GIA Risk Management Selected to Offer The Hartford’s AARP Home Insurance Program

GIA Risk Management Selected to Offer The Hartford’s AARP Home Insurance Program

After meeting Several social and business requirements, GIA Risk Management, LLC. now authorized to off the popular insurance program in Colorado. Click Here for More.

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GIA Risk Management Selected to Offer The Hartford’s AARP Auto Insurance Program

GIA Risk Management Selected to Offer The Hartford’s AARP Auto Insurance Program

After meeting Several social and business requirements, GIA Risk Management, LLC. now authorized to off the popular insurance program in Colorado. Click Here for More.

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Colorado Health Benefit Exchange Announces New SHOP Exchange Manager and Chief Operating Officer

Please join us in welcoming two individuals who will help us build a successful health insurance marketplace for Colorado. On Monday, Jim Sugden joined the team as SHOP Exchange Manager and Lindy Hinman joined the team as Chief Operating Officer. Lindy will lead overall policy implementation and business operations and Jim will manage the strategic direction of the Small Business Health Options Program (SHOP), the component of the Exchange that will serve small businesses and non-profit organizations in Colorado. Lindy was raised in Arapahoe County and moved back to Colorado to join the Exchange. She brings deep expertise about health care policy and health insurance operations through her previous positions at the national organization representing health plans (AHIP) and Blue Cross Blue Shield of New Jersey, among other posts. Jim brings more than four decades of experience with employee benefit marketing and administration and understands the needs of businesses in Colorado. He has served in leadership roles at the state and national associations representing health underwriters. Jim has actively participated in Board and advisory group meetings over the last year and is uniquely qualified to help us develop a vibrant SHOP Exchange that will fulfill the vision of Senate Bill 11-200. You can learn more about Lindy and Jim and find their contact information here.

Post from the Colorado Helath Benefit Exchange blog posted on August 24, 2012 by Patty Fontneau, CEO of the CHBE. Click Here for a direct link to their post.

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Big “I” Releases Updated PPACA Timeline

In light of the recent ruling by the U.S. Supreme Court and the complex nature of the Patient Protection and Affordable Care Act, the Big “I” government affairs team has released an updated implementation timeline with highlighted provisions of the law.

As the timeline reflects, the biggest change to the law has been the Supreme Court’s ruling on the Medicaid expansion. The court’s decision did nothing to affect any of the provisions of the law already implemented, and going forward it only made changes to the way the Medicaid eligibility expansion to 133% of poverty level will be implemented in 2014.

Among the many provisions already in effect are the so-called Sept. 23 reforms from 2010, which include requiring plans to allow young adults up to age 26 to remain on their parents’ plans and the prohibition of consideration of pre-existing conditions of children. Also, the medical loss ratio regulations have been in effect since Jan. 1, 2011 and have led to significant cuts in agent compensation. There are also several other provisions of interest already in effect such as new restrictions on flexible spending accounts and the first steps toward filling in the “doughnut hole” for Medicare Part D beneficiaries.

The structure of the PPACA is such that many of the most consequential portions of the law have yet to be implemented.

For instance, some of the tax increases on small businesses take effect in 2013; these include the 0.9% increase on wages for certain taxpayers and a 3.8% increase on investment income.

The PPACA’s landmark year will be 2014 because that’s when provisions will be implemented on guaranteed issue, the individual mandate, the employer mandate, exchanges and the Medicaid expansion. Implementation of the law is scheduled to wrap up in 2018 with the so-called Cadillac tax, which is a punitive excise tax on high-cost plans.

With almost six years of implementation remaining and controversy surrounding the PPACA still at a fever pitch, the future of the law remains somewhat murky. The Big “I” government affairs team will continue to work on efforts to resolve issues with the law that impact agents and brokers most directly.

Ryan Young (ryan.young@iiaba.net) is Big “I” senior director of federal government affairs.

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Health Reform and Self-Insurance

Health Reform and Self-Insurance

While the health reform law holds self-insured plans responsible for some of the same taxes and fees as fully insured plans, self-insured plans are exempt from exposure to the excise tax on insurance, community rating on premiums and mandates for essential health benefits. Beginning in 2014, PPACA requires modified community rating in the individual and small-group health insurance markets that will allow insurers to vary rates only based on age, geographic location, family size and smoking status. These rating rules will apply to products offered in the state insurance exchanges and to fully insured products purchased outside of the exchanges by employers with up to 100 employees. The maximum ratio of rates for older people compared to those for younger people will be 3:1, in contrast to a 5:1 or 6:1 ratio that insurance respondents indicated is typical of pricing in states that do not now restrict age rating. This change in rating method may draw firms with younger workforces toward self-insuring.

