New Rule Ensures Students Get Health Insurance Protections of the Affordable Care Act

A new proposed regulation announced today by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act. Students enrolled in college plans would have the freedom from worrying about losing their insurance, or having it capped unexpectedly if they are in an accident or become sick.

"Thanks to the Affordable Care Act, college students will have more control over their health care," said Secretary Sebelius. "This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students."

Student health plans are often purchased when family coverage is not available, or is unaffordable. Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they're regulated vary widely. The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as "individual health insurance coverage." Under the proposed rules, some of the new health insurance protections include:
* No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
* No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
* No Pre-Existing Condition Exclusions for Students Under Age 19: Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.

Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.

The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012. Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act's annual limit restrictions.

The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act-bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.

As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.

To find the new proposed rule, visit www.ofr.gov/inspection.aspx. For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html . For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.

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New report: 129 million Americans with a pre-existing condition could be denied coverage without new health reform law

Health and Human Services Secretary Kathleen Sebelius today released a new analysis showing that, without the Affordable Care Act, up to 129 million non-elderly Americans who have some type of pre-existing health condition, like heart disease, high blood pressure, arthritis or cancer, would be at risk of losing health insurance when they need it most, or be denied coverage altogether. Under the full range of policies in the Affordable Care Act to be enacted by 2014, Americans living with pre-existing conditions are free from discrimination and can get the health coverage they need, and families are free from the worry of having their insurance cancelled or capped when a family member gets sick, or going broke because of the medical costs of an accident or disease. Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it.

“The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our health care decisions,” said Secretary Sebelius. “The new law is already helping to free Americans from the fear that an insurer will drop, limit or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need.”

The analysis found that:

· Anywhere from 50 to 129 million (19 to 50 percent) of Americans under age 65 have some type of pre-existing condition. Examples of what may be considered a pre-existing condition include:

· Heart disease

· Cancer

· Asthma

· High blood pressure

· Arthritis

· Older Americans between ages 55 and 64 are at particular risk; 48 to 86 percent of people in that age bracket live with a pre-existing condition.

· 15 to 30 percent of people under age 65 in perfectly good health today are likely to develop a pre-existing condition over the next eight years.

· Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.

Prior to the Affordable Care Act, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36 percent of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.

A number of protections are already in place thanks to the Affordable Care Act. Insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those locked out of the insurance market because of a preexisting condition. The PCIP program – which has already saved people’s lives by covering services like chemotherapy – serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a preexisting condition. There is a Pre-existing Condition Insurance Plan available in every state, and more information can be found at www.HealthCare.gov or by calling 1-866-717-5826.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through competitive marketplaces called health insurance exchanges.

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New Affordable Care Act rules shed light on high health insurance rate hikes

New proposed Affordable Care Act regulations announced today by the U.S. Department of Health and Human Services (HHS) will bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

“Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius. “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.”

Health insurance premiums have risen rapidly over the past decade, straining pocketbooks for American families and businesses. Since 1999, average premiums for family coverage have risen 131 percent.

The Affordable Care Act has already begun to help states strengthen or create rate review processes. On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.

Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. Insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

“The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified,” said Jay Angoff, director of HHS’ Office of Consumer Information and Insurance Oversight.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

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New Affordable Care Act rules give consumers better value for insurance premiums

New regulations issued November 22 by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money.

“Thanks to the Affordable Care Act, millions of Americans will get better value for their health insurance premium dollar,” said HHS Secretary Kathleen Sebelius. “These new rules are an important step to hold insurance companies accountable and increase value for consumers.”

Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.

In 2011, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market. Important details regarding the new regulation are included below.

The medical loss ratio regulation outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization.

Beginning in 2011, the law requires that insurance companies publicly report how they spend premium dollars, providing meaningful information to consumers. Also beginning in 2011, insurers are required to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies that are not meeting the medical loss ratio standard will be required to provide rebates to their consumers. Insurers will be required to make the first round of rebates to consumers in 2012.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the States, and other key stakeholders,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at HHS. “As we build a bridge to 2014, when better, more affordable options are available to consumers, these rules will help make health insurance fairer for consumers now.”

The Affordable Care Act required the National Association of Insurance Commissioners (NAIC) to develop uniform definitions and methodologies for calculating insurance companies’ medical loss ratios. Insurance commissioners in every State have a responsibility to protect the interests of the general public, policyholders, and enrollees within their respective States. Today’s regulation certifies and adopts the recommendations submitted to the Secretary of HHS on October 27, 2010 by the NAIC. It also incorporates recommendations from a letter sent to the Secretary by the NAIC on October 13, 2010.

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Many Important Health Insurance Choices Must Be Made Now in Georgia

PRNewswire/ -- For employees who work for companies that offer health insurance benefits through late November/early December, this is usually the time when important health plan decisions must be made for the upcoming year - 2011. Interestingly, studies show consumers typically spend more time researching car and computer purchases than they do when selecting a health insurance plan. These studies also indicate that most people spend an hour or less reviewing their insurance plan options and often default to the plan they had the previous year.

With health care reform changes in the mix, the comprehensive long-term impact is still uncertain. Nevertheless, employees must make educated and well-thought-out decisions for their 2011 benefits now, using the information that is currently available to them. Equally important, employers must do everything they can to provide their employees with the information necessary to make an informed decision. And, since open enrollment season is upon us, this is the best time to share tips to help employees navigate through the choices they must make.

