Viewing posts from: May 2012

How do we put "insurance" back into health insurance?

Posted May 25, 2012 by PHaynes

The point of insurance?  Risk pools & adverse selection – approaches to the concept of health insurance are explored by Forbes.  Here’s a link to a thought-provoking article.  Putting the ‘Insurance’ Back in Health Insurance


Workers Unclear on ‘Safety Net’ Voluntary Benefits Can Provide

Posted May 25, 2012 by Megan DiMartino

From IFAWebNews

The majority of workers don’t expect they or their family members to be diagnosed with a serious illness, factors that discourage them from seeking employee benefits to protect them from these possibilities, according to a new survey. The majority (58%) also lack a financial plan for handling an unexpected illness or injury, according to the 2012 Aflac WorkForces Report. Exactly 57% say they would tap into savings were an unexpected incident to occur, while 30% would use their credit card to pay and 19% plan to withdraw money from their 401(k) plan to cover costs, researchers found.

The report found that 62% of workers polled think it’s not very or not at all likely they or a family member will be diagnosed with a serious illness like cancer, and 55% said they were not very or not at all likely to be diagnosed with a chronic illness such as heart disease or diabetes. “The fact that American workers aren’t aware of their medical risks and the potential financial impact of those risks is a very real concern that is only compounded when workers don’t take full advantage of available benefits options or adjust their savings strategies to be more prepared,” said Audrey Boone Tillman, executive vice president of corporate services at Aflac, in a statement.

The situation opens to door to greater discussions with employees. “Most individuals are looking to their employers to educate them about all available benefits options, not just traditional benefits changes or choices, to better understand how they can have a more secure safety net,” Tillman said. “It’s critical for employers to effectively communicate year-round about how new benefit options, like voluntary insurance, can help with high out-of-pocket expenses associated with a serious illness or accident.” Exactly 60% of workers would be at least somewhat likely to purchase voluntary health insurance plans if offered by their employer.

The 2012 Aflac WorkForces Report is an online survey of nearly 1,900 benefits decision-makers and more than 6,100 U.S. workers, conducted in January and February. The American Cancer Society suggests that one in three women and one in two men will be diagnosed with cancer at some point in their lives. Fully, 38.9 million injuries requiring a medical consultation occur each year, according to the National Safety Council. Just 8% of respondents strongly agree their family will be financially prepared in the event of an unexpected emergency, and 28% have less than $500 (51% have less than $1,000) in savings for emergency expenses.

Coping with Stress in the Workplace

Posted May 22, 2012 by PHaynes

Work stress is something we all face as employees and we all handle it differently. Being consistently overwhelmed at work can cause you to feel less confident, less productive and less satisfied with your job. Chronic work stress can also lead to mental and physical health problems.

Common Causes of Job Stress –  The following are common causes of excessive stress in the workplace:

1  Fear of job loss

2  Longer hours and more overtime as a result of staff cutbacks

3   Rising expectations for performance, with no raise in compensation or benefits

Know When You’ve Reached Your Limit – Here are some warning signs that you may have a little too much on your plate:

  • Loss of interest in work
  • Difficulty sleeping, daytime fatigue
  • Feelings of anxiousness, irritability or depression
  • Social withdrawal
  • Difficulty concentrating
  • Headaches and muscle tension

Learn How to Cope – You can learn how to manage job stress. There are many steps that can be taken to reduce work-related stress levels:

  • Take responsibility for improving your physical and emotional well-being. Making time for regular physical activity and finding healthy ways to express yourself are things that only you can do for yourself, and will leave you feeling more resilient.
  • Avoid pitfalls by taking a few moments to recognize any personal habits you might have that contribute to increased levels of stress. What knee-jerk habits or negative attitudes to you have at work that you could change?
  • Improve your communication skills to make dealing with management and coworkers easier and to better your relationships within the workplace.

For more information on how to manage stress in the workplace, visit:


PPACA: IRS Releases Final Health Tax Credit Regulations

Posted May 21, 2012 by Megan DiMartino

From LifeHealthPro

Final regulations for implementing the health insurance purchase tax credit provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) are set to appear in the Federal Register Wednesday.

