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Dear :
Question:
What is MLR (Medical Loss Ratio) requirement?
Answer:
In Massachusetts, at least 90% of every premium dollar in the individual and small group market (under 50 employees) must go towards paying claims or improving the quality of care. If an HMO's MLR is below 90%, they need to issue a rebate.
Update:
- Harvard-Pilgrim rebate will be issued (13.5 million)
- Tufts rebate will be issued (33.4 million) Fallon rebate will be issued (4.0 million)
- Blue Cross no rebate
- Neighborhood Health Plans rebate will issued (6.6 million)
Remember going through this last year?
Its that time again....
We are always available - call or send an email to Bill or Vanessa today.
Sincerely,
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Massachusett Wellness tax credit
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Last week, the Massachusetts Department of Public Health published final regulations and an online application that employers need to complete for consideration of a maximum $10,000 Wellness Tax Credit providing incentives to small businesses in Massachusetts to design and implement a Wellness program.
Massachusetts businesses employing 200 or fewer workers may qualify for the tax credit, up to 25% of the cost (with a $10,000 cap), by implementing a certified wellness program for their employees. Employers must meet eligibility requirements in addition to wellness program criteria. These requirements include offering health benefits, having a majority of employees working in Massachusetts, not having willful or repeat OSHA violations in the past five years, and meeting all other requirements as set forth in the final regulations.
The online application must be completed before December 31, 2013. Because of state budgetary constraints, the legislature has placed a $15 million per year limit on the total credits that can be issued. Consequently, any employer should submit their application as soon as possible.
At first this sounds great! But now look at the details,click here. This takes a lot of work and money up front with no guarantee that you will get awarded the credit. We call this your attention- but do not see this as something practical for our small business clients.
If you are a small group with less than 50 employees the Blue Cross Healthy Actions program would be easier to implement.
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Wellness options
HMO's are starting to offer wellness options with their plans, these are worth your time to look into!
 Fallon has"Healthy Health Plan" which is automatically included in the rates. Just fill out the on line health assessment and receive $50. From there, subscribers can choose to participate in a customized health action plan that may include health coaching, wellness workshops, interactive tools and more to earn an additional $150.
One of the reasons we enjoy doing
 | | Dave Przesiak |
business with Fallon is that the home office is right across the street from us so we are able to talk to the Senior Vice President of Sales and Marketing, Dave Przesiek. Today we asked him how the participation has been with the Healthy Health Plan. According to Dave "it's off and running with an excess of 750 subscribers and we have paid out close to 100,000 dollars. Keep in mind, although it started April 1st, groups can only add this when they renew."
Another advantage with Fallon is that they are easily accessible for help. Most of the account managers and executives have been there for 10 years plus and we have a strong relationship with them. They understand that small businesses need flexibility and immediate attention when a problem arises.
Blue Cross has Health Actions. This is not included in the rates and an employer has to add this rider for a nominal cost (refer to the link), but the employer can get this back and more if employees participate; for example if 50 to 74% of the employees participate, an employer can receive 2.5% of the annual premium back. Employees can earn up to $300.
Harvard-Pilgrim and Tufts will be sure to have their version coming out soon.
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| Forbes: health insurance rates in Washington | |
It has been understood that states like Massachusetts, which already mandate many benefits through the Division of Insurance, would not be effected as much as states which did not. This latest story from Forbes does not back up this theory.
Here is a small part:
For all the talk about rate shock-next year's Obamacare-induced spike in health insurance prices-there are a few states where you'd think rate shock shouldn't happen. In Maine, New Jersey, New York, Vermont, and Washington, insurance markets are already regulated in much the same way that Obamacare will. These states force insurers to cover everyone, despite pre-existing conditions, and they oblige carriers to charge similar rates to younger and older customers. Despite these factors, it turns out that in Washington state, Obamacare will still increase the underlying cost of individually purchased health insurance by 34 to 80 percent, on average
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