Many of Georgia's companies offer more than one health insurance plan option, which typically have different costs to the employees, both in the amount deducted from their paychecks and the total cost of the coverage for deductibles, co-pays and co-insurance during the course of the year. In addition, many employers are offering base coverage plans and then offer a 'buy up' plan option where employees can purchase additional coverage not covered by the employer.

"It's a mistake not to review your health plan options each year and carefully weigh which plan will be the best fit for you and your family," said Morgan Kendrick, President, Blue Cross and Blue Shield of Georgia (BCBSGa) who noted that often consumers choose the plan that has the least impact on their paycheck when that option may not be the best choice overall.

Plans with higher monthly premiums and lower co-pays and deductibles might be best for those who anticipate using a lot of health care services throughout the course of the year. On the other hand, young and healthy employees without kids might save more with a plan that features low premiums and a high deductible.

We encourage employers to provide their employees with the tools and resources needed to help them make informed decisions about their health care coverage. Below are a few things employers can do to make this process easier:

1. Encourage Healthy Behaviors. Research shows that approximately 85 percent of ill health comes from poor health choices. Therefore, open enrollment provides a great opportunity for the promotion of health and wellness programs and incentives, including smoking cessation or weight management courses, gym subsidies, etc. Not only will this help contain company costs long-term, it also helps employees feel and perform better.
2. Hold open enrollment meetings. If possible, make them mandatory, but make them fun and interactive. Bring in an account manager from your insurance carrier or have an onsite benefits manager/HR representative explain the various health care options and answer questions on-the-spot.
3. Avoid acronyms when communicating with employees. Use simple terms and definitions, and communicate early and often. An Institute of Medicine report showed that nearly half of all U.S. adults have difficulty understanding healthcare benefits information. As a result, the materials go unread and plan selections are made haphazardly.
4. Help Familiarize Employees with Consumer-Driven Health Plans (CDHPs). CDHPs continue to gain popularity because they help employers and employees control health care costs. CDHPs provide you with health account options to help you pay for the costs of health care such as Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). Companies that are the most successful in introducing and migrating to CDHPs take time to explain these plans to employees up front, which usually results in higher adoption rates.


Here are some items employees should keep in mind when choosing a health insurance plan:

1. Do your homework and take advantage of the tools offered to you. If your company holds open enrollment meetings, attend at least one and be prepared with questions. Take the information home and review the details in a more relaxed environment. Make sure to follow up with your company benefits advisor if you have additional questions – that's what the benefits advisor is there for.
2. Understand and learn what basic health insurance terms mean. Use online tools provided by your current health plan or other tools such as www.wikipedia.org as a reference. For example, make sure you can answer the following:
-What is the difference between co-payment and co-insurance?
-What does deductible mean and how could it impact your out-of-pocket costs?
-What does it mean to seek "out-of-network" services?
3. Examine your family's past health care spending. An excellent way to determine a good plan fit for 2010 is to understand what health care services your family used in 2010 and take into consideration what expenses may occur in the coming year—like having a child or if you will have to deal with a chronic health condition like diabetes.
4. Before continuing on your current plan, read the details. What you signed up for last year may have changed. Have the co-pays and deductibles increased? Often employers will adjust these levels as a result of the increasing cost of health care services. Pay attention to the details in order to avoid surprises down the line.
5. Verify in advance that your physician and hospital are part of the network for the plan you are choosing. This is especially important if the insurance company is changing or if you are switching to a different health plan.
6. Take advantage of your HSA, HRA or Flexible Spending Account (FSA) if appropriate. Make sure you understand the difference between an HSA, HIA, HRA and an FSA, as well as any changes in access to these funds, for example, FSA accounts have new prescription requirements surrounding over-the-counter medications.


"In the past, consumers may have quickly looked over their benefit options and made a selection without seriously considering the comprehensive financial impact it could have on them and their family," said Kendrick. "But this year, with the additional economic pressures consumers are facing and new health care reform mandates, it makes sense to really study all plan options in order to make the best choice to meet their needs."

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Open Enrollment for 2011 Medicare prescription drug and health plans begins Nov. 15th

The Centers for Medicare & Medicaid Services (CMS) is encouraging all Medicare beneficiaries to take advantage of the annual Open Enrollment period to make sure they have the best coverage available to meet their health care needs in 2011.

The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.

"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."

"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."

"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care

Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."


Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:

. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.

. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.

. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.

. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp

Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.

There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Protecting Against Fraud and Identity Theft

The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.

Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.

More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.

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Our Nation's Veterans Have Options for Health Care Coverage

/PRNewswire/ -- As the nation pauses to honor its veterans on Nov. 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good, Blue Cross and Blue Shield of Georgia (BCBSGA) wants our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options surrounding their health care coverage.

Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."

"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.

Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.

Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.

Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.

Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.

On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.

Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.

Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.

There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:

* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services


It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare

"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."

For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."

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Medicare Open Enrollment Starts November 15th

The GeorgiaCares State Health Insurance Assistance Program (SHIP) is helping Medicare recipients make informed decisions about which prescription drug and Advantage plan options are best for them. Beginning on October 15, consumers can compare available plans by visiting www.Medicare.gov. They may also call GeorgiaCares toll-free at 1-800-669-8387 for personalized assistance.

Open enrollment for Medicare Part C and D begins November 15, and recipients will have until December 31, 2010, to make their choices. With so many options available, choosing the right one is important. This is the first year that there will be one election period for both Part C and D plans. After this time, plan changes can be made during the annual Disenrollment Period of January 1 - February 15th of each year. During the Disenrollment Period, beneficiaries will only be allowed to leave a Medicare Part C plan and return to Original Medicare (Parts A and B) with the option of choosing a prescription drug plan.

