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:

"HHS ... will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 emergency." https://t.co/ODkfMA9Smk

— AssocAmerPhys&Surg (@AAPSonline) March 17, 2020

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:

A bigger fear than paying for COVID-19 testing and treatment is how do small businesses & people being laid off pay premiums for health insurance? @insureblog @MikeBertaut

— Patrick Paule (@patpaule) March 17, 2020

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]

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]

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.

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]

COVID-19 vs Nonna & Nanno

Shot:

"It is a fact that we will have to choose [whom to treat] ...  prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions."

So, essentially a death sentence for Italian Bubbeh's and Zaydie's.

Chaser:

"Coronavirus patients who refuse to self-isolate face murder charges in Italy"

#EmptyThreat, no?

HSA vs COVID-19

This is big:

"The Internal Revenue Service today advised that high-deductible health plans (HDHPs) can pay for 2019 Novel Coronavirus (COVID-19)-related testing and treatment, without jeopardizing their status."https://t.co/ItIWGHrpEu

— Joe Kristan (@joebwan) March 11, 2020

Here's why:

HSA-compliant health insurance plans must include certain features (and are proscribed from including others). In general, so-called first-dollar benefits are strictly prohibited. Waiving co-pays and deductibles for CV-19 testing would seem to fall into this category, so the IRS has pro-actively gone on record waiving the potential fines:

"To facilitate the nation’s response to the 2019 Novel Coronavirus (COVID-19) ... a health plan that otherwise satisfies the requirements to be a high deductible health plan (HDHP) ... will not fail to be an HDHP ... merely because the health plan provides health benefits associated with testing for and treatment of COVID-19 without a deductible, or with a deductible below the minimum deductible (self only or family) for an HDHP."

Sweet.

Promises Broken: TomTom edition

On the one hand, we had a pretty good experience with the TomTom folks a few years back:

"Over the next few days, I called tech support a number of times, and they could not have been more helpful, professional or courteous."

But that was then, and this is now; via email from "Dave @ TomTom" (likely not his real name):

"Hi there,

We have been trying to contact you [ED: NO, THEY HAVEN'T] about the end of product support for your TomTom XL IQR.

The last compatible map update for your TomTom XL IQR was released around 09/01/2018, which means your current map might be 26 months old, missing 9 map updates. Therefore, me and my colleagues here highly recommend to no longer use your beloved TomTom XL IQRand consider replacing your device."

[ed: 'me and my colleagues.' Ever heard of Grammarly®, Dave?]

I replied:

"So the contractual obligation that comes with Lifetime Map Updates (see attached) is meaningless?"
 

Why the heck would I ever consider buying another product from you?

Wow."

Naturally, that email bounced:

"Thank you for contacting TomTom Customer Care. Unfortunately we are unable to respond to any messages sent to this email address."

Because of course it did.

So, I've taken this public, in the hopes of helping others avoid my fate by purchasing a product with explicit features and promises that the company can arbitrarily decide to cease providing.

#CaveatEmptor

#CheatinTomTom

Truth in Advertising

Got a LinkedIn invite recently from a gentleman (whose identity I've redacted) asking to be added to my network:

"Hi Henry,

I’m looking to grow my community with leaders that are interested in giving their members a better healthcare experience. If you think your members deserve more while paying less, then we should connect and chat. (Don’t worry, I’m not selling health insurance!)

Thanks,
[Redacted]"

It's that last bit that caught my eye:

"Don’t worry, I’m not selling health insurance!"

Why?

Well, because he's a regional poobah for Sedera Health.

And what is Sedera health, you ask?

Well, it's a "cost sharing community" ('community' now being the more politically correct version of 'ministry,' one supposes) to which one may subscribe. As we've noted in the past, these sharing ministries/communities/whatever are ACA-compliant, and generally much less expensive than ObamaPlans (particularly for folks who don't qualify for a subsidy or cost-sharing).

What they are not, however, and as my would-be associate notes, is insurance. That's because "Members agree to share one-another’s medical expenses through an act of voluntary giving." That's very different from a government-regulated (and enforced) insurance contract.

Which is not to absolve the carriers of their various and sundry shenanigans, oft-reported here at IB. But in those cases, there are avenues of redress: arbitration, litigation, and even criminal prosecution.

