also important to note that you don’t necessarily want administrative costs as low as they could possibly be. Some activities that are considered ‘administrative’ are useful. Disease management, for instance, which accounts for some of the difference between Medicare and Medicare Advantage. Mental health counselors who are available by phone. Good-faith investigations into waste, fraud and abuse. Care coordination. Nurses who use e-mail or telephones to remind patients to take their drugs. Administration is not always wasteful.”

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It's January 1st and ACA / ObamaCare takes effect. What does this mean to you?

01/02/2014 -

Well, we made and it appears more than 2,000,000 people were signed up for health insurance under the new rules of the Affordable Care Act. While I don't know how many in Tennessee or Nashville signed up, I can say we were very busy helping clients find and apply for their new health policies. Not to fear if you don't have a policy yet, open enrollment runs through March 31st so you have plenty of time to find your policy. 

Attached is a great 2014 healthcare summary from the Kaiser Family Foundation. Find out more about....

What if I don't have insurance, will I pay a penalty and how much?

I get my health insurance at work, is that changing? can I stay on that policy?

What is changing to health insurance policies and how will that effect me?

I can't afford health insurance, what are my options?

Will my pre-existing condition be covered?

I own a business, am I required to offer health insurance to my employees? What happens if I don't?

Will my Medicare policy be changed?

Can I still see my regular doctor? 

And the best for last, how much will my insurance cost? I heard costs are going up because of the new rules. 

Find the answers to these questions and more here

Want to find out how much your insurance will cost? Download our marketplace guide where you can compare policies and premiums on what we think are the best options from BlueCross and BlueShield of Tennessee. 

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Marketplace deadline came and went - now what? What to do if you signed up and what to do if you did not.

12/26/2013 -

Even with the deadline extension to sign up for heath insurance, may are still without healthcare. If you signed up through Healthcare.gov and got all your approvals you probably think you are good to go, maybe or maybe not. We recommend to wait a few days for your information to hit the insurance company and then call them to make sure you are in the system. If you did not pay by electronic check or credit card, it's extremely important that you call and pay the first premium. Without paying, you will not finish the application process and be covered. The deadline with Blue Cross for payment is January 15th. 

If you have not applied yet, no worries you have until January 15th to apply and have coverage for February 1st. The open enrollment continues through March 31st and based on past experience that will probably be extended. 

Here is more information for you to consider.....

The Christmas Eve deadline to enroll via HeatlhCare.gov for health care insurance that starts Jan. 1 has passed.

The federal website received 2 million visits on Monday, and heavy - but not as heavy - traffic on Tuesday. A White House spokeswoman said there was no immediate estimate of visitors or how many succeeded in obtaining insurance before the deadline.

Here are some tips for those who met the deadline and those who didn't.

___

MET THE DEADLINE?

1. Allow a few days for your application to reach the insurance company providing your health plan, then call to make sure it has been successfully processed.

2. If you didn't click "pay now" when you enrolled, make sure you send your first monthly premium payment to your insurance company by Jan. 10. You won't be covered until you've paid.

3. Learn about the details of your health plan. What's covered? What do you pay for out of pocket? Find out which doctors and hospitals are covered in the plan's network. Learn what services the insurer provides, such as 24-hour hotlines and online health resources.

___

MISSED THE DEADLINE

1. If you're uninsured and still want coverage, you can still sign up. Your coverage will start as soon as Feb. 1 if you choose a plan and pay before mid-January.

2. You can window-shop to compare the details on plans available in your region. Click on "See plans before I apply" at HealthCare.gov. Many state online marketplaces also offer this window-shopping feature.

3. Enrollment ends March 31. Miss that deadline and you'll pay a tax penalty for next year of $95 or 1 percent of your income, whichever is higher. Some people may qualify for an exemption because of hardships or if their insurance policy was canceled.


Read more at http://www.philly.com/philly/health/healthcare-exchange/20131225_ap_299bb848f2694700b31542ae67f6f357.html#qVeTWm3PZty0kxGi.99

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Obama grants one day health insurance enrollment extension - Merry Christmas

12/24/2013 -

As the Marketplace is finally working pretty smoothly for most and there is a huge backlog of people wanting and needing to sign up for health insurance and subsidies the government has decided to grant a one day extension to sign up for Tennessee health insurance. While Blue Cross and Blue Shield of Tn is not open for business today, it does appear you can still sign up and be covered for January 1st. 

