Author Archives: Reeve Conover

Walmart will require workers to travel for spine surgery in effort to cut healthcare costs

Walmart is aiming to lower healthcare spending by requiring employees to travel to certain hospitals for spine surgeries, according to The Wall Street Journal. Here are four things to know:

1. Over the past five years, Walmart has encouraged employees to undergo a variety of procedures, including spine, heart, hip and knee surgeries, at hospitals known for providing high-quality care. As an incentive, the retail giant offered to pay for the full cost of the procedures and travel.

2. Beginning in January, Walmart is mandating the travel for spine surgeries in an effort to lower healthcare costs and reduce unnecessary procedures.

3. Walmart has teamed up with major health systems for the mandatory program, including Rochester, Minn.-based Mayo Clinic, Danville, Pa.-based Geisinger and Houston-based Memorial Hermann Health System.

4. Walmart, which provides health benefits that cover more than 1 million people, will not require workers to travel to designated hospitals for heart surgeries and other procedures included in the voluntary program.

Oscar Health sues Florida Blue, alleging monopoly of individual ACA health insurance market

Naseem S. Miller / Orlando Sentinel

Oscar Health, the new player in Florida’s ACA marketplace, has filed a federal lawsuit against Florida Blue, alleging that the insurer is using improper tactics to stifle competition in the state and monopolize the individual plan market.

In an antitrust lawsuit filed on Tuesday morning in the federal court’s Middle District of Florida, Oscar alleges that Florida Blue, the largest provider of ACA plans in Florida, has launched a “targeted campaign” to prevent Oscar from entering Orlando by “coercing” brokers into “anticompetitive exclusive agreements” and preventing them from selling Oscar’s plans.

More than 190 brokers have backed out of agreements to sell Oscar’s individual plans, resulting in loss of sales for Oscar, it said.

“When we go to a new city, one of the first things we do is to introduce ourselves to local brokers,” said Bruce Gottlieb, general counsel and executive vice president of strategic partnerships at Oscar. “In every city we’ve gone to, we’ve been able to sign up most of the largest brokers in the city. … Except for Orlando. Florida Blue is preventing brokers telling clients about the lowest-priced plans in the region.”

Florida-based Simple Health Plans shut down for selling “sham insurance”

According to the FTC, Simple Health Plans and its subsidiaries collected more than $100 million through deceptive marketing and sales practices that left many people stuck with thousands in unpaid medical costs.
By KEVIN TRUONG / MedCity News

Hollywood, Florida-based Simple Health Plans has been shut down by a federal judge due to allegations from the Federal Trade Commission that the company was selling junk insurance under the guise of providing comprehensive coverage to patients.

According to an announcement from the FTC, Simple Health Plans and its subsidiaries collected more than $100 million through deceptive marketing and sales practices that left many people stuck with thousands in unpaid medical costs.

While the company portrayed its coverage as comprehensive, customers reported paying as much as $500 a month for extremely limited benefit programs that “effectively left consumers uninsured,” according to the FTC.

The federal court order is only temporary, but the FTC is seeking to permanently shut down the company’s operations and return money to customers.

Medicare Costs for 2019 Released

Description 2018 2019
Part A Inpatient hospital deductible $1,340 $1,364
Daily coinsurance for 61st-90th Day $ 335 $ 341
Daily coinsurance for lifetime reserve days $ 670 $ 682
Skilled Nursing Facility coinsurance $167.50 $170.50
Medicare Part B annual deductible $183 $185
Medicare Part B standard monthly premium $134 $135.50
High-Deductible Plan F $2,240 $2,300
Plan K out-of-pocket limit $5,240 $5,560
Plan L out-of-pocket limit $2,620 $2,780

Expanding HRA’s to help individual employees

A recent article in Employee Benefit Adviser on 10/25:

If this change is allowed it would help small business owners and employees alike, providing an alternative to traditional group insurance, along with level- funded plans.- Reeve

“A new proposed law loosening restrictions on health reimbursement accounts could significantly expand the use of such accounts and make them a much bigger part of employers’ healthcare offerings.

The Trump administration this week proposed to allow employers to fund tax-exempted HRAs to help pay for employees’ individual health insurance premiums, undoing Obama-era guidance that restricted HRAs for that purpose. HRAs currently have to be connected to a group health plan, with some exceptions for retirees, and are typically used to pay out-of-pocket expenses and for other medical and dental services defined by the IRS.

The proposed rule also would allow employers that offer traditional group health coverage to fund an HRA of up to $1,800 each year to reimburse employees for “qualified medical expenses” such as stand-alone dental visits.”

September 2019
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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck