Obamacare May Be Repealed Before Replacement is Arranged

According to the Associated Press, Congress may vote to repeal Obamacare before arranging  replacement legislation. GOP representatives expect that repealing the health care law without a replacement would encourage representatives from both parties to cooperate in quickly finding a replacement policy that benefits all.


Click here for the full story.

The Next Generation of Health Care: Telemedicine

Jennifer Agnello, President

Jennifer Agnello, President

Wikipedia defines Telemedicine as: “the use of telecommunication and information technologies to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.”

Sometimes referred to as “telehealth”, this technology came to be in the 1970s-1980 when hospitals needed to extend patient care to the more rural, remote areas. It has since developed rapidly to other segments of the provider community such as home health care, physician offices, etc. Telemedicine has extended its services to include email, smart phone technology, two-way video along with other forms of communication applications.

With the rapid increase of patient out-of-pocket costs and narrowing of provider networks, telemedicine has quickly become one of the most rapidly growing healthcare tools.

The call for telemedicine has also increased as employers and employees embrace wellness initiatives and seek a greater efficiency in their health care model. Time away from work not only financially affects employees themselves but employers seek greater productivity and “presenteeism” from their workforce. Physicians are implementing alternatives to the traditional office visit as demand for their time increases. Patients are connected electronically to glucose trackers, pacemakers and many other remote monitoring devices. Mobile apps such as fitness trackers, weight management programs, personal health coaching tools etc. have become increasingly popular and very personalized. As a low cost, high benefit product, telemedicine can deliver what buyers and users are seeking.

If all that is needed is a quick, easy diagnosis resulting in a prescription for a non-narcotic drug, this new tool allows a simple phone call, sometimes at no cost to the employee, which avoids time off work along with lowering the immense claim costs that health plans amass (consider self-funded employers and the increased availability of those products to smaller employers). Everyday examples such as sinus infections, flu symptoms, ear aches, sore throats, etc. can easily be diagnosed without the need to physically visit the doctor’s office, wait in line and then wait some more at the pharmacy for their prescription. Most services provide 24/7 access to accommodate those weekend and evening concerns. The ratio of patient convenience, productivity and member out-of-pocket costs greatly outweighs the premium cost factor.

From a December 2015 PricewaterhouseCoopers survey, results conclude that both consumers and clinicians are more supportive to mobile technology:

Consumer results

  • 60% are willing to have a video visit with a physician through a mobile device
  • 21% have used a mobile device to order a refill prescription

Clinician results:

  • 81% say mobile access to medical information helps coordinate patient care
  • 38% use email to stay connected with their chronic disease patients
  • 58% would rather provide a portion of care virtually

These statistics show that consumers are driving adoption and demanding better technology. Since 2013, the percentage of consumers with at least one medical, health or fitness app on their mobile devices has doubled from 16% to 32%.

More states have laws that require insurers to pay for telemedicine, physicians are running into less trouble when prescribing drugs across state lines and the technology and equipment that is available for installation in provider’s offices is more available and less costly than ever.

Telemedicine is an attractive concept all around; consumers, health care providers and those consulting for them gain a competitive financial advantage when incorporating telemedicine into their health care models. As telemedicine continues to gain popularity in large numbers, make sure that you are offering a quality product to your client population. Cornerstone has teamed up with Healthiest You (Teladoc) to offer premier products with no copays at low cost to your clientele.

For more information, contact Cornerstone today.

Reminder from Anthem – Modification to Medicare Advantage Commission Payment Schedule

A reminder that Anthem is modifying their Medicare Advantage/Prescription Drug Plan (MAPD) and Prescription Drug Plan (PDP) commission payment schedule so that payments are made in the effective month of the policy.

As a result, there will be two commission payments made in December for MAPD and PDP policies.  One will be with a statement date of November 30, 2016, and the other will be with a statement date of December 18, 2106.  Brokers will be paid on MAPD and PDP commissions during the first week of December for November policy effective and due dates (based on the current schedule).  There will also be a second MAPD and PDP commission payment after December 18, 2016, for December policy effective and due dates.  December 2016 is the only month brokers will receive two commission payments.  The monthly schedule will resume with commission payments in the effective month of the policy for MAPD and PDP policies in January.


