Stephenson Welsh Insurance Services

Over the weekend, the House passed extensive health care reform that if enacted would radically reshape the American health care system. The final vote was 220-215, with a single Republican supporting the bill’s passage.

That brings us the halfway point of the legislative process. Well, maybe one-third since the final House and Senate bills would have to first be cobbled together before heading to President Obama’s desk.

The House bill does include a public health insurance option that would compete with private insurers as well as equally controversial employer coverage mandates for businesses with payrolls in excess of $500,000. The Senate bills introduced so far do not include employer mandates, and it’s unclear if a bill with such provisions could ever pass the Senate.

The diverse opinions on the public option, employer mandates, abortion funding and the trillion dollar price tag set up a legislative showdown in the Senate, with less than five weeks to pass their version in order to meet an unofficial goal of completing the entire process before the end of the year.

For our clients (and Americans in general), each day’s news brings myriad new questions. What we can do as brokers is continue to remain dialed in to the events on Capital Hill so we can be poised for change and proactive in our approach leading up to any final legislation.

Whether we’re talking about the current system, an insurance marketplace exchange or a public alternative to private carriers, it’s clear there’s going to be plenty for individuals, employees and employers to navigate. Our job is to know what’s available inside and out, help clients sort through choices and ultimately select the best possible coverage based on their status and situation.

The need for that type of help is perhaps the only thing in the world of health insurance that’s not about to change.

Brian Stephenson Health Care Reform broker's role, Health Care Reform, House bill, latest developments, public option

To say the legislative process has been “messy” would be an understatement. But despite all the heated rhetoric, we still seem to be moving closer to some form of health care reform day by day.

One of the main questions at this point is whether any degree of bipartisan consensus is possible, or if the Democratic majority will attempt to push a bill (or bills) through to passage on their own … either through a filibuster-proof 60-vote senate majority or the complicated “budget reconciliation” course of last resort, which theoretically would only require 50 senators for passage. Many people are uneasy about this approach.

Of course the other dominant question is whether the bill ultimately heading to President Obama’s desk will include a “public option” to compete against the offerings of private insurance companies. According to the latest reports out of Washington, the life of the public option is largely now a numbers game. This is the most volatile element of the legislative process at the moment, so we’ll keep an eye on the latest. We could know significantly more as early as Friday.

Meanwhile, the latest figures show health care advertisements on television have topped $100 million, illustrating how high the perceived stakes are for many parties and industries that would be affected by reform.

There are still many, many moving parts and how all the pieces of the puzzle fit together is not yet clear. Right now we are waiting on the Senate Finance Committee to complete its work so senate leaders get begin cobbling all the different versions of bills together into a package to take to the senate floor. The floor debate could last weeks (or longer) depending on how things go.

At this point as insurance brokers, we see our job as staying up to date on everything that could affect our current clients and having a firm grasp of what the re-formed health insurance landscape will look like (so we can properly advise new and renewing clients). One thing seems clear: No matter what health care looks like, there will be a need for expert help navigating all the choices and plans and key details—and matching people and groups with the programs that best suit their specific needs. That’s what we’re here for.

Brian Stephenson Health Care Reform, Health care plans broker's role, Health Care Reform, latest developments, public option

Health care reform is moving at a lightning pace, so we thought we’d provide another update on all the latest developments. We reached a major milestone, as two House committees approved reform legislation. That’s never happened before, and an overhaul of our health care system has never been so close.

… or so far away. As Reuters reports, there’s a long way to go and many hurdles to overcome. The biggest recent “pitfall” has been a report out of the non-partisan overseer Congressional Budget Office, which declared that the most recent iteration of the Democratic health care proposal wouldn’t actually curb escalating health care costs. Then, there was the news that Massachusetts was backpedalling from universal health coverage. (Mass. was often cited as evidence that health care reform can succeed.)

President Obama came forward Friday to address any growing concerns and voice vociferous support for speedy reform. And while the path to comprehensive reform is daunting and the best direction for Americans still unclear (especially small business employers), it would seem unwise to bet against the president getting this done before 2010.

