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Showing posts with label HealthInsurance. Show all posts
Showing posts with label HealthInsurance. Show all posts
Wednesday, March 6, 2013
Upcoming Webinars from NYCON and an Important message
Monday, February 25, 2013
Did You Know: Dental PPO Balanced Billing?
Dental Benefits: What is Balanced Billing?
This year, once a month, Council Services Plus will be bringing you tid-bits of helpful and interesting facts and information about insurance.
Last month we discussed Dental Benefit Maximums; so keeping with that theme, this month we
we'll focus on another term that often is associated with dental benefits: PPO Balanced Billing.
Many times employees choose a dentist that may not participate in the "network" of dentists approved by the plan offered by the employer. Many dental plans offer out-of-network benefits and still pay claims submitted by dentists that do not participate with that plan. If your plan has out-of-network coverage (usually associated with Point of Service (POS) or Preferred Provider organization (PPO) plans) you need to be aware of the fees charged by that dentist, and what your plan deems as reasonable and customary (R&C) charges that they will pay for.
When you use a participating (or preferred) provider, that dentist has agreed to accept the company's R&C fees as the basis for their billing. For example, if a filling R&C fee is $100, then the participating dentist must charge that for a filling. If your coinsurance is 80%, then you pay $20 (20% of $100) and the company pays $80.
Let's now assume you go to a non-participating provider and they charge $150 for the same filling. The insurance plan will still base the amount they pay at 80% of R&C ($100) and you must pay the "balance" of the bill due to the non-participating dentist. Under this situation, your cost is $70 ($150-$80). You can see why you may "prefer" to see a "preferred" provider in a PPO plan to help keep your costs down.
Wednesday, February 13, 2013
Help Your Employees Cover the Cost of Healthcare
| CS Plus Now Offers Access to Affordable, Comprehensive Voluntary Benefits for Your Employees In a stressful time, specified disease insurance can help protect your employees and let them concentrate on what matters most. The American Cancer Society reports that cancer costs Americans nearly $230 billion annually, and much of that is considered indirect or hidden costs not covered by major medical plans (Loss of wages, deductibles/coinsurance, travel expenses, lodging/meals, child care, etc). CS Plus now offers your employees access to Specified Disease Insurance for Cancer from Colonial Voluntary Benefits (underwritten by The Paul Revere Life Insurance Company). This type of policy pays specific benefits for cancer diagnosis and treatment. |
Specified Disease Insurance for Cancer Plan Benefit Includes:
Rates starting as low as $13.75 per month, per employee.
For More Information Please Contact:
Licensed Account Representatives Kristie Hood at x129, khood@councilservicesplus.com; or Eric Laughlin at x128, elaughlin@councilservicesplus.com
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Employer Notice of Health Insurance Exchange to Employees – Delayed
Employer Notice of Health Insurance Exchange to Employees – Delayed
The Departments of Labor, Health and Human Services, and U.S. Treasury issued new guidance on January 24, 2013 delaying the requirement that employers notify all employees about the existence of the new health insurance exchanges.
Originally scheduled to take effect by March 1 of this year, the notice requirement has been put on hold until late summer or early fall of 2013. A new effective date has not yet been determined. Once a new effective date is announced, it is expected that employers will be required to distribute the notice to all existing employees, as well as to new employees upon hire.
The Department of Labor may issue model language for employers to use in satisfying the notice requirement.
It is expected that the notice must include:
We will keep you informed when new guidance becomes available.
Please visit our Health Reform page often for the latest information and updates
Sunday, February 10, 2013
How Are You and Your Clients Impacted by Health Care Reform?
How Are YOU and Your Clients Impacted by Health Care Reform?
Health care reform is intended to overhaul the health care system, expand affordable coverage, change insurance rules and create an online marketplace (exchange) in each state for the individual and small group markets.
Health care reform will affect individuals, families, businesses, physicians, hospitals and health insurance carriers.
Some aspects of the law are already effective and others will be phased in over the next few years. Regulations will continue to be issued as implementation of the health care reform law is not yet complete. To help you understand the law, the most important provisions and dates are outlined in a new brochure (PDF), "How are YOU Impacted? An Employer's Guide to Health Care Reform."
To request printed copies of the brochure, please contact your Account Consultant and reference form number B-4280.
View Brochure (PDF) >>
Sunday, February 3, 2013
Comptroller Thomas P. DiNapoli's Weekly News
Comptroller Thomas P. DiNapoli's Weekly News
DiNapoli Finalizes Fiscal Monitoring System
State Comptroller Thomas P. DiNapoli announced Monday his office has finalized plans to implement a statewide fiscal monitoring system that would publicly identify local governments experiencing financial strain.
DiNapoli: Inappropriate Payments Cited In Kingston Audit
The city of Kingston made $23,000 in improper payments to employees for unearned leave time, according to an audit released Thursday by State Comptroller Thomas P. DiNapoli. As a result of the audit, former fire chief Richard Salzmann was arrested and charged by Ulster County District Attorney D. Holley Carnright with offering a false instrument for filing in the second degree, a class A misdemeanor.
DiNapoli: Empire BlueCross BlueShield Paying Hospitals Windfalls For Special Medical Items
New York State health insurance provider Empire BlueCross BlueShield has routinely allowed hospitals to charge excessive amounts for special medical items such as implants, drugs and blood, because they did not sign agreements to limit reimbursement for those items, according to an audit of the New York State Health Insurance Program released Friday by State Comptroller Thomas P. DiNapoli.