From our experience in Nashville, Hendersonville, Brentwood and Franklin signing up individuals and companies, things have worked pretty smoothly though the Healthcare.gov site is quite complex and frustrating. We are recommending that people allow an hour to get through the application process for subsidies. We also recommend if you don't qualify for a subsidy, skip that process and work directly with the insurance company. 

You can apply directly on our website and be signed up in less than 15 minutes. Our health insurance marketplace guide will help you choose the best health plan for your situation and budget. This is the first step, once you know what plan you want it's quite easy to get signed up. If you need assistance you can always call us at 615-577-7976. 

Merry Christmas

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Initial payment for Health Insurance in Tennessee Marketplace is extended.

12/19/2013 -

UPDATE: To help protect Marketplace consumers from potential gaps in coverage, we are now allowing those who select their plans by Dec. 23 to pay their first month's premium by Jan. 15 for coverage effective Jan. 1, 2014.

Clients can now mail a payment to BC once they get their policy ID or still call Billing and pay by phone.  This extension is a grace period, so payment MUST be received at BC by 1/15.  If it is not – coverage will be termed back to 1/1/14.  Also, no claims will be paid until payment is received, so if your client has a claim between 1/1 – 1/15 and premium has not been paid yet, that claim will be held until premium is received. 

This should help with the long wait times on the Billing line and give your clients another option to pay – since they can mail it now.  Merry Christmas from Blue Cross!!

ENROLLMENT DEADLINE FOR 1/1/14 EFF DATE IS STILL 12/23/13 – NEXT MONDAY!!  APPS MUST BE RECEIVED AT BC ON 12/23.  

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Healthcare.gov first impressions

12/16/2013 -

Today I helped two people sign up for subsidies on the healthcare.gov website. Let me tell you, it's very time consuming and can be frustrating if you don't have details in front of you. Most of the time is spent setting up your account and verifying you are who you say you are. Like most websites today, setting the user name a password takes 2-3 tries before working because of all the required symbols. 

Be patient, one person not only got a generous subsidy, she qualified for a benefit credit reducing her deductible down from $3,500 to $2,950. This program is very generous if your income qualifies you for benefits. 

Of course there is a big story on the wires today about how "excruciatingly awful" the site is. Yes, it's frustrating and time consuming but if you qualify it's a mighty good deal and way to spend an hour of your time. 

read more here 

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BlueCross BlueShield of Tennessee grants extension to individual health insurance policy holders.

12/09/2013 -

Update on BlueCross Coverage Extensions

BlueCross BlueShield of Tennessee (BlueCross) has been committed to full compliance with the Affordable Care Act (ACA) since the law was passed in 2010. This year, much of our efforts have been focused on building the requirements of ACA into our 2014 health plans that must be ready for groups and individuals in just a few weeks.

President Barack Obama announced in November a plan to allow certain non-grandfathered individual and small group health plans to keep their current coverage for one more year, so they could delay meeting some ACA requirements. This announcement caused us to carefully re-examine the impact on our customers.

Small Groups can't continue with current coverage

Many BlueCross groups took advantage of our Early Renewal offer. This option allowed them to keep their existing plans through most of 2014. Giving employers the choice to extend or move to new coverage sounds like a good thing in the short term and to that extent, options were discussed with the Tennessee Department of Insurance (TDCI) that would mitigate risk pool issues. This scenario would create two separate risk pools that, once merged, would create higher rates for our customers in the long run. Also, the problems with healthcare.gov have not prohibited groups from obtaining coverage. Therefore small group plans will not be extended.

 

Individual Policy Holders

To alleviate concerns of consumers who have had difficulty accessing the Marketplace, BlueCross will offer policy extensions for members with individual coverage. We will allow individuals with coverage renewal dates January 1, 2014 – October 1, 2014, to keep their existing health plans for another year.

Individual BlueCross members will need to keep the exact same level of benefits and renewal dates to qualify for the extensions. We will notify individual members about their options as soon as we have rate approvals from TDCI.

While there are many questions about the extension of individual coverage, our 2014 plans are available for your clients on the Marketplace. BlueCross is the only insurer in Tennessee with Marketplace plans in all 95 counties. We remain hopeful healthcare.gov performance will continue to improve; ensuring consumers can purchase these policies and take advantage of subsidies, if eligible.

While you have the ability to keep your current coverage, many are finding better, less expensive coverage with the new EHB plans. To see if you qualify for a subsidy or get pricing for a new policy, visit our homepage at www.thebenefitbrokers.com 

Thank you for your continued patience as we all work through the changes of health care reform.


BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.

-----------------------------------------------------
Please see the following link for the BlueCross BlueShield of Tennessee E-mail disclaimer:  http://www.bcbst.com/email_disclaimer.shtm

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Amazon to start collecting sales tax in Tennessee on January 1st. The free ride ends to start the new year.

12/08/2013 -

It's hard to believe it's been two years since we signed the deal to bring thousands of Amazon jobs to Tennessee. As part of the expansion of distribution centers to Chattanooga and middle Tennessee Amazon agreed to begin collecting sales tax on in-state purchases. 

While this does not have anything to do with health insurance in Tennessee or the Tn marketplace it is important news and just one more reason to do your after Christmas shopping early. 

Read the entire story here

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IRS tasked with nearly 50 new rules to manage - Can they pull it off better than healthcare.gov?

12/05/2013 -

While the healthcare.gov website and HHS have gotten all the scrutiny of the marketplace rollout up to this point, there are plenty of tests that remain and many fall on the IRS. There are nearly four dozen new tasks that must be carried out representing the largest increase in responsibility for the IRS in years. 

Part of the problem they will face is that lawmakers intentionally barred the IRS from using its customary tools for collecting penalties (liens, foreclosures and criminal prosecutions) with the only means to collect fines being the reduction of refunds from those who have overpaid their taxes. While the individual mandate is not a huge penalty, this lack of enforcement will make it that much less of a threat to millions of Americans. 

While IRS officials say they are on track to meet the law's requirements and the computer systems are performing well. They acknowledge that some departments - such as those who are tasked with distributing subsidy checks to the insurance companies on behalf of millions who are eligible for subsidies - are not completely built. IRS officials not that most of the responsibilities don't really begin until the 2014 tax season so they have time to complete their build outs. 

read more

 

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800,000 people try healthcare.gov again.

12/03/2013 -

More than 800,000 people visited healthcare.gov to give it another try after the Obama Administration gave its blessing and confirmed that repairs had been completed. There are still problems with data and Social Security numbers being transmitted correctly to insurers. Julie Bataille a spokeswoman from CMS said a fix announced yesterday will solve 80% of these issues.

We at Benefit Brokers are still recommending that if you qualify for subsidies should continue to wait a little longer to improve your chances of success in not only applying for a subsidy but having the application and your insurance plan of choice sent to the insurance carrier. Read more

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CoverTN enrollee's not allowed to "keep their coverage if they like it" 15,400 kicked of the states Medicaid option on January 1st.

11/28/2013 -

NASHVILLE, Tennessee — The federal government has declined a request to extend a waiver to keep the state-subsidized CoverTN health coverage plan beyond the end of the year.

Republican Gov. Bill Haslam's administration had sought the waiver to keep the program's 15,400 enrollees going through the first four months of the new year while the federal government works out problems with online health insurance marketplaces.

CoverTN premiums are split between the state, the employer and the worker. But the program's annual benefit limit of $25,000 runs afoul of coverage rules under the federal health care law.

New enrollment in the program had been halted in 2009, but businesses already participating in CoverTN had been allowed to continue to add workers.

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SHOP Exchange for small businesses in Tennessee delayed until November, 2014

11/27/2013 -

The Small Business Health Options Plans (SHOP) are officially off the table until late 2014 as the Healthcare.gov website is not ready to administer that side of the enrollment. The SHOP exchange was supposed to make shopping, buying and administering small group medical plans easier and less expensive than the current arrangements. Many have discounted the SHOP as a non-starter and BlueCross Blue Shield of Tennessee was only planning to offer two plans on that marketplace. 

The question remains about how small business will claim their premium tax credits for providing and paying for medical coverage. The tax credits going forward were only to be available for companies who purchased group coverage through the SHOP. This delay could allow small lower income employers to continue with their current policies and still receive premium tax credits. More on that to come as details are released. 

Read the full story here 

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Tennessee Health Insurance Marketplace sees delays and now extensions to enroll in a health policy

11/23/2013 -

Changes are happening on what seems a daily basis to the Tennessee Health Exchange with two more announcements coming this week. After the push to allow insurance companies to continue offering "non EHB" policies through 2014 to postpone large premium increases for many. The next changes have to do with extending the enrollment date for a January 1 effective date and now the open enrollment for 2015. Blue Cross and Blue Shield has agreed to allow their policy holders to keep their current coverage if they want. We have not heard from Humana, United HealthCare or Aetna about their decisions. 

The cutoff for first of the month effective dates was the 15th of the month. So if you needed coverage for January 1, 2014 because you were losing coverage or just to gain a new policy you would  have to be enrolled by December 15th. This open enrollment deadline is now December 23rd. Many have found it impossible to sign up due to the healthcare.gov woes and concerns of a rush at yearend are providing an extension. I can't say for sure but I imagine the health insurance carriers who are reeling for current changes are less then thrilled with this latest change forced on them. 

The other change to ObamaCare may have more to do with the mid-term elections than providing health insurance. Open enrollment for 2015 was supposed to begin on October 15th and run through December 15th. Today it was announced they would delay the start of open enrollment to November 15th. The mid-term elections are on November 4th and many speculate the change is due to many seeing the steep premiums in the Marketplace for the first time and showing their disapproval at the voting booth. President Obama and his administration says the change will allow insurers more time to prepare and submit premiums for the new year. 

Nashville, Tn 

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Healthcare.gov at 60% of completion - Insurance companies are not being being paid for promised subsidies

11/23/2013 -

A bombshell was revealed by Henry Chao, the deputy chief information officer for the CMS Information Services. During a hearing before the House Energy and Commerce Committee he explained that 40% of the IT systems that support the federal health insurance exchange still need to be built. When pressed for more information he explained that specifically the "financial management tools" (this is the process that pays insurance companies the subsidies for Americans who sign up and qualify) still had not been built. 

A Health and Human Services spokesperson further explained that health plans can receive premiums that consumers pay when they enroll, its the federal payments and subsidies are not set up to be paid to insurers. Chao later explained that this part of the system was intended to be operational by December so it technically hasn't missed any deadlines and is not behind schedule. 

For more information click here

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BlueCross BlueShield of Tennessee to extend existing individual and small group policies for one year.

11/20/2013 -

There is great news across the state for the 66,000 policyholders who were to begin receiving cancelation letters for their current health plans. Julie McPeak, the Tn Insurance Commissioner met with the states insurance representatives and she agreed to allow them to extend the current policies for an additional year. Carriers are not required to continue offering policies that do not meet the minimum requirements of PPACA and each can make that decision individually. 

BCBST agreed to extend not only individual policies but those for companies with less than 50 employees who were required to renew with Essential Health Benefit (EHB) plans beginning on January 1st. For many individuals and small groups these policies came with higher price tags along with higher deductibles and out of pockets.

As a health insurance consultant and broker, I can say this is great news for the majority of our group insurance clients who were facing steep increases and a more complicated pricing structure. 

Here is a copy of the press release. 

 

CHATTANOOGA, Tenn. -BlueCross BlueShield of Tennessee will allow members with individual and small group health policies that did not meet requirements of the health care law to have the choice to extend that coverage for one year beyond their renewal dates, or transition to a policy that is compliant with the law.

The Tennessee Department of Commerce and Insurance (TDCI) today stated it would allow health plans to offer extensions, noting that carriers would have the ultimate decision.

