Archive for category Insurance News

Federal Reform News from Council for Affordable Health Insurnace

Federal News
Supreme Court 2012 Review of Reform Law Likely
The recent ruling by the 11th Circuit Court of Appeals makes it almost certain the Supreme Court will decide the federal health care reform law’s constitutionality in its 2012 term. To date, two circuit courts have produced contradictory rulings on the law’s individual mandate. The Obama administration, by virtue of being the loser in the latest ruling, will file the appeal to the Supreme Court, which rarely turns down requests from the federal government.

9th Circuit Rejects Reform Suit
In another case against the federal health care reform law, the 9th Circuit Court of Appeals threw out a suit filed by a former California state lawmaker and the Pacific Justice Institute. The court upheld the decision by a lower court that neither party had a legal standing to challenge the law.
Read more at: http://bit.ly/odeg08

Congress Takes a Break; Supercommittee Formed
Congress has taken its annual August recess after completing a last-minute deal to increase the nation’s debt limit. The House and Senate will not return until after Labor Day. Shortly after leaving town, House and Senate leaders appointed their representatives to the new “supercommittee” that was created as part of the debt limit deal. The supercommittee is charged with creating a proposal to eliminate $1.5 trillion in government spending over the next ten years. Their first meeting is September 16, with results due by Thanksgiving. Members include Representatives Dave Camp (R-MI), Fred Upton (R-MI), Jeb Hensarling (R-TX), James Clyburn (D-SC), Chris Van Hollen (D-MD), and Xavier Becerra (D-CA) and Senators Patty Murray (D-WA), Max Baucus (D-MT), John Kerry (D-MA), John Kyl (R-AZ), Rob Portman (R-OH), and Pat Toomey (R-PA)

Administration Releases Regulations on Exchanges & Subsidies
The Obama administration has published three new proposed regulations to (1) establish processes for enrolling individuals and families in plans offered by state-based exchanges; (2) lay out how an estimated 20 million Americans will get tax credits to help them pay the premiums charged by insurers through the exchanges; and (3) establish a “seamless” enrollment process in which people benefit from “one-stop shopping” in exchanges to easily enroll in Medicaid or the Children’s Health Insurance Program if they don’t qualify for the tax credits. Comments on the proposed regulations are due by October 31. The regulations can be found in the Federal Register at:
Exchange enrollment processes: http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20776.pdf

Premium tax credits: http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20728.pdf

Medicaid/CHIP eligibility changes: http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20756.pdf

HHS May Not Be Able to Fund Federal Exchanges
The U.S. Department of Health and Human Services (HHS) is facing a funding dilemma with respect to establishing a federal health insurance exchange. Although the federal health care reform law gives HHS the authority to create a federal exchange for states that don’t develop their own, it does not provide funding. In comparison, the law provides robust financial resources to help states build their own exchanges. One expert says HHS will have to “get creative about the [federal exchange] financing,” by asking contractors to delay getting paid until the exchange begins collecting fees.
http://www.politico.com/news/stories/0811/61513.html

NAIC Warns Feds about Exchange Loophole
A part of the federal health care reform law requires each state-based health insurance exchange to offer at least two plans which will be available in every exchange nationwide. In a letter to the U.S. Office of Personnel Management (OPM), NAIC President and Iowa Commissioner of Insurance Susan Voss has expressed concern the Multi-State Plan program will create an uneven playing field for insurers by favoring large national insurers who would offer these plans. “Insurance Commissioners and the NAIC have serious concerns about the potential for market disruption and adverse selection, and the resulting negative impact on consumers and health insurance markets which would arise if Multi-State Plans are allowed to operate under different rules than their competitors.” Voss wrote.
Read more at: here

Feds Issue Proposed Rule on Benefits, Coverage Disclosures
The IRS, the Department of Labor (DOL), and HHS have released proposed rules on insurance-related forms required by the federal health care reform law. The “summary of benefits and coverage” and a uniform glossary for group and individual health insurance were released almost five months late due to infighting between HHS and DOL over the extent to which large employer plans will be expected to comply with the provision. Both rules were published in the Aug. 22 Federal Register with comments due 60 days after publication.
The proposed rules can be found at: http://www.ofr.gov/OFRUpload/OFRData/2011-21193_PI.pdf