While there are significant differences between the national and Massachusetts model, what the Bay State’s woes illustrate is that perhaps it’s not in our country’s best interests to rush through reform intended to meet or beat a self-imposed deadline. Maybe if Massachusetts is taking major steps backward, it’s an indication that they moved too quickly in the first place and some important elements slipped through the cracks. Now, some feel if national reform doesn’t pass this year, it never will. But whether or not that’s true (there’s no way for us to really know), it shouldn’t have to be that way.

Really, we’ve waited this long, so it would be wonderful if we could fully deliberate all the reform possibilities and be as sure as possible that we’re doing this right. Someone said to me recently that what’s happening right now with this accelerated timeline feels like Congress is “trying to force a watermelon through a garden hose.” It’s true that these are really big changes, so there’s a whole lot to thoughtfully consider and not a lot of time to do it in.

It’s still extremely early in the process, and there’s still plenty of reason for optimism. Hopefully, moving forward in the wake of the CBO report and the news out of Massachusetts, the emphasis will be on taking the time to do reform right, rather than getting reform done by a particular date.

Just know that if you’re a current Stephenson-Welsh client, we’ll keep following all the news out of Washington and blogging about anything that has a direct impact on your insurance.

Brian Stephenson Health Care Reform, Health care plans broker's role, Health Care Reform, latest developments, Obama Administration, universal health coverage

There has been a great deal of recent confusion about the COBRA subsidy in the American Recovery and Reinvestment Act (ARRA). The uncertainty has stemmed from a lack of “ownership” on the local level as to who was going to notify all the small group assistance-eligible individuals (AEIs) of their new COBRA rights.

AEIs are employees involuntary terminated between Sept. 1, 2008 and Dec. 31, 2009 who also meet other qualifying criteria.

Pending legislation addresses this issue head-on, but some important details remain open-ended. This bill (AB 23) dictates that it’s the insurers who should notify all qualified beneficiaries eligible for premium assistance under Cal-COBRA (sending out these “second-chance” letters).

The insurance carriers will comply. But instead of sending specific, detailed letters only to assistance-eligible individuals, most insurers plan to send notifications to all terminated employees in the relevant timeframe (Sept. 1, 2008-March 31, 2009). Those former employees will have to read the form letter and determine for themselves if they’re eligible for the subsidy, as defined by the ARRA. That means small group employers may well be getting some phone calls from confused former employees who don’t know where they stand.

Additionally, some carriers are requesting small group employers to identify their own AEIs and send that information along to the carrier. If AB 23 passes in its current form, we know it’s the insurer who will be ultimately sending out these notification letters. But it’s clear that any small group with 2-20 employees should be proactively identifying all their AEIs. Your carrier may ask you for information … and so could AEIs themselves.

At Stephenson Welsh Insurance Services, we’re helping our small groups identify their AEIs. Your broker should be doing that, too. We’re also finding that some employers are receiving requests for information from carriers but aren’t sure exactly what to do or what specific information to send back. Your broker should be touching base with you so you’re aware of what’s happening and, if necessary, educate you so you’re comfortable complying with any requests made.

One final note on this topic: If you are an individual reading this who was involuntarily terminated from your job between Sept. 1, 2008 and now, we encourage you to contact your former employer directly if you’re unclear about your “second-chance” COBRA eligibility or COBRA rights. Regardless of this momentary confusion, many will benefit from this new ARRA subsidy and should be taking advantage of it.

Brian Stephenson ARRA, COBRA AB 23, broker's role, Cal-COBRA, COBRA subsidy, notification

If you’re terminated from your job or otherwise lose your employment, you automatically become eligible for COBRA coverage. But it’s not given to you. You have to elect it, and then you’re responsible for its hefty premiums. You also have a deadline for electing coverage and cannot miss a payment without running the risk of plan termination. COBRA also only lasts a set amount of time, so it’s important individuals are looking down the road to their post-COBRA coverage decisions.

