Medical tourism is on the rise. But what’s driving it and what are the effects on governments and individuals? A helpful article on international insurance by our partners, Aetna International.
Thousands of patients benefit from access to cheaper treatment, as do the governments of many developing nations who can earn millions by offering cheaper procedures. But even this latter benefit brings a difficult conundrum to the governments of many developing nations: to provide the best health care for nationals by sending them abroad for treatments unavailable at home, or retain that money to invest in national health systems at home? Those that choose the former, are placing increased pressure on their national health services as much-needed investment is going abroad. This is also a driver of medical inflation: flying a patient to another country can mean higher costs than if it were carried out at home. This means there is less to invest in the national system and costs are driven up.
And for those nations making a virtue of selling cheaper treatment, the cost is often reduced levels of care for nationals, as tourists use up national resources and the private sector attracts the best clinicians.
Leading the health tourism charge is the U.S., closely followed by Europe, where thousands of patients fly abroad to receive treatment, avoiding domestic waiting lists and potentially enjoying reduced treatment costs. Asia Pacific and South and Central America currently dominate the market, where Americans can save up to 60% on treatment.
Driving this global trend are a number of factors, explored below, from aging populations and medical inflation to inadequate domestic care and health care cuts.
This article explores some of the implications of the rising numbers of people travelling for treatment. It also begins to explore how health and wellness systems and institutions – from national health services to health insurance companies — are responding to this trend.
Why?
The root causes of this increase are cuts in national health funding, ageing and affluent populations, staff shortages and a range of lifestyle factors.
Cost and access are the main drivers for travel.
Company executives, the C-suite and those on assignment are travelling to access better treatment in the country of their choice, and not just when they’re unwell or managing a condition, but in pursuit of preventative wellness care as well.
Many people travel to countries that offer lower-cost medical treatment because they can’t afford them at home or don’t have access to the treatment at all. 1.7 million Americans live in households that will declare bankruptcy due to their inability to pay their medical bills; while savings of 65-80% can be saved on medical bills if Americans fly to Malaysia (December 2017). Many around the world are in the same situation. Others are flying for cheap elective surgery and treatments for things such as cosmetic surgery and dentistry.
The third contributing factor is certain nations’ reliance on foreign countries for specialist treatments. Nigeria’s national health service sends many patients abroad for treatment, paying other countries for access. In an effort to “reduce our dependence on foreign medical tourism” Nigeria announced the construction of a N7.5 billion (£14.9m, $20.7m) ultra-modern specialist hospital in Kano Statein (February 2018).
Another reason for travel is national health care system waiting times. The UK’s Telegraphreported in 2017 that many UK citizens are travelling abroad to receive immediate treatment as NHS waiting times can be long — waiting times in Wales have gone up by 400% since 2013.
The aging populations of developed nations are also having an impact — and continues to grow. Aging is a concern for costs to health care systems, with increased care needs over longer lifespans. Also of concern are health care costs for older people. As national health services buckle under the pressure of increased demand from an aging population, waiting lists expand and medical inflation drives up costs. As such, many older people seek alternative, cheaper treatments abroad.
1. The blessing and the curse for governments
While some countries are benefitting from an influx of patients keen to exploit cheaper care, some national health services are feeling the pressure. For example, while Costa Rica earned $338 million from the trade in 2012, the UK’s National Health Service (NHS) said in 2016 that 0.3% of NHS spending went to “deliberate health tourism” and those taking advantage of free NHS services. Another estimate in the same year came from Lord Bates who said the cost of visitors to the NHS in 2012-13 was £2bn — approximately 2% of the NHS budget. Though increased immigration health surcharge has been proposed to tackle this.
This is proving a challenge for many governments who want to provide the best health care for nationals. Sometimes this means using specialist care in other countries, but flying a patient to another country can mean higher costs than necessary — contributing to medical inflation. This in turn means that governments have less to invest in their own national system… and costs go up again.
