Category Archives: Investing and fiduciary requirements

Enhancements to Oxford Member ID Cards

 In keeping with the initiative to move to a single UnitedHealthcare brand across all benefits businesses, the refreshed UnitedHealthcare–Oxford blended logo will begin appearing on Oxford commercial business member identification (ID) cards on June 1, 2011. Oxford will remain a modifier under the UnitedHealthcare master brand logo (as shown above).

 An industry-standard bar code is also being applied to ID cards, beginning June 1, 2011, in place of the magnetic strip previously used. The bar code holds more patient information than the magnetic strip and can be read by provider offices using a universal card reader.

 In addition, beginning with ID cards printed on May 14, 2011 for members of an Oxford New Jersey commercial plan, more plan information appears on the front of the card. In compliance with guidelines for ID card standards set by the New Jersey Department of Banking and Insurance, cards now show:

  • Primary Care Provider (PCP) name, if applicable;
  • Copayments for PCP, specialists, urgent care and emergency room visits, and hospital stays;
  • Deductible (family and individual) amount; and
  • Coinsurance amount.

Judges question health care overhaul: No ruling made as panel examines invalidating entire law

Associated Press
Thursday, June 9, 2011

ATLANTA — Judges on a federal appeals court panel on Wednesday repeatedly raised questions about President Barack Obama’s health care overhaul, expressing unease with the requirement that virtually all Americans carry health insurance or face penalties.

All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates.

The Atlanta panel did not immediately rule on the lawsuit brought by 26 states, a coalition of small businesses and private individuals who urged the three to side with a federal judge in Florida who struck down the law.

But the pointed questions about the so-called individual mandate during almost three hours of oral arguments suggests the appeals court panel is considering whether to rule against at least part of the federal law to expand health care coverage to tens of millions of Americans.

Federal appeals courts in Cincinnati and Richmond have heard similar legal constitutional challenges to the law within the last month, and lawyers on both sides agree the case is headed for the U.S. Supreme Court.

At issue Wednesday was a ruling by U.S. District Judge Roger Vinson of Florida to invalidate the entire law, from the Medicare expansion to a change that allows adult children up to age 26 to remain on their parents’ insurance. The government contends that the law falls within its powers to regulate interstate commerce.

Chief Judge Joel Dubina, who was tapped by Republican President George H.W. Bush, struck early by asking the government’s attorney “if we uphold the individual mandate in this case, are there any limits on Congressional power?” Circuit Judges Frank Hull and Stanley Marcus, who were tapped by Democratic President Bill Clinton, echoed his concerns later in the hearing.

Acting U.S. Solicitor Neal Katyal sought to ease their concerns by saying the legislative branch can only exercise its powers to regulate commerce if it will have a substantial effect on the economy and solve a national, not local, problem. Health care coverage, he said, is unique because of the billions of dollars shifted in the economy when Americans without coverage seek medical care.

“That’s what stops the slippery slope,” he said.

Paul Clement, a former U.S. solicitor representing the states, countered that the federal government should not have the power to compel residents to buy to engage in commercial transactions. “This is the case that crosses the line,” he said.

Healthcare costs for typical family of four double

May 11th, 2011

Milliman today released the results of the 2011 Milliman Medical Index (MMI), which measures the total cost of healthcare for a typical family of four covered by a preferred provider organization (PPO). The 2011 MMI cost is $19,393, an increase of 7.3% over 2010, which is the lowest annual rate of increase in more than a decade. Yet even though the rate of increase is the lowest in recent memory, the increase in total dollars—$1,319 in 2011—is the highest in the history of this study.

“In 2002, American families had healthcare costs of $9,235, and those costs have now doubled in fewer than nine years,” said Lorraine Mayne, Milliman principal and consulting actuary. “As costs continue to grow—and even as the cost trend decelerates—the total cost of care for American families constitutes a larger and larger portion of the household budget.”

Of the $1,319 total cost increase, employers bore $641 while employees shouldered the rest—$403 in payroll contributions and $275 in additional cost sharing.

“As has been the case in four of the last five years, employees are paying a larger share of the cost increase than their employers,” said Scott Weltz, consulting actuary at Milliman. “That said, in absolute dollars, both employers and employees have shouldered approximately the same amount of additional costs since 2006, with employers absorbing $3,023 and employees absorbing $2,988.”

In addition to looking at costs on a nationwide basis, the Milliman Medical Index also examines 14 geographic areas.

“This year, six of the fourteen cities we studied exceeded $20,000 in total costs for a typical family of four,” said Milliman principal and consulting actuary Chris Girod. “But we still have several cities, Phoenix, Atlanta, and Seattle, with less than $19,000 in total costs for the typical family. These cost differences result from variation in local practice patterns and from differing costs for healthcare goods and services.”