DiNapoli: Utica Facing Continued Fiscal Challenges
The city of Utica continues to struggle with recurring budget gaps and has nearly depleted its fund balances, according to a fiscal report issued Tuesday by State Comptroller Thomas P. DiNapoli. The report is the latest in a series of fiscal profiles on cities across the state.
State Comptroller Thomas P. DiNapoli announced Monday his office has finalized plans to implement a statewide fiscal monitoring system that would publicly identify local governments experiencing financial strain.
DiNapoli: Inappropriate Payments Cited In Kingston Audit
The city of Kingston made $23,000 in improper payments to employees for unearned leave time, according to an audit released Thursday by State Comptroller Thomas P. DiNapoli. As a result of the audit, former fire chief Richard Salzmann was arrested and charged by Ulster County District Attorney D. Holley Carnright with offering a false instrument for filing in the second degree, a class A misdemeanor.
DiNapoli: Empire BlueCross BlueShield Paying Hospitals Windfalls For Special Medical Items
New York State health insurance provider Empire BlueCross BlueShield has routinely allowed hospitals to charge excessive amounts for special medical items such as implants, drugs and blood, because they did not sign agreements to limit reimbursement for those items, according to an audit of the New York State Health Insurance Program released Friday by State Comptroller Thomas P. DiNapoli.
DiNapoli: Utica Facing Continued Fiscal Challenges
The city of Utica continues to struggle with recurring budget gaps and has nearly depleted its fund balances, according to a fiscal report issued Tuesday by State Comptroller Thomas P. DiNapoli. The report is the latest in a series of fiscal profiles on cities across the state.
Comptroller DiNapoli Releases Municipal Audits
New York State Comptroller Thomas P. DiNapoli Thursday announced his office completed audits of:
Comptroller DiNapoli Releases School Audits
New York State Comptroller Thomas P. DiNapoli Thursday announced his office completed audits of:
Tuesday, January 29, 2013
The Inexpensive Solution to Volunteer Protection
The Inexpensive Solution to Volunteer Protection
Sometimes, volunteers have accidents - injure someone, get hurt themselves, or have an auto accident. Usually, their own insurance is not enough to take care of the damage. And the nonprofit organization's insurance does not protect the volunteer in some critical areas of risk.
Your nonprofit organization has the option of adding volunteers as additional insureds on the commercial general liability (CGL) policy. However, such an endorsement usually excludes volunteers' travel between home and the place of volunteer duty. Also, a CGL endorsement excludes coverage for claims made by one volunteer against another. Finally, the organization risks sharing its own limits of insurance - under the CGL policy - with the volunteer.
Your nonprofit organization has the option of adding volunteers as additional insureds on the commercial general liability (CGL) policy. However, such an endorsement usually excludes volunteers' travel between home and the place of volunteer duty. Also, a CGL endorsement excludes coverage for claims made by one volunteer against another. Finally, the organization risks sharing its own limits of insurance - under the CGL policy - with the volunteer.
Covering volunteers under workers' compensation usually is not the wisest approach. First, a volunteer's injury would affect the claims experience of the nonprofit, which could increase workers' compensation insurance costs. Second, workers' compensation does not protect the volunteer during travel to and from their volunteer duty.
However, there is an inexpensive solution to the problem...
To protect volunteers, the Volunteers Insurance Service (VIS®) program offers the following three coverages separately or combined:
- Up to $50,000 in accident medical reimbursement as a result of covered accident - at a cost of $3.94 per volunteer per year;
- Up to $1,000,000 in personal liability insurance - $1.72 per volunteer per year with a minimum premium of $100;
- For those volunteers who drive, up to $500,000 in excess automobile liability insurance above the volunteer's own insurance -$6.34 per volunteer per year with a minimum premium of $100.
VIS® Membership is required in order to sign up for any of the above programs; which an annual membership fee of $135 (July-June fiscal year).
For More Info Click Here
For More Info Click Here
Tuesday, September 4, 2012
Answers About Health Care Reform for New Yorkers
Many of you have questions about health care reform in New York and what its implications are for both you and your clients. Here is an article that clearly explains some of the main questions people are asking. These answers come from James Knickman, a knowledgeable and reputable source, who is the President and Chief Executive Officer of the New York State Health Foundation (NYSHealth), a private, statewide foundation dedicated to improving the health of all New Yorkers.
Wednesday, August 8, 2012
Council Services Plus Update on Health Care Reform: Are You Prepared?
NYCON's insurance subsidiary Council Services Plus (CS Plus) offers info, resources and direct insurance assistance to nonprofits across NYS. CS Plus only works with nonprofits, and has brought over $1 million in savings to nonprofit clients. Visit www.councilservicesplus.com for more info or e-mail.
Most U.S. citizens and legal residents will be required to have health insurance in 2014. Those without coverage would pay a tax penalty based on household income to be phased-in starting in 2014. Federal subsidies will be available to assist those who cannot afford to purchase coverage. Large employers (50 or more full-time employees) will be required to "pay or play" starting in 2014. Qualifying small employers (no more than 25 employees) are eligible for a tax credit for offering coverage beginning in 2010. The tax credit increases in 2014 if employers buy from the exchange, and then phases out in 2016. Some of the key mandates are below. 
