| Issue: # 72 | October 11, 2011 |
|
Greetings!
We often have insurance companies solicit us to sell their products. If we find an interesting product that is well priced and underwritten by a secure insurance company then we sign contracts to market their products. There are many times, however, we look at these products and decline to sell.
We appreciate that our client's time is valuable and do not want to waste it with products that do not fit a need. Most importantly, we only sell products that will not have issues when you actually need it and claims need to be paid. We can not stress that enough, thus our section on HMA Direct below.
We hope you find these newsletters helpful, please forward to anyone who may find this of interest, by using the forward link at the bottom of this e-mail. Thank you for your referrals. To learn more about us, click here.
If you have a question or want a a quote, send us an email Bill or Vanessa.
Bill Randell CLU,CHFC, Vanessa Costa CLU,CHFC,
|
|
HMA Direct
Not all insurance products are the same
| |
Two years ago we declined to contract with HMA Direct, and warned our clients in a newsletter to stay clear of them. Last month the US Attorney pressed charges against 9 of the employees, including the owner. 
There are other companies out there today, although of much better character then HMA Direct, trying to sell similar products. As we said in our newsletter two years ago, these products are typically what is referred to as self-insurance. Since they are self-insured products, they do not fall under the auspices of the Division of Insurance, but the Department of Labor. As a result, none of the state mandated mandated benefits, as stipulated by the Division of Insurance ,need to be covered. In order to verify exactly what is and is not covered, you NEED to see a copy of the Summary Plan Description (SPD).
In addition, there is usually full underwriting. Depending on the overall health of employees, the quoted rates may change once the underwriter reviews the health information. Even after approval, rates could change if an employee failed to divulge a pre-existing condition in the initial application. More importantly, any new hires that currently do not have insurance will be subject to a pre-existing conditions limitation for a stipulated period of time (usually 6 months).
If you are presented with a product like this, feel free to contact us and we will review with you. In the end, you can do the same thing (self- insure), by choosing a high deductible fully-insured plan and install an HRA to cover the deductible. All state mandated benefits will be covered, there will be no underwriting, and pre-existing conditions will be covered.
|
|
ObamaCare unconstitutional?
Supreme Court will hear case in 2012 before election
|
Last August, a three member panel of the 11th Circuit Court in Atlanta decided 2 to 1 that Congress overstepped its authority in passing the Affordable Care Act, which found the individual mandate unconstitutional. Story click here. Here is the key part of their decision:
"This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them repurchase that insurance product every month for their entire lives," the majority said in its 207-page opinion.
On September 26th, the Justice Department decided not to ask the full U.S. Court of Appeals for the 11th Circuit in Atlanta to take up the case. Why? They did not want the Supreme Court to rule on this.
In response on September 28th,the National Federation of Independent Businesses (NFIB) has filed a petition with the Supreme Court appealing the 11th Court's decision that the indvidual mandate can merely be severed from ObamaCare legislation. Their argument being, if Congress deemed the mandate an essential part of this legislation, how can the legislation continue without it .
Bottom line is that the Supreme Court will be listening to this case and make a ruling on it next year before the 2012 election. |
|
Express Scripts
Dropping Walgreens
| |
The HMO's do not run their own pharmacy benefits. Instead they hire companies who negotiate with pharmacies to sell the prescriptions you buy with an ID card.
Blue Cross of Massachusetts contracts with Express Scripts to handle prescriptions for subscribers. Currently Express Scripts is at an impasse with Walgreens and are scheduled to drop them January 1st, 2012, click here for story.
What does this mean to you? If you have Blue Cross and buy prescriptions at Walgreens, you will no longer be able to purchase them starting on January 1st, 2012. Blue Cross is sending out letters informing employees of this change to provide plenty of time to change to another pharmacy.
|
|
|