“The GeorgiaCares SHIP network provides one-on-one assistance, so that callers can get personalized help as they compare their options and decide on which plans best meet their needs,” said Dr. James J. Bulot, director of the DHS Division of Aging Services.

GeorgiaCares SHIP counselors are available through the statewide network of Area Agencies on Aging and will provide community education sessions and answer hotline calls to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP and the Centers for Medicare and Medicaid Services (CMS) advise people who wish to make a change to do so as close as possible to the November 15 opening date to ensure their coverage will be available on January 1, 2011. Companies began marketing their plans on October 1.

GeorgiaCares SHIP services are free and also assist Medicare beneficiaries on Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, resolution to billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who do not want to make a change can remain in their plan from 2010.

Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).

Oxendine: Choose Carefully During Open Enrollment

Insurance Commissioner John W. Oxendine urges consumers who are part of a group health plan to be prepared to make the right choices during health insurance open enrollment.

“It's the time of year when many companies across the country hold open enrollment periods for their group health insurance plans,” Oxendine said. “Consider the options carefully to be sure you and your family are properly covered.”

Open enrollment refers to the period of time during which all members of your group health insurance plan have the opportunity to enroll in certain benefit programs. During this period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year, so if you miss it, you likely will not be able to enroll in your employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life-changing events.

Make sure to check with your human resources department to see when your company’s open enrollment period begins and ends, and when your policy goes into effect.

There are many different types of major medical plans typically offered by employers. For help understanding the fundamental differences between preferred provider organizations (PPO), health maintenance organizations (HMO), point of service plans (POS) or indemnity plans, visit our website at www.oci.ga.gov/publicInformation/healthInsuranceFAQ.aspx.

Before making a choice:
Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
If you take prescription medications, check them against the list of approved drugs in each plan booklet.
If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.

If you are not satisfied with the answers to your questions, contact Oxendine’s Consumer Services Division for help and advice at 1-800-656-2298.

In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you until you do the figures.

To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning.

Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that you are responsible to pay. Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.

Finally, decide how much you can afford to pay. Other things to keep in mind:
Check for any annual limits and prior authorization requirements.
Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost to you.
If your dependents have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same type of comparisons for any dental or vision care plans that you are offered.

Once enrolled in a health plan, you will not be able to make changes until the next open enrollment period, unless there is a life changing event such as divorce, a job change, marriage or the birth or adoption of a baby.

If you do not receive insurance cards and/or enrollment information, contact your HR administrator, or call the insurance company.

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Affordable Care Act gives consumers new tools, makes health insurance market more transparent

The U.S. Department of Health and Human Services (HHS) today announced that new information and tools have been added to HHS' consumer website www.healthcare.gov that will make the health insurance market more transparent, increase competition and help lower costs for individuals.

For the first time ever, price estimates for private insurance policies are available, allowing consumers to easily compare health insurance plans - putting consumers, not their insurance companies, in charge by providing one-stop shopping and taking the guesswork and confusion out of buying insurance.

To help consumers make more informed choices, the site includes new information including two notable metrics never before made public:
* Insurance providers are required to provide the percentage of people who applied for insurance and were denied coverage.

* Insurance companies are required to provide the percentage of applicants who were charged higher premiums because of their health status.

"Millions of Americas have already logged-on to www.HealthCare.gov's Insurance Finder to see what health coverage options are available to them," said Secretary Kathleen Sebelius. "This already unprecedented ability to search and compare coverage options is getting better with the new benefits and price information now available. These changes will help Americans find coverage that meets their needs and that gives them value for their dollars now."

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information and links to health insurance plans into one place to make it easy for consumers to learn about and compare their insurance choices. HHS' Office of Consumer Information and Insurance Oversight (OCIIO) worked to define and collect detailed benefits and premium rating information from insurers across the country, and starting October 1, 2010, consumers will also be able to find information about health insurance options such as:
* Monthly premium estimates;
* Cost-sharing information, including annual deductibles and out-of-pocket limits;
* Major categories of services covered;
* Consumer's share of cost for these services;
* Percent of people in the plan who pay more than the base premium estimate due to their health status; and
* Percent of people denied coverage from a health plan;

More than 225 insurance companies have provided information about their individual and family plans for more than 4,400 policies, including policies in every state and the District of Columbia. Consumers can search for and compare information on plans available to them based on their age, gender, family size, tobacco use and location.

"We applaud the insurance companies that have provided us this information about their products. Together, we are improving competition in the insurance marketplace," said Jay Angoff, director of the Office for Consumer Information and Insurance Oversight. "This type of transparent competition is critical to improving quality of coverage and lowering costs for consumers."

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Forty-eight states receive new resources to build competitive health insurance marketplaces

The U.S. Department of Health and Human Services (HHS) today awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. A key part of the Affordable Care Act, starting in 2014, health insurance exchanges - new, competitive, consumer-centered private health insurance marketplaces - will put greater control and greater choice in the hands of individuals and small businesses.

"Today, too many individuals and small businesses are on their own in dealing with insurance companies. They pay higher costs than Americans who get their insurance through big companies or other large employers because they can't pool their costs or spread the risk," said Secretary Kathleen Sebelius. "That's why the Affordable Care Act helps states create exchanges, so individuals and small businesses can band together, have the same purchasing power as those big employers, and get a fairer deal when it comes to their health care. Today, we're providing critical resources to help states take the first step toward creating these competitive marketplaces."