A quick sweep of recent news shows many countries are getting in on the action, building pay-to-play services and promoting them. For example:
One nation making the most of the opportunity is Cuba. Speaking at the ITIC in Barcelona in November 2017, Humberto Barreto Nardo, Director General of Asistur SA explained how Cuba wanted to build a strong infrastructure which offered basic medical care and the best medical standards for its population and medical tourists. He detailed how, in addition to this, the Cuban Medical Services Market Developer — a corporate entity created to guarantee medical care with best means and human resources
2. The blessing and the curse for individuals
Nations and private enterprise tapping the market isn’t helping patients because it’s contributing to global health care inflation — the cost of health care — and not addressing the prevention and intervention of diseases and conditions.
The results are: health insurance premium increases, higher costs to governments (budget/target shortfalls and/or potential tax increases) and, most importantly, fewer healthier people.
And that’s if it all goes well… Many patients fly for lower cost treatment, only to find there are subsequent complications. But, having not budgeted for it and finding themselves miles away, are unable to deal with them.
A 2013 report found that: “Researchers examining outbound medical tourism from Oman found that 15% of 45 surveyed medical tourists experienced complications following treatment abroad, while a survey of the British Association of Plastic, Reconstructive and Aesthetic Surgery found that 37% of members had seen patients with complications resulting from medical tourism.”
The role of the expat
Demands on the system from expats traveling back to their countries of origin is also causing waiting lists to lengthen and costs to rise.
For many expats, international Private Medical Insurance (iPMI) is the best way to ensure you have access to good quality care and treatments wherever you are. This has its own effect as increased pressure on private resources can drain national health services of staff and hospitals.
Best practise
It is something of a truism in the West that the best health care is preventative, not curative. For too long, health services focused on reducing pain, exchanging organs and curing diseases. The 21st century has seen the blossoming of what Aetna International calls, value-based care. This approach puts the whole patient at the centre of their health journey (not their condition, not their disease), making it easier for people to get quality care, while keeping medical inflation in check. Many governments are investing in keeping people healthy with nutrition information, quit smoking campaigns and other initiatives. In a pay-to-play system, everyone loses out: nations have less money to spend on keeping their population healthy, medical inflation effects insurers, which then puts premium costs up for individuals.
Our value-based system aims to put the patient at the centre of their plan to keep them healthier and keep premiums low. Recognising that, individuals are increasingly demanding global access to care, it’s important that they can choose the regions in which to access care. Each region offers a carefully maintained network of care providers and the area of cover chosen helps shape the plan and premium. Our in-house Care and Response Excellence (CARE) team of specialised clinicians and multilingual case managers available 24/7/365 to support individuals pre-trip, post-trip, and anytime in between.
The medical tourism trend looks set to continue as more people look to travel for treatment. While this means that the iPMI industry is booming, it’s important for employers and individuals to rely on a health benefits and wellness partner that ensures the right care and outcome, at the right time, in the right place and at the right cost. At Aetna International, our strength lies in our global network of health care providers and our in-depth local knowledge and our ability to provide access to quality care no matter where they are.
If you’re looking to better understand iPMI market trends or for international health and wellness benefit solutions, contact us for more information.
Learn more about international travel insurance and iPMI. We are successfully helping navigate SMB for 20+ years. Please contact us at 855-667-4621 or info@medicalsolutionscorp.com.
In preparation of open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2019. Employers should review their plan documents to confirm that they include these required changes.
Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.
Below is an Employer 2019 Open Enrollment Checklist including some administrative items to prepare for in 2019.
PLAN DESIGN CHANGES
Out-of-pocket Maximum
Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.
The annual limit on total enrollee cost sharing for EHB for plan years beginning on or after Jan. 1, 2019, is $7,900 for self-only coverage and $15,800 for family coverage.
Also, the ACA’s self-only out-of-pocket maximum applies to all individuals, regardless of whether they have self-only or family coverage under a non-grandfathered plan. This means that non-grandfathered health plans are required to embed an individual out-of-pocket maximum in the plan’s family coverage when the family out-of-pocket maximum exceeds the ACA’s out-of-pocket maximum for self-only coverage.
