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Mon, 23 Jan 2012 00:00:00 -0500 -
NAHU’s Capitol Conference Looks at Health Reform Moving Forward
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Adams will run in new 7th Congressional District
Thu, 12 Jan 2012 00:00:00 -0500 -
NAHU's Capitol Conference, “Taking Care of Business: Our Response to Health Reform Moving Forward”
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McCarty to HHS: Florida Already Damaged by Agent Commissions in MLR
WASHINGTON-The state of Florida continues to carry the banner of agents on the medical loss ratio issue, asking federal health regulators to review its decision not to exempt Florida from the rule.
In a Dec. 30 letter to the U.S. Department of Health and Human Services, Florida's Office of Insurance Regulation says the provision of the healthcare insurance reform law limiting administrative costs to 20 percent of premiums is harming the state's insurance market.

The letter objects to HHS's Dec. 15 letter rejecting the state's demand for an exemption from the MLR provision of the healthcare law, the Patient Protection and Affordable Care Act.

Kevin McCarty, Florida's insurance commissioner who is now the president of the National Association of Insurance Commissioners, led the battle by the NAIC to have agent commissions removed from the MLR formula. NAIC commissioners supported McCarty by a narrow margin in a Nov. 23 conference call.

But, in a final rule and interim final rule issued a week later, HHS affirmed an earlier NAIC decision that included agent commissions in the MLR.

The latest Florida OIR letter was sent to Steve Larsen, deputy director of the Center for Consumer Information and Insurance Oversight at HHS.

Industry analysts and lawyers assert that HHS is correct in saying it doesn't have the legal authority to exempt agents from the MLR.

In the letter, McCarty says, "Failure to obtain the requested adjustment will cause permanent, irreparable harm to our market and the distribution channel for health products and services."
McCarty says the HHS has been dismissive of insurers' testimony and announcements that companies would leave the individual market. In fact, significant damage has already occurred.
"Since the passage of the [PPACA], Florida has not received any applications for new entrants into the individual market, and no new issuers appear to be interested in expanding into this market," McCarty's letter says.  McCarty outlined the severe impact on the agent community as a result of the HHS decision to deny the exemption. He cites an "informal survey" to show harm to agents as a result of cuts in agent commissions, and says the OIR intends to send notarized letters that clearly document the MLR's impact on the agent community by Jan. 6.

The OIR has been collecting data and testimony for almost a year on the challenges to its market created by the higher MLR, which indirectly cuts off agent commission at the knees by considering those fees as part of the administrative element of the ratio and not the care portion.

McCarty portrayed the agents as consumer advocates in his letter, saying their role is to assist consumers in gaining precertifications for various medical procedures and helping consumers navigate the healthcare delivery system.

McCarty also issued a memo Dec. 28  notifying Florida health insurers and HMOs that Florida has not enacted any guidance electing to use the statutory 50 employee mark  as the upper limit for purposes of reporting small employer MLRs, so that, in effect the state law would be superseded by the more generous (for MLR purposes) federal PPACA definition of a small group employer as having employees between 1 and 100.

For more information, please click on the following link:

The Florida Association of Health Underwriters and its members would like to thank Commissioner McCarty for his continued support on this issue on behalf of Florida insurance .
Thu, 05 Jan 2012 00:00:00 -0500 -
Survey Demonstrates Americans Receive Comprehensive Health Benefits through Employer Plans
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Florida Insurance Commissioner Will Be Next NAIC President
NATIONAL HARBOR, Md. -- Today Susan Voss (Iowa Commissioner) the outgoing President of the National Association of Insurance Commissioners (NAIC) announced that Commissioner Kevin McCarty will officially ascend to the NAIC presidency effective January 1, 2012. Commissioner McCarty will continue to serve as President-Elect of the NAIC through 2011.
 
"It is an honor and privilege to be elevated by my colleagues and to this leadership role," remarked Commissioner McCarty, "Over the next year we must confront several important challenges. Whether it is Dodd-Frank or the Affordable Care Act, the federal government has become increasingly involved in the insurance arena.  As your president, I intend to vigorously defend the role of state-based regulation, highlight our accomplishments, and continue to work for regulatory modernization and national uniformity to create an insurance framework that benefits both consumers and the insurance industry."  
 
Other officers elected by the NAIC during the Fall Meeting include James Donelon as President-Elect (Louisiana Commissioner), Adam Hamm as Vice-President (North Dakota Commissioner) and Monica Lindeen as Secretary-Treasurer (Montana Commissioner).  All of the commissioners will assume their new roles January 1, 2011.
 
The NAIC also issued a press release about the NAIC elections.
 

