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Health and Human Services Issues New Guidance on Health Insurance Premium Refunds

December 5, 2011 by Craig

The loss ratio provisions in the Health Care Reform law make it mandatory for Health insurers to either: (1) maintain a minimum medical loss ratio (MLR) or (2) to refund premium to the insured.  The first refunds are supposed to be issued in August of 2012.  Here is a story from the Wall Street Journal on some new guidance which HHS put out on Friday.

A couple of key items:

  1. HHS declined to exclude broker commissions from MLR calculations, a blow to health insurance agents.
  2. HHS will make it more difficult for “mini-med” plans to operate between 2012 and 2014.
  3. HHS estimates that 9 million refunds will be due averaging somewhere between $67 to $155/check.  It seems to me that the cost to calculate and administer payment for these checks will exceed the actual amount of the check, however HHS believes the initiative might have improved pricing patterns on rate increases for health insurance due to the existence of the MLR requirements and refunds.
  4. The rebate checks will not be considered taxable income.

Here is a link to the CMS press release.

Here is more detailed information from CMS on Friday’s announcement.

Posted in All, CMS, News | 4 Comments »

Medicare Will Begin Covering Obesity Counseling as a Preventative Benefit

November 30, 2011 by Craig

Yesterday, CMS announced that there will be coverage under Medicare’s preventative benefits for obesity counseling.  Here is a link to their press release with detailed information.

The therapy sessions can last for up to one year with more frequent sessions early in the year and sessions become less frequent as the year progresses (roughly 20 sessions for the year).  Medicare beneficiaries must meet or exceed a body mass index of 30kg/m2.  Here is a link to a body mass calculator, but by example, if you are 5″ 9″ tall, you would meet the criteria for counseling if you weighed 205 pounds or more.

CMS estimates that roughly 30% of Medicare beneficiaries would be qualified as obese by the BMI measurement.

Posted in All, CMS, Uncategorized | 1 Comment »

Insurance Product Training – Dec. 5th – Dec. 12th

November 30, 2011 by Craig

Do you need insurance product training? RitterIm.com has an up-to-date posting of all the top carriers’ trainings on our event calendar. Registration is “one click” away at Ritter Insurance’s “Events’ Calendar”! (You must be logged in to register!)
  • Monday, December 5, 2011; IBC Sales Training webinar is open to all licensed IBC agents. Florida NDP Broker CCP Product Training is being held in Hollywood, FL.
  • Tuesday, December 6, 2011; Baltimore Life Tele-sales Training for Silver Guard Products Using INSpeed webinar is open to all Baltimore Life licensed agents. Aetna Senior Supplemental Product Training seminar is being held in Hattiesburg, MS. Coventry Medicare Basic Training seminar is being held in Stuart, FL.
  • Wednesday, December 7, 2011; Aetna Senior Supplemental Product Training seminar is being held in Pearl, MS.
  • Thursday, December 8, 2011; Aetna Senior Supplemental Product Training seminar is being held in Tupelo, MS. Care Improvement Plus Understanding Your SEP Opportunity webinar is open to all agents.
  • Friday, December 9, 2011; No scheduled training at this time.
  • Monday, December 12, 2011; Florida NDP Broker CCP Product Training seminar is being held in Miami, FL.

Posted in Aetna, All, Baltimore Life, Care Improvement Plus, Coventry, Education/Training, Final Expense Life, Independence Blue Cross, Insurance Companies, Insurance Products, Medicare, Medicare Supplement, States | Leave a Comment »

Ohio Department of Insurance Issues Ruling Prohibiting Unsolicited Contact for Medicare Supplement (Medigap) Sales

November 30, 2011 by Craig

Here is a copy of the draft ruling.  While this document clearly states “DRAFT”, I’ve now seen this from several insurance companies as final rule making (here is one example).  Looking at section D2 on page 2, Ohio DOI now prohibits “any unsolicited contact with a medicare-eligible person” and goes on to give examples (email, telephone, door to door, etc.)  This appears to rather closely follow the CMS regulations with regard to unsolicited contact for Part D and Medicare advantage.  The prohibition appears to be specific to Medicare supplement and doesn’t appear to apply to other life and health products (long term care, life insurance and annuities).

Posted in Medicare, Ohio | 3 Comments »

Donald Berwick to Resign as Head of Center for Medicare and Medicaid Services (CMS)

November 29, 2011 by Craig

Here is the story for the Washington Post.  President Obama appointed Dr. Donald Berwick using a recess appointment in July of 2010.  His recess appointment was set to expire on December 31st, 2011.  In the face of heavy Republican opposition to confirm his appointment, Dr. Berwick announced his resignation effective December 2nd.

The White House will nominate Marilyn Tavenner as the new head for CMS, however, the process for confirming the nomination may take some time.  Ms. Tavenner is currently serving as Medicare’s deputy administrator.

Posted in CMS, News, Uncategorized | Leave a Comment »

Is There a Consensus Building for a Fundamental Change to the Medicare System?

November 27, 2011 by Craig

Robert Pear of the New York Times published an interesting article on the future of Medicare cuts in his Thanksgiving day article, “Support Builds for a Plan to Rein in Medicare Costs.”  Looking at the projected future cost of funding health benefits for our most vulnerable populations (both seniors and the disabled rely on the Medicare system), the Medicare system must be closely examined to find ways to most efficiently provide necessary care as well as ensure the viability of the Medicare system for the long term.

One of the ways to rein in costs and ensure financial solvency is to move to a “premium support” model as opposed to (or in concert with) a defined benefit model.  For years, companies have been moving away from defined benefits in favor of “defined contributions”.  This is especially true in the area of pensions and other retiree benefits such as 401(k) plans and 403(b) plans.  Companies (and now even governments) are finding it financially crippling to guarantee benefits versus making a fixed contribution.

By understanding this background, it’s a little clearer why both parties, Democrats and Republicans, are beginning to embrace a “premium support” model for health insurance benefits.  Even the funding for the new health care law is structured as a “premium support” where the amount of support is based on the individual’s income.

As with any proposal, the devil is in the details.  One of the key questions will be how to ensure that those in the most need are protected within a new system.  Also, there is concern that the most healthy may siphon off funds by choosing low cost plans with lavish “value added” benefits.  Clearly, private companies will have a financial interest in seeking out the most health Medicare beneficiaries, unless the system is properly structured.  This could create an “adverse selection” for Traditional Medicare or for plans with higher premiums and richer benefits.

Given the magnitude of the financial obligations of the US Federal Government and the massive amount of projected spending within the Medicare system, it seems prudent that the parties work exceedingly hard on a compromise with regard to Medicare that protects the existing beneficiaries and also reins in costs to protect the system for future generations.

Posted in All, CMS, News | Leave a Comment »

Insurance Product Training – Nov. 28th – Dec. 5th

November 23, 2011 by Craig

Do you need insurance product training? RitterIm.com has an up-to-date posting of all the top carriers’ trainings on our event calendar. Registration is “one click” away at Ritter Insurance’s “Events’ Calendar”! (You must be logged in to register!)
  • Monday, November 28th; Washington National New Group Process & Procedures Training webinar is open to all agents.  IBC Sales Training webinar is open to all licensed IBC agents. Coventry SFL; Florida NDP Broker CCP Product Training is being held in Miami, FL.
  • Tuesday, November 29th; Baltimore Life Tele-sales Training for Silver Guard Products Using INSpeed and Baltimore Life Silver Guard Training webinars are open to all Baltimore Life licensed agent.
  • Wednesday, November 30th; No Scheduled Trainings at this time.
  • Thursday, December 1st; Baltimore Life Silver Guard Training webinar is open to all Baltimore Life licensed agent.
  • Friday, December 2nd; No Scheduled Trainings at this time.
  • Monday, December 5th; IBC Sales Training webinar is open to all licensed IBC agents. Coventry SFL; Florida NDP Broker CCP Product Training is being held in Hollywood, FL.

Posted in About Ritter Insurance Marketing, All, Baltimore Life, Coventry, Education/Training, Final Expense Life, Independence Blue Cross, Individual Major Med, Insurance Companies, Insurance Products, Medicare Advantage, Medicare Supplement, States | Leave a Comment »

Thanksgiving Poem

November 23, 2011 by Craig

Here is a poem about Thanksgiving written by my 9 year old daughter, Callie.  I hope you enjoy it!

THANKSGIVING

by Callie Ritter

November 2011

T is together, differences aren’t bad,

H is for hope, one thing they had.

A is America, isn’t it grand?

            They traveled the ocean to “N”, the

New land.

K is for kindness, never thought it would happen,

S is for stuffed, never want to eat again.

G is for games that they played after dinner,

I for imagine how to survive a whole winter.

V is for venture, that they did around,

I is for Indians, Pilgrims they found.

N’s Native Americans, what they’re really name-ed

G is for gathering, and then say “Amen”.

Posted in About Ritter Insurance Marketing | 7 Comments »

Medicare Advantage Health Plan in Florida to be Liquidated

November 23, 2011 by Craig

Quality Health Plan of FL has been ordered to be liquidated as of 12/1/2012.  Here is the story from TheLedger.com.  The plan had 10,242 members as of September of 2011 who will be automatically enrolled in a Humana drug plan and Original Medicare as of 12/1/2012.  All of the members will also get a Special Election to choose a new plan and have guarantee issue rights to obtain Medigap coverage, if they so choose.

Here is a breakdown of the plan’s membership by county obtained from a CMS report:

Bradford 11
Brevard 477
Charlotte 79
Citrus 170
Clay 241
Duval 682
Hernando 121
Hillsborough 187
Indian River 1,044
Lake 147
Lee 154
Manatee 83
Marion 107
Martin 317
Okeechobee 389
Orange 166
Osceola 118
Palm Beach 20
Pasco 426
Pinellas 360
Polk 2,696
Sarasota 109
Seminole 44
St. Johns 33
St. Lucie 660
Sumter 103
Volusia 918

Posted in Florida, Insurance Companies, Medicare Advantage, News | 1 Comment »

Pennsylvania DOI Recommends Creation of an Insurance Exchange

November 23, 2011 by Craig

The PA DOI studied the issue of whether the state should create an insurance exchange for Pennsylvania and determined that an exchange should be created.  Now, they have to work with the Congress and Governor of PA to create enabling legislation to build the exchange.  Here is the story from the Pittsburgh Tribune-Review.

Posted in Health Care Reform, News | 1 Comment »

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