2013 HSA Limits Announced

HSA Contribution Limit:
     Indvidual coverage: $3,250
     Family coverage:  $6,450

HDHP Minimum deductible:
     $1,250 Individual coverage
     $2,500 Family coverage

Out-of-Pocket Maximum Expense:
     $6,250 Individual coverage
     $12,500 Family coverage

Remember as of 2011 over-the-counter drugs may only be reimbursed if they have a prescription.

If a policyholder uses an HSA to pay for items or services that aren't qualified medical expenses, the tax penalty is 20% of the HSA distribution.

What to ask your doctor

Here are some important questions you should ask your doctor when you go for a visit:

•  Do I need to come back for another visit?
•  Can I call for any test results?
•  What else do I need to know or do?
•  Is this a preventive or a diagnostic care visit?
•  What should I do to prevent or delay health problems?
•  Are there any changes I should make to improve my health?
•  Are there any tests or screenings I should have, based on my age or other risk factors?
•  Am I due for any shots?

After you’ve talked with your doctor, there are three questions you should be able to answer for yourself:

   1. What is my main problem?
   2. What do I need to do?
   3. Why is it important that I do this?
If you can answer those three questions, you’ll know you got the information you need to get or stay healthy.

National Patient Safety Foundation, Ask Me 3.(Accessed January 2011): npsf.org
Anthem publication MANSH3911ABS Rev. 1/11 F007545

What’s preventive care and diagnostic care?

Did you know that there are tests that can help you stay healthy, catch any problems early on and could save your life? These tests are called preventive care because they can help prevent some health problems. They’re different from diagnostic tests, which help diagnose a health problem. Diagnostic tests are given when someone has symptoms of a health problem and the doctor wants to find out why.


It’s important to know the difference between preventive tests and diagnostic tests. For example, if your doctor wants you to get a colonoscopy (a test that checks your colon) because of your age or because your family has a history of colon problems, that’s called preventive care. But, if your doctor wants you to get a colonoscopy because you’re having symptoms of a problem, like pain, that’s called diagnostic care.

Preventive care is paid for by most medical benefit plans, but you’ll have to pay part of the cost of diagnostic care, depending on your specific plan.

Not all preventive care is recommended for everyone, so talk to your doctor about what you need.

Anthem: MANSH3911ABS Rev. 1/11 F007545

State Prohibition on Funding Non-therapeutic Abortions Expanded to Certain Political Subdivisions

The recently signed Ohio Budget Bill prohibits the use of state or political subdivision funds from directly or indirectly paying costs related to or coverage of non-therapeutic abortions. The law defines a non-therapeutic abortion as an abortion "performed or induced when the life of the mother would not be endangered if the fetus were carried to term or when the pregnancy of the mother was not the result of rape or incest reported to a law enforcement agency". 
To comply with this law, coverage of non-therapeutic abortions for impacted groups will be discontinued as of the stated effective date, September 28, 2011.  We will be notifying impacted groups of these changes by letter in the next few weeks. 
Impacted Groups
The following political subdivisions must discontinue coverage of non-therapeutic abortions:

• Townships
• Counties *
• School districts
• All other bodies corporate and politic responsible for governmental activities in a geographic area smaller than the state

(applies to all group sizes and fully insured and self funded)
*Excepted from the law are municipal corporations (e.g., cities and villages) and counties that have adopted a constitutional charter exercising the powers of self-government.


From "Anthem Broker News Flash" 10/21/2011

What is everyone talking about!?? HSA's and QHDHP

I talk to people everyday about Health Savings Accounts (HSA) and most of them just don’t understand HSA’s.   Let’s face it, the government regulates these things so it’s got to be confusing – when was the last time they made something simple?

They have been around since 2003 and they are finally gaining popularity.   So, here is my effort at trying to explain them!

There are 2 parts to an HSA: Part 1, you have a Qualified High Deductible Health Plan (QHDHP) through an insurance company.   This is your health insurance.   The QHDHP legally allows you to have part 2, a special bank account called a Health Savings Account (HSA) that allows you to pay for healthcare expenses tax free.  To help confuse you, people use the term HSA to refer to both the QHDHP and the actual HSA.

Part 1

What is a QHDHP?  Well it changes every year but, for 2010:

•    Minimum $1200 single or $2400 family deductible

•    No first dollar copays – except for preventive care on some plans

•    Must be filed with the state as a QHDHP

Part 2 – The cool part

What is an HSA?

This is an actual bank account.  It can be at any bank that offers HSA’s (almost every bank now).  This account is usually free of charge (If it’s not, you may want to try a different bank) and earns interest.   

The money you put in this account is tax free and can be used for any “qualifying medical expense.”   This means that the expense has to fall within certain IRS guidelines, which is probably more than you would expect!  For example:

•    All the normal stuff – Doctor & Hospital expenses, prescriptions

•    Over the counter drugs – cold medicine, aspirin etc

•    Vision exams, contacts, glasses

•    Dental expenses

Ok, so now let's see how this would work if you had some medical expenses.  Let's say you have an insurance plan that has a $2000 deductible and 100% coinsurance.  (Plan pays 100% after you meet the deductible.)  

Claim#1

Claim #2

That's enough for one day.  I'll get into why you might want one of these plans and how much they cost next time.   In the meantime if you have any questions please let me know!

COBRA - What It Is & How Long It Lasts

Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986. The law helps provide continuation of group health coverage that otherwise might be terminated.  The key to this is that the employer must have a minimum of 20 employees.

How long you can continue your health benefits with COBRA depends on why you are eligible.  Most people qualify of 18 months of extended coverage but it is possible to qualify for 36.

18 Month Qualifying Events:       

•   Voluntary termination
•   Involuntary termination (Gross misconduct exception)
•   Reduction of hours

36 Month Qualifying Events:          

•   Death of an employee (Spouse & Dependents can stay on plan)
•   Employees medicare entitlement (Spouse & Dependents can stay on plan)
•   Divorce
•   Dependent child in no long a dependent

Coverage begins on the date that coverage would have been lost by reason of a qualifying event and will end at the end of the maximum period. It may end earlier if:

Premiums are not paid on a timely basis

The employer ceases to have a group health plan (this is happening More and more)

After the COBRA election, coverage is obtained with another employer group health plan.

After the COBRA election, a beneficiary becomes entitled to Medicare benefits. 

For additional information please visit: 

The Dept of Labor web site

Major Differences In House, Senate Healthcare Bills

(Reuters) - The healthcare legislation released by the U.S. Senate's Democratic leaders on Wednesday resembles a bill passed by the House of Representatives on November 7 in many ways but there are some major differences between the two.

The Senate has yet to begin debate on its bill, which is likely to change during the amendment process. Here is a summary of some of the major differences between the proposed Senate bill and the House-passed legislation.

PUBLIC OPTION

Both bills would establish a new government insurance program to compete with private companies on proposed new state insurance exchanges. Under the Senate bill, states would be allowed to opt out of offering the federal health plan.

INDIVIDUAL MANDATES

Both the Senate and the House require most individuals to obtain health insurance. But the penalties on those who fail to get coverage are different.

The House would impose a 2.5 percent penalty tax on income up to the average cost of an insurance policy.

The Senate would phase in a maximum $750-per-adult annual penalty. A slightly higher penalty would be imposed for failure to obtain coverage for children.

EMPLOYER MANDATES

The House bill requires employers with payrolls above $750,000 to provide health insurance to workers. Those who fail to do so face a penalty of 8 percent of payroll. Employers with payrolls between $500,000 and $750,000 pay fines on a sliding scale of 2 percent, 4 percent and 6 percent of payroll.

The Senate bill has no employer mandate. But firms with more than 50 workers would have to pay a fine of $750 annually per worker if any of their employees obtain federally subsidized coverage on the exchange.

ABORTION

Both the Senate and the House bills bar the use of federal funds to finance abortion. The House bill contains tougher language that would require anyone seeking coverage for elective abortions to purchase separate insurance riders.

FINANCING

The biggest difference between the two bills is in the area of financing.

The House bill would impose a 5.4 percent surtax on individuals earning more than $500,000 a year and couples making more than $1 million. It also raises money by imposing a 2.5 percent excise tax on medical devices, by ending some tax breaks for multinational companies and by closing a biofuels tax loophole for paper companies.

The Senate bill includes a 40 percent excise tax on high- cost health insurance plans.

It also raises payroll taxes for Medicare, the government health insurance plan for the elderly, to 1.95 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more.

The Senate bill includes special fees on insurers, drug companies and medical device makers and it imposes a 5 percent tax on elective cosmetic surgery.

(Reporting by Donna Smith; Editing by Peter Cooney)