Not so with these plans.

Does that make them evil (or carcinogenic, or fattening)?

Of course not!

But certainly food for thought if one is considering signing up.

About your LTCi plan and the Stock Market

As the stock market continues its roller coaster ride, this seems like a good time to remind folks about the folly of self-insuring Long Term Care expenses:

Even though her #investments are down about 20%, my mother-in-law's #longtermcare insurance policy will pay the full cost of her assisted-living facility this month just like it did last month. #bearmarket #personalfinance #RetirementPlanning

Thank you, @johnhancockusa! https://t.co/aVzSy4Nit2

— Scott A. Olson, CLTC (@LTCShop) March 10, 2020

That is, regardless of how the market does (or doesn't do), once you're on-claim, you're on-claim for the duration of your policy's benefit period.

 

On the other hand, if you've chosen to self-insure, that certainty becomes a lot less ... certain.

Just sayin'.

Laundry time (Again)

So, another two years has rolled by, and it's time to re-certify for Anti-Money Laundering. This entails a brief, but silly, online course about the perils and pitfalls, Red Flags and Due Diligence as a result of the USA Patriot Act and our government's concern about money laundering and identity theft.

Or, as a good friend puts it, a very helpful "How To" guide on the subject.

Last time out, I remarked on the apparent xenophobia suffered by the good folks who wrote the course.

This time, it's a different (but oh so timely!) political cynicism:"

"Enhanced Due Diligence

A client’s location, affiliation, or type of business may raise red flags that indicate a need for increased scrutiny. For example, regulators have identified senior political figures as individuals that require greater due diligence. This enhanced due diligence will be conducted by the carrier."

Heh.

[Emphasis added]

CMMS vs COVID-19

Via email from CMMS:

"[This past Friday], the Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well."

This seems especially crucial given the increased risk favors faced by those on Medicare (seasoned citizens).

The agency also released 3 helpful publications:

■ Medicare Fact Sheet Highlights

■ Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights

■ Individual and Small Group Market Insurance Coverage

#Kudos!

[The entire press release is also available here]

Chilling, but #TruthWillOut

We generally don't do partisan politics here at IB, but this particular example of (inadvertent?) truth-telling is important:

Biden tells crowd he wants to increase premiums and make sure that healthcare is 'not quality, but only affordable'... pic.twitter.com/fNhtcW7kxx

— Sean Hannity (@seanhannity) March 6, 2020

"[W]e’ll make sure it’s not quality, but only affordable”

And that, in a nutshell, is the whole premise of a "Public Option" (or any "universal care" scheme, really).

But what, exactly, is the problem with a Public Option?

"The "Public Option" is a euphemism for Single Payer, the obvious end-game for the ObamaTax from the get-go. And how do we know this?"The [Obama] administration still intends to control medical costs by ... a single payer mechanism"

And there you have it: full circle.

#Medicaid4All

[Hat Tip: Mr Jones]

One step forward?

On the one hand:

"As the Board of Directors for America’s Health Insurance Plans, we are fully committed to help America’s powerful health care system meet the challenges posed by the Coronavirus strain COVID-19 ... We are taking decisive action to help prevent the spread of this disease, to ensure that people have coverage for and access to needed testing, and to help patients who are infected receive the care and treatment they need."

They go on to say that this includes coverage for diagnostic testing, as well as easing up on network issues (ie no "surprise billing"), and sharing information among different health care stakeholders (such as hospitals and physicians). It's pretty comprehensive.

But (and you knew there'd be a 'but' here, right?):

First, this is a promise from a trade group, not a specific contract waiver from any given carrier. In fact, I received an email the other day from Anthem saying that their "clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part."

And, of course, given AHIP's history, skepticism is absolutely warranted here.

Life or Death: A Healthy Bet?

If nothing else, one has to admire the creativity of this idea:

"Life Settlement Players Root for Health Account Bill"

So let's unpack this, shall we?

First: what, pray tell, are "Life Settlement Players?"

Long time readers know that this refers to the viatical market:

"Since life insurance is property, it can generally be sold. In this case, the client saved the annual premium and picked up an easy $5,000."

