The market for pet Insurance has grown quite a bit over the last few years.  Most who have the coverage purchase individually, but some employers have looked to add the option for employees to purchase on a group-rated, voluntary basis through their benefit programs. 

Do you have pet insurance?  What’s been your experience?  Have you been pleased with the cost/benefit?  We appreciate your comments and feedback.

CareFirst Blue Cross Blue Shield is now offering a free pedometer app as a means to encourage healthy living. 

You’ll be able to count your steps, distance traveled and calories burned for each workout with Ready, Step, Go!.  Aim for 10,000 steps a day to help control your weight, reduce stress, strengthen your heart and lungs, and improve bone density.   Just visit your favorite app store and search for Ready, Step, Go!  It’s a free download for those who have an iPhone, iPod Touch or Droid smartphone.  

Go get it and start walking today.  It’s free! 

Since it’s passage on march 23, 2010, public opinion about the Patient Protection and Affordable Care Act (PPACA) has remained deeply divided.  For two years now we’ve been treated to an endless supply of polls that demonstrate the philosophical differences amoung Democrats and Republicans.   It’s been great fodder for campaign commercials and weekend news shows.  But what do the party polls really tell us – that Democrats and Republicans disagree?  We should all be surprised! 

The Henry J. Kaiser Family Foundation recently released an interesting tracking tool that looks at public opinion of PPACA in a more detailed, more interesting, way.  This tracker looks at opinions and how they may or may not have changed for of a variety of groups since President Obama signed the legislation.  The data demonstrates differences among party affiliation, but more importantly, it also demonstrates the differences among groups based upon age, gender, income, and even insurance status.  While these results may not be so surprising either, the data certainly paints a better picture of how deeply divided the country remains over ObamaCare.  

It’s an interesting tool.  Check it out.    Click here.

We’ve all seen the duck.  He’s the quacky little fella who tells us to ask about AFLAC at work.  But what is AFLAC?  Why would we ask for it at work?  And why should we listen to a duck?

The duck leads an advertising campaign created in 1999.  The marketing has been so brilliant that today AFLAC is perhaps known more for the quacky character than it is for the insurance services it provides.  In fact, the duck has been so successful that it even holds a place on Madison Avenue’s Walk of Fame as one of America’s Favorite Advertising Icons.

AFLAC insures members by offering cash benefits for a variety of events that create out of pocket expenses.  Policies include, but are not limited to, accident, sickness, cancer and other specified health events, hospital confinement, disability and dental and vision.  Each policy can be selected individually and are typically offered through employers who conveniently payroll deduct the monthly premiums.  This is why we’re told to “ask about it at work.”

AFLAC policies are generally available without much in the way of medical underwriting and they do not require medical exams.  Where an employer does not offer a benefit, for example dental or disability income protection, employees can purchase a policy based upon individual needs, regardless of whether other employees have the same needs.  It’s truly a voluntary product.

One of the best uses of an AFLAC benefit can be found within the accident and sickness plans.  With so many medical plans adopting high deductibles these days, cash benefits for injuries and illness compliment the health plan by providing dollars that can be used to help pay the deductible.  This can be a great help to the many without savings or disposable dollars, particularly at time when stresses are likely high as a result of the injury or sickness.

With over 60 million members worldwide AFLAC, a Fortune 500 company, is one the largest insurance companies providing individual policies.  There are many reasons for this success, including the wide variety of products, low cost, little paperwork, speedy claim turnaround, and yes, even the duck.  If you don’t already have AFLAC, then you may want to “ask for it at work.”  It’s worth it.

A broken arm recovers in three months but medical claims and billing will last much longer.

As insurance advisors we review medical claims for clients every day.  Today my family has claims of our own.

A Saturday evening basketball game recently brought us to the emergency room after our 13 year-old took a bad spill and broke his arm on the court.  Six hours, and the-still-yet-to-be-determined number of dollars later, we had our young man home adjusting to his newly fitted full-arm cast.  Three weeks and a handful of x-rays later he’s doing just fine.   That was the easy part.

Now we have to deal with the medical bills.  Making sense of medical billing is difficult for most people.  We have a $2400 family deductible, so we’re responsible for payments up to this amount before our insurance begins to pay.   This means we’ll receive bills from many different providers for many different values for treatment rendered at several different points of service.  We’ll see statements from the hospital for the emergency room, the office of the orthopedic surgeon, anesthesiology, radiology, pharmacy, and at least half a dozen follow up visits, many of these with even more radiology.  We’ll even see a bill for the ambulance ride.