In addition, nongroup and fully insured small-group plans will have to provide an essential health benefits package that covers a standardized set of benefits, as determined by federal and state requirements. Though PPACA specifies that the essential health benefits package should be equal in scope to those offered by a typical employer plan, small employers that want to potentially save money by offering less generous coverage may opt to self-insure.

Respondents also suggested that employers may see self-insurance as a way to manage uncertainty about the impact of greater regulation of the health insurance industry under PPACA. For example, by not being subject to review of medical-loss ratios that indicate how premium dollars are spent, self-insured employers may avoid exposure to the potential administrative burden and complexities involved with the process.

Policy Implications

The intersection of state and federal policies, some not yet fully formed, make the future costs and benefits of self-insurance, as well as its overall prevalence among small firms, highly uncertain. Rising premiums, coupled with new regulations on fully insured products and declining costs of stop-loss insurance, could lead to an increase in self-insurance among small employers, which could pose challenges for state and federal policy makers.

The potential for adverse selection, or attracting a much sicker population than average, in health plans offered to small groups—whether in or outside state exchanges—has been cited as a primary concern by market observers. Small employers’ decisions about self-insurance may be influenced by the risk profile of their workforce, which could disrupt the small-group market risk pool. Also, if small employers that self-insure fail to purchase adequate stop-loss coverage, large unexpected medical claims could threaten the firms’ financial solvency and result in unpaid enrollee medical claims.

Some respondents suggested that growth in self-insurance among small employers could complicate some federal health reform goals, including making coverage affordable for older people. When the new rating requirements are in place, small employers with younger workforces could pay more than they currently do for a fully insured plan, whether purchased inside or outside the exchanges. This could make self-insurance more attractive to such firms but not for those with older workforces. A greater concentration of older workers in fully insured plans could lead to higher premiums and create a market dynamic that encourages still more employers to exit the state-regulated health insurance market in favor of self-insurance.

In a separate but related PPACA provision, beginning in 2017, states can decide whether larger firms—those with more than 100 employees—can purchase coverage in the exchanges. If states allow this, the potential for adverse selection could increase, since larger firms with older and/or sicker workers that now self-insure might find it advantageous to buy coverage in the exchange, while those with younger and/or healthier workforces would continue to self-insure. Although the law is silent on whether insurers need to charge the same price for coverage of larger firms inside or outside the exchange, such adverse selection would be a problem in either case.

PPACA recognized these issues and mandated a study “to determine the extent to which its insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure.” The study, conducted by RAND Health, predicted a sizable increase in self-insurance only if stop-loss policies with low individual attachment points—for example, $20,000—become widely available after the law takes full effect in 2014. But, the market for stop-loss insurance already is moving toward lower attachment points. HSC study respondents indicated that policies with low attachment points are likely to be widely available, noting that policies with stop-loss attachment points as low as $10,000 are marketed today.

Another policy issue related to extremely low attachment points for stop-loss coverage raises questions about how much risk self-insured firms are bearing and whether self-insurance is merely a way to avoid state insurance regulation. Such concerns have precedent. In the past, fraud and insolvencies involving Multiple Employer Welfare Arrangements, or MEWAs, where small firms banded together to self-insure workers, have left enrollees unprotected and liable for their medical costs.

Because of these concerns, the National Association of Insurance Commissioners (NAIC) has charged a working group to look into updating recommendations to states about regulating stop-loss insurance. The NAIC created a model law in 1995 that prohibits specific individual attachment points lower than $20,000 and aggregate attachment points lower than 120 percent of expected claim costs for groups with 50 or fewer members. NAIC has been discussing revisions to this model law that may include higher attachment points, which might preclude many small firms from self-insuring.

Policy options for revising regulation of stop-loss coverage for small groups have been offered for states to consider and may be a necessary step toward ensuring stability of the small-group market and state exchanges. The California Department of Insurance is pursuing legislation to ban stop-loss attachment points below $95,000 per employee, which would make it more difficult for most small employers to obtain adequate stop-loss coverage. Depending on how the California legislation proceeds, other states may follow suit with similar legislation designed to curtail small employers from opting for self-insured health plans with low attachment points.

