Special Hearing for Dual Enrollies

A little over a week ago the Senate Special Committee on Aging (Chaired by Senator Bob Corker) held a hearing on Medicare and Medicaid coordination of benefits for Dual -Eligible.  The Director of CMS Medicare-Medicaid Coordination Office, Melanie Bella testified that CMS hopes to get up to 2 million beneficiaries to participate in its demonstration program for dual eligibles.  The hope is to reduce costs through better management of benefits. Many Senators on the committee worry about  the Medicare Advantage plans.  They note that those plans are very popular in their home states.  They view this coordination as a possible threat to those plans.  The CMS expressed its desire not to harm those plans at this point. 

At Ansa Insurance Services we work with all major carriers to provide a comprehensive look at health insurance benefits.  As you change and age your needs change.  Income levels and lifestyle changes can create more or less need for health insurance benefits.  We work with you to make these adjustments.  If you would like to find out more about us look us up on our website at www.ansainsuranceservices.com or you can email us at info@ansainsuranceservices.com .

Illegal Immigrants: Issue Not Addressed in PPACA

His came from Yahoo.News...

Hospital leaders told The New York Times they're wary of terms in the health care reform law that will eventually halve the amount of money they receive for caring for uninsured people without addressing the estimated 11 million illegal immigrants in the country, most of them lacking insurance.

Emergency rooms are required to take in all patients, insured or uninsured, under a federal law signed by President Ronald Reagan. The government used a pot of about $20 billion to reimburse hospitals each year for this care. But that pot is going to be cut in half by 2019, under the reasoning that the health care law will dramatically cut the number of people who don't have insurance, thus saving hospitals money. The calculation leaves out one key group of uninsured people: illegal immigrants, who will not be required to buy health insurance or be eligible for Medicaid, or be allowed to purchase insurance on state-run exchanges under the law.

Earlier proposals that addressed illegal immigrants were scrapped during the health care debate after they drew controversy.

In New York City public hospitals, an estimated 40 percent of all uninsured patients treated are undocumented, and other hospital systems have an even larger share. Experts estimate that about 6 million of the nation's uninsured are illegal immigrants.

There is still so much to be worked out with the ACA let's hope our officials (whether appointed or elected) can do more something to help fix this.  If we want to have hospitals in our neighborhood to stay open we need to address this in a reasonable fashion.  If we bury our heads in the sand we will look up someday when it is too late. 

If you would like information on health care or life insurance please contact us at www.ansainsuranceservices.com or call us at (714)680-5900.

One out of Eleven Employers May Drop Health Benefits

Yes this is the second time I have just attached an entire article to our blog, but it is a very simple yet telling article of what is to come in this industry and in your work environment.  Though this article is overly simplistic and optimistic the trend seems to be about right.  What it does not address is the shear amount of compliance administration that will go along with the new law for every employer, regardless of whether they offer insurance benefits or not.  This is where having a knowledgeable broker will be helpful.  If you would like to get more information on insurance benefits, please call us at 714-680-5900 or email us at info@ansainsuranceservices.com .  You can also find us at our website www.ansainsuranceservices.com .

Read On...

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Survey: One in 11 employers plan to drop health coverage

By Parija Kavilanz | CNNMoney.com – 21 hours ago

One in 11 employers is planning to drop health insurance coverage for workers over the next three years because of the high expense, according to a report from consulting firm Deloitte.

While Deloitte's 2012 survey of employers -- conducted before the Supreme Court's ruling in June to uphold health reform -- showed that 9% of them planned to stop offering health care coverage, 81% of companies polled said they would continue providing the benefit as a means to attract and retain employees.

That's good news for more than 160 million people -- more than half the U.S. population -- who currently get health insurance directly through their employers.

[Related: $1 Billion in Health Insurance Rebates: Taxable or Tax-free?]

Another 10% of employers polled in the Deloitte survey indicated that they hadn't yet made up their mind.