"At BlueCross, we've always believed people should be able to choose the plan they think best meets their needs, so we support this decision to let our individual members and small business customers keep their existing coverage," said Bill Gracey, BlueCross CEO.

The Affordable Care Act mandates all health plans provide 10 categories of essential health benefits. Because some existing plans did not include these benefits, they could no longer be offered and members were notified that they were being transitioned to new plans that complied with the ACA requirements. On Nov. 14, President Obama announced a plan to allow those non-compliant individual and small group plans to be extended for one year.

Gracey said BlueCross will work closely with state regulators to update policies and review rates to keep these plans available to existing members and small groups.

The company continues to hope technical issues with the Health Insurance Marketplace will be fixed quickly to allow consumers access to Marketplace policies and subsidies, if eligible, Gracey said.

BlueCross continues to offer current and future members an array of insurance options, providing marketplace plans in all 95 Tennessee counties - the only insurer in the state to do so.

About BlueCross

BlueCross BlueShield of Tennessee's mission is to provide its customers and communities with peace of mind through affordable solutions for health and healing, life and living. Founded in 1945, the Chattanooga-based company is focused on reinventing the health plan for its 3 million members in Tennessee and across the country. Through its integrated health management approach, BlueCross provides patient-centric products and services that drive health improvement and positively impact health care quality and value. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association.www.bcbst.com.

- See more at: http://www.noodls.com/view/65BD82831686597EDA38FADC247E612384320C73?155xxx1384909270#sthash.h57Wa1sl.dpuf

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Blue Cross to keep existing policies if Tn DOI gives it's approval

11/17/2013 -

In a fast changing environment of healthcare compromises, Departments of Insurance across the country are now trying to figure out if it's possible to undo the cancelation of millions of individual insurance policies across the country. There are many challenges, the biggest being that in some states rates and benefits have not been submitted to the DOI because insurance companies thought the policies would not exist. 

In Tennessee Kate Abernathy, the spokesperson for the Department of Insurance said a decision has not been reached but they should have definitive answers by early next week. 

Blue Cross and Blue Shield of Tennessee have decided to extend the 66,000 policies up for cancelation if the DOI gives their approval. 

In a statement issued on Friday afternoon a Blue Cross Blue Shield spokesman said:

"At BlueCross, we’ve always believed people should be able to choose the plan they think best meets their needs, so we support this effort to let our individual members and small business customers keep their existing coverage. To make this change as quickly as possible, we’ll need to work closely with our state regulators to update our policies and review rates to keep these plans available to existing members and small groups. Our marketplace plans will continue to be an option for our members as well. We remain hopeful that healthcare.gov will be fixed to ensure consumers have access to these policies and any subsidies, if eligible."

We will keep you up to date with the latest news concerning Tennessee and your health insurance options. 

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Obama says Tennesseans can keep their health plans after all.

11/14/2013 -

President Obama is making a change to the Affordable Care Act that could have long lasting effects on everyone buying coverage with EHB's and mandates. This afternoon, the President proposed an administrative fix to postpone the cancelling of millions of individual health insurance policies across the country. In Tennessee BCBST was planning to cancel some 66,000 policies forcing those indivdiuals to buy the more expensive policies that provide mandates and guarantee issue. 

The final decision will come down to each states insurance commissioners who will have the right to override the proposal. The concern is that if too many people are allowed to keep their older policies that did not require mandates, they are not on the same pricing level as the new policies. The carriers are anticipating this increased revenue to offset the increased risk they are taking with the new policies, this could lead to higher prices for everyone.  Read more here 

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Healthcare.gov not likely to be functional by Nov. 30th. for the Tennessee Health Insurance Marketplace

11/13/2013 -

It appears the Federal website to register and apply for Advance Premium Tax credits (APTC) will not be fully functioning by the November 30th as first promised. As a reminder, you only need to use Healthcare.gov if you qualify for premium subsidies, if your income is too high you can still purchase a health insurance policy "off exchange" by buying directly from the insurance company. We have an easy to use subsidy calculator and link to apply directly with BlueCross and BlueShield of Tennessee on our homepage.

