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by Leila Morris
IN CALIFORNIA
• Many to Transition in and Out of Covered California
• Guardian Acquires Premier Access Dental Plan
HEALTH CARE
• Bill Would Redefine FTEs
• Service Helps Doctors With Cash Business
• Transitioning Specially Meds to the Pharmacy Benefit
• Weekly Health Reform Update
• Employers’ Biggest Health Benefit Challenges
EMPLOYEE BENEFITS
• Disability Plans Can Reduce Worker’s Comp Claims
• Reducing Work-Related Stress is a Popular Wellness Goal
• Certification in HealthCare Consumerism (CHC)
EVENTS
• Private Exchange Webinar
• Online Access to LTC Conference
NEW PRODUCTS
• Voluntary Retiree Life Insurance
MOVERS & SHAKERS
• Colonial Life Names Senior Vice President
• Humana Announces New Broker Liaisons
IN CALIFORNIA
Many to Transition In and Out of Covered California
Recent media reports about have focused on the crush of people trying to sign up for Covered California, but analysts at UC Berkeley say not to overlook the many people who will join or leave the program after that deadline. “For many people, Covered California is a place where they will access coverage for a short time during a life transition, such as job-loss or divorce. People will enter and leave coverage on a regular basis,” said Ken Jacobs, who co-authored the report. Forty-three percent to 47% of those who are enrolled in a Covered California plan and are receiving federal tax subsidies to finance their coverage will leave that plan within 12 months. Twenty-one percent of those will move to Medi-Cal due to changing income and 19% will move to job-based coverage.
Sixteen percent of non-elderly people who signed up for Medi-Cal are expected to become eligible for plans offered through Covered California within 12 months, due to their crossing over the Medi-Cal income eligibility threshold. An additional 9.1% of this group will move into job-based coverage.
Some will enter the Covered California marketplace outside the open enrollment period when they experience a life transition that triggers a special enrollment period. These transitions include losing job-based coverage, gaining or becoming a dependent through marriage, having a new child through birth or adoption, becoming a citizen or lawfully present immigrant, and moving into a new service area.
Making sure that people transition successfully will depend partly on how much Medi-Cal and Covered California get the word out to eligible populations through the unemployment office, the DMV, and the food stamp program. “For health insurance reform to be successful in reducing the numbers of uninsured, Medi-Cal and Covered California will need to be prepared for not just long-term enrollees, but also for enrollees who…are enrolled for less than a year,” the authors conclude. For more information, visit https://newscenter.berkeley.edu.
Guardian Acquires Premier Access Dental Plan
Guardian will acquire Premier Access Insurance Company, which provides dental coverage and care to employers. Premier Access has more than 634,000 members. As part of Guardian, Premier Access customers will gain access to Guardian’s nationwide dental network. Premier’s exchange and government-funded program businesses will expand nationally. The company was founded in 1989 and is based in Sacramento, Calif. The acquisition strengthens Guardian’s dental PPO and DHMO network in several states including California, Utah, Nevada and Arizona. Guardian’s is also expanding through the state-run Medicaid and Children’s Health Insurance Program (CHIP) markets, which are expected to grow significantly due to expanded eligibility under the Affordable Care Act (ACA). Guardian will also gain a presence on six individual state exchanges, complementing its existing offering on 48 of the small business health (SHOP) exchanges. For more information, visit www.GuardianLife.com.
HEALTHCARE
Bill Would Redefine FTEs
The National Association of Health Underwriters (NAHU) applauds Congress for passing legislation that would define full-time employees from 30 hours to 40 hours (or 174 hours a month for full-time equivalents under the Affordable Care Act’s (ACA) employer shared responsibility provisions. Janet Trautwein, CEO of NAHU, made the following statement in support of the Save American Workers Act (H.R. 2575):
This bill encourages businesses to continue offering health insurance to employees who are truly full time. Thirty hours of service per week does not reflect most employers’ full-time workforce needs nor employees’ desire for flexible hours. Changing the definition of a full-time employee from 30 hours to the traditional 40 hours will help discourage business owners from reducing employee hours and provides the greatest flexibility for employers with variable workforce needs. Under the current law, employers with 50 or more full-time equivalent employees must provide all employees who work an average of 30 hours or more a week with health coverage or face a financial penalty. Health and Human Services (HHS) regulations have also applied the 30-hours as the full-time definition to the SHOP exchange. Both small and large businesses are finding it difficult to comply with this change to the traditional definition of a full-time employee. H.R. 2575 will not only help employers run their businesses, but it ultimately encourages the economic growth this country so desperately needs. NAHU recognizes the House’s efforts to make health insurance more affordable, especially for those not eligible for the federal individual tax credit, and we look forward to the Senate’s companion bill, the Forty Hours Is Full Time Act (S. 1188), that will fully resolve this critical issue.
Service Helps Doctors Create A Cash Business
The new DrforCash.com web site allows physicians who have become frustrated with surging insurance costs and dwindling payouts to shift to a cash-based business.DrforCash.com has been designed for physicians who want to change their business model in the face of healthcare reform. Many of those in good health may choose a high deductible insurance plan that keeps them from being penalized while allowing them the freedom to operate on a cash basis with their doctor. It offers customizable profile listings including a breakdown of cash prices for procedures. For more information, visit http://www.drforcash.com.
Transitioning Specially Meds to the Pharmacy Benefit
Transitioning specialty medications from the medical benefit to the pharmacy benefit can save payers an average of 19% across 14 classes of self- or provider-administered injectable specialty drugs, according to a CVS Caremark survey. They drugs are used to treat conditions, such as multiple sclerosis and autoimmune disorders. Moving coverage to the pharmacy benefit allows payers to implement formulary design, utilization management, and preferred or exclusive networks. Fifty-three percent of specialty medication spending occurs under the medical benefit. Specialty patients are more likely to have multiple diagnoses, see more specialists, and fill more prescriptions. They are also likely have more lab tests, ER visits, and hospitalizations. All of these factors result in health care costs that are as much as 8.5% higher than costs for non-specialty patients. For more information, visit http://info.cvscaremark.com/insights2014/Singh06-Medical-Specialty-Utilization-and-Management-Opportunities.pdf
Weekly Health Reform Update
The following is a statement by Mark Hobraczk on behalf of Patient Services:
In the Health Reform Update for the past week, the health insurance Marketplaces created by the Affordable Care Act (ACA) surpass the initial goal of seven million signing-up for private plans during the inaugural open enrollment period. Another 12 million have gained Medicaid or CHIP coverage since October 1st. The final Marketplace tally will rise further once in-process applications are included after April 15th and outstanding state-based Marketplaces (SBMs) figures are counted. California leads all Marketplaces with more than 1.22 million enrolled. Five SBMs continue to struggle with limited online functionality but only Hawaii will seek additional federal funding. President Obama signs the latest temporary delay in Medicare physician payment cuts while House Republicans push their renewed budget plan to privatize Medicare, block grant Medicaid, and repeal the entire ACA. For more information, visit http://www.patientservicesinc.org.
Employers’ Biggest Health Benefit Challenges
Texas employers say their biggest challenges in 2014 are getting employees to make better health care decisions, evaluating health exchanges, and dealing with the lack of health care price transparency, according to a recent survey of 73 large- and mid-size Texas employers by the Texas Business Group on Health. More than half of employers want to reward measurable health improvements rather than participation in wellness activities. About 42% want to improve employee engagement in their health and well-being. Also, 42% say there is a lack of health care price transparency. Forty percent face challenges in evaluating the impact and opportunities afforded by private exchanges. About 38% face challenges in educating employees to become well-informed health care consumers. For more information, visit
http://www.dfwbgh.org/documents/2014_Benefits_Challenges_Survey
EMPLOYEE BENEFITS
Disability Plans Can Reduce Worker’s Comp Claims
Forty-two percent of companies that offer voluntary accident and disability insurance saw reduced workers’ compensation claims, according to an Aflac survey. Fifty-five percent of large companies that provide accident insurance had fewer workers’ comp claims as did 34% of small- and medium companies. The survey reveals the following:
• 14% of employers reported declines of 50% or more while 17% reported declines of 25% to 49%.
• 12% of large businesses reported reductions of 50% or more while 29% reported declines of 25% to 49%.
• 13% of medium businesses reported reductions of 50% or more while 14% reported declines of 25% to 49%.
• 15% of small businesses reported reductions of 50% or more while 9% reported declines of 25% to 49%.
Forty-seven percent of large employers reported decreases in workers’ compensation claims after providing voluntary disability insurance, as did 43% of small companies and 33% of medium companies. Respondents were also asked to gauge the significance of the declines:
• 15% of employers reported declines of 50% or more while 15% reported declines of 25% to 49%.
• 11% of large employers reported declines of 50% or more while 20% reported declines of 25% to 49%.
• 18% of medium employers reported declines of 50% or more while 7% reported declines of 25% to 49%.
• 18% of small employers reported declines of 50% or more while 17% reported declines of 25% to 49%.
For more information, visit aflac.com.
Reducing Work-Related Stress is a Popular Wellness Goal
Helping employees cope with work-related stress is the most popular option for employers to create a healthier, better-performing workplace, according to a survey of attendees at the 2014 IBI Annual Forum. Attendees said that the following actions are most effective in creating a healthier and more productive workplace:
• 67% Help workers cope with work-related stress.
• 64% Get senior leadership to support the wellness plan.
• 52% Make sure that workloads don’t undermine employees’ health and well-being.
• 47% Help workers manage demands on their time.
• 43% Better track lost work time.
• 40% Provide healthier food and beverage choices.
• 40% Make sure that the workload does not undermine employees’ ability to take advantage of wellness programs.
• 21% Monitor employees’ workloads more closely.
For more information, visit www.ibiweb.org.
Certification in HealthCare Consumerism (CHC)
All preparations for becoming Certified in HealthCare Consumerism (CHC) will take place at the 5th Annual 2014 IHC FORUM & Expo conference on May 7 to 9 in Atlanta. For more information, visit http://www.theihccforum.com/2014-ihc-forum-and-expo/register.
EVENTS
Private Exchange Webinar
Sun Life Financial is holding a private exchange webinar on Wednesday, April 16 from 10:00 a.m. to 1:00 p.m. Authors of best-selling books, Freakonomics and Super Freakonomics, will deliver the keynote address and apply their Freakonomics theories to the health benefit system. “The Sun Life Wake Up Summit is doing something no one has done before by allowing private exchanges to debate the merits of their respective models and to discuss the future of how employee benefits are delivered,” said Dan Fishbein, President of Sun Life Financial U.S. Moderated by Fox News’ Juan Williams, Summit will feature two panel discussions. The first, which will focus on the different private exchange models, will have panelists debating the pros and cons of each program. The second will feature healthcare experts discussing the growth of private exchanges and how they could potentially change the benefits landscape. For more information, visit www.sunlife.com/us.
Online Access to LTC Conference
The American Association for Long-Term Care Insurance will be streaming selected sessions live from the 2014 Long Term Care Solutions Sales Summit in Kansas City next month. The CEO panel takes place Monday, May 19 at 9:00 a.m. For more information, visit http://www.insuranceexpos.com/signup.
NEW PRODUCTS
Voluntary Retiree Life Insurance
MetLife is now offering voluntary retiree life insurance. This new group term life insurance provides retiree-paid life insurance for when employees are entering retirement and throughout their retirement years. The initial amounts for plan coverage options include up to $25,000 as guaranteed issue and up to $75,000 or $150,000 in coverage, both of which require medical evidence. It includes face-to-face will preparation and face-to-face estate resolution services provided by Hyatt Legal Plans and the Total Control Account. MetLife will also provide full plan administration. For more information, visit https://www.metlife.com/business/benefit-products/group-benefits/voluntary-life-insurance/index.html.
MOVERS & SHAKERS
Colonial Life Names Senior Vice President
Rich Williams has been named senior vice president, Growth Markets, at Colonial Life. He will lead the company’s brokerage, direct, large account, and public sector marketing programs and services. Williams joined Colonial Life as an actuarial assistant in 1999 leading product development and pricing. He also has held positions in the finance, operations, national accounts and broker marketing areas. He previously served as chief operating officer and chief financial officer of Strategic Resource Company, an Aetna subsidiary, and managed a retirement consulting actuarial practice for Mercer.
Humana Announces New Broker Liaisons
Humana has promoted Steve Macias as the Northern California Market vice president for Humana’s Employer Group segment. Macias will lead the Northern California sales team and will focus exclusively on partnering with agents and employers delivering ongoing support, data-driven insights and coordinated service. Macias has been with Humana for five years and most recently served as the Northern California Market President. Macias holds a bachelor’s degree from Grand Canyon University and a Masters of Business Administration in health care management from the University of Phoenix. Macias will be based in Humana’s Walnut Creek office.
The company also appointed Brian Sullivan as the Southern California Market vice president for Humana’s Employer Group segment. Sullivan will lead the Southern California sales team and will focus exclusively on partnering with agents and employers delivering ongoing support, data-driven insights and coordinated service. Sullivan is a senior sales executive with more than 30 years of experience. He most recently served as the President, Employee Benefits with Martin J. Wolff & Company, Inc. Sullivan holds a bachelor’s degree in Political Science from Bridgewater State University located in Bridgewater, Mass. He will be based in Humana’s Woodland Hills office.