The state-based exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with "one-stop-shopping" where they can compare and purchase health insurance coverage. Americans will have the same health care choices as members of Congress - who will also purchase coverage through the exchanges. Individuals and families purchasing health insurance through exchanges may also qualify for tax credits and reduced cost-sharing depending on their income.

These grants of up to $1 million each will give states the resources they need to conduct the research and planning needed to build a better health insurance marketplace and determine how their exchanges will be operated and governed, including:
. Assessing current information technology (IT) systems and infrastructure and determining new requirements.
. Developing partnerships with community organizations to gain public input into the exchange planning process.
. Planning for consumer call centers to answer questions from their residents.
. Determining the statutory rules needed to build the exchanges.
. Hiring key staff and determining ongoing staffing needs.
. Planning the coordination of eligibility and enrollment systems across Medicaid, the Children's Health Insurance Program (CHIP), and the exchanges.
. Developing performance metrics, milestones and ongoing evaluation.

Although state exchanges are not required to be operational until 2014, these planning grants begin the path toward 2014 when health insurance exchanges will take what is now a very complicated and confusing process and turn it into a simple, easy to navigate experience that benefits consumers, not insurance companies.

The Department of Health and Human Services is working closely with states in implementing the Affordable Care Act. This is just the first round of state planning and establishment grants, which are one of several resources available to states to help with implementation of the Affordable Care Act. Already, 46 states have received resources from the Affordable Care Act to help improve the oversight of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure consumers receive value for their premium dollars. To learn more about the Affordable Care Act please visit www.HealthCare.gov.

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Medicare beneficiaries in donut hole will see 50-percent discount on brand name drugs in 2011

Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation's pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011.

Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.

"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."

The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.

"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."

Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.

"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."

Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.

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NAIC: Few Aware That Additional Health Care Reform Provisions Take Effect This Month

/PRNewswire/ -- Earlier this year, Congress passed sweeping reforms designed to revamp the health care system and increase access to care for many Americans. Yet, according to a new survey by the National Association of Insurance Commissioners (NAIC), many consumers are confused about the provisions and unsure of timing for actual implementation.

When asked to choose from four dates for which the first health care reform provisions officially take effect, only 14 percent correctly identified Sept. 23, 2010.

"Our survey findings are a clear indicator that most Americans are not aware of how soon some of the early health care changes may impact them," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline. "It's essential for consumers to understand what to expect and when to consult their state insurance departments for more information."

When asked about specific reform provisions that take effect Sept. 23, most respondents correctly identified provisions concerning children. Specifically, 72 percent knew that children with pre-existing conditions may not be excluded from coverage and 70 percent understood that individuals up to age 26 may be covered under their parents' insurance.

However, half of the respondents were under the impression that employers with fewer than 50 employees will have to offer coverage to employees, and 47 percent incorrectly thought that all health insurance plans must cover approved preventive care and checkups without co-payment.

In reality, employers with fewer than 50 employees are not required by the new law to provide health insurance to staff, and all co-payments for preventive care and checkups are not eliminated. However, those qualifying for Medicare will receive new preventive care benefits that will include annual visits free of co-payments, but this is not mandated for all health insurance plans.

"The results show that while most consumers are well attuned to provisions specifically affecting their children's health care, they do not grasp the overall reform framework," said Cline. "It's promising to see this, but we feel it necessary for consumers to fully understand the changes and get informed about what to expect."

To keep up with the complex health reform process that includes multiple implementation phases in the coming years, the NAIC urges consumers to contact their state insurance department with questions. Go to http://map.naic.org/ to find your state contact information.

In addition, the NAIC website has a special section dedicated to health care reform questions and resources. Visit http://www.naic.org/index_health_reform_section.htm to learn more.

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Nearly 2,000 employers and unions approved into new program to provide health coverage to early retirees

Affordable Care Act program will help pay health benefit claims for early retirees; applications still being accepted


The U.S. Department of Health and Human Services today announced the first round of applicants accepted into the Early Retiree Reinsurance Program. Nearly 2,000 employers, representing large and small businesses, State and local governments, educational institutions, non-profits, and unions have been accepted into the program and will begin to receive reimbursements for employee claims this fall.

Created by the Affordable Care Act as a bridge to the new health insurance Exchanges in 2014, the Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare. Businesses and other employers and unions that are accepted into the program will receive reimbursement for medical claims for early retirees and their spouses, surviving spouses, and dependents. Savings can be used to reduce employer health care costs, provide premium relief to workers and families, or both. The program ends on January 1, 2014 when State health insurance Exchanges are up and running.

"In these tough economic times, it is difficult for employers to keep up with skyrocketing health care costs for employees and retirees. Many Americans who retire before they are eligible for Medicare see their life savings disappear because of medical bills and exorbitant rates in the individual health insurance market," said Health and Human Services Secretary Kathleen Sebelius. "The Affordable Care Act's Early Retiree Reinsurance Program will make it a little easier for employers to
provide high-quality health benefits to their retirees as we work to put in place market reforms to lower costs for all."

"In conversations with business leaders throughout the country, I hear over and over again about the escalating health care costs for employees and retirees," U.S. Commerce Secretary Gary Locke said. "The new reinsurance program in the Affordable Care Act will directly reduce companies' health premiums for many retirees, offering critical cost relief for American businesses in a difficult economy and an important bridge for early retirees who are not yet eligible for Medicare."

