Friday, 01/14/22
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Walt Podgurski, Editor
Walt@DailyInsuranceReport.com
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Healthcare sharing ministry 'sham' faces suit for allegedly defrauding consumers in California
Samantha Liss, Senior Reporter / Healthcare Dive / / Read Article

Dive Brief:

An Atlanta-based company claiming to be a healthcare sharing ministry is now facing a lawsuit from California's attorney general for allegedly committing fraud. California is now the 14th state to bring action against Aliera Companies, AG Rob Bonta said Wednesday in a statement that slammed the business as a "sham."

Aliera allegedly scammed thousands of consumers in California by collecting hundreds of millions of dollars in monthly payments but denying coverage of medical costs. Instead, the owners "funneled the majority of members' monthly payments into their own pockets," according to the the complaint.



COMPLAINT - PEOPLE V. THE ALIERA COMPANIES, INC. ET AL
California Department Of Insurance / / Read Article

1. Defendant, The Aliera Companies, Inc. f/k/a Aliera Healthcare, Inc., directly and through its wholly owned subsidiaries (collectively “Aliera”), 1 created, operated, and sold unauthorized health plans and insurance to thousands of Californians and others nationwide. Aliera collected hundreds of millions of dollars in monthly premiums. Yet, when members suffered medical emergencies and incurred substantial debts, Aliera claimed it had no obligation to pay for any member’s medical costs, even those costs that state and federal law require health plans and insurance to cover. Instead, defendants Shelley Steele, Tim Moses, and Chase Moses (collectively the “Moses family”)—owners and officers of Aliera—funneled the majority of members’ monthly payments into their own pockets. This has left many Californians trapped under crippling amounts of medical debt.

2. Aliera created and marketed its health insurance products as “health care sharing ministry” (HCSM) plans. HCSMs are nonprofit corporations historically comprised of members of a particular religious community, who contribute money to a shared pool with the understanding that the money would pay for catastrophic or surprise healthcare costs pursuant to the members’ shared religious tenets.
Read all 34-Pages



Supreme Court blocks Biden Covid vaccine mandate for businesses, allows health-care worker rule
Kevin Breuninger / CNBC / / Read Article

The Supreme Court on Thursday blocked the Biden administration from enforcing its sweeping vaccine-or-test requirements for large private companies, but allowed a vaccine mandate to stand for medical facilities that take Medicare or Medicaid payments.

The rulings came three days after the Occupational Safety and Health Administration’s emergency measure for businesses started to take effect.

The mandate required that workers at businesses with 100 or more employees get vaccinated or submit a negative Covid test weekly to enter the workplace. It also required unvaccinated workers to wear masks indoors at work.

“Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly,” the court wrote in an unsigned opinion.



State Trends in Employer Premiums and Deductibles, 2010–2020
Employer health coverage fell only slightly during the pandemic, but U.S. median family incomes are not keeping pace with rising health plan costs and deductibles
Sara R. Collins, David C. Radley, Jesse C. Baumgartner / The Commonwealth Fund / / Read Article

More than a decade after passage of the Affordable Care Act (ACA), employer health insurance coverage remains the backbone of health insurance in the United States, covering more than half of Americans under age 65 — about 163 million people.1 This coverage has proved to be resilient in the COVID-19 pandemic.

Highlights

Premium contributions and deductibles in employer health plans accounted for 11.6 percent of median household income in 2020, up from 9.1 percent a decade earlier.

In 37 states, premium contributions and deductibles amounted to 10 percent or more of median income in 2020, up from 10 states in 2010.

Middle-income workers in Mississippi and New Mexico faced the highest potential costs relative to income, 19 percent and 18 percent, respectively.

The total cost of premiums plus potential spending on deductibles ranged from a low of $6,528 in Hawaii to a high of more than $9,000 in Florida, Kansas, Missouri, South Dakota, and Texas.



Changes coming to your ERISA employee benefit plan audit
By Jenna Hamilton / The patriot Ledger / / Read Article

The upshot is that SAS 136 significantly changes the way auditors are required to audit and report on employee benefit plans subject to the Employee Retirement Income Security Act (ERISA). It is intended to enhance the quality of audits, clarify reporting requirements, and increase the transparency of the auditor’s report.

