IMAGE
Friday, October 27, 2023

Gag Clause Prohibition ~ Compliance Requirement

The Consolidated Appropriations Act (CAA) requires an annual “gag clause prohibition compliance attestation” (GCPCA) be submitted by Dec. 31, 2023, and annually hereafter.  Importantly, carriers/administrators/payers have largely removed any references to gag clauses and prohibitions of sharing pricing and quality data, which was prohibited by the CAA. 

IMAGE
Wednesday, January 12, 2022

Home COVID-19 Test Kits Covered by Health Insurance

Earlier this week (January 10, 2022) the White House announced a requirement that most private health insurance payers must cover the cost of home COVID-19 test kits, starting January 15, 2022.  The new benefit waives any plan related cost sharing (e.g., copay/deductible/coinsurance) for the purchase of a limited supply of physician prescribed home test kits.  

IMAGE
Wednesday, May 19, 2021

Blue Cross Blue Shield Class Action Settlement

A settlement has been reached involving antitrust litigation brought against the 36 Blue Cross Blue Shield (BCBS) plans throughout the county.  The litigation involved a class of BCBS subscribers who alleged that BCBS violated antitrust laws when it engaged in what is known as illegal market division.

IMAGE
Tuesday, April 7, 2020

Health Ins. Options During Coronavirus Pandemic

The COVID-19 pandemic has disrupted and changed the health insurance landscape for many people.  Here’s a review of the various options available to people, depending on their specific situation and eligibility:

IMAGE
Wednesday, March 11, 2020

Coronavirus Health Insurance Benefits

Leaders of the major health insurance companies in the U.S. agreed to expand insurance benefits related to Corornavirus/COVID-19, in a historical meeting held at the White House yesterday (March 10, 2020).  Present at the meeting were executives from: Aetna
Blue Cross Blue Shield (BCBS) Association (representing the 36 BCBS plans throughout the nation, including Anthem)
Cigna
Humana
UnitedHealth Group (aka United Healthcare)

IMAGE
Thursday, May 9, 2019

Accountable Care…The Savior of U.S. Healthcare?

Since the passage of the Affordable Care Act (ACA) in March of 2010, much has been discussed, debated, written, and deployed relative to healthcare FINANCING reforms (see insurance, Medicare, Medicaid, self-insured employers, fees/taxes, pre-existing conditions, essential health benefits, community rating, minimum loss ratio, etc.).  But very little has been written, or even revealed for that matter, about the ACA’s healthcare DELIVERY reforms and incentives.  This is too bad, since we know that $.80 to $.85 of every dollar of billed health insurance premium is directly related to healthcare delivery.  So it stands to reason that if we could reduce health CARE costs, health insurance PREMIUMS would follow suit.  Enter Accountable Care Organizations (ACO) into the equation.  Let’s examine what ACO’s are…who they are…and why many are looking to them to save America’s healthcare system from imploding.

IMAGE
Tuesday, September 18, 2018

Cigna Express Scripts Merger APPROVED

The United States Department of Justice (DOJ) has given the necessary approval of Cigna’s acquisition of pharmacy benefit manager (PBM) – Express Scripts.  The $52 billion deal will result in a consolidated healthcare behemoth that some say, is in reaction to recent healthcare sector entrant – Amazon.  Another large scale healthcare acquisition/merger – CVS/Caremark and Aetna – is currently under DOJ review, but is expected to be approved soon, in a $69 billion transaction.  The Cigna/Express Scripts transaction is scheduled to be completed by the end of 2018.

IMAGE
Thursday, July 13, 2017

Stabilizing the Individual Health Ins. Market

Those of you who read my previously released – “7-Point Health Care/Insurance Reform Plan” – may recall point no. 2, which was to entice and encourage insurers to come back to the markets and resume offering affordable coverage to willing, able, and ready buyers. (See – https://smstevensandassociates.com/my-7-point-health-care-insurance-reform-plan/) Several folks that read the blog outlining myLEARN MORE

Wednesday, May 6, 2015

Health Insurer For Sale!

Insurance holding company – Assurant Inc. – announced their intent to exit the health insurance marketplace by 2016; and have retained investment banking firm – Barclays Capital – to locate a potential buyer for their health insurance and employee benefits subsidiaries.  Like the legions of health insurers that have exited the market before and after passage of the Affordable Care Act (ACA), the reason is simple – quarterly losses in the millions with seemingly no end in sight.  In the case of Assurant Health (and its more recognizable subsidiary insurers in the health insurance market including Time, John Alden Life, and Union Security Life) it appears the ACA was the proverbial “straw that broker the camel’s back”

Wednesday, January 28, 2015

The Demise of a Health Insurer in 1 Year!

    Although the following chain of events directly affects some 120,000 health insurance policyholders residing in the states of Nebraska and Iowa, it could be a bell weather for individuals residing in one of the other 23 states that have/offer health insurance through a federal government approved/funded, non-profit, member owned health insurer. (see http://sstevenshealthcare.blogspot.com/2014/12/coop-health-insurancealert.html forLEARN MORE