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Health Care Reform: Medical Loss Ratios and Federal Mandated Rebates

Compliance AlertsReprinted courtesy of Alfred (Mike) B. Fowler, ERISA and employment attorney for Kutack Rock LLP. www.abferisa.com. Contact Mike at mike@abferisa.com.

As one of the major pieces of Health Care Reform legislation (HCR), the Medical Loss Ratio (MLR) provisions are intended to assure that health care coverage will be reasonably affordable. However, by requiring health care policy issuers to limit their administrative expenses to no more than 15% (large group) or 20% (small group) of premium, HCR opened Pandora’s Box. We are about to see the results. Please note that the MLR rules apply to both group and individual policies; however, we will limit our discussion in this Memorandum to group policies.

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Early Statistics show Health Care Reform costs more, but Startups aim to influence long term effects

Rising health care costsIn Business Insurance, Matt Dunning writes that an early survey of compliance with the Patient Protection and Affordable Care Act shows increases in some employers’ health benefits costs up to 5%.

Early Results

Here are a few highlight statistics, but read the rest of the article for the whole story:

  • 55% of those who calculated the effects attributed Health Care Reform directly to cost increases of at least 2%
  • 15% said Health Care Reform directly increased their costs at least 5%
  • 62% said they expect employers to pass more costs to employees in the form of higher contributions to premiums
  • 56% said they expect employers to raise deductibles and copays

Long Term Effects: Entrepreneurial Spirit to the Rescue

These early results can’t predict the final effects of Health Care Reform. Even though the national health care debate centers around health insurance, it has shed a lot of light on the root cause of the problem: the cost of the health care itself and how we pay for it. This spotlight has given rise to a lot of new companies like Castlight Health and SeeChangeHealth that saw the importance of end user decision making and revealing the actual cost of health care and not just the size of health insurance premiums and copays. Companies like Apixio and entrepreneurs like Jay Parkinson who started HelloHealth and Future Well are taking advantage of the attention to get funding for companies that improve data analysis and efficiency in the behemoth that is our health care system.

Many industries that have become Institutions with a capital “I” end up doing things “the way they’ve always done them” because, well, that’s they way they’ve always been done. Whether or not the Patient Protection and Affordable Care Act ends up raising or lowering costs on its own, as the dust of the debate between fierce proponents and opponents settles, there are many more companies focused on making sensible health care choices and employing health care data more efficiently. And for that, we’ll all be better off.

At Andreini & Company, we have a range of insurance products from traditional guaranteed cost to fully self-insured that allow employers to take advantage of improved transparency and data efficiency as well as new wellness and employee decision making information to take control of their own health care costs. Want to see a variety of options? Contact us today.

Find out how Health Care Reform and compliance will affect your company in our free webinars:

Leave of Absence: Effectively Navigating the Legal Maze 

2012 Health Care Reform and Other Matters – An Update

Summary of Benefits & Coverage Requirement: Final Rule and Action Plan

Compliance Alerts

Compliance AlertsReprinted courtesy of Alfred (Mike) B. Fowler, ERISA and employment attorney for Kutack Rock LLP. www.abferisa.com. Contact Mike at mike@abferisa.com.

Summary of Benefits: Agencies Provide Some Relief

The Department of the Treasury, Department of Labor, and the Department of Health and Human Services (the Agencies) have concurrent jurisdiction over most federal health care legislation including the implementation of the “Summary of Benefits and Coverage” (SBC) requirement under the Patient Protection and Affordable Care Act (PPACA). The Agencies published proposed SBC regulations in August 2011 with a target effective date of March 23, 2012. On February 14, 2012, the Agencies published the SBC Final Rule, which moved the effective date to September 23, 2012.

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View the Webinar: 2012 Health Care Reform and Other Matters – An Update

Are you ready to comply with Health Care Reform regulations that go into effect in 2012 and 2013? Watch our very informative, easy to understand webinar on what your company needs to do to comply. The Webinar outlines what employers need to do right now – not in 2014 or some other far off time, but right now – to comply with Health Care Reform. Average rating by people who attended the webinar was 4.25 out of 5 stars.

Click below to watch:

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Legislative Update: California SB 299 and Companion Legislation – A New Maternity Mandate

SB 299Reprinted courtesy of Alfred (Mike) B. Fowler, ERISA and employment attorney for Kutack Rock LLP. www.abferisa.com. Contact Mike at mike@abferisa.com.

New Laws

As the cornerstone of four new laws (SB 299, AB 592, SB 222, and AB 210), the California legislature intends to assure health care coverage for pregnancy, childbirth, and related conditions. These new laws expand protection under California insurance policies and health care plans in a significant way:

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7 reasons why mid-sized Employers are looking into self-funded employee benefits options more now than ever

Self-funded employee health benefitsFortune 500 companies have been self-funding their employee health benefits programs for years. Why now are more mid-sized employers looking for ways to self-fund theirs also? According to the 2011 Kaiser Foundation Employer Health Benefits Survey:

  • 60% of workers are insured under a self-funded or partially self-funded plan as opposed to 49% in 2001.
  • 50% of workers in companies with 200-999 employees are insured under a self-funded or partially self-funded plan.

And here’s why:

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How do you know whether Self-Funding Employee Benefits is a good choice for your company?

Self-Funding Employee Benefits plans is on the riseSelf-Funding any type of insurance can be huge boon to some organizations, but a colossal headache for others. For the right organization, Self-Funding offers greatly improved cash flow, more control over costs and the ability to realize the benefits of strong Risk Management techniques.

With health insurance costs rising much faster than inflation and wages, as the Kaiser Foundation Health Insurance Survey illustrated, many companies are considering Self-Funding part or all of their Health Benefits programs. But what do you look for in a Self-Funded plan? What are the advantages of Self-Funding? How will it reduce your costs over traditional first dollar insurance? How does Self-Funding provide cost saving mechanisms beyond charging employees a larger portion of premiums or reducing benefit offerings? Is there a plan for your size business?

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Kaiser Family Foundation Survey: Health Benefits Costs Make Highest Jump in Six Years

Rising health care costsIt’s no secret that Health Benefits costs have been increasing at many times the rate of inflation for a long time. Every year, the Henry J. Kaiser Family Foundation and the American Hospital Association’s Health Research and Educational Trust take a survey of costs and trends in Health Benefits and Insurance. Jeffrey Young of Bloomberg reports that the average cost of a family policy climbed 9 percent in 2011 to $15,073 is the largest single year increase in six years. If you feel like a little light reading, you can download the full survey here.

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Transportation Industry: 17% Savings on Health Benefits Costs

Truck on the roadAndreini & Company successfully cut health insurance costs 16-17% per year over the last two years for a large transportation client while maintaining a rich employee benefits package. Our client was able to gain a cost advantage over competitors while still retaining valuable, trained employees.

Client Profile

Industry: Transportation
Operations: Propane Distribution
Employees: 100
Scope: California, Nevada, Utah
Ownership: Private
Years in Business: 40

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