In addition to the mounds of bills from the various providers we’ll also receive explanations of benefits from the insurance company.  Our insurance company calls these statements EOBs.  Other carriers use the term explanation of coverage, or EOC.  Explanations are provided to members to illustrate how the insurance company processes a claim.  And the calculations can be confusing.

Understand the amount a doctor or facility charges isn’t normally the amount an insurance carrier agrees to pay for a particular service.  Insurance plans usually have contracts with providers to pay lower pre-agreed upon rates.  The EOB shows the provider’s actual charge, the fee reduction, the member’s responsibility, and the total amount the provider is allowed to collect from the member.  Ideally the bill the doctor sends should match the member responsibility amount shown on the EOB.  Members should always review and compare both the EOB and the doctor’s bill for consistency.

Unfortunately this isn’t always quite so simple.  Often the carrier denies certain fees outright and explains the reason by listing an adjustment code.  The adjustment code is usually found elsewhere in the EOB.  For example, a claim may have been submitted by the doctor for a service that should have been charged as part of a different service.  Think about a doctor’s office charging for an evaluation where the overall office visit should have included an evaluation.  In this case the carrier would deny the duplicate fee and code the line item as such.  A member may at first glance see only the denied fee and mistakenly believe a charge remains due.  Only if the member carefully reviews the coding and member responsibility amount will it be determined the fee is unallowable.  The member should then scrutinize the bill eventually received by the doctor to be sure the unallowable fee described by the EOB is waived.

Further complicating the EOB and billing process is that many plans only pay benefits (or pay higher benefits) when members seek services from network, or participating providers.  Network providers have agreed to the fee schedule on which the carrier bases its payments.  When a member seeks care from a non-participating provider the EOB will describe and code the charges as unallowable or reduced.  In this case all or some of the charges are payable by the member and the doctor will send a bill.  Still, even in this case the EOB will indicate the total member responsibility and the doctor’s bill should match.

Examples of other typical adjustments can include denials or reductions in coverage amounts for failure to obtain pre-authorizations or seeking care without proper referrals.  There are many reasons for adjustments and all are coded and explained within EOB.

It’s been about three weeks since our youngster broke his arm.  We’ll begin to see EOBs within the next week or so.  Doctor and facility bills will begin to follow.  Ultimately we’ll see dozens of EOBs and billing statements over the next couple of months for just this one event.

In our case, we’re responsible for the first $2400 in charges, the total of which accumulates as each EOB arrives.  If we’re diligent, then we’ll maintain all records in a single place, and we’ll carefully match each EOB with each bill received.  If we identify a mismatch we’ll contact the insurance carrier for further explanation.  If it’s determined the insurance carrier made a calculation or coding error, then we’ll work to get that corrected.   If we determine a provider’s bill to be incorrect, then we’ll contact the doctor’s office or facility to straighten it out.

Once we’ve satisfied our deductible requirement the EOBs will illustrate lower payment responsibilities in the form of copays and/or coinsurance.  We’ll have to match these new amounts with future bills we receive, all the while maintaining the same careful review.

Billing is largely electronic these days, and members have a great deal of online access to view claims and provider payments.  But the bureaucracy and number of providers involved, a general misunderstanding by members of the claims process, and the shear amount of paper in the form of EOBs and doctor bills remains a sure recipe for confusion.   To simply pay bills and ignore the EOBs doesn’t allow a member to track the deductible, nor does it allow the member to verify the accuracy of payments to providers.  Plan members should review and compare every EOB and every provider bill.

We know our young man will be back on the court in a couple of months, but we’ll still be thumbing through mounds of bills and EOBs, hoping to eventually put the confusion behind us…until the next time.

Businesses offer benefit programs as a means to attract and retain quality employees.  Most offer medical, dental and vision policies.  Others offer life insurance and disability income protection.   Still, there are many low-cost ideas employers can embrace to enhance their programs.  To truly offer competitive vs. comparable benefits employers can improve a program by including simple, value-added perks.  As an introduction to this concept we reprint the following column with permission by its author, Kyle Lagunas, HR analyst at Software Advice.

Creative Benefits to Engage, Motivate, and Retain

Fact: A standard package of health, dental and vision insurance, some paid vacation, a modest life insurance policy is not “competitive.” Although attracting and retaining top talent continues to be a challenge for business leaders, most employers still boast of their competitive benefits offerings… which are really nothing special (“comparable,” even). And employers who continue to offer the same old benefits package will fall behind in attracting, motivating and retaining the best.

The lines between work and personal lives are blurring for many employees. They’re seeking balance between the two, and are finding value in the ability to choose the specific benefits that best meet their needs at this point in their lives. And employers are learning that, when chosen and implemented effectively, however, benefits can demonstrate leadership’s concern for the well-being of employees, reinforce cultural values, and foster deeper employee engagement.

According to James Berkeley, Director of Berkeley Burke International, however, there’s still a disconnect. “The decisions made regarding what benefits to offer are often based on subjective viewpoints, viewpoints that are far removed from the actual needs of employees.” Rather than assuming you know what your employees want, Berkeley suggests you ask them. Though answers will vary, many people are interested in more benefits in these areas:

Healthy Living and Wellness Benefits. Susan Combs, President of Combs & Company, “The biggest benefit that employees ask for is gym membership reimbursement.” Wellness programs like WalkingSpree–which creates walking clubs, assigns teams and creates competitions–are another great way to motivate and engage employees to live healthy (thereby reducing your health care costs).

Flexible Work Options. Telecommuting and other forms of flexible work options make employees healthier and happier.  And as Sara Sutton Fell, Founder and CEO of FlexJobs points out, studies show that, “Employers who offer flexible schedules and alternatives to the traditional nine-to-five not only see higher productivity, but also save on health-related benefits they already offer.” Stanford University conducted a big study that showed that telecommuters were four percent more productive than office workers, working more hours and taking a larger workload.

Commuting Relief Benefits. More and more are looking for commuting relief benefits from their employers. Incentivize carpooling; use services like Transit Chek so employees can purchase transit tickets with pre-tax dollars; Or promote healthy living and alternative commuting options by installing bike racks your the office.

Perks You Can Afford. Great perks aren’t just for the guys in Silicon Valley. Many companies–big and small–bring in a massage therapist who offers chair massages to employees. Convenient and relaxing, this perk costs the employer nothing and might just keep employees in the office longer. Others adopt reward programs like BetterWorks where employees are given an allowance to spend on discounted food from local restaurants, dry cleaning, gym memberships and more.

Clearing The Great Leadership Hurdle

By offering benefits that are actually competitive, an organization can set itself above the competition–and build a strong culture of engagement and motivation. But as Eddie Trieber, CEO of HRI, points out, “Getting there requires the support of leadership–and there are a few common concerns that need addressing.” Leaders are often focused on Costs, Immediate Benefit, and Employee Utilization. It’s up to you to deliver on these key points.

Address the issues of cost by reminding leadership how little (if anything) creative benefits cost the organization. It might also help to frame benefits in terms of investments–not costs–in new employee acquisition and retention. And educate your employees. Actively promoting offerings in your recruiting strategy. Use open enrollment to re-educate employees. Add FAQs and educational content to the employee self-service portals in your HRMS.

About the Author: Kyle Lagunas is the HR Analyst at Software Advice – which reviews products offered by various HR software vendors. Kyle reports on trends, technology, and best practices in human resources and recruiting.

Position: Associate Agency Producer
Salary: Commensurate with experience
Benefits: Medical, dental, life insurance, disability protection, AFLAC, paid vacation and holidays, 401(k)
Company: Reilly Benefits, Inc.

Job Description: The Associate Producer seeks to acquire clients who wish to purchase health and dental insurance plans.

Responsibilities:
 Sales and marketing in the Maryland, VA, and Washington DC area
 Community outreach through traditional networking and through social media outlets
 Presentation of plan options and rate comparisons
 Assisting clients through the application process
 Communications to include explanation of benefits
 Tracking of policies in progress
 Lead generation and prospect management
 Additional marketing projects and responsibilities as assigned

Qualifications:
 Two or four year college degree
 Health/Life license desired but not required
 Computer skills: Microsoft Office (Word, Excel, and Outlook)
 Basic understanding of social media (Facebook, LinkedIn, Twitter)
 Excellent communication skills, both written and verbal
 Strong presentation skills
 Strong organizational skills
 Fast learning skills

Reilly Benefits is a small insurance and employee benefits consulting agency, located in Southern Anne Arundel County, Maryland. The firm has an energetic and enjoyable company culture. We’re looking for a member who wishes to be part of a close working group, someone who will contribute thoughts and ideas as a means to strengthen the team. The position offers opportunity for advancement.

