Posts Tagged ‘Prescription Benefits’

PostHeaderIcon Health Reform – Implementation 2011

Below are some highlights in phase two of the Health Care Reform Bill.

This is the year when our tax codes are going through significant changes driven by the health care law.  Overall, health care is getting more regulated, therefore it is forcing businesses, health care providers and insurance companies to spend more money on administration.  There are a lot of plans that are studying and “advising” on how to make health care better.  Sadly, those groups and advisory bodies should have been created prior to the enactment of this law.

  • Minimum Medical Loss Ratio

Health plans, including grandfathered plans, must report on the share of premium dollars spent on medical care and provide consumer rebates for excessive medical loss ratios.

  • Consumer Protection

Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage as well as rescinding coverage except in cases of fraud.  Annual limits are still in effect until 2014.  The provision also prohibits plans from denying children coverage based on pre-existing medical conditions.

  • Standardizing the Definition of Qualified Medical Expense

Match the definition of qualified medical expenses for HSAs, FSAs and HRAs to the definition used by the IRS itemized deduction.  Over-the-counter medicine will now only be considered as medical expense of accompanied by a doctor’s prescription.

  • Reporting Health Coverage Costs on Form W-2

Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2.

  • Creating Simple Cafeteria Plans

Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax‐free benefits to their employees.

  • Appealing Health Plan Decisions

Appoints the right to appeal medical claim and/or policy decisions made by any health plan and the right to appeal decisions made by the health plan to an outside, independent decision-maker, no matter what state a person lives in or what type of health coverage a person may have. This includes, for the first time, new self-funded plans.

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PostHeaderIcon Medicare Prescription Benefits in 2010

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PostHeaderIcon Insurance company found new way to add administrative burden and increase member cost

Creating new programs to administer more and pay less is an ever growing trend with insurance companies. United Healthcare new specialty medication management program is just that; more hoops to jump for less.

Industry insiders long known that the federal Medicare program is a leader in the creation of more administration and less payment.  Blue Cross and Blue Shield usually follow closely, and then the rest of the pack (insurance companies in general).

Now United Healthcare seems to be taking the leading role of creating an additional program without benefits to its members.  The Specialty Pharmacy Program is designated to put more stops in prescription utilization for high cost drugs. New and renewal members will be forced to obtain certain medications from a participating specialty pharmacy to receive in network coverage. Furthermore this policy eliminates the previous 90 day supply benefits, both as a discount and convenience. Members will be forced to renew prescriptions each month and pay the 30 day co pays.

Typical of insurance policies, coverage by out of network pharmacy is not clearly defined. No one can tell until they visit a local pharmacy.