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US Health and Life Insurance Company (USHL), a subsidiary of U.S. Health Holdings, Ltd. provides insured medical, prescription, dental and life insurance for Michigan, Illinois, Indiana, Ohio, Wisconsin and Texas groups.

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USHL NEWS & Updates

On March 5, 2014, CMS announced that it would allow insurers to extend some health plans until October 2016 even if the plans do not meet new healthcare reform standards.

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The USHL Metal Plan lineup is now available for Indiana groups.

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Standard Analytical Service, Inc. (SAS), publishers of independent insurance reports, recently released its 2014 annual comparative report of the 25 leading domestic health insurance providers. USHL received a favorable ranking.

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USHL recently introduced its Wellness Resources Center, a convenient one-stop health and wellness information library on the USHL website which visitors can reference for a variety of objectives.

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  • Pitfalls Emerge in Health Insurance Renewals

    For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins.

    Seems like good news after all the headaches consumers endured after the program’s launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances.

    “(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop,” said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm.

    If you made a good choice last year, what could be so wrong about re-upping with the same plan?

    Turns out plenty, particularly for those among the 87 percent of enrollees in health insurance exchange plans who received a federal subsidy to help pay for premiums. Understanding why that’s a problem isn’t easy, the result of complicated quirks in the Affordable Care Act, which established the exchanges in the first place.

    Premiums Up 8 Percent

    Overall, premiums on the exchanges in 2015 may be a bit higher for most people, at least according to one analysis of proposed plans and rates in nine states. Avalere found that the average premiums for Silver plans will climb an average of 8 percent. (There are four grades of plans offered, starting with Bronze plans with the cheapest premiums, but higher deductibles and co-pays, and moving up to Silver, Gold and Platinum.)

    The Obama Administration announced last month that consumers who bought their policies on the federal exchange would have them automatically renewed, as well as the amount of their subsidies.  It will be up to each state exchange whether to offer a similar automatic renewal. People whose level of income has changed would need to enroll again since it would affect the amount of their subsidies. 

    But consumers who automatically re-up with the plan they already have could face steep and unexpected premiums and out-of-pocket costs, particularly if they received a federal subsidy.

    Changing Benchmark Plans

    Here’s why. The subsidy people receive is pegged to the second-lowest priced Silver plan, the so-called “benchmark plan,” meaning that the amount of a subsidy any individual receives no matter which plan he or she selects, is based on how much they would receive if they picked that benchmark plan.

    In a hypothetical example Avalere provides, “Sue,” a Maryland resident, enrolled in the 2014 benchmark Silver plan in her region – offered by CareFirst Blue Cross -- which had a monthly premium of $214. Based on her income, Sue’s contribution toward her monthly premium was set at $58, so she qualified for a monthly federal subsidy of $156 to make up the difference. If Sue had chosen a plan with a higher premium, her federal subsidy would have remained fixed at $156 and she would have had to pay more out of her own pocket.

    However, in 2015, according to Avalere’s analysis of early rate filings, CareFirst Blue Cross will no longer be the second lowest Silver plan in Sue’s region but the ninth lowest out of 18 Silver plans, meaning that it will lose its status as the benchmark plan. CareFirst’s new monthly premium is $267. The new benchmark Silver plan (the Silver plan with the second lowest premium) will be the Kaiser Foundation Health Plan with a monthly premium of $231.

    Sue’s contribution remains the same, but she will now qualify for a higher federal subsidy of $173 to make up the difference between her ability to pay $58 per month and the higher $231 monthly premium of the new benchmark.

    If she automatically re-enrolls with CareFirst, however, she will have to cough up another $36 a month. By doing nothing, her out-of-pocket contribution will rise by 62 percent.

    In another example, “Dave” enrolled in the benchmark Silver plan in Washington state, Group Health Cooperative, which had a monthly premium of $281. He received a federal subsidy of $85 each month, leaving him with a monthly out-of-pocket bill of $196.

