Author Archives: Reeve Conover

Calculating your out of pocket costs in advance

image of cash and health insurance card

The link below is to a very interesting website called Fair Health.  It allows you to calculate your potential costs if you go out of network. 

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ObamaCare update…

We will hear about the “repeal and replacement of ObamaCare” everyday for a while.  Not much as actually happened yet, and I will discuss that later in this post.

The insurance Brokers Lobbying group is active, seeking “the preservation and enhancement of the employer-sponsored insurance group and health insurance marketplace.”  They point out that ObamaCare “… has a million moving pieces and lots of potential implications and intended consequences – and potential unintended consequences – depending on which replacement plan you’re looking at.”

It appears that the administration has thrown everything on the table – including age 26 coverage, pre-existing conditions, and other popular benefits.  Meanwhile, its clear what needs to be addressed:

Reeves Recommendations:

  1.  Lower Health-care costs – Note I did not say health insurance costs.  Premiums cannot go down if the underlying claim costs continue to rise.  We need to address medical fraud, tort reform, malpractice prices, and medical standards.  Without these corrections, costs will continue to rise.
  2. Less Regulation-  more regulation = more compliance = more time and money out of the employers pocket.  An easy example to any company that has had to comply is the 1094/5 reporting requirements.
  3. Take the time to do it right – Had this been done the first time we wouldn’t be in this mess in the first place.  Don’t rush to repeal.  Take the time, talk to industry leaders, reach across the aisle, involve the broker community, small business leaders, take the good from the PPACA and fix the rest.  Rushing to repeal may actually lead more carriers to pull out, if there is no clear pathway for them to base rates on.
  4. Don’t get distracted by the rhetoric – like buying insurance across state lines.  This won’t save any costs.  The driving factor in costs where you live is the cost where you live.  It costs a lot more for a procedure in Manhattan than it does for the same procedure in, say, Iowa.  Other distractions- increasing the flexibility of HSA’s, and allowing association plans.  These do not change the underlying cost of healthcare one iota.

 

What has happened?

Essentially the action so far, on the morning of January 25,  has to be to provide wide latitude to federal agencies to “change, delay or waive” parts of ObamaCare.Here are links to this weeks ObamaCare news…  this appears to be a temporary measure to give them time to come up with a replacement plan.  The concern is “They warn that effectively gutting the mandate – or even suggesting to consumers that they won’t face any penalty for not buying coverage – could unravel the individual insurance market and prompt insurers not to offer plans in 2018. That could lead to 20 million Americans losing coverage next year.”

https://www.pgpbenefits.com/trump-issues-executive-order-scaling-back-parts-obamacare/

https://www.pgpbenefits.com/2541-2/

How do I stay on top of all of this?

This is a pretty common question – I probably get asked it a couple of times a month.  In addition to at least two hours of reading each week (minimum) and paying attention to current events, in 2016, I had more than 100 hours of formal training (online, webconference or in person) in these areas:

Healthcare.gov  (8 hours)

Specific Carrier and Plan Training (25 hours)

Regulations and changes (24 hours)

Retirement Plans and Investments (24 hours)

General Knowledge (21 hours)

Employers That Hire Holiday Help: Understand the ACA Rules Around Seasonal Workers

holiday help seasonal workers

“If you have at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, your organization is an ALE…. If your workforce exceeds 50 full-time employees for 120 days or fewer during a calendar year, and the employees in excess of 50 during that period were seasonal workers, your organization is not considered an ALE. For this purpose, a seasonal worker is an employee who performs labor or services on a seasonal basis.”
Internal Revenue Service [IRS]

Major Changes to NY Empire and Oxford plans for 2017

logos for blue cross and oxford

Empire Blue Cross Network Changes-

  1. EPO/PPO (i.e. “BlueCard”) –this is Empire’s best-in-class legacy BlueCard network
  2. Blue Priority – full BlueCard hospital network with a narrowed practitioner (doctor) network when in Empire’s 28-county service area. Plans are non-gated with National BlueCard access for folks living and traveling outside of NY.  Most of Northwell doctors now are non-participating in the Blue Priority Network.  Doctors were just notified in November. The change does not impact BlueCard and/or Pathway networks – Northwell doctors and hospitals still participate in both of those.
  3. Pathway – narrowed hospital and practitioner network limited to Empire’s 28-county service area (though this network has grown to be fairly comprehensive, missing really only Memorial Sloan Kettering & SUNY Stonybrook)

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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.
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