![Legislative Alert: Stimulus Package/COBRA UPDATE]()
by Admin. | Mar 9, 2009 | COBRA, healthcare
The American Resources and Recovery and Reinvestment Act of 2009 was signed into law by President Obama February 17th. Under the Act, certain individuals who are eligible for COBRA continuation health coverage, or similar coverage under State law, may receive a subsidy for 65 percent of the premiums for themselves and their families for up to nine months.
Click on the link below for detailed information on the American Recovery and Reinvestment Act of 2009 which went into effect February 17, 2009
http://www.dol.gov/ebsa/cobra.html
These individuals are required to pay only 35 percent of the premium.
The employer may recover the subsidy provided to assistance-eligible individuals by taking the subsidy amount as a credit on its quarterly employment tax return. The employer may provide the subsidy – and take the credit on its employment tax return – only after it has received the 35 percent premium payment from the individual.
To qualify, a worker must have been involuntarily separated between Sept. 1, 2008, and Dec. 31, 2009. Workers who lost their jobs between Sept. 1, 2008, and enactment, but failed to initially elect COBRA because it was unaffordable, get an additional 60 days to elect COBRA and receive the subsidy.
This subsidy phases out for individuals whose modified adjusted gross income exceeds $125,000, or $250,000 for those filing joint returns. Taxpayers with modified adjusted gross income exceeding $145,000, or $290,000 for those filing joint returns, do not qualify for the subsidy.
On February 26, the Internal Revenue Service released its first round of information for employers to use in administering the new subsidy program. Included are the subsidy reporting form, instructions and a very detailed questions-and-answers piece. The Department of Labor is still working on model notices and other guidance for release by March 17.
by Admin. | Jan 21, 2009 | group health insurance, United Healthcare
UnitedHealth announces class-action settlement.
In conjunction with the suit from last week, United announced this yesterday. They have set aside $350 million dollars to fund the settlement for members who had used out of network providers dating back to 1994. If a member is eligible they will be notified by a form approved by the court.
by Admin. | Jan 21, 2009 | group health insurance
Obama Healthcare Reform Promises
HealthDay (1/20, Pallarito) reported, “Early indications now suggest that, despite an ailing economy — or perhaps because of it,” President Barack Obama “is resolved to keep his promise” to reform healthcare. He was praised for “his nomination of former South Dakota Sen. Tom Daschle to serve as Secretary of Health and Human Services,” who “is thought to have a solid grasp of health policy.” In addition, Obama has crafted “an economic stimulus plan that positions healthcare as a cornerstone of financial growth and recovery.” He has proposed “allowing Americans who can’t get insurance through employer plans or Medicaid/SCHIP to purchase insurance through a national health insurance exchange,” and “to expand eligibility under Medicaid and the State Children’s Health Insurance Program (SCHIP).” In addition, last week, the House “voted to reauthorize and expand SCHIP.”
“Reform advocates have largely fallen in line with Obama’s call for a health system overhaul, based on the use of electronic health records, new and expanded government programs and payment reform,” Modern Healthcare (1/21, DoBias) adds. And, Congress is expected to approve “about $100 billion in healthcare funding, the lion’s share going to a boost in the federal government’s share of Medicaid” as part of the stimulus package.
Obama mentions medical costs, health IT in his inaugural address. In the Wall Street Journal (1/20) Health Blog, Sarah Rubenstein wrote that “during President Obama’s inaugural address to the nation,” he mentioned healthcare twice. First, there “was an acknowledgement of the expense of healthcare in a long list of woes the nation faces.” She quotes Obama as saying, “Our healthcare is too costly; our schools fail too many; and each day brings further evidence that the ways we use energy strengthen our adversaries and threaten our planet.” Then, when he discussed “how the U.S. can ‘lay a new foundation for growth,'” Obama stated, “We will restore science to its rightful place, and wield technology’s wonders to raise healthcare’s quality and lower its costs.”
by Admin. | Jan 16, 2009 | healthcare, Pharmaceutical Industry
GENERIC VERSUS BRAND NAME MEDICATIONS
Many people have heard that switching to a generic medication will save them money. One of the questions we hear most often is, “How do generic medications compare to their brand name counterparts?” Knowing the facts about generics versus brand names can help make us all better consumers.