That is, one can sell one's life insurance policy to another person for a quick buck or three (depending on one's health and life expectancy). This is generally perfectly legal (there are, of course, other considerations, biut that's another post). And, thanks to a little known piece of HIPAA, there are some great tax advantages, as well:

"A viatical settlement made to an individual considered terminally ill (under HIPAA, one who has a life expectancy of 24 months or less) is entirely tax free."

We'll circle back to that "terminally ill" qualifier in a moment.

Okay, Henry, but what's that got to do with the price of tea in China, or some pending health insurance-related legislation?

Well, let's see what H.R. 5958's all about, shall we?

A clue may be found in the name: "Senior Health Planning Account Act."

Basically, it "could help people use the proceeds from the sale of life insurance policies to pay health care expenses."

So what's the big deal?

Well, let's circle back to HIPAA, viaticals, and taxes:

Remember, one can only receive viatication funds tax-free if one is either terminally ill or using the the proceeds to fund one's (uninsured) long term are needs. But if you're not in one of those categories, there are some taxes to be paid. What this bill does is to obliterate that distinction for tax purposes:

"Under the provisions of H.R. 5958, a consumer who sold an in-force policy and put the money in a senior health planning account could spend the money on “qualified health care expenses” without paying federal income taxes on the proceeds from the life insurance policy sale."

Sweet!

Of course, we then have to define "qualified health care expenses," but that should be relatively easy under existing regs (specifically, Section 213d, also used for HSAs/HRAs/FSAs).

So one can see why this would be an attractive marketing tool for folks in the viatical settlement industry: it basically opens up a (potentially vast) new market.

Of course, still has to pass...

[Hat Tip: FoIB Allison Bell]

The Magic 50th

As in 50th employee:

"[I]f you employ more than 49 people, you've either got to offer (and help pay for) a group plan or pay a penalty tax"

One can see the problem here for potential employee #50: what are the odds he (or, of course she) will actually be offered a job? Because that new employee is going to raise the employer's cost of doing business substantially, what with having to either install a group plan or face a stiff penalty. The Boss is going to have some major soul-searching on this hire.

But at least there's a light at the end of the tunnel, yes? The rule/tax/penalty sunsets eventually, right?

Ummm, not so much:

"The Internal Revenue Service (IRS), in a recently released memorandum from the Office of Chief Counsel.... has taken the position that the Employer Shared Responsibility Payment (ESRP) imposed by section 4980H of the Internal Revenue Code is not limited by any statute of limitations, and that it could assess these payments for years — potentially indefinitely — after a failure to comply." [emphasis in original]

Oy.

Breathe a sigh of relief if you're #49.

Or maybe not:

 

Oy Canada - Another day, another looney

So to speak:

Still waiting for emergency surgery on broken ankle. Hospital ER overloaded and no private options for surgery in SK, the birthplace of Canadian Medicare. https://t.co/HVW5rrFmT8

— Heather Chapman (@PatientFactor) March 1, 2020

#Medicaid4All

Sausage making and the ACA: A How-To Guide

When applying for an ObamaPlan on the 404Care.gov website, one is required to provide certain information, including date(s) of birth, Social Security number(s), and the like. This is then matched against other government databases for confirmation.

But what if you (or the person helping you) enters incorrect information?

Well, this may be of help (via email from CMMS):

"The information consumers provide when applying for Marketplace coverage is used to determine whether they are eligible for coverage and, possibly, financial assistance. In some cases, the information on a consumer’s application may be different from the Marketplace’s trusted data sources, including the Social Security Administration, the Department of Homeland Security, and the Internal Revenue Service ... The Marketplace may require a consumer to provide documentation to resolve this inconsistency or DMI [Data Matching Issue]"

And how, precisely can this be done?

So glad you asked:



Your tax-dollars at work!

Another CanuckCare© #InconvenientTruth

Show me the (Canadian) money:

"Canadians’ out-of-pocket health costs are nearly identical to what Americans pay — a difference of roughly $15 per month. In return, Canadians pay ... roughly $50 in additional taxes per dollar saved in out-of-pocket costs."https://t.co/3ZHdNW0dKC

— AssocAmerPhys&Surg (@AAPSonline) February 28, 2020

#Medicaid4All