The recent federal stimulus plan provides for a 65% reduction in COBRA premiums for eligible individuals for up to nine months. Assembly Bill 23 (AB 23) requires insurers to mail a notice of the right to elect Cal-COBRA health insurance coverage to everyone who was laid off between September 1, 2008 and December 31, 2009. This includes current Cal-COBRA recipients and allows them to choose the 65% reduction as well.
How is AB 23 different than the American Recovery and Reinvestment Act of 2009 (ARRA) signed into federal law on February 17, 2009?
AB 23 requires insurers to extend federal premium assistance of 65% reduction to Cal-COBRA premiums to employees who were involuntarily terminated between September 1, 2008 and December 31, 2009 and worked for an employer with fewer than 20 employees that offers health care coverage.
Which segments of the business community does this affect?
This bill impacts small businesses (2-19 employees) that offer health care benefits and would notify their health insurers of involuntarily terminated employees.
What are clients that are members of this segment of the business community responsible for?
These employers are still required to promptly notify their health insurer of all employees who are involuntarily terminated. In addition, they must respond promptly to their insurer’s requests for employee verification of the involuntary termination. If they involuntarily terminate(d) employees between September 1, 2008 and December 31, 2009 they must sign a “Verification of Involuntary Termination Form.” These forms will be supplied by the insurers to verify the involuntary layoff.
If my clients have former employees that enrolled in Cal-COBRA after September 1, 2008, what are they eligible for?
These employees must complete a “Request for Treatment as an Assistance Eligible Individual Form.” If eligible, they can obtain premium assistance back to March 1, 2009 or later. If an employee is currently enrolled under Cal-COBRA, they are eligible as of March 1, 2009.
If my clients have former employees that chose not to enroll in Cal-COBRA after September 1, 2008, can they enroll now and what are they eligible for?
If an employee was involuntarily terminated between September 1, 2008 and December 31, 2009, they should be eligible for the premium assistance assuming they meet the other federal requirements. The insurer has 14 days from the date AB 23 was signed by the Governor (May 12, 2009) to notify the former employees of their ability to enroll, similar to the notifications the employee received when employment was originally terminated but now it will include information about the federal premium assistance. The employee then has 60 days to enroll in Cal-COBRA and elect to receive the premium assistance.
What can be done if the former employer’s group health plan denies an application for the premium reduction for Cal-COBRA participants?
The applicant can appeal. The Secretary of the Department of Health and Human Services (HHS) is required to make a determination regarding an appeal within 15 business days after receiving a request for review. The Center for Medicare and Medicaid Services (CMS), which is part of HHS, will oversee appeals for federal, state, and local governmental employees, as well as appeals related to Cal-COBRA. CMS expects to begin processing appeals no later than May 1, 2009, and will provide further information regarding where to submit appeals in the near future.
Inquiries regarding Cal-COBRA subsidy appeals should be directed to :
NewCobraRights@cms.hhs.gov or the following address: CMS c/o COBRA APPEALS 7500 Security Blvd. Baltimore, MD 21244 Mail Stop C2-12-16
California Department of Insurance 1-800-927-HELP www.insurance.ca.gov
Wednesday, May 13, 2009
Friday, April 24, 2009
CAHU Plays a Major Role in Gutting AB 1521 & Also in Editing the Proposed New Language for This Bill by Assemblyman Dave Jones
For all CAHU Members who responded to our AB 1521 Operation Drumbeat E-Mail Action Alert...THANK YOU SO MUCH! We can't thank you enough for taking the time to respond to CAHU's Operation Drumbeat. YOUR pressure made all the difference in making it possible for CAHU to succeed in totally changing this bill! This past week, AB 1521 was gutted and amended to remove both the commission disclosure and additional fiduciary duties for Health insurance agents.
On Tuesday April 14th, 2009, the author, who is also the chair of the Assembly Health Committee, presented AB 1521 to his committee. The first vote left the author short of the necessary votes to move the bill out of committee and was put on call. After much personal lobbying of committee members by the author, the bill passed out with 10 votes which is just the minimum necessary to pass in this committee. Surprise!! The conventional wisdom had been that this bill would get out on a strong party line vote.
CAHU next met with the author at his request of CAHU on Friday morning, April 17th, to see if we could reach agreement on amendments to remove our opposition to the bill, but we concluded we could not. The bill was set to be heard in Assembly Insurance Committee on April 22.
On that same Friday in the afternoon, the authors office emailed a new proposal to CAHU- offering to remove all the language in the bill and submit new language on controlling commission payment practices by carriers in the individual and group market and additional disclosures by agents - IF CAHU would support this total new bill language. The proposed amendments were less harmful than the original language but still caused us a problem. But the author and sponsor, Health Access - a liberal advocacy group, indicated they were open to working with us on the language.
Negotiation continued over this past weekend (April 18 & 19) and right up to the hearing in Assembly Insurance on April 22, 2009. At last count we had met three times, gone through 15 plus different drafts, and finally had an acceptable deal. In the end the bill will put in statute some of the current commission payment practices of the carriers in the individual market only, which have been in place for years.
CAHU's Legislative Advocate, Steven Lindsay, persuasively debated with them that the language in their proposed new version unnecessarily included the small group market and that this language should be removed...and it was. Steven also was responsible for pointing out to them that their proposed new language would unintentionally have increased agent commission payments (in dollars), and thus also premiums, for "rated up" individual health polices, and he helped them rewrite that language (part of the reason for 15 drafts of this revised bill).
So this totally revised version of AB 1521 contains no additional duties or disclosures beyond what we currently are required to do and all references to the group market were stricken. Thus CAHU can now support passage of this revised version of AB 1521, which did pass out of the Assembly Insurance Committee on April 22nd.
CAHU Members - this is another in a very long list of great legislative advocacy accomplishments that CAHU is responsible for over the years.....and why your membership support (and renewal of your membership each year) is such a very worthy investment in protecting your clients and your careers in the health insurance industry!
Monday, March 23, 2009
Craig Gussin of SDAHU Appears on Channel 6
Congratulations to Craig Gussin of the San Diego Association of Health Underwriters for his continued outreach into the community and his recent appearance on San Diego's Channel 6 News as a part of their coverage on the new ARRA COBRA changes.
In addition to doing an excellent job on ARRA COBRA, Craig also touted the importance of working with your own professional agent who should be a member of the Association of Health Underwriters. Craig also took the opportunity to plug the Matrix as an important health insurance resource and that your local agent is the best place to get one!
Great job, Craig! Keep up the great work!
You can view the video on this segment at:
http://www.sandiego6.com/mediacenter/local.aspx?videoID=592745
PS Craig says Paula Wilson taught him everything he knows! Thanks to you, too, Paula!
In addition to doing an excellent job on ARRA COBRA, Craig also touted the importance of working with your own professional agent who should be a member of the Association of Health Underwriters. Craig also took the opportunity to plug the Matrix as an important health insurance resource and that your local agent is the best place to get one!
Great job, Craig! Keep up the great work!
You can view the video on this segment at:
http://www.sandiego6.com/mediacenter/local.aspx?videoID=592745
PS Craig says Paula Wilson taught him everything he knows! Thanks to you, too, Paula!
Friday, March 6, 2009
www.CoverageForAll.org Showcased by Insurance Commissioner
Sam Smith, CFP
Vice President, Public Affairs
California Association of Health Underwriters
Friday, March 6, 2009
Sacramento Business Journal
Poizner Showcases Web Site With Information on Health Insurance
On Thursday, California State Insurance Commissioner Steve Poizner (R) showcased the website www.coverageforall.org intended to highlight health insurance options for unemployed people, according to the Sacramento Business Journal.
The San Jose based Foundation for Health Coverage Education maintains the site and a 24 hour uninsured hotline as part of an effort to facilitate access to state and federal health insurance programs. Founded in 2004 by Phil Lebherz, FHCE is a non-profit 501(c)3 public organization that has long been supported by the California Association of Health Underwriters and has served as the model for a national program through the National Association of Health Underwriters that serves consumers in all the 50 states in the search for available health insurance coverage options, the Healthy Access Database, which can be found at www.nahu.org/consumer/healthcare/ .
As California and the nation embark on the challenging journey to reform America's health care system, it is important to remember that there is no group, no organization or entity that understands consumers or our health care system better than our national and state associations of Health Underwriters. The work of the Foundation, CAHU and NAHU in providing these consumer directed data bases is just another example of the solid commitment of agents all across this country to their clients.
Congratulations to Phil Lebherz, Executive Director of the Foundation for Health Coverage Education, Ankeny Minoux, the Foundation's president and the dedicated folks that have worked with them over the last several years. Being singled out as "the source" by the Department of Insurance is a tremendous achievement!
Vice President, Public Affairs
California Association of Health Underwriters
Friday, March 6, 2009
Sacramento Business Journal
Poizner Showcases Web Site With Information on Health Insurance
On Thursday, California State Insurance Commissioner Steve Poizner (R) showcased the website www.coverageforall.org intended to highlight health insurance options for unemployed people, according to the Sacramento Business Journal.
The San Jose based Foundation for Health Coverage Education maintains the site and a 24 hour uninsured hotline as part of an effort to facilitate access to state and federal health insurance programs. Founded in 2004 by Phil Lebherz, FHCE is a non-profit 501(c)3 public organization that has long been supported by the California Association of Health Underwriters and has served as the model for a national program through the National Association of Health Underwriters that serves consumers in all the 50 states in the search for available health insurance coverage options, the Healthy Access Database, which can be found at www.nahu.org/consumer/healthcare/ .
As California and the nation embark on the challenging journey to reform America's health care system, it is important to remember that there is no group, no organization or entity that understands consumers or our health care system better than our national and state associations of Health Underwriters. The work of the Foundation, CAHU and NAHU in providing these consumer directed data bases is just another example of the solid commitment of agents all across this country to their clients.
Congratulations to Phil Lebherz, Executive Director of the Foundation for Health Coverage Education, Ankeny Minoux, the Foundation's president and the dedicated folks that have worked with them over the last several years. Being singled out as "the source" by the Department of Insurance is a tremendous achievement!
Sunday, February 8, 2009
If We Could Just Be More Judicious About Our Choice of Words…
I am posting this meaningful message taken from NAHU's B2B Internet discussion group.
As posted 2/7/2009 on NAHU B2B
by Tom Gibson - Senior Market Services - Camas, WA
(he is a NAHU member but not a CAHU member)
You would think that over 20 years of insurance reform and over a thousand state and federal mandates later someone might have realized that trying to cure our health care system through insurance reform wasn't the answer. A big part of why has to do with the very imprecise way most Americans speak. Unlike most other English speaking people we speak in such vague terms, using the same words to mean vastly different things that many people that don't speak English as a native language can't follow what an American is saying at all.
A case in point is the way we use health care and health care provider to mean either a doctor or an insurance company when in fact insurance companies are not health care providers in the strictest sense of the word. If you disagree with that statement then you have just made my point for me. Insurance companies do bundle contracts and providers together and kind of sell those like a product, but this leaves the indelible impression in a majority of people's minds that insurers and their agents are somehow involved in escalating prices and since most agents seem either fairly well to do, better off financially than most people that buy insurance there isn't any evidence to disabuse them of that notion.
It isn't really well understood that insurance has actually been the only brake on really wild runaway spending in lieu of a strong governmental organization that sets prices and standards of care. We have no real price controls or standards of care, just this free market illusion that all doctors should be respected and that the doctor is always right. I talk to Medicare beneficiaries every day and it is amazing how many people agree with this but how out of touch Congress is about this matter.
If we could just be more judicious about our choice of words I believe that would do more than all the lobbyists in Washington to change the nature of the debate about health care reform. According to CMS, administration expenses, and by that I assume they mean insurance and other administrative costs, are 14 cents of every health dollar spent. If we are paying twice as much for our health care system as several reports show that we are then insurance reform is a 10% solution for a 50% problem. Even someone that survived our public schools should have figured out that isn't going to work.
As posted 2/7/2009 on NAHU B2B
by Tom Gibson - Senior Market Services - Camas, WA
(he is a NAHU member but not a CAHU member)
You would think that over 20 years of insurance reform and over a thousand state and federal mandates later someone might have realized that trying to cure our health care system through insurance reform wasn't the answer. A big part of why has to do with the very imprecise way most Americans speak. Unlike most other English speaking people we speak in such vague terms, using the same words to mean vastly different things that many people that don't speak English as a native language can't follow what an American is saying at all.
A case in point is the way we use health care and health care provider to mean either a doctor or an insurance company when in fact insurance companies are not health care providers in the strictest sense of the word. If you disagree with that statement then you have just made my point for me. Insurance companies do bundle contracts and providers together and kind of sell those like a product, but this leaves the indelible impression in a majority of people's minds that insurers and their agents are somehow involved in escalating prices and since most agents seem either fairly well to do, better off financially than most people that buy insurance there isn't any evidence to disabuse them of that notion.
It isn't really well understood that insurance has actually been the only brake on really wild runaway spending in lieu of a strong governmental organization that sets prices and standards of care. We have no real price controls or standards of care, just this free market illusion that all doctors should be respected and that the doctor is always right. I talk to Medicare beneficiaries every day and it is amazing how many people agree with this but how out of touch Congress is about this matter.
If we could just be more judicious about our choice of words I believe that would do more than all the lobbyists in Washington to change the nature of the debate about health care reform. According to CMS, administration expenses, and by that I assume they mean insurance and other administrative costs, are 14 cents of every health dollar spent. If we are paying twice as much for our health care system as several reports show that we are then insurance reform is a 10% solution for a 50% problem. Even someone that survived our public schools should have figured out that isn't going to work.
Tuesday, February 3, 2009
CAHU Steps Into Leadership Role to Help Shape California's Future
MD Sam Smith, CFP
CAHU VP, Public Affairs
On January 26th, the California Association of Health Underwriters was invited to give testimony at the first public hearing by California State Auditor Elaine Howle to solicit comments about the processes that should be established for individuals to apply to become members of the new Commission established by the California Voters First Act (Proposition 11). Representing CAHU was Sam Smith, Vice President of Public Affairs. Testifying along with CAHU was California Common Cause, the League of Women Voters of California, AARP, and Charles Munger, Jr., California visionary and philanthropist. The purpose of the hearing was to gather information to address the role of the State Auditor's office in the selection of the Commission and implementing the act that will establish an entirely new process for drawing legislative districts in the State of California after the 2010 census. CAHU members are encouraged to follow the progress of implementation of the California Voters First Act by visiting
http://bsa.ca.gov/bsa/prop11.php. Proposition 11 represents the California Association of Health Underwriter's first effort to effect how the future of California is shaped and CAHU's grassroots participation in the 2008 campaign its first foray in activist politics. Through this successful effort and the upcoming redistricting process we hope to have a more moderate and responsive legislature.
In another important area, CAHU was proud to be a Premier Sponsor at this year's California Women Lead Legislative Reception in Sacramento for new and returning legislators and potential future candidates. Leading the CAHU delegation for this important event was CAHU Legislative Vice Chair, Meg McComb, and accompanying her as CAHU representatives were Linda Rose Koehler, Sam Smith and CAHU lobbyist, Steven Lindsay. Joining the CAHU delegation as special guests were Kathay Feng, Executive Director of California Common Cause and Janice Hirohama, President of the League of Women Voters of California. Founded in 1974, California Women Lead is a nonpartisan, nonprofit organization dedicated to providing leadership and campaign trainings, networking opportunities, and policy discussion forums for women interested in or who hold elected and appointed offices. California Women Lead's mission, as women in government, is to inform and educate its constituencies as well as encourage and support women to seek public office. CAHU is proud to be a Premier Sponsor of California Women Lead!
CAHU VP, Public Affairs
On January 26th, the California Association of Health Underwriters was invited to give testimony at the first public hearing by California State Auditor Elaine Howle to solicit comments about the processes that should be established for individuals to apply to become members of the new Commission established by the California Voters First Act (Proposition 11). Representing CAHU was Sam Smith, Vice President of Public Affairs. Testifying along with CAHU was California Common Cause, the League of Women Voters of California, AARP, and Charles Munger, Jr., California visionary and philanthropist. The purpose of the hearing was to gather information to address the role of the State Auditor's office in the selection of the Commission and implementing the act that will establish an entirely new process for drawing legislative districts in the State of California after the 2010 census. CAHU members are encouraged to follow the progress of implementation of the California Voters First Act by visiting
http://bsa.ca.gov/bsa/prop11.php. Proposition 11 represents the California Association of Health Underwriter's first effort to effect how the future of California is shaped and CAHU's grassroots participation in the 2008 campaign its first foray in activist politics. Through this successful effort and the upcoming redistricting process we hope to have a more moderate and responsive legislature.
In another important area, CAHU was proud to be a Premier Sponsor at this year's California Women Lead Legislative Reception in Sacramento for new and returning legislators and potential future candidates. Leading the CAHU delegation for this important event was CAHU Legislative Vice Chair, Meg McComb, and accompanying her as CAHU representatives were Linda Rose Koehler, Sam Smith and CAHU lobbyist, Steven Lindsay. Joining the CAHU delegation as special guests were Kathay Feng, Executive Director of California Common Cause and Janice Hirohama, President of the League of Women Voters of California. Founded in 1974, California Women Lead is a nonpartisan, nonprofit organization dedicated to providing leadership and campaign trainings, networking opportunities, and policy discussion forums for women interested in or who hold elected and appointed offices. California Women Lead's mission, as women in government, is to inform and educate its constituencies as well as encourage and support women to seek public office. CAHU is proud to be a Premier Sponsor of California Women Lead!
Monday, January 19, 2009
Put a Health Insurance Expert to Work for You!
Kansas City Star, (Diane Stafford)
MD Sam Smith, CFP
CAHU VP, Public Affairs
“If you’ve lost your health insurance in a layoff…
If you’re confused about which retirement health plan you should take…
If you’re buried under hospital bills and don’t know what to do next…
Steve Luptak feels your pain.”
So begins a recent newspaper story about Steve Luptak, a member of a growing cottage industry of individuals who are making a business out of helping people navigate the confusing waters of health insurance and health care costs.
“Every part to the health care financing encounter has high-paid consultants working for them”, Luptak said, “But there’s usually nobody representing the consumer with the same level of advocacy.” After retiring from a health care industry job a few years ago, Luptak started helping, for a fee, people who had problems getting health insurance or negotiating medical bills. By charging those who could afford to pay, he has been able to help others for free. “I’m doing a lot of pro bono work to get off the ground. I consider this my mission.”
“I’ve gotten to be very efficient at analyzing health insurance,” Luptak said. “For a basic fee of $200, I can do an initial evaluation-what coverage do you have? What coverage do you need? Or I can charge a contingency fee if I negotiate down your medical bills and get hospitals or insurance companies to write off some of your debt.”
….and so the article goes, talking about how he charges in on his white horse helping those whose policies have been rescinded and whose claims have been denied…and then charges upfront fees and a percentage of negotiated claims.
Imagine that! Comparing policies for the consumer. Helping them understand what they have and what they need. Helping with claims and negotiating with hospitals and providers. What a great job!
When I spoke with the columnist for the Kansas City Star, Diane Stafford, we had a lively conversation about professional agents and their role as consumer advocates. It took some doing, but Ms. Stafford finally agreed that perhaps a professional agent might in fact have an advantage in dealing with insurance companies and health care providers because of the business we have and not in spite of it. That an agent is seen more as a partner and less likely to be viewed as an adversary when negotiating and that our internal knowledge of the system is an asset, not a liability. If we didn’t place our clients first, just how long would stay in business?
We finally ended the conversation on a positive note and a commitment to consider professional agents the premier health care advocate for the consumer…for all the right reasons.
This story is but one of a large number of articles coming out in the face of ever growing interest in health care reform and a good example of the great need for us to tell our story every chance we get. I am not confident that we can rely on the press to tell it fairly. In fact, I think it would be a safe bet that they will not. In the absence of their support, the job falls back to us.
This is why we must develop our Public Affairs Teams in every chapter across the state. We must have members who are committed to go out and tell our story in our communities. What we do and the important role we play as consumer advocates is a message that we must deliver and do it now. If agents continue to wait for someone else to do it, soon there will be no story to tell.
I was very pleased to see over the course of the last week evidence of the work that our National Association has done in making sure we have a place at the table in the looming health care reform debate. In many stories last week regarding the passage of the renewal of SCHIP funding in the US House of Representatives, the National Association of Health Underwriters was mentioned as one of the key players in the debate along with America’s Health Insurance Plans and the Blue Cross Blue Shield Association. A big part of what makes this possible is member support of HUPAC. In 2008, HUPAC was listed as the fourth largest player amongst professional agents and broker PACs by contributing $392,250 to federal issues and offices.
We’re number 4! We’re number 4! Somehow, that just doesn’t sound like something to be all that proud of.
MD Sam Smith, CFP
CAHU VP, Public Affairs
“If you’ve lost your health insurance in a layoff…
If you’re confused about which retirement health plan you should take…
If you’re buried under hospital bills and don’t know what to do next…
Steve Luptak feels your pain.”
So begins a recent newspaper story about Steve Luptak, a member of a growing cottage industry of individuals who are making a business out of helping people navigate the confusing waters of health insurance and health care costs.
“Every part to the health care financing encounter has high-paid consultants working for them”, Luptak said, “But there’s usually nobody representing the consumer with the same level of advocacy.” After retiring from a health care industry job a few years ago, Luptak started helping, for a fee, people who had problems getting health insurance or negotiating medical bills. By charging those who could afford to pay, he has been able to help others for free. “I’m doing a lot of pro bono work to get off the ground. I consider this my mission.”
“I’ve gotten to be very efficient at analyzing health insurance,” Luptak said. “For a basic fee of $200, I can do an initial evaluation-what coverage do you have? What coverage do you need? Or I can charge a contingency fee if I negotiate down your medical bills and get hospitals or insurance companies to write off some of your debt.”
….and so the article goes, talking about how he charges in on his white horse helping those whose policies have been rescinded and whose claims have been denied…and then charges upfront fees and a percentage of negotiated claims.
Imagine that! Comparing policies for the consumer. Helping them understand what they have and what they need. Helping with claims and negotiating with hospitals and providers. What a great job!
When I spoke with the columnist for the Kansas City Star, Diane Stafford, we had a lively conversation about professional agents and their role as consumer advocates. It took some doing, but Ms. Stafford finally agreed that perhaps a professional agent might in fact have an advantage in dealing with insurance companies and health care providers because of the business we have and not in spite of it. That an agent is seen more as a partner and less likely to be viewed as an adversary when negotiating and that our internal knowledge of the system is an asset, not a liability. If we didn’t place our clients first, just how long would stay in business?
We finally ended the conversation on a positive note and a commitment to consider professional agents the premier health care advocate for the consumer…for all the right reasons.
This story is but one of a large number of articles coming out in the face of ever growing interest in health care reform and a good example of the great need for us to tell our story every chance we get. I am not confident that we can rely on the press to tell it fairly. In fact, I think it would be a safe bet that they will not. In the absence of their support, the job falls back to us.
This is why we must develop our Public Affairs Teams in every chapter across the state. We must have members who are committed to go out and tell our story in our communities. What we do and the important role we play as consumer advocates is a message that we must deliver and do it now. If agents continue to wait for someone else to do it, soon there will be no story to tell.
I was very pleased to see over the course of the last week evidence of the work that our National Association has done in making sure we have a place at the table in the looming health care reform debate. In many stories last week regarding the passage of the renewal of SCHIP funding in the US House of Representatives, the National Association of Health Underwriters was mentioned as one of the key players in the debate along with America’s Health Insurance Plans and the Blue Cross Blue Shield Association. A big part of what makes this possible is member support of HUPAC. In 2008, HUPAC was listed as the fourth largest player amongst professional agents and broker PACs by contributing $392,250 to federal issues and offices.
We’re number 4! We’re number 4! Somehow, that just doesn’t sound like something to be all that proud of.
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