Benefits.....Opinion, Hearsay & News Review
As PPACA moves on, more
employers are bailing out of fully insured plans for partial self-funding. Why?
If PPACA reaches full implementation, community rating, minimum loss ratios
required by law, state premium taxes and state mandates will continue to drive
up costs, leaving little flexibility for employers. Insurance carriers are
purchasing TPA's to gain the flexibility needed in the self-funded market and
stop loss carriers are offering lower specific stop loss levels to accommodate
smaller employers. The percentage of smaller employers using partial
self-funding is up to 58% from 44% in 1999.
The Texas Department of
Insurance applied for relief from PPACA loss ratio rules and was denied by HHS.
This was in spite of the fact that of the 34 Texas carriers subject to the law,
23 will pay rebates based on 2010 data based on the 80% Medical Loss Ratio (MLR)
rule. The rebates would absorb the net underwriting profit for the entire
individual market-effectively putting the insurance carriers out of business.
Not surprising-since that is the intended end result of PPACA.
Consider the HHS approach at telling insurance companies
their rates are out of line when they increase by 10% or more. Then consider
this: As part of defense cuts ordered by the Obama administration, the Tricare
health program for uniformed members of the armed services and their families
will be increasing premiums. Significantly, the plan calls for
increases between 30 percent to 78 percent in Tricare annual premiums for
the first year. After that, the plan will impose five-year increases ranging
from 94 percent to 345 percent—more than 3 times current levels. They
expect that this will drive many members into the state exchanges.---Below is
the response from an interested party when we emailed this information to him.
We thought it was worth sharing.
Damn those greedy, for profit
Insurance companies gaining dollars on the backs of the sick and ill.
Someone call Kathleen Sebelius and have her people call out these monsters for
their greater than 10% rate increase request. We’ll show them to be the
blood sucking, heartless, SOBs that they are and …………….What?
These are Obama government officials? Are they raising rates on our
military people and on our public aid recipients? Oh, not the public aid
recipients, just the military people who go into harm’s way for us.
They want to drive them into the State Exchanges where they, the younger
members, will pay a higher premium rate than actuarially called for so that they
can subsidize the older and unhealthy participants. Well, isn’t that
patriotic on their behalf. Well, I guess they should be somewhat used to
it as war is hell, and so is the new Obama healthcare program.
If you wish to be added or removed from the distribution of this
newsletter, please email firstname.lastname@example.org
The National Federation of
Independent Business on behalf of its 350,000 members is joining 26 state
governments as co-plaintiffs in the PPACA case before the Supreme Court.
Blue Cross of Nebraska has
administered the Nebraska state employee medical program for at
least 25 years. Effective July 1, the state is switching to UHC, citing an
expected savings of $8 million per year. Blue Cross is protesting and claiming
UHC will actually cost the state $10 million, since UHC excluded claims over
$75,000 and MNSA claims from its discount guarantees. Ah, the old game of who
has better discounts. In our opinion, it's liar's poker.
In other Blues news, a circuit
court jury has ordered BCBS Michigan to pay the city of Holland $1.6 million for
wrongfully charging it excess fees as part of the medical plan. The jury said
the Blues fraudulently concealed a 13.5% access fee on city employee claims for
14 years. The Blues say they will appeal. It is reported there have been at
least 30 cases filed against the Michigan Blues about the fees.
A survey of 10,000 consumers
in January covered 13 health plans. Kaiser was the only plan to receive an
"okay" rating. Every major health carrier received a "poor"
rating. That is just another reason
to self fund with an independent TPA to pay claims since their model is based on
In the continuing saga of the
constitutionality of requiring coverage of contraceptives costs by those
religiously opposed to it, a federal judge declared a Washington state rule
requiring pharmacists to dispense emergency contraceptives against their beliefs
to be unconstitutional.
In 2010, Wisconsin got $73
million from the feds to run their temporary high risk pool. It was estimated
8,000 people would apply, but only 1,100 have. That's a good thing, since the
program is expected to run out of money in 2014 with only that small enrollment.
It seems those enrolled have higher costs than expected. Imagine that. Low cost
insurance for those with pre-existing conditions and they are surprised by the
adverse selection. Duh?