Monday, August 30, 2010

Patient Protection and Affordable Care Act Compliance

Pre-existing Medical conditions
Beginning in January 2014 health plans will be prohibited from using pre-existing conditions as a reason to deny coverage to an individual. For children under the age of 19 this provision goes into effect on the plan year beginning on or after September 23, 2010. As of October 1, 2010, coverage for children will not be denied based on medical history.
Policy limits
The new law prohibits lifetime maximum limits beginning January 1, 2011.
Preventive care
For plan years beginning on or after September 23, 2010, the new law requires that certain preventive services are covered without any cost-share requirements from the insured.

As the Department of Health and Human Services releases further rules and guidelines, changes to health insurance plans will be necessary and will be announced on this blog. 

Lean Beef, Pork, Chicken, Turkey

Secret Ingredient: Protein

How it works: It takes more energy for your body to digest the protein in meat than it does for it to digest carbohydrates or fat, according to Doug Kalman, R.D., director of nutrition at Miami Research Associates, a nationally recognized pharmaceutical-research facility. "That means that the more protein you eat, the harder your body has to work to digest it, and the more calories you'll burn in the process," he says.

When researchers at Arizona State University compared the benefits of a high-protein diet with those of a high-carbohydrate diet, they found that people who ate a high-protein diet burned more than twice as many calories in the hours following their meal as those eating carbs. Even better, researchers in Denmark found that men who substituted protein for 20 percent of the carbs in their diets were able to boost their metabolisms, increasing the number of calories they burned each day by up to 5 percent.

Make it a healthy day!

Monday, May 3, 2010

COBRA Subsidies

A one year extension of federal subsidies for COBRA premiums paid by those who have lost their jobs as a result of the past two years’ economic conditions is contained in H. R. 4213, a bill designed to create new jobs and extend tax benefits that have expired or are about to expire. Both the House and Senate have passed H.R.4213, and lawmakers are now engaged in negotiations on how to resolve differences between the House and Senate-approved versions of the bill.

There is bicameral agreement on the COBRA subsidies. But as-yet unresolved disputes over the extent to which the $140 billion bill must be “paid for” (with new taxes or decreased spending) is slowing the bill’s movement. House and Senate Leaders say they hope to complete work on the bill by Memorial Day.

Sunday, May 2, 2010

PPACA prohibition from rescinding coverage

Within six months of enactment, all health plans are prohibited from rescinding coverage except for acts of fraud or intentional misrepresentation, required to provide dependent coverage until the age of 26, and prohibited from imposing lifetime benefit limits under the reconciliation bill. Annual benefit limits are prohibited starting in 2014, but restrictions are placed on the use of annual limits by all group plans within six months of enactment. The reconciliation bill clarifies that all plans, including grandfathered plans, are prohibited from applying pre-existing condition exclusions starting in 2014.

Tuesday, April 6, 2010


The Community Living Assistance Services and Supports (CLASS) provisions for long-term care passed as part of the Act will be developed by the Department of Health and Human Services over the next few years. 

CLASS provisions create a voluntary government program under which participants will pay (not the taxpayers) a monthly premium, on a guaranteed-issue basis, and will be eligible for modest benefits for their long-term care needs after five years of paying premiums.

What are the details of the coverage that would be provided?

Enrollees will:

 • pay a monthly premium, through payroll deduction. Estimates indicate that the average premium will be $180-$240/month; that premium could be increased yearly to ensure that the CLASS fund is actuarially sound,

 • be covered on a guaranteed-issue basis,

 • be eligible for benefits for their long-term care needs after paying premiums for the first 60 months of coverage (i.e., a 5-year waiting period) and have worked at least three of those five years,

 • receive a lifetime cash benefit after meeting benefit eligibility criteria, based on the degree of impairment, which is expected to average about $75/day or more than $27,000 per year and is payable as long as the claimant remains disabled. Enrollees will be offered coverage through their employers and will be automatically covered unless they opt out. They can opt back in later. Self-employed people or those whose employers do not offer the benefit will also be able to join the CLASS program through a government payment mechanism.

 What if a client is considering the government plan now rather than LTC insurance?

 It will be at least two years before the CLASS Act is operational and another five years from that time before any benefits can be paid. Since the government plan is highly limited, delaying the purchase of an LTC insurance policy can have an effect on the cost of your policy and possibly your insurability. Some advantages of a obtaining a private LTC insurance policy today are:

• no employment requirement

 • a broad range of benefits better suited to address the high cost of care.

• no minimum number of years you must pay premiums before benefits are payable; the coverage will begin paying benefits once the benefits trigger and waiting periods have been met.

 • Any unused LTC insurance benefits are carried over from year to year.

• The policy provides access to care coordination services, quality providers, and provider discounts.

 Do you still need his/her LTC insurance policy?

 Yes, it is recommended that all private LTCI policyholders retain their private LTC insurance policies due to the highly limited nature of the long-term care benefits that will be offered under CLASS, and potentially very high premiums for CLASS due to adverse selection.

 In Summary

 CLASS provisions do not negate the need for private LTC insurance coverage. In addition, the program should play a significant role in raising consumer awareness about the many issues surrounding long-term care and the need to be prepared for a long-term care event.