Even if the healthcare.gov website is running by December 1st we have concerns about it's actual behind the scenes functionality as it's a very complicated system. There are numerous reports of people being quoted the wroing prices, subsidy amounts and not actually being enrolled after completing the online process. Open enrollment continues through March 31st so if you are not in a critical situation we recommend waiting until everything is running properly.

To read the full article click here

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Blue Cross Blue Shield of Tennessee to cancel 66,000 policies across the state.

11/11/2013 -

The termination of individual health policies has reached policy holders in Tennessee. Today Blue Cross Blue Shield of Tennessee announced that they not renew any non-grandfathered policies. While BCBST says they plan to renew members to new ACA compliant policies many will find that their costs are much higher.

The new policies that go into effect on January 1st, 2014 are more comprehensive but for many they were not concernerd about pre-existing conditions or a young man having to pay for maternity coverage that he will never use. None the less, the law is the law and this is about sharing risk. To read the full story click here.

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Obamacare gets it own song (funny)

11/07/2013 -

While this is not necessarily headline making material, it is very funny in light of all the problems with the Healthcare.gov website. If you are one of the millions trying to sign up for your subsidy and can't get past first base, I am pretty sure you won't like this. Brad Paisley and CarrieUnderwrood rock it out. 

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HSAs benefit from ObamaCare

11/05/2013 -

With healthy young adults seeing their premiums jump by up to 100% or more under the new ACA guidelines many are finding High Deductible Health Plans (HDHPs) the only affordable health insurance option. Fortunately Health Savings Accounts have come through all the legislation unscathed. HSA's have been a popular way to pay for healthcare and other medical/dental/vision and other expenses with tax free dollars. Now that medical plans with co-pays are being priced out of reach many will find their dollars go farther if deposited into a HSA rather than in inflated premiums. read more

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Insurance companies explain their side of cancellations

11/03/2013 -

While we have not yet seen health insurance policies being cancelled in Tennessee it is certainly a possibility especially if enrollment in the new plans is slow. Insurance companies are taking a lot of risk offering guarantee issued policies at a fixed price with the hope of many healthy people signing up to share the risk. If that does not happen, more

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My insurance policy was cancelled, now what should I do?

10/30/2013 -

Millions are learning that "you can keep your current coverage if you like it" is not quite as it sounded a few years ago. Many carriers are seeing the increased risk of guarantee issue and community rating and are determining that the older inexpensive policies they have on the books will not help offset this new risk. Thus, they want to get as many people on the new EHB policies as possible.

Many of those losing coverage will be eligible for premium subsidies and the costs may actually be less, unfortunately that is not true for everyone.

Here is a great article from the Kaiser Family Foundation titled "Why insurers cancel health insurance policies." This will give you a better understanding of what millions are facing and possibly many more as the full impact of PPACA is rolled out.

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Small Employer Tax Credit - New Rules?

10/16/2013 -

ON August 26, 2013 the IRA issued a notice of proposed rulemaking concerning the tax credit available to small employers. This is one of the key provisions of the SHOP marketplace and will make or break the decision for many small employers to continue offering group health insurance. 

Today small employers with lower paid emloyees can  receive a tax CREDIT equal to 35% of the premiums paid toward health insurance, this is to increase up to 50% after January 1st, 2014. 

This brief will give details about the two notices published by the Treasury Department and IRS about the eligibility requirements for employers to claim the credit. Read more here 

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HHS announces SHOP exchange delay

10/03/2013 -

 

On Sept. 26, 2013, HHS issued a news release launching its education and outreach efforts to help small employers learn more about how to take advantage of the SHOP. The news release notes that the FF-SHOP opens  more

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IRS and DOL release guidance on HRAs and FSAs

10/03/2013 -

On September 13 our hopes were dashed with tax strategies to help small businesses and their employees purchase individual health policies on the marketplace and use tax-advantaged strategies to pay the premiums. This is a real shame for small business owners with lower paid employees as the dependents won't have any chance of getting subsidies at this point. read more

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HHS Announces Final Rule on Exchanges