Most people also don’t realize that if their former company goes out of business, COBRA coverage will die with it. If there’s no plan, there’s no COBRA. That also means if all the employees under a plan leave or are laid off, that plan—and its associated COBRA benefits—can be terminated.

And then what do you do?

Well, you’ve got to go find your own insurance. And people scramble—especially those with preexisting conditions. They’re all wondering, “How do I secure health insurance for my family?

The reality is people who are considered “uninsurable” by carriers don’t have many options. They either need to find a new job with group coverage or start their own business. (A business owner with at least two employees can secure a guaranteed-issue group plan). Unfortunately, a lot of people are otherwise uninsurable in a market that has only gotten more difficult. Carrier underwriters are extremely picky right now in terms of whom they’ll insure for individual/family coverage.

The most important thing for people in any of these scenarios to know is there are affordable options out there. People just aren’t aware how to find them … or if they’re eligible … or where to look. They should be getting help from their broker to do so—and to discuss all the options and strategies available to someone in their specific situation.

People should also be sure to use their broker for regular reviews of their individual plan to make sure it’s still the best option (with realistic premium levels) for current circumstances. When individual/family plan premiums skyrocket, a lot of times that person is eligible for a free transfer to a more affordable plan under the same carrier. Importantly, that switch can be made without having to again go through the underwriting process. Carriers just aren’t always quick to volunteer that information.

These are all issues and questions that a broker can answer in minutes, as opposed to the hours or days that it may take someone to call customer service lines and do research on their own. There are ways to secure coverage or lower premiums, but people need the help of a good broker to know how.

Brian Stephenson COBRA, Health care plans affordable alternatives, broker's role, COBRA, small business groups, underwriting process

Right now thousands of people are losing their jobs because of the rough economic conditions, and one thing that comes with that is the loss of health insurance.

With so many people out of work, a big question out there is: How do I secure affordable health care?

Quality health care plans are out there, but it’s an extremely difficult process to navigate on your own. The truth is it’s not easy to secure insurance right now in the individual/family (non-employee) market. You almost have to be in perfect health because of underwriting.

Any application has to be underwritten, which means carriers have the right of refusal. It’s up to the carrier do decide if it wants to take on the “risk” of insuring you. If you have any preexisting conditions, the chances are very slim a major carrier will take you on.

The bright side is if you are healthy (as an individual or a family), there are a lot of great, affordable plans out there, including a lot of the same plans you enjoyed under employee group coverage.

As a broker, I find a lot of people paying around $1,500 a month for family coverage who aren’t aware of vastly more affordable alternatives. This is often because they don’t have a broker for their non-employee coverage. They went direct—went online and picked a plan on their own. Now, they’re paying $1,500/month, for example, for coverage they rarely use when they could be on a high-deductible plan and paying around $500/month. They could be saving $1,000 every month in some cases and still have an excellent health care plan.

There are some really affordable plans out there right now. We recently put a healthy 18-year-old female in a plan that was only $70 a month. It’s a nice plan with great preventative care features. It has a high deductible, but she’s not going to pay a lot of money up front.

But unfortunately, there are so many people out there with the same healthy profile and circumstances who are paying far more (or have no insurance at all) because they’re unaware of their options and really need some help.

The issue is that often people simply aren’t aware that they can have a broker representing them for individual/family coverage without it costing them a penny. The carrier pays the broker in full, so there’s no disincentive whatsoever to having the expertise of a broker guiding you through the process of securing individual/family insurance. And even if someone has an existing plan, they can still assign a broker (just like with an employee group) to that plan without having to switch to something else.

It costs you nothing to work with an insurance broker. It doesn’t impact your rates in any way, so you should absolutely have and leverage a broker as your partner in your health care decisions.

This process can be so difficult to figure out on your own—especially now. There are so many plans out there and so many decisions to make. If you didn’t know where to look as an individual, you could search for days trying to understand what all the plans mean and what’s the best fit for you.

Some plan names and terminology can be misleading; you could think you’re going to be covered only to find out that what you bought on your own wasn’t what you thought it was. And terribly, most people find that out when in the hospital or submitting a big claim—when they have much more important things to focus on.

