Insurance Sales Hit the Mall
Theresa Pugh stopped at a store near Lord & Taylor after eating at the restaurant a few doors down. She picked herself up a supplemental Medicare plan from the Horizon Connect store.
Theresa Pugh stopped at a store near Lord & Taylor after eating at the restaurant a few doors down. She picked herself up a supplemental Medicare plan from the Horizon Connect store.
By Josie Martinez, Senior Partner and Legal Counsel
EBS Capstone, A UBA Partner Firm
Add another item to the growing list of provisions of Health Care Reform (aka “Obamacare”) that will be delayed for an additional year: caps on out-of-pocket health care expenses (“OOP”). According to the law, health plans are required to cap the total amount consumers can be charged through deductibles, co-payments and co-insurance. This provision, a main consumer protection to control how much people will have to spend on health care, was supposed to limit total out-of-pocket costs in 2014 to $6,350 for individual policies and $12,700 for family policies. The Department of Labor quietly announced delays of these caps for some plans until 2015 which means anything goes next year.
According to the guidance, non-grandfathered group health plans will generally need to comply with the OOP maximums described above, unless the plan uses multiple claim payers (e.g., medical TPA and separate pharmacy benefit manager (“PBM”)). Plans that use multiple claim payers may apply the statutory OOP separately to the major medical coverage (that is, medical/surgical plus mental health and substance use disorder benefits) versus the nonmedical benefits, such as prescription drug coverage, thus effectively doubling the OOP max for the combined plan for the 2014 plan year.
That’s good news for some, bad news for others. Individuals with chronic diseases, such as cancer or multiple sclerosis, covered by such plans will be hurt by the delay as they continue to pay hefty out of pocket costs because the cap provision will not be implemented for another year. These individuals could, for example, be required to pay $6,350 for doctors’ services and/or hospital treatments, on top of $6,350 for prescription drugs – a major blow to those who need quality care the most.
The reason cited by federal officials for the delay is that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another. Apparently, it comes down to technology, but the fallout of this setback is that some plans can double their caps next year. Administration officials have said that companies have until 2015 to insure that out of pocket spending maximums will include all types of spending, including prescription drugs.
“The single biggest problem in communication is the illusion that it has taken place”. – George
Bernard Shaw
“Effective employee communication” is definitely a buzzword in the human resources industry. We all intuitively know communication is a good thing, but how many of us actually practice it on a daily basis? And let’s face it: Pressing deadlines always seem to trump establishing positive communication in the workplace. However, when a project or other initiative fails
due to a communication breakdown, we are all the first to say, “I wish I had communicated that more effectively.”
So why does communication fall so low on the priority list? It may have to do with the fact that we may need some tools to know how to communicate effectively. As much as we think it’s intuitive, it actually is a skill that needs to consistently be cultivated.
I recently ran across a TLNT article, Good Workplace Communication? It Means Good
Workplace Performance, that provided three great tips to increase positive
communication:
When it comes to benefits, I can’t think of a more crucial area that demands effective communication. In a recent survey by Colonial Life, only 23 percent of employees think their employers communicate their benefits very effectively. United Benefit Advisors will be hosting a webinar, presented by Touchpoints, that will share tips to help you create an effective communication strategy, and most importantly, execute that strategy and measure
the results.
The webinar, How Effective Communication Happens: Benefits Style!, will take place on Thursday, Sept. 12 at 2 p.m. EDT. To receive the $149 discount for this webinar, enter the code “UBATP” when registering.
The confusing swirl of PPACA regulations present a great opportunity to impress and retain your employees by ensuring they understand your benefits offerings.
By Thomas Mangan
CEO, United Benefit Advisors
Whatever your view of the massive law that is The Affordable Care Act, there is no denying that it is having a big impact on the market. As we sifted through the enormous amounts of data that comprise the 2013 UBA Health Plan Survey, the reality of the law’s impact became clearer. In short, if you are a single employee without dependents who is mostly healthy, you likely saw your health care costs decrease. If you’re anyone else, you probably felt a punch below the belt.
On the positive side, for the first time in my 22-year career in the health insurance industry, this year we saw employers take back some of the premiums they have been asking employees to pay – a good sign the economy has improved and employers are concerned with attracting and retaining top talent. Unfortunately, dependents are being asked to pick up more of the tab, which could signal an increasing anti-family trend.
While employers covered 18 percent more of a single employee’s health insurance premium, or $934 per employee, this year, they asked employees with dependents to pick up 3 percent more of the family premium, $492 on average. The average worker, however, saw an overall increase in health care cost due to rising out-of-pocket costs, including higher in-network deductibles, in-network co-insurance and significantly higher out-of-pocket maximums.
In-network deductibles increased $91 to $1,852 for a single and $216 to $4,225 for a family. Out-of-pocket maximums (after the deductible) for in-network increased $152 to $3,641 for a single and $433 to $8,043 for a family – increasing more than 17 times from five years ago. The survey also shows that the average in-network co-insurance dropped from 90 percent to 80 percent, a significant decrease in coverage.
Other important trends from the survey show:
Data in the 2013 UBA Health Plan Survey are based on responses from 10,551 employers sponsoring 16,928 health plans nationwide. This unparalleled number of reported plans is nearly three times larger than the next two of the nation’s largest health plan benchmarking surveys, combined. The resulting volume of data provide employers of all sizes more detailed — and therefore more meaningful — benchmarks and trends than any other source.
For further information about the 2013 Health Plan Survey, request a copy online or contact a local UBA Partner for a customized benchmarking report.
Earlier this year, technology giant Intel Corp. began an experiment in health care delivery at its largest semiconductor manufacturing facility in Rio Rancho, N.M.
UBA Partner Firm the Cornerstone Group’s Vice President, Amy Gallagher, was quoted in a Boston Globe story on Sept. 2.
UBA has released its 2013 Health Plan Survey. The purpose of the survey is to provide employers with comparative data regarding plan costs, employee contributions and plan designs that will allow them to benchmark their plan against those of similar em…