All generic drugs are reviewed and approved by the United States Food and Drug Administration (FDA) or in other countries, by an equivalent federal regulatory body. The regulatory boards all require that generic drugs have the same active ingredients, quality, strength, purity, and stability as brand name drugs. They also must have the same dosage form, whether you swallow it (pill/tablet/capsule/caplet), drink it (liquid), or inject the medication.
Many people are concerned that because generic drugs are often much cheaper than the brand-name versions, the quality and effectiveness have been compromised to make a less expensive product. The FDA requires that generic drugs be as safe and effective as the original brand name drugs. Generic drugs are copies of brand name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, the pharmacological effects of generic medications are exactly the same as those of their brand name counterparts. Another common myth is that generic drugs take longer to work. The FDA requires that generic drugs work as fast and as effectively as the original brand name products.
Generic drugs are cheaper because the manufacturers do not have the expense of developing and marketing a new drug. When a company brings a new drug to the market, the firm has already spent substantial money on research, development, marketing and promotion of the drug. A patent is granted which gives the company that developed the drug exclusive rights to sell the drug for as long as the patent remains in effect.
As a patent nears expiration, manufacturers may apply to the FDA for permission to make and sell generic versions of a drug. Since there are no startup costs for development of a new drug, other companies can afford to make and sell it for a less expensive amount. When multiple companies produce and sell a drug, the competition drives the price down even further.
The FDA applies the same standards for all drug-manufacturing facilities. Many companies manufacture both brand name and generic drugs. In fact, the FDA estimates that 50% of the generic drugs are produced by the same company that created the initial brand name drug.
Generic versions of drugs have different colors, flavors, or combinations of inactive ingredients than the original medications because United States trademark laws do not allow the generic drugs to look exactly like the brand name medication. However, the active ingredients must be the same in both generic and brand name medications, ensuring that both have the same effectiveness in treating a medical condition.
A physician’s decision to prescribe a brand name over a generic is based on the needs of the patient. Three in four physicians allow generic substitutes for brand-name drugs, even though most of them do not have a “dispense as generic” box on their prescription pad.
Pennsylvania law allows pharmacists to substitute generic drugs for original brand named drugs, unless the person writing the prescription, or the patient, directs otherwise. If the physician writes “Brand Necessary” or “Dispense As Written (DAW)” on the prescription, the pharmacist may not substitute the brand name medication with a generic alternative.
All patients are encouraged to discuss generic alternatives with their physicians prior to filling a prescription. The doctor and the patient should agree on the best course of treatment for any diagnosed medical condition.
A Guide to Legal Issues in Health Care: Prescription Drugs Retrived September 16, 2006 from http://www.upenn.edu/ogc/legal/pred.html Are Generic Medications the Same as Branded Counterparts? Retrieved September 16, 2006 from http://counsellingresource.com/medications/discount-drugs/generics.html COMMONWEALTH OF PENNSYLVANIA GENERIC DRUG EQUIVALENCY/SUBSTITUTION LAWS & REGULATIONS Retrieved September 16, 2006 from http://ecapps.health.state.pa.us/pdf/ddc/generic33.ps.pdf#search=%22pennsylvania%20drug%20dispensing%22How Physicians Feel About Prescribing Generics Retrieved September 16, 2006 from http://www.aarp.org/health/affordable_drugs/physiciansandgenericdrugs.html
Prescription Drugs – Generic vs Brand Name Retrieved September 16, 2006 from http://www.crossborderpharmacy.com/Canadian-Generics-vs-Brand-Name.htmlStoppler, MD, M., Generic Drugs, Are They As Good as Brand-Names? Retrieved September 16, 2006 from http://www.medicinenet.com/script/main/art.asp?articlekey=46204
by Admin. | Jan 16, 2009 | healthcare, HSA, NY News, Pharmaceutical Industry
Happy Holidays!
We are pleased to present the Winter issue of the MMS newsletter. As we enter 2009 we want include some timely information on year end tips, house cleaning and helpful articles.
As guidance for 2009, we are seeing various industry patterns. These are heady economic times and we remain cautiously optimistic with the new presidential administration. There are many proposed legislations on the table as well as free reports from PriceWaterHouse Cooper reports on what “Employers Want” and “9 Trends for 2009”.
We have seen recent consolidations with recent mergers between GHI and HIP to form EmblemHealth. Both non profits follow the Empire Blue Cross for-profit conversion of 5 years ago and covered in my blog.
Insurers such as Aetna, Empire and Oxford have been dropping Pharmaceutical Benefits Management companies and using their own resources instead. As self acting PBMs’ they can negotiate effectively by using their large numbers. This trend has not gone unnoticed by Pharmacy retailers such as CVS and Walgreens who must compete with mail order PBMs’.
Pharmaceutical Corps are bracing themselves for brand expirations on 80% of the most commonly prescribed drugs within 2 years. They have issued double digit rate increases while simultaneously manufacturing generics of their own drugs. This will make sense as generics average 1/4 the cost of brands. In fact, this will be a significant future cost saver as Rx have doubled in 10 years and represents over 25% of our insurance costs.
Insurers are saving members 20-40% by including value added discounts or reimbursements for gym membership, weight management programs, alternative medicine & holistic healing, vision, laser vision care, dental , hearing care and vitamins/natural supplements.
The technology investments will improve patient care and the public is already seeing early payoffs. Various online medical sites have helped inform patients and advocacy. Insurers such as Empire actually offer a $5 Copay to interact with one’s doctor online.
In addition, “consumer driven healthcare plans” are taking off as copays have risen. Its not unusual to find plans with specialist $50 copay. As a result our consumers have been re-evaluating whether it makes sense to self insure on rare items such as hoispiatls and surgeries. The HSA (health Savings Account) a model, especially the one form Aetna, has become actually a high end plan since the savings are significant enough to self insure and have universal coverage. The average PPO plan is $650/single while an HSA at $370/single only asks that you self insure on $1500. The invisible hand leading you say? Agreed!
Perhaps things will be more localized as hospitals have consolidated and have a virtual monopoly in LI and Bronx as an example. Insurers such as Oxford, Aetna and Atlantis already offer localized NYC plans which are 30% less expensive but have a limited NYC network.
Our agency has strived to be ahead of the curve and keep our clients within budget regardless. We have employed creative tools, personalized advise and latest technologies in the past and plan on adding to this model going forward. We thank you all for reading our material, referring us business and most of all believing in us!
Once again thank you and we wish you and your family a wonderful Holiday Season!
by Admin. | Jan 16, 2009 | Uncategorized
UnitedHealth announces class-action settlement.
The New York Times (1/16, B3, Abelson) reports, “The insurance giant UnitedHealth Group said Thursday that it had reached a $350 million deal to settle class-action lawsuits claiming it had underpaid patients and doctors.” The agreement resolves three suits against the insurer. The proposed settlement, however, is being contested by “one of the lawyers for the plaintiffs” who “says the money is not enough and has filed an objection with one of the judges overseeing the cases.” Nevertheless, the company stated that it is “confident the agreement will be approved by the court.” The company’s announcement comes two days after UnitedHealth “settled allegations from New York Attorney General Andrew Cuomo by paying $50 million and transferring to a nonprofit group its database that set the amount to be reimbursed when patients used doctors outside their network,” Bloomberg News (1/16, Goldstein, Freifeld) adds. UnitedHealth’s Ingenix subsidiary “maintains the out-of-network fee database to determine the ‘usual and customary’ fees.” The database is used by “hundreds of insurers,” according to UnitedHealth. Cuomo claimed that these insurers “used Ingenix’s ‘defective and manipulated’ database to set artificially low reimbursement rates.” The class-action suit against UnitedHealth “alleged that insurers lowered the data they contributed, which then helped them lower their payment obligations,” the AP (1/16, Murphy) notes. As a result, “doctors or other providers often billed patients for the difference.” According to the Chicago Tribune (1/16, Japsen), UnitedHealth stated that its agreement “contains no admission of wrongdoing.” The money is expected to “fund a settlement with health plan members and providers in connection with claims dating back to 1994.” In addition, Thursday’s agreement may “lead to settlements from other insurers” that used Ingenix as well. Minnesota’s Star Tribune (1/16, Yee) and the Minneapolis/St. Paul Business Journal (1/15, Stevens) also covered the story. Aetna agrees to $20 million settlement in reimbursement system probe. The AP (1/16) reports, “Health insurer Aetna Inc. said Thursday it will pay $20 million to help set up a database to calculate out-of-network medical payments in an effort to end a dispute with UnitedHealth Group Inc. over a system that allegedly passed more costs to plan members.” Working with the office of New York Attorney General Andrew Cuomo, Aetna is expected to “set up an independent public database,” as well as “a system to help plan members find out what they will have to pay out of pocket before they visit a doctor who is not part of Aetna’s network,” under the agreement. Earlier this week, Cuomo announced that UnitedHealth had agreed “to shut the database operated by its Ingenix subsidiary, which insurers use to help determine ‘reasonable and customary’ costs for claims for out-of-network physicians,” Bloomberg News (1/15, Freifeld, Goldstein) added. After conducting “an industrywide probe of out-of-network claims,” Cuomo determined that “the Ingenix database was rigged.” He contended that the “corrupted reimbursement system…took hundreds of millions of dollars from the pockets of patients nationwide.” Under UnitedHealth’s settlement, the insurer will “pay $50 million to fund a nonprofit entity to provide independent data on costs.” Dow Jones Newswires (1/16, Bray) also covers the story.
by Admin. | Sep 2, 2008 | family health insurance, group health insurance, individual health insurance, latest health insurance news
JD Power and Associates Ranks U.S. Health Insurance Companies
. Tags: Arizona, Benefits, BlueCross BlueShield of Alabama, BlueCross BlueShield of Arizona, BlueCross BlueShield of Florida, BlueCross BlueShield of Illinois, Coverage, Health Alliance Plan of Michigan, Health Insurance Companies, Health Insurance Study, Health Plans, Humana of Ohio, Humana of Texas, Insurance Study, JD Power and Associates, Kaiser Health Plan of California, Kaiser Health Plan of Colorado, National Health Insurance Plans, Utah, Wellmark BlueCross BlueShield of Iowa.
Always an advocate for business and consumers alike, JD Power and Associates has administered an insurance study for the last two years. The study measures member satisfaction among 107 health plans in 17 regions across the United States. They focus on seven key areas: coverage and benefits; choice of doctors; hospitals and pharmacies; information and communication; approval processes; claims processing; insurance statements; and customer service.
The 2008 National Health Insurance Plan Study included responses from over 37,000 members of large commercial health plans. To be included in the study, plans had to contain at least 250,000 members across all commercial products, excluding Medicare and Medicaid. They were ranked on 1,000-point scale.
And the winners are…
* Arizona and Utah region: BlueCross BlueShield of Arizona, 763 points
* California Region: Kaiser Foundation Health Plan of California, 755 points
* Colorado Region: Kaiser Foundation Health Plan of Colorado, 748 points
* East South Central Region: BlueCross BlueShield of Alabama, 759 points
* Florida Region: BlueCross BlueShield of Florida, 751 points
* Heartland Region: Wellmark BlueCross BlueShield of Iowa, 742 points
* Illinois and Indiana Region: BlueCross BlueShield of Illinois, 729 points
* Michigan Region: Health Alliance Plan of Michigan, 772 points
* Minnesota and Wisconsin Region: HealthPartners, 768 points
* New England Region: Anthem BlueCross BlueShield of Connecticut, 772 points
* New York and New Jersey Region: United Healthcare (New Jersey/New York), 749 points
* Northwest Region: Group Health Cooperative, 778 points
* Ohio Region: Humana of Ohio, 748 points
* Pennsylvania and Delaware Region: Highmark Blue Cross and Blue Shield, 784 points (** Highest score across all regions**)
* South Atlantic Region: Kaiser Foundation Health Plan of Georgia, 746 points
* Texas Region: Humana of Texas, 753 points
* Virginia and Maryland Region: CareFirst BlueCross BlueShield, 740 points
For more information on the JD Power and Associates Health Insurance Study, view their Press Release.
by Admin. | May 20, 2008 | Uncategorized
Greetings!
We are pleased to announce our 10th year anniversary this past March. Back in 1998, the average HMO was only $325/month with office copays at only $10. Then again, gas prices were $2.50, there was Monicagate saga, Google was just a neophyte startup, the Y2K looming as the world’s demise, Seinfeld was still funny, and the US dollar dominated.
At the time, I was working out of my home office wondering will I get a client before my unemployment checks run out? I was short on time and money for creating a web presence, organizing a marketing plan and seeking outside lending. I was way in over my head as they say.
Healthcare was volatile at the time with carriers shifting the costs burden onto businesses. I suppose nothing has changed in 10 years with the exception of less companies vying for our business as consolidation was abound. Since that time, Aetna bought U.S. healthcare which bought NYL Care and PruCare. Oxford almost went out of business, their stock dropping from $86 to $6 in a matter of weeks. Five years later United Healthcare bought out Oxford. Empire survived 9/11 but was bought by WellPoint 2 years later. The Blue Crosses stopped competing against each other with Horizon Blue Cross dropping out of NY and Empire leaving NJ.