    In 2015, BridgeSpan Health will replace Group Health as the benchmark plan in Dave’s area, with a premium of $263 a month. Because of that lower premium, Dave will be entitled to only a $67 a month federal subsidy, leaving him again with a $196 monthly out-of-pocket expense if he switched to BridgeSpan. But if Dave sticks with Group Health, which hiked its premiums to $313, he will have to pay $246 each month out of his own pocket, a nearly $600 increase compared to last year.

    This is not a theoretical wrinkle. Of the nine states whose 2015 premiums Avalere examined (Connecticut, Indiana, Maryland, Maine, Oregon, Rhode Island, Vermont, Virginia and Washington), all but Vermont appear headed for a new benchmark plan when open enrollment commences. Consumers who live in six of these states may have an unpleasant surprise when they see their bills if they let their policies automatically renew.

    In Rhode Island and Virginia, the opposite may be true. Last year’s benchmark plans are expected to become the lowest price Silver plans, instead of the second lowest. Consumers renewing the 2014 benchmark plans in those two states could actually see their out-of-pocket premium costs decrease in 2015.

    “There could be significant financial value to take a look at the site and see if there might be more affordable options for you, given the changes since last year,” Steno said.

    Website Tools

    As re-enrollment approaches, numerous health care advocacy organizations, including Easter Seals, the March of Dimes, the Livestrong Foundation, the National Alliance on Mental Illness, and many others have urged the U.S. Department of Health and Human Services, which operates the federal health exchange, and the states that run their own exchanges to develop tools on their websites that will help consumers identify the plans that best fit their particular circumstances, not only in terms or premium costs, but also their actual usage.

    In the first year, all exchanges showed the differences in premiums of the various health care plans as well as their differing cost-sharing formulas. Cost-sharing refers to deductibles, copays and co-insurance. (Copays are a fixed amount you pay for a particular medical service, such as $40 per primary care visit; co-insurance is a percentage that you have to pay for each service, such as 20 percent of a hospitalization.)

    The lower the premiums, the higher the cost-sharing burdens on patients. As a result, cost-sharing formulas can result in the difference of thousands of dollars between one plan and the next, depending on an individual’s or family’s specific health care needs.

    Those with chronic conditions, for example, who need many doctor visits in the course of a year, would do best to enroll in a higher premium plan with lower co-pays for individual visits. Relatively healthy people, on the other hand, would likely come out ahead by enrolling in a lower premium plan with higher co-pays.

    That is why health advocates want all the exchanges to offer calculating tools that would enable customers to plug in information on their actual health care usage from the previous year to get an idea of how much they would be likely to spend in each plan in the year ahead.

    “Our goal is that every state website will have the information to help you understand your real out-of-pocket costs,” said Marc Boutin, president of the National Health Council, which offered its own calculating tool for customers during the last enrollment.

    But with all the computer mishaps in the first enrollment year, neither the 36 federal nor 15 state exchanges had such a tool in the first year. Colorado tried in the first year, but consumers found the tool confusing and the exchange disabled it, said Adele Work, director of product implementation for Connect for Health Colorado. Consultants are working on a replacement, she said, but it may not be available in time for November. It’s not clear which, if any, other states will have such a tool in place either.

    Exchanges also did poorly in providing two other categories of information of great interest to consumers. Many exchange websites were unable to offer up-to-date lists of the medical providers who were in each network plan. And very few exchanges – Colorado and Nevada were exceptions – could tell consumers which medications each health plan covered, information that could make a difference of thousands of dollars.

    Because of last year’s disastrous roll-out, most exchanges will have modest ambitions for the second enrollment period. Offering consumers a smooth enrollment experience is the goal of most exchanges. But a smooth experience won’t necessarily be enough to guarantee landing the best policy. 

  • Obama Administration Moves Forward On Employer Mandate

    A signal came Thursday when the Internal Revenue Service posted drafts of forms that employers will have to fill out to comply with the requirement that they provide workers with health insurance.