This year’s Milliman Medical Index also helps put healthcare reform changes in perspective, and includes various analyses of how healthcare reform is (or is not) contributing to the underlying cost of care. The report also looks at how healthcare reform changes may affect the typical family of four represented in this analysis.

The full MMI is available here.

Governor signs Maine health insurance overhaul

AUGUSTA, Maine (AP) — Calling it a top priority of his administration, Gov. Paul LePage on Tuesday signed into law a bill designed to lower health insurance costs and cover more Mainers through a series of market changes including a new high risk pool and allowing smaller companies to band together to get better rates.

Backed by dozens of legislative Republicans who supported the bill, LePage thanked party leaders who shepherded the bill through grueling House and Senate debates, making it the biggest political trophy for the GOP so far this session.

“This legislation has been a top priority,” the governor said during the State House bill signing.

“Most importantly, this will create choice for Mainers,” LePage said. “This will lower health care costs for Mainers. This will help Maine small businesses. This will create more jobs for Maine people. This is a step in the right direction. This legislation is going to drive health care costs down so we can be competitive with our neighbors.”

But even before LePage had signed the bill, Democrats branded it “reckless” and said it would hurt Mainers over age 48 and those living in rural areas, who stand to see higher rates. They also took aim at a provision to add a $4 charge to the monthly premium of every Mainer with private coverage. The fees will pay for a high risk pool that will cover Mainers with high health care expenses.

Maine Democratic Party Chairman Ben Grant labeled the charge a tax, and said its enactment by a party that abhors tax increases “is hypocrisy of the highest order.”

Meanwhile, the health care activist group Maine People’s Alliance Despite said it’s considering launching a People’s Veto referendum campaign to stop the law from taking effect. Calling the bill a “handout to the insurance companies,” the alliance also expressed worries about the impact on older and rural Mainers.

Republicans dismissed opponents’ claims.

Rep. Andre Cushing of Hampden, the assistant House GOP leader, said the $4 “assessment” will replace a charge on health insurance claims Mainers have been paying to keep the Dirigo Health program — the previous administration’s attempt at health insurance reform — in operation. The LePage administration wants to phase out Dirigo.

“So this $4 assessment could be more than an offset for what people are paying now,” said Cushing. “It could be considerably less than what they are now paying.”

In addition to the risk pool, the new law will allow companies with fewer than 50 employees to band together to create larger insurance pools to obtain better rates.

Mainers buying individual insurance, not through employers, could buy policies from companies based in New Hampshire, Massachusetts, Rhode Island and Connecticut starting in 2014, the same year a similar provision kicks in under the national Affordable Care Act.

The law will also change Maine’s community rating policy so the differential in rates gradually increases. While the expanded “rating bands” will allow insurers to charge significantly less to younger, healthier Mainers and spread the risk over a larger pool, they could also mean higher rates for those who are older, sicker and live in rural areas.

Copyright 2011 Associated Press. All rights reserved. This material may not be publ

Another reason why Medical Loss Ratios matter…

Indiana to Seek MLR Waiver 

Published 5/17/2011 


The Indiana Department of Insurance is asking federal regulators to waive the new minimum medical loss ratio (MLR) requirement for insurers in the Indiana individual health insurance market.

Indiana Insurance Commissioner Stephen Robertson will be asking federal regulators to phase in higher MLR levels, rather than imposing a strict cut-off this year.

The Indiana department supports efforts to challenge the constitutionality of the Patient CaduceusProtection and Affordable Care Act of 2010 (PPACA) as a whole, Robertson says in a statement.

“But, if [PPACA]  remains the law of the land, I must do everything in my power to protect Hoosiers and the health insurance market from its unintended consequences,” Robertson says.

PPACA requires health insurers to spend 80% of individual health insurance policy revenue on health care and quality improvement efforts or else provide rebates.

The Indiana department has prepared a MLR rule effect analysis that shows that 5 carriers report more than $10 million in annual individual health premium revenue in the state. Together, the carriers account for about 85% of the state’s estimated $446 million in total annual individual health premium revenue.

The top 5 individual health carriers had estimated MLRs ranging from about 60% to about 77% in Indiana in 2010.

If individual health insurers in Indiana had been required to meet the 80% minimum MLR requirement in 2010, then 44 of all 63 insurers in the market might have had to pay MLR rebates. They might have had to return about $30 million, or about 7.1% of the individual health premium revenue collected, to about 181,000 individuals, or 94% of the covered individuals. Rebates would have averaged about $165 per individual. 

Robertson is proposing that Indiana set the minimum MLR level at 65% in 2011, 68.75% in 2012, 72.5% in 2013, 76.25% in 2014, and 80% in later years.

If PPACA takes effect as written, it will impose major changes, such as a requirement that insurers sell individual health insurance on a guaranteed-issue, mostly community-rated basis, on the individual health market in 2014.

“Relief through 2014 allows for pricing stability so that Hoosiers can budget for their premiums in what will undoubtedly be a volatile year,” Robertson says.

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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