Review your plan’s out-of-pocket maximum to make sure it complies with the ACA’s limits for the 2019 plan year ($7,900 for self-only coverage and $15,800 for family coverage).
If you have a high deductible health plan (HDHP) that is compatible with a health savings account (HSA), keep in mind that your plan’s out-of-pocket maximum must be lower than the ACA’s limit. For 2019 plan years, the out-of-pocket maximum limit for HDHPs is $6,750 for self-only coverage and $13,500 for family coverage.
If your plan uses multiple service providers to administer benefits, confirm that the plan coordinates all claims for EHB across the plan’s service providers or divides the out-of-pocket maximum across the categories of benefits, with a combined limit that does not exceed the maximum for 2019.
Group health plans with a family out-of-pocket maximum that is higher than the ACA’s self-only out-of-pocket maximum limit must embed an individual out-of-pocket maximum in family coverage so that no individual’s out-of-pocket expenses exceed $7,900 for the 2019 plan year.
Preventive Care Benefits
The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost sharing.
The ACA imposes a dollar limit on employees’ salary reduction contributions to a health FSA offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year.
The ACA’s limit on employees’ pre-tax health FSA contributions first became effective for plan years beginning on or after Jan. 1, 2013. The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. The health FSA limit has been increased to $2,700 for 2019 plan years.
Confirm that your health FSA will not allow employees to make pre-tax contributions in excess of the limit for the 2019 plan year
Communicate the health FSA limit to employees as part of the open enrollment process.
HDHP and HSA Limits for 2019
If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2019 limits. The IRS limits for HSA contributions and HDHP cost sharing will all increase for 2019. The HSA contribution limits will increase effective Jan. 1, 2019, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2019.
The following table contains the HDHP and HSA limits for 2019:
ACA EMPLOYER MANDATE AND OTHER REQUIREMENTS
Applicable Large Employer Status (ALE)
Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.
To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.
Determine your ALE status for 2019
Calculate the number of full-time employees for all 12 calendar months of 2018. A full-time employee is an employee who is employed on average for at least 30 hours of service per week.
Calculate the number of FTEs for all 12 calendar months of 2018 by calculating the aggregate number of hours of service (but not more than 120 hours of service for any employee) for all employees who were not full-time employees for that month and dividing the total hours of service by 120.
Add the number of full-time employees and FTEs (including fractions) calculated above for all 12 calendar months of 2018.
Add up the monthly numbers from the preceding step and divide the sum by 12. Disregard fractions.
If your result is 50 or more, you are likely an ALE for 2019.
Identify Full-time Employees
All full-time employees must be offered affordable minimum value coverage. A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.
Determine which method you are going to use to determine full-time status
Monthly measurement method involves a month-to-month analysis where full-time employees are identified based on their hours of service for each month. This method is not based on averaging hours of service over a prior measurement method. Month-to-month measuring may cause practical difficulties for employers, particularly if there are employees with varying hours or employment schedules, and could result in employees moving in and out of employer coverage on a monthly
Look-back measurement method allows an employer to determine full-time status based on average hours worked by an employee in a prior period. This method involves a measurement period for counting/averaging hours of service, an administrative period that allows time for enrollment and disenrollment, and a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement
Offer of Coverage
An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. Employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies.
Offer minimum essential coverage to all full-time employees
Ensure that at least one of those plans provides minimum value (60% actuarial value)
Ensure that the minimum value plan offered is affordable to all full-time employees by ensuring that the employee contribution for the lowest cost single minimum value plan does not exceed 86% of an employee’s earnings based on the employee’s W-2 wages, the employee’s rate of pay, or the federal poverty level for a single individual.
Reporting of Coverage
The ACA requires ALEs to report information to the IRS and to employees regarding the employer- sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer shared responsibility provisions (Code Section 6056).
In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055).
