Health Insurance Regulations – ObamaCare

Might I add, this is just the first few pages of what everyone calls ObamaCare. Our company is slowly processing the data and information involved in ObamaCare and informing the public how to “translate” the legal jargon into common every-day terminology. If you think anything has been mis-translated, give us a comment and we’ll re-review. Now that President Obama has been re-elected, we all have to know what’s in this Act. The following information is what we have so far “in translation”:

  • Insurance companies can no longer cutoff policy holders who have reached their lifetime limit in medical expenses.
  • Annual limits on these coverages will begin to phase out for a period of 3 years
  • Limits will be completely banned beginning September 1, 2014
  • Limit of 1.45 Million after September 23, 2011
  • Limit rises to 2 Million after September 23, 2012
  • These limitations and bans do not apply to those grandfathered in – only new employer sponsored and individual plans
  • Policies may not be cancelled (rescinded) unless it amounts to fraud or misrepresentation of material fact
  • Insurance companies cannot impose cost-sharing requirements for:
    • Evidence-based items or services with A/B Rating
    • Recommended immunizations
    • Infants, children, adolescents of preventative care and screenings
    • Evidence-based preventative care and screenings for women
  • The Secretary can create a value-based insurance design
  • A dependent may be on parents coverage up until age 26
  • The Secretary designs a uniform pamphlet explaining the coverage one is to receive and include medical definitions so that a normal enrollee may understand the pamphlet
    • Must list exceptions, reductions and limitations on coverage
    • Printed in a language the enrollee understands and reads
    • Contact Information and a summary statement of the coverage document itself
    • Failure to provide this information is $1,000 fine for each stated failure
  • The Insurance Company may not establish rules relating to the eligibility of a full-time employee that are based on the total hourly or annual salary – cannot discriminate low-income earners.
    • A plan sponsor can still setup a payment plan for those who have low income

QUALITY OF CARE

  • The Secretary along with experts and stakeholders must develop reporting requirements for use by Insurance Companies with respect to a plan/coverage and healthcare reimbursement structures:
    • Improve health outcomes (via quality reporting, case management, care coordination)
    • Implement activities to prevent re-admission (via patient-center education, counseling, comprehensive discharge planning)
    • Implement activities to improve patient safety and reduce medical errors (via clinical practices, evidence-based medicine, health information technology)
    • Implement wellness
  • Insurance companies must file an annual report with the Secretary and enrollees regarding whether the benefits under the plan/coverage satisfy the four above
    • Report is made available during open enrollment
    • Reports may be available online through a website made by the Secretary to the public
    • No definite dollar amount for penalties when not in compliance with Report, penalty chosen by the Secretary

WELLNESS AND PREVENTION PROGRAMS

  • Wellness and Prevention Programs may be personalized and coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager or organization that conducts health-risk assessments or offers face to face, telephonic or web intervention regarding the following conditions:
    • Smoking Recession / Heart Disease Prevention
    • Weight-management / Physical fitness / Nutrition / Healthy Lifestyle Support / Stress Management
    • Diabetes prevention

BRINGING DOWN THE COST OF HEALTHCARE COVERAGE

  • An insurance company must submit to the Secretary a report on the percentage of total premium revenue that such coverage expends 1) on reimbursement for clinical services; 2) for activities that improve health care quality; and 3) all other non-claim costs including an explanation of the nature of such costs
    • State taxes and licensing/regulatory fees do not need to be reported
    • These reports are made available to the public on the Department of Health and Human Services website
  • An insurance company must provide an annual rebate to each enrollee under its coverages on a pro rata basis in an amount that is equal to the amount by which premium revenue exceeds: 1) within a group plan, 20% and 2) within an individual plan, 25%
    • The State must ensure that premiums are used for clinical services and quality improvements
    • This terminates on 12/31/2013
  • Each hospital must make a list that is available to the public operating costs and its standard charges including diagnosis related charges

To be continued…

A Way to Save the Postal Service

If you come to a four-way stop consecutively with a police car, a fire truck, and a mailman, who goes first? The legal answer is the mailman goes first. But why? Shouldn’t the fire truck or police car go first because they have authority? No. They actually don’t. The mailman goes first because you can never stop the flow of commerce. But the flow of commerce is at risk because of the Postal Service Crisis.

September 30th has passed. This was the date that the USPS claimed (on their own website) that they could not make their mandated payments to a trust fund that reserves retiree health benefits. I call it a trust because it essentially is. It’s a fund that they cannot touch and must abide by. They also cannot make their monthly payment of $5.6 billion to the US Treasury. Back in August, $5.5 billion was due. They were unable to make that payment in full as well. USPS requests Congress to make reforms that provide an outdated system a boost.

Here’s a video that explains exactly what a bailout is and who pays for it (created by the Oversight Committee)

Representative Darrell Issa, Chairman of Committee on Oversight and Government Reform listened to that request and have presented the House with bill HR 2309, which is more commonly known as the “Postal Service Act of 2011-2012” in which he provides a method that could help the Postal Service.

However, reading it, it doesn’t. Closing down offices and electing more non-delivery days prevents the flow of commerce. Providing a bigger credit-line to the USPS is not a solution; that only causes the USPS to “owe” more. There should be methods that involve better technology and to reduce the mandated payment as much as humanly and legally possible. The Treasury is affecting the Flow of Commerce, and I repeat this because its vital to every small, medium and large business. Without mail, bills would be unpaid, advertisements of new businesses would go unread and online purchases could not be delivered.

Here’s a way to reduce costs, which may sound ridiculous at first, but they are cost savings:

  1. The USPS should use hybrid vehicles only for transportation such as a Prius. All the vehicles would be of the same color with the same USPS emblem. That alone could have a potential savings of millions considering the rising cast of gasoline. The LLV model of the current USA mail truck gets 17 MPG (16 city/ 18 hwy) equivalent to a Toyota Tacoma and a Ford F-250. 
  2. Reduce cost of domestic shipping. Raising costs only enforces people to stay mobile in their correspondences. Reducing the cost even by $0.05 could result in more business.
  3. Raise cost of international shipping and provide a more efficient way to ship packages via Internet postage.
  4. Large corporations must deliver all correspondence by mail; whether it be a bill, a notice,  an offer, etc. To go “paperless” means that corporation saves $0.44 per person who elects paperless and USPS loses $0.44 per person.
  5. Programs that use USPS such as Paypal/eBay/Ship and Stamps.com should not charge the user to pay for their mail. USPS should instead, give a percentage. This causes the person to use the program more. $15 a month for stamps is inconvenient for a small business considering their mailing list is not very large.

Unemployment Falls Below 8% Highly Unlikely

The Bureau of Labor Statistics (BLS), released yesterday that unemployment has dropped to 7.8%.  Now, that percentage doesn’t mean anything unless you compare it to another percentage or numbers. Let’s compare it to the numbers. 23 Million people were out of work during the RNC convention as well as the DNC convention and assumingly, still, to this day. Other sources such as the AP claim that a rough 12 Million are unemployed. That number is not the reality of the situation.

For the BLS to claim that unemployment dropped 7.8% is the same as stating that 460,000 have entered the workforce. In one month’s time in such an unstable, slow growing economy, that number is not likely. Facts show that for the past 40 months, unemployment has always been above 8%. But is that the real number percentage? The answer is no, and here’s why.

There are ways that number is skewed. To include some:

  1. Many states have revised their Unemployment Insurance coverage 6-22 less weeks than their standard amount of covered weeks, usually 99. The idea behind reducing the amount of people receiving governmental assistance via checks was to stimulate growth.
  2. Some have quit looking for work entirely.
  3. 50% of College Graduates who have worked hard to earn their degree and obtained mass student loan debts are obligated to pay those debts within 6 months of the graduation date cannot find work. They are living with their parents or relatives. Their education is simply not enough. They cannot file for unemployment.
  4. Does not include farmers.

Florida was a 99 week state; however, it is now a 26 week state plus the federal extension amount. Florida is one state that took a hard hit, for sure. In August, the UI program had tightened their eligibility requirements by forcing those applying to strictly apply online and to complete a 45-minute test which assessed their job skills. This is unfair to those who have limited computer access, poor English speaking/reading skills, poor computer skills or even a physical disability in which no way is a fault of their own. Since then, denial for unemployment insurance has sky rocketed, rejecting almost half of those who apply. On a national standard, 30% is the standard “denial rate”.

This change saved Florida $2.7 million and ultimately declined the unemployment rate. Imagine this change taking affect in all 50 states. You can see clearly how unemployment would decrease dramatically in months to come.

Title Insurance Premiums Grow Substantially Including Florida

They are only risingTitle insurance premiums increased in all 50 states during the second quarter of 2012 (April – July) compared with the same period of 2011, according to the “2012 Second-Quarter Market Share Analysis,” from American Land Title Association (ALTA). Title insurance premiums reached $2.76 billion in the second quarter, an almost 20 percent increase compared to the same quarter a year ago.

The title insurance industry generated $9.47 billion in the title insurance premiums in 2011, down 1.5 percent from the prior year, according to ALTA’s 2011 premium data; Q2 2011 premiums were $445 million. Title insurance premiums in the first three months of 2012 were $2.32 billion, up from $2.25 billion in premiums in the same period of 2011.

States generating the most premiums in title insurance for Q2 2012:

  1. California: $415.1 million, up 29.8 percent compared with $320 million for the same quarter 2011
  2. Texas: $333.7 million, up 16.6 percent compared with $286 million in Q2 2011
  3. Florida: $218.1 million, 17.4 percent compared with $186 million in Q2 2011
  4. New York: $193.6 million, up 14.8 percent compared with $169 million in Q2 2011
  5. Pennsylvania: $113.2 million, up 16.8 percent compared with $97 million in Q2 2011

Victims of Foreclosure May Be Eligible for Claim in National Foreclosure Settlement Judgement

Pam Bondi, Florida’s Attorney General, announced that claim forms are going out to approximately 167,398 Florida borrowers who lost their home to foreclosure between Jan. 1, 2008 and Dec. 31, 2011 and who may be eligible for payment under the $25 billion national mortgage foreclosure settlement. Florida’s portion received is 8.4 billion. If you are a borrower and you want to apply to be in this settlement, go here. You have until January 18, 2013 to file this claim! On this website you can read the Settlement Judgements and also using the first link at the bottom of the page, file a claim. You are eligible if your mortgage was serviced by Ally/GMAC, Bank of America, JP Morgan Chase, Citibank and Wells Fargo. Their following payment settlement amounts are as follows, in order of greatest to least:

  1. Bank of America – $2,382,415,075 ($2.4 B – rounded)
  2. JP Morgan Chase – $1,121,188,661 ($1.2 B)
  3. Wells Fargo – $1,005,233,716 ($1 B)
  4. Citibank – $413,041,577 ($413 M)
  5. Ally/GMAC – $109,628,425 ($109 M)

The following Borrower Payment Amount (provide cash payments to borrowers whose homes were finally sold or taken in foreclosure between and including Jan 1, 2008 and Dec 31, 2011 and who submitted claims for harm) are the same for each Bank/Lender, each one owing $1,489,813,925.

The following Consumer Relief amounts and Refinancing Relief amounts, are amounts that the banks/lenders must provide to those consumers who meet the eligibility criteria. The following numbers have been rounded.

  1. Wells Fargo – Consumer Relief: $3.4 M || Refinancing Relief: $903M
  2. Ally/GMAC – Consumer Relief: $185 M || Refinancing Relief: $15 M
  3. Bank of America – Consumer Relief: $7.6 B || Refinancing Relief: $948 M
  4. Citibank – Consumer Relief: $1.4 B || Refinancing Relief: $378 M
  5. JP Morgan Chase – Consumer Relief: $3.7 B || Refinancing Relief: $537 M

The Settlement Judgments essentially say that the top five leading banks/lenders violated, among other laws, the:

  1. Unfair and Deceptive Acts and Practices
  2. False Claims Act
  3. Financial Institutions Reform, Recovery and Enforcement Act of 1989
  4. Servicemembers Civil Relief Act
  5. Bankruptcy Code and Federal Rules of Bankruptcy Procedure

Things to know: 

  • You must have received the form by January 18 by your Attorney General
  • You can have someone help you fill the form; it should be an Attorney or the Toll-Free admin at 1 (866) 430-8358
  • Payment’s won’t stop other legal claims – meaning you do not need to prove any financial harm to receive a payment nor do they  make you give up your rights to pursue a lawsuit against the mortgage servicer
  • Eligible borrowers may get a payment from this settlement even if they participated in another foreclosure claims process; however payment may be reduced
  • If you are eligible and you were NOT notified, you need to contact the AG of your state
  • Beware of scams – paying strangers to file the claim, any known settlement-related scams regarding homeowners