Category Archives: health care

Change is the only constant

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PPACA, re-named the Affordable Care Act, has some fast-approaching effective dates.  September 23, 2010, all plans, including self-funded, fully-funded individual and group plans will no longer have lifetime limits.  This will apply only to policies renewing after 9/23/2010 until the full cycle is complete.

This means that if your renewal is not until next March, that will be when you will no longer have a lifetime limit.  The caveat is that up to January, 2014, the Dept of Health and Human Services may still define benefits it deems non-essential, and can prohibit them from being unlimited.  After that,  nothing will have a limit.

In addition, effective with renewals after 9/23, there will be no deductibles or co-pays for services which the DHHS lists as preventative.  The list is said to contain over 500 procedures, and is still growing.  Among them are colonoscopies, Pap tests, PSA tests, routine mammograms, bone density tests, immunizations, physicals, and tobacco cessation.  We’ll also be seeing further implementation of the 26 and under group, who can return to their parents’ policy, even if they are married and live elsewhere.

I have no idea how we are going to pay for all this without raising taxes and/or premiums.

Stay tuned.  There’s more to come.

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Blue Cross Awaits approval on new GI policy

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On July 16, 2010 Blue Cross filed with the Illinois DOI for a new child-only policy to comply with the guaranteed-issue regulations to take place September 23rd. The policy details of the new Blue Pathway have not been made public pending the approval of the policy. However, in filing for this plan, Blue Cross renews its committment to stay in the individual market. Contact me for more information on what’s happening now.

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Are you a grandfather?

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Over the last several days I have attended meetings, webinars, and spoken with people brighter than myself on the Afforable healthcare act.

There are so many changes, and so many dates of change that it concerns me that people will fend for themselves with their decision-making on their insurance without the counsel of someone like myself, who is making it a full-time profession. For example, if you have an insurance plan which was written or renewed prior to March 23rd of this year you have a grandfathered plan which will not change. However your renewal premiums could be going up and if you want to keep the same plan you have to pay them. If you change your c0-pays more than $5.00 or signifcantly change the contribution you make to your employee’s plan, you will no longer be grandfathered.

If you change plans, many new laws will affect you, which may include a higher cost. please don’t make these decisions on your own. It can be dangerous to your health.

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High-Riskpool or Dunk Tank?

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Sources at IDOI and IlCHIP tell me that there is still a great deal of uncertainty about how and when and if the high risk pool will be implemented in Illinois.  The funding for the plan hasn’t even been released yet.  Nor do they know who will actually administer it.

The AP (6/26) reported, “Illinois may be one of the first states to start providing health insurance in a new high-risk pool funded under national health overhaul, but enrollment will be limited, eligibility requirements tight and coverage may not begin until late summer.” Notably, “Illinois Department of Insurance Director Michael McRaith said the state will manage the program carefully to make sure there’s enough money to keep everyone who enrolls covered until Jan. 1, 2014, when the new health law will prohibit insurers from denying coverage to people with pre-existing conditions.”

I have two questions:

1.  How can they manage eligibility on total cost, and

2.  If they have trouble funding this plan, what are they going to do in 2014?

Stay tuned…..

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Policy Downgrades Suspended due to PPACA Interim Final Rules

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The followoing was recently posted by Blue Cross/Blue Shield and explains some of the rules changes and their effects on current BC/BS customers:

“As we shared with you last week, the Departments of Health and Human Services, Labor, and Treasury released interim final rules concerning grandfathered health plans under the Patient Protection and Affordable Care Act of 2010 (PPACA).

Given the new details provided in the rules, we have determined that a decrease in benefits (e.g., increasing deductible) will result in the loss of grandfathered status and that this change may result in a future premium increase that offsets any savings from the downgrade. As a result, Blue Cross and Blue Shield of Illinois (BCBSIL) is temporarily suspending the processing of all downgrade benefit changes for individual member policies that are not currently marketed plans (i.e., closed plans). Any applications from members in closed plans for downgrades in benefits that were not processed prior to June 14 will be returned to members, explaining in additional detail this temporary change in processing policy downgrades.

Members in plans that are currently marketed (i.e., open plans) can continue to downgrade their benefits; however, those whose original effective dates were prior to March 23, 2010, will lose their grandfathered status and will be moved to a PPACA compliant version of their product Jan. 1, 2011, with an appropriate rate.”

Please note this is a temporary change for 90 days while we are reviewing the regulations and determining what changes may be allowed in the future.

Thanks,

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Thorny issues of Health Care Reform

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Welcome to my blog.  I started my blog to help those interested in understanding more about the cost of healthcare. I will be exploring issues that will impact not only the small business owner, but anyone who wants to learn more about the complexities of our current health care system. I will be writing from the patient’s point of view in order to help people make the best choices — for themselves, their families and their businesses.

Dick Durbin was recently on NPR talking about the on-going changes to health coverage.  He states that there are currently 52 million uninsured. He believes that people in the 54 to 64 age range will have a really tough time finding individual health insurance until the pre-existing condition clauses are permanently removed for all.

He also states that insurance will become more expensive until the mandates to purchase it take effect. He believes the exchanges (ability to purchase insurance across state lines) will help solve this problem.

I for one am not in favor of the exchanges because there are 50 separate sets of regulation – one for each state –which govern how much one can be surcharged for specific conditions for health and occupation.  In small groups there can be no rejection.  However, each state has different maximum surcharges.  Illinois has one of the lowest in the Midwest – 67%.  I was recently contacted by an Illinois businessman doing work in Georgia. He talked to a Georgia agent who quoted him a $1,200.00 premium for his group of two young families.  The final offer came back $3,000.00!!  The Georgia agent was using Georgia rules. In Illinois the maximum he would pay would have been $2004.00.”

If you have questions about what I have written, or would like me to address other issues in my blog, please feel free to contact me.”

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