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Reform may spur more small firms to self-insure

Reform may spur more small firms to self-insure

By Melanie Evans

Posted: July 19, 2012 – 3:00 pm ET

 

Small employers with fewer than 100 workers could see incentives to self-insure under the healthcare reform law, a paper by the Center for Studying Health System Change says.

Self-insured employers, which accept the risk of workers’ healthcare costs, are exempt from new rules under health reform for fully insured products, including state review of premium rate increases, community rating for premiums and essential health benefits, according to the report.

Small employers are less likely to self-insure than large employers because of the risk and cost of stop-loss insurance for workers with catastrophic illness. But interviews for the Center for Studying Health System Change Community Tracking Study in 2010 and 2011 suggest more competitive pricing among insurers that administer and provide stop-loss insurance to self-insured employers, the report said.

 

That could lead to a shift in the market, wrote authors Tracy Yee, Jon Christanson and Paul Ginsburg. “Rising premiums, coupled with new regulations on fully insured products and declining costs of stop-loss insurance, could lead to an increase in self-insurance among small employers, which could pose challenges for state and federal policy makers,” the report said. Small employers with younger, healthier workers could opt for self-insurance and drive up premiums in the fully insured market, according to the authors.

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Colorado Health Benefit Exchange

The Colorado Health Benefit Exchange was created by the Colorado legislature to comply with the requirements of the ACA. When fully implemented on January 1, 2014, the Colorado Health Benefit Exchange will serve as a market place for individual consumers and small businesses to purchase their health insurance policy. Certain eligible individuals, up to 400 percent of the federal poverty level, will qualify for a subsidy on their health insurance premiums, but only if the policy is purchased through the Colorado Health Benefit Exchange. For those who do not qualify for a subsidy, they can also compare plans outside the exchange to see where they can get the best policy to fit their needs.

As a convenience to consumers, they can purchase their policy directly through the Colorado Health Benefit Exchange, or through a licensed broker of their choice, at no additional cost. Each person applying for coverage must be issued a policy regardless of their prior or ongoing medical conditions. Those conditions must also be covered by the policy and a consumer cannot be charged a higher premium for those conditions.

The ACA does contain a mandate that everyone purchase insurance or pay a tax penalty. Paying the tax penalty does not entitle that person to get free medical care. Enrollments through the Colorado Health Benefit Exchange will begin October 1, 2013 and end December 31, 2013 for the initial January 1, 2014 effective date. It is expected that with such a large number of enrollments and re-enrollments for that date, there will be delays processing applications so it is best to get those applications in as soon as possible after 10/1/2013. Premium and subsidy information will also be available at that time.

The final details for the Colorado Health Benefit Exchange are still being finalized. As these changes materialize, we will continue to provide updates of their progress. For more information about health insurance in Colorado or the Colorado Health Benefit Exchange, please contact GIA at 888-423-3232 ext 100, or visit www.e-gia.com.

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Reducing the Confusion Over Coordination of Medicare and Employer Health Plans

In the decades that preceded the Great Recession, many employees opted for retirement at age 65. That’s changing. According to the U.S. Bureau of Labor Statistics data, older workers make up the fastest-growing segment of the workforce. Statisticians say that by 2014, 21 percent of all employees will be 55 years of age and older.

This highly experienced and knowledgeable workforce offers many advantages for companies. More and more of these workers are working past age 65, the current age individuals become eligible for Medicare. In fact, the number of Americans working past 65 years of age has climbed 52 percent over the past 10 years, according to U.S. government data. This trend is expected to continue. As a result, more and more companies are taking steps to coordinate healthcare coverage options and providing decision-making information to the employees as they approach Medicare-eligibility age.

Coordinating Medicare and employer health plans isn’t a complicated proposition if you know the facts. Active employees cannot be dropped from employer group health plans without violating the federal Age Discrimination Employment Act (ADEA) except in specific circumstances. Medicare secondary payer rules also prohibit employers from reducing health benefits to current employees because of their Medicare eligibility. Plus, the Equal Employment Opportunity Commission issued an informal letter late last year that advised that the exemption for coordination with Medicare is only applicable to retirees, not current employees. As older workers delay retirement – or opting to forego retirement altogether, the need for clarity on how to navigate coordination of Medicare and employer-based insurance has become crucial.

Coordination requirements depend on the size of the employer-based healthcare plan.