Issa Questions Why HHS Is Ending Waivers for Mini-Med Plans
House Oversight and Government Reform Chairman Darrell Issa (R-CA) is questioning HHS’s decision to end the waiver process for health plans to comply with certain requirements of the federal health care reform law. Issa said in a letter to HHS Secretary Kathleen Sebelius that he wants HHS to explain why they are shutting down the waiver program and provide the committee will all the documents and communications related to the decision to stop it.
Read more at: here

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Hows your VISION? What kind of ROI can you have with Great Vision

STAYING CONNECTED
Why buy Vision? 127% ROI with VSP Vision Care
Lower your healthcare and human capital costs by offering a VSP vision plan every time. How does a VSP plan provide a 127% ROI? Read the white paper and learn more at our complimentary webinar on Thursday, March 31.

THE VSP EFFECT
Watch this short video to learn how The VSP Effect can lead to healthier employees and 127% ROI.

WELLNESS WATCH
Seeing in 3D: Its Impact on your Eyes
Are 3D movies and video games bad for your eyes? Find out more on The Center.

Small Employer Health Tax Credit


“Small employers” who qualify for this 2010 income tax credit (including churches and section 501(C) (3) charitable organizations) must satisfy ALL of the following conditions:

One component of  the huge  healthcare legislation is a tax credit for small employers who pay at least 50% of their employees’ health insurance premiums. Unlike most of the future healthcare bill provisions, this employer federal tax credit can be claimed for year 2010 tax returns due this Spring.

Calculations for this new tax credit are very complex (even by tax law standards!) and are reported on new IRS Form 8941 – a one page tax form which requires completion of 7 different worksheets to accurately calculate the tax credit. You can review IRS Form 8941 with instructions at www.irs.gov.  IRS information and resources

Initially, the IRS outlined rules for the tax credit in Notice 2010-44. A follow-up document, Notice 2010-82, explained transition relief related to the rules for a qualifying arrangement and provided more details about the requirements. For example, Notice 2010-82 clarifies how an employer that offers more than one plan determines whether its contribution amount meets the threshold for a qualifying arrangement. The IRS has released several additional items related to the tax credit, including:

Three Simple Steps Fact Sheet |  Frequently Asked Questions |  YouTube Video |  More information is available on the IRS website

“Small employers” who qualify for this 2010 income tax credit (including churches and section 501(C) (3) charitable organizations) must satisfy ALL of the following conditions:

1)      You paid at least 50% of the “single employee” premium cost for year 2010. Insurance costs are for primary health insurance and dental and vision insurance. Employer contributions to HSAs, HRAs and FSA medical accounts are not deemed insurance and thus are not eligible for the tax credit; AND

2)      You employed fewer than 25 “full-time equivalent” (FTE) employees during 2010. In determining FTE employees, 30 employees who worked 20 hours per week count as 15 FTE employees. Employees who you exclude from this FTE “count” include:

  • Owners of the employer and their relatives (parents, children, in-laws, aunts/uncles, etc);
  • “Seasonal” employees who worked 120 or fewer days for you during 2010; AND

3)   Your “average annual wages” paid to employees during 2010 were less than $50,000 per FTE employee. For this purpose “wages” are gross wages paid before any tax or retirement withholdings.

IF YOU MEET ALL 3 OF THESE CONDITIONS, YOU LIKELY QUALIFY FOR THE TAX CREDIT.

How Much is the Tax Credit?

Small employers who pay at least 50% of their employees’ health insurance, have 10 or fewer full-time equivalent employees, with average annual wages of $25,000 or less per “FTE” employee, will receive a tax credit of 35% (25% for churches and 501(C) (3) charitable organizations) of the employer-paid health insurance premiums in 2010. This can be a large tax credit! HOWEVER, as the FTE employee count trends from 10 employees to 25, and the “average wages” per FTE employee trends from $25,000 to $50,000, the tax credit percentage decreases from the 35%/25% ”starting” tax credit rates.

CAN I “EYEBALL” IT?

Catalist has posted a “Short-Cut Small Employer Insurance Credit Percentage” worksheet as a downloadable form, CLICK HERE .  Note that the worksheet is divided unto 2 sections, For-Profit Business and Nonprofit Entity. A for-profit business with 14 “FTE” employees and with average 2010 wages per FTE employee of $35,000 would be eligible to claim a federal tax credit of 12% of the employer-paid health insurance premiums paid during 2010. If the employer paid $30,000 of health insurance premiums for their employees in 2010, their 2010 tax credit would be $3,600.