PPACA opponents are challenging PPACA in Congress and the courts. If the act takes effect on schedules and works as drafters hope, individuals and small groups will be able to use PPACA tax incentives to buy coverage through a new system of health insurance exchanges, or Web-based health insurance supermarkets.

The new regulations, the Health Insurance Premium Tax Credit regulations, apply to individuals who buy coverage through the exchanges. The final regulations are based on draft PPACA tax credit regulations that were published in August 2011.

PPACA calls for individuals with incomes under 100% of the federal poverty level to be eligible for free coverage.

The U.S. Treasury Department, the parent of the IRS, says PPACA individual health insurance tax credits will be available to individuals and families with incomes from 100% to 400% of the poverty level. In 2011, families of four with incomes of $22,350 to $89,400 could have qualified for the credit, officials say.

The average credit for eligible individuals and families could be about $5,000 per year, officials say, citing estimates from the Congressional Budget Office. Milliman Inc., Seattle, recently reported that a typical employer is probably spending about $21,000 per year on health benefits for good preferred provider organization coverage for a worker in a family of four.

The typical credit amount will be equal to the difference between the premium for a “benchmark plan” and the taxpayer’s “expected contribution” for health coverage.

Taxpayers can get the credit during the year, months before they file their income tax returns, to help them pay for coverage.

Under PPACA, exchanges are supposed to offer 4 levels of health plans — platinum, gold, silver and bronze — with the levels based on how much of the cost of “essential health benefits” that a particular plan will cover.

For health insurance tax credit purposes, the benchmark plan will be the second-lowest-cost plan available through an exchange that would cover a family at the “silver” level of coverage, officials say.

The “expected contribution” is defined by PPACA and will range from 2% of income for families at 100% of the federal poverty level to 9.5% of income for families at 400% of the federal poverty level.

PPACA will not let carriers reject applicants with health problems or base premiums on applicants’ age, but it will let carriers charge older enrollees up to 4 times as much as they charge younger enrollees. Older tax credit recipients will be able to get larger credits than younger recipients, officials say.

Families can receive the full value of the credit even if the value of the credit exceeds the value of the income taxes they pay, but no family can get a credit that exceeds the premium for the plan purchased, officials say.

One question insurers, agents and brokers have had is how the IRS and other agencies will treat health savings account (HSA) plans, health reimbursement arrangement (HRA) plans, and other individual health account plans in connection with PPACA provisions and programs.

PPACA requires an employer that fails to offer affordable health coverage to an employee to pay a “shared responsibility” penalty for the employee. The IRS has suggested that an employer might have to pay the penalty if the employee’s share of the cost of the employer’s cheapest plan exceeds 9.5% of the employee’s W-2 pay from that employer.

The IRS will not include employer HSA contributions when determining whether the employer’s coverage is affordable, officials say.

The IRS also will not include amounts available through an HRA that may be used only to reimburse medical expenses other than the employee’s required share of the cost of employer-sponsored coverage, officials say.

“These final regulations do not address how other HRAs are treated for purposes of determining the affordability of an employer-sponsored plan, which may be addressed further in additional published guidance,” officials say.

The regulations authorize the IRS commissioner to determine whether wellness incentive programs should count in affordability calculations, officials say.

“Comments are requested on types of wellness incentives, how these programs affect the affordability of eligible employer-sponsored coverage for employees and related individuals, and how incentives are earned and applied,” officials say. “The administrability of any rule on wellness incentives must consider the extent to which employees can be certain they will qualify for the incentives at the time they otherwise would be evaluated for eligibility for advance credit payments.”

The IRS will require individuals applying for health insurance tax credits to give information about whether they have access to employer-sponsored coverage.

The IRS will provide a “safe harbor” for individuals who give the IRS information about whether they have access to affordable employer-sponsored coverage. But “the final regulations provide that the affordability safe harbor does not apply if a taxpayer, with reckless disregard for the facts, provides incorrect information to an exchange concerning an employee’s portion of the annual premium for employer coverage,” officials say.

Individuals who are getting a credit must notify the IRS when they get access to different coverage, officials say.