Determine which reporting requirements apply to you and your health plans
Determine the information you will need for reporting and coordinate internal and external resources to help compile the required data for the 1094-C and 1095-C
Complete the appropriate forms for the 2018 reporting year. Furnish statements to individuals on or before January 31, 2019, and file returns with the IRS on or before February 28, 2019 (March 31, 2019, if filing electronically).
Comparative Effectiveness Research Fee (PCORI)
Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.39 per covered life in 2019 and are next due July 31, 2019.
W-2 Reporting
Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.
The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.
ACA DISCLOSURE REQUIREMENTS
Summary of Benefits and Coverage
The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).
In connection with a plan’s 2019 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs. Please contact your representative at Lawley for assistance.
Grandfathered Plan Notice
If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL.
Notice of Patient Protections
Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.
If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.
OTHER NOTICES
Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials.
Initial COBRA Notice
The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans. Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD. A model initial COBRA notice is available from the DOL.
Notice of HIPAA Special Enrollment Rights
At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA. This notice may be included in the plan’s SPD. Model language for this disclosure is available on the DOL’s website.
Annual CHIPRA Notice
Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.
WHCRA Notice
Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis. Model language for this disclosure is available on the DOL’s website.
NMHPA Notice
Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.
Medicare Part D Notices
Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th(when the Medicare annual open enrollment period begins). Model notices are available on the Centers for Medicare and Medicaid Services’ website.
HIPAA Privacy Notice
The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.
Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Model Privacy Notices are available through the Department of Health and Human Services
Summary Plan Description (SPD)
Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).
Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years.
Summary Annual Report
Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.
Wellness Program Notices
Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.
HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
ADA Wellness Program Notice—Employers with 15 or more employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.
Learn how our Agency is helping businesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
Another Patriots Super Bowl can give a Jets fan such as myself heartburn but with good reason. As folks gear up for Super Bowl Sunday to watch the New England Patriots face the LA Rams they’ll indulge in their favorite game-day foods, share a few laughs and lament the fact that the Monday after the Super Bowl is not a recognized as a national holiday.
Eight Super health facts as presented by Hartford Healthcare.
Player size has changed (and it matters): One of the biggest differences between Super Bowl I and Super Bowl LIII is the size of the players. This year, the averageNFL player stands 6 feet 2 and weighs almost 250 pounds. Contrast that to Super Bowl I, when the biggest football player on the world champion Green Bay Packers roster was Gale Gillingham, who was only 255 pounds. The average adult male in the United States is 5 feet 9 and 195 pounds. The United States has the highest rate of obesity in the world with more than 109 million people considered obese. When comparing that to the country’s population, more than 30 percent of people in America are overweight.
Concussion is a MUCH bigger deal than ever before: Recent concussion tests have sparked nationwide conversation surrounding the connection between head injuries and contact sports, specifically football. In high schools across the country, 47 percent of all reported sports concussions are from football. Dr. Subramani Seetharama, a physiatrist and sports medicine specialist at the Hartford HealthCare Bone & Joint Institute who is also the medical director of the Sports Health and Concussion Clinic programs, says parents and athletes should not get caught up in the moment when dealing with potential concussions.“I tell kids, if you have a headache, get off the field immediately,” said Dr. Seetharama. “Studies show if they continue playing, there is a 40 percent chance they will have a prolonged symptom scale and they’re going to miss school.”
Sprains, strains and ACL injuries, too:Aside from concussions, there are other dangers to the body from playing football. The most common
football injuries are musculoskeletal injuries, such as ligament sprains and muscle strains. Knee injuries are common in football, with most occurring in the anterior or posterior cruciate ligaments (ACLs and PCLs). Most ACL injuries in football happen on non-contact plays, usually when the foot becomes stuck on the playing surface.“Not everyone who tears their ACL will hear or feel a pop,” said Dr. Clifford Rios, orthopedic surgeon and board-certified in sports medicine at the Hartford HealthCare Bone & Joint Institute. “When an ACL injury typically happens, the play goes one way and the athlete plants a foot with the knee partially flexed. Then they’ll try to turn the body away from the direction their foot is facing and push off to change direction, ultimately causing the injury.”
Football players like to eat – a lot: The average person in America eats approximately 3,600 calories a day – that’s quite a bit more than the 1,800-2,200 calories a day recommended for the average adult male. Unless, of course, you are a pro football player. The average 300-pound NFL player may eat up to 9,000 calories a day.“There isn’t a ‘magic number’ to determine how many calories you should eat,” said May Harter, MS, RD, CD-N, a registered dietitian at The Hospital of Central Connecticut. “The amount of calories you should eat per day really depends on a variety of factors, including your age, gender, medical history, and how much daily physical activity you typically engage in.”
Chicken wings are a BIG thing (so is pizza): This Super Bowl weekend, nearly 1.3 billion chicken wings will be consumed in the country. To give perspective, imagine a straight line of chicken wings end-to-end from Hartford to Los Angeles – 28 times over. The pizza company industry is also grateful for the biggest sporting event of the year, as many businesses will see their orders double on Super Bowl Sunday.
Don’t forget the guacamole: Wings and pizza aren’t the only items on the menu on Super Bowl Sunday. More than 8 million pounds of guacamole will be consumed as well. The good news for guacamole lovers? Avocados are on the healthier side, low in saturated fat and packed with about 20 vitamins and minerals.“Avocados are loaded with heart-healthy monounsaturated fatty acids that are good for your heart health,” says Harter. “Like any food, they are good in moderation. They can lower your cholesterol while increasing your fiber and potassium intakes.”
The high-fat spread is delish — but at what price to your health?:All that delicious food can comes at a price. Antacid sales are expected to increase by roughly 20 percent on the day after the Super Bowl. And 6 percent of people in America will call in sick the day after, and not all of them are just hoping to celebrate their team’s victory for an extra day. A recent Tulane University study found evidence that Super Bowl parties help spread the flu. The study showed that between 1974 and 2009, cities with teams in the Super Bowl experienced an 18 percent increase in influenza deaths that season. Be sure to wash your hands before and after eating and don’t forget your hand sanitizers!
The Super Bowl wasn’t always an evening affair: Once the big game is over and you finally climb into bed, you may realize it’s only a short while before you need to be back up and ready for work the next day. One major difference between the first Super Bowl and now is the game’s start and end times. This year’s Super Bowl is scheduled to kick off at 6:30 p.m. Factor in all the commercials and a halftime show that’s 30 minutes long (15 minutes longer than the average football game halftime), and the game can easily go past 10 p.m. The first Super Bowl started at 1 p.m. EST (which was 10 a.m. local time in Los Angeles, where the game was held) and the game ended well before anyone’s bedtime. Though it may be tough to get enough sleep after the Super Bowl, Dr. Brett Volpe, a board-certified sleep specialist at MidState Medical Center’s Sleep Care Center, stresses the importance of getting back on a regular sleep schedule for the rest of the week and staying away from caffeine when possible. “A lot of people don’t realize that caffeine has a half-life of 12-16 hours,” said Dr. Volpe. “High-caffeine foods and drinks we take in the morning can potentially affect our sleeping that night, especially in younger adults and children. An irregular sleep schedule makes it harder for our brain and body to rest properly and it’s almost like intentionally putting yourself through jet lag.”
It’s a super caloric day but if you fall from your New Year’s resolution let it be just one day – SUPER BOWL SUNDAY. Enjoy!
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Healthfirst has released affordable new 2019 plans for NY small businesses and not a moment too soon. With the recent exit of popular CareConnect of NY the market is starving for an affordable option.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.3 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Value
Healthfirst’s new January 2019 rates are in fact virtually the same as 4th Q 2018. Example, a single rate is approximately $16 or 1.7% higher. Todays largest networks with popular in-network only GOLD are priced at $900/single monthly. By comparison the Healthfirst Gold plan is $732 annually or 18% less expensive. For platinum the price gap jumps are even higher – $1100/single vs $896/single.
