Tag Archives: Insurance

An Insurance Penalty From Postpartum Depression

In January, a government-appointed panel recommended that all pregnant women and new mothers be screened for depression. Public health advocates rejoiced, as did untold numbers of women who had not known that maternal mental illness even existed before it hit them like a freight train.

But the panel did not mention one possible consequence of a diagnosis: Life and disability insurance providers have sometimes penalized women with these mental illnesses by charging them more money, excluding mental illness from coverage or declining to cover them at all. And it’s perfectly legal.

Many insurance companies lump these women with the larger pool of people in whom more general depression has been diagnosed. That can leave those with mild to moderate cases that came and went facing higher rates, even if they may not be at higher risk of suicide or being unable to work. But insurers base decisions on actuarial data, and the historical underdiagnosis of mild to moderate postpartum depression means there is not much long-term data for insurance companies to use.

Not every woman will pay higher rates, and the fear of doing so is not a good reason to avoid screening or necessary treatment. Women who are aware of the potential insurance problems can theoretically circumvent them in the short term. Any woman who has never given birth but hopes to get pregnant soon should buy as much life and disability insurance as she thinks she will need before she conceives.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Vision Insurance on The Uptick

Employees have their eyes set on vision insurance, as sales have increased close to 25% since 2013 and are leading the pack in worksite voluntary sales growth.

In fact, voluntary benefits sales increased 5% in 2014 compared to 2013, marking the fourth straight year of growth for voluntary, according to LIMRA’s U.S. Worksite Sales survey.

According to the Society of Human Resource Management’s 2014 Employee Benefits Survey, 83% of employers offer vision insurance to employees and five-year trends show an increase in the percentage of organizations offering vision insurance.

Following vision insurance sales is critical illness at 19% and accident insurance at 12%. LIMRA notes each product has grown by 12% or more in the past four years. Life insurance products also noted an increase too, with stand-alone accidental death and dismemberment sales up 11% and universal life sales increasing by 7%.

“Voluntary benefits are on a growth trend, in part because they allow employers to enrich their employee benefits portfolio at no direct cost,” said Ron Neyer, assistant research director, LIMRA Distribution Research. “In a recent LIMRA study 7 in 10 employers who offer voluntary benefits said these options help improve morale for existing employees and assist them in attracting and retaining new talent.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Out-Of-Network Protection In Emergencies

New protections against big surprise medical bills are starting in New York.

Enacted last year, they require insurance payments for out-of-network medical treatment in emergencies, when similar services or specialists are unavailable within the insurer’s network or when care is provided without the patient’s knowledge.

“The surprise bill is only in a situation where they couldn’t choose in advance,” said Dr. Andrew Kleinman, a surgeon and president of the Medical Society of the State of New York. “If they’re coming to see me in my office, that’s not a surprise.”

The immediate requirement for doctors and hospitals is to update online or give written notice to patients about the insurance networks they belong to and tell patients about treatment referrals to other doctors, lab testing or other services. Their trade associations have been providing briefings and guidance.


The Department of Financial Services, which regulates insurers, has received more than 10,000 consumer complaints about billing for out-of-network health care, Superintendent Ben Lawsky said. His agency was involved in drafting the law, which the Cuomo administration pushed.

“This is a huge national problem,” Lawsky said. One other state, Illinois, has taken a similar approach to drop consumers out of billing disputes between insurers and care providers, and officials in many other states have taken an interest in New York’s approach, he said.

Chuck Bell, program director for Consumers Union, said it should remove consumers from the disputes that could drag on for months and now can go to independent dispute resolution.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Mental Health Benefits In ACA Plans Are Disappointing

Insurance coverage for mental and physical illness remains unequal despite promises that Obamacare would help level the playing field, mental health advocates and researchers say.

A new study by the Johns Hopkins Bloomberg School of Public Health found that consumer information on a quarter of the Obamacare plans that researchers examined appeared to go against a federal “parity” law designed to stop discrimination in coverage for people with mental health or addiction problems.

This makes it nearly impossible for consumers to find the best plan to cover their mental health needs, the research suggests.

“It’s critical to monitor whether these regulations are being implemented in a way that fulfills the promise of parity,” says associate professor Colleen Barry, who led the study published in the current online issue of the journal Psychiatric Services. “Clearly, better monitoring is needed.”

Barry and her colleagues examined benefit brochures offered during the first Affordable Care Act enrollment period in 2013-14 in two state-run exchanges, hoping to replicate a consumer’s shopping experience. Although she won’t name the states, Barry says one was large and the other small, and adds that the results can be extrapolated to plans offered in other states and on the federal exchange.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Long-Term Care on the Rise, but Varied

Rates for long-term care insurance, which can help pay for care in your own house or in a nursing home, rose this year an average of nearly 9 percent, a new industry report finds.

Still, rates vary greatly depending on the insurer and the specifics; increases for some policies were much larger, and in some cases — like certain policies covering couples — quite modest, according to Jesse Slome, executive director of the American Association for Long-Term Care Insurance, a trade group.

Each January, the association compares top-selling policies offered by major insurers to determine average rates. This year’s analysis includes rates from 10 insurers, using policies sold in Tennessee, a “representative” state, Mr. Slome said. Factors behind the rates include higher claims costs, he said; in 2014, insurers paid out $7.8 billion in claims, an increase of nearly 5 percent.

A healthy 55-year-old man can now expect to pay, on average, $2,075 per year for $164,000 in initial benefits, up from $1,765 last year, the report found.

The cost for a healthy, single woman of the same age is higher: Her average premium is $2,411, up from $2,307. Insurers take gender into account when pricing long-term care policies, since, statistically, women live longer and are more likely to need long-term care.

Last year, the National Women’s Law Center filed federal sex-discrimination complaints against four insurers, challenging such gender-based pricing on the grounds that the practice violates a provision of the Affordable Care Act barring sex discrimination in health care. The action is pending with the Department of Health and Human Services’s Office for Civil Rights.

Couples generally get a discount if they buy a joint policy; the rationale is that one or the other is likely to provide some care for a spouse initially, Mr. Slome said. A married couple, both age 60, would now pay $3,930 combined, up from $3,840, for $328,000 of initial coverage.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

You Have Extra Time to Sign Up for Obamacare Plans

Americans who couldn’t enroll in federal Obamacare insurance plans over the weekend because of computer glitches or long waits will now have until next Sunday to sign up, federal officials announced early Monday.

“We are pleased that the vast majority of consumers were able to apply and pick a plan through HealthCare.gov or its call center without a problem,” said Aaron Albright, spokesman for the U.S. Centers for Medicare and Medicaid Services.

“For those consumers who were unable to complete their enrollment because of longer than normal wait times at the call center in the last three days or because of a technical issue such as being unable to submit an application because their income could not be verified, we will provide them with a time-limited special enrollment period for March 1 coverage.”

The special enrollment period begins Monday and ends Feb. 22.

The extension was prompted by the Saturday outage of an Internal Revenue Service function for Obamacare enrollment, which could have prevented about 500,000 people from enrolling. The glitch prevented some people from getting their income verified so they could enroll on HealthCare.gov and at least some state exchanges by the Sunday deadline.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New Goals Shift to Value-Based Medicare Payments

In a “historic” announcement, the Department of Health and Human Services on Monday set new goals for tying Medicare payments to quality or value through alternative payment models. The news received widespread print and online media coverage and is portrayed as an ambitious step by the Administration. Most sources also report on the generally positive response by providers, insurers and other stakeholders.

The Washington Post  (1/27, Millman) reports in its “Wonkblog” that the Obama Administration on Monday “announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.” Rather than pay more money to physicians for every procedure they perform, Medicare will also evaluate whether patients are healthier, “among other measures.” HHS Secretary Sylvia Mathews Burwell said in a press conference, “As a very large payer in the system, we believe we have a responsibility to lead.” She added, “For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.”

USA Today  (1/27, O’Donnell) reports that HHS hopes to tie 30 percent of traditional Medicare payments to quality or value through “alternative payment models” by the end of 2016, up from 20 percent. These plans include accountable care organizations and “bundled payments,” which are groups of payments for treatments of the same issue. By the end of 2018, “HHS hopes to link 50% of payments to these arrangements.” Secretary Burwell stated, “We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement.”

Bloomberg News  (1/27, Wayne) reports that the Administration’s “historic” announcement on Monday marks “the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.” According to Bloomberg, the plan would be a major transformation for hospitals, health facilities and physicians, “eventually more than doubling the reach of programs that the U.S. said has saved $417 million and that have been a model for how the government hopes to influence, and slow down, health spending.”

