Rx Impact – Specialty Drugs (Part 1 of 2)
Specialty Drugs – generally referring to drugs costing over $600 per month – are estimated to account for 30% of total drug costs and expected to reach 50% by 2018. These drugs are expensive to develop and pose challenges manufacturing. However they target life altering illnesses making them an absolute must if needed. These patients […]
New Rule on Market Reforms – 22% MLR
The rule makes a temporary change to the administrative cost ceiling. Currently, as a result of the Medical Loss Ratio (MLR), insurers are allowed to have 20% of their costs be administrative, with the other 80% devoted to claims. That number has been increased to 22% for 2015 under the proposal to accommodate the increased […]
ACA Recap – Employer Checklist (Part 5 of 5): Exchanges
Types of Exchanges 1. State Exchanges – Individual Consumer – Federal or State Run Carrier participation will be voluntary State determines plan designs: Bronze (low cost), Silver, Gold, Platinum (high cost); Catastrophic Plan – young invincibles (18 -30) 2. SHOP Exchange – Small Employers Open in 2015 Limited to 50 FTE’s Employer picks plan for […]
ACA Recap – Employer Checklist (Part 4 of 5): Underwriting
Under ACA beginning with all new groups and for groups renewing in the 2014 calendar year the following criteria will be used to underwrite group. (In Florida, group size is determined by ATNE, Average Total Number of Employees. ATNE is calculated by averaging the total number all employees, full & part time, seasonal, temporary, etc… for […]
ACA Recap – Employer Checklist (Part 3 of 5): Compliant Plans
What is a Minimum Value Plan? Coverage that has an actuarial value (AV) of at least 60%. AV is the plan’s share of the total allowed cost of benefits provided to an enrolled individual Example, if a plan has an AV of 60% then the individual is theoretically responsible for 40% of the costs for all […]
ACA Recap – Employer Checklist (Part 2 of 5): Affordability
ACA Employer Responsibility Affordable Coverage Requirement Companies are only required to offer at least one medical plan that meets the “affordability” requirement (at the employee-only coverage level). Regulatory guidance allows companies to calculate affordability based on the employee’s income, using one of three IRS safe harbors. The Safe Harbors are: 9.5% of W-2 wages from […]
ACA Recap – Employer Checklist (Part 1 of 5): Accessibility
ACA Employer Responsibility: “Pay or Play” (Delay Announced) Large Employer Subject to “Pay” if they do not “Play” – Starting in 2015, applies to employers with 100 or more FTEs (Full Time Equivalents) Offer Minimum Essential Health Care to 70% of employees effective on the start of the plan year beginning on or after January […]
The best employee absences are the ones that never happen
A 2012 study showed half (48%) of a company’s employees experience business or personal legal-related issues each year, spending an average of 51 hours to resolve them. Compared to the average, these employees: Are absent five times more Use medical benefits four times more Use sick leave twice as often A range of employee assistance services […]
Medical Tourism
The Medical Tourism Association is helping employers and hospitals connect with companies to save millions in medical expenses. It’s popularity will grow as healthcare reform (Obamacare) is expected to create backlogs for medical services. Medical tourism (MT) is the patient travelling from highly developed nations to other areas of the world for medical care, usually […]
The Eyes, a Window to Health – Part 2
Employers and employees aren’t seeing the health and productivity boosts that would be possible if more employees took advantage of their vision benefit, especially in an aging workforce. According to Transitions Optical, Inc., nearly half of employees aren’t taking advantage of their vision benefit, by either not enrolling (24%) or by not using their benefit […]