About the Florida Office of Insurance Regulation
The Florida Office of Insurance Regulation (Office) has primary responsibility for regulation, compliance and enforcement of statutes related to the business of insurance and the monitoring of industry markets. For more information about the Office, please visit www.floir.com or follow us on Twitter @FLOIR_comm.
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Your VOICE and ACTIONS makes a difference!
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NCOIL to Vote on MLR Bill at Summer Meeting
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Questions linger about health exchanges
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HHS on PCIP: Yes, We Need Agents
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Confused by your health options? Reform could make it worse
Proponents of the new health care law claim to have seen the future of American health care - and they say it's a lot like air travel. According to some, come January 2014, choosing a health insurance plan in the new exchanges will be as easy as shopping on Orbitz. By cutting insurance agents from the transaction and forcing consumers and employers to buy policies direct, advocates claim that the exchanges will trim costs. Of course, these folks seem to overlook that selecting a health insurance policy is a tad more complicated than buying a plane ticket. Many consumers rely on agents and brokers to help them make informed insurance choices and take advantage of cost saving opportunities - and should be allowed to consult with them if they so choose. Most of the products consumers buy online are simple commodities. For instance, to buy a plane ticket through a Web portal, all a traveler needs to know is where he's from, where's he going, and when he'd like to leave. The amount of legroom, the quality of the food and the reputation of the airline may factor into his decision, but most folks are just looking for the lowest possible fare. When it comes to health insurance, consumers are looking for more than just the lowest price - they're also searching for the best value. For some folks, that may be the cheapest available plan. But other individuals and small businesses may have more specific needs in navigating the system, requiring help when problems arise and information when new products and changes are introduced that may impact them. Imagine if buying airline tickets were as complicated as picking a health insurance policy. Travelers wouldn't have to simply select their destination and date of departure. They may not even know anything about their future destination or journey toward it. They'd have to select the thickness of their seat cushions. And tell the airline whether they planned to use the bathroom during flight. And whether they'd have chili or Indian food before boarding the plane. And if you're an employer, the number of workers could change product offerings and cost. Each answer could change the price of their seat - or perhaps bar them from traveling altogether. The consequences for purchasing the wrong plane ticket are minor - loss of money and time. But buying the wrong health insurance can jeopardize a person's health and financial security. And for small business owners that provide health benefits to their workers, the risks are magnified across many families and lives. That's where licensed professional agents and brokers come in. Few things are more important than our health - and expert agents can ensure that individuals and businesses find the plans that best suit their needs. Unlike travel agents, insurance brokers are more than salespeople. They can assist their customers by helping them appeal denied claims and correct administrative errors. For small businesses, outside brokers frequently serve as virtual human resources departments, providing administrative savings by assisting in compliance, completing enrollment forms, answering questions about benefits, and ensuring that enrollees have the documentation they need to access medical care. According to the nonpartisan Center for Studying Health System Change, at least half of all small firms in the United States obtain their health benefits through a broker or agent. These companies appreciate the services brokers provide. A survey commissioned by IBM found that three-quarters of small-business owners were very satisfied with their agents' work. The health reform law claims to offer some help to confused consumers by establishing so-called "navigators" to conduct public education activities, distribute information about enrollment and premium credits, and provide enrollment assistance. Unfortunately, the law does not specify what training or certification navigators must receive to advise customers - unlike professional agents who are state-licensed and accountable. Consumers may thus be at risk of encountering sham operators who could give them faulty advice or information. By empowering consumers with useful information, brokers make the health care marketplace more - not less - efficient.
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Confused by your health options? Reform could make it worse
Proponents of the new health care law claim to have seen the future of American health care - and they say it's a lot like air travel. According to some, come January 2014, choosing a health insurance plan in the new exchanges will be as easy as shopping on Orbitz. By cutting insurance agents from the transaction and forcing consumers and employers to buy policies direct, advocates claim that the exchanges will trim costs. Of course, these folks seem to overlook that selecting a health insurance policy is a tad more complicated than buying a plane ticket. Many consumers rely on agents and brokers to help them make informed insurance choices and take advantage of cost saving opportunities - and should be allowed to consult with them if they so choose. Most of the products consumers buy online are simple commodities. For instance, to buy a plane ticket through a Web portal, all a traveler needs to know is where he's from, where's he going, and when he'd like to leave. The amount of legroom, the quality of the food and the reputation of the airline may factor into his decision, but most folks are just looking for the lowest possible fare. When it comes to health insurance, consumers are looking for more than just the lowest price - they're also searching for the best value. For some folks, that may be the cheapest available plan. But other individuals and small businesses may have more specific needs in navigating the system, requiring help when problems arise and information when new products and changes are introduced that may impact them. Imagine if buying airline tickets were as complicated as picking a health insurance policy. Travelers wouldn't have to simply select their destination and date of departure. They may not even know anything about their future destination or journey toward it. They'd have to select the thickness of their seat cushions. And tell the airline whether they planned to use the bathroom during flight. And whether they'd have chili or Indian food before boarding the plane. And if you're an employer, the number of workers could change product offerings and cost. Each answer could change the price of their seat - or perhaps bar them from traveling altogether. The consequences for purchasing the wrong plane ticket are minor - loss of money and time. But buying the wrong health insurance can jeopardize a person's health and financial security. And for small business owners that provide health benefits to their workers, the risks are magnified across many families and lives. That's where licensed professional agents and brokers come in. Few things are more important than our health - and expert agents can ensure that individuals and businesses find the plans that best suit their needs. Unlike travel agents, insurance brokers are more than salespeople. They can assist their customers by helping them appeal denied claims and correct administrative errors. For small businesses, outside brokers frequently serve as virtual human resources departments, providing administrative savings by assisting in compliance, completing enrollment forms, answering questions about benefits, and ensuring that enrollees have the documentation they need to access medical care. According to the nonpartisan Center for Studying Health System Change, at least half of all small firms in the United States obtain their health benefits through a broker or agent. These companies appreciate the services brokers provide. A survey commissioned by IBM found that three-quarters of small-business owners were very satisfied with their agents' work. The health reform law claims to offer some help to confused consumers by establishing so-called "navigators" to conduct public education activities, distribute information about enrollment and premium credits, and provide enrollment assistance. Unfortunately, the law does not specify what training or certification navigators must receive to advise customers - unlike professional agents who are state-licensed and accountable. Consumers may thus be at risk of encountering sham operators who could give them faulty advice or information. By empowering consumers with useful information, brokers make the health care marketplace more - not less - efficient.
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Why We Don’t Need Health Insurance Agents Under Health Care Reform
Washington's view of health insurance agents comes from extensive research into the practices of the health insurance agent. Agents merely help people sort through the myriad of health insurance choices to complete a purchase transaction. For that one transaction the agent receives an exorbitant commission, a commission so large that it impacts the affordability of health insurance for the average family. Eliminate the myriad of choices and there is no need for an agent. Cut out the agent and not only will the insurance companies be able to comply with the new medical loss ratio requirements, but health insurance will also be more affordable for all Americans.

To facilitate this, we have created an insurance exchange pothole so that everyone can buy health insurance online with just a few clicks at a state-run superstore, www.Healthocity.com. There will be only be four plans (platinum, gold, silver, bronze) so all confusion will be eliminated. If you have questions, you can use the Internet chat feature and communicate with Peggy or Scott in New Delhi. After all, health care is not local in scope and it does not matter what doctors participate locally or where your 20-year-old son goes to college. This is a very simple process. Once you purchase the product, the system will work perfectly and you will have no need for any service afterwards. If you do not have access to the Internet (although we assume everyone does), just call us at 1-877-onholdforever.

Employer Benefits
If you are an employer purchasing through the insurance exchange pothole, we have eliminated the 4 percent commission normally paid to agents so you will find your group insurance premiums to be much lower than in years past. There will be a small service fee built into the premiums to administer the pothole, but don't worry, it will not be paid to some greedy insurance agent. It will go to your fiscally responsible and trusted government agency.

Once your employees enroll, they are covered. If Suzy your receptionist calls you from the local drugstore saying that the pharmacist is saying she in not in the system, just have her tell the pharmacist to call 1-877-onholdforever.

We realize that as an employer your insurance agent may have assisted you with compliance of various federal laws such as COBRA, HIPPA, FMLA and now PPACA. We are pleased to inform you that those services can be obtained by calling the DOL, IRS, CMS or HHS directly. Please be patient as we do experience heavy call volume between 8 a.m. and 6 p.m. We can only recite the law to you, so if you require an interpretation on how certain aspects of the law would apply to your specific situation we suggest you hire a labor attorney at $400 per hour. Those insurance agents who were giving you free interpretations of these laws could not charge you because they were already receiving commission.

Another exciting part of health care reform is that doctors' offices and hospitals are now required to code all claims correctly so there is no longer a need to question your EOB (explanation of benefits) when you receive it. Your out-of-pocket expenses will match up perfectly with what the provider has billed and what your health plan pays. If you receive a bill from the doctor or hospital, just pay it.

Easy Online Payments
Speaking of paying, the benefit of an online pothole is that you can pay your premiums with your corporate credit card. As you know, paying online is a simple and easy process. Your credit card information will be secure and protected. You can also use PayPal. It charges a fee, but it will be paid by the pothole administrator and it is cheaper than paying commission to an insurance agent.

Another advantage of the pothole is that there will be no need for you, the employer, to hold educational enrollment meetings. These meetings are time consuming and cause employees to ask way too many questions of the insurance agent conducting the meetings.

The good news is that employees will now ask those same questions to you, which will help break up your busy day. In addition you will get to know your employees most intimate health conditions and be able to share this information with other employees. It will be like a built-in wellness program. Wellness is a big part of health care reform. In order to qualify for certain grants and to keep your health insurance costs down, you can develop and administer a wellness program for your employees. Previously it was assumed that insurance agents would help with this, but they are greedy and would have done it for free.

Finally, please be advised that the pothole may not function on all computer systems. Older versions of Windows, Macintosh and iPads are not supported by the pothole. If you have one of these systems, then either go buy a new one or call us at 1-877-onholdforever.
  

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