Benefits.....Opinion, Hearsay & News Review
Group term life premium grew by 2% in 2010 and STD and LTD premiums rose
by 1%, mostly due to an STD increase. However, the total number of employers
offering coverage declined by 1% for Group Life, Group STD and LTD each. New
sales of STD (-4% ) and LTD (-17%) decreased. An economic sign?
In Illinois, a new law passed
for fully insured plans that has “ologists” covered as in-network as of June
1st. The person who sees an “ologist” while using an in-network
facility can have no higher out of pocket expenses than if the person were
in-network. The patient cannot be subject to balance billing if they have
assigned benefits in writing to the provider. The benefits are for radiologists,
pathologists, anesthesiologists, neonatologists and ER department services. Will
we see providers asking for assignment of benefits, once they figure it out?
They do now.
Try to define the typical
health plan and what is covered. Mercer conducted a survey attempt to do this.
Results were somewhat predictable in that most major services are covered by
employer plans. However, some items of interest were: Nicotine addiction was
covered by 64% and TMJ by 55% of all respondents. Limits were placed on physical
therapy (58% had limits), DME (41%) and organ transplants (22%). Mercer surveyed
HHS has announced that health
insurers seeking rate increases of 10% or more will face increased scrutiny
starting in September. The Feds don’t have the authority to do anything about
it, but the implication will be there. Queen Sebelius is again trying to insert
control that belongs to state regulators.
Meanwhile the feds have
approved one year waivers for 1,372 employers that have annual plan limits below
those set by PPACA. The waivers cover nearly 3.1 million enrollees, reportedly
mostly union plans or for companies with large union employee populations. Until
we see a list of waiver denials, we will not have any idea of how political this
provision has become.
A PwC survey indicates
that 22% of employers have in-network deductibles of at least $1,000, up
from 16% in 2010 and 8% in 2009. Double that percentage imposed deductibles of
at least $1,000 for out of network services. Sixty-nine percent of employers
require employees to pay more than
20% of premium as contributions for their health plans. This year, 17% of
employers reported the greatest percentage of their employees were enrolled in
high deductible plans, up from 13% in 2010 and 8% in 2009. Not noting that high
deductible plans can be PPO, the survey said 57% of employers reported the
highest enrollment in their traditional PPO plans.
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A relatively new interpretation
of PPACA is out. A report in Business Insurance says that lawyers reading the
bill have noted that employers who have employees join the exchanges with a
premium subsidy must pay the $2,000 fine on all full-time employees working over
30 hours a week, not just those joining the exchanges!
Romneycare anyone? Today the
wait time to see an internist is 48 days and family doc is 36 days in MA.
Pediatricians are better at 24 days and 53% of family docs are not accepting new
patients. Only 56% of family docs accept Romneycare while 87% of the same group
accept Medicare. The number of ER visits has risen. Looking forward to the
consequences of Obamacare?
The Milliman Medical Index
measures the total cost of healthcare for a family of 4 covered by a PPO. The
2011 cost is $19,393 per year, an increase of 7.3% over 2010. Included are costs
paid by the employer and employee. The employee paid portion of costs now stands
at $8,008. Fortune Magazine did a profit margin survey by sector.
Pharmaceuticals were 15.9%, medical products and equipment were 11.6%, pharmacy
services were 5.8% and medical facilities were 5.3%.
Support for Obamacare has
reached a new low. We’d like to think that we are part of the reason (Ha!). An
AP-GfK poll shows that support has slipped to 35% while 45% oppose and 17% are
neutral. Seniors had less than 30% support for the law, despite the fact that
AARP lobbied heavily for the law.
Two Republican congressmen
have written to the IRS Commissioner Doug Shulman seeking details on how the IRS
intends to spend over 1 billion in funds from the Health Reform Implementation
Fund above and beyond the IRS FY 2012 request of $473.3 million for healthcare
related funding. Could that be a
salary of $62,500 for each of the 16,000 new IRS agents being hired to enforce
the provisions of Obamacare?
The Feds have announced that
not enough people are taking plans for the uninsurable, so they are cutting
rates by 40% , thus increasing the tax dollar subsidy (Sounds reasonable for a
country arguing about debt ceilings). Only
18,000 out of an expected 375,000 have enrolled. This
sounds similar to the poor economic reports for the last year that are always