Healthcare

No More Surprises

Shock by your hospital bill?The No Surprises Act, a ban on surprise medical bills, will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. – A patient goes to an in-network hospital for surgery or emergency care, and an out-of-network doctor is involved in the patient’s care. Patients are not able to determine the network status of providers, such as emergency room doctors or anesthesiologists. The patient is simply not involved in the choice of provider.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals, and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Providers will have to work with the health insurance issuer carrier to determine the appropriate amount to be paid by the plan.

(The No Surprise Act was included in the stimulus bill signed by President Trump on Dec 27, 2020.)

EBA will continue to keep you updated as information becomes available on the details of the law.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Health Care Transparency

New transparency requirements on group health plans and health insurers in the individual and group markets were issued by the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments).

The final rule requires plans and issuers to disclose:

  • Price and cost-sharing information for a list of 500 services must be available via the internet for plan years beginning Jan. 1, 2023. All items and services are required to be available for plan years beginning Jan. 1, 2024.
  • In-network provider-negotiated rates and historical out-of-network allowed amounts on their website for plan years beginning Jan. 1, 2022.

The final rule also allows insurers that share savings with consumers—resulting from consumers shopping for lower-cost, higher-value services—to take credit for those “shared savings” payments in their medical loss ratio calculations.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Lifestyle Choices – Creating a Wellness Culture

BenefitsPro ran an article saying… Changing lifestyle choices could cut $730B in annual health care spending and that more than a quarter of all health care spending is due to conditions such as smoking, diabetes and poor diet.

“Nearly three-quarters of a trillion dollars in health care spending can be linked to modifiable health risks, such as obesity, high blood pressure, and smoking…”

There are three key strategies that would prove to be very effective towards changing lifestyle choices.

(1) Preventative – Individuals have a responsibility to be examined at least periodically (every two years, yearly as we get older – I will let the AMA set the standard) and get their immunizations. Those that do receive a premium credit.

(2) Wellness / Biometrics – Smokers should be charged more (no need to argue why, everyone should be aware of the added health risks and costs). Premium credits for those actively managing and meeting standards for blood pressure, BMI, cholesterol, and blood sugar level. People with obesity appear to have triple the risk of hospitalization with COVID-19, compared to people without obesity, the CDC reports. Being severely obese may increase the risk by 4.5 times. – All these biometrics are key indicators of health. Control these factors and receive a premium credit, those that do not should pay more. They are costing everyone else.

(3) Genetics & DNA – Technology is a great tool. Let us use it to help predetermine the medical conditions which we are predisposed. Not to punish people with higher costs, but to be proactive. A lifestyle change at an early age could help prevent certain illnesses. Information can be kept confidential with case managers and not shared or used with underwriting. – i.e. If you knew you had a family history of cancer, breast or colon, you could be proactive and monitor the signs. Same principle for other genetic diseases.

An important part of any health care discussions is preexisting conditions.  No one should be denied coverage due to preexisting conditions. However, no one should be allowed to burden the system who carries no insurance, goes to the doctor, learns they need medical care and now applies for insurance. They should be required to apply for insurance, bear a heavy portion of the medical expenses for a year or two (contracted rate), and have the carrier assign a case manager.

How do we pay for preexisting conditions? – Every transaction, buying aspirin, medical procedures, hospital stays – anything medical related – should be charged a ‘PreX’ fee of 1 penny (maybe 2 depending on the accounting). The money would go towards funding preexisting conditions, nothing else. If it raises more than is needed the surplus can be used for cancer or other medical research.

 

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Bringing People Back to the Workplace Safely & Efficiently

Key to bringing people back is developing and implementing industry best practice safety and wellness protocols.

Meridian’s temperature sensing Personnel Management Kiosk is designed to help protect the health and safety of both employees and guests by helping prevent anyone with a temperature or those without access from entering a facility.

Features

  • Temperature Verification
  • Facial Identification
  • Temperature Threshold Alarms
  • Pedestal & Countertop Configurations

Designed to monitor multiple kiosks in remote locations it is ideal for businesses requiring system security and remote performance management.

Temperature Management Solutions help balance the need to get back to business as quickly as possible while ensuring workplace health and safety. Easy to setup and use. Potential integration, current and development, will make this product a powerful monitoring service tool. More information available at www.meridiankiosks.com.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

COVID-19 and Fat People

I posted Fat People Have Issues November 19th. 2014. – Medical Issues.

Once again, before offending anyone – I posted the politically incorrect title in hopes of getting more people to read. I like fat people, many of my friends are fat. And to be honest, I would like to lose a few lbs. So please take it in good humor. I do not need hate mail. I also recognize some people have genetic challenges.

The statistics for COVID-19 are showing 94% of the deaths have underlying medical conditions, 88% have two conditions and 19% at least one. Elevated blood pressure is the number one underlying medical condition at 53%, overweight 42%, diabetes 32%.

One of the most effective ways to ensure quality healthcare services is to not need it in the first place. All those overweight, please raise your hand. All those currently being treated for a preventable healthcare issue raise your hand. Employee Benefit Advisors has seen, time after time with my own clients, that weight loss is the number one factor to controlling health care costs.

One my biggest beefs with Obamacare is that it did nothing to promote a healthy lifestyle. A good BMI can resolve many medical issues. Maintaining a proper BMI has the potential for the doctor to remove you from your high blood pressure, cholesterol, diabetes, and other medications.

As for COVID-19, it is recommended people with underlying conditions stay home during phase 1 and 2 of the reopening of the economy.

Want more info on the Dietary Impact on Health? Check out https://ebafl.com/dietary-impact-on-health/

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida Department of Health

The Florida Department of Health has received accolades from the Presidential Response Team during the daily briefing. Doctor Deborah Brix has mentioned several times it is an ideal resource and one that other states should try to emulate.

Florida Health 201 Novel Coronavirus Response (COVID-19) https://floridahealthcovid19.gov/. The site includes the county-specific Surveillance Dashboard I mentioned in my previously blog.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

COVID-19 and Medicare

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Coronavirus – do the 5

I’ve been seeing this advice on Google the past few days. I think it’s simple and easy for employees t grasp. Pass it on.

Help Stop Coronavirus

1. Hands – Wash them often
2. Elbow – Cough into it
3. Face – Don’t touch it
4. Feet – Stay more than 3ft apart
5. Feel sick? Stay home

 

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Coronavirus – easy to understand info for employees

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

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