    The Wall Street Journal: Obama Administration Moves Ahead With Employer Insurance Forms
    The Obama administration on Thursday released draft forms for employers and individuals to use when reporting their health coverage to the Internal Revenue Service starting next year despite calls for delaying the requirement. The Affordable Care Act requires most big employers to offer health benefits that are deemed affordable, or to pay fines starting at $2,000 per worker if they don't (Radnofsky, 7/24).

    Politico: IRS Prepping For Obamacare Employer Mandate In 2015
    The Obama administration signaled Thursday it’s not backing down from the controversial health law employer mandate that has been delayed twice and is the centerpiece of the House’s lawsuit against the president. The IRS posted drafts of the forms that employers will have to fill out to comply with the Obamacare requirement that employers provide health insurance to workers (Haberkorn and Snell, 7/24).

  • Health Law's 'Uninsurance' Fine Capped At $2,448 For Individuals

    The cap for a family of five is set at $12,240 -- an amount equal to the national average annual premium cost of a bronze level plan.  

    The Hill: Uninsured Face Fine of Nearly $2,500
    The Internal Revenue Service said Thursday individuals who fail to get health insurance this year will be fined a maximum of $2,448 and families with five or more members can be fined up to $12,240. Under the Affordable Care Act’s individual mandate, people are either required to obtain health insurance or risk a tax penalty from the IRS (Al-Faruque, 7/24).

    The Associated Press: Federal Officials Cap Fines for Not Buying Health Insurance
    Federal officials have capped the amount of money scofflaws will be forced to pay if they don't buy insurance this year at $2,448 per person and $12,240 for a family of five. The amount is equal to the national average annual premium for a bronze level health plan. But only those with an income above about a quarter of a million dollars would benefit from the cap. Those making less would still have to pay as much as 1 percent of their annual income (7/24).

  • For Consumers, Some Pitfalls In Obamacare Coverage Could Lie Ahead

    Stateline reports that automatic re-enrollment of health plans bought through the state and federal exchanges could mean that people pay more than they would if they comparison shopped. In addition, The Associated Press reports that inconsistent subsidy amounts are leading some people to go without insurance.   

    Stateline: Pitfalls Emerge In Health Insurance Renewals
    For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins. Seems like good news after all the headaches consumers endured after the program's launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances. "(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop," said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm (Ollove, 7/25).

    The Associated Press: Varying Health Premium Subsidies Worry Consumers
    Government officials say [Linda] Close — and other consumers who have received different subsidy amounts — probably made some mistake entering personal details such as income, age and even ZIP codes. The Associated Press interviewed insurance agents, health counselors and attorneys around the country who said they received varying subsidy amounts for the same consumers. As consumers wait for a resolution, some have decided to go without health insurance because of the uncertainty while others who went ahead with policies purchased through the exchanges worry they are going to owe the government money next tax season (Kennedy, 7/24).

    Meanwhile, in the news from Florida -

    Health News Florida: Hispanic Health Advocates Push For Votes
    Advocates for health insurance are calling on Hispanics to get insured under the Affordable Care Act. And they're asking those same people to vote against lawmakers who oppose Obamacare. Latino community leaders in Central Florida say more than 200,000 Hispanic Floridians are uninsured. They're urging state lawmakers to accept federal funding and expand health care for all Floridians. Josephine Mercado of Hispanic Health Initiatives called it a human rights issue. Betsy Franceshini, a Florida-based representative of the Puerto Rican government, says many uninsured Hispanics work in industries like hospitality (Green, 7/24).

  • House Panel Backs Lawsuit Against Obama On Health Law

    The Rules Committee approved a resolution challenging whether the president has constitutional authority to delay provisions of the law. The full House will likely consider it before its August recess begins.

    Politico: House Panel Backs Obama Lawsuit
    The lawsuit has deepened the tension and mistrust between House Republicans and the White House. Republicans say they’re simply holding the president accountable for circumventing Congress on a major policy change related to the implementation of Obamacare. Obama and congressional Democrats have dismissed the suit as little more than election year theater (French, 7/24).