Reference:  Dec 2016/2017 Commission Payment Schedule.

Questions:  commissions@crnstone.com

President-Elect Trump Nominates Price for HHS Chief

According to Benefits Pro, President-elect Donald Trump has decided to nominate U.S. Representative Tom Price as the secretary of the Department of Health and Human Services. Price has been a key figure in the attempt to pass legislation repealing and replacing Obamacare.

“There is much work to be done to ensure we have a healthcare system that works for patients, families, and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovation spirit,” Price said in a statement.

The President-elect also announced his nomination of Seema Verma as the administrator for the Centers for Medicare and Medicaid Services.

Read the full story here.

New Jersey Residents May Lose Coverage if Trump Cuts Medicaid


To read the full article, click here.

Confusion Among Buyers with Medicare Advantage Plans and Networks

The Wall Street Journal reports that there may be some confusion with Medicare Advantage plans among buyers, especially in determining which hospitals are included in the plans’ networks. A report from the Henry J. Kaiser Family Foundation finds that incorrect and confusing information in plan directories is leading to difficulty in navigating the plans.

For more information, click here.

Repealing Obamacare May Be More Complex Than Expected

Politico reports that President-elect Donald Trump and the GOP’s promise to repeal Obamacare without a replacement program underway may cause health insurers to prematurely bolt from the individual market and increase premiums.


Read the full article here.

Symantec to Acquire LifeLock for $2.3 Billion

Symantec Corp. will acquire LifeLock Inc. for $24 per share or $2.3 billion in enterprise value. The deal, still pending regulatory approval, is expected to close in the first quarter of 2017. Both companies will create the world’s largest consumer security business with an estimated $2.2 billion in annual revenue (based on the revenues of the last fiscal year for both companies).


Read the full article here.

Check out what Steve Geis, Vice President of Employee Benefits at Cornerstone, has to say about the acquisition here on Hank Stern’s blog.

Bill Presented from GOP to Block Payments to Obamacare Insurers

The Hill reports that four Republican lawmakers have presented a bill to block the Obama administration from making payments to Obamacare insurers. The bill would prevent the administration from using an obscure fund to pay legal settlements to insurers. With the election of President-elect Donald Trump, the bill has lost some prevalence, though the Republican lawmakers still want to be sure payments will not be made to insurers during the repeal of Obamacare.


To read the full story, click here.

ACA Section 1557 Nondiscrimination Requirements Impact on Employer-Sponsored Health Plans

Danny Bradford, Corporate Counsel and Compliance Officer

Danny Bradford, Corporate Counsel and Compliance Officer

Earlier this year, The Department of Health and Human Services (HHS) issued final regulations under an ACA nondiscrimination provision, which prohibits excluding from participation, or denying benefits to an individual based on race, color, national origin, sex, age, or disability. These regulations specifically apply to any health program or activity (covered entity) that is receiving federal financial assistance. Many employer-sponsored health plans are required to comply with these regulations.

What action is required to comply with these regulations?

Health plans may not include categorical exclusions for health services related to gender transition and any denials of coverage for gender transition services must be made on a nondiscriminatory basis.

The regulations also require additional notices to employees including:

  • A notice that the employer does not engage in prohibited discrimination
  • Guidance for disabled individuals and non-English speakers needing additional assistance

What does this mean for employer health plans?

For fully insured health plans, the carrier is almost certainly a covered entity and will be required to comply with the non-discrimination requirements. This means the carrier will add required notice language and remove discriminatory provisions from plans.

For self-funded plans, it is possible that the new regulations will not apply if the plan does not receive any federal financial assistance, including Medicare Part D subsidies.

While the regulations are already in effect, health plans affected by the new regulations are required to adopt any necessary plan amendments by the first day of the plan year on or after January 1, 2017.

The additional requirements under Section 1557 may increase enforcement and litigation risks for all employers (regardless of whether or not they receive federal funds) as HHS has indicated the agency may refer an employer to another federal agency, such as the U.S. Equal Employment Opportunity Commission, if discrimination is found.

Additionally, while there is still a great deal of uncertainty surrounding the future of the ACA, health plans and brokers should prepare for changing nondiscrimination requirements.

For more information, contact Cornerstone today.