At the same time, new players have entered the industry. Healthpass has become a great way for small businesses to offer multiple plan options and carriers and compete with larger corporations. Atlantis Health Plans has become a medical inflation controller with rates still below $300/month. There was no Healthy NY to offer state supplemented corporate plans. The online functionalities has also evened the playing field for small businesses by keeping costs down, reaching the end users quickly and carving market niches.
By being a small business ourselves, this experience has made us more in tune and sensitive to our client needs. We are batting virtually 100% with claim and billing disputes and help employers maximize their benefits while discovering market inefficiencies. Borrowing from Google’s creed, “don’t be evil”, has helped us grow to over 300 employer groups and over 3500 members strong.
We are proud of our achievements and have been awarded the industry’s 2008 NAHU Golden Eagle Award for outstanding sales & achievement. Last summer’s move to Armonk, NY has allowed us to merge with a long time Property & Casualty brokerage firm, Avanti Associates. This will give our clients competitive markets for building, auto, malpractice insurance, professional liability and workman’s comp that they may not have had.
What’s next? We are ramping up an HR Kiosk service from the existing “physician locator” and “forms warehouse” links on our website. Many of you have already been using these tools when shopping for the annual plan renewals. But what about offering an intranet like kiosk where your employees can view, for example, their Aetna medical and Oxford dental plans from on one site? Or having the ability to post HR policies on vacation days, COBRA information or 401k documents?
We’ve enjoyed our experience and learned a lot from challenges faced but we really learn the most from our clients at the end of the day. You are the reason we have been fortunate to be in business and we depend on your suggestions and referrals to sustain our business model. We offer many extra’s and help you stretch your healthcare dollars as a way of thanking you and hope to continue to grow as a valuable part of your business.
Finally, I want to congratulate my brother Jonathan on his recent marriage this past Valentine’s Day. Also, he has dedicated 5 years at MMS, Inc. and I owe him a world of gratitude for realizing many of the goals of the firm. He has distinguished himself from a young college grad to a marketing and accounts manager who runs everything from renewal proposals to managing the day to day nuts and bolts that makes the agency work.
Sincerely,
Alex Miller
by Admin. | Mar 27, 2008 | NY News
HIP and GHI merger. GHI and HIP have been working since 2005 on merging under a common parent, EmblemHealth, serving more than four million members across the tri-state area. As sister companies, GHI and HIP has continued to operate separately until they get NY State Approval. Affiliation is the first step as GHI and HIP begin the process of combining and integrating as they move toward an eventual merger. Existing group coverage will not change as a result of the affiliation. Over time, their stated mission is to will develop and make available an expanded range of cost effective products and new services to you and your employee’s. There have been a recent executive fall out of the changes and expect more to come. NY will be losing the last few non-profits left in the state. The state is running public forums to review this, see state insurance site on recent meetings. Will this be NY State politics as usual and allow political leaders to dole out the stock market gains for personal gains or will citizens stand to gain? Unlike our state, California took a long term view for the medical care of its citizens. They set up a non-profit with a mission that the Blue Cross conversion set up a fund of not less than $100 million to be spent on charitable activities in 1994 and not less than 40 percent of WellPoint stock ($1.2 billion) to be contributed to a newly formed foundation. Pataki on the other hand used 90% of the $1.1Billion Empire Blue Cross 2002 conversion for Mr. Rivera’s powerful 1199 Union. I’m sure that this did not harm his 2002 reelection campaign but I wish New Yorkers did as well as California. See article in NY Times for your consideration.
by Admin. | Mar 25, 2008 | Uncategorized
Today, march 25th, 2008 I will start a blog. Blogging has fascinated me as a way of sharing ideas with people. Unlike my website, I can quickly share topical points of interest, highlight links, and info on the local NY Healthcare market. In today’s age, I can’t imagine 2 more compelling topics than Gotham and Healthcare.
One day I stumbled upon http://www.techcrunch.com/, and immediately thought that I would enjoy creating my own healthcare blog.
My opinions are my own. I hope that I make readers think. I look forward to interacting with readers and seeing their perspectives. I have always learned more from clients in my line of work than any other source especially from physician groups.
Thanks for visiting my personal place to rant and pontificate.