    Modern Healthcare: House Plan to Sue Obama Over Employer-Mandate Delay Moves Forward
    A resolution authorizing the U.S. House of Representatives to sue President Barack Obama for exceeding his constitutional authority by delaying the employer mandate in the federal healthcare law, cleared the House Rules Committee Thursday. The legislation passed on a party-line 7-4 vote. The full House is expected to take up the measure next week prior to its August recess (Demko, 7/24).

    Meanwhile, what does the public think?

    CNN: Majority Say No To Impeachment And Lawsuit
    There’s not a lot of public appetite for a Republican push to sue President Barack Obama, or for calls by some conservatives to impeach him, according to a new national survey. A CNN/ORC International poll released Friday morning also indicates that a small majority of Americans do not believe that Obama has gone too far in expanding the powers of the presidency (Steinhauser, 7/25).

  • Expensive Hepatitis Drug Challenges Medicaid Programs' Funding

    State officials are nervous about how to afford the new medicine, which can run $84,000 for treatment. Also in Medicaid news, federal data show children using emergency room treatment at night or weekends are often on Medicaid.

    The Washington Post's Wonkblog: The Drug That's Forcing America's Most Important – And Uncomfortable – Health-Care Debate
    Expensive specialty drugs aren't new to health care. But Sovaldi stands out because it is aimed at helping millions of Americans who carry hepatitis C, and a large share of those infected are low-income and qualify for government coverage. Its arrival also coincides with the aggressive expansion of Medicaid and private coverage under the Affordable Care Act, whose purpose was to extend health care to tens of millions Americans who previously couldn't afford it (Millman, 7/24).

    CQ Healthbeat:  More Medicaid Families Sought Emergency Room Care, Statistics Show
    Three-fourths of children treated in emergency rooms in 2012 were taken at night or on weekends, according to federal statistics released Thursday. The figures also showed that families on Medicaid were more likely than those with private insurance or without any coverage to use the emergency department. The frequency with which people use pricey emergency department care is getting attention as policymakers struggle to find ways to lower federal health spending. Lawmakers want to persuade people to use less expensive outpatient care whenever possible. The Centers for Disease Control and Prevention statistics released Thursday suggests that families still use the emergency room in part because of convenience, and that Medicaid families may need help in finding a primary care physician or understanding when an emergency visit is necessary (Adams, 7/25).

  • New Mexico Likely To Decide Health Exchange Plan Today

    Also in the news, Colorado's health exchange chief executive announced she will leave her post to become president of Cigna's private exchange business.

    The Associated Press: New Mexico Set To Decide On Health Exchange Plan
    The governing board of New Mexico's health insurance exchange is to consider Friday whether to continue relying on a federal online system for enrolling individuals in medical plans. Board vice chairman Jason Sandel said Thursday that he expected members to decide at a meeting in Santa Fe how to handle the next round of enrollment, which will start in November (7/24).

    The Denver Post: Colorado Health Insurance Exchange CEO Patty Fontneau Leaves for Cigna
    The state health insurance exchange's chief executive, Patty Fontneau, announced Thursday she will leave Connect for Health Colorado to take a job as president of Private Exchange Business for Cigna. She will leave her post in mid-August. The exchange's board of directors said they plan to name an interim CEO within a week. (Draper, 7/24).

    Health News Colorado: Exchange Boss Resigns To Join Cigna
    Patty Fontneau, the executive who has been synonymous with Colorado’s health exchange and both its successes and shortcomings, is leaving to join the insurance industry. Fontneau announced Thursday that she will resign as CEO and executive director of Connect for Health Colorado in mid-August. She plans to join Cigna where she will become president of its private exchange business (McCrimmon, 7/24).

  • Consumers In States Around The Country To Get Premium Rebates

    Local news outlets report on a federal announcement Thursday showing how much money will be sent back to people and employers under rules that say insurers must spend at least 80 percent of premium payments on medical care.