Officials note that families may be eligible for tax credits if a member of the family is covered by affordable employer-sponsored health insurance but other family members must buy coverage through an exchange. Officials do not say whether the ability of a family to qualify for a health insurance tax credit would have any effect on whether an employer owes shared responsibility penalties.

Comments on the final regulations will be due 90 days after the official Federal Register publication date.

Article Source

Study Finds Physicians Slow To Transition to Electronic Records

Posted May 21, 2012 by Megan DiMartino

Just 25% of physicians are “on target” to meet the meaningful use standards established under the federal stimulus package, according to a according to a study by the Deloitte Center for Health Solutions, National Journal reports (Sanger-Katz, National Journal, 2/22).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Researchers polled a random sample of 501 American Medical Association members. The study found that:

  • About 66% of respondents use some form of EHR system to manage clinical information;
  • Around two-thirds said they believe EHR systems can help improve care over the long term;
  • No more than 20% provide scheduling or offer test results online, while just 6% use social media to communicate with patients;
  • About 66% of physicians said upfront costs were their primary concern about adopting health IT systems, while 54% cited concerns about disrupting operations;
  • 46% of single practices do not have EHR systems, compared with 22% of practices with between 10 and 49 full-time staff members;
  • 39% of physicians in practices with 10 or more full-time staff members are not familiar with the new ICD-10 diagnosis and procedure codes, compared with 25% of those in single practices; and
  • Only 21% of respondents said they do not expect to meet the October 2013 deadline for transitioning to ICD-10, but 62% said managing ICD-10 documentation is a “major concern” (Deloitte release, 2/21).

more at

Feds Are Auditing PPACA Compliance

Posted May 16, 2012 by Megan DiMartino

By Allison Bell, May 10, 2012

The Labor department seems to be sending one type of written PPACA audit notice to plans that claim “grandfathered” status, a second type to non-grandfathered plans, and a third type to both grandfathered and non-grandfathered plans. A plan can qualify for grandfathered status by showing that it is roughly the same today as it was before March 23, 2010, when PPACA was signed into law.

PPACA exempts grandfathered plans from some PPACA coverage requirements. Some of the PPACA provisions that already apply to plans deal with matters such as young adult dependents’ access to coverage, coverage for preventive services, coverage for emergency services, annual benefits limits, and appeal rights.

Lawmakers are fighting PPACA in Congress, and states and others are fighting PPACA at the Supreme Court. But, unless and until the court rules that PPACA is unconstitutional, “the act is enforceable and will be enforced by the [Labor Department],” the Proskauer Rose compliance specialists say in a PPACA audit client alert posted on the firm’s website.

The Labor Department has been doing plan audits for compliance with other benefits rules, such as 401(k) plan rules, for years. From grandfathered plans, the Labor Department is asking for copies of grandfathered status disclosure documents and documents showing that the plans qualify for grandfathered status, the compliance specialists say.

From non-grandfathered plans, the department is asking for documents such as emergency services benefits documents, preventive services documents, and descriptions of internal claims and appeals procedures. Plans must show, for example, that they they are covering out-of-network emergency services without requiring more cost sharing than they would require of enrollees using in-network emergency services.

The Labor Department also is auditing plans’ compliance with provisions that affect both grandfathered and non-grandfathered plans, such as the requirement that plans offering dependent coverage make dependent coverage available to adult children up to age 26. The Proskauer Rose compliance specialists are recommending that employers and plans keep written records of any steps taken to comply with PPACA since Sept. 23, 2010.

“For example, plans should keep and be able to produce notices of coverage for children up to 26 years of age, and evidence of distribution,” the compliance specialists say. Anyone who gets a PPACA compliance audit request should talk to lawyers immeidately, because the parties involved may need to act quickly to protect their interests, the compliance specialists say.

DOL: More SBC Guidance, Fewer Penalties?

Posted May 15, 2012 by PHaynes

Additional Clarity?  Certainty?  Or, just more guidance to help Employers/Plan Sponsors avoid fines?