Among those employers who indicated that they wouldn't dump health coverage, most plan to make workers pick up more of the cost associated with it through higher premiums, co-pays and deductibles.


The survey also showed that smaller businesses -- those with fewer than 50 employers -- view health insurance exchanges more favorably than bigger companies.

Under health reform, states are mandated to set up health insurance exchanges -- online marketplaces where consumers can buy subsidized health plans -- by 2014.

These exchanges are geared toward making health insurance affordable to underinsured and uninsured individuals.

By 2014, companies with 50 or more full-time employees must start providing health insurance or face penalties.

Related: Demise of the solo doctor

For most small businesses, that means a new way to shop for less-expensive health insurance on the exchanges where they can buy plans for their workers.

Deloitte's online survey, conducted between February and April, polled 560 randomly selected companies with 50 or more workers that offer health.

3 Ingredients for a Successful Business Article

I thought this was an interesting article.  It back's up a lot of what and why we do what we do at Ansa Insurance Services  We just didn't think about it in terms of the 3P's.  To learn more about Ansa Insurance Services check out our website at www.ansainsuranceservices.com .  If you need to contact us you can reach us at (714)680-5900.

3 Ingredients for a Successful Business

By CNBC | CNBC – 6 hours ago

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When my husband Jonas and I started Auntie Anne's in 1988, we never expected or anticipated building an international pretzel franchise. It was the farthest thing from our minds.

In fact, the only dream I ever had was to be a stay-at-home mom and wife. For many years, I had the chance to live out that dream, but the tragic death of our 19-month-old daughter changed all that.
The path our life took led us to some of the darkest times in our lives and nearly caused us to end our marriage. Had that been the end of our story, it would be categorized as a sad saga. But our story didn't end there.
[More From CNBC: 10 Ideas That Made $100 Million]
We continued to push through and eventually found ourselves as the leaders of a fresh, new franchise that was growing beyond our wildest imagination. By the world's standards, we shouldn't have made it.
In the beginning, we had no education, no capital, and no business plan. However, rather than focusing on what we didn't have, we focused on what we did have: purpose, product, people. I've come to call these "The Three P's." I believe that if you have these three P's, they ultimately lead to the fourth "P" - profit.
Purpose
When we started Auntie Anne's, I had a purpose. It was simply to provide for my family and give back to our community. Jonas had a desire to counsel others free of charge, and so we needed an income. Our purpose has always been about giving back. It's the foundation that Auntie Anne's was built on and thrived at during my years at the company.
It's so important for business leaders to discover what their purpose is. In the days when the business seems overwhelming or you aren't certain you can continue, it is your purpose that will compel you to push through.
[More From CNBC: People Who Quit Their Jobs and Made Millions]
Discovering your purpose doesn't have to be complicated. Look at what you do and why you do it. Is it to support your family? That's your purpose. Is it to make a difference in your customer's life? That's your purpose. For us, it was giving. Maybe your purpose is to give back as well.
Product
I think this goes without saying but if we didn't have a "better than the best" product, Auntie Anne's wouldn't have been successful. Our product, the pretzel, was why we had lines all day long. Customers would buy the pretzel, take a bite, and want to know how they can sell these in their own town.
When we started Auntie Anne's, our pretzel recipe was terrible. The product was bad. I was ready to give up. When you have a product you're proud of, it will sell itself. What is your "better than the best" product? I encourage you to take a look at what you offer, whether it's a product or service, and strive to make it the best out there.

People
I didn't build Auntie Anne's alone. That would have been impossible. From the very beginning we had a team around us that was exceptional. Our company was successful because of the dedicated people who worked for us.

As we grew, we knew it was important to surround ourselves with those that had experience and expertise in the areas we lacked. We looked for people who understood our culture, our philosophy, and worked hard. The employees built the company.
[More From CNBC: Surprising Million-Dollar Ideas]
Bringing in the right people is so important to overall health of your organization. Surround yourself with a team of dedicated, purpose driven, employees. Don't settle for mediocrity. There are plenty of willing and able people out there that can help take a business to the next level.
The combination of these three ingredients is what made Auntie Anne's successful and I believe that if you apply the Three P methodology to what you're doing, both in business and your personal life, you will be successful. In business, that means more profit.
Did we always do it right? Absolutely not! However, our passion carried us through. Our product kept us going, and the people we had on board worked hard to be successful.
Watch the full story of Auntie Anne's on "How I Made My Millions" Monday, July 23 at 9 p.m. ET, with a re-air at 12 a.m. ET.
________________________

Summary of Benefits and Coverage Rule (SBC)

Blue Shield just announced how it will be handling the Summary of Benefits and Coverage Rule (SBC) under the Affordable Care Act (ACA).  By September 23, 2012 carriers are to distribute the SBC to all members.  Blue Shield has announced that for group coverage they will be electronically sending the SBC to the policy holder (the owner/administration of the business) and that they will then be responsible to distribute it out to the members/employees. 

As for Individual and Family Plans the SBC will be available online at www.blueshieldca.com .  Members will be able to go online and get it.  If they can not go online, they can call Blue Shield and request it. 

It is reasonable to conclude that the other carriers will be handling this the same way.  By August the carriers will be sending out information to the policy holders on their exact implementation of this rule.  If your carrier is planning something different they will notify you of this.  If you have any questions about this or any other item relating to health insurance or life insurance you may reach us at (714)680-5900 or email us at angela@ansainsuranceservices.com.  You can also look us up at our website at www.ansainsuranceservices.com .

Costs of Care

Anthem Blue Cross just published a fantastic brochure explaining the costs of care and why health care premiums have risen so much over the past few years and what the projected costs will be in coming years.  Here is one statistic that stands out and that we have written about in the past.  By 2019 it is expected that the U.S. will spend $4.4 trillion on health care.  That amount represents 1/5 of the economy and is almost twice as much as what was spent on health care in the year 2007!  The brochure also goes on to detail many other aspects of the rising health care costs and what is being done to curb some of these costs. 

Although this brochure is intended for small businesses we think it would be a helpful  and informative tool for everyone.  If you would like for us to send you a copy of it or email it to you please contact us at (714)680-5900 or you may email us at info@ansainsuranceservices.com .  You can also find us on our website at www.ansainsuranceservices.com .  We believe that it is important that everyone be informed and educated as to what and why health insurance is changing and what it will mean to them personally. 

PPACA New Rules for Women's Preventative Care

The new requirements for women’s preventative services are listed below.

•  Well-woman visits
•  Screening for gestational diabetes
• Testing for human papillomavirus (HPV)
•  Counseling for sexually transmitted infections
• Screening and counseling for human immunodeficiency virus (HIV)
•            FDA-approved contraception methods and contraceptive counseling
• Breastfeeding support, supplies and counseling
•        Screening and counseling for interpersonal and domestic violence  

For some people these benefits are not that different from what they already had.  For others, these benefits are very different.  Remember these benefits are to be provided at “no cost sharing” for the subscriber.  There are some exceptions (we will discuss religious exemptions at a later time) though.  Contraceptive benefits are for prescriptions only.  Over the counter contraceptives are not covered under this ruling.  As for prescriptions, the generic form is covered as well as the brand if no generic is available.  If a generic is available and the patient wants the brand name then they would have to pay a co-pay.

So when do these benefits start?  As with everything attached to the PPACA it depends.  If you are under an old “grandfathered plan” (either individual or group) than these rules and added benefits do not apply to you.  If you have group coverage through an employer it must start the first plan year after August 1, 2012.  If you have an existing individual plan benefits must be expanded no later than January 1, 2013.  For new individual plans the benefits start August 1, 2012.

