Participation: Is It a Good Thing or a Bad Thing?

prepare filling item form, business background

One of the central tenets of underwriting medical plans is to avoid adverse selection at all cost. Adverse selection results when a plan is designed or priced in such a way that it only adequately incentivizes sicker employees to enroll; failing to attract good risk to offset the bad. For this reason, most insurers historically… [Read More]

Reference-Based Pricing – Not Just for Large Groups Anymore

Reference-Based Pricing – Not Just for Large Groups Anymore

“It’s not health insurance that’s expensive; it’s the cost of healthcare,” a keen observation from a recent blog post by Frenkel Benefits’ president, Craig Hasday. It’s safe to reason that anything which lowers the cost of healthcare should lower premium rates – but is it that easy to get done? Employers try to mitigate healthcare costs in… [Read More]

2017 Kaiser Family Foundation Survey Results

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Kaiser has just published its 2017 annual benefits survey and I think the folks in Washington, D.C. all need a copy. Approximately half of the United States’ non-elderly population gets healthcare coverage through their employer, so this survey reveals what many Americans are experiencing. While employer coverage is far better, in many respects, than the coverage… [Read More]

McKinsey Study Is the Latest Evidence That Obamacare Is Not Working


After years of politically biased pontification, likely created by the effects of the ACA, the last few weeks have been littered with actual data-driven evidence on performance. And the news has not been good – that is, depending on your definition of success. Some industry experts seem to have very mixed measures of success that… [Read More]

Examining Multi-Tiered Networks to Minimize Premiums and Foster Consumerism

Examining Multi-Tiered Networks

As health insurance premiums, copays and deductibles become unbearable, we’re often faced with clients who feel completely out of options during renewal conversations. They don’t want to switch carriers, but are out of levers to pull in order to control costs. Now we’re seeing carriers step in with an interesting solution: multi-tiered networks that align… [Read More]

Reality Setting In – Health Co-ops Failure


CoOportunity Health, a not-for-profit cooperative insurer, has failed in Iowa and Nebraska. It is unlikely that the government will recover any of the $146 million in low-cost loans provided to support this ACA-spawned venture. The market is in chaos and the CoOportunity policyholders are scrambling to get claims covered during this time of disarray. While assured… [Read More]

SCOTUS Ruling Can Undermine ACA


Next week, SCOTUS will be hearing King v. Burwell, a potentially watershed case for the Affordable Care Act, which will rule on the legality of allowing subsidies on the federally sponsored health insurance exchanges. The language of the ACA provides that the only place where governments can award advance tax credits is for coverage purchased… [Read More]

Healthcare Cost Pressure Lessened, but It’s Coming Back


The Kaiser Family Foundation has released its latest healthcare cost update. Average premium growth for family coverage is up only 3% over last year. However, as we know, real medical inflation is significantly higher.  How was this accomplished? Deductibles have been increased to an average of $1,217 for single coverage. And in reducing premiums, employers… [Read More]

Taxation Ahead – Limiting Health Premium Tax Deductibility


The big golden goose in paying for government’s healthcare costs is tax deductibility of health insurance premiums. The idea of limiting, or even eliminating, deductibility is often discussed because it solves a lot. However, when the fog clears, legislators realize that this will give an inducement to employers to head to the hills and discontinue… [Read More]

Flash News: 2015 Rates Going Up, System Becoming Even More Complex


Recently I was quoted in Employee Benefit Adviser magazine about requested increases on the New York State health insurance exchange. In what is turning into an annual dance, insurers have requested an average increase of 14.6%. When the reporter called, I paused to consider the irony. New York insureds would not take an increase of this… [Read More]