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Over at Health Business Blog , proprietor David Williams has an interesting post about an insurer that � tells patients how much insurance will cover and how much is the patient's responsibility --right at the point of care. � Apparently, BX of South Carolina has started doing just that. Is this the wave of the future? Check it out .

There are days�Case in point: Bill and Loni are a nice older couple who�ve recently lost their jobs. Their old employer, XYZ Boxes, was sold to Acme Bags, which laid off most of XYZ�s workforce (gee, THAT hardly ever happens, hunh), including Bill and Loni. Their termination date was June 14, but the coverage was good through the end of the month. Since there were more than 20 employees working at XYZ, they were subject to COBRA. In any case, they were told that they needed to send XYZ a check for $870 to cover their July insurance premiums. They were given nothing in writing to indicate how that number was arrived at, nor how much of that was for Bill and how much for Loni. In fact, they had literally nothing in writing to indicate that the check would even be used to pay their insurance premium. Nevertheless, they knew that they needed the coverage, so they sent the check. I first came into the picture last week, when Loni called me for help and advice. Her sister is one of my client...

If you�re filed as an S-Corp, then you�ll want to check out Roth & Co�s new posts on IRS audits. Seems that the Infernal Revenooers have launched a new �Research Program� that could increase your chance of being audited. Read all about it here and here .

is up at Pharyngula . This is a great way to "sample" a lot of interesting medblogs. Recommended.

In the first part of this series we learned about what High Risk Health Pools (HRP) are, what they do, and a little about how they work. The Ohio Department of Insurance commissioned a study [ ed: your tax $ at work ] to determine how such a plan might work here in the Buckeye State. Conducted by Leif Associates , the study concluded (ALERT: Shocking Conclusions Follow]: An HRP is a �viable option� for Ohio residents who are uninsurable HRP�s charge high rates, � therefore a high-risk pool does not entirely solve the problem of affordability. � I suspect most people saw that one coming. According to the report, � many states have adopted discount programs to assist low-income participants .� Isn�t that just a fancy way of saying �raised taxes on everyone to help uninsurable folks buy insurance?� Will it work? That is to say, will it dramatically reduce the number of uninsureds? Well, according to the report, there are about 1.3 million Ohians currently without health insurance. Some...

As you may recall, a few weeks ago I wrote about a carrier�s decision to penalize its insureds who received emergency care from non-participating providers. My understanding was that this was a no-no, and I began a correspondence with the Ohio Department of Insurance about it. The carrier in question is Anthem Blue Cross/Blue Shield, and I�ve received this answer from the DOI, which says that Anthem�s position is �kosher:� � (A)n indemnity insurer licensed to do business under Title 39 of the Ohio Revised Code would not be prohibited under applicable Ohio law from implementing the practice described in Anthem's notification. � In short, plans such as this are not subject to the limitation on Out of Network (OON) penalties. Now comes word that Anthem won�t implement this change until the first of next year. They can�t resist the cheap shot, though: � (C)urrently there are only two hospitals that offer emergency services in Ohio, Kentucky and Indiana that are not contracted with An...

And no, that�s not redundant. Most agents, and most companies are not inherently evil, although a lot may be shortsighted. According to dictionary.com , despicable means: �worthy only of being despised and rejected.� And to which nasty practice do I refer? This one: " Dear terrorists, new firman issued. Kill 10, take a branded T-shirt and be best terrorist in the group. Jehad begins from July 18-20 � Osama bin Laden.�� It is creative minds at work at ICICI-Prudential Insurance Company, exhorting local agents to go for a �sales kill�. The new strategy was aptly named �MissionJehad�. In a meeting of the company�s agents on Tuesday night, employees were asked to adopt the �binLaden strategy�, ie, one terrorist killing 10 people. Here, though, jehad meant sale of insurance policies . As I said, this is absolutely the most disgusting insurance idea I have EVER seen. And in over 20 years in the biz, I've seen a few. Now, according to A M Best , the �Prudential� in this case is Prud...

UNION, JACK!

Some 30 states currently have High Risk Pools for those who are considered uninsurable for medical coverage. And so, you ask? Well, the Ohio Department of Insurance recently received a rather hefty grant to study whether or not such a plan should be implemented here. In this post, we�ll review how High Risk Pools work in other states, and in Part 2, we�ll look at the results of Ohio�s study. According to the National Association of Health Underwriters , High Risk Health Pools (HRP�s) � provide an important safety net for people with catastrophic medical conditions who do not have access to employer-based group health insurance, such as early retirees, self-employed individuals, and employees of businesses that do not offer health insurance coverage. In addition, in most states, high-risk pools serve as the guaranteed-issue purchasing option for individuals who wish to exercise their federal group-to-individual health insurance portability rights as provided by the federal Health Insura...

Grand Rounds is up over at AggravatedDocSurge . The Doc did a particularly good job with this weeks 'Rounds -- recommended.

Recently, I received this email from a colleague, whose nom-de-plume is smansfield. He�s graciously allowed me to share it with you: I love the concept of the HSA, but it appears that the QHDHP's [ ed: Qualified High Deductible Health Plan ] for both individual and group don't seem to offer any real savings. I can't help but think that these carriers have the pricing structure all wrong for these plans. I just met with a 13 person group. They have a plan with UHC that was/is a $1,500 deductible. The renewal came in June and they decided they were going to go with a higher deductible to save on premiums. The new plan they decided on with UHC was an HSA plan with a $2,850/$5,600 deductible (although they had no idea it was an HSA plan they switched to). The new premium, $7,200 per month. They actually thought they were getting a plan that paid 100% for doctor visits. I kindly explained to them that they had no benefits until the deductible was met. So they hurriedly switched...

Over at Health Business Blog , proprietor David Williams recently excoriated the Bush administration for it�s underwhelming commitment to VA funding. That was two weeks ago . Today, the Wall Street Journal had this to say : "Less than two weeks ago, the administration asked for an extra $975 million for this summer. Now the VA estimates it needs another $300 million prior to Sept. 30 and as much as $1.7 billion -- on top of the president's budget request -- for fiscal 2006." The VA system is one which doesn't get a lot of play in the blog world (well, at least in my little corner of it). David's post is important, in that it heightens our awareness of that system. Thanks, Dave!

In the first post of my recent HRA-HSA series, I stated that there were no hard numbers identifying just how many HSA plans had been sold to date. That statement was made based on an exhaustive search of relevant government sites, but I failed to take into account the resourcefulness of my own industry. To wit: America�s Health Insurance Plans (the carriers� association and lobbying group) has completed a survey of their membership, and found some surprising information. According to AHIP�s report , more than a million Americans are covered by HSA-eligible medical plans. This represents a more than two-fold increase over the number of such folks only 8 months previously. Even more remarkably, the study indicates that some 37% of those purchasing these plans were previously uninsured; that�s one good way to lower the overall number of uninsureds. And over a quarter of the group HSA plans were sold to employers who had not previously offered medical coverage. Another common misconcepti...

Well, that was certainly an interesting exercise: I�ve never done a 3-parter before. Any feedback is, of course, quite welcome. Given the lengths of the previous posts, I�ll try to be brief in summation. First, it seems to me that the most important lesson to take away from this whole �debate� is that one needs to ask questions. Lots and lots of questions. Ultimately, whether you�re an employer or an employee (or self-employed, in the case of HSA), you�re going to have to live with the decisions, and its consequences, for a while. Second, it�s critical that one avoid confusing the benefits and drawbacks of each program. The HSA certainly has an appeal to the employee, in that � by staying healthy, and exercising good judgment in health-care purchases � said employee stands to collect a nice windfall. On the other hand, an employee covered under an HRA can look forward to generally lower gross out-of-pocket expenses. From the employer standpoint, both programs seem pretty equally matche...

Grand Rounds is up at Shrinkette's site. Check it out.

[UPDATE: I've corrected some of the numerical assumptions in the HSA section] Okay, enough with the theory, let�s talk turkey. One of my small group clients asked me about changing their plan to an HSA. Let�s review some basic information of how this group�s plan currently works: A small professional practice, 8 people work at the XYZ Company. Their current plan is relatively rich, with $10 office visit co-payments and a modest $500 annual deductible per person for �the big stuff.� Once the deductible�s met in a given year, the plan pays 80% of the next $5,000 of covered expenses, leaving any one person with a maximum exposure of $1,500 in a year. There�s a family maximum of two on the deductible and co-insurance. This means that, even if all 4 members of a particular family have major claims in a year, the family�s only responsible for $3,000, not $6,000. There�s also a prescription drug card, with $10 co-pays for generics and $20 for brand names. All in all, a decent enough plan,...

UNION, JACK!

In Ohio, the law says that, in an emergency, one should go to the nearest facility, regardless of whether or not it�s in-network. In fact, the law says that one�s insurance carrier must cover the treatment in such a case as if it was in-network, even if it�s not. �Emergency� is defined under the �prudent layperson� rule: � a prudent layperson is someone with average knowledge of health and medicine .� In other words, even a rocket scientist could be a prudent layperson, as could I. The definition continues: � An emergency is a condition of such strong pain and severe symptoms that a prudent layperson could reasonably expect that a lack of immediate attention would - Place the person�s health in serious risk; - In the case of pregnancy, place the baby�s health in serious risk; - Cause serious damage to bodily functions; or - Cause serious damage to an organ or other body part ." In such a case, one�s � managed care plan [HMO, PPO, etc] must pay your medical bills for that emergenc...

So what, exactly, is an HRA? Well, it�s a tax-advantaged Health Reimbursement Arrangement that allows an employer to reimburse employees (and/or their dependents) for some of their medical expenses. In this regard, it�s similar to the Health Savings Account (HSA), because it means that the employer can help the employee by cushioning the blow on a major claim. And, the same kinds of expenses that are approved for reimbursement on an HSA plan are okay for HRA, as well. So what�s the difference? It really comes down to who contributes the money for reimbursement, and who ultimately owns that money. In an HSA, either the employer or the employee (or both) can contribute to the �rainy day� account, but � no matter what � the employee �owns� whatever money is in that account, and is free to spend it however he chooses (subject, of course, to potential wrist-slapping if the funds are misused). Whoever makes the contribution gets the tax deduction (again, could be both). The type of insuran...

Lest anyone fret, I'm taking some family time over the long weekend. InsureBlog will be back on Tuesday the 5th with a new installment on HSA's vs HRA's. Have a great 4th!