Rising health care costs have made it difficult for employers to provide quality, affordable health insurance for workers and retirees while also remaining competitive in the global marketplace. The percentage of large firms providing workers with retiree health coverage has dropped from 66
percent in 1988 to 29 percent in 2009. Health insurance premiums for older Americans are over four times more expensive than they are for young adults and the deductible these enrollees pay is, on average, almost four times that for a typical employer-sponsored insurance plan.

The Department of Health and Human Services' Office of Consumer Information and Insurance Oversight has approved nearly 2,000 plans representing a broad range of employers from all 50 States and the District of Columbia into the Early Retiree Reinsurance Program in this first round of approvals with more applications being reviewed every day. Starting in September, approved applicants can begin submitting claims dating back to June 1, 2010 and, starting in October, approved
applicants will begin to receive reinsurance payments on those claims. This policy allows more health benefit claims to qualify for reinsurance payments for plans this year.

The approved applications represent nearly every sector of the economy: 32 percent of applications came from businesses, 26 percent from State and local governments, 22 percent from union sponsors, 14 percent from schools and other educational institutions, and 5 percent from non profits. For a list of approved applications by State, visit http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_prog ram.html.

"There has been a tremendous amount of interest from businesses and organizations from across the country since the Early Retiree Reinsurance Program was announced just a few months ago," said Secretary Sebelius. "We have received applications from more than 50 percent of Fortune 500 companies, all major unions, and government entities in all 50 States and the District of Columbia, and we are delighted to be able to notify our first round of successful applicants here today."

The nearly 2,000 approvals announced today are a subset of applications that have been received. HHS' Office of Consumer Information and Insurance Oversight is continuing to accept and review additional applications in the order in which they were submitted.

In addition to announcing these approved applications, HHS announced today two new information tools for employers and unions interested in the Early Retiree Reinsurance Program - a new website (www.ERRP.gov) and a new hotline (877-574-3777 or 877-574-ERRP). Employers and unions can
find the application form and application instructions online, as well as other relevant guidance and regulations from HHS.

For more information about the Early Retiree Reinsurance Program and an interactive map displaying the employers that have been accepted into the Early Retiree Reinsurance Program please visit:
http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_program.html.

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Consumer Advocates Ask for White House/HHS Probe of Health Insurers' Reduced Medical Care Spending, Even As Premiums Spike

/PRNewswire/ -- Consumer Watchdog and the Center for Media and Democracy today asked the Obama administration to investigate how the major for-profit health insurance companies are reducing their proportion of spending on health care in advance of health reform, even as premiums spike upward. In a letter to Health and Human Services chief Kathleen Sebelius, the groups compared insurers' actions to those of credit card companies, which spiked annual interest rates last year in advance of new federal regulations that would curb corporate abuses.

"Insurance companies appear to be making sure that when new federal rules for spending on health care kick in next year, they can keep their administrative bloat and profits intact," said Judy Dugan, research director of Consumer Watchdog.

The groups noted in the letter that insurance companies are lobbying intensely to distort new rules meant to require increased medical spending -- 80% of premium dollars for individual and small group policies and 85% for large group policies. The insurers seek to redefine billions of dollars in overhead and administration expenses as health care. By cutting their medical ratio now, they can make room for the redefined overhead expenses next year and meet but not exceed the 80% to 85% minimums.

Co-signer Wendell Potter of the Center for Media and Democracy said that red flags went up when Cigna, the last major insurer to report 2nd quarter results, showed a startling 6.4% drop in its medical spending ratio (also called medical loss ratio, or MLR) to 78.8%, a cut that appears unprecedented for a large insurer.

Read the full letter at http://www.consumerwatchdog.org/resources/sebeliusletterCWDCMD081110.pdf

The letter said:

"We write jointly as advocates for consumer rights and transparency to urge you to examine health insurers' reports of reductions in their proportion of medical spending in recent quarters, even as premiums have risen substantially in advance of the new health reform law. The major insurance companies' behavior looks suspiciously like that of credit card companies, which spiked annual interest rates in advance of consumer protection laws intended to restrict the conditions under which rates could go up.

"Like the credit card companies, health insurers assume that they can get away with what amounts to bilking their customers now to set up higher profits in the future. The health insurers appear to be cutting the proportion of premium dollars spent on medical care, in the case of CIGNA by likely record proportions, in advance of regulations intended to make them spend a higher proportion on care, and less on administrative bloat.

"Unlike with credit card companies, you have the power to curb their gaming of the system. The regulations that you put in place to enforce the new health law requirement that they spend 80% to 85% of customers' premium on health care will decide whether the companies cater to Wall Street or to their patients.

"The outcome of the regulations that are now being written will depend on your resistance to a massive lobbying effort by the insurance industry.

"As you know, insurers already expect that changes in the [medical loss ratio] calculation specified in the Patient Protection and Affordable Care Act will allow more insurer activities to be defined as 'health quality improvements' and counted as health care. At least some and possibly all of their state and federal taxes will also be deducted from premium revenue. The combined effect, depending on vagueness or laxness in final regulations, could amount to a 5% or larger insurer 'bonus' in calculating the MLR.

"See Consumer Watchdog comment on tax deduction regulation at http://www.naic.org/committees_lhatf_ahwg.htm

"The result of this bonus is that it pays for an insurer to suppress MLR as much as possible now, to keep future MLR at -- but not above -- 80% for individual and small business policies, and 85% for large groups. It is not possible for the public to accurately determine how the company's drastic reduction in MLR -- which increases its value to Wall Street--was accomplished.