Members have access to a broad network of providers and dozens of industry-leading hospitals.
Community locations throughout New York City, Long Island and parts of Westchester.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Network Overview:
Healthfirst EPO Pro Network – Provider count expanded to 30,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk and Southern Westchester. 136+ Urgent Care locations and 50+ hospitals included. Examples:
Free 24/7 Telemedicine Through Teladoc –Members can speak to a doctor anytime, anywhere, with a $0 copay.Telemedicine accessed via phone call or video chat.
Gym Reimbursement – Annual $400/member and $200/spouse reimbursement
Accupuncture Covered Benefit
CVS/Caremark – 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
Free Flu Vaccine
Pro Plus EPO plans Option
Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow up care and limited orthodontia.
Vision – Exams, Lenses, Frames or Contacts covered every 12 months
SHOP Credits – SMB groups can enroll on tax credit program directly with our Brokerage
A business must have fewer than 25 employees
Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Healths Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer
Empire Blue Cross Blue Shield has announced the new Empire Blue Access Network for 2019. This networks pairs with the long successful industry leading Empire PPO/EPO network. The Blue Access plan unifies the Pathways and Priority Network and adds 5,000 more providers. Additionally, the Blue Access network offers access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
Blue Access Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 71,000 physicians network. BlueCard PPO Access from home. Examples of hospitals:
Hospital for Special Surgery
NY Columbia Presbyterian
NYU Langone
Mt Sinai Health System
Montefiore
Westchester Medical Center
Maimonides
Staten Island University Hospital
SUNY Stoneybrook
Northwell Health (formerly North Shore LIJ)
Winthrop
LI Health Network
Bon Secours
Additional Features:
Telemedicine will be Free on all products except H.S.A. which will cost $49.
Vision – Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
Dental – price competitive plans with 127,000 Dentists and 385,000 locations.
Pharmacy – All plans use their large BCBS formulary Except Blue Access Plans. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
Cash Rewards andHealthy Support – Wellness program offers easy ways to earn up to $700 per member, per year. Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
Contact Us Now Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
EmblemHealth, formerly GHI and HIP, has recapitalized and reloaded dynamic plan offerings for 2019. They have had recent 3 years of single digit increases. Emblem has added significant new small group plans for 2019 thats fits the needs and budgets of small businesses. Each plan offers quality coverage with comprehensive benefits and network access.
New Expanded Prime Network: Access to a narrow and broad network
NYS – EmblemHealth has expanded small group Prime Network to include both the QualCare Network in New Jersey another ConnectiCare Network in Connecticut. This is in addition to the current HIP Prime Network in New York. Members can choose from over 90,000 private and group practice health professionals, facilities, and 144 hospitals in 28 New York State counties — all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties, and upstate areas that stretch north of Albany.
CT – The ConnectiCare HMO Network has 17,000 primary care providers and specialists, and 33 hospitals in all eight counties in the State of Connecticut.
NJ – The QualCare HMO Network includes 26,000 primary care providers and specialists, and 76 hospitals in all 21 counties across the State of New Jersey.
New Select Care Network
It is a smaller subset of the larger Prime Network. It includes over 41,000 health care professionals, facilities, and hospitals throughout 28 counties in New York State. PRIME vs. SELECT NETWORK: Click Here
New Plan Features
3 free copays for PCP on selected plans.
Urgent Care no deductible
Labs no deductible
Adult & pediatric preventive dental no deductible
FREE Telemedicine through Teledoc. Members can get non-urgent medical care. It’s convenient, immediate, and available 24 hours a day, 365 days a year. Telemedicine doctors can even prescribe certain medicines.
FREE Acupuncture
Vision Included – free annual exam and lenses at 20% coinsurance.
Gym Reimbursements – up to $400 for member and $200 for spouse.
Emblem has been a NYS mainstay for 80 years. They insure 612,000 members. Notable clients are Union plans such as the NYC Teachers Union.
