Health Alliance: Illinois Civil Union Law Effective June 1

The Illinois Religious Freedom Protection and Civil Union Act (PA 96-1513) takes effect on June 1, 2011. The new law provides civil union partnerships between same-sex and opposite-sex partners with the same state law protections as those provided under marriage.

As a result of the new law, Health Alliance will now offer coverage to a legally recognized civil union partner as standard. A legally recognized civil union partner shall also be included in any definition or use of the terms spouse, family and dependent, as these terms are used for insurance coverage purposes. This law does not apply to self-funded ERISA plans in which the term spouse would be in accordance with federal law.

Unlike domestic partnership, a civil union partnership is officiated by a judge, public official or any person with the power to solemnize marriages under Illinois law. The date a civil union is officiated would be treated as a qualifying event for special enrollment under a group health insurance plan to add a legally recognized civil union partner as a dependent of the enrollee. In addition, the State of Illinois will automatically recognize an existing same-sex marriage or a civil union officiated in another state as an Illinois civil union partnership starting June 1, 2011. Employers and brokers may contact their account representatives for details.

For My Health Alliance individual plan plans, the applicant would make a selection on the Health Alliance standard application supplemental form that they are applying for coverage of a civil union partner. Coverage would be effective on the first day of the month following underwriting approval for coverage.

Should the Illinois Department of Insurance issue guidance on civil unions, Health Alliance will provide additional details.

PPACA: CMS Sticks with 10% Rate Review Trigger

The Centers for Medicare and Medicaid Services (CMS) plans to use a 10% cut-off to decide whether to look more closely at individual and small group health insurance rate hikes in states.

The 10% threshold will apply both in states where CMS handles rate reviews and in states that do the reviews themselves, officials say.

CMS, an arm of the U.S. Department of Health and Human Services (HHS), will begin to apply the review program rules Sept. 1.

Starting Sept. 1, 2012, each state will get its own review threshold, officials say.

CMS has described the rate review program regulations in an early version of the 94-page Rate Increase Disclosure and Review final rule.

The final rule, set to appear Monday in the Federal Register, will implement Section 1003 of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA Section 1003 requires HHS and the states to develop a process for conducting annual reviews of “unreasonable increases in premiums for health insurance coverage.”

HHS is encouraging states to conduct their own rate reviews. In states where regulators cannot or will not conduct reviews, an arm of CMS will conduct the reviews.

Originally, the rules were set to take effect July 1; CMS responded to pleas for relief from industry commenters by pushing the effective date back two months.

Many state regulators and insurance industry commenters also had asked CMS to reconsider using a 10% review threshold in every state. They suggested that the 10% threshold would lead to reviewers reviewing virtually all proposed rate increases in many states.

CMS declined to change cut-off.

PPACA Section 1003 gives CMS the authority to require justification and disclosure of proposed rate increases but no direct authority to block rate increases.

“However, if an issuer fails to comply with the requirements set forth in this final rule, CMS could seek a court order against the issuer to enforce compliance,” officials say in the preamble to the final rule.

Many insurance industry commenters had asked CMS to establish safe harbors or an expedited rate review procedure.

The commenters asked, for example, for a rate increase that seemed likely to satisfy the new federal minimum medical loss ratio requirements for individual and small group health insurance.

“We have not modified the final rule to provide safe harbors or expedited rate review procedures given that many factors are relevant in determining whether a particular proposed rate increase is unreasonable, thus supporting the need for a more detailed review process,” officials say.

Also in the preamble, CMS officials say:

• The definition of the word “state” used in the rate review program regulations includes District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.
• A state that reviews rates itself and excludes short-term health insurance from its definition of “individual health insurance” can keep short-term health insurance out of the rate review program.
• The rate review program will not affect grandfathered health insurance, retiree-only health plans or self-funded health plans.

CMS officials say they have not made up their mind about how to handle individual or small group coverage provided through associations.

CMS has included a list of questions aimed at commenters with an interest in the association health plan market.

CMS may grant confidential status for some information submitted to rate reviewers on a case-by-case basis.

Today, however, “based on a review of state filing guidelines and state websites, it appears at least 12 states do not redact any information when making rate filings available to the public,” officials say.

Karen Ignagni, president of America's Health Insurance Plans (AHIP), Washington, put out a statement suggesting that focusing solely on health insurance premiums while ignoring the underlying medical cost drivers will do nothing to make coverage more affordable.

"The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage," Ignagni says. “Health plans are doing their part to restrain health care cost growth by partnering with providers across the country to change payment models to promote and reward safe, high-quality, cost-effective care.

“Premium review must adequately factor in all of the components that determine premium rates, including geographic variation, the cost of new benefit mandates, and the impact of younger and healthier people dropping coverage. An arbitrary threshold for review will establish a de facto presumption of unreasonableness in what should be an objective, actuarially-based evaluation."