The Department of Labor (DOL) issued additional guidance on May 11, 2012.  Clarifying some points, federal regulators made clear(er), that they will not be imposing financial penalties on employers that do not “fully comply” with the Affordable Care Act’s new requirements to distribute SBCs (Summaries of Benefits and Coverage), provided they continue to make “good faith efforts” to comply.  In their FAQ, series (Part 9), they update us all regarding:

  1. Electronic distribution?
  2. Triggering events for SBC distribution?
  3. Question – is there a need to reissue an SBC upon application (if the SBC remains unchanged)?
  4. Issue SBCs to people that are only “shopping” the coverage?
  5. Can the SBCs guide people to documents other than an SPD?
  6. Can SBCs contain electronic features (like scrolling, etc.)?
  7. Can SBCs be combined with other documents/materials?
  8. Circumstances under which penalties can be imposed?
  9. Safe harbor calculator for the first years’ examples?
  10. Any obligation to describe carved-out coverages within the SBC?
  11. Where can written translations of the SBC’s uniform glossary be found?  Does that include Spanish, Chinese, Tagalog and Navajo?  Yes.  English is available here.  To request either the SBC or Uniform Glossary in Spanish, Chinese, Tagalog or Navajo, contact to request copies.
  12. Do carriers have to issues SBCs for insurance products that are no longer being offered?
  13. Can expatriate plans/policies be shown some leeway for the first year of SBC compliance?
  14. Other than the FAQs, are there any other updates to the SBC templates?  Yes.  The updated versions of these documents are labeled “corrected on May 11, 2012” in the lower right corner of the first page and are available at and These three documents replace the prior versions issued contemporaneously with the final regulations in February 2012.

For Clients & Friends of AP Benefit Advisors:  If you need additional help/assistance with your SBCs please contact your Sales Executive or Account Manager.  Thank you.


Previous SBC updates from AP Benefit Advisors

Doctor Panels Recommend Fewer Tests for Patients

Posted May 14, 2012 by Megan DiMartino

In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

To read more, sign up for our newsletter.

Why Employers Need to Encourage Good Dental Hygiene Habits

Posted May 8, 2012 by Megan DiMartino

By Charles Wheeler, A.B., M.D., J.D.

One important risk factor that many employers overlook in their wellness programs is dental health. It’s true. You may wonder what does dental hygiene have to do with preventing serious illness? The answer to that question is simple. Poor dental health leads to chronic diseases, not only in the mouth, but also in the rest of the body.

Recent research shows that at least one dental cleaning a year can reduce risk for heart disease.(1)

Additionally, it has been found that:

  • People with gum disease are almost twice as likely to suffer from coronary artery disease (CAD). (2) Bacteria built up in the mouth can lead to blood clots, plaque build-up and swelling of the arteries.
  • Bacteria can be aspirated into the lungs to cause respiratory diseases such as pneumonia.(3)
  • People suffering from stroke are more likely to have an oral infection.(4)

Most of us think of bad oral hygiene as the culprit behind decaying teeth, swollen gums and gum disease, also known as periodontal disease – an infection caused by bacteria that gets under the gum tissue and destroys the gums and bone over time. But if oral infections are not diagnosed and treated, bacteria can enter the circulatory system and result in infections and inflammation in other parts of the body.

Another reason why dental check-ups are important is because oral problems are indicators of other problems in the body that the person may have not become aware of yet. A dentist can encourage a person to report the issue with their regular doctor, which can result in early identification and treatment of physical problems that could develop into a chronic condition.

As you communicate about your wellness program with your employees and the importance of prevention, let them know that gum disease is another risk factor for heart disease and other chronic conditions. Inform them regularly that annual dental check-ups can significantly reduce their risk for heart disease. Build messages about good dental hygiene into your wellness and prevention programs and your engagement communications.

Here are some tips you can share with employees to help them prevent gum disease:

  • Brush twice a day with a fluoride toothpaste
  • Clean between teeth daily with floss or interdental cleaner
  • Eat nutritious meals and limit snacking, especially on high-sugar foods
  • Visit a dentist twice a year (or at least once) for a professional cleaning and oral exam
  • Check with your dentist about supplemental fluoride and other preventive measures they can offer

Oral health is something that can easily be taken for granted. For some, it is not until they lose the capacity to chew, taste and swallow without pain and discomfort, or to smile without embarrassment that they realize the importance of good dental care. Never mind the loss of their health and quality of life! Don’t let that happen to your employees!


Subscribe to Our Blog