Zika Virus and Summer Travel

zikaVSummer is upon us and with it comes more outdoor activities, more sunscreen and, for some, more travel. What you may not expect summer to bring is the risk of the Zika virus. But, U.S. health officials warn that mosquitos carrying the virus could hit the mainland’s southern borders, starting with Florida and the Gulf Coast, in a few weeks.

Whether you’re traveling this summer or you’re staying put, the CDC says the best way to reduce your risk is to avoid bug bites by using repellent and covering your skin. If possible while traveling, choose hotels with screens or air-conditioning. While using both sunscreen and repellent, apply the sunscreen first, let it dry and then apply the repellent. However, you do not want to use products that contain both sunscreen and repellent and you should not spray repellent on the skin under clothing.

Pregnant women, especially those in their first trimester, are most at risk for the virus and should take every possible precaution and are advised to avoid affected areas. A current list of countries where Zika is active can be found on the CDC’s main site – http://www.cdc.gov.

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Drugs Drive Rising Costs

medicalWhile all treatment costs have risen consistently in the past 2 decades, the pharmaceutical sector has put up some amazing numbers. In 2011 alone, Americans spent an average of $985 per person, approximately twice the amount spent in other developed countries for the same benefit. In 2015, aggregate prescription drug sales in the U.S. totaled $374 billion – $190 billion more than other industrialized countries would have spent for a similar population.

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Corporate Fitness & Health Offers Summer Screening Special – Call Today!

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For a limited time only, Corporate Fitness & Health (CF&H) is offering discounted onsite health screenings! Schedule your screening for anytime from now until August 31, 2016 and receive 20% off per person.

965aab05-0823-4c6a-b9a6-b8f590b2351dScreening Includes:

  • A Non-Fasting Finger Stick Test which includes:
    • Total Cholesterol
    • HDL
    • Cholesterol Risk Ratio
    • Glucose
  • Blood Pressure Check
  • Height
  • Weight
  • BMI
  • Body Fat Percentage
  • Estimated Level of Hydration

Contact Corporate Fitness & Health today for more information via email at info@cfandh.com or call toll-free (800) 423-5591.

To be eligible for this discounted rate, you must be a first time Corporate Fitness & Health client and schedule your onsite health screening for the months of July or August 2016.  Travel costs may apply for locations outside of Connecticut.

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Engaging Employees in Health Benefits

health-benefitsEven though this issue also discusses the importance of reaching millennials, it seems an appropriate time to explore this topic from an even broader perspective. Studies like the 2015 Aflac Workforce Report show that more than 7 of 10 employees seldom, if ever, understand what is covered in their healthcare plan. On top of that, a USA Today analysis of government records shows that 1 in 5 invasive surgeries may be unnecessary. On the other side of the coin, we know that when employees fail to obtain the preventive care they need, serious health risks and the potential for even larger health claims exist.

So with the value of your health benefit plan and its cost control and wellness enhancement features hanging in the balance, let’s consider a few thoughts that may motivate your employees to care enough about their benefits to make smarter healthcare decisions.

Timing is Everything – It isn’t a lack of information keeping people from understanding their benefits; it’s how and when people are choosing to get their information. While benefit booklets and plan documents are required, they simply can’t compete with push notifications, text alerts and other “real time” communication. In a world where too many people still pay little or no attention to their healthcare plan until they need it – plan, provider and cost-related information must be more personal and more accessible.

Consumers Rule The Day – In many areas of their lives, your employees are behaving as informed and empowered consumers every day. While this behavior isn’t carrying over to healthcare as quickly as we would like, new products and services are making actionable information easily accessible to both employees and employers. HealthiestYou and Real Time Choices are just two services capable of delivering more personalized, comparative data to individuals when they are making a healthcare decision.

One Stop Shop – More and more TPAs are taking steps to offer one integrated, online “hub” where members can access their benefit plan, claims data and much more. From network providers to cost and quality comparisons to individualized wellness incentives and rewards, the ability to provide one place where members can find the information they want is critical.

As these and other technologies continue to evolve, they will do more and more to connect your employees with the right information at the right time – the real key to engaging employees in their health benefits.

