Simply stated health care

It’s one of the provisions of the Affordable Care Act where everyone seemed to have an opinion.

What health care services deserve essential benefits status?

• There are 10 categories
• Individual/small group health plans in state Exchanges must offer them
• All Medicaid plans must offer them
• The provision is effective in 2014

The tricky part was what services should be included in those categories. HHS sought the opinion of the Institute of Medicine (IOM). Continue Reading »

It sounded like a good idea – require insurance companies to spend most of its premium dollars on health care and quality improvement.

Insurance brokers and agents are not feeling the love from the Medical Loss Ratio (MLR) provision of healthcare reform’s Affordable Care Act. Continue Reading »

Consulting firm, McKinsey & Co., created quite a summer breeze with a report it released in June.

According to the report, 45 to 50 percent of employers were definitely or probably going to pursue other alternatives to sponsoring health coverage – including dropping coverage.

This is all based on healthcare reform’s Affordable Care Act, and the provision that creates state insurance exchanges in 2014.

Enter another report that says Not so fast.  Continue Reading »

Health care reform’s Community Living Assistance Services and Support program (CLASS Act) was supposed to be a national voluntary insurance program for long-term care.

It is now gone before it even started.

Government officials dismissed the CLASS Act from health care reform.

CLASS Act Curriculum

The CLASS Act was Senator Ted Kennedy’s baby and co-sponsored by New Jersey’s Representative Frank Pallone.

It was meant to act as a supplement (not a replacement) to private Long-Term Care (LTC) insurance or Medicaid.

From the start, there were problems with the provision. Continue Reading »

Merriam-Webster defines essential as: of the utmost importance. 

How would you apply that to health benefits?

That’s the request the federal government made to the Institute of Medicine (IOM) –

Help define the essential benefits package required by

health reform’s Affordable Care Act

Continue Reading »

For those of us who started in the business before the gods invented computers, understanding employee benefit summaries is easy. That’s not to say we like them.

Most consumers don’t either.

• Legalese peppers the forms for fear of lawsuits
• Medical terms only a doctor could love strangle comprehension
• And if a pink elephant’s crossing the street, forget about coverage

So, when you need simplicity, who do you call? The government. Continue Reading »

The creation of state-based health insurance exchanges is the magic elixir for what ails healthcare reform. At least that’s what supporters hope.

The Department of Health and Human Service (HHS) released the first of undoubtedly many versions of proposed rules for the insurance exchanges.

If you can’t wait to read the 244 pages, you can download a pdf version here. Continue Reading »

Merriam-Webster defines quality as –

• A degree of excellence
• A distinguishing attribute

The challenge in delivering quality health care is making life and death decisions – literally. Continue Reading »

Are dental and vision plans off the hook for health reform?

The answer – it depends.

The Patient Protection and Affordable Care Act (Affordable Care Act) confused more than one group health plan sponsor. Early assumptions were standalone dental and vision plans were exempt from the Affordable Care Act.

A recent publication by Segal, an employee benefits consulting firm, indicates it’s not that black and white. Continue Reading »

While legislators continue to fight the health reform law, restaurant chains are also feeling the bite. Restaurants?

Yes, section 4205 of the Patient Protection and Affordable Care Act of 2010 (”Affordable Care Act”) set standards for nutritional labeling at chain restaurants and food sold from vending machines. Continue Reading »