SAS 136 also addresses management’s responsibilities. In preparation for your plan audit — even before an auditor accepts the engagement —understand your responsibility for:

1. Maintaining a current plan instrument, including all plan amendments

2. Administering and determining if plan transactions presented and disclosed in the plan’s financial statements are in conformity with plan provisions

3. Maintaining sufficient records on each participant to determine benefits currently due or that may become due

4. Providing your auditor with a substantially completed draft Form 5500, including forms and schedules that could have a material effect on the plan, qualitative and quantitative considerations on the information in the financial statements, and ERISA-required supplemental schedule, prior to the dating of the auditor’s report



The Pandemic’s “Great Resignation” Indicates Employee Feedback Is More Important Than Ever for Benefits Decision-Making
BUSINESS WIRE / / Read Article

Three out of four companies base employee benefits decisions on employee feedback, up 33% since 2019, an Artemis Health survey shows. It’s a sign that listening to employees is the prevailing strategy for combating the Great Resignation—but some employers lack the tools to use this data successfully.

Other key findings from the survey include the following:

Quality is king: 78% of organizations are more focused on quality of healthcare over cost management. Despite the cost of individual employee benefits reaching an average of $7,739, benefits leaders are focused primarily on healthcare quality as opposed to healthcare costs in designing benefits packages.

The most challenging parts of the “benefits lifecycle” are choosing and measuring point solutions. When asked to rank the challenges they face in finding and administering new benefit programs, 69% say identifying new programs is among their top 3 biggest challenges, followed by measuring and managing new programs (67%). With the rising demand for condition-specific point solutions, including mental health, new expectations around digital care, and the need for competitive benefits, leading organizations rely on partnerships with brokers, consultants, and benefits analytics solutions to find and implement point solutions that will deliver value.

The C-Suite doesn’t know how hard benefits management is. ompanies that self-identified as “falling behind their peers” in benefits design were more likely to cite lack of C-suite support for benefits data solutions.

For more information, read the full report.
https://www.artemishealth.com/success/great-resignation-effective-employee-benefit-programs



Medicare plans to pay for controversial Alzheimer’s drug, from Biogen
NBC NEWS / / Read Article

Medicare plans to provide insurance coverage for Aduhelm, a contentious Alzheimer’s treatment from the drugmaker Biogen, the Centers for Medicare & Medicaid Services announced Tuesday.

The drug, which is intended for Alzheimer’s patients in the early stages of the disease, will be limited to Medicare recipients who are willing to enroll in qualifying clinical trials, the CMS said.

The drug is the first treatment approved in the U.S. to slow cognitive decline in people living with Alzheimer’s, but some doctors have refused to prescribe it because of mixed data supporting Biogen’s application to the Food and Drug Administration. The FDA approved the drug last June under an accelerated pathway, but asked the company to continue to study it to confirm its benefits or risk withdrawal of the therapy.



3 Ways the Pandemic Reformed Employee Benefits
Megan Holstein, SVP Absence And Claims, FINEOS / TOOLBOX HR / / Read Article

The COVID-19 pandemic changed the way employees think about compensation and benefits. In this article, Megan Holstein, Esq., SVP absence and claims product, FINEOS, discusses how the pandemic has changed the employee benefits industry and what employers can do to stay competitive.

The COVID-19 pandemic dramatically changed the world of work, including expectations around employee benefits. As a result, the employee benefits industry is experiencing a pivotal moment. Employers and insurance carriers must take steps to transform and stay competitive in this new world of workplace benefits. Let us explore three ways the pandemic changed the employee benefits industry.

1. How We Work: The Benefits of Remote, Hybrid, and Flexible Work Have Become the Norm The COVID-19 pandemic disrupted global labor markets, including millions furloughed, terminated or retiring early and unexpectedly. Millions of others were forced to work from home and are not returning to a workplace in a pre-pandemic state.

2. Focus on Financial Ability To Take Time Off of Work Workers’ expectations of employment benefits are changing, and they are looking for employers to rectify what one author has deemed “…a childcare shortage, a paid sick leave shortage, and a healthcare shortage.”

3. Tailored Benefits To Fit Today’s Workforce



CREATING TEAM SUCCESS WITH EUGENE STARKS
In Rockstars Rocking Podcast by Ryan Miller / / Read Article

This episode of the #RockstarsRocking podcast features my rockstar benefits friend, Eugene Starks, President of the National Association of Health Underwriters (NAHU) and Principal of Acuity Group, out of the Jackson, Mississippi area.

Episode Highlights:

The definition teamwork
Handling the ego-driven person who isn’t being a ‘team player’
Building relationships that go beyond the transactional level
His focus on fitness and healthy living
Balancing his focus on his health with the demands of family and business
Resilience and finding the willpower to fight through setbacks
Working through NAHU leadership progression to create multi-year/term goals
Making NAHU a preeminent organization for thoughtful health leadership



Businessolver Announces Product