Any reviews that are conducted should be done at the state level, because state officials have the experience, infrastructure, and local market knowledge needed to ensure that consumers are protected and that health plans are solvent, Ignagni says.

Employee health care deductibles rising

Employers continue to boost deductibles, particularly for out-of-network services, as health care costs show no signs of easing, according to a survey released Wednesday.

Twenty-two percent of employers imposed deductibles of at least $1,000 this year for in-network services for their health care plans that had the largest enrollment, up from 16% last year and just 8% in 2008, according to PricewaterhouseCoopers L.L.P.

Double that percentage of employers—44%—imposed deductibles of at least $1,000 for out-of-network services, up from 29% in 2010. As recently as 2008, only about 20% of employers imposed deductibles of $1,000 or higher on out-of-network services, according to the survey of more than 1,700 employers.

“The biggest change in the past two years has been the increase in cost-sharing with employees,” said Michael Thompson, a PwC principal in New York. Increased cost-shifting has come as health care cost increases continue to outstrip increases in corporate profits as well as employee wages, he said.

Rising health care costs add pressure on employers already affected by the difficult economy, but boosting employee cost-sharing may make employees more careful consumers of services, Mr. Thompson said.

Premium contributions

On the other hand, employers have limited increasing employees’ premiums. For example, 31% of employers require employees to pay less than 20% of the total premium for family coverage this year, virtually unchanged from last year, according to the survey.

“Employers have been careful not to shift premium costs to employees, but have decided that the better way to shift costs is to require those who use health care services to pay more,” Mr. Thompson said.

The survey also found a surge in employees enrolling in high-deductible, consumer-driven health care plans.

This year, 17% of employers reported that the greatest percentage of their employees was enrolled in high-deductible plans, up from 13% in 2010 and 8% in 2009. By contrast, 57% of employers reported that traditional preferred provider organizations had the highest enrollment this year, down from 63% last year.

(Business Insurance)

Vision Plans Important for Employees to Consider

According to a recent survey conducted by Transitions Optical 24% of U.S. workers do not enroll in their employer's vision plan, and 30% of those who do enroll do not use their coverage to receive a comprehensive eye exam for themselves. Vision plans were not chosen by employees most commonly due to not having any current vision and eye problems. Good eye health is important to the performance of employees and not receiving available care could potentially put a person in greater risk for costly eye problems and diseases.

“While all employees surveyed reported access to a vision benefit through their employer, they were less likely to enroll in vision than medical and dental benefits,” says Pat Huot, director of managed vision care at Transitions Optical. “This is a serious lost opportunity for employers to help lower potential health care costs and boost productivity.”

According to Vision Optical's survey 30% of all employees felt their employers did not take the appropriate steps to make sure that employees understand their vision benefits. As well as 50% of all employees were not sure what eyeglass lens options were included in their vision coverage, but survey responses showed that having a greater understanding could increase enrollment and utilization of the benefits.

Barham Benefit Group is there for employees and employers on the matter. BBG will work with employers to give them a full comprehensive understanding of possible vision benefit plans that their company can provide. As well, BBG is available for individuals that are interested in being more proactive about their vision health and wish to find the best possible plan for preventive vision health and/or current diagnosed needs. Questions from employees concerning what options are included and general exam coverage can be handled by giving a call to the Barham Benefit Group office- 217.356.1978.

How to Select A Small Business Insurance Broker

Here are some basic steps in understanding small business brokers such as Barham Benefit Group. BBG works with several types of insurance products and can help you sort through the insurance offerings from multiple companies. An insurance broker can help to ensure that you meet all state and local requirements for insuring your small business. You can select an insurance broker in much the same way that you would choose any other business professional.

1. Determine the types of insurance your business will need. You may need a wide variety, from worker's compensation to accident coverage on a company vehicle.

Barham Benefit Group can assist small businesses with medical, dental, disability, and life.

2. Ask for referrals to insurance brokers. Good sources of referrals include professional associations, their commitment to the community, and other business owners with similar insurance needs. While you can pick a broker out of the phone book, knowing which brokers are reputable can help you narrow the field.

Barham Benefit Group is known for being extremely dedicated to the community, a large supporter of programs such as Swan Special Care Center, Champaign Public Library Foundation, and for all others click here. As well as BBG's support of their own endeavors of continuing the arts with Indi Go Artist Co-Op.

3- Interview potential brokers before you select one to handle your business. Ask about the broker's experience, other companies they may have worked with and what sort of insurance needs they expect your business to have.

Meeting often with clients to discuss their plans, being available for assistance on insurance plans, and having an expansive client base further shows BBG's commitment to serving their clients. They are very open to meeting with potential clients to discuss the needs of the business and offering one-on-one help through the process of creating benefit plans.