You should be receiving information from your carrier if you will be getting these extra benefits.  If you have an older plan and would like to see about changing plans to now get these benefits you can check out our website and see if the cost savings would make sense for you.  Our website can be found at www.ansainsuranceservices.com or you can contact Lisa Boyajian or Angela Gambino at 714-680-5900.

Rate Reduction for Some Small Businesses

State Insurance Commissioner, Dave Jones, announced on July 7^th that Anthem Blue Cross, Blue Shield, and Aetna are going to modify their small group rate hikes that went into effect on July 1^st.  The collective savings to small business is estimated to be $48 million on their health insurance premiums.

The actual savings are as follows.  Anthem Blue Cross withdrew a 2.5% rate hike saving $25 million for their 45,000 policy holders.  Blue Shield will reduce their rates by $15 million for some 58,000 policy holders and Aetna will reduce its rates by 1.3% saving $8 million for 9,200 policy holders.

Another Example of Uncertainty with the ACA

Here is another example of the unintended consequences of the ACA.  Businesses are beginning to get checks back from carriers to distribute to their employees.  This sounds great, and in time it will be.  But for now it has caused a huge can of worms.  The checks are rebates from the carriers for not spending (in these cases) 80%  of the money they bring in on health care related items.  When the checks are issued they are issued with a statement that says that the money must be distributed, but does not let the employer know the formula to figure out how much goes to each employee.  Because these are small businesses with less than 50 employees, the amount that each employee contributes is different.  The rates are based, in most cases, on employee age and home zip code.  Then factor in some employees add dependents.  The cost the dependents is based on the employees age and home zip code as well, plus the cost for the dependents is based on 1) employee plus spouse 2) employee plus children 3) employee plus family. 

So when the rebates come in and a company has to figure out how much goes back to each employee it is not as simple as it sounds.  To add insult to injury, the check comes with an email address for the Department of Labor that is no longer active.  This is another case of the cart before the horse.  The carriers were under the gun to get the checks out to their clients or face penalties, but no clear distribution process has been set up. 

Will the employers face penalties if they distribute wrong?  Maybe, like we have written before, much of the practical aspects of this law have yet to be seen.  We at Ansa will continue to work on this until we have a definitive answer for you.  If you or your company are faced with any of these types of issues, please write and let us know.  You can reach us at info@ansainsuranceservices.com or find us on the web at www.ansainsuranceservices.com .  We believe that if we work together we can work through the issues that come up.

Autism Resources

On July 1, 2012 in California the new regulations for carriers to expand coverage for children with Autism went into effect.  The insurance carriers are working hard to get everything in place but they are still behind in the provider area.  If you need services, please contact your carrier.  If they are short of providers in your area and you know of providers, be the go between to get them hooked up. 

If you are not sure if your child has autism or you just found out that they do, be sure to educate yourself on the condition.  It is vitally important to your child that you do.  There are numerous sources on the internet to help you.  Below are just a few of the sources we have used.

www.ninds.gov

www.autism.com

www.autismspeaks.org

www.mayoclinic.com/health/autism/do00348

Don’t let autism remain a mystery.  There are tools out there to help the children.  If you are insured and have questions on your coverage, you should call your provider.  If you need help with this or other questions regarding health insurance please feel free to contact us at 888-800-5855 or check us out on our website at www.ansainsuranceservices.com .  In California all children have guaranteed issue, if your child was previously declined due to autism (or anything else), you can get them insured.  Don’t let this go untreated.

Regulations, Regulations, Regulations!

Regulations, regulations, regulations! The Affordable Care Act set up the provisions for the new health care law.  Now administrators (not elected officials) write the interim rules that will eventually lead to the regulations.  The interim rules are set to give a “heads up” to all involved so they can begin to plan, adopt and coordinate these rules into practice.  The interim rules can be changed if there is enough pressure on those writing the rules.  That is why so much of the actual law is still an unknown. 

