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S&S Benefits.....Opinion, Hearsay & News Review

S&S Benefits Consulting, Inc.  219 Darien , Dundee , IL 60118   Phone: 847-428-5353, Fax:847-428-9876

Email :jseiler@ssbenefits.net                                              http://www.ssbenefits.net/     November 2014 Issue

HHS and the Treasury Department have concluded that minimum value plans that do not cover hospitalization based on the MV calculator are improperly being offered and regulations will be changed that will not allow employers to avoid penalties by offering these plans so that their employees cannot get exchange subsidies.

On October 31, 2014, the Department of Health and Human Services (HHS) announced that, until further notice, it will delay enforcement of regulations related to obtaining the Health Plan Identifier (HPID) and using the HPID in Health Insurance Portability & Accountability Act (HIPAA) transactions that were adopted in the HPID final rule.

The EEOC is saying a Wisconsin company (Flambeau, Inc.) violated the ADA by requiring an employee to submit to medical testing and assessment in connection with a wellness program. When an employee did not submit to the biometric testing and health risk assessment the company required the employee to pay the full medical premium in order to stay on the company plan. Employees who complete the testing and assessment are only required to pay 25% of the premium. According to the EEOC, that violates ADA. Now the EEOC has also filed a similar lawsuit against Honeywell.


Anthem, CareFirst BCBS, HCSC (BCBS of IL,NM,OK,TX,MT), Kaiser, Humana and UHC are all canceling grandfathered plans that were extended earlier by the administration. The insurers are saying they can make more money selling the higher premium ACA policies.


The GAO has said that HHS cannot make payments to insurers under ACA under the risk corridor program to bail out insurers who lose money with money from successful insurers. Congress needs to approve any appropriations and may choose not to do so.


The Segal trend survey puts PPO medical trend at 7.5% for 2015, HDHPs at 7.9% and stand alone Rx at 8.6%. Dental PPO is 4.7% with FFS Dental at 5.4% and Vision at 2.7%.


Wal-Mart is ending coverage on 30,000 employees who work fewer than 30 hours per week that were grandfathered on to their health plan. The move comes as the company expects to incur an additional $500 million in cost as a greater number of full time employees are expected to enroll on their health plan due to ACA.


If you wish to be added or removed from the distribution of this newsletter, please email jseiler@ssbenefits.net


Blue Cross of Illinois has announced it will not negotiate rates on the basis of hospital affiliations that do not maintain common ownership. Hospitals have been affiliating, in order to negotiate better rates with insurance companies.


2015 Medicare Part B premiums ($104.90)and deductible ($147)will remain the same as in 2014 according to CMS.


Covered California is canceling Obamacare coverage for 10,474 who failed to prove citizenship out of 1.2 Million enrolled.


According to AARP Magazine, one million people will leave the country to seek medical and dental treatment in 2015, up from 3/4 million this year. The most common travel is for dental, followed by coronary bypasses, bariatric operations and cosmetic surgery.


ACA increased enrollment in individual market plans (on and off exchange) by 6.3 million, but that was offset  by a decline in group plan enrollment of about 3.8 million for a net private sector increase of 2.5 million.  Medicaid expansion in states implementing Obamacare grew by 5.7 million, while states not taking the Medicaid subsidy grew in Medicaid enrollment by 356,000. So the 47 million uninsured were reduced to 38 million uninsured by screwing up the plans  of the 269 million who had coverage before this” Obamanation” of a law. What a great success the administration can claim.


A HealthPocket survey of health plans in 2014 showed premiums going up by 78% for 23 year old men and 44.9% for 23 year old women. The survey found similar increases for 30  year olds while they went up 22.7% for 63 year old men and 37.5% for 63 year old women.


The maximum allowable FSA contribution for 2015 has gone up by $50 to $2,550.