ACA Startup Oscar Struggles, Retains Value

Posted by & filed under Affordable Care Act, California, Individual Major Med, New Jersey, New York, Texas.

When new insurance markets emerged from the Affordable Care Act (ACA), investors put their money into Oscar, an insurance startup that approached health care with a modern website, design, and easy-to-use app. It purports itself as a health insurance company as the founders would want for themselves – simple, intuitive, and human. This kind…

Refresh Yourself on Scope of Appointments for 2016

Posted by & filed under Insurance Products, Medicare, Medicare Advantage, Medicare Supplement, Part D.

Scope of Appointment documentation is required for ALL face-to-face marketing appointments with individual beneficiaries, regardless where the appointment takes place. Group sales presentations (formal and informal CMS filed sales events) do not require the documentation because the scope of products that will be discussed should be indicated on all event advertising materials. The documentation must…

NY Nonprofit Health Insurers Facing Increased Losses Under ACA

Posted by & filed under Affordable Care Act, Medicare Advantage, New York, Uncategorized, Under 65.

By passing the Affordable Care Act (ACA), Congress sought to give health insurance shoppers more rights, benefits, and protections; increase buyers’ options; and develop a more competitive marketplace. However, due to a few of the law’s provisions, some of New York State’s nonprofit health insurers seem to be sinking deeper and deeper into a financial hole….

Clover Health Raises $100M with Revolutionary Approach to Health Insurance

Posted by & filed under Clover Health, Medicare Advantage, New Jersey, News, Uncategorized.

As the 2016 Annual Enrollment Period approaches, one thing is clear: investors are already banking on Clover Health having a successful selling season. Clover Health, based in San Francisco, is a digital health insurance startup offering a Medicare Advantage government-subsidized plan in nine counties throughout New Jersey. Formerly known as CarePoint Health Plan, the…

More Improvements for PA’s CHIP

Posted by & filed under Affordable Care Act, Health Care Reform, Pennsylvania, Uncategorized.

Effective December 1, 2015, all Children’s Health Insurance Program (CHIP) policies will offer more benefits important to children’s health. The addition of these enhanced benefits ensures that all CHIP plans meet the minimum essential coverage requirements set forth by the Affordable Care Act (ACA). It also provides all 148,000 children using CHIP…

OptumRx and Catamaran Form Stronger PBM

Posted by & filed under United Healthcare.

UnitedHealth Group’s pharmacy benefit management (PBM) company, OptumRx, recently partnered with fellow servicer Catamaran to create a new offering in pharmacy care, continuing a trend of consolidation. A PBM processes prescriptions for the groups that pay for drug, usually insurance companies or corporations, and use their size to negotiate with drug makers and pharmacies. According…

CMS to Begin Trial of Value-Based Insurance Design for MA

Posted by & filed under Arizona, CMS, Health Partners Plans, Independence Blue Cross, Indiana, Insurance Products, Iowa, Massachusetts, Medicare Advantage, Oregon, Pennsylvania, Tennessee, Uncategorized.

Beginning January 1, 2017, CMS will begin testing value-based insurance design (VBID) models to encourage using “high-value” clinical services to improve quality and reduce costs. “High-value” services are those that have the best chance to positively impact enrollee health. For five years, the model will be tested in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and…

Torchmark Corporation Faces CMS Sanctions

Posted by & filed under CMS, Medicare.

The Centers for Medicare & Medicaid Services (CMS) is imposing intermediate sanctions on Torchmark Corporation and its carriers First United Life Insurance and United American Insurance Company. Due to several noncompliance issues, CMS has placed a suspension on Torchmark’s enrollment of beneficiaries and marketing to beneficiaries for Prescription Drug Plan Contract Numbers S5580 and S5755….