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Walls Closing In On Obamacare Lawlessness

Article written by Grace-Marie Turner and Doug Badger, as seen in Hartfor Business.com on May 23, 2016

The Obama Administration is unlawfully diverting billions of dollars from taxpayers to insurance companies that sell Obamacare policies.

That is the conclusion reached in a legal opinion letter released today by former Ambassador and White House Counsel Boyden Gray.

Mr. Gray’s letter reinforces the conclusion of legal experts at the nonpartisan Congressional Research Service who found that the administration’s actions “would appear to be in conflict with the plain text” of the Obamacare statute.

Mr. Gray’s letter documents how the Centers for Medicare and Medicaid Services is diverting $3.5 billion that it was legally obliged to remit to the Treasury and instead providing it to sponsors of Obamacare policies to compensate them for medical expenses of high-cost policyholders.

This unlawful diversion is occurring through the Transitional Reinsurance Program (TRP), established to smooth out losses for insurance companies selling Obamacare policies in the individual market. The TRP compensates these insurers for the costs of large medical claims incurred by their customers. CMS picked up the entire cost of medical claims between $45,000 and $250,000 for individuals enrolled in Obamacare individual policies in 2014, relieving insurers of the burden of paying these high medical bills.

The money for the TRP comes from an annual assessment on all individual and group insurance policy holders—primarily people with employer-based coverage—of $63 in 2014, $44 in 2015 and $27 in 2016.  In addition to financing the TRP program, the Affordable Care Act (ACA) requires CMS to remit $5 billion of these collections to Treasury.

When these collections came up $3.5 billion short over the first two years, CMS made a fateful and unlawful decision: the agency decided to fleece taxpayers in order to pay insurers.

According to the Gray legal opinion letter, “by the time the books close on TRP for the 2014 and 2015 benefit years at the end of 2016, reinsurance-eligible issuers will likely have received 98% of expected payments ($15.6 billion out of an expected $16 billion), whereas Treasury will likely have received only 12% of expected payments ($495 million out of an expected $4 billion).”

“The HHS allocation scheme prioritizing payments to reinsurance-eligible issuers over payments to Treasury violates the ACA,” Gray concludes.

HHS initially issued regulations that would provide taxpayers with their legal share of the reinsurance taxes, but it quickly changed course to put taxpayers last in line for funding. In a March 2014 rulemaking, CMS said Treasury would get its share of the funds even if collections fell short. But 10 days later, the agency reversed its position and said, essentially, it would stiff the taxpayer if there was a shortfall.

Which is just what it is doing. Unlawfully, as Gray’s legal opinion demonstrates.

The administration is flatfooted in its defense. Acting CMS Administrator Andy Slavitt testified before the House Energy and Commerce Subcommittee on Oversight on April 15 but was at a loss to explain why the agency changed its rules so swiftly and dramatically.

Gray explains that HHS failed to set the tax rate at a level that would produce the required revenue, saying “the ACA requires the implementation of a collection methodology” to produce the $5 billion owed to Treasury. “Congress,” he emphasizes, “did not make contributions for payments to Treasury ‘secondary’ to contributions for payments to reinsurance-eligible insurers.”

Gray’s letter references multiple legal precedents to demonstrate that CMS does not have any leeway to ignore this statutory language, as it has done. “[T]he statute does not use ‘permissive language’ with respect to collections for payments to Treasury,” his letter says. In addition, “HHS’s prioritization scheme is not a permissible interpretation of the law. None of the rationales HHS has offered in support of its prioritization scheme withstand textual scrutiny.”

“Congress specifically protected Treasury’s share of each contribution, declaring that it ‘may not be used’ for payments to reinsurance-eligible issuers,” the letter declares.

The ACA requires the administration to remit a total of $5 billion of its reinsurance tax collections to the Treasury, reserving the rest for reinsurance subsidies. The administration chose to bilk the taxpayers to keep health insurers in the game, even as the billions of dollars they are receiving through the TRP and other subsidies subsidies are inadequate to stem their losses for coverage they are offering in the Obamacare exchanges.