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Oxford has expanded on their successful Oxford Metro Network plan released in 2016. For 2019 the network has expanded with most Metro plans enjoying rate reductions for 2019.
Oxford Metro Network:
The NY network has grown to approx. 12,000 Primary Care Providers, 29,000 Specialists and 71 hospitals. Furthermore, the Oxford Garden State network has been added as well onto the Metro Network. The Garden State network alone has access to 23,000 physicians and 62 hospitals.
All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists. Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Caremount, formerly Mt Kisko Medical Group, are NOT in the network.
Oxford Metro Costs:
Today’s largest networks with in-network only GOLD are priced at $11,000 /single annually. They typically are accompanied with $50 copays and non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 20% IN SAVINGS. For example, a popular Oxford Liberty HMO Gold is $880 vs.Oxford Metro Gold $735.
New Plan Added
New lower cost Oxford Primary Advantage Plans added. The plan provides in-network coverage with lower copayments and no deductibles when seeking care form PCP’s and OBGYNs and Tier 1 prescription drugs.
The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
The Google of health insurance?Oscar entered the NY market on Jan 1, 2014 and had around 16,000 members. In 2015, it expanded coverage to New Jersey and grew to about 40,000 members. In 2016, Oscar had 145,000 members in New York, New Jersey, California, and Texas. Oscar’s cutting edge technology and pioneering benefits have simplified the consumer health insurance experience propelled easier access and understanding of health plans. Examples of success have been ease of physician locator, online appointment setting and no cost telemedicine 24/7. Additionally, some plans have $0 Copay generics and annual 3 free office visits
The Numbers:
NY based with 900+ employees
260,000 members across 6 states
$890M raised from top investors (Fidelity, Goldman Sachs, Google, etc.)
$375M investment from Alphabet Inc. (Google parent company)
After doubling footprint for 2018,Oscar is on-track for 3x growth
Oscar Member Engagement:
27% of Oscar members utilize DocOnCall vs. industry average of 3%
35% of first time doctor appointments start with Oscar
3x customer satisfaction score vs. the industry average
48% of all Oscar members use the Oscar app, compared to 7% of other health insurance carriers
Doctor on Call has led to approximately $600 in savings per member
Concierge Team has led to an approx. $3,600 in savings in member OON claims
Pre-medicare population almost 2x Concierge Team utilization vs. the “younger” demographic
The Oscar Member Experience
Concierge Service: Every member is placed on a team of 5 care guides and 1 nurse that help members achieve better health outcomes and lower costs.
Doctor on Call: 24/7, free and unlimited telemedicine that works nationwide. This is a great way to care of basic primary care at the member’s convenience
New Oscar 2019
Oscar’s current network will be rebranded as Circle Network
15 plans across 4 metal tiers
NEWCircle Plus Network include:
Northwell (formerly North Shore LIJ)
Memorial Sloan-Kettering
Multiplan National Network for out of state
Westchester Expansion – Northern Westchester Hospital (Mt. Kisko), Phelps Hospital (Tarrytown) and the Westmed Medical Gorup added.
NEW: Only $0 deductible required Silver Plans!
Transitioning before 2019. Groups enrolling 11/1/19 can upgrade 1/1/19 to Circle Plus Network
NYS Pushes Back Association Plans and Short Term Medical
NYS is pushing back on Association Health Plans (AHP) In reaction to President Trump’s Executive Order of Association Health Plans expansion. The President expanded the role of association plans earlier this week rule to makes it easier for small businesses and trade groups to band together to purchase health coverage outside of Obamacare’s insurance markets.
These regulations provide an additional basis for a group or association of employers to be treated as an “employer. New York’s top insurance official said the Trump administration’s final rule making it easier to form association health plans will not hamper the state’s ability to continue regulating the health insurance industry. Other states like Massachusettes have have also pushed back over Association Plans. “Yesterday’s announcement by the Trump Administration to dramatically expand the footprint of Association Health Plans will invite fraud, mismanagement, and deception – and, as we’ve made clear, will do nothing to help ease the real health care challenges facing Americans,” Healey and Underwood said in a joint statement. “We believe the rule, as proposed, is unlawful and would lead to fewer critical consumer health protections.”
One program getting attention are inpexpesivive but limited short-term health insurance plans. According to yesterdays NYS DFS annoncment, however, New York regardless of federal actions will prohibit these plans as consumer protection. Current federal rules only permit short-term plans — which are exempted from certain health benefits coverage requirements, such as chronic pre-existing conditions — to last up to three months, but the Trump administration wants to expand that up to 364 days. “Such ‘limited health’ plans, whether limited to less than three months or one year, are not short-term at all, but rather an end-run around requirements applicable to individual or group hospital, surgical or medical expense coverage and are prohibited under New York State law,” DFS wrote in a circular letter to insurers.
Summary of Trump’s Association Health Plans Expansion
• Purpose of Association. Employers may band together in an association for thepurpose of obtaining health coverage.However, the association also “musthave at least one substantial business purpose unrelated to offering andproviding health coverage or other employee benefits to its employer membersand their employees.”The DOL clarifies in its safe harbor that a “substantialbusiness purpose is considered to exist if the group or association would be aviable entity in the absence of sponsoring an employee benefit plan.”
• Commonality of Interest. Employers in the association can either (1) be fromthe same trade, industry, line of business, or profession; or (2) all have aprincipal place of business in a State (or portion of a State, such as a city orcounty) or in the same metropolitan area (even if the metropolitan area spansmore than one State, like New York, Washington, D.C., or Kansas City
• Structure and Control.There must be a formal organizational structure with agoverning body and by-laws or similar formalities, to control the association,including the establishment and maintenance of the group health plan. Thecontrol can be direct or indirect through the regular election of directors,officers, or other similar representatives; however control must be present bothin form and in substance. Ultimately, the functions and activities of the group orassociation are controlled by its employer members, and the group’s orassociation’s employer members that participate in the group health plancontrol the plan, by determining contributions, plan designs, and benefits.
• Eligibility. Only employees and former employees of association members (andtheir eligible family members) may participate in the association health plan.Inother words, it cannot be an insurance exchange for any interested party.
We will closely monitor this as awell as all Health Care Reform developments. Sign up for our premium newsletter below. Learn how our Agency is helping buinsesses thrive in today’s economy. Check out PEO Case Studies here and learn how they can apply to you. Please contact us at info@medicalsolutionscorp.com or (855) 667-4621.
perspective, imagine a straight line of chicken wings end-to-end from Hartford to Los Angeles – 28 times over. The pizza company industry is also grateful for the biggest sporting event of the year, as many businesses will see their orders double on Super Bowl Sunday.
The Super Bowl wasn’t always an evening affair: Once the big game is over and you finally climb into bed, you may realize it’s only a short while before you need to be back up and ready for work the next day. One major difference between the first Super Bowl and now is the game’s start and end times. This year’s Super Bowl is scheduled to kick off at 6:30 p.m. Factor in all the commercials and a halftime show that’s 30 minutes long (15 minutes longer than the average football game halftime), and the game can easily go past 10 p.m. The first Super Bowl started at 1 p.m. EST (which was 10 a.m. local time in Los Angeles, where the game was held) and the game ended well before anyone’s bedtime. Though it may be tough to get enough sleep after the Super Bowl, Dr. Brett Volpe, a board-certified sleep specialist at MidState Medical Center’s Sleep Care Center, stresses the importance of getting back on a regular sleep schedule for the rest of the week and staying away from caffeine when possible. “A lot of people don’t realize that caffeine has a half-life of 12-16 hours,” said Dr. Volpe. “High-caffeine foods and drinks we take in the morning can potentially affect our sleeping that night, especially in younger adults and children. An irregular sleep schedule makes it harder for our brain and body to rest properly and it’s almost like intentionally putting yourself through jet lag.”