To
view a larger image of the timeline, CLICK HERE.
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Monday, June 13, 2011
Senate unveils health ‘market’
The Daily Mail reported that a bill key to implementing last year’s federal health care overhaul in New York state was introduced this week in the state Senate.
The proposed legislation would establish a health insurance exchange, a marketplace where individuals and small businesses can, come 2014, shop for and compare private insurance plans.
The Senate bill “is a first step in advancing a health insurance exchange that will ensure affordable and accessible coverage that meets the unique insurance needs of all New Yorkers,” said Sen. James Seward, R-Oneonta, who, as chairman of the Senate Insurance Committee, has sponsored the legislation.
Sen. Kemp Hannon, R-Garden City, chairman of the Senate Health Committee, is the bill’s cosponsor.
The bill was drafted following a roundtable discussion in April with health care and insurance experts.
“This legislation sets up the governing structure and basic functions that are required in order for the exchange to begin to function, while providing for a transparent process and careful consideration of policy choices,” Hannon said.
There has yet to be a companion bill introduced in the state Assembly. Seward says talks are ongoing with the Assembly and the governor’s office.
Seward’s bill establishes the exchange as a public authority with an 11-member board of directors. States have the power to choose how the exchanges are governed and whether it will exist as a nonprofit organization, quasi-governmental entity like a public authority or within a state agency.
“We don’t want this to turn into an expensive and beaurcratic program,” Seward said in explaining the decision to create the exchange as a public authority.
The exchange will not receive any state funding, under the bill. Seward said its operation could be kept going by fees paid by participating health care providers and others. It’s unknown at this point how much it will cost to keep the exchange running.
According to Seward, the federal government has given New York $28 million to date to establish the exchange.
Although a public authority operates with more independence than a state agency, questions still exist about whether the exchange will be sufficiently insulated from political influence and special interests within the insurance industry, including who will be charged with choosing the board of directors. “Some of these decisions are yet to be made,” Seward said.
Under the health care law, states must establish the governing structure of the exchanges by the end of this year. By 2013, states must prove to the federal government they are qualified to run the program. Consumers will be able to purchase insurance through the exchanges in 2014.
Members of Congress, too, will be getting their health insurance through exchanges starting in 2014.
The exchanges are a main provision of the health care law. The hope is that by increasing competition among health care plans and providing more choices for individuals and businesses, costs will come down.
“As a result of high costs, the market for individuals in the state has been in sharp decline for years,” said Paul Howard, a senior fellow at the Manhattan Institute for Policy Research, in a recent report. “As recently as 2001, more than 128,000 individuals were enrolled in (health maintenance organizations) in the direct-pay market. By 2010, enrollment had plummeted to just 31,000.” Premiums have roughly tripled during that period, according to Howard.
“In all, about 15 percent (2.6 million) of New York’s residents are uninsured, a group that is largely young (about half are aged 18 to 34), in good health and without dependents,” he added. Under the new federal law, young adults can remain on their parents’ plan until they turn 26. That provision has already taken effect.
To learn more about the law’s many provisions and when they take effect, visit www.healthcare.gov.
“Frankly, I have mixed feelings (about the health care law),” Seward said.
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 panel is made up of two Democratic appointees and one Republican appointee.
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 Florida judge who struck down the law. And it's never easy to predict how an appeals panel will decide.
But during almost three hours of oral arguments, the judges asked pointed questions about the so-called individual mandate, which the federal government says is needed to expand coverage to tens of millions of uninsured Americans.
With other challenges to the law before other federal appeals courts, lawyers expect that its fate will ultimately be decided by the U.S. Supreme Court.
Chief Judge Joel Dubina, who was tapped by 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 both appointed by 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.
Hull also seemed skeptical about the government's claim that the mandate was crucial to covering the 50 million or so uninsured Americans. She said the rolls of the uninsured could be pared significantly through other parts of the package, including expanded Medicare discounts for some seniors and a change that makes it easier for those with pre-existing medical conditions to get coverage.
The court, which did not indicate when it would rule, has several options. But Hull and Dubina asked the lawyers on both sides to focus on a particular outcome: What could happen to the overhaul, they asked separately, if the individual mandate were invalidated but the rest of the package were upheld?
Parts of the overall law should still survive, said Katyal, but he warned the judges they’d make a “deep, deep mistake” if the insurance requirement were found to be unconstitutional. He said Congress had the right to regulate what uninsured Americans must buy because they shift $43 billion each year in medical costs to other taxpayers.
Clement, however, argued that the insurance requirement is the “driving force” of the broader package, which he said violates the Constitution's legitimate authority. Without it, he said, the rest of the package should collapse.
“If you take out the hub, the spokes will fall,” Clement said.
Marcus, meanwhile, said the case struck him as an argument over individual liberties, but questioned whether the judicial branch should “stop at the water’s edge” or intervene.
The 11th Circuit is not the first appeals court to hear arguments about the constitutionality of the federal health care overhaul, as panels in Cincinnati and Richmond have both heard similar legal challenges to the law within the last month. But legal observers say the Atlanta panel’s decision could be the most pivotal because the ruling by U.S. District Judge Roger Vinson of Florida is considered the broadest assault yet on the law.
