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Issue: # 109
January 24, 2014
  
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Dear  :     

 


Two effective ways to control health insurance costs is to 1) avoid claims all together and 2) control claims costs when incurred.  Even if everyone has health insurance, the cost of services and ultimately premiums, will not decrease if these issues are not addressed.

Health insurance companies help people avoid claims by promoting healthy living through various rewards programs.  The purpose of annual well-care physicals with no co-payment is to catch potential problems early, thus avoiding larger claims later. Lastly, the Commonwealth of Massachusetts Wellness Tax Credit also  promotes "health awareness & education" and healthy lifestyles to avoid claims.

Health insurance companies also address claim costs by offering plans with tiered networks, and adding riders that charge extra if you utilize hospitals deemed  "expensive".  The introduction of deductible plans has also made subscribers more aware of the actual costs which are disclosed on the Explanation of Benefits Statements.

Providers, however, need to do a better job making costs more transparent allowing subscribers to be better shoppers. In particular those providers that have "lower" costs need to do a better job selling their services. We've all seen the commercials for Shields MRI which we think are terrific.  See video above.
 
Below you will see information on the Work Opportunity Tax Credit (WOTC).  We are exploring the possibility of adding this as a service, whereby our clients forward us information every time they hire someone.  We would then determine eligibility, submit and track for your tax credit.  Any input on this idea would be appreciated.  Are any of you taking advantage of this now?

Although they came up a little short, great season by the New England Patriots.
 
 
Sincerely,
 
Blue Cross Renewal
Many things to consider 

Renewing health insurance use to consist of simply comparing co-payments and rates. Unfortunately the process has become more complex.  Typically at renewals in today's marketplace, below is what we recently discussed with a Blue Cross client: 

1) HCCS- Should they add this rider to lower rates by 7% but will charge subscribers an extra 1,000 for day surgeries, extra $1,000 for hospitalization and $450 for MRI-PET-CAT scans  done at what Blue Cross deems an "expensive" hospitals.

2) Healthy Actions- For a premium of only .4% (.4 not 4%) for groups up to 99 employees, employees automatically earn $100 if they participate in the program and an additional $200 if they are deemed healthy or have met goals.  For once the Employer can win too, depending on participation of the employees.
  • 20-49% participation =1.25% annual premium refund
  • 50-79% participation =2.50% annual premium refund
  • >80% participation = 5.00% annual premium refund 
3) Deductible plan- 
This particular company still had a co-payment plan, so deductibles were reviewed.  All procedures outside a normal office vist, for example blood work, -MRI-CAT scans, hospitalizations and day surgeries apply to an annual deductible. 

4) Tiering Plan- This plan puts hospitals in different tiers - Low-Middle-High. Depending on which tier your hospital falls into will determine your co-payment/deductible. 

We went through all of these before we even discussed rates! 



 

Annual well-care physical
Costs nothing

One of the positive benefits from Obamacare is that annual well-care physicals are covered with NO co-payment.  Encourage employees to take advantage of this free benefit.

At the same time they need to:
  • Don't Pay a Co-Pay.  Unfortunately it is common for the front desk to ask for the co-pay.  You must speak up and tell there the Co- Pay is $0.
  • If any tests are run, make sure the PCP office codes them in for billing as part of their annual physical and not as "diagnostic".

This happens all the time.  The burden is on the individual to correct the problem.   

Massachusetts Connector update

Massachusetts now ranks last in its progress toward enrolling people under the federal law.

By the end of December, three months into the enrollment period, only 5,428 Connector shoppers had succeeded in choosing their preferred health plan, according to a report released this week. That is far short of where the state needs to be to meet a goal of enrolling 250,000 in private health plans by the end of March.
 
Work opportunity tax credit  (WOTC)
Not passed yet for 2014 
WOTC is a Federal tax credit available to employers who hire and retain veterans and individuals from other target groups with significant barriers to employment. Read the brochure, eligible employees much larger then expected.

Employers claim about $1 billion in tax credits each year under the WOTC program. There is no limit on the number of individuals an employer can hire to qualify to claim the tax credit, and there are a few simple steps to follow to apply for WOTC.

The legislative authority for the WOTC program expired on December 31, 2013. At this time, we have no indication whether Congress may pass legislation extending authority for the program beyond December 31, 2013. However, in the past when the program's authority lapsed, Congress has retroactively reauthorized the program back to the date of expiration.

In anticipation of possible retroactive reauthorization, employers should continue to submit WOTC applications for all target groups to State Workforce Agencies. For further information, please review Training and Employment Guidance Letter No. 8-13 or contact the WOTC coordinator in your state.