The Wall Street Journal  (1/27, Radnofsky, Beck, Subscription Publication) reports that the government’s ambitious goal to rework hundreds of billions of dollars in Medicare payments will likely see resistance from healthcare providers and skepticism from beneficiaries and lawmakers. Indeed, American Medical Association President Robert Wah, MD, said that while he was “encouraged” by the announcement, physicians need more flexibility in the way the payments would be administered. The AP  (1/27, Alonso-Zaldivar) adds that Dr. Wah “stopped short of an endorsement, telling reporters his group is encouraged but wants specifics.”

The Los Angeles Times  (1/27, Levey), however, reports that the “ambitious new goals” set by HHS were “broadly hailed by consumer advocates, leading medical providers and insurance industry officials.” Douglas E. Henley, chief executive of the American Academy of Family Physicians, praised the goals and hailed Monday as a “bless your heart day.” The article adds that the shift away from fee-for-service healthcare “is a central, if little recognized, goal of the Affordable Care Act.”

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Did You Forgo Health Insurance, You May Receive a Tax Penalty

If you decided to skip health insurance this year, consider this: Unless you can prove you have a valid excuse, you will be liable for a penalty during the coming tax season — and the time to start making your case is now.

That’s not all. People who bought subsidized insurance through one of the marketplaces may have new tax forms to complete, while paying the penalty itself may demand some serious number-crunching.

The Internal Revenue Service is gearing up to answer questions, but it warns that only half of the callers may get through — and those who succeed may have to wait a half-hour or more.

“There are quite a number of moving parts that taxpayers have not had to deal with,” said Kristin Esposito, technical tax manager for the American Institute of Certified Public Accountants.

The Obama administration’s Affordable Care Act — including its penalty provision — is in effect for the first time this year and will be reconciled through a person’s tax return.

For most taxpayers, this will simply mean checking a box on a tax return indicating they had insurance for the full year. But millions of others will have to grapple with new tax forms and calculations that may generate unexpected results.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Economy Grew Due to Increased Consumer Spending and Investments

The U.S. economy grew at a sizzling 5% annual rate in the July-September period, the fastest in more than a decade, boosted by strength in consumer spending and business investment.
The Commerce Department on Tuesday sharply revised up its estimate of third-quarter growth from a previous figure of 3.9%. Much of the strength came from consumer spending on health care and business spending on structures and computer software.

It was the fastest quarterly growth since the summer of 2003. It followed a 4.6% annual growth rate in the April-June quarter.

Most economists think growth is slowing to an annual rate of around 2.5% in the current October-December quarter. They foresee growth around 3% in 2015.
That would be the strongest figure since the economy expanded 3.3% in 2005, two years before the Great Recession began.

The 2007-2009 downturn, the worst since the 1930s, cost millions of people their jobs. Since then, the economy has struggled to regain full health. Even after the recession ended in June 2009, the economy has turned in mediocre growth rates averaging 2.2% annually.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Another Ruling on Subsidies by a Federal Judge

Though New York is unaffected, yet another ruling that affirms enrollees in the Federal Exchange cannot receive subsidies.

A federal judge in Oklahoma has ruled that Obamacare subsidies cannot go to residents of states that are not running their own insurance exchanges, a second blow to the Obama administration on a issue that threatens a key element of the health law’s coverage expansion.

Judge Ronald A. White said that the administration’s decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck.

White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in.

“The court holds that the IRS rule is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law,” White wrote in his ruling. The IRS had allowed people to get subsidies in all states.

Oklahoma Attorney General Scott Pruitt, who brought the lawsuit, welcomed the decision.

“Today’s ruling is a consequential victory for the rule of law,” he said in a statement. “The administration and its bureaucrats in the IRS handed out billions in illegal tax credits and subsidies and vastly expanded the reach of the health care law because they didn’t like the way Congress wrote the Affordable Care Act. That’s not how our system of government works.”

Split decisions in U.S. appeals courts came earlier this year. The 4th Circuit Court of Appeals in Richmond, Va., ruled with the Obama administration, saying the IRS had the right to allow the subsidies to go to residents of any state. The D.C. Court of Appeals ruled against that regulation but it recently vacated that decision when it decided to have the full court, not just a three judge panel, rehear the case.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary