 |
 |
|
 |
AHIA Advocates Health Care Reform
The health care reform challenge is to bring millions of uninsured Americans into the system and to reduce the high cost of health care for everyone. Of course, these two challenges are related and one cannot be solved without tackling the other. The plan builds on the strengths of the current system with targeted state and federal tactic that can make health insurance more affordable for all American families. Key elements of the AHIA plan include:
With the Census Bureau (see following article) recently reporting an increase in both the percentage and the number of people without health insurance, it's time to adopt policies that will make less expensive coverage available. AHIA looks forward to working with Congress and the state legislature to implement affordable access proposals. Health care reform plays a major role in the 2008 Presidential campaigns. As the election creeps closer, AHIA will provide information on and analysis of the various health care reform proposals. On September 17, Senator Clinton unveiled her health care reform proposal - American Health Choices Plan.
The 2008 Presidential Candidates' Health Care Platforms provides the health care reform position advocated by the candidates along with a link to their official websites. The rapid pace of the 2008 White House hunt has also sparked a contest among candidates for endorsements from members of Congress. See who your elected officials are supporting as well as a running tally of Lawmaker Endorsements. Limited Medical Plans – Sales Gimmick or Sustainable Solution? By Brian Robertson
Limited medical plans work best for the employee base that has not previously been insured – and there is big opportunity out there for advisors who understand the marketplace and how to successfully address its needs. It's important to understand that limited medical plans are not a replacement for major medical plans and should never be marketed as such. The delivery is different, the limits on the benefits are substantive, and the expectations of the employees who come from major medical can overwhelm the situation causing a breakdown. The untapped market potential for limited medical plans is enormous, and you are probably already serving companies that have these kinds of employees.
With this understanding of the best potential candidates for a limited medical plan, let's briefly talk about the different kinds of products available today. There is what I call, "Honey, I shrunk the major medical program" which looks very similar to major medical programs, except that the catastrophic coverage has been ripped off the top. There are co-pays, co-insurance, deductibles, in-network benefits and out-of-network benefits and there is a pre-existing condition limitation. It looks and feels like a major medical program, but it is not. A great approach is the hospital indemnity-based policy, which is an old insurance idea that has been around for a very long time. It offers a per day amount when you go into the hospital. With fixed indemnity benefits, it is first-dollar coverage. The employee does not have to reach in their pocket to use the program in many situations. The first-dollar coverage provides a lot of value to a group of employees who cannot afford to spend a whole lot of money on insurance. With no deductible and no pre-ex, access to care is unrivaled. Additional considerations when evaluating limited medical plans: Eligibility. Look for a plan that allows the employer to set the eligibility requirements. Most programs will take the employees from the first day that they're hired, meaning there are no waiting periods on the program whatsoever. Simplicity. Can the employees understand the benefits? Read the insurance policy and make sure you understand how it works. If you can't understand the product easily, then the demographic that we serve is not going to be able to understand the product easily and therefore the plan provides no value. Making the plan work. A key factor in successful limited medical plans is administration. In the major medical community, the number one thing administrators must do well is pay a claim. In the limited medical world, it is not about paying claims, limited medical programs are about providing day-to-day benefits, medical benefits for a group of employees who otherwise have nothing. The administrator must be able to handle fulfillment, turnover/eligibility, customer service and enrollment. Many times a client list can tell you a lot about what that administrator does, who they serve and how well they do it. Prestigious companies are not going to stick around in places where the plan does not rate correctly. Also, ask if the provider has ever been canceled by a carrier. Look for a partner. As an advisor, your role is crucial. Call