It depends upon the way you look at it.

A little known provision included in the healthcare law includes a new tax for health insurers.  Beginning in 2012, insurers will be required to pay $1 per member as a means to finance comparative effective research.  This fee rises to $2 in 2013.

The goal of comparative effectiveness research is to determine which procedures and approaches to health management achieve the most successful and cost effective results.  Does medicine A produce better results than medicine B?  Does one procedure outperform another procedure?  Do differences exist by geographic region?  By population segment?    By medical school?  By insurance company?

These are all of course good questions that should be answered, and a tax of dollar or two doesn’t sound so bad to pay for the research.  Understanding which medications and procedures produce the best and most cost effective results would provide enormous help in controlling health costs.

Now to be sure private industry already conducts comparative research.  But a general distrust of insurance companies and the inevitable pushback from plan participants (and from politicians) of any suggestion to change or limit choice diminishes the potential investment.  It’s driven by profit margin, many say.

Now Obamacare charges the duty to the federal government.  Makes sense.  After all, federal officials don’t make decisions based upon profit margins, right?  They have no interest in steering patients to specific hospitals or to replace higher cost medications with lower cost alternatives, do they?  They wouldn’t limit choice or procedures based upon cost, would they?

Comparative effectiveness is important.  It’s necessary.  And it’s integral to the survival of the U.S. healthcare system.  Insurance companies have pursued their own research for years.  Now the federal government will lead the way.  The question is this.  What will the government do with the research?

The passage of ObamaCare divided Congress and divided the country.   More recently it’s divided the judiciary.

As expected, dozens of lawsuits have been filed against the Patient Protection and Affordable Care Act since its final passage in March of 2010.  The most-watched cases challenge the individual mandate, the idea the government can require a citizen to purchase a specific insurance plan or face a tax.

To date five district courts have ruled on the individual mandate.  Three courts have upheld the law, Eastern Michigan, District of Columbia, and Western Virginia.  And two courts have struck it down: Eastern Virginia, and Northern Florida.

Next up are the Courts of Appeal.   There have been two decisions so far with the Sixth Circuit upholding the Eastern Michigan case and the Eleventh Circuit agreeing with the Northern Florida court to strike down the law down.

Still to rule is the Fourth Circuit to settle the split decisions from the two Virginia cases.  And the District of Columbia Circuit will hear its appeal in September.

If you’re scoring, that’s four courts to uphold the mandate, three courts to strike it down, two appeals still pending.   The judiciary is split, some decided, ultimately undecided.   But do any of these lower decisions really matter?   After all, it was concluded with that fateful Christmas Eve vote in 2009 that the U.S. Supreme Court would decide the issue.   So, in the meantime, aren’t we just following process and reading headlines?

The Patient Protection and Affordable Care Act includes a provision to develop a federally sponsored long term care program known as the Community Living Assistance Services and Support Act(CLASS Act).  The law requires theDepartment of Health and Human Services to release details of the program by October 1, 2012.  The program will likely begin enrolling members in 2013.

Americans 18 and older and actively at work will be eligible to enroll.  Employers who elect to participate will automatically enroll workers but workers will have the ability to opt out.  With no exclusions for pre-existing conditions participation will be highly selective and the program will disproportionately attract unhealthy members.

The Congressional Budget Office estimated the monthly premium cost at $123 on average, yet according to a white paper released by The Cato Institute earlier this year premiums could actually be in the range of $180-$240.  Cost will dissuade participants as will a requirement that premiums be paid for five years before benefits become available.

Cash benefits will be paid directly to a qualified participant who experiences a loss of at least two activities of daily living (ability to eat, dress, bathe, etc).  Payments are expected to be no less than $50 per day on average and there is no provision to limit benefits on a lifetime basis.

Only 6% of the population is expected to enroll according to estimates provided by the American Academy of Actuaries.  This number could be much lower given the voluntary nature of the program, the expense, and the five year vesting period.

The CLASS Act is doomed.  Low participation and adverse selection will render the program unsustainable.  The CBO is concerned it becomes “a new federal entitlement program with large, long-term spending increases that far exceed revenues.” and the bipartisanCommission on Fiscal Responsibility and Reform suggests a repeal if the program cannot be “reformed” in short order.  Reform?  The healthcare law was supposed to be reform!  Repeal is better than reform, at least for the CLASS Act.