    The Oregonian: Three Health Insurers Will Pay Rebates In Oregon
    Three health insurers in Oregon owe rebates to consumers under a federal rule limiting administrative expenses for carriers. According to the U.S. Department of Health and Human Services, 49,412 people will benefit from refunds averaging $101 per family covered. Only about 23,000 people who purchased their own policy directly, in the individual market, will see a check, however. Rebates for employer-provided insurance will be send to the businesses that purchased the policy (Budnick, 7/24).

    Georgia Health News: Insurers To Pay $11 Million In Georgia Rebates
    A federal rule on health insurers’ spending will bring $11 million in rebates to Georgia individuals and employers this summer. Federal figures released Thursday show that 304,000 Georgians will benefit from the refunds, with an average rebate of $53 per family, as a result of the “Medical Loss Ratio” (MLR) rule on 2013 insurance plans. Created by the Affordable Care Act, the MLR standard generally requires health insurers to spend at least 80 percent of the premium dollars they collect on medical care or activities to improve the quality of health care (Miller, 7/24).

    The Denver Post: Coloradans Could See $2.7 Million in Premium Refunds From ACA Rule
    Health and Human Services on Thursday announced that 52,277 consumers in Colorado will get $2.7 million in refunds, an average of $93 a family, from insurance companies this summer because of the Affordable Care Act's 80/20 rule (Draper, 7/24).

    The Baltimore Sun: Marylanders Received $17M In Insurance Refunds Under Health Reform Rule
    Health insurers refunded more than $17 million to Marylanders last year because of a rule in the Affordable Care Act limiting the amounts the companies can spend on overhead costs as opposed to providing care, according to federal data. About 206,000 consumers in Maryland received the refunds, an average of $140 per family, according to a report from the Department of Health and Human Services released Thursday (Dance, 7/24).

    Des Moines Register: $1.8M In Health Insurance Rebates Ordered In Iowa
    About 3,500 Iowans will receive rebates from their health insurer, thanks to a rule that is part of the Affordable Care Act. Another 11,100 Iowans will have rebates sent to their employers. The consumers receiving direct rebates purchased individual health insurance policies from Wellmark Blue Cross & Blue Shield. The other affected Iowans obtained Coventry Health Care policies via their employers. The rebates, totaling nearly $1.8 million, are going to people whose insurance plans didn't spend as much as required last year on health-care services. The rules, which are part of the Affordable Care Act, require that policies covering individuals or small businesses spend at least 80 percent of premium dollars on medical services instead of on administrative costs or profit. Large-group plans must spend at least 85 percent of premiums on medical care (Leys, 7/24).

  • State Highlights: Public Comments On Mass. Hospital Deal; Wash. Insurance Case Brings Allegations

    A selection of health policy stories from Massachusetts, Washington state, Missouri and Pennsylvania.

    WBUR: In Public Comments, Partners-Coakley Deal Brings Praise And Protest
    Quite an “only in Massachusetts” moment. Patriots owner Robert Kraft and leaders of Raytheon, Suffolk Construction and Putnam Investments have all filed letters in support of an anti-trust agreement that would not normally see the light of day before a judge approves the deal. The opposition includes public health professors, a group of top economists and politicians battling Attorney General Martha Coakley in the governor’s race. This show of force is weighing in on a deal Coakley negotiated with Partners HealthCare. It would let the state’s largest hospital network expand its market power, but with constraints, some of which would last for 10 years (Bebinger, 7/24).

    Seattle Times: Investigator: Children’s Hospital Ex-Hearing Judge Was Untruthful, Investigator Says 
    Patricia Petersen, the state insurance office’s top administrative-law judge suspended in May over a messy set of dueling allegations, was misleading and untruthful in her characterizations of events surrounding a high-profile insurance case, an independent investigator has concluded. In a rebuttal and memo released Thursday with the investigation report, her lawyers accused the investigator of cherry-picking facts in an error-filled effort to wrongly castigate a judge who stood up for “judicial independence.” For example, her lawyers said, the investigator concluded that Petersen should have told lawyers in a case before her involving Seattle Children’s hospital that her husband had been a medical resident there. But that was over three decades ago, they noted, and he had no current financial interest in the hospital (Ostrom, 7/24).

