Expect Something Different

 
 

Mergers Will Impact Prices

Merger activity among hospitals seems to be increasing in anticipation of the Affordable Health Care Act becoming the law of the land in 2014. Two decades ago, there were on average about four rival hospital systems of roughly equal size in each metropolitan area, according to research done by Martin S. Gaynor of Carnegie Mellon University and Robert J. Town of the University of Pennsylvania. By 2006, the number of competitors was down to three. Consolidation has continued, in 2002 doctors owned about three in four physician practices. By 2008 more than half were owned by hospitals.

If there is one thing that we all know, it is that limited sources of care drive prices up while quality and innovation suffer. A report by Leemore S. Dafny of Northwestern University found that hospitals raise prices by about 40 percent after the merger of nearby rivals.

The rate of increase in health care spending has slowed. Since 2009 health care spending has been growing less than 4 percent per year, the slowest rate in more than half a century, according to information from the Office of the Actuary at the Centers for Medicare and Medicaid Services. But it is still outpacing inflation by a significant margin, despite a sharp slowdown in the use of medical services.

According to the Health Care Cost Institute,  the rising health care spending of Americans under 65 in the last two years has been driven entirely by rising prices; not by more use. From 2009 though 2011 the fee for an outpatient visit to the emergency room rose 17 percent. The price of a routine office visit to a primary care doctor rose 8 percent. The price of radiology services rose 12 percent.

There are provisions of the health care law such as accountable care organizations that lend themselves to limiting competition. “Hospitals want to maintain their revenue streams and enhance their bargaining leverage,” said Professor Gaynor. “This is a way to do so.”


Contact Heather Matias Ainesworth for group quotes and other information relating to health care reform.

 

 


Prudential Introduces New Rider

Effective July 1, 2013- A repriced PruLife Universal Protector is being enhanced with the BenefitAccess Rider, which provides Chronic and Terminal Illness Benefits!

Prudential announced two key developments in their individual life insurance portfolio:

First, the introduction of the BenefitAccess Rider (BenefitAccess), an optional accelerated death benefit rider which offers chronic and terminal illness benefits, will be added to PruLife Universal (UL Protector) effective July 1, 2013.

Second, based on our practice of continually reviewing our portfolio for consumer needs, profitability, and competitiveness, UL Protector will be repriced, as of the same date.


The combination of UL Protector with BenefitAccess provides your clients with a product that can help them address their life insurance, chronic illness, and terminal illness protection needs-with one policy.


Based upon state approvals, the following changes will take place.

BenefitAccess:

This optional rider is now available in approved states.

Provides your clients with Chronic and Terminal Illness Benefits.

Is now available on the repriced UL Protector.

Is not available on prior versions of UL Protector.

 Is not currently available on other products
 

On the repriced UL Protector:


Full-pay scenario premium will increase approximately 2%.

Single-pay scenario premium will increase approximately 5%.

Guaranteed minimum effective annual crediting rate is being reduced from 2% to 1%.

Type B Variable Death Benefit will no longer be available.

Premium limitation in each of the first 3 years will be the greater of 7 times the Commissionable Target Premium or $250,000

Starting on the introduction date within a state, a 28-day transition period will follow for that state.

Please click here for the Transition Rules.
 

Contact Steve Gresso at 713.977.0611 for quotes and or information.

 

 

 

Are Your Clients Concerned About The Coming Impact Of The ACA?


The OptiMed Essential Bronze “Plus” Program may be the cost effective solution you have been looking for.

Features:

• Bronze Major Medical Plan, Voluntary GAP and Limited Medical Plan
• Flexible to “Low” Participation Guidelines for the Bronze Major Medical Plan
• No Individual Health Questions Asked
• Major Medical Plan ACA Certified by an Independent Actuary
• 5% First Year and Renewal Commissions

The OptiMed Essential Bronze “Plus” program may provide a cost savings when complying with the rules and requirements governing the Affordable Care Act. The OptiMed Essential Bronze Plus program may offer the option and opportunity to the employer to satisfy ACA guidelines with an overall cost of 20-30% of the tax penalties inherent with non-compliance. The OptiMed Essential Bronze “Plus” benefit program is designed for the company;

1. With a relatively small group of core employees that currently enjoy a comprehensive major medical program and have a much larger group who may have limited or no coverage.

2. That is a virgin group with a medium to large sized population that currently has no coverage in place.

Starting 1/1/2014, under the rules of the ACA, 95% of the employees working 30 hours or more hours per week must now be offered comprehensive major medical coverage meeting the government guidelines which provide for a threshold of no less than the Bronze level of benefits. There are steep “non-deductible” tax penalties for failure to comply with these new rules and regulations.