around, learn the ropes and begin to determine if you need additional help. Sometimes it is a good idea to have someone from the plan make a call with you and work side-by-side with you as you begin delivering the program to the employer. If you take a look at your existing client base, there's a good chance that some of your groups have a need for limited medical insurance. You can increase your revenue simply on expanding the relationships that you have today. Insuring your clients in more than one way can help strengthen your relationship. Don't let a limited medical plan catch you off guard. It's a great way to expand your business, but you must ask the right questions and find the right limited medical plan partner. Brian Robertson is executive vice president of Fringe Benefit Group, Austin, Texas, a firm thatdesigns and administers limited-benefit medical plans. Robertson can be reached at brobertson@fibi.com. Census Says 47 Million Uninsured The number of Americans without health insurance grew from 44.8 million in 2005 to 47 million in 2006 according to the Census Bureau. A decline in access to private health insurance (including employer-provided coverage) is the major factor contributing to increasing the rate of uninsured. The share of Americans with private insurance through employers decreased to 59.7 percent in 2006, down from 60.2 percent in 2005, according to the report, Income, Poverty, and Health Insurance Coverage in the United States: 2006. Meanwhile, the share of the population covered by government-sponsored health programs dropped to 27 percent in 2006, from 27.3 percent in 2005 according to the Census. Texas was the state with the highest uninsured rate, at 24.1 percent. New Mexico, Florida, Arizona, Oklahoma, Louisiana, California, Nevada, Mississippi, and Georgia rounded out the top 10 states with the highest uninsured rate. On the flip side, Minnesota had the lowest uninsured rate, with just 8.5 percent lacking insurance. The drop in private insurance coverage was not isolated; coverage through government funded health insurance (including Medicaid, Medicare, and the State Children's Health Insurance Program) also saw a decline from 27.3 percent in 2005 to 27 percent of the population in 2006. While people with higher annual incomes were more likely to have health insurance, the report also found that the number of working Americans age 18 to 64 without health coverage had also increased. An estimated 27.6 million people who worked at some time during 2006 had no health insurance, an increase of 1.3 million people from 2005, the report found. Medicare Prescription Drug Plan Guide: How to Choose Your 2008 Plan America's Health Insurance Plans (AHIP), a national trade association representing nearly 1,300 health insurance companies, is pleased to announce to AHIA's members the on-line publication of the 2008 edition of our Medicare Prescription Drug Plan Guide: How to Choose Your 2008 Plan. Health insurance plans are committed to providing individuals with Medicare the tools and resources they need to make informed decisions and recognize the critical role that brokers and agents play in helping Medicare beneficiaries understand their Medicare options. This book, which was used last year by thousands of Medicare beneficiaries and their families, as well as brokers/agents, counselors, trainers, pharmacies, and health plans, is an interactive on-line tool designed to help individuals evaluate their Medicare prescription drug plan choices for 2008. It includes updates to reflect how things will work in the coming year. Developed in 2006 with feedback from Medicare beneficiaries and key partners, the easy-to-use guide provides step-by-step considerations for choosing plans that are most appropriate for each individual"s needs. The guide works for those who are newly eligible for the prescription drug benefit, as well as those considering a change. Beneficiaries who are happy with their current Medicare drug plans can use the guide to confirm whether or not their current plans are still the best available choices. The guide also serves as a resource to help beneficiaries make the most out of their benefits. We believe you will find the guide to be an excellent resource for reference, training, and use with individual beneficiaries. The guide is color coded for ease of use, and includes quick reference guides. Brokers, agents, and beneficiaries may print some parts of the guide, or the entire guide, from the website for personal use. Visit www.healthdecisions.org/guide to access the Medicare Prescription Drug Plan Guide: How to Choose Your 2008 Plan. AHIA Secretary Robelynn H. Abadie, LUTCF, CSA, RFC, RDA and AHIA Immediate Past President Debra C. Newman, CLU, ChFC, LTCP are answering questions posted online about their 2007 NAIFA Convention presentations.