    Kansas Health Institute News Service: New Missouri Law Pays Dividends For Kansas City Clinic
    A year and a half ago, a local safety net clinic underwent one of the most significant changes in its more than four decades of serving the metropolitan area: It went from a purely free provider to one that also accepted paying patients covered by insurance. Known for years as the Kansas City Free Health Clinic, the organization became the Kansas City CARE Clinic to reflect that its donation-based operation had evolved to a fee-based, sliding-scale system with a minimum payment of $10. The shift promised hundreds of thousands of dollars in new revenue for the clinic, at 3515 Broadway in Kansas City, Mo., but lawmakers first needed to fix a glitch in a state statute. That finally occurred last week when Missouri Gov. Jay Nixon signed legislation shepherded through the General Assembly by State Sen. Jolie Justus, a Kansas City Democrat (Sherry, 7/24).

    The Associated Press: Doctor Fires Back At Pennsylvania Hospital Gunman
    A doctor told police that a patient fatally shot a caseworker at their hospital complex before the doctor pulled out his own gun and exchanged fire with him and wounded him, a prosecutor said Thursday night. Dr. Lee Silverman, a psychiatrist, was grazed in the temple during the gunfight in his office with patient Richard Plotts, according to Delaware District Attorney Jack Whelan (7/24).

  • N.C. Senate Votes For Managed Care Medicaid Overhaul

    The move would offer a set amount of money per patient to managed care companies and would set up a new department run by a politically appointed board.

    Raleigh News & Observer: NC Senate Votes For Medicaid Overhaul
    A major Medicaid overhaul that largely disregards the wishes of health care providers, the state House and Gov. Pat McCrory won overwhelming support in the state Senate on Thursday in a 28-17 vote. The overhaul would introduce to the state commercial managed care for Medicaid patients, a move that doctors and hospitals are fighting. But after several years of overruns, legislators crave “budget predictability” for Medicaid (Bonner, 7/24).

    WRAL: Senate Votes To Overhaul Medicaid
    The proposal, House Bill 1181, would remove Medicaid from the Department of Health and Human Services, setting it up as an independent agency called the Department of Medical Services governed by an independent, although politically appointed, board. Under the proposal, the state would end its direct fee-for-service management of the program, contracting it out to managed care and accountable care organizations. The contracts would be "capitated," offering a set amount of money for care per patient (Leslie, 7/24).

    North Carolina Health News:  Senate Moves Medicaid Reform Bill, But Objections Abound
    If a majority of members of the North Carolina Senate get their way, the state’s Medicaid program is up for big changes. A bill that passed the Senate Thursday afternoon would speed up implementation of both provider-led plans and commercial managed care plans to compete to cover patients in Medicaid, the state and federally funded program that provides health care coverage for low-income children, pregnant women, low-income elderly and people with disabilities. The bill would also carve the Division of Medical Assistance – which runs Medicaid – out of the Department of Health and Human Services and create a freestanding executive Department of Medical Benefits, which would be run by a seven-member board (Hoban, 7/25).

    Elsewhere, a report examines the state's "Medicaid gap" --

    Raleigh News & Observer: Many Low-Income N.C. Workers Are Locked Out Of Medicaid
    They’re construction workers, waitresses and cashiers. They care for our children and elderly parents, clean our offices and bathrooms. But they go without health insurance because their incomes aren’t high enough to qualify for federal subsidies and too high to qualify for North Carolina’s current Medicaid program for low-income and disabled citizens. More than half of the 689,000 uninsured adults North Carolinians who fall into this so-called “Medicaid gap” are employed in jobs that are critical to the state’s economy, according to a report released Thursday by the North Carolina Justice Center, the North Carolina Community Health Center Association and Families USA (Garloch, 7/25).