"The Center for Media and Democracy and Consumer Watchdog ask that HHS demand much more detail about the nature of the MLR reductions from CIGNA and lesser reductions by other insurers, and make the results public. The examination should seek to determine if financial coercion of employers and individuals (through unaffordable and unjustifiable spikes in the rates of less profitable plans, or the targeted closure of some plans) was part of any shift to higher-deductible and lower benefit plans.

"HHS should also seek to tighten new definitions of what can be included in the medical loss ratio. The National Association of Insurance Commissioners, which is finalizing proposed regulations to decide how medical loss ratios are defined, is being lobbied by insurers and their lawyers with an intensity that makes the lobbying of Congress pale by comparison. As the proposed regulations are being finalized, they risk being further weakened. It will be up to HHS to right the balance.

"Presumably the MLR reductions at CIGNA and other companies involved what insurers call 'aggressive medical management' to reduce the amount of care provided enrollees. However, it likely also involved the movement of more enrollees into plans that require greater cost sharing and provide less care, through marketing or price coercion."

Insurers and their lobbyists count on the technical detail of financial reports and regulatory actions to mask their intent, said Consumer Watchdog and the Center for Media and Democracy.

Consumers don't notice until their premiums shoot through the roof and their health benefit are reduced. Regulators must resist corporate lobbies and act to protect ordinary citizens, the groups said.

Consumer Watchdog and the Center for Media and Democracy are nonprofit, nonpartisan consumer advocates. For more information, see www.consumerwatchdog.org and www.prwatch.org

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AHRQ State Snapshots Expanded To Include New Data on Health Insurance Coverage

Editor Note:  According to this new database, Georgia has improved its health care quality from "weak" to a low "average."

/PRNewswire/ -- The Agency for Healthcare Research and Quality's annual release of state-by-state quality data has been expanded to include new data on health insurance, including data on health care quality categorized by source of payment, including private insurance, Medicare, Medicaid and those without insurance.

The new health insurance section allows users to compare payer-specific quality rates as well as differences among payers. For example, a state can compare the quality of care received by Medicaid or uninsured patients with that received by these same patients nationally. In addition, a state can assess whether its insurance-related disparities are larger or smaller compared with the nation as a whole.

The 2009 State Snapshots provide state-specific health care quality information, including strengths, weaknesses and opportunities for improvement. State-level information used to create the State Snapshots is based on data collected for the 2009 National Healthcare Quality Report. Overall, states get mixed reviews for the quality of care they provide. As in previous years, AHRQ's 2009 State Snapshots show that no state does well or poorly on all quality measures.

Maine, Maryland, Wyoming, South Carolina and the District of Columbia showed the greatest improvement. The five states showing the smallest improvement were North Dakota, Texas, West Virginia, Nebraska and Washington State. For each state, specific clinical conditions could be identified that account for different rates of improvement.

"The addition of the insurance information to the State Snapshots adds one more dimension to the picture of health care quality and disparities in individual states and regions," said AHRQ Director Carolyn M. Clancy, M.D. "The 2009 State Snapshots continue to evolve into an invaluable resource for state officials and other stakeholders."

The 2009 State Snapshots summarizes health care quality in three dimensions: types of care (preventive, acute and chronic care), settings of care (hospitals, ambulatory settings, nursing homes and home health care) and clinical conditions (cancer, diabetes, heart disease, maternal and child health and respiratory disease). There are also special focus areas on diabetes, asthma, Healthy People 2010 objectives, clinical preventive services and disparities.

Additional features in the 2009 State Snapshots provide more ways to analyze the quality of health care for each state compared with all states, as well as with states in the same region. New and enhanced features include enhanced sections on asthma care, diabetes care and health care disparities.

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Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care

The Departments of Health and Human Services (HHS), Labor, and the Treasury issued new regulations today, requiring new private health plans to cover evidence-based preventive services and eliminate cost sharing requirements for such services. The new rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children.

"Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," said HHS Secretary Sebelius. "From the Recovery Act to the First Lady's Let's Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy."

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation's health spending - and often are preventable. Nationally, Americans use preventive services at about half the recommended rate. An estimated 11 million children and 59 million adults have private insurance that does not adequately cover immunization, for instance. Cost sharing, including deductibles, coinsurance, or copayments, has been found to reduce the likelihood that preventive services will be used.

"Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure," said First Lady Michelle Obama. "And good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother - and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them."

"One of the best ways to improve the quality of your life - and control health care costs - is to prevent illness in the first place," said Dr. Jill Biden. "Focusing on prevention and early treatment makes more sense than trying to play catch-up with a potentially deadly disease. Quite simply, these preventative services will save lives."

Under the regulations issued today, new health plans beginning on or after September 23, 2010, must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider. Specifically, these recommendations include:

* Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a "grade" of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

* Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.

* Prevention for children: Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults. The types of services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

* Prevention for women: Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.

Today's announcement builds on other provisions in the Affordable Care Act that support prevention, including the creation of a first-ever National Prevention, Health Promotion and public Health Council tasked with developing a national strategy and a Prevention and Public Health Fund to invest in prevention initiatives and, this year, policies to increase the number of primary care professionals to help ensure access to these services. The Affordable Care Act also helps make it easier and more affordable for Americans enrolled in Medicare or Medicaid to access critical preventive screenings and services.