CLAIMING THE TAX CREDIT

So you have met all three of the eligibility requirements and have “eyeballed” our worksheet and estimated you can claim a tax credit of several thousand dollars. Now what?

You begin the process of completing IRS Form 8941, which for-profit employers will attach to their 2010 business income tax return, and churches and other 501 (C) (3) charities/ministries will complete and attach to non-profit IRS Form 990-T.

Since the Form 8941 calculations are confusing and lack substantial guidance from the IRS, we recommend that you be “pragmatic” and make your best effort to complete an accurate Form 8941 and claim the tax credit based on your calculations. “Close is good enough” in horseshoes and with Form 8941 calculations! If your calculations are later found to be slightly incorrect by the IRS, and you have made a “reasonable effort” to accurately prepare Form 8941, then you will be fine.

The small business tax credit is designed to encourage small businesses to offer health care coverage for the first time or to help them maintain the coverage they already have. To help make health care reform work for our customers, One of our Carriers has partnered with H&R Block® to develop the tax credit calculator tool that is available on Anthem’s health care reform website for employers and brokers. Neither this document nor the tax credit calculator is intended to give tax advice. Customers should consult with their tax adviser due to the complexity of the calculation required to determine the amount of credit.

The calculations require that you capture 2010 payroll information for employee hours paid during 2010, and gross wages paid for 2010. Legal updates and tax considerations intended to inform clients and colleagues of Catalist about current payroll issues and planning techniques.  You should consult with your CPA or tax advisor before implementing any ideas, comments or planning techniques.  For a recommendations, Catalist recommends first consulting with Strategic Partner Profitable Accounting Services.

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Insurance Solutions for Breast Cancer Survivors

Catalist Financial has partnered with one of our Top Carriers to let the community know about some very important Insurance S0lutions for Breast Cancer Survivors.  Finding protection for your family should be the least of your challenges.

For more than 45 years, we’ve been providing protection for breast cancer survivors — and those who love them Massachusetts Mutual Life Insurance Company (MassMutual) has been proudly providing insurance coverage for breast cancer survivors since 1964. Today, thanks to the continuous evaluation of our underwriting guidelines, we believe more survivors than ever are qualifying for coverage with shorter waiting periods and lower premiums.

We work to ensure that the benefits of the most up-to-date diagnostic and treatment advancements are considered. As you take the next step in your journey, you can be assured that MassMutual will help you explore your various coverage options.
To learn more, contact a MassMutual financial professional at 317-441-4321

MassMutual’s insurance coverage can help provide the following “living benefits” for you and your family:
• Whole life insurance products (as long as the policy is in force) offer a guaranteed, cash value accumulation, which is tax-deferred and can be borrowed for any purpose. With supplemental retirement income, educational funding and a source of funds for emergencies, these products can offer comfort for you during your lifetime.1

• Term life insurance products offer death benefit coverage for a specified time frame and can provide policy owners with the ability to convert the policy during the conversion period to a permanent MassMutual policy, regardless of changes in the insured’s health.

• Disability income insurance benefits can help pay your mortgage or rent, medical bills and other expenses, if you are too sick and cannot work. A lengthy, chronic healthcare issue can affect so many parts of your life: from placing caregiving burdens on your family and potential asset depletion, to fulfilling your desire to live independently. A MassMutual professional will work with you and those closest to you to develop a strategy to address these concerns.

Protecting your family over the long term
Usual Medical Underwriting Requirements:
• Abbreviated medical examination (breast and gynecologic exams not required)
• Blood and urine studies
• Records from your physicians, to include:
• Pathology and surgery reports
• Records of any other treatment
• Follow-up visits and mammograms

For those currently in good health with no evidence of recurrent cancer, MassMutual uses the following general guidelines:

The above is a summary of MassMutual’s general underwriting guidelines. Because each person’s medical situation is unique, actual offers may vary depending on the specific factors involved.

