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Tag: Virginia

Composite Premiums in the Small Group Market in Virginia

On Oct. 7, 2014, the Virginia Bureau of Insurance published two documents relating to composite premiums in the Virginia small group market. As background, final rules issued by HHS on March 11, 2014, provided for a two-tiered federal calculation method for composite rates (one tier for each covered adult age 21 or older and a second tier for each covered child under age 21). However, the same final rule permitted states to substitute their own alternative to the federal methodology by seeking approval from HHS.

According to the two documents, Virginia has been approved for and will implement a four-tiered rating structure, including employee, employee plus spouse, employee plus children and employee plus family. This means that while insurers issuing small group market plans in Virginia may continue to provide per-member billing, they may choose to provide family composite premiums on an optional basis. If so, the insurer must follow the state’s four-tiered alternative method, and must make it available for each small employer in the market, regardless of size. Importantly, tiered composite rates must be set at the beginning of the plan year and do not change throughout the plan year, even if the distribution of employees among the tier levels changes.

The tiered-composite methodology applies to Virginia small employer premium rates for plans offered outside of the federally-facilitated exchange in Virginia beginning Jan. 1, 2015. Those offered on the exchange must use per-member ratings.

Composite Premiums in the Small Group Market in Virginia

Approved Virginia Alternate Methodology

On July 28, 2014, the U.S. Court of Appeals for the Fourth Circuit, in Bostic v. Rainey, No. 14-1167 (4th Cir. 2014), upheld a federal district court ruling against Virginia’s ban on same-sex marriage. However, the court issued a stay on their ruling, meaning the ban on same-sex marriage remains in effect pending the outcome of any appeals. So for now, the ban remains the law in Virginia. The issue seems headed eventually to the U.S. Supreme Court.

Bostic v. Rainey

Read the full nationwide compliance report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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AAPPO Study: Consumer-Driven Health Plans Grew By 15 Percent Last Year

Enrollment in consumer-directed health plans (CDHPs) grew by 15 percent in 2013, according to a survey released today by the American Association of Preferred Provider Organizations (AAPPO).

Enrollment in the plans – which include health savings accounts, health reimbursement arrangements and flexible spending accounts – grew from 39 million in 2012 to 45 million in 2013, according to an AAPPO analysis of the Mercer National Survey of Employer Sponsored Health Plans.

“As major changes to the health system loomed last year, employers continued to look to consumer-directed health plans to offer the affordability, flexibility and stability to ensure their workforces get the care they need,” said Karen Greenrose, AAPPO President and CEO.

Among the survey’s findings:

– 23 percent of all employers offered CDHPs last year – up from 22 percent in 2012.
– 39 percent of large employers (500 or more employees) offered CDHPs in 2013 – up from 36 percent the year before.
– 23 percent of small employers offered CDHPs – up from 22 percent in 2012.
– 63 percent of the largest employers (more than 20,000 employees) offered CDHPs in 2013 – up from 32 percent.
– 35 percent of all employers expect to offer CDHPs in 2016, with 64 percent of large employers expecting to offer them.

The increase continues represents a more than doubling of employers that offer CDHPs since 2008 – from 10 percent in 2008 to 23 percent.

“Consumer-driven health plans offer patients more control over how their health dollars are spent while providing employers more affordability and stability in the cost of covering their workforces,” said Rep. Cathy McMorris Rodgers (R-WA). “In a challenging health care environment, these plans and the PPO networks they are built on provide a strong foundation for affordable care.”

To view the entire study – along with an infographic and video about the report, visit:
http://aappo.org/Resources/Research.aspx.

About the American Association of Preferred Provider Organizations (AAPPO)
Founded in 1983, AAPPO (www.aappo.org) is the leading national association of preferred provider organizations (PPOs). PPOs put control for medical decisions in the hands of the physician and patient, resulting in easy access to the right care, provided by the right doctor, at the right time. AAPPO creates a forum for discussion and dissemination of PPO best practices.

SOURCE: American Association of Preferred Provider Organizations

Read full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Senate Approves VA Reform Bill

The Senate on Wednesday overwhelmingly approved broad reforms to the Department of Veterans Affairs less than two weeks after a health care scandal led to the resignation of VA Secretary Eric Shinseki.

The unusually swift bipartisan passage spoke to the alarm lawmakers felt when reports revealed tens of thousands of veterans waited months for doctor appointments. The problems were worsened by agency employees who created false waiting lists to try to hide the crisis.

The bill makes it easier for the VA secretary to fire executive employees, creates 26 new VA medical facilities around the country, and authorizes $500 million for the hiring of new doctors and nurses.

It allows veterans waiting for care to go to private physicians and send their bills to the VA, among other provisions.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

The White House’s Five Most Egregiously Unilateral Changes to Obamacare

It’s above my pay grade to weigh in on the national security ramifications of President Obama’s release of five Guantanamo Bay detainees in exchange for American soldier Bowe Bergdahl. Likewise, I don’t pretend to be an expert on the law, but am willing to take CNN Senior Legal Analyst Jeffrey Toobin’s assertion that the president ”clearly broke the law” in doing so. This unequivocal conclusion was echoed by George Washington University law professor Jonathan Turley.

This matter wouldn’t seem to have much to do with health policy, except that as Professor Turley points out, “to make matters worse, this is a long series of violations of federal law that the president’s been accused of…This is going to add to that pile.” While I certainly don’t maintain a master list of the president’s long series of law violations, my impression is that the numerous law violations surrounding the lawless rollout of the the health care law likely constitute a non-trivial fraction of the total. Indeed, so far there have been at least 23 major changes to the law made through unilateral executive action.

Read full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.