Under a small group plan, defined as 20 or fewer employees, Medicare becomes the primary health coverage for the eligible employee. The employee might not have health insurance if he or she declines Medicare Part B coverage, outpatient, and doctors benefits. Expenses of Part B-eligible employees who become injured and are covered by the group health plan can see the program stop payment or attempt to recoup payments – could create a nightmarish scenario for employees. An employer that decides to remain the primary payer (an option currently allowed) must receive written confirmation from the employee and the health plan.

In large group plans of 20 or more employees, the amount of coverage employers must provide changes. The employee is not required to opt for Part B but can accept Part B as secondary coverage. When the employee stops working, Part B becomes the primary payer. In the case of a multiple-employer plan, the size of the largest employer dictates whether the group plan size is small or large and therefore, the category of coordination requirements and coverage to which all the employers in the group must adhere.

Additional guidance is available from several sources. National nonprofit consumer service group Medicare Rights Center, along with Cook County, Illinois-based AgeOptions, created a toolkit of educational materials on this subject. The toolkit, “How Medicare Works with Employer-Based Health Insurance: A Guide for Employers, Professionals and Consumers,” is designed to help older workers knowledgeably make their way through the transition from employer-based health insurance to Medicare.

“We’ve seen a surge of calls on our helpline from older adults who can’t get a straight answer about how their employer insurance coordinates with Medicare,” said Doug Goggin-Callahan, Director of Education at the Medicare Rights Center in the organization’s news release announcing the toolkit. “The toolkit will not only help the older adults who are turning 65 today, but will also help us prepare for tomorrow, as people continue to retire later and the insurance landscape continues to transform as a result of the Affordable Care Act.”

Included in the toolkit are clear explanations about how Medicare coordinates with different kinds of employer-based health insurance, including current employer coverage, retiree or union coverage, and COBRA. It contains PowerPoint trainings, FAQs, common scenarios, and a glossary of terms, among other features. According to the officials whose organizations created the toolkit, the guide is especially helpful for employment benefit counselors, health care providers, human resource specialists, and others to whom older employees call on for answers.

“They can use the different documents to learn the rules, refresh their understanding, create presentations for [employees] and share specific handouts with the people they counsel,” said Terri Gendel, director of benefits and advocacy at AgeOptions.

Also available from the Centers of Medicare and Medicaid Services is, “Medicare and Other Health Benefits: Your Guide to Who Pays First,” a comprehensive guide produced by the U.S. government that describes how Medicare works with other types of insurance or coverage.

For more information on Medicare and Medicare options in Colorado, contact GIA at 303-423-0162 ext 100, or visit www.e-gia.com.

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Understanding the cost to rebuild your home

Cost to rebuild

 

Cost to rebuild (reconstruction cost) reflects estimated construction material, labor and equipment costs to rebuild your home while maintaining the same size and quality of construction, at today’s prices.

 

Key features that impact the cost to rebuild your home include:

 

  • Total living area (square footage of home)
  • Style of home (e.g. ranch, contemporary, colonial, etc.)
  • Exterior wall construction (e.g. frame, brick, etc.), materials and roofing
  • Number of kitchens and bathrooms and quality of materials
  • Garage type (e.g. attached, detached, built-in)
  • Special features (e.g. fireplaces, porches, skylights, etc.)

Make sure you tell your Travelers representative or agent about any of these features when discussing your homeowners coverage.

 

Don’t rely on market value

 

The cost to rebuild often differs from what you paid for your home, or what you might pay for a similar home in your area. For this reason, market value is not used to determine the coverage amount needed. Market value can be affected by many factors, including:

 

  • Location of your home
  • Economic conditions
  • Value of the land

It’s important to know that rebuild costs for insurance purposes can also differ from mortgage requirements, tax assessments, new construction costs and other appraisals of your home.

 

Why rebuild costs can differ

 

  • Building codes may have changed since your home was built
  • More specialized workers are needed to prevent further damage and to rebuild the home
  • Trees, shrubs and power lines can make it difficult for large equipment to access the property
  • Materials to restore your home may be more expensive or hard to find
  • Keep your coverage up-to-date

 

Updates, additions and improvements to your home may increase the amount of coverage you need. Most common changes like installing hardwood floors, updating a kitchen or bath, or adding a deck can affect the cost to rebuild.

