Writing for CBS MoneyWatch.com (8/24), Carla Fried says, "Well, there's one area where deflation will definitely not be at play in 2011: health insurance. A survey of large businesses reports that employers expect their healthcare insurance costs to rise by an average of 8.9 percent in 2011. And to help cover those rising health insurance costs, more than six out of 10 employers also expect to raise their employees' share of the premium cost." Fried adds that it is "likely many Americans are going to see any bump in their compensation eaten up by having to pay more for health insurance." Fried notes, "According to the National Business Group on Health survey...out-pocket maximums and bigger in-network deductibles are the next two 'most popular' options employers will enlist to share the pain of rising insurance coverage."

The Richmond (VA) Times-Dispatch (8/24, Smith) reports, "Health-care reform will change the insurance landscape for consumers, but it also will change it for insurance brokers and agents who earn a living helping people choose plans." The new healthcare "law requires states to set up health insurance exchanges that consumers can go to and shop for a health plan. It also requires that exchanges provide 'navigators' that do outreach and help people understand options," but the "role of these navigators and how brokers and agents will be paid have created uncertainty for agents."

Vision benefits can have a positive impact on employee’s health and workplace productivity

August 13, 2010

Vision benefits can have a positive impact on employee’s health and workplace productivity

Keeping employees healthy means fewer sick days and higher productivity. For example, uncorrected vision problems cost businesses an estimated $8 billion in lost productivity each year according to The Vision Council.

Annual eye examinations not only help promote vision health, but doctors can catch major health issues too. Many diseases - diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis, and rheumatoid arthritis - can be diagnosed by looking into the eyes.

Your clients can offer a Humana vision plan on an employer-sponsored, administrative-services only, or voluntary basis. Voluntary simply means the benefits are 100 percent employee paid and there is no cost to their benefits budget.

Here are a few advantages to choosing a Humana vision plan:

• Members have access to large, national networks
• Discounts on LASIK and PRK procedures
• Benefits encourage prevention, early diagnosis, and treatment
• Genuine, friendly service and prompt answers to questions

Dueling voters

Last week, 71 percent of Missouri voters approved Proposition C – a controversial ballot measure to prohibit the state from requiring people to have health insurance. The vote was mostly considered symbolic, since federal law usually trumps state law. But it was thought to be important for other reasons. First, it is being interpreted as evidence of general discontent with Washington, Democratic leaders and health reform. And, second, those who oppose the health reform law were much more energized to get out and vote than those who favor it (only 23 percent of registered voters voted).

Republican National Committee chairman Michael Steele said, "Missouri sent a clear message to Democrats and the Obama administration that government-run health care is a gross overreach of the federal government that needs to be repealed and replaced."

Senate Majority Leader Harry Reid responded, "It's very obvious that people have a lack of understanding of our health care reform bill. The more people learn about this bill, the more they like it... The trend is turning in America today. Once you explain what's in the bill, the American people, of course, like it."

Actually, even the polls don't agree on the subject of health reform. A Kaiser Family Foundation poll found that 50 percent of the people now favor the reform bill, while only 35 percent oppose it. A Pew Research Center poll shows the opposite: that 35 percent approve and 47 percent disapprove.

Several polls have found that senior citizens have little understanding of the law. To build support and understanding, the Centers for Medicare and Medicaid Services released a TV ad featuring actor Andy Griffith touting some of the benefits. "This year, like always, we'll have our guaranteed benefits," he promises. "And with the new health care law, more good things are coming: free check ups, lower prescription costs, and better ways to protect us and Medicare from fraud... I think you're going to like it."

Senate Minority Leader Mitch McConnell's reaction to the ad was, "It's going to take more than slick taxpayer-funded ads to convince skeptical seniors that cutting a half-trillion dollars from Medicare is good for them." The White House blog defended the ad and the initial $700,000 buy of TV time, saying, "Seniors were the target of a major misinformation campaign."

For 10/1/10 and later effective dates, Aetna will discontinue new business sales of our child-only policies to applicants (under the age of 19) for our Aetna Advantage Plans for Individuals, Families and the Self Employed. No existing policyholder is affected by this action.

Effective immediately, any applications received requesting a child-only policy with a 10/1/10 effective date (or later) will be closed.  Underwriting will notify applicants by mail of their ineligibility, but also provide options for coverage – see below.

