The Health Insurance Blog of Attorney Adam V. Russo
Welcome to Passion for Subro! The purpose of this site is to share my passion for the health insurance industry with the rest of you fanatics. I hope this site will be your destination for the latest in health care as well as self insured news across the country. While I envision that this site will serve as a great educational resource, it will also keep you entertained with the funny, difficult, confusing and just plain weird world of self insurance.
Thanks for visiting!
Posted By cmonfils on April 16, 2012
Two weeks ago, the Supreme Court heard arguments on the constitutionality of the administration’s health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down.
http://thehealthcareblog.com/blog/2012/04/09/what-to-do-on-the-day-after-obamacare/
Posted By cmonfils on April 16, 2012
Most health benefit plans include some kind of wellness program. As costs rise, plan administrators hope that their wellness programs will help stem and reduce rising health plan costs. Plan administrators might harbor over-optimistic expectations of what a wellness initiative can deliver, however.
Posted By cmonfils on April 16, 2012
For individuals ages 65 and older, Medicare fee-for-service coverage, even including the Part D prescription drug benefit, continues to less generous on average compared with preferred provider option (PPO) coverage in the standard Federal Employee Health Benefit Plan (FEHBP) and in the typical large employer plan, a new Kaiser Family Foundation report reveals. The average benefit value of Medicare for a person age 65 or older in 2011 is 97 percent of the FEHBP Standard Option benefit value and 93 percent of the typical large employer PPO benefit value, the study, conducted by Aon Hewitt for Kaiser, found. Medicare coverage likely is more favorably comparable with coverage provided in small and mid-size firms, the study added.
Posted By cmonfils on April 16, 2012
April 13, 2012 – The U.S. Department of Treasury this week signaled how the Internal Revenue Service (IRS) will implement rules designed to collect fees from health insurers and self-insured health plans imposed by the Affordable Care Act in order to fund the Patient-Centered Outcome Research Trust Fund. According to the ACA, the funding requirements are as follows: (more…)
Posted By cmonfils on April 13, 2012
The Affordable Care Act calls for the U.S. Secretary of Health and Human Services to issue quality improvement reporting requirements for employer group health plans, including self-insured plans, and individual plans, as well as for qualifying plans in health insurance exchanges. Health plans will need to report on their quality improvement activities regarding plan or coverage benefits and provider reimbursement structures that: improve health outcomes, prevent hospital readmissions, improve patient safety and reduce medical errors, and implement wellness and health promotion activities. Mindful of the opportunity to leverage existing plan reporting tools and achieve administrative efficiencies, this report summarizes key features of the eValue8 Health Plan Request for Information, National Committee for Quality Assurance accreditation, and Medicaid’s external quality review process. The authors offer the National Quality Strategy as a framework for quality improvement reporting requirements to align efforts among health plans, health care providers, and health care purchasers.
Posted By cmonfils on April 13, 2012
After three days of oral arguments last week, the fate of the Patient Protection and Affordable Care Act (ACA) now lies in the hands of the nine Supreme Court justices. What, if any, provisions of the sweeping health care reform law will survive remains very much in question after the historic arguments. The questioning revealed deep divisions within the Court about the constitutionality of the law’s so-called “individual mandate” and whether the rest of the Act should stand if the mandate is struck down. Even after the Supreme Court renders its decision, which is expected in June, the debate over the landmark legislation likely will continue for years to come.
Posted By cmonfils on April 13, 2012
SouthCoast Medical Group had long provided health insurance to its employees the conventional way, paying premiums to an insurance company that covered medical claims. Then in January 2011 the 65-doctor practice with offices in and around Savannah, Ga., opted to take on more of the risk itself.
Posted By cmonfils on April 13, 2012
Santa Monica, CA — Four of the largest health insurance companies in California have increased premiums for 1.1 million Californians and small business owners by as much as 20% on April and May 1st according to data filed with state regulators, said Consumer Watchdog Campaign today. The rate increases are the second or third for most policyholders over the last two years.
Posted By cmonfils on April 13, 2012
Marcus Aurelius is a plan member of the Imperial group health plan. Imperial has contracted with Augustan, a preferred provider network or “PPO”.
Augustan has in place a managed care contract with a wide variety of physicians and hospitals. Under the contact, the providers agree to accept a discounted rate in exchange for steerage of patients by inclusion of the providers in the Augustan network that will be promoted to group health plans and claims administrators.
Posted By cmonfils on April 13, 2012
April 12, 2012 – A bill was amended this week in the California State Legislature in a way that would effectively take away the ability of smaller employers in that state to operate self-insurde group health plans by restricting access to stop-loss insurance. Sponsored by Senator Kevin De Leon, SB 1431 now prohibits the sale of stop-loss policies to employers with fewer than 50 employees that does any of the following (more…)
Posted By cmonfils on April 11, 2012
In a field assistance bulletin, the Department of Labor (DOL) addressed when the use of Employee Retirement Income Security Act of 1974 (ERISA) plan assets to pay for marketing and graduation ceremonies for training and apprenticeship programs may be permissible. To promote compliance with these standards, the DOL recommends that plans establish internal controls designed to prevent inappropriate, excessive or abusive expenditure of plan assets.
Posted By cmonfils on April 11, 2012
The SJC heard three days of oral arguments about the individual mandate last week. The arguments were many: Do prior laws prevent us from even discussing it? Is it constitutional? Is it severable from the rest of the law? First I want to take a step back and say that I feel very fortunate to live in a country with the kind of government that thinks very carefully about our civil liberties, especially after seeing the governing body in The Hunger Games (!). I’ll also say that the Supreme Court Justices could easily rule on the individual mandate either way and back it up with a beautifully written opinion. There were compelling arguments on both sides. The truth is the Justices have already made their decision. We just have to wait until June to find out what it is.
Posted By cmonfils on April 11, 2012
The health care reform memos are issued on a weekly basis, highlighting news from the previous week’s activities in the administration and implications for the C-suite and various stakeholder groups.
Posted By cmonfils on April 11, 2012
ROSELAND, N.J., April 3, 2012 /PRNewswire via COMTEX/ — A new ADP® survey shows that wellness programs are one of the best ways for employers to promote a healthy workforce, contain rising healthcare expenses, and generate productivity among their employees.
Posted By cmonfils on April 11, 2012
Oklahoma State Senator Brecheen has co-authored HB 2155. If enacted, the bill will do away with the threshold for the number of employees an employer must have to be allowed the option of establishing and managing an ERISA-compliant Benefit Plan for their employees in lieu of participation in the state workers’ compensation system. In order for employers to be allowed to provide alternative coverage, their Benefit Plan must provide benefits that meet or exceed the statutory minimums, which are outlined in the bill. (more)