4- Check that your insurance broker will be available to you when needed. Typically, it is acceptable to expect that a broker is able to return your phone calls within a day, especially since your broker is often your only point of contact for your insurance. You should make your expectations clear before agreeing to work with a broker, including expectations such as when you expect monthly statements to arrive.

Call Barham Benefit Group at 217-356-1978, or email James at jab@barhambenefit.com or John at jkatsinas@barhambenefit.com they will promptly get back to you and be there throughout the process.

How to Appeal a Denied Health Insurance Claim

Problem Solver with the Chicago Tribune covered a problem many people face and is often an issue lamented in the health care debate. When working with a broker, such as Barham Benefit Group, step-by-step assistance is given and handled by the broker for minimal hassle for the clients. These tips explains how to handle a denied health insurance claim on your own.

Few things are more disheartening -- or often terrifying -- than having a medical claim denied by your health insurance provider.

Every week, the Problem Solver is inundated with e-mails from readers fraught with tales of health insurance woe. In some cases, an insurance claim denial can lead to financial ruin.

To help navigate the confusing world of health insurance claims, the Problem Solver has compiled a list of tips on how to appeal a denied health insurance claim.

Before filing an appeal, make sure you have all of your paperwork in order. Read your policy carefully, and make copies of any documents that might help you argue your case, such as the pertinent medical files. It is essential you can prove that your treatment qualifies for coverage under your health insurance plan.

When you speak to a customer service agent from your insurance company, take detailed notes. Ask for documentation to support their denial, and talk with your doctor or doctor’s office for advice on how to refute it.

If your insurance policy is employer-sponsored, federal law gives you 180 days from receipt of the denial notice to file an appeal.

You can call the number on the back of your insurance card for help in filing your appeal, or find the address for your insurance company online. When filing, make sure to include:

* The patient’s name and identification number
* The date or dates of medical service
* The doctor’s name and a bill for the services in question
* Copies of related medical records
* A detailed letter describing why you think the claim should be paid
* Copies of your policy highlighting any passages that support your appeal

If your appeal is denied, most insurance companies allow you to appeal again.

If the claim is again denied, you still have options. If your plan is self-funded, meaning it is administered by an insurance company based on rules set forth by your employer, you can ask your company’s benefits coordinator to consider your case. The Problem Solver did this with a denied claim several years ago and got the claim paid.

Under a recently passed state law, Illinois residents will soon also be able to request an external review of denied claims. The law, signed Jan. 5 by Gov. Pat Quinn, goes into effect July 1.

The external review is paid for by the insurer and is completed by an independent review organization. The review is available if you have exhausted the insurance company’s appeal process.

The law requires you to request the review within 120 days of the appeal denial.

For more information on the external review process, visit the Illinois Department of Insurance on the web, at insurance.illinois.gov.

Chicago Tribune Problem Solver Blog

Barham and Indi Go

Barham Benefit Group began as the sole beneficiary for Indi Go Artist Co Op. Seeking more ways to assist the community and to improve upon opportunities for marginalized artists, James Barham opened the gallery originally in time for the 2009 40 North Boneyard Arts Festival so that he could feature Ryan Slattery's artwork. Ryan Slattery was at that time living in one of Barham's rental homes and making stainless steel sculptures out of his garage. Seeing the unique abilities this young, unfound artist had Barham worked to pull off redecorating the gallery space from the previous Furniture Lounge and getting the event organized in a month.

The mission of the gallery is "visual space has essentially no owner" and those community organizations, student groups, local artists, and others that have benefitted from their involvement can attest to this.

A variety of events have already taken place at the gallery including benefit events, civil rights activism art shows, classical guitar performances, wedding receptions, CD release shows, a Halloween "funhouse", individual parties, improv comedy skits, tango dancing nights, fundraisers for many area nonprofits, Calendar release parties, wedding showers, and much more. The cost being nothing to very little for all of these groups.

In the near future, CU Design Organization, CUDO, is hosting Speaking Unconventionally: Letterpress Posters of Amos Paul Kennedy Jr. Amazing artwork with emotionally charged statements about race and individuality. Barham's work with Indi Go Artist Co-Op is anything but fearful of perceptions, pushing the boundaries and making a statement is common here and desired.

"The main reason I opened indi go is to provide space to encourage students to show their art," Barham has said. Another upcoming show exemplifies this. "Eric's Show" will be held from March 9th to the 21st. See this News Gazette article for more details about the extraordinary cause of this show. http://www.news-gazette.com/news/art/2010-02-28/copule-endows-art-competition-memorial-slain-teen-son.html

Soon to have nonprofit status, there are so many ways the community can take part in supporting the gallery as well as benefit from it's existence. How will you?