Medicare Private Fee-for-Service Update This notice updates the email sent to you in June regarding seven health plans who market Private Fee-for-Service (PFFS) plans that agreed to voluntarily stop all marketing activities until CMS determined they were compliant with CMS marketing requirements. To date, CMS has completed a review of three of the seven plans (Coventry Health Care Inc., Universal American Financial Corp., and WellCare Health Plans Inc.). These plans have demonstrated compliance with the CMS criteria and will immediately begin to resume marketing activities to new Medicare beneficiaries and the limited group of beneficiaries who currently have special enrollment periods. Reviews are still being scheduled with the remaining health care plans (Blue Cross Blue Shield of Tennessee, Humana Inc., Sterling Life Insurance Co., and UnitedHealth Group). All PFFS plans will need to be compliant to be allowed to begin marketing activities to all people with Medicare for the 2008 benefit year on October 1st. Among the criteria to be compliant, all brokers and agents must now pass a written exam to demonstrate an understanding of Medicare policies and the products being marketed. In addition, plans have to telephone beneficiaries requesting enrollment in a PFFS plan to confirm that they understand the terms and conditions of the plan. As you know, CMS considers any health plan marketing violations to be a serious breach of contractual agreements. CMS has asked AHIA members to continue working with them to urge any beneficiary who may have been misled or given incorrect information and enrolled in a PFFS plan to call 1-800 MEDICARE (1-800-633-4227). A Customer Service Representative will assist them in selecting either a new Medicare Advantage Plan or the Original Medicare Plan. CMS will continue to hold plans accountable for marketing violations discovered by beneficiaries, our reviews, or you—CMS’s extended network of grassroots partners. CMS intends to track beneficiary concerns and plan compliance with marketing guidelines, and realizes it can do this even more effectively with your help. CMS asks that if you or your organization, a Medicare beneficiary, their caregiver or a family member observe, suspect or otherwise become aware of prohibited plan marketing practices that you contact 1-800 MEDICARE or your CMS Regional Office (contact information below) to report a possible violation. CMS will immediately investigate. CMS has expressed its appreciation for the work done by AHIA members to help them reach Medicare beneficiaries and thanks you for helping to protect Medicare beneficiaries from any and all health plan marketing violations. CMS Resources on PFFS:
Fiscal Year 2006-2007 In Review By AHIA 2006-2007 President Lawrence E. Lounds, CLU, ChFC, LUTCF The past 12 months began a marked change in legislative activity. The House and Senate both changed over from Republican to Democratic control. Margins remain slim, so gridlock continues to be the most common outcome of legislative activity. But the Democratic agenda has rearranged the health legislative priorities. For example, there is considerably less risk of legislation to create the association/small business health plans (AHPs/SBHPs) that would potentially deliver a crippling competitive disadvantage to traditional group health insurance plans. On the other hand, there is equally less support for expanding the tax incentives applicable to health savings accounts (HSAs) and high deductible health plans (HDHPs). Polls affirm health care as the top domestic issue for most lawmakers—Democratic and Republican. Grand systemic overhaul proposals, including everything from national health care to mandatory health care to be purchased by individuals—dominate the debate. But action is occurring more incrementally. Mental health parity and health information technology are examples of legislation on the move in this Congress. However, “some things never change.” Persistent federal deficits and restored budget discipline rules mean it is even harder to enact new incentives and programs, even where they are widely supported. Such is the fate of improvements to long-term care insurance rules, and of efforts to allow at least some rollover of unused funds in FSAs and/or cafeteria plans into the subsequent plan year. A further reality that colors all legislation, including health care initiatives, is the early run-up to the 2008 presidential election. Add to that the struggle of the GOP to regain at least some of its former power. Consensus leading to enacted legislation is hard to find. In preparation for the reinvigorated reform environment, the association has spent considerable energy enhancing its infrastructure to support the role of the insurance advisor. To carry out the mission, AHIA has dedicated teams in the areas of Advocacy, Finance, Membership, Member Benefits and Professional Development. We encourage vigorous member involvement: our efforts are only enhanced by the ideas, participation, responsiveness and energy of our members. Please take a moment to contact AHIA at ahia@naifa.org to volunteer your expertise, share your input or contribute to our war chest. .A strong AHIA is an integral part of our members’ success – both personal and professional. AHIA is a vital, dynamic organization that routinely meets every expectation to achieve laws and regulations that help your clients enjoy helpful laws, stabilize the health insurance industry, and promote prosperous business for you now and into the future. Please take a moment to review the AHIA’s Year in Review. 2007-2008 AHIA Board of Directors
PRESIDENT-ELECT SECRETARY TREASURER IMMEDIATE PAST PRESIDENT DIRECTORS |
AHIA has developed principles that would support a workable solution to the health insurance coverage issue. 
Appearances can be deceiving. This is certainly the case with limited medical benefit plans, which have gained a lot of attention and distribution in the last few years.
PRESIDENT |
|
|
|
||||
 |