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U.S. Departments of Health and Human Services, Labor, and Treasury Issue Regulation on "Grandfathered" Health Plans under the Affordable Care Act

Allowing Americans to Keep Current Health Plans or Choose a New Plan While Extending Important New Benefits to All Consumers

The U.S. Departments of Health and Human Services, Labor and Treasury today issued a new regulation that makes good on President Obama's promise that Americans who like their health plan can keep it.

The new regulation protects the ability of individuals and businesses to keep their current plan while providing important consumer protections that give Americans - rather than insurance companies - control over their own health care. The new regulation also provides stability and flexibility to insurers and businesses that offer health insurance coverage as the nation transitions to a more competitive marketplace in 2014 when businesses and consumers will have more affordable choices through exchanges.

"The Affordable Care Act gives American families more control over their health care by providing greater benefits, cost savings and protections," said Secretary of Health and Human Services Kathleen Sebelius. "Today, with the announcement of the new 'grandfather' rule, we're providing the market stability and flexibility to ensure that families and businesses can make the choices that work best for them."

While the Affordable Care Act requires all health plans to provide important new benefits to consumers, under the law, plans that existed on March 23, 2010 are exempt from some new requirements. The "grandfather rule" issued today makes it clear that these plans can continue to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status. Plans will lose their "grandfather" status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers - and consumers in plans that make such changes will gain new consumer protections.

"The rule we are announcing today will allow employers to make routine and modest adjustments to co-payments, deductibles and employer contributions to their employees' premiums without forfeiting grandfather status. This flexibility will encourage employers to continue offering health coverage to their employees and help to ensure coverage for all Americans," said Secretary of Labor Hilda Solis.

All health plans - whether or not they are grandfathered plans - must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

* No lifetime limits on coverage for all plans;

* No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application; and

* Extension of parents' coverage to young adults under 26 years old;

For the vast majority of Americans who get their health insurance through employers, additional benefits will be offered, irrespective of whether their plan is grandfathered, including:

* No coverage exclusions for children with pre-existing conditions; and

* No "restricted" annual limits (e.g., annual dollar-amount limits on coverage below standards to be set in future regulations).

"The Affordable Care Act positions consumers, instead of insurance companies, as decision makers when it comes to their health care," said Assistant Treasury Secretary for Tax Policy Michael Mundaca. "The rule we're announcing today preserves individuals' ability to keep their current plan and provides strong consumer protections that give Americans more control over their health insurance choices."

Grandfathered health plans will be able to make routine changes to their policies and maintain their status. These routine changes include cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law, or making changes to comply with State or other Federal laws. Premium changes are not taken into account when determining whether or not a plan is grandfathered.

Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including:

* Coverage of recommended prevention services with no cost sharing; and

* Patient protections such as access to OB-GYNs and pediatricians without a referral by a separate primary care provider.

Details about what routine changes insurers and employers can make without losing their grandfathered status, and the projected impact on large and small employer plans and the individual plan market can be found at http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html.

Most of the 133 million Americans with employer-sponsored health insurance through large employers will maintain the coverage they have today. Additionally, large employer-based plans already offer most of the comprehensive benefits and consumer protections that the Affordable Care Act will provide to all Americans this year - such as preventing rescission of coverage.

The roughly 42 million people insured through small businesses will likely transition from their current plan to one with the new Affordable Care Act protections over the next few years. Small plans tend to make substantial changes to cost sharing, employer contributions, and health insurance issuers more frequently than large plans. To help small businesses afford employee coverage, the Affordable Care Act includes a tax credit for up to 35% of their premium contributions.

The 17 million people who are covered in the individual health insurance market, where switching of plans and substantial changes in coverage are common, will receive the new protections of the Affordable Care Act sooner rather than later. Roughly 40 percent to two-thirds of people in individual market policies normally change plans within a year. In the short run, individuals whose plan changes and is no longer grandfathered will gain access to free preventive services, protections against restricted annual limits, and patient protections such as improved access to emergency rooms.

In 2014, small businesses and individuals who purchase insurance on their own will gain access to the competitive market Exchanges. These Exchanges will offer individuals and workers in small businesses with a much greater choice of plans at more affordable rates - the same choice as members of Congress. In fact, the Congressional Budget Office (CBO) has estimated that, on an apples-to-apples basis, premiums will be 14- 20 percent lower than they would be under current law in 2016 due to competition, lower insurance overhead, and increased pooling and purchasing power. Small businesses also will have more affordable options. CBO has estimated that a family policy for small businesses would be available in the Exchanges at a premium that is $4,000 lower than under current law in 2016.

These reduced premiums do not take into account the tax credits available to small businesses and middle class families to help make insurance affordable. These additional new choices and cost savings may further lower the likelihood that small businesses workers will remain in grandfathered health plans. Consumers insured through large employers are more likely to remain in grandfathered plans in 2014 and beyond.

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Deloitte Survey: Majority of Insured Consumers Satisfied With Current Health Plan -- But Concerned About Changes Health Care Reform Act May Bring

/PRNewswire/ -- Of the 82 percent of consumers surveyed who consider themselves "well" or "adequately" insured, nearly all (96 percent) are somewhat or very satisfied with their health plans overall, according to a new Deloitte poll. (www.deloitte.com/us/consumerhealthpulse) Many are concerned the new health reform law will bring about significant changes to their current coverage. Of those enrolled in employer-sponsored health plans, 61 percent believe their employer will reduce benefits for dependents and retirees and 32 percent think employers will probably pay the penalty and discontinue health coverage for employees altogether.

