Monday, April 06, 2020

Medicare Supplement G Plan 2020 - Learn About Medigap G Plan

Medicare supplement plan G 2020. Learn about Medigap G plan.







You don't have to be terminal to run up a lot of medical bills:

■ People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. In the US over 34 million have diabetes.



■ An estimated 22 million people in the US have CVD (Cardio-Vascular Disease). The annual direct cost of care per person is $18,953; for related care the total is $39,036.

This chart shows annual cost of cancer care for those 65 and over.

Bottom line?

Limit your out of pocket costs with Medicare supplement plan G.

“Doing Twice the Work for 60% of the Pay”

COVID 19 has touched each part of our lives, none more so than medical practices. I have been following my medical administrative list serve groups and I am now reading about practices closing and laying off employees.  Doctors are adapting by doing telehealth, but this has proven difficult due to the billing rules and regulations changing daily. Additionally, the reimbursement is a fraction of what is normally paid for an office visit.

This title sums up the medical practice world today:  Doctors worried about survival of their medical practices: ‘This could be the death blow,’ says physician”. “Since the coronavirus outbreak began, the medical practice has seen patient visits drop to 20% of its regular workload.”

Not only are medical practices facing revenue shortfalls, but since elective surgeries have been stopped Surgery Centers have been forced to closed their doors and lay off employees.

Medical facilities are often working on a thin margin in good times. By now, the payments from their February appointments have come in and their March postings will be significantly less, depending on their ability to turn in person visits into telehealth visits, while navigating the numerous changes to the process.

Why is telehealth so difficult to set up? It has to do with the original rules. Telehealth was designed to assist with patients in rural communities that might not have access to specialists. The patient would go to a clinic, the clinic would connect the patient with a specialist and then the patient and specialist or other medical professional would discuss the issue. The provider would create an assessment and treatment plan that would be done at the local clinical site. Telehealth was never intended to be done at home with Skype. Due to the rules, most, if any telehealth, was done by mental health professionals, clinic to clinic.

Now, practices have to scramble to create telehealth platforms, learn the new rules for coding and billing, and create appointment protocols while trying to manage their business. In the best of times, a project of this scale would take months to complete and doctors are trying to do it in days.

Those practices that have been able to do the telehealth and bill correctly are now getting their reimbursement and are very disappointed at the payments coming in. What they have discovered is that they did the work without the monetary compensation, or doing twice the work for 60% of the pay.

Friday, April 03, 2020

You CAN Enroll In Health Insurance

News flash: ACA exchanges are open and all states have Special Enrollment Periods!

In a day and age when 240 characters is our limit for reading news, it becomes very important that we don't overlook the facts within the story. Unfortunately our media outlets would rather garner clicks and scare people than provide a real understanding of what people can do.

Look at these headlines:

Trump Rejects Obamacare Special Enrollment Period Amid Pandemic - Politico

Trump Rejects Opening Obamacare Enrollment for Uninsured Americans - Fox Business News

Obamacare Markets Will Not Reopen, Trump Decides - New York Times

The list goes on: The Daily Beast, Salon, Business Insider, NBC, all have headlines that create fear.

This shameful tactic is bad enough during normal times, but playing on people's emotions during a pandemic where many are losing their jobs and their benefits is downright f'ed up.

Instead of dwelling on a lost cause, I would like to share the facts. Not only the facts as it relates to Special Enrollment Periods (SEP) being available, but also the challenges an individual faces when signing up for coverage.

An SEP is an enrollment opportunity for individuals dealing with certain life events including losing health coverage, moving, getting married, having a baby, or adopting a child. Aside from an SEP, someone may also qualify for COBRA (likely high cost) or Medicaid/CHIP (income limits apply).

For now we will focus on losing health coverage.

When you lose your job you have 60 days before or 60 days following the event to enroll in a plan. To enroll you need to create an account at Healthcare.gov (or your state's exchange platform). When creating an account you are asked quite a bit about your demographics. Answering these questions are essential to your account and don't require much heavy lifting to complete.

The more challenging parts of the application process deal with providing your projected income, understanding your results, and uploading the proper documents to finalize your insurance.

During the application process you will be asked to provide your projected income for the year. This is the first challenge as nobody knows how much they will make in the future. It's important to note that many sources of income count including wages, tips, income from investments/rentals, Social Security, retirement/pensions, and unemployment. I highlight the last because it will likely be a focus for those losing employer based insurance.

