Estimated Savings from MLR /Premium Review program
- Tuesday, 18 December 2012 12:35
The Medical Loss Ratio (MLR) is essentially the percentage of your premium that goes to paying medical claims. Things that are excluded are administration and overhead, commissions, premium taxes, marketing costs, etc. Health Care Reform requires a minimum of 80-85% (depending on group size) be paid to claims, and any “excess” to be refunded to the preium payors. For example, if your plan had a 78% loss ratio, they would have to refund 2% to all the policy holders that year.
At the same time, all increases over 10% now have to ba approved at the state level. While alot of states did not do this in 2012 (NJ, PA, MA, NH, OH, VA, GA, IL are among those), the “Calculated savings ” to consumers is pretty substantial. THe largest “amounts saved” are
1- Washington State ($49. million)
2- California ($34.5 million)
3- New York ($20.2 million)
4- Michigan ($15.5 million)
5- Colorado ($11.3 million)
Source- Benefits Selling 12/12
Health Care Reform Schedule for 2013
- Tuesday, 18 December 2012 12:22
This year , there is very little direct effect on Employers in the schedule, however you are hardly off the hook- Beginning this summer you will have to eveluate all the exchanges, coops and penalties to determine the best pathway for you in 2014. Open enrollment begins 10/1 of this year! – Reeve
January 1- Physician Comparison Website becomes operational
January 1- Retiree Drug Subsidies change- Employers that offered retiree drug plans received tax-free subsidies previously, now these subsidies are taxable to the employer.
January 1- Health Care streamlining and processing rules become effective
January 1- Pilot program within Medicare on bundled payment for episodes of care begins. Runs through 2016
January 1- Medicare Part D Donut Hole closure begins
July 1- COOP Programs (non-profit, member run health plans) must be established by this date.
Health Insurance Costs in small and large firms – a study
- Monday, 17 December 2012 13:57
Small and large firms vary substantially on health insurance offer
rates and costs. Small firms are less likely to offer coverage, and
there are important differences in the health benefits that small and
larger firms offer. Workers at small firms are responsible for paying
both a larger share of family premiums as well as higher cost sharing
than workers in large firms. This Snapshot expands on information
presented in the 2012 Kaiser/HRET Survey of Employer-Sponsored Health
Benefits to look exclusively at differences in offer rates, plan costs,
and cost sharing between small firms and large firms.
We define “small firms” as employers with three to 199 workers and
“large firms” as employers with 200 or more workers. While the vast
majority of businesses in the United States are small businesses, the
majority of workers are employed at large firms. Of the over three
million firms with three or more workers, 98% have between three and 199
employees. Small firms employ 39% of all workers and 33% of workers
who receive health insurance through their own job. Information on the Survey’s methodology can be found in the 2012 Kaiser/HRET Employer Health Benefits Survey full report.
Health Insurance Offer and Coverage Rates
Small firms are much less likely to offer health insurance than
large firms. Of firms with 3 to 199 employees, 61% offer health
insurance, a stark contrast to the 98% of firms with 200 or more
employees that offer coverage to at least some of their employees.
Very small firms (3-9 workers) are least likely to offer health
insurance to employees, with only 50% of these firms offering coverage
in 2012. Since most firms in the country are small, the overall offer
rate is determined primarily by the percentage of the smallest firms
(3-9 workers) offering health benefits. Small firms may not offer
coverage for a variety of reasons, including the inability to afford
premiums, employees may be covered elsewhere, or the firm may feel that
the benefit does not impact their ability to recruit and retain
qualified employees. In 2012, 48% of small firms
not offering coverage indicated that the cost of health insurance was
the primary reason that they did not offer coverage. 
For the full article and alot of charts and graphs, go to http://www.kff.org/insurance/snapshot/chcm121112oth.cfm
NJ governor vetoes Health Exchange bill
- Tuesday, 11 December 2012 12:07
By Peter Rudegeair
(Reuters) – New Jersey Governor Chris Christie said on Thursday he
vetoed a bill that would have created a health insurance exchange for
his state under President Barack Obama’s signature healthcare program.
whose announcement came on a day when he was visiting the White House
to discuss tens of billions in federal recovery aid after Superstorm
Sandy, joined 18 other states in rejecting a measure to create
state-based health insurance markets where consumers could purchase
private, federally subsidized coverage.
a Republican who has nurtured a reputation as a cost cutter, cited
uncertainty over what such an exchange would cost the state and over
what kind of flexibility New Jersey will have in managing it.
will not ask New Jerseyans to commit today to a state-based exchange
when the federal government cannot tell us what it will cost, how that
cost compares to other options, and how much control they will give the
states over this option that comes at the cost of our state’s
taxpayers,” Christie said in a statement.
U.S. Department of Health and Human Services has set a Dec. 14
deadline for states to decide whether they will participate in
state-based, federal or partnership exchange. Some 18 states have said
they will create their own state-based exchanges and another 18 plan to
default to a federal exchange, according to the Kaiser Family
This marks the second time this year
that Christie vetoed an attempt to create a state healthcare exchange.
He rejected a similar bill in May on the grounds that the healthcare
law, called the Affordable Care Act, might be unconstitutional, a view
the Supreme Court rebuffed when it ruled in favor of the law in June.
veto also comes as Christie pressed his case in closed door meetings
with Obama and House Speaker John Boehner for funds to finance
clean-up and rebuilding efforts following the storm.
Jersey and New York officials are seeking $80 billion, despite a media
report that the White House will request only $50 billion.