Over the next couple of years, while all these laws start as interim rules and then become regulation, business owners need to pay attention and begin implementing these regulations as they arise.  Staying on top of these rules from the onset will make the transition so much easier.  Waiting until the last minute to comply will cause much undue stress.  Owners of businesses will find that they need to spend much more of their time (or hiring someone to do it for them) to keep up on all the new rules.

Reporting, reporting, reporting, this will be the name of the game.  All these new regulations, for practical purposes, mean that everything needs to be reported.  More of every company’s income (time and money) will go to set up and implement the reporting of their data so as to be compliant with the regulations.  Like it or not this is what we all face.  We might as well come to terms with it so we can move on.  Resisting will waste even more of your time, talent and profit. 

If you are worried about the future and what is ahead for you, do not be afraid to contact us.  We are here to help you work through these times.  No one knows the details of what is ahead, but as we find out we will continue to share it with you.  If you would like to talk to either Lisa Boyajian or Angela Gambino you may reach us at (714)680-5900 or check out our website at www.ansainsuranceservices.com .  We work with all major health carriers (Aetna, Anthem, Blue Shield, Health Net, Kaiser, United, and Sea Change) and will continue to stay up to date with them as these regulations come to fruition. 

Funding for California Health Benefits Exchange

Before the Supreme Court had made its ruling on the ACA, California had already sent in its request for more funding from the Federal Government to the tune of $190 million.  According to Peter Lee, the executive director of the California Health Benefits Exchange, the money is slated to be used for the setting up of the enrollment system. The system needs to be up and ready to enroll individuals by October of 2013. 

Within a month or so the carriers should start finding out what the exact requirements for health plans that wish to be sold on the exchange will be.  At that point it will become clearer on just how the exchange will look and feel.  Right now there is only speculation, once the interim rules are set there will be even more clarity.

Continue to check this blog for more changes on the way.  If you wish to get information on a specific topic or you wish to look into your current plan and compare it to other plans, please feel free to call us at (714)680-5900 or find us on the web at www.ansainsuranceservices.com .  We are continuing to educate ourselves so we can guide you through this massive law and all that goes with it. 

Changes to Health Care Over the Next Year

We all know that the Affordable Care Act will move forward so what will it look like? One thing we know is that the ACA predominantly addressed access to care not cost of care. This means that we will continue to see rates rise, at least for the near future. Why? As we talk to our clients and people in general the question is often raised; why are rates continually increasing?

Let us review. In California over the last two years we have seen the following: 1) Children can remain on their parent’s group plan until 26 years of age, regardless of student status. 2) Children, under age 19, have guaranteed issue. 3) Every plan must contain maternity benefits. 4)Women's preventative care covered at 100% - No copay, coinsurance or deductible for contraceptives as well as many other women's related issues. 5) Medical Loss Ratio as well as rebates for plans that don't meet them. 6) Expanded care for Autism. 7) Expanded Mental Health Benefits for all plans. This list does not include all the other internal reasons for the cost increases. Hospitals and Doctors have been mandated to change the way they deliver and report care. It has been a costly couple of years for them as well.

All of the above is what we have seen implemented. Over the next two years and for the following 4 years after that we will see many more policy changes take effect. From guaranteed issue to all to Insurance Exchanges and to fines for not participating these are just some of the things we know are ahead of us. What we don't know is what we don't know. As we write this, they are still writing the details of the law.

So what can be done to tame some of these costs? The mandate to buy insurance will help. The more healthy people paying and not receiving services will help contain some of the costs. We will also see a strong push to coordinate benefits with Medicaid and Medical (also referred to as Medi-Medi). In addition to these, we will see more Accountable Care Organizations (ACO's) taking shape. In theory the ACO's are designed to force doctors and hospitals to form networks that deliver more efficient care.
 
As always, if you have questions as to what all this means to you personally, please call us at (714)680-5900 or find us on our website at www.ansainsuranceservices.com . We will stay on top of any new regulations and clarifications in the health care laws.