10/03/2013 -

 On Aug. 30, 2013, the Department of Health and Human Services (HHS) published a final rule on the Exchanges. The final rule takes effect on Sept. 30, 2013. This rule, which generally finalizes provisions in proposed rules without significant changes, outlines Exchange standards with respect to eligibility appeals, privacy and security, agents and brokers, issuer direct enrollment and the handling of consumer cases. Read More

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Health Exchanges Open for Business - With Glitches

10/03/2013 -

Wall Street Journal: The health-insurance marketplaces at the center of President Barack Obama's health law saw a surge of consumer interest Tuesday that surprised even many of the law's backers. But the debut proved patchy, with few applicants actually able to buy coverage on clogged websites that were bedeviled with technological problems. Read More

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30 Million uninsured - half are eligible for subsidies

03/09/2015 -

By the end of January, 2015 nearly 11 million people  had signed up for health insurance through the state and federal health insurance marketplaces. While this is good, there is a lot of room for improvement. In a Kaiser Family Foundation survey many had not even tried to get coverage but for those who did an elected not to buy a policy, price was the leading factor in why they did not purchase coverage. 

Read the full story here 

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Child health insurance in Tn includes dental and vision benefits.

11/12/2014 -

If you are covering one or two children on your companies health insurance plan you may be paying too much for their health coverage. The new "Affordable Care Act" policies provide excellent benefits for children under age 19. These new policies are guarantee issued with no health questions or pre-existing conditions. That means your child has full coverage from day one.,

Better yet, the Tennessee policies with BlueCross and BlueShield of Tn include comprehensive dental and vision benefits with no maximum limits. Orthodontics are not included but all other dental services are and the vision includes glasses or contacts.,

Pricing is per child and can be as little as $100 per month. The challenge with group policies is you pay the same to cover one or five children, the price is the same. That is why we encourage those with just one or two children to compare an individual policy with what they currently pay for medical, dental and vision to cover their child(ren).,

Need help or want more information? Feel free to call us at 615-724-1701 or get a quote quickly and easily from our website, www.thebenefitbrokers.com,

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Specialty Rx costs are driving medical costs - 7 things you should know.

10/08/2014 -

7 things we learned at the Health Affairs briefing on specialty drugs

Specialty drugs took center stage at today's Health Affairs event, which introduced research from the October issue titled "Specialty Pharmaceutical Spending and Policy." Below are some highlights.

1. Specialty drugs have much higher prices than traditional drugs. The specialty drugs are more expensive even when taking into account resultant reductions in hospitalizations, noted James Chambers from Tufts Medical Center Institute for Clinical Research and Health Policy Studies.

2. About 2 percent to 3 percent of all prescribed medications will be of the specialty variety by the end of this decade, but they will account for roughly 50 percent of the total drug spend, said Troy Brennan of CVS Health.

3. Spending on oral oncologics has far outpaced spending on general medical care. About $6 billion is spent on oral oncologics in a given recent year, according to the University of Chicago's Rena Conti.

4. The degree of use of oral oncologics relative to spending growth is always lower, which implies that price increases are driving the growth in spending.

5. Drug makers set prices relative to existing treatments not in response to development costs. If one competing drug costs $80,000, and another costs $85,000, they'll charge $90,000, said Brennan. Put simply: "Look left, look right and raise it by 5 percent."

6. Even the pharmaceutical industry is confused about their price setting. Drugmakers claim they have to price high because the drug treats a rare condition. But for meds like Sovaldi, they claim they must set the price high because of treating a widespread disease. "All roads lead to Oz … all consequences can be adjusted to justify high prices," said Peter Bach of Memorial Sloan Kettering's Center for Health Policy and Outcomes.

7. Sky-high prices in the name of innovation? Not exactly. About a third of new drugs are no better than existing treatments, said Chambers. He highlighted the need for a broader discussion about how to stimulate innovation while making sure patients have access to advancements that will truly benefit them.

While the eyes of the health care world are focused on the high prices of specialty drugs, let's hope drug companies are paying attention and ready to bring down prices to levels that enable affordability and innovation in health care.

- See more at: http://www.ahipcoverage.com/2014/10/07/7-things-we-learned-at-the-health-affairs-briefing-on-specialty-drugs/#sthash.sfyxQWuC.mD5vEs0f.dpuf

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