Facing breast cancer is enough of a challenge without having to worry about how your family will be protected if something happens to you. At this time, there are about 2.5 million breast cancer survivors in the United States. Thanks to early detection and improved treatment options, that number is rising every day and more women are surviving breast cancer than ever before.*

You deserve a team of professionals who understand the challenges you face, and can provide options to help you make good decisions for yourself and for your family.

Take care of yourself, and protect those who love you, too.

Insurance products issued by Massachusetts Mutual Life Insurance Company, Springfield, MA 01111-0001.  Some products and riders may not be available for sale in all states, and may have exclusions and limitations. For costs and complete details of coverage call your agent or MassMutual at 317-441-4321 for your local agent.

© 2009 Massachusetts Mutual Life Insurance Company, Springfield, MA.
All rights reserved. www.massmutual.com. MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company (MassMutual) and its affiliated companies and sales representatives.

* Source: American Cancer Society, Detailed guide: Breast Cancer www.cancer.org, updated May 2009

1 Distributions under a policy (including cash dividends, withdrawals and partial/full surrenders) are not subject to taxation up to the amount paid into the policy (the cost basis). If the policy is a Modified Endowment Contract, policy loans and/or distributions are taxable to the extent of gain and are subject to a 10% tax penalty.

Access to cash values through borrowing, withdrawals or partial surrenders can reduce the policy’s cash value and death benefit, increase the chance the policy will lapse, and may result in a tax liability if the policy terminates before the death of the insured.
WMI1292 909
CRN201109-124568

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Health care reform provision at-a-glance Long-Term Care

Under the Patient Protection and Affordable Care Act (or health care reform law), the secretary of Health and Human Services will establish a voluntary long-term care (LTC) insurance program called Community Living Assistance Services and Supports (CLASS) by January 1, 2011. The program will offer the CLASS Independence Benefit Plan, but the new law does not specify a date for enrollment. This is a government program.

What the provision does

The long-term care provision of health care reform law is designed to help individuals and families pay for long-term care. Fewer than 10% of older Americans currently have private LTC coverage. The CLASS program attempts to address gaps in coverage by offering a long-term care insurance plan. However, it offers limited benefits.

Who can enroll

Employers will need to decide if they will offer the CLASS program to employees. If an employer chooses to participate, employees age 18 and older must be automatically enrolled in the program, regardless of their pre-existing conditions. Employees can choose to “opt-out” if they don’t want to participate. CLASS is also available to individuals who are self-employed, have more than one employer or have an employer who chooses not to participate.

How the premiums will be determined

Premiums will be established by the U.S. Department of Health and Human Services secretary and will be based on age and not health risk. Based on the information available, we believe premium subsidies will be available for workers with incomes below the federal poverty level and full-time students age 18 to 21 who work.

How to qualify for benefits

After paying premiums for five years, enrollees will be eligible to receive benefits.CLASS will be administered by the U.S. Department of Health and Human Services

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This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

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September is National Life Insurance Awareness Month

Life Insurance Awareness Month

People buy life insurance for the death benefit to help replace income and cover daily expenses. Life insurance can also help protect your financial future with a death benefit you can use for:

  • Mortgage payments
  • College tuition
  • Child care
  • Everyday expenses

With many life insurance products available, you can tailor your policy for a living benefit in case of an unexpected illness, or to supplement retirement income with a cash value accumulation product. (note: cash value accumulation Life Insurance products only work for a small portion of the population as part of an overall strategic financial plan, contact your CATALIST ADVISOR to see which Life Insurance products are best for you)

Nearly four in five families in the U.S. are protected … ARE YOU

Individual Life Insurance can serve many different purposes, depending on what your needs are.  Life Insurance is really “Death Insurance” and the most common type of Life insurance is TERM INSURANCE.  This is typically purchased to cover debts and fund other planned items for the insureds family in the event of an un-timely death. To figure out how much TERM life insurance you need CLICK HERE

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Once you have determined your need, you should talk to a Licensed Insurance Broker who is able to Shop MULTIPLE CARRIERS and get you the best price monthly premium for your desired death benefit. You may run a few quotes by CLICKING HERE on your own, however to ensure the most competitive rates, let our brokers scour the market for you, just look at all the companies we can research for you:

OUR BROKERS WILL SCOUR & CHECK ALL OF THE FOLLOWING CARRIERS FOR THE BEST PRICING & HELP YOU DETERMINE THE RIGHT NEED:

WRL Western Reserve Life Insurance Company an Aegon CompanyWest Coast Life Insurance Company A Protective CompanyUnited Home Life Insurance CompanyTransamerica Life Insurance Aegon CompnayThe Chesapeake LIfe Insurance CompanySymetra Life Insurance Financial CompnaySun Life Financial Insurance Company of Canada USIllinois Mutual Life & Disability Insurance CompanyGuardian Life Insurance CompanyGTL Guarantee Life Insurance CompanyGreat American Financial Resources Insurance CompanyGenworth Financial Insurance Company
Stonebridge Life Insurance Company an Aegon companyShenLife Shenandoah Life Insurance CompanyPrincipal Financial Group Insurance CompanyOMFN OM Old Mutual Financial Network F&G Fidelity & Guarantee Life Insurance CompanyNorth American Company for Life and Health InsuranceMutual of Omaha United World Life & Health Insurance CompanyMetropolitain Met Life Insurance CompanyMassMutual Financial Group Mass Mutual Insurance CompanyLSW Life of Southwest National Life Group Insurance Annuity CompanyLincoln Financial Group Insurance CompanyJohn Hancock Life Insurance CompanyING USA Life Insurance CompanyForethought Life Insurance & Annuity CompanyForesters Life Insurance CompanyEMC National Life Insurance CompanyEquitrust Financial Life Insurance & Annuity CompanyColorado Bankers Life Insurance CompanyColonial Life Insurance Benefits CompanyBanner Life Insurance CompanyAVIVA USA Life & Annuity Insurance CompanyAssurity Life Insurance CompanyAmerus Life Insurance CompanyAmerican Equity Investment Life Insurance CompanyAllianz Life & Annuity Insurance CompanyAegon Life Insurance CompanyAIG American Insurance Group American General Insurance Company

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If You Like Your Health Care Plan, You Can Start Beating Your Head Against the Wall Now

Obama Promises Made Promises Broken

Obama Promises Made Promises Broken

If you like your health care plan, tough luck – if you’re on a Medicare prescription drug plan:
More than 3 million seniors may have to switch their Medicare prescription plan next year, even if they’re perfectly happy with it, thanks to an attempt by the government to simplify their lives.

The policy change could turn into a hassle for seniors who hadn’t intended to switch plans during Medicare’s open enrollment season this fall.

And it risks undercutting President Barack Obama’s promise that people who like their health care plans can keep them….”As a result of this policy, there are going to be fewer plans offered in 2011,” said Bonnie Washington, a senior analyst with Avalere Health, which produced the study.

If you like your health care plan, better luck next time – if you’re a college student:

Along comes word that the bill “could make it impossible for colleges and universities to continue to offer student health plans.” That’s how the American Council on Education and a dozen other higher-ed lobbies put it in a recent letter to the Obama Administration, warning that the insurance coverage they offer may get junked by ObamaCare’s decrees.

Between 4.5 million to 5.5 million students annually are insured by short-term plans sponsored by their schools, which are tailored to upperclassman who have aged out of their parents’ coverage or to international and graduate students. These plans are very low cost because the benefits are designed for generally healthy young people and often organized around campus health services and academic medical centers.

All of which means these plans aren’t likely to qualify under ObamaCare’s “minimal essential coverage” rules that mandate rich benefit packages, even if colleges have the flexibility to make exceptions for special needs. And given that insurance must now be sold anytime to everyone, colleges may be required to continue to cover students after they’ve graduated-leaving this type of coverage unaffordable.

If you like your health care plan, cross your fingers and hope you’ll like your new one better – if your employer sponsored plan doesn’t meet the law’s strict grandfathering requirements:

While many U.S. companies initially hoped they could preserve much of their existing group health plans under the new grandfather provision, a new survey by Hewitt Associates, a global human resources consulting and outsourcing company, shows that almost all now believe they will not. Ninety percent of companies said they anticipate losing grandfathered status by 2014, with the majority expecting to do so in the next two years.

Under the “grandfather” provision of the U.S. Patient Protection and Affordable Care Act, companies can maintain many of their current health care coverage provisions and are required to make fewer changes to plan documents and administrative procedures in order to comply with the new law. Companies can lose their grandfather status if they take certain steps such as reducing benefits, significantly raising co-payment charges, significantly raising deductibles or changing insurance carriers.