University of Houston Prof. Seth Chandler sums it in Forbes: “It’s a scheme in which the Obama administration collected less in taxes from health insurers (mostly off the Exchanges) than they were required to do under the Affordable Care Act, created a plan to pay insurers selling policies on the Exchange considerably more than originally projected, and stiffed the United States Treasury on the money it was supposed to receive from the taxes.”

Congress and the courts are rapidly losing patience with the agency’s pattern of malfeasance.  In a separate but related case, a federal judge earlier this month ruled that CMS was unlawfully providing billions of dollars in cost-sharing subsidies to insurers, spending money that Congress did not appropriate.

Last week, the House Energy and Commerce Committee moved one step closer to issuing a subpoena to CMS to obtain documents explaining how the agency came to adopt its unlawful approach to the TRP program. Senator Ben Sasse (R-NE) has introduced a bill to address the agency’s actions.

The walls are closing in on CMS’s lawlessness.

Key arguments in the legal opinion letter from Boyden Gray & Associates

Boyden Gray’s letter analyzes five key areas in which the administration’s justification for its actions involving reinsurance fails legal tests:

  1. The ACA requires HHS to implement a collection methodology that fully finances the transitional reinsurance program, rendering irrelevant its silence with regard to allocation of insufficient collections.
  2. None of HHS’s rationales for prioritizing payments to reinsurance-eligible issuers over payments to Treasury withstand scrutiny. A) the statute does not use “permissive language” for payments to Treasury; and B) HHS distorts the ACA’s text by asserting that collections for payments to Treasury are secondary because they are to “be collected ‘in addition to’” contributions for payments to reinsurance-eligible issuers.
  3. The Secretary does not have “general authority” to “design the method for determining the contribution amounts” that go “toward reinsurance payments.”
  4. HHS’s reliance on the ACA’s policy goals of market certainty and premium stabilization to justify its prioritization scheme impermissibly ignores the act’s competing policy goal of protecting the federal fisc.
  5. HHS’s use of notice-and-comment to adopt its regulations prioritizing payments to reinsurance-eligible issuers does not render them lawful.

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Why Wait for a Physician When You Can Talk With a Physician – 24/7?

dg-teladoc-postTo help members resolve minor medical issues by consulting with a physician, Diversified Group partners with TelaDoc® – the most widely known provider of telephone, email, video or mobile medical consults.

  • When the TelaDoc service is in place, members can consult with a doctor in a variety of ways, from home or on the go…
  • Members are able to connect with a doctor to receive medical advice by phone in as little as 2 minutes
  • Set an appointment that fits your schedule, Monday through Friday
  • Consult with a doctor discreetly by using secure messaging
  • Use a video consult to obtain a diagnosis, treatment plan or prescription

24/7 physician access will give members an easier way to get the medical advice they need. And easier access to medical advice means less waiting and fewer trips to the ER. Talk to Diversified Group about TelaDoc and take control of healthcare costs.

Does Your Health Plan Need a Physical Exam?

physical-examYou might wonder why this question at this time of year, but that’s exactly the point. Now that crunch time and the pressure of renewal are behind us, take a deep dive into your health plan to learn where your health care dollars are going.

Performing a checkup on your health plan means reviewing data on claims and utilization. While employers with fully insured plans may lack this data, those who self-fund should have reports that identify how your company and your members have benefitted from the plan. More importantly, reviewing claims and utilization data can help determine if any patterns are developing that might call for additional health screenings or wellness measures. Finally, it’s a good time to see how your plan is performing compared to national or perhaps regional trends.

Put Your Information to Work
Many employers are simply not aware of what is available to them in terms of data. Others know they have the data but don’t know what to do with it. That’s where the right TPA can help. Our data analysis and custom reporting capabilities help our self-funded clients analyze plan performance and benchmark data to compare diagnoses, procedure costs and utilization patterns.

These tools can help employers and advisors forecast future plan costs and take steps to contain future costs. Plan design changes, chronic disease management, health coaching – these options and many more can help when plan information is analyzed and understood. Resolve to put claims data to work for your health plan this year. Your members will enjoy better benefits and your plan will be much more efficient.

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