"Anxiety about current and future health insurance coverage will continue to be a major issue for American consumers as health care reform is implemented nationally," stated Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions. "For example, our research shows that consumers who are covered through Medicare are more highly satisfied with their health care services than those in employer-sponsored plans."

Among survey respondents who consider themselves "very knowledgeable" about the Patient Protection and Affordable Care Act, many also indicated concerns over the impact of health reform on access to quality health care. They believe that some hospitals and medical practices will close (72 percent) and that their employers may drop their coverage (51 percent).

The cost of care is also an issue for the majority of consumers. Survey respondents anticipate increases in taxes (76 percent), health insurance costs, including premiums and out-of pocket expenses (65 percent), hospitals and physicians services (66 percent), and the cost of medications (54 percent) as reform is implemented.

Age is a major factor contributing to opinions about health care reform. In general, younger adults are more positive about health reform than older consumers. According to the survey, more than half (51 percent) of 18-34 year-olds believe that the reform bill will reduce health care costs in the long term, compared to respondents 45-54 years old (23 percent), 55-64 years old (36 percent), and 65 years old and above (30 percent).

"Younger consumers are beginning to embrace a new norm for health care," said Keckley. "Those in the younger age groups, (18-44 years old), are increasingly aware that the health care reform process has many moving parts and that they may find themselves entering into a new pact with employers."

The Deloitte survey also identified that consumers with employer-sponsored coverage seem to be the most skeptical and expect to experience negative impacts from the implementation of reform. This segment of survey respondents agree with the following:

-- The cost of the health reform act will be higher than expected (82
percent), which is significantly different from those who are
individually insured (68 percent).
-- The health reform act will not reduce health care costs in the
long-term (58 percent), which is significantly different from the
uninsured (43 percent).
-- Employers will pass the increased cost of health benefits through to
their employees (80 percent).


"Our research indicates that health insurance plans and employers may need to collaborate more than ever to help ease the anxiety of plan participants and employees as new health reform measures are implemented," said John T. Bigalke, vice chairman and Deloitte's health sciences and government industry leader.

Additional key findings from the survey include:

-- Eighty-four percent of all consumers surveyed have health insurance.
-- More than half (56 percent) of those surveyed believe that incentives
for doctors and hospitals to use electronic medical records will be
effective or very effective at improving the overall performance of
the health care system.
-- Cutting the rate of growth of Medicare costs will be only somewhat or
not effective at improving the overall performance of the health care
system according to 60 percent of those surveyed.
-- Sixty-nine percent of those surveyed believe the issue is not whether
an organization is for-profit or not-for-profit -- it's what they do
that matters.
-- Sixty-one percent of respondents agree that a mix of for-profit and
not-for-profit organizations stimulates positive competition and
innovation.

Methodology:


This survey was conducted via telephone interviews within the United States by Harris Interactive on behalf of the Deloitte Center for Health Solutions from May 21-24, 2010 among 1,019 adults ages 18 years old and above. Results were weighted to reflect the U.S. adult population. The survey results have a sampling error of +/- 3 percentage points at the 95% confidence level.

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Secretary Sebelius Announces $51 Million in Affordable Care Act Grants to Innovate, Improve and Enhance Health Insurance Premium Rate Review

New grant program providing $250 million to states over next five years will strengthen oversight of insurance premiums and rate hikes

HHS Secretary Kathleen Sebelius today (June 7) announced the availability of $51 million in Health Insurance Premium Review Grants through the Affordable Care Act. These funds are the first round of grants available to states through a new $250 million grant program to create and strengthen insurance rate review processes.

"This is an important step in putting consumers back in control of their health care," said Secretary Sebelius. "These new grants will help states protect consumers and small employers by holding insurers accountable for unreasonable insurance rate increases that have made coverage unaffordable for many American families. By strengthening oversight of insurance premiums, these grants will help put affordable coverage back within the reach for Americans who have been hit hard by skyrocketing costs."

All states and the District of Columbia are eligible for this first round of rate review grants. To receive a grant, a state must submit a plan for how it will use grant funds to develop or enhance its process of reviewing and approving, disapproving, or modifying health insurance premium requests. States with successful applications will receive a $1 million grant during the first round.

"These funds will help states strengthen their oversight capabilities and will allow states that do not currently review rates to establish a program," said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight. "By subjecting rates to new public scrutiny, the oversight of premium increases will ultimately help ensure that consumers receive substantial value for their insurance dollars."

In early May, Secretary Sebelius sent a letter to Governors and State Insurance Commissioners urging them to review the authority they have under their state laws to determine whether they have all of the regulatory tools needed to approve health insurance rates before they take effect.

Several provisions in the Affordable Care Act strengthen HHS' and states' oversight of insurance premiums and rate hikes. These include the Medical Loss Ratio, requiring insurers in the individual and small group markets to spend at least 80 percent of the premium dollar on health care, and insurers in the large group market to spend at least 85 percent of the premium dollar on health care; rate review, requiring insurers to justify unreasonable premium increases to state regulators and the Secretary of Health and Human Services; and grant funds for states to help create or strengthen reporting and review processes.

The Health Insurance Premium Review Grants that will be available during FY 2010 are only the first in a five-year grant program. HHS will take applications for a second round of state grants beginning in Fiscal Year 2011, after new regulations regarding rate review take effect. Second-round grants will allow states to further strengthen their rate review, and begin to provide the Secretary of HHS with the rate data required under the law.

This grant solicitation can be found at grants.gov.

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