According to Hewitt’s survey of 466 companies–representing 6.9 million employees–most companies expect to lose grandfather status because of health plan design changes (72 percent) and/or changes to company subsidy levels (39 percent).

None of this is exactly surprising—at least if you’ve been paying attention. Any health system overhaul as sweeping as the PPACA was bound to upset existing coverage arrangements, especially given the dominance of insurance in American health care. But given how disastrous the possibility of forced plan changes proved to HillaryCare in the 90s, the law’s supporters couldn’t admit that. So President Obama and congressional leadership and the progressive activist class had to promise, repeatedly, that no one would have to change plans if they didn’t want to.

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Please watch this… some insight on what is going on in Healthcare.

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Preventative Care Provision: Interim Rules Health Reform Update

Preventative Care Update
Interim final rules contain details about the preventive care provision

As you may know, the health care reform law includes a provision requiring health insurers to cover preventive services with no member cost sharing. Recently-published interim final regulations clarify this provision. Non-grandfathered plans issued or renewed on or after September 23, 2010, will not include member cost sharing or copays for the following preventive care provided in-network:

- Evidence-based items or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force.

- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.

- For infants, children and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.

- For women, to the extent not otherwise addressed by the United States Preventive Services Task Force recommendations, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.

Other key points:

- This impacts non-grandfathered plans issued or renewed on or after September 23, 2010.

- This applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.

- Most of the recommended screenings, immunizations and exam services are already on our preventive services list. We are adding the new, required preventive services to this existing list.

- An example of a new preventive service is counseling related to aspirin use, tobacco cessation, obesity and alcohol use.

- Some services currently covered as medical/maternity will now be considered preventive services. This includes several recommended screenings for pregnant women.

As with the other provisions in the health care reform law, we’re committed to implementing this provision in a manner that helps members have access to quality health care services. If you have any questions, talk with your sales representative.

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The Best Life & Health Policy Ever

Best Policy EverIf you would like to know more about how to get this policy, please CONTACT US:

POLICY PDF

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Grandfathering Allowed: Final Regulations Update

GRANDFATHERING

Grandfathering allowed for most standard and non-standard plans

As we recently communicated with you, the federal government has issued Interim Final Regulations for the grandfathering provision. Because there are advantages to grandfathering, we will grandfather most standard and non-standard plans in our portfolio. To help you better understand what this means to you, we’ve put together this Grandfathering Fact Sheet. It explains:

£ More about grandfathering

£ What changes can be made without losing grandfathered status

£ What changes will result in losing the grandfathered status

This is an important provision for many individuals and group policyholders. You can expect more information about grandfathering, including how we will implement it. As always, please talk with your consultant if you have any questions.

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Grandfathering Fact Sheet

Under the recently enacted federal health care reform legislation, health plans can be grandfathered. Interim Final Regulations have been published to provide further clarification on grandfathering. These rules are designed, according to the Obama administration, to allow grandfathered plans to “innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status.” In general, grandfather status will be lost if there are significant reductions to benefits or increases in out-of-pocket spending for consumers, such as deductibles or co-pays.

We believe there are benefits to grandfathering for our groups and individual members who wish to maintain their existing health benefit coverage. For this reason, we will grandfather most group and individual plans. In a continued effort to simplify our plan offerings, we are reviewing our current options by state to determine which ones we will offer as grandfathered plans. More information explaining how we will implement grandfathering for our individual and group customers will be provided in the near future.

Additionally, in limited situations, the legislation allows clients that made benefit changes after March 23, 2010, that would not meet the grandfathering rules to regain grandfathered status at the next renewal in 2011. We are working to determine how to help plans possibly regain grandfathered status.

What is grandfathering?

Grandfathering allows groups and individual members that keep their existing plan from March 23, 2010, to January 1, 2014, to be exempt from the new product and rating framework that is effective in 2014. To maintain grandfathered status, a client must continue to keep the plan and the plan’s benefits essentially the same. Grandfathering also exempts plans from some of the requirements of the plan-related provisions effective September 23, 2010.