 

Here are some ways to help keep your coverage and limits current:

 

  • Review your policy each year to be sure it reflects the cost to rebuild
  • Inform your agent or broker of any home improvements
  • Consider that even small home improvements can affect the cost to rebuild your house


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Rise in Medicare premiums less than feared

October 27, 2011
By Ricardo Alonso-Zaldivar

WASHINGTON (AP) — Medicare’s basic monthly premium will rise significantly less than expected next year, the government announced Thursday. That could pay political dividends for President Barack Obama and for Democrats struggling to win over seniors in a close election.

The new Part B premium for outpatient care will be $99.90 a month for 2012, or about $7 less than projected as recently as May.

The bottom line: most seniors will pay an additional $3.50 a month next year, instead of $10.20, as forecast earlier.

Some younger retirees who enrolled recently have been paying up to $115.40 a month. Instead, they’ll get a sizable break next year.

Premiums have been frozen at the 2008 level of $96.40 a month for about three-fourths of Medicare beneficiaries. That was due to the lack of a Social Security cost-of-living adjustment during the depths of the economic downturn. But Social Security recently announced a raise in monthly checks averaging $39 for 2012. The Medicare news means the majority of seniors will have to fork over only a small part of their long-awaited COLA for premiums.

The reason for the lower-than-expected premiums has to do with the interaction between Social Security COLAs and Medicare premiums. But the Obama administration is hoping seniors will get a simple takeaway message: Medicare is under sound management.

Older voters went decisively for Republicans in the 2010 elections, after Obama’s health care overhaul law cut Medicare spending to help finance coverage for uninsured working-age adults and their families.

Since then, the administration has doubled down to try to reverse any perception that Obama is steering Medicare into decline.

Earlier this year, officials had announced that premiums for Medicare’s prescription benefit would remain unchanged for 2012, on average. Similarly, average premiums for popular Medicare Advantage plans will dip slightly in 2012. But
those announcements do not have as much impact. Averages used by the government don’t reflect individual experiences. And fewer beneficiaries are enrolled in either of those two benefits.

The Part B premium is one number that most of the 49 million people on Medicare can connect with.

Upper-income retirees pay more, and premiums for low-income beneficiaries are covered by Medicaid. But middleclass beneficiaries on tight budgets watch the Part B figure.

In a statement accompanying release of the Medicare premiums, Health and Human Services Secretary Kathleen Sebelius asserted that seniors have nothing to fear from the new health care law.

“The Affordable Care Act is helping to keep Medicare strong and affordable,” she said. “People with Medicare are seeing higher quality benefits, better health care choices and lower costs.”

A leading nonpartisan expert on Medicare said she doubted election-year politics are behind the lower-than-expected premiums for 2012.

“Changes in premiums are obviously important to seniors but the numbers are based on what the law requires, and determined by independent actuaries, rather than politics,” said Tricia Neuman of the Kaiser Family Foundation.

Neuman said the explanation is likely due to the complicated relationship between Social Security COLAs and Medicare premiums.

By law, the Part B premium is set to cover 25 percent of the cost of Medicare’s outpatient care benefit.

But premiums have been frozen for most beneficiaries in recent years because federal law also says that — with some exceptions — an individual’s Medicare premium cannot go up more than their Social Security COLA.

That left a relatively small share of beneficiaries, including recent enrollees, bearing the brunt of higher Medicare costs. Indeed, the so-called “standard premium” for 2011 rose to $115.40.

Back in May, when government experts originally forecast a premium of $106.60 for 2012, they were also projecting a Social Security COLA of just 0.7 percent. But the final COLA increase turned out to be much bigger, a 3.6 percent
raise. And that meant rising Medicare costs could be spread among many more people, resulting in smaller increases for each individual.

“It has been an odd several years because of what has been going on with the COLA,” said Neuman. “Not everybody was paying in the standard amount. Because more people are contributing, the effect of that is that the amount should go down.”

Indeed, baby boomers who signed up for Medicare this year and were paying $115.40 a month will save $15.50 a month next year, an annual total of $186.

HHS also said the 2012 premium figure takes into account a fix for the biggest problem hanging over Medicare. Unless Congress acts by the end of the year, doctors will be hit with a 30 percent pay cut. But the department said since Congress is almost certain to override that cut, the cost of keeping doctors whole has been factored in to the premium calculations.

Medicare’s Part B annual deductible, the amount beneficiaries pay before their coverage begins, will also drop next year to $140, a decrease of $22.

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