A broker can help you navigate your way through the approval process, find the right plan for you and your family and understand the benefits of that plan. Families can save money every month with the right plan, and in this economy the savings go a long way.

It’s just all about understanding what’s out there and what it takes to get covered when insurance isn’t guaranteed-issue. It’s not the friendliest market out there right now for individual/family coverage, but with a little help you can still end up in a great insurance situation.

Brian Stephenson Health care plans affordable alternatives, broker's role, economic conditions, individual/family coverage, underwriting process

The most frequently talked-about reason for switching to a high-deductible health care plan is the premium savings. But there is also another element to these high-deductible plans that’s highly desirable: rich, useful and comprehensive preventive care benefits.

These services are covered at 100 percent and plan deductibles and HSA dollars don’t apply. So long as you go to an in-network provider and stay within the allowed frequency (some services are annual, etc.), these exceptional benefits are totally free.

Well-baby and well-child preventive care includes vision, hearing and lead exposure screenings as well as a host of free immunizations.

Adult preventive care includes vision, hearing and routine blood and urine screenings. But it also includes “less obvious” free services such as cholesterol and lipid level screenings, blood glucose tests for detecting diabetes, prostate cancer screenings, HIV tests, bone density scans and colonoscopies. There are also breast exams, mammography screenings, pelvic exams, pap tests and contraceptive management for females.

Just always be sure to check in with your doctor first so that you get the coverage to which you’re entitled. Call ahead, give the office your insurance information and ask if the services that interest you are covered in full at that time.

When you schedule a routine office visit, that’s a great opportunity to request additional preventive care services covered under your plan. Just always confirm that those benefits fall under your free preventive care.

Preventive Care Services: What’s In It for Them?

So, why are all of the major carriers offering all these no-charge preventive services with their high-deductible plans? Because they’re counting on these services keeping people healthier and detecting health issues before they become costly catastrophic problems down the road. A healthier America for them translates into fewer insurance claims. A healthier America for you means less time ultimately receiving medical care and a better-conditioned body to live the life you want.

These preventive care services are recommended by everyone from the American Cancer Society to the U.S. Preventive Services Task Force, but people aren’t utilizing these benefits nearly as much as you’d think.

On one hand, that’s because people aren’t used to services of this breadth and scope being truly 100 percent covered. They expect copays and deductibles and other charges to apply, so they stay away unless it’s absolutely medically necessary.

On the other hand, many people simply aren’t aware they’re entitled to these free preventive services with a high-deductible plan or aren’t clear enough about their benefits to feel confident using them.

We picked up a new client the other day that had super-rich preventive benefits as part of their existing plan, but they had no idea so much was covered for free because their last broker didn’t do any reviews with them. They had fantastic insurance but nobody in the group knew how to utilize it or when they could use it.

That’s why the role of the insurance broker is such a critical part of the process. A good broker is a good partner—reviewing or reminding clients about plan benefits and informing employees exactly how to best utilize their plan.

The goal is that hopefully you’re healthy and you don’t need to use you plan services very often, but when something comes up, you need to know what benefits you’re entitled to. It’s the broker’s role to keep people up to speed on how to best take advantage of their insurance.

Whether it’s on a quarterly, semi-annual or annual basis, our role as brokers is to continuously review with groups what benefits they have. That can be a quick highlight summary or a lunch-and-learn refresher meeting. Reeducating groups on little things such as plan usage plays a big role and goes a long way … and you’d be surprised how many people don’t realize or completely forgot what rich benefits are included and free with their insurance plan.

The more the broker can stay in front of people, the easier it is for those individuals to ask questions and find a comfort level. That’s our job as brokers: to be as available and proactive as is necessary to make sure people understand their benefits. And quite frankly, that’s a lost art in this business.

Remember that with employee benefits, the key word is “benefit.” Don’t hesitate to take advantage of what’s included in your plan.

Brian Stephenson Health care plans broker's role, effective communicaton, high-deductible health plans, HSA-compatible plans, Preventive care