While a Republican-appointed federal judge in Virginia struck down the requirement that nearly all Americans carry health insurance, Vinson invalidated the entire law, from the Medicare expansion to a change that allows adult children up to age 26 to remain on their parents’ insurance. Three federal judges, all Democratic appointees, have upheld the law.
The proposed legislation would establish a health insurance exchange, a marketplace where individuals and small businesses can, come 2014, shop for and compare private insurance plans.
The Senate bill “is a first step in advancing a health insurance exchange that will ensure affordable and accessible coverage that meets the unique insurance needs of all New Yorkers,” said Sen. James Seward, R-Oneonta, who, as chairman of the Senate Insurance Committee, has sponsored the legislation.
Sen. Kemp Hannon, R-Garden City, chairman of the Senate Health Committee, is the bill’s cosponsor.
The bill was drafted following a roundtable discussion in April with health care and insurance experts.
“This legislation sets up the governing structure and basic functions that are required in order for the exchange to begin to function, while providing for a transparent process and careful consideration of policy choices,” Hannon said.
There has yet to be a companion bill introduced in the state Assembly. Seward says talks are ongoing with the Assembly and the governor’s office.
Seward’s bill establishes the exchange as a public authority with an 11-member board of directors. States have the power to choose how the exchanges are governed and whether it will exist as a nonprofit organization, quasi-governmental entity like a public authority or within a state agency.
“We don’t want this to turn into an expensive and beaurcratic program,” Seward said in explaining the decision to create the exchange as a public authority.
The exchange will not receive any state funding, under the bill. Seward said its operation could be kept going by fees paid by participating health care providers and others. It’s unknown at this point how much it will cost to keep the exchange running.
According to Seward, the federal government has given New York $28 million to date to establish the exchange.
Although a public authority operates with more independence than a state agency, questions still exist about whether the exchange will be sufficiently insulated from political influence and special interests within the insurance industry, including who will be charged with choosing the board of directors. “Some of these decisions are yet to be made,” Seward said.
Under the health care law, states must establish the governing structure of the exchanges by the end of this year. By 2013, states must prove to the federal government they are qualified to run the program. Consumers will be able to purchase insurance through the exchanges in 2014.
Members of Congress, too, will be getting their health insurance through exchanges starting in 2014.
The exchanges are a main provision of the health care law. The hope is that by increasing competition among health care plans and providing more choices for individuals and businesses, costs will come down.
“As a result of high costs, the market for individuals in the state has been in sharp decline for years,” said Paul Howard, a senior fellow at the Manhattan Institute for Policy Research, in a recent report. “As recently as 2001, more than 128,000 individuals were enrolled in (health maintenance organizations) in the direct-pay market. By 2010, enrollment had plummeted to just 31,000.” Premiums have roughly tripled during that period, according to Howard.
“In all, about 15 percent (2.6 million) of New York’s residents are uninsured, a group that is largely young (about half are aged 18 to 34), in good health and without dependents,” he added. Under the new federal law, young adults can remain on their parents’ plan until they turn 26. That provision has already taken effect.
To learn more about the law’s many provisions and when they take effect, visit www.healthcare.gov.
“Frankly, I have mixed feelings (about the health care law),” Seward said.
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 panel is made up of two Democratic appointees and one Republican appointee.
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 Florida judge who struck down the law. And it's never easy to predict how an appeals panel will decide.
But during almost three hours of oral arguments, the judges asked pointed questions about the so-called individual mandate, which the federal government says is needed to expand coverage to tens of millions of uninsured Americans.
With other challenges to the law before other federal appeals courts, lawyers expect that its fate will ultimately be decided by the U.S. Supreme Court.
Chief Judge Joel Dubina, who was tapped by 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 both appointed by 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.
Hull also seemed skeptical about the government's claim that the mandate was crucial to covering the 50 million or so uninsured Americans. She said the rolls of the uninsured could be pared significantly through other parts of the package, including expanded Medicare discounts for some seniors and a change that makes it easier for those with pre-existing medical conditions to get coverage.
The court, which did not indicate when it would rule, has several options. But Hull and Dubina asked the lawyers on both sides to focus on a particular outcome: What could happen to the overhaul, they asked separately, if the individual mandate were invalidated but the rest of the package were upheld?
Parts of the overall law should still survive, said Katyal, but he warned the judges they’d make a “deep, deep mistake” if the insurance requirement were found to be unconstitutional. He said Congress had the right to regulate what uninsured Americans must buy because they shift $43 billion each year in medical costs to other taxpayers.
Clement, however, argued that the insurance requirement is the “driving force” of the broader package, which he said violates the Constitution's legitimate authority. Without it, he said, the rest of the package should collapse.
“If you take out the hub, the spokes will fall,” Clement said.
Marcus, meanwhile, said the case struck him as an argument over individual liberties, but questioned whether the judicial branch should “stop at the water’s edge” or intervene.
The 11th Circuit is not the first appeals court to hear arguments about the constitutionality of the federal health care overhaul, as panels in Cincinnati and Richmond have both heard similar legal challenges to the law within the last month. But legal observers say the Atlanta panel’s decision could be the most pivotal because the ruling by U.S. District Judge Roger Vinson of Florida is considered the broadest assault yet on the law.