For those employees participating in the OptiMed Essential Bronze “Plus” program, a standalone voluntary GAP program is available to help offset out of pocket expenses should the core employees with comprehensive major medical desire an enhanced level of coverage. In addition to the ACA Bronze Major Medical program, the OptiMed Essential Bronze “Plus” program offers a standalone 100% employer paid non-compliant limited medical benefit plan for those employees who decline to participate in the major medical program.

Please note: Each Essential Bronze Benefit Plus plan includes an evaluation, conducted by an independent actuary, confirming that the client’s Essential Bronze Major Medical Program meets the actuarial requirements as set forth by the Affordable Care Act.


OptiMed GAP Program

OptiMed GAP covers eligible expenses in relation to deductible and coinsurance for the underlying major medical plan. OptiMed GAP is designed to help save direct health insurance premium costs by allowing employers greater freedom in selecting lower cost high deductible plans or plans with higher out of pocket coinsurance maximums.

Simply put, by plugging in OptiMed GAP, employers may be able to raise deductibles and out of pocket maximums to obtain lower cost coverage, while still providing a quality benefit program.

OptiMed GAP may be written with PPO, POS, HMO and HDHP comprehensive major medical plans.

HSA Compatible GAP: In addition, OptiMed has a separate HSA compatible GAP Program, please ask your group representative for more information and state availability on this product.

Features:

• 15% First Year and Renewal Commission
• Guaranteed issue
• No pre-existing condition limitations
• No health questions asked
• First dollar benefit
• Composite rating for groups of 25 or more
• May be offered on a voluntary basis
• May be written down to 5 lives in most states
• Available in California for small groups of 5 or more
• Electronic enrollment options available

What is the Employer Group Target Market?

Groups that:

1. Have a comprehensive major medical plan currently in place or looking to implement such a program.
2. Have received a large and difficult renewal.
3. Can no longer afford escalating costs of their current health program.
4. Are looking to save, but still offer a quality benefit program for their employees.

OptiMed GAP may be offered on a Voluntary Basis.

Please ask Heather Matias for additional information, including exclusions, limitations and state availability. This program is different and separate from our HSA compatible GAP program. Please note that under current IRS rules OptiMed Traditional GAP is not compatible with a Qualified Health Savings Account.




 

 
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Our proprietary web based one page application that is the same for all carriers.

You can quote and submit our one page application in less than 15 minutes.

It is the easiest system available for writing  life insurance and best of all, you retain control of your case, have 24/7 status updates available and there is no reduction in commissions.

 

 
 

Navigator Pay

As most of you are aware, in addition to brokers and agents selling though the insurance exchanges (if approved by your state), there will be a new group called Navigators that will assist individuals and groups when they chose a plan through the exchange.

Here are a couple of states that have announced the payments that will be made to their navigators:

California will pay Navigators $58 per successful enrollment. Assuming a California Navigator successfully enrolls 4 applications per day or 940 applications annually, California estimated that a full-time Navigator with supervision, overhead, and labor expenses will cost $54,500 annually, or $26.20 per hour. The actual rate of pay for a Navigators and Enrollment Assisters will depend on the entity that employs the Navigator or Enrollment Assister and the awarded block grants.

Arkansas estimates it would pay In Person Assisters (IPA) $12.00 per hour, excluding taxes, benefits or other employment costs. Nevada’s contract with Kelly Services uses an administrative fee of 35%. If this same formula was used in Arkansas, the estimated cost of Arkansas’s IPAs would actually be $16.20 per hour.

 

Contact Heather Matias Ainesworth for group quotes and other information relating to health care reform.

 

   
  The Ex Spouse Gets The Money

WASHINGTON (AP) - The Supreme Court says a Virginia law can't override a federal employee's decision to make his ex-wife, not his wife, his beneficiary in a federal insurance program.

Warren Hillman made Judy Maretta beneficiary of his Federal Employees' Group Life Insurance policy before their divorce and his re-marriage to Jacqueline Hillman. He never changed his beneficiary designation, and Maretta got the money after his death.

The second wife sued, but the Virginia Supreme Court said the first wife gets the money since her name was on the form.

Virginia law revokes a beneficiary designation in favor of the current spouse. But Maretta argued it was pre-empted by federal law saying named beneficiaries get the money.

The high court agreed in a unanimous judgment.


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