The following changes can be made without impacting grandfathered status:

 Changes in premiums of a policy or plan
 Changes required to comply with federal or state law
 Changes to increase benefits, or voluntarily comply with provisions of the Patient Protection and Affordable Care Act
 Changes to plan structure, for example, switching from a health reimbursement arrangement to major medical coverage, or from insured to self-funded coverage
 Changes to a provider network
 Changes to a prescription drug formulary
 Changes to accommodate mergers and acquisitions (as long as the merger or acquisition is not done solely to allow a group to move from one grandfathered plan to another when the plan change would reduce benefits or increase cost sharing in excess of that allowed by the regulations)

 Changes to an ASO plan’s third-party administrator

The following changes would cause a loss of grandfathered status:
 Eliminate all (or substantially all) benefits to diagnose or treat a particular condition.
 Increase coinsurance (or another percentage cost-sharing requirement) above the level at which it was set on March 23, 2010. In other words, any increase in an insurer or plan’s coinsurance will result in a loss of grandfathered status.
 Increase fixed-amount cost-sharing requirements other than copayments, such as a deductible or an out-of-pocket limit, by a total percentage (measured from March 23, 2010) that is more than the sum of medical inflation plus 15%.
 Increase copayments above the level in effect on March 23, 2010, by an amount that exceeds the greater of (a) the sum of medical inflation plus 15%, or (B) $5 increased by medical inflation.
 Reduce employer contributions (calculated by cost or formula, such as hours worked) toward any tier of group health insurance coverage or a group health plan by more than 5% below the contribution rate on March 23, 2010.
 Impose an annual limit on the dollar value of benefits if an annual or lifetime limit had not been previously imposed on all benefits or, for plans that previously imposed a lifetime limit of all benefits, impose an overall annual dollar limit that is lower than the lifetime limit, or, for plans that
previously imposed an annual limit on all benefits, decreases the dollar value of the annual limit.
 Issuer or plan sponsor does not disclose to participants and beneficiaries that the plan or coverage is a grandfathered health plan.
 Change from one insurer to another

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New government website lets consumers compare insurance plans

The U.S. Department of Health and Human Services (HHS) has just launchedHealthCare.gov, a website designed to help individuals and small businesses compare both private and public health insurance plans. Through HealthCare.gov, consumers can find information on literally thousands of private and public health care products.

Important note about how some products appear on the site

Please note that the products are listed under the legal entities – not their brand names, which may cause confusion. Companies currently working with HHS to correct this matter, and they hope to have their familiar brand names appear on the website soon. Until then, please be aware of how our products are listed on the website, state by state:

£ California: Blue Cross of California, Anthem Blue Cross Life & Health Insurance Company

£ Colorado: Rocky Mountain Hospital and Medical Service, Inc.

£ Connecticut: Anthem Health Plans, Inc.

£ Georgia: Blue Cross and Blue Shield of Georgia, Inc., Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

£ Indiana: Anthem Insurance Companies, Inc.

£ Kentucky: Anthem Health Plans of Kentucky, Inc.

£ Maine: Anthem Health Plans of Maine, Inc.

£ Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC),

£ Nevada: Rocky Mountain Hospital and Medical Service, Inc.

£ New Hampshire:  Anthem Health Plans of New Hampshire, Inc.

£ New York: Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc.,

£ Ohio: Community Insurance Company

£ Virginia: Anthem Health Plans of Virginia, Inc.

£ Wisconsin: Blue Cross Blue Shield of Wisconsin, Compcare Health Services Insurance Corporation

In October, HealthCare.gov will also start including rate estimates for private insurance plans. Insurance companies are working with the government to determine how small group information will appear in states with no community ratings.

HealthCare.gov can be a valuable tool for you, which is why Insurance Companies are working hard to have their recognizable names appear on it soon. We’ll keep you posted as more information becomes available to us. If you have any comments or questions, please talk with your sales representative.

Getting to the bottom of health care costs

Did you know: Only three cents of every premium dollar is profit?

On average, 87 cents of every premium dollar you pay is spent covering medical care and services that members receive like doctor visits, hospital costs, prescription drugs and more according to a PriceWaterhouseCoopers medical cost trend report for 2009. Another 10 cents funds services we provide like claims processing, enrollment and billing and provider credentialing. That leaves 3 cents of every premium dollar for profits. Kaiser Health news has reported that the combined annual profits of the top 10 health insurers are equal to just two days work of national health care expenditures or just 0.5% of the estimated $2.5 trillion the nation spent on health care in 2009.

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