Once you have completed the basic sections you will be able to "review your results". It is here where you find out if you qualify for a subsidy or not. Also in this document will be details on what you need to provide as proof you are losing insurance coverage. This document - once you receive it - will have to be uploaded and sent to healthcare.gov. Documents that can be submitted include a letter from the health insurance company, a letter from your employer, a letter regarding COBRA, or many others based on your situation.

From here you will determine how much of your subsidy you want to use on a monthly basis (we recommend all of it), review all plans and prices, make a plan selection, and then pay your initial premium.

It's important to remember that if you have already lost insurance that you must pick a plan within 60 days of losing coverage, submit documents within 30 days of picking a plan, and your new plan won't start until the first of the month after you have picked a plan.

This is a very cumbersome process for most and there are many pitfalls that come along with trying to navigate the website on your own. Above everything I would recommend finding a licensed agent in your area to help you through the process. In many areas there is no cost for this assistance as compensation is built in to the insurance premiums you pay.

One last note, if you are looking for insurance make sure you complete the process within the required timeframe. Failing to do so will result in you having to wait until open enrollment which doesn't start your coverage until January 1, 2021.

MVNHS© Goes Bare

Not all heroes wear capes.

Or even clothes, for that matter:
"The British company MedFet, which describes itself as the "only online store 100% dedicated to medical fetish, kink, and roleplay," donated medical scrubs to a hospital to help its staff protect themselves from the virus while treating an influx of patients."

Here in the states, we're seeing company's like MyPillow making masks, and GM building ventilators, so this is definitely a bit ... er ... different.

Still, it speaks to the fallacy that nationalized, single-payer healthy "care" schemes are somehow better up to the daunting task than our admittedly flawed system.

#Medicaid4AllFail

Thursday, April 02, 2020

Is this something?

New guy on the block:



On the surface, it's a (now) standard  MEWA/AHP for self-employed Lone Star Staters, but also a hybrid of insurance & DPC.

The FAQ says doesn't price for pre-ex, which is nice, as well.

I reached out to their CEO, who assured me that:

"It’s not underwritten at all. We ask your age, your zip code, and whether you smoke. Our plans cover comprehensive EHBs too. You need to be self-employed to sign up"

And there's this: the versions of this that are available in my market require membership in an association or chamber of commerce, which can add substantially to the actual cost (one such runs $1,000/year in chamber fees!). Decent's differtent:

"You become part of the Texas Freelance Association, which is free to join, when you choose one of our plans."

Nice!

And I also like that they do use agents/brokers for marketing.

I do have some concerns about the product labeling, but not a huge deal.

Will be interesting to see if this catches on.

So, mystery solved?

Maybe, maybe not:

Earlier this week, we pondered how (and/or if) off-label uses of certain meds might be covered. I reached out to one of our carriers (whose rep was willing to at least kick this up the food chain for me). In the meantime, a commenter points out:

"The FDA issued an emergency-use authorization late Sunday for chloroquine and its next-generation version, hydroxychloroquine, as treatments for the novel coronavirus"

So it will be interesting to see how that plays out.

Oh, I have now heard back from my "inside source," who offers this helpful perspective on the general subject:
"Once a physician writes a prescription and the member has it filled by a pharmacy, the pharmacist won’t know specifically what is the patient’s diagnosis, or whether or not the physician prescribed something for the patient that is prescribed for an off label use.

Many specific drugs have programs such as Prior Approval and Step Therapy associated with them. The latter will require the physician to submit to Anthem for a prior authorization, indicating why a member needs a specific medication - or in the case of Step Therapy, the patient would have to try a medication in that same class, before what is written can be filled. The latter typically halts the use of “off label” prescribing for most of the higher cost brand medications."

Thank you!

Wednesday, April 01, 2020

3 Point Conversion?

No, not at all, but a conversion opportunity nonetheless.

Many folks choose term life products as a biggest-bang-for-the-buck life insurance option. These plans feature lower premiums than their permanent coverage brethren (eg Whole and Universal, etc), and the premiums are guaranteed for a specific number of years, after which the rates tend to sky-rocket. By then, of course, many (most?) folks no longer need all that coverage, and at least a few who do need it no longer qualify health-wise for a new plan.

What to do?

Well, one really helpful feature of most term life plans is their convertibility feature, which allows one to purchase a like amount (or less, if desired) of permanent insurance with rates that are guaranteed for the rest of one's day's on this mortal coil. Yes, they can be a bit pricey, as well, but there are some unique benefits, as described by FoIB Brian D:

"So, what can you do when you realize you need all or a portion of your life insurance to last beyond the initial length of your term?It means that any time after the first policy year, you can change from a limited-time benefit to a permanent one without answering health questions, having bloodwork or any other physical examination. In most cases, the death benefit for the new permanent policy will be in force until age 121, providing you with lifelong coverage."

Highly recommended reading (no foolin'!).

Tuesday, March 31, 2020

Breaking: *Full* COVID-19 coverage

This is HUGE - Humana waiving all CV-19 costs, treatment included:
"[C]osts related to subsequent treatment for COVID-19—including inpatient hospital admissions— will be waived for enrollees of Medicare Advantage plans, fully insured commercial members, Medicare Supplement and Medicaid.The waiver applies to all medical costs related to the treatment of COVID-19 as well as FDA-approved medications or vaccines when they become available."

CV-19 & Labels

Well, off-label, actually:

I've been asked how carriers might handle the off-label use of meds like Chloroquine (generally used as an anti-malarial drug, and also for lupus) . That is, would this "off-label use" still be considered a valid/covered expense?

To that end, I've reached out to one of our carriers (and been trying to do so with others) to see how this issue has historically been addressed. By way of example, I've posed this:
"Researching a post on how carriers *might* handle use of chloroquine for COVID-19. NOT asking how y'all will handle that issue specifically, but just how/if cover off-label use of meds for medically-necessary issues. For example, using Colchicine (gout med) for Pericarditis (pericardium inflammation). *In general*, is this kind of thing usually covered?"
As one might imagine, carriers are (understandably) reluctant to pre-adjudicate a hypothetical claim, and so I've been very carefiul to emphasize that I'm looking only for a historical perspective, which may be of value in the current situation.

So far, I've been kicked up the food chain, but still awaiting an on-point response.

If you are in a position (or know someone who is) to help us with an answer, I would be very grateful for your help. And, of course, confidentiality is a given.

COVID, Fraud and You

From our friends at the Ohio Insurance Agents association:

"Phishing emails are a great way for hackers to gain access to your system. Phishing is a cyber-crime term that describes how criminals pose as legitimate institutions or a trustworthy entity/individual to trick you into providing sensitive data such as login ID’s and passwords.

Due to the COVID-19 outbreak, cyber-criminals are using fear and uncertainty to prompt people to click on emails that promise supplies of paper products, hand sanitizer, and other products that are in short supply. Some reports are indicating that consumers are giving credit card information thinking they are buying supplies for their household.  Phishing doesn’t come in just the form of emails; you need to be aware that phishing can happen via text and phone calls as well
."

So what can you do?

Well, for one thing, always check the return address on these emails, they'll often (usually?) be an obvious fake. And before clicking any links, check with your (or your company's) IT folks for verification.

Be careful out there!!

Monday, March 30, 2020

CV-19 vs P&C: Grace Period Update

A few days ago, we mentioned that (at least) one of our carriers was offering to "adjust the customer’s current bill and to waive any late fees for any premium payments due between March 16 and April 30."

Well that was then, and this is now, and it's no longer just a nice gesture on the carriers' part. Our friends at the Ohio Insurance Agents association just tipped us:
"This bulletin pertains to all insurers (“Insurers”) providing property and casualty, life, and long term care insurance policies (“policies”) in the State of Ohio. The purpose of this bulletin is to notify Insurers that they must provide their insureds with at least a 60-day grace period to pay insurance premiums or submit information."

As with the similar decree about group insurance (and from the Feds on ObamaPlans), it's critical to keep in mind that this is a deferral, not a waiver: at some point the bill will come due. So think long and hard about your financial status now vs early summer.

OSHA vs HIPAA

Got this from our primary P&C carrier:

"Employers must report COVID-19 illness in workplace."

Which makes sense, but (as I pointed out at that post) seems to contradict HIPAA/privacy requirements, as well as guidance we noted the other day:
"Applicable law limits Anthem’s ability to share an individual’s protected health information with an employer absent an authorization or certain extenuating circumstances. As a result, Anthem is limited by law in its ability to disclose individual’s protected health information to an employer."

So how to square that circle?

Friday, March 27, 2020

Business Interruption vs CV-19: Revisited

This is what I love (and hate) about the insurance biz: to paraphrase a former POTUS, it depends on what the meaning of "covered loss" is.

Hunh?

Well, last week we posted what we thought was the definitive answer to the question of whether one's Business Interruption coverage would be triggered by the current Pandemic:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

And that, it seemed (at the time, at least) was that.

But maybe not:

"By way of example, some policies require “direct physical loss of or damage to” property. “Loss” and “damage” are not synonymous and may require separate analysis. Such wording could arguably trigger coverage where there is a loss of the premise’s use (even if the property is not physically damaged)."

That is, maybe BI cover does extend, even absent a "direct, physical loss."

The article notes, for example that if "a property has been contaminated by an infected person, or because COVID-19 is in the airspace or on surfaces, this will likely constitute direct physical damage." I would argue that this alone doesn't seem to reach the threshold, but then, I'm not the judge or the claims adjustor.

And, of course, that particular cite pertained to a New Jersey Appellate Court decision, so its relevance in other jurisdictions is up for grabs.

And there's this:

"Depending on the circumstances, the governing law, and the applicable policy’s language, they may very well be wrong. By way of example, some policies require “direct physical loss of or damage to” property. “Loss” and “damage” are not synonymous and may require separate analysis."

Will be interesting to see how this shakes out.


As always, consult with your own agent about how your policy may (or may not) handle this.

Thursday, March 26, 2020

And now for something completely different (and cute!)

Because we could all use a smile 'bout now:

Breaking: CV-19 & ObamaPlans

That is, premium deferment options similar to what we're seeing in the group market:

The key is that the Feds seem to be allowing such flexibility, not requiring it. And, as we've noted with the group extended grace period offer, these premiums are deferred, not waived; that is, the piper will eventually have to be paid.

Be careful...


Full text of notice here.

Updates as appropriate.

Wednesday, March 25, 2020

LTCi: When to make a claim

Courtesy of co-blogger Mike:

During a visit to my doctor, I asked him, "How do you determine whether or not an older person is ready to make a Long Term Care claim for Assisted Living?"

"Well," he said, "we fill up a bathtub, then we offer a teaspoon, a teacup and a bucket to the person to empty the bathtub."

"Oh, I understand," I said. "A normal person would use the bucket because it is bigger than the spoon or the teacup."

"No" he said. "A normal person would pull the plug. Here’s your claim form."


😃

Tuesday, March 24, 2020

Retiring Age 65 With Younger Spouse - Medicare COBRA Trap

Planning to retire? You are Medicare age but your spouse is not. What are your options?

Age 65 Younger Spouse

You MAY continue to work if that is available.


You can enroll with Medicare, your spouse opts for an #Obamacare plan.


Or you take Medicare and spouse chooses COBRA.


Just don't pick COBRA for BOTH of you. That triggers the Medicare COBRA trap.





#Medicare #YoungerSpouse #COBRA

From the P&C Files: More CV-19 News

I think we've had more P&C-related posts the past week or so than the past year combined. But it is Insureblog, so...

■ From one of our carriers (and, I'm sure, we'll see others following suit):
"Billing

Policyholders are understandably concerned about their ability to pay premiums as government mandated closures continue to increase. To help, we’re suspending all property casualty cancellations due to nonpayment from March 16 to April 30 – or later if required by an individual state.

While we hope that most policyholders can stick with their current payment arrangements, if you have a standard lines commercial, personal or life policyholder asking about alternative payment arrangements our billing associates are authorized to adjust the customer’s current bill and to waive any late fees for any premium payments due between March 16 and April 30. This is not a waiver of payments during the suspension period, but an extension or grace period for those directly impacted by this pandemic. Please have them contact our billing departments"

■ We've discussed Special Event coverage before:

"World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free."

And of course there's so-called 'Hole-in-one' cover and the like, as well.

Typically, these cover unforeseen issues like weather or the like, but what about the current situation? Well, our friends at the Ohio Insurance Agents association offer this heads' up:

"Read the policy language. Every policy is different. Prepare yourself by reading the policy language and specific exclusions on the Special Event Policies that you have issued. In addition, contact your underwriters for clarification on the exclusions to ensure you have a thorough understanding and will be able to communicate it back to your clients."

Always good advice.

What could go wrong?

Let's say that you deliberately skipped Open Enrollment (because, hey, why not?). And let's say that you now regret that decision.

No problem, mi amigo:

"Eleven States Now Letting Uninsured Sign Up for Obamacare"

Never let a crisis go to waste.

#Medicaid4All

[Hat Tip: FoIB Holly R]

Monday, March 23, 2020

Anthem Update

Just off conference call with Anthem execs, lots of interesting info, and will try to put together a more complete post, but some highlights:

Extraordinary focus on "Virtual Care" - what we've been calling 'telehealth' or 'telemedicine' and which has been mostly under the radar, until now. This is as much about capacity as it is social distancing, and the government is requiring carriers (like Anthem) to offer these services with no cost-sharing.

Relaxed rules on early refills for maintenance meds - this makes sense, again to minimize travel and maximize social distancing.

Group Plan Special Enrollment - This was a surprise to me: employees who initially waived group coverage can actually enroll between now and April 3rd, with full coverage.

There's more, and I'll try to update as quickly as possible. Stay tuned.

And speaking of Group Insurance

Last Friday, we posted a breaking news item pertaining to group health insurance plans and grace periods:

"Employers can defer their premium payments for health insurance for up to 2 months."

Now, we have more details:

"Insurers must permit employers to continue covering employees under group policies even if the employee would become ineligible due to a decrease in hours worked ... Employees who lose coverage are eligible for a special enrollment period to enroll in new [individual] coverage."

More at this link.

One presumes other states will also roll out similar decrees.


Oh!

We also got some interesting info from Anthem, courtesy of FoIB Beth D:

Q: Can Anthem provide my company with information regarding COVID-19 cases within our member population?

A: Applicable law limits Anthem’s ability to share an individual’s protected health information with an employer absent an authorization or certain extenuating circumstances. As a result, Anthem is limited by law in its ability to disclose individual’s protected health information to an employer.


Q: Can an employer receive information on the number of claims — but not specific names — for COVID-19 tests and related services?
 

A: No. Currently, it may be possible to identify someone specifically even if, for example, their name is not shared. We recommend checking in with local health authorities to understand the total number of cases in any given area.


Hadn't even considered the HIPAA/Privacy angles here. Thanks, Anthem (and Beth)!

And one more thing (because I'd been wondering about how this will affect self-insured plans, as well):


Self-insured plans no longer have the option not to waive out-of-pocket member expenses for the diagnostic test and the visit associated with the test, as laid out in the federal mandate.

So there ya go.
 

Underwriting, Selling, and CV-19 [UPDATED]

We've been discussing some of the insurance issues which agents, companies and clients are facing while the Pandemic continues. Obviously, people still need insurance, and of course a lot of policies are negotiated at the proverbial kitchen table. But what happens when the kitchen table meets 'social distancing?'

Well, our friends at Mutual of Omaha have some suggestions:

"We encourage you to also do your part to slow the spread of the coronavirus. You're likely rethinking how you can keep yourself and others safe in a business that's built on relationships with people and, most often, face-to-face interactions ... We strongly encourage you not to conduct in-person client meetings and we should all be prudent to exercise an abundance of caution."

And they go on to list some reasonable alternatives:

o Opt for video meetings or phone calls when possible.
o Avoid in-person meetings if either you or another participant is at risk.

They also suggest contacting folks in advance, and avoid meetings where any of the participants aren't feeling well. And they also suggest - and I think this is particularly helpful - that if one does "proceed with an in-person meeting, please document the client's agreement to meet ... This will be key if there are any questions later regarding meetings or participants."

Or, as our friends at Issue Insurance call it, 'Professional Distancing.'

I like it.


All of these strictures apply, of course, to any insurance sales opportunity, from a simple auto policy renewal to complex Long Term Care insurance reviews.

And remember Sgt Esterhaus' admonition.


 Of course, Professional Distancing just got a lot easier for us folks in the Buckeye State.

UPDATE: We've also just learned that we're actually considered an Essential Service:

In this order, the business of insurance falls under EssentialBusinesses and Operations. This means that you can continue to operate but mustdo so under the Director of Health’s operating requirements.

How nice for us.

Friday, March 20, 2020

Breaking (Group Health Insurance) News: Buckeye State edition

Co-blogger Patrick just sent me this:



This is relevant to our post the other day wondering about the short term future of group health plans, and is welcome news indeed.

More from P&C World: CV-19 update

While we've been focused primarily on the health insurance aspect of the pandemic, we've also blogged petty extensively about Business Interruption coverage in commercial lines packages, and even noted how the P&C side of the biz is likely sheltered from catastrophic losses.

But something I hadn't seen addressed, at least until now, is the Worker's Comp issue:



That is, as more workers succumb to the Chinese Coronavirus while on the job. I can see this; for example:

Had to meet a relative at the ER yesterday, and while she was squadded in, I had to walk to the ER from the parking lot. I was immediately stopped by a very polite yong nurse tech(?) who took and reported my temp and asked a few health questions. Her PPE consisted of a blanket (it was a bit chilly, and the door was propped open) and a pair of latex gloves. And yet, here I waltz in, breathing (and maybe coughing?) and I'm thinking that that blanket and those gloves are no match for CV-19.

#Food4Thought

Good news, bad news: CV-19 style

The good news is that, through government action and insurance company efforts, (initial) CV-19 testing is "free" (scare quotes because, well, we all know why).

The bad news, as FoIB Sheron Sidbury notes, is less obvious:


And it gets worse: pretty much all individual plans, and not a few group ones, are built on an HMO-chassis, which means that if the only (or closest) treatment facility is out-of-network, you're outta luck.

Ouch.

Thursday, March 19, 2020

Disability Insurance and CV-19

As we continue to monitor carriers' response to the pandemic, here's some helpful info from our friends at Companion Life (full discourage: CompLife is our go-to carrier for ancillary non-medical group coverage, including short- and long-term disability plans):

"If you have, or have been exposed to, COVID-19 and have been diagnosed by a certified medical professional, you can file a short-term disability claim."

Subject to waiting periods and the like.

Now, we've also been following the Business Interruption coverage issue:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

Okay, but what about disability coverage?

Well:

"We understand that some of our groups maybe faced with temporarily closing their doors dure to COVID-19. As an employer, if you choose to deem your employees still "actively employed" and "benefits-eligible" during that temporary closure, Companion Life will recognize those statuses."

This is similar to the Medical Mutual of Ohio stance on group plans.

It's important to note, of course,  that as with the BI issue, absent an actual "physical loss" these folks aren't 'disabled,' so aren't eligible for benefits.

On the other hand, and in keeping with current sentiments currently coming out of DC, the company is "extending the grace period for remitting premium payments."

Kudos.

Speaking of #SurpriseBilling

Out-of-network balance billing has long been a bugaboo of ours; it's part of the whole "transparency in health care" issue we've long since supported. Here, for example:

"Briefly, the issue is that there is essentially a class of providers who, although they may ply their trade inside a network-approved facility, are nonetheless not contracted with a given (or any) network."

This has became a burgeoning problem, especially since so many ObamaPlans are now on an HMO chassis (that is, very skinny networks coupled with virtually no out-of-network coverage).

But there may be a light at the end of the tunnel. Our friend tsrblke has been pushing this for at least the past year, and graciously sent us this link: :

"MemorialCare instituted a policy for physicians’ groups that provide doctors to treat patients in its hospitals: make sure those doctors are in the same insurance networks as the hospitals."

#GreatStart

[Hat Tip: FoIB tsrblke]

Wednesday, March 18, 2020

Anthem & CV-19

As noted yesterday, Medical Mutual of Oho seems to be the first (and thus far only) carrier to address the question of group plans and continued eligibility:

"If one person remains employed by the company and covered by the plan, e.g. the owner or a management employee, the company can continue to cover laid-off employees as long as premium is paid."

We did receive an email from UHC announcing a conference cll on the current situation, but thus far have received no written guidelines.

And Anthem just sent this:

"As our communities work through these challenging and uncertain times, our commitment to our customers and the health and safety of our communities remains our focus."

They went on to identify all the processes they've put in place regarding social distancing and the like, but nary a word on what employees (and employees) mare supposed to be doing if their company is (temporarily) shuttered.

It seems to me that these carriers have had sufficient time to craft and disseminate a policy on this, and I'm keenly disappointed that only one has seen fit to do so.

Again, we'll keep updating as appropriate.

Skype calls vs Housecalls

As more folks (and providers) turn to telemedicine as an alternative health care delivery option, especially now due to CV-19, the issue of patient privacy comes up:

I reached out to co-blogger Kelley for conformation and she responded:

"The tweet is correct, here is the information."

She also graciously attached an email from the Medical Group Management Association (MGMA), which says (in part):

"Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services ... CMS will:

• Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas;

• Waive originating site restrictions, meaning patients can receive telehealth services in their home;

• Allow use of telephones that have audio and video capabilities
"

And more. Click here for the full report.

And wash your hands:

Now what? CV-19 vs Group Health Insurance

Co-blogger Patrick has, perhaps, the quintessential COVID-19 tweet, at least as it applies to group health insurance:


That is, if companies are (temporarily?) shuttered, what happens to their group plans?

And, of course, there's the question of folks with individual policies, as well, but that's a bigger can of worms.

As it is, there are a number of issues here, and answers will also depend on whether a given plan is fully or self-insured.

One of my small groups provides vending and games machines to bars, so our Governor's order closing all of those has left his company shuttered. He called to ask if he laid off all his employees (including himself), could he keep the group plan in place, and even pay the premiums for his employees?

For now, the only carrier that has given me specific, actionable guidance has been Medical Mutual of Ohio, but I'm certain that other carriers will offer the same options. For example:

"Q. My plan is fully insured. If I have to lay off my entire workforce in response to the COVID-19 crisis, can the company continue to cover those employees?

A. If one person remains employed by the company and covered by the plan, e.g. the owner or a management employee, the company can continue to cover laid-off employees as long as premium is paid. Please note that you must offer this coverage on a uniform, non-discriminatory basis. In other words, you may not choose only certain people for whom you continue to pay premium
."

Typically, carriers require a minimum group size (usually at least one or two, sometimes three, employees); this seems to indicate that this requirement may be waived for the nonce. That would certainly make sense.

He also asked me what his options were if he just canceled the group for now, and we discussed some of those (generally about Short Term Medical plans, for now).

I'm going to update this post as more carriers weigh in.


[Special Thanks to FoIB Beth D]

Tuesday, March 17, 2020

Safety Uber Alles

Depending on the carrier, one's age and the face amount at (potential) risk, many life insurance applicants must undergo a paramedical exam (or more). This usually entails a service obtaining blood and urine specimens, taking a blood pressure reading, and the like. Given the current CV-19 situation, I wasn't surprised to receive this notice form our primary carrier:

"With the coronavirus, ExamOne has been taking precautions when performing exams for your clients.  Below is a link to their site for updates on how they are responding and implementing safeguards.  Due to the declared state of emergency requiring all non-essential businesses to close, examiners are no longer performing exams in Pennsylvania (entire state) and the San Francisco Bay area (San Francisco, San Jose, Oakland, and the surrounding counties). This is effective immediately."

And of course, that moratorium may soon extend to other states, as well.

This means that at least a few folks will gave to wait on their new policies to be underwritten.

Now, there's an interesting twist here: when one initially makes application, if one also includes a check for the first premium with that app, one is issued a "conditional binding receipt." This obligates the company during the underwriting phase, but only so far: "It provides that the applicant is covered immediately from the date of application as long as he or she passes the insurer's underwriting requirements." [emphasis in original]

One can imagine the role this little tidbit may end up playing here...

[Hat Tip: FoIB Major B]

Medicare 101 - Math Is Hard

In 2013 Mayor Rahmbo Emanuel instituted a cost cutting measure that saved Chicago "tens of millions of dollars". And retired city workers paid the price.
How to qualify for Medicare when you did not pay Medicare taxes

Among the perks promised to older city workers — affordable health insurance in retirement.

But in 2013, then-Mayor Rahm Emanuel announced he was ending the benefit to save cash.

Retirees who started working before 1986 were hit the hardest.

They never contributed to Medicare during their employment — the city’s choice, not theirs.

As a result, many now don’t qualify for government health insurance, even at age 65.

For a single retiree, the annual cost is now more than $33,000, whereas before it cost a few thousand dollars. - WGNTV News

More than $33,000 per year . . .

Missing the Mark

One is not required to pay into the Social Security system via payroll (FICA + MEDICARE) taxes to be ELIGIBLE for Medicare.

If you or your spouse are US citizens with 5 years residency you may BUY IN to Medicare.

Buy In To Medicare


Medicare Part A premium $458 (2020) - Current premium for those who do not have 40 quarters of Medicare wages.

Medicare Part B premium $145 (2020)

$458 + $145 = $503 x 12 = $6,036

$33,000 - $6,036 = $26,964

Math is hard . . .

Never let a serious crisis go to waste.

Monday, March 16, 2020

Hunh: CV-19 testing - Covered?

So-called "excepted benefit" plans, which include Short Term and Travel Medical policies, have gotten short-shrift in the CV-19 discussion, but that may be changing (for the good). These policies, which are not ACA-compliant (NTTAWWT), may also include Coronavirus testing.

Here's why:

These plans, while exempt from federal oversight, are still generally subject to rules and reg's put forth by the individual states in which they're sold:

"In Washington state, for example, Mike Kreidler, the insurance commissioner, is requiring all health insurers in the state to cover testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19 pneumonia, without imposing preauthorization requirements, co-payment requirements or deductibles, at least until May ."

In other words: "free."

GeoBlue, for instance, which offers ravel medical plans, "has announced that it will cover medically necessary, prescribed SARS-CoV-2 diagnostic testing at no cost to  the enrollee."

As has National General on their Short Term Medical plans.

And other carriers are also stepping up.

Kudos!

Now we just have to wait for the tests to be (more?) widely available.

Also: Wash your hands!

From the P&C Files: CV-19 Exclusions

The other day, we learned that Business Interruption coverage is unlikely to extend to business that (temporarily) close their doors while the pandemic plays out. Turns out, there's likely a few more lines of coverage that will likely exclude CV-1-related claims.

Our good friend (and P&C guru) Bill M tips us to this item:

"U.S. P&C insurers face 'limited exposures' from coronavirus"

"While the virus will undoubtedly impact the health and life insurance markets, the U.S. property & casualty (P&C) sector may emerge relatively unscathed once the pandemic subsides."

Okay, I'll bite: why is that?

Well, it comes back to something we've seen before:

"Bill taught me a new phrase, and suggested I use it whenever I'm looking at these kinds of (potential) claims: "cause of loss." That is, which circumstances are specifically covered, and which are specifically excluded."

And here's where that phrase comes into play, CV-19-wise:

"However, if a factory closes because of fears that an infected worker contaminated equipment, BI coverage could be triggered. “But even in this case,” Fitch says, “claim exposures would likely be limited by policy sub-limits.”

This is different from the situation we discussed this past Friday: in this case, there seems to be an actual physical cause; but again, even that claim will probably be limited in scope.

This would also apply, for example, to supply chain disruptions and even travel interruption plans.

We  discussed this a couple of weeks ago:

"Plans where the Cancel for Any Reason upgrade has been purchased allows travelers to decide for themselves whether to travel or cancel their trip according to the terms of the plan."

One can imagine there's been a substantial uptick in interest in those kinds of plans, but as the article notes, "the adverse impact insurers will likely face will be from a decrease in demand" as folks decide to maybe trade in a staycation for that cruise (at least for the nonce). And it doesn't have to be international travel, either:

A colleague told me the other day about a friend of his who had tickets for the A-10 (?) basketball tourney in New York. He cabbed from the airport to his hotel, checked in, and learned that the event ha been canceled. Okay, disappointing, but we'll just take in a show, right?

Ummm:

"Broadway Shuts Down: Performances Canceled Through April 12 Due to COVID-19 Pandemic"

/sigh

Now, one area where carriers may see specific exposure is event cancellation (see above). When basketball and now even golf tournaments are canceled (or postponed), there may well be valid claims, depending on what type of coverage the organizers bought (if any). For example, "if the Olympics were to be canceled, Moody’s asserts that “losses could become material for some insurers,” with industry experts estimating insurance coverage for the games to be around $2 billion."

That's a lot of gold.

Friday, March 13, 2020

Business: Interrupted (COVID-19 edition) [Updated]

[Scroll to bottom for update]

We've blogged on the subject of Business Interruption coverage before, most recently here:

"[W]hen a business must temporarily close its doors due to damage to or destruction of business property, Business Interruption insurance coverage pays for business income lost while the property is rebuilt. This coverage is intended to help keep the company in business while recovery is underway."

In that case, it was a burned up food truck, but we've also addressed weather and even civil unrest-related cases. But what about health-related ones, specifically as they may arise from businesses deciding to (temporarily?) close their doors "out of an abundance of caution?"

Well, got this from one of my P&C gurus:

"In the event of my absence, if anyone for commercial lines calls and asks if there is any business income coverage due to their business shutting down during the Coronavirus outbreak, the answer is "No"."

And why is this?

"No direct physical loss."

Which makes sense, since the physical premises haven't actually been affected.

But what if the government mandates that your business close up (at least temporarily)?

Still outta luck.

Why?

Same reason.

The key is that the coverage is tied to the physical premises, not the business itself.

Caveat: This is true at least in Ohio; as always, consult with your own agent about your specific coverage.

UPDATE: I asked my two gurus "if BI coverage doesn’t extend because no physical loss, is there some kind of policy/coverage an owner can but that would?"

Both told me no.

I did point out to a Twitter follower that perhaps such coverage might be available through a Lloyd's syndicate, but that it would likely be prohibitively expensive (especially now, in the middle of the pandemic).

[Hat Tip: FoIB Teresa S and Bill M]