Why are we making this change?
This change positions Aetna for the future so we can effectively handle upcoming changes resulting from healthcare reform. New federal rules require guaranteed issue (GI) of coverage for individuals under the age of 19 and no corresponding coverage requirement. These conditions have the potential to significantly increase the cost of premiums and make coverage unaffordable.

No impact to existing child-only policies
Existing policyholders will not be impacted by this action and they may continue their current coverage. These policies are renewable

States affected
Discontinuation of child-only coverage for the following states AK, AR, AZ, CA, CO, DC, DE, FL, GA, IL, IN, KS, KY, LA, MI, MO, MS, NC, NE, NV, PA, SC, TN, TX, VA, WV, and WY will occur on 10/1/10. The implementation date for the following states CT, MD, OH, and OK is still being established. We will notify you once dates are confirmed for these states.

Other health insurance options available for individuals under age 19

• Be added as a dependent to a parent's plan.
• If the above option is not a viable solution, applicants can check www.healthcare.gov for alternatives

Aetna continues to explore options with states where we are ceasing the sales of new child-only policies, including reviewing other regulatory changes that may allow us to re-enter this market and provide a valuable product between now and 2014.

The field underwriting guide for all states will be updated in Producer World by Friday, August 20^th.

Several Provisions In Healthcare Law To Take Effect In September.

Your Humana online billing experience just got a lot better with the creation of eBilling.

With eBilling you’ll have many of the capabilities you’re currently using along with some exciting new features, which includes payment and online termination options.

There was good news last week for those who are concerned that the medical loss ratio provision (MLR) of the new federal health care reform law could seriously harm quality improvement programs and member counseling programs. The law requires health insurers to spend at least 80 percent of premium revenue on medical claims in the individual and small group markets and 85 percent in the large group markets. But exactly what qualifies as medical costs is still an open question. Representatives of the National Association of Insurance Commissioners, which is developing a recommendation for the federal government on what should be counted, indicated last week that they are inclined to allow some quality-improvement programs to be considered medical costs. This comes as good news for employers and consumers. Aetna has actively argued that narrow MLR definitions could lead to the elimination or reduction of valuable care review programs, increase health care costs overall and employer premiums, and threaten the solvency of some insurers or force them to leave certain markets.

Changes to open enrollment processes for Small Business

Humana is implementing changes* to its eligibility and enrollment processes. These changes are intended to align the open enrollment time frames between our commercial small group products, wherever possible and applicable. In doing so, the overall enrollment experience is made easier for our customers.

In addition, this process will be incorporated into the benefit plan document provisions for our Preferred Provider Organization products (which is similar to our National Point of Service and Health Maintenance Organization products).

*Enrollment process changes excludes the following states: CA, CO, IL, KS, MO, TN, NV, VA & UT

Overview:

Open enrollment is a period of time occurring annually, during which employees will be given the opportunity to enroll themselves and their eligible dependents for coverage under the employer group policy.

The below illustrates how Humana will align its small business commercial products. Small business is defined as companies with up to 99 employees:

• Medical products: All Humana medical products, which will now include PPO products, will be subject to this open enrollment process. The open enrollment period will be thirty-one (31) days before and after the employer group's renewal date.
• Dental** & Vision products: The open enrollment period will now be thirty-one (31) days before and after the employer group's renewal date and is similar to the medical open enrollment period. You will continue to have the ability to change the open enrollment period, should your client request to alter the open enrollment time period.

Open enrollment will have an impact on individuals who enroll late for their employer's group coverage. In general, an employee or dependent that enrolls for coverage more than 31 days after their eligibility date (or after group's renewal date) will be considered a late applicant under this new open enrollment process.

A late applicant will not be added to the employer group policy at the time of application and will instead be required to wait until the group's next open enrollment period to enroll. If a late applicant attempts to enroll:

• The enrollment will be postponed because the applicant did not meet plan eligibility standards;
• An identification card(s) will not be issued;
• A letter will be sent informing the applicant that their enrollment was postponed based on the plan eligibility standards and informing the applicant to enroll at the group's next open enrollment period. The employer will receive a carbon copy of this letter.

The open enrollment provisions will go in effect as of:

• New business groups effective August 1, 2010 or later
• Existing business groups with renewal dates on or after November 1, 2010

Note: existing business groups will be notified of this material change to their policy prior to their renewal date.