While a Republican-appointed federal judge in Virginia struck down the requirement that nearly all Americans carry health insurance, Vinson invalidated the entire law, from the Medicare expansion to a change that allows adult children up to age 26 to remain on their parents’ insurance. Three federal judges, all Democratic appointees, have upheld the law.
Tuesday, February 22, 2011
NONDISCRIMINATION TESTING FOR EMPLOYER-SPONSORED HEALTH PLANS
Council Services Plus has formed a partnership with Watson and West, LLP to assist employers with nondiscrimination testing requirements. We are following the legislation and updates to keep abreast of the mandate. We have the resources and expertise to provide the testing requirements once the rules and regulations are established. It will be imperative for employers to satisfy these rules to avoid penalties under section 2716 of the Public Health Services Act (PHSA).
You are receiving this email as a courtesy to help you and your organization prepare for compliance with this aspect of The Patient Protection and Affordable Care Act (PPACA).
Employers are familiar with Section 105(h) testing for retirement plans. PPACA includes similar testing for group health plans to ensure that highly compensated employees (HCE) do not receive favorable treatment in comparison to rank-and-file employees. The full picture of the impact is not yet available due to administrative reviews by the IRS and other federal government agencies; however, we can anticipate that employer groups with 100 employees or more will be required to perform nondiscrimination testing similar, but not the same as, Section 105(h). Oversight of nondiscrimination testing for health plans is shared by the US Departments of Treasury, Labor and HHS.
At this time, please be aware that nondiscrimination requirements focus on plan benefits, eligibility, premium contribution, and administration of benefits to prohibit employers from granting highly compensated employees health benefits that are more generous than the general population of employees. We anticipate clarification of regulations to be available around May. If you are interested in learning more details of the legislation, or want us to keep you informed regarding updates to the regulations, please feel fre to contact us.
For more information or questions concerning the above, please contact Cathy Connors, at (800) 515-5012 x131; or via email at cconnorscconnors@councilservicesplus.com
You are receiving this email as a courtesy to help you and your organization prepare for compliance with this aspect of The Patient Protection and Affordable Care Act (PPACA).
Employers are familiar with Section 105(h) testing for retirement plans. PPACA includes similar testing for group health plans to ensure that highly compensated employees (HCE) do not receive favorable treatment in comparison to rank-and-file employees. The full picture of the impact is not yet available due to administrative reviews by the IRS and other federal government agencies; however, we can anticipate that employer groups with 100 employees or more will be required to perform nondiscrimination testing similar, but not the same as, Section 105(h). Oversight of nondiscrimination testing for health plans is shared by the US Departments of Treasury, Labor and HHS.
At this time, please be aware that nondiscrimination requirements focus on plan benefits, eligibility, premium contribution, and administration of benefits to prohibit employers from granting highly compensated employees health benefits that are more generous than the general population of employees. We anticipate clarification of regulations to be available around May. If you are interested in learning more details of the legislation, or want us to keep you informed regarding updates to the regulations, please feel fre to contact us.
For more information or questions concerning the above, please contact Cathy Connors, at (800) 515-5012 x131; or via email at cconnorscconnors@councilservicesplus.com
Tuesday, January 18, 2011
Study Reports Up to Half in US Impacted by Pre-existing Conditions for Health Insurance Coverage
http://www.msnbc.com/ reported on a study that as many 129 million Americans at risk of being rejected for insurance coverage or having to pay more.
As many as 129 million Americans under age 65 have medical problems putting them at risk of being rejected by insurance companies or having to pay more for coverage, according to a U.S. government study reported by the Washington Post on Tuesday.
The Department of Health and Human Services is scheduled to release the study on Tuesday, the Post said, the same day the House of Representatives is expected to begin considering a Republican bill to repeal President Barack Obama's healthcare overall.
Health highlights fda.gov Online diet pills often contain dangerous ingredients
More and more, weight loss products are being "adulterated" with potentially dangerous ingredients by their manufacturers.
.Bummed out? 'Blue Monday' is here. (Or is it?)
Updated 117 minutes ago 1/18/2011 1:54:52 PM +00:00 Giffords doing well after two surgeries over weekend
Bullet to the head can be overcome, survivors say
Don't choke! Students write off test anxiety
..The report is part of the Obama administration's effort to convince the public of the advantages of the law, which contains insurance protections for people with pre-existing medical conditions.
"Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need," HHS Secretary Kathleen Sebelius said in a statement to be released Tuesday, the Post reported.
The study found that one-fifth to one-half of non-elderly people in the United States have conditions that trigger rejection or higher prices in the individual insurance market, the Post said. They range from cancer to chronic illnesses such as heart disease, asthma and high blood pressure.
A Republican House aide, speaking on condition of anonymity because the report was not yet public, told the Post: "When a new analysis is released on the eve of a vote in Congress, it's hard to view it as anything but politics and public relations."
The repeal vote would fulfil a campaign promise of Republicans who won control of the House in November elections. But the measure will likely die in the Senate, where Democrats held on to their majority.
As many as 129 million Americans under age 65 have medical problems putting them at risk of being rejected by insurance companies or having to pay more for coverage, according to a U.S. government study reported by the Washington Post on Tuesday.
The Department of Health and Human Services is scheduled to release the study on Tuesday, the Post said, the same day the House of Representatives is expected to begin considering a Republican bill to repeal President Barack Obama's healthcare overall.
Health highlights fda.gov Online diet pills often contain dangerous ingredients
More and more, weight loss products are being "adulterated" with potentially dangerous ingredients by their manufacturers.
.Bummed out? 'Blue Monday' is here. (Or is it?)
Updated 117 minutes ago 1/18/2011 1:54:52 PM +00:00 Giffords doing well after two surgeries over weekend
Bullet to the head can be overcome, survivors say
Don't choke! Students write off test anxiety
..The report is part of the Obama administration's effort to convince the public of the advantages of the law, which contains insurance protections for people with pre-existing medical conditions.
"Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need," HHS Secretary Kathleen Sebelius said in a statement to be released Tuesday, the Post reported.
The study found that one-fifth to one-half of non-elderly people in the United States have conditions that trigger rejection or higher prices in the individual insurance market, the Post said. They range from cancer to chronic illnesses such as heart disease, asthma and high blood pressure.
A Republican House aide, speaking on condition of anonymity because the report was not yet public, told the Post: "When a new analysis is released on the eve of a vote in Congress, it's hard to view it as anything but politics and public relations."
The repeal vote would fulfil a campaign promise of Republicans who won control of the House in November elections. But the measure will likely die in the Senate, where Democrats held on to their majority.
Monday, September 6, 2010
Governor Paterson Names Advisory Committee to Help Health Care Reform Cabinet
Governor David A. Paterson today named 37 organizations to the Health Care Reform Advisory Committee, which will provide input to the Governor's Health Care Reform Cabinet on the implementation of federal health care reform in New York State. The Advisory Committee includes organizations representing health care providers, consumers, businesses, organized labor, local governments, health plans and health insurers, and health policy experts.
"Federal health care reform will have a significantly positive impact for New York's residents, families, small business owners and the 2.5 million New Yorkers who are currently uninsured," Governor Paterson said. "It is essential that we get health reform right, making the most of this opportunity to improve access to health care while reducing cost. Our broad advisory group will help us achieve this goal."
The Advisory Committee will advise the Cabinet on reform provisions and ensure stakeholder and public engagement in all aspects of federal health care reform. It will support the implementation of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. In addition, Advisory Committee Workgroups will be created to focus on specific issues and additional organizations with expertise will be asked to join those work groups. A series of public forums across the State will also be held to provide opportunities for further stakeholder input.
Wendy Saunders, Deputy Secretary for Health, Medicaid and Oversight and Chair of the Health Care Reform Cabinet, said: "I commend Governor Paterson for his dedication to health care reform and for his efforts to expand access to quality health care for all New Yorkers. Implementing federal health care reform is a complex task, and many decisions must be made by the end of this year. We need public participation and input to help make reform a success and the Advisory Committee is an essential part of that input."
The Health Care Reform Cabinet is responsible for:
• Identifying deadlines for the completion of interim or final steps necessary or desired to comply with the provisions of federal health care reform;
• Determining those provisions of federal health care reform with which the State must comply and those that are optional, and evaluating whether participation in optional programs is appropriate;
• Assessing the State's capacity to carry out those provisions of federal health care reform that affect or potentially affect the State;
• Identifying any changes needed to State statute, regulation, policy or procedure in order to implement such provisions, and facilitating the achievement of such changes as necessary;
• Communicating with the federal government, local governments, other states, health care providers, and other stakeholders as advisable or necessary; and
• Providing public outreach to educate individuals on the implementation of the reforms as necessary.
Under Governor Paterson's leadership, New York State has become a national leader in expanding access to quality health care for children and adults through its public health insurance programs, including Child Health Plus, Family Health Plus, Healthy New York and Medicaid, while implementing efficiencies to ensure that funds are used in the most cost-effective manner. New York is the only state in the nation with both open enrollment and pure community rating and has been a leader in efforts to guarantee access to private health insurance coverage.
Organizations participating in the Governor's Health Care Reform Advisory Committee include:
• 1199 SEIU
• AFL-CIO
• Business and Labor Coalition of New York
• Business Council of New York State
• Centerstate CEO
• Chamber Alliance of New York State
• Children's Defense Fund
• Coalition of New York State Public Health Plans
• Community Health Care Association of New York State
• Community Service Society
• Consumer Directed Choices
• Empire Justice Center
• Family Planning Advocates
• Finger Lakes Health Systems Agency
• Greater New York Hospital Association
• Health Care for All New York
• Healthcare Association of New York State
• Hispanic Federation
• Medicaid Matters
• Medical Society of the State of New York
• Medicare Rights Center
• National Black Leadership Commission on AIDS
• New York Health Plan Association
• New York Immigration Coalition
• New York State Association of Counties
• New York State Association of Health Underwriters
• New York State Conference of Blue Cross Plans
• New York State Council for Community Behavioral Healthcare
• New York State Health Foundation
• New Yorkers for Accessible Health Coverage
• Office of the Mayor of New York City
• P2 Collaborative of Western New York
• Partnership for New York City
• Project CHARGE
• United Hospital Fund
• Visiting Nurse Service of New York
• Young Invincibles
For additional information on health care reform implementation in New York State, please visit: www.HealthCareReform.ny.gov.
"Federal health care reform will have a significantly positive impact for New York's residents, families, small business owners and the 2.5 million New Yorkers who are currently uninsured," Governor Paterson said. "It is essential that we get health reform right, making the most of this opportunity to improve access to health care while reducing cost. Our broad advisory group will help us achieve this goal."
The Advisory Committee will advise the Cabinet on reform provisions and ensure stakeholder and public engagement in all aspects of federal health care reform. It will support the implementation of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. In addition, Advisory Committee Workgroups will be created to focus on specific issues and additional organizations with expertise will be asked to join those work groups. A series of public forums across the State will also be held to provide opportunities for further stakeholder input.
Wendy Saunders, Deputy Secretary for Health, Medicaid and Oversight and Chair of the Health Care Reform Cabinet, said: "I commend Governor Paterson for his dedication to health care reform and for his efforts to expand access to quality health care for all New Yorkers. Implementing federal health care reform is a complex task, and many decisions must be made by the end of this year. We need public participation and input to help make reform a success and the Advisory Committee is an essential part of that input."
The Health Care Reform Cabinet is responsible for:
• Identifying deadlines for the completion of interim or final steps necessary or desired to comply with the provisions of federal health care reform;
• Determining those provisions of federal health care reform with which the State must comply and those that are optional, and evaluating whether participation in optional programs is appropriate;
• Assessing the State's capacity to carry out those provisions of federal health care reform that affect or potentially affect the State;
• Identifying any changes needed to State statute, regulation, policy or procedure in order to implement such provisions, and facilitating the achievement of such changes as necessary;
• Communicating with the federal government, local governments, other states, health care providers, and other stakeholders as advisable or necessary; and
• Providing public outreach to educate individuals on the implementation of the reforms as necessary.
Under Governor Paterson's leadership, New York State has become a national leader in expanding access to quality health care for children and adults through its public health insurance programs, including Child Health Plus, Family Health Plus, Healthy New York and Medicaid, while implementing efficiencies to ensure that funds are used in the most cost-effective manner. New York is the only state in the nation with both open enrollment and pure community rating and has been a leader in efforts to guarantee access to private health insurance coverage.
Organizations participating in the Governor's Health Care Reform Advisory Committee include:
• 1199 SEIU
• AFL-CIO
• Business and Labor Coalition of New York
• Business Council of New York State
• Centerstate CEO
• Chamber Alliance of New York State
• Children's Defense Fund
• Coalition of New York State Public Health Plans
• Community Health Care Association of New York State
• Community Service Society
• Consumer Directed Choices
• Empire Justice Center
• Family Planning Advocates
• Finger Lakes Health Systems Agency
• Greater New York Hospital Association
• Health Care for All New York
• Healthcare Association of New York State
• Hispanic Federation
• Medicaid Matters
• Medical Society of the State of New York
• Medicare Rights Center
• National Black Leadership Commission on AIDS
• New York Health Plan Association
• New York Immigration Coalition
• New York State Association of Counties
• New York State Association of Health Underwriters
• New York State Conference of Blue Cross Plans
• New York State Council for Community Behavioral Healthcare
• New York State Health Foundation
• New Yorkers for Accessible Health Coverage
• Office of the Mayor of New York City
• P2 Collaborative of Western New York
• Partnership for New York City
• Project CHARGE
• United Hospital Fund
• Visiting Nurse Service of New York
• Young Invincibles
For additional information on health care reform implementation in New York State, please visit: www.HealthCareReform.ny.gov.
Tuesday, August 3, 2010
2010 New York State Grand Rounds on the Abuse of Prescription Pain Relievers
September 20, 2010
9:00 a.m. – 10:30 a.m.
Room MS169
Albany Medical College
Live, Video conference and/or webcast
The streaming link is:
http://streaming.aanet.org/ramgen/amc/AMC_PRC092010.smil
Dial in participants will dial
1-866-719-1998
Pass code 800285.
Your phones will be muted during the panel presentations and will turned on when the panel is open for discussion.
If you have Codecs and want to be active participants via ISDN or IP, that can be arranged as well.
Please contact Joyce Davis with any questions you might have at:
518-686-0221 or jnadine@roadrunner.com.
2010 New York State Grand Rounds on the Abuse of Prescription Pain Relievers
Panel Discussion
Non-medical use of prescription pain relievers rose 111 percent between 2004 and 2008, according to a new study by the Substance Abuse and Mental Health Services Administrations (SAMHSA) and the Centers for Disease Control and Prevention (CDC).
In Rensselaer County 4 youth died between September 2009 and April 2010 from abusing prescription pain medications. This CME program is geared to assist medical personnel who prescribe prescription pain medications assure they are not abused by youth and adults.
The training will be offered in four venues: at the Medical College, by video conference and webcast live and an archive stream provided by the Adirondack Area Network. Participants in the webcast will be able to call in and ask questions during the presentation.
9:00 a.m. – 10:30 a.m.
Room MS169
Albany Medical College
Live, Video conference and/or webcast
The streaming link is:
http://streaming.aanet.org/ramgen/amc/AMC_PRC092010.smil
Dial in participants will dial
1-866-719-1998
Pass code 800285.
Your phones will be muted during the panel presentations and will turned on when the panel is open for discussion.
If you have Codecs and want to be active participants via ISDN or IP, that can be arranged as well.
Please contact Joyce Davis with any questions you might have at:
518-686-0221 or jnadine@roadrunner.com.
2010 New York State Grand Rounds on the Abuse of Prescription Pain Relievers
Panel Discussion
Non-medical use of prescription pain relievers rose 111 percent between 2004 and 2008, according to a new study by the Substance Abuse and Mental Health Services Administrations (SAMHSA) and the Centers for Disease Control and Prevention (CDC).
In Rensselaer County 4 youth died between September 2009 and April 2010 from abusing prescription pain medications. This CME program is geared to assist medical personnel who prescribe prescription pain medications assure they are not abused by youth and adults.
The training will be offered in four venues: at the Medical College, by video conference and webcast live and an archive stream provided by the Adirondack Area Network. Participants in the webcast will be able to call in and ask questions during the presentation.
Friday, June 25, 2010
Bill Passed in Albany to Make Insurers Pay for Autism Care
By Danny Hakim New York Times June 22, 2010
State lawmakers passed legislation this week that would require insurers to cover autism-related screenings, diagnoses and treatments. The move was a relief for parents of children with autism spectrum disorders, but was sure to increase insurance premiums across the board.
The State Assembly passed the measure Monday night, a few weeks after it passed in the Senate. The measure passed unanimously in both houses.
It now goes to Gov. David A. Paterson. New York would become the 22nd state in which insurers are required to cover autism-related treatments.
“We’ll review it once it’s delivered,” said Morgan Hook, a spokesman for the governor.
In a statement, Sheldon Silver, the Assembly speaker and a Manhattan Democrat, said, “It would be unconscionable to force New Yorkers to pay out-of-pocket for this common, chronic condition.”
There have been a variety of estimates of the effect of the legislation on insurance premiums.
“The bill sponsors acknowledge it will raise premiums up to 2 percent,” said Paul F. Macielak, the chief executive of the New York Health Plan Association, an insurance industry group, in a statement earlier this month.
“Each additional coverage requirement, while they may seem well intentioned, also carries a cost,” he said.
His group has criticized lawmakers for proposing a flurry of mandated coverage this year for things like prenatal vitamins, infant baby formula and wheelchair purchases.
“Lawmakers can’t have it both ways,” Mr. Macielak said. “It’s hypocritical for them to criticize insurance premiums as being too high and then turn around and mandate a slew of new benefits that only drive up costs.”
Peter H. Bell, an executive vice president of Autism Speaks, an advocacy group, said, “Our estimate is that it was closer to a 0.5 percent premium increase, and our experience in other states is that the increase is lower than expected.”
Mr. Bell added that the bill was more sweeping than those passed in most other states.
“It has the potential to be the most comprehensive of its kind, because other states have a dollar cap and an age cap, which means that the treatments are only available up to a certain amount of money or for specific ages,” he said. “But the bill in New York does not have those limitations.”
Statistics from the American Academy of Pediatrics, which supports the legislation, found that the autism rate among children in New York has been increasing by about 15 percent annually, now affecting close to 1 in 90 children.
“This is the next step towards making certain that individuals with autism and their families are given the appropriate insurance coverage they deserve and have earned,” said Senator Roy J. McDonald, a Saratoga County Republican who has two autistic grandchildren. “But this is only the beginning, and the state needs to do more.”
State lawmakers passed legislation this week that would require insurers to cover autism-related screenings, diagnoses and treatments. The move was a relief for parents of children with autism spectrum disorders, but was sure to increase insurance premiums across the board.
The State Assembly passed the measure Monday night, a few weeks after it passed in the Senate. The measure passed unanimously in both houses.
It now goes to Gov. David A. Paterson. New York would become the 22nd state in which insurers are required to cover autism-related treatments.
“We’ll review it once it’s delivered,” said Morgan Hook, a spokesman for the governor.
In a statement, Sheldon Silver, the Assembly speaker and a Manhattan Democrat, said, “It would be unconscionable to force New Yorkers to pay out-of-pocket for this common, chronic condition.”
There have been a variety of estimates of the effect of the legislation on insurance premiums.
“The bill sponsors acknowledge it will raise premiums up to 2 percent,” said Paul F. Macielak, the chief executive of the New York Health Plan Association, an insurance industry group, in a statement earlier this month.
“Each additional coverage requirement, while they may seem well intentioned, also carries a cost,” he said.
His group has criticized lawmakers for proposing a flurry of mandated coverage this year for things like prenatal vitamins, infant baby formula and wheelchair purchases.
“Lawmakers can’t have it both ways,” Mr. Macielak said. “It’s hypocritical for them to criticize insurance premiums as being too high and then turn around and mandate a slew of new benefits that only drive up costs.”
Peter H. Bell, an executive vice president of Autism Speaks, an advocacy group, said, “Our estimate is that it was closer to a 0.5 percent premium increase, and our experience in other states is that the increase is lower than expected.”
Mr. Bell added that the bill was more sweeping than those passed in most other states.
“It has the potential to be the most comprehensive of its kind, because other states have a dollar cap and an age cap, which means that the treatments are only available up to a certain amount of money or for specific ages,” he said. “But the bill in New York does not have those limitations.”
Statistics from the American Academy of Pediatrics, which supports the legislation, found that the autism rate among children in New York has been increasing by about 15 percent annually, now affecting close to 1 in 90 children.
“This is the next step towards making certain that individuals with autism and their families are given the appropriate insurance coverage they deserve and have earned,” said Senator Roy J. McDonald, a Saratoga County Republican who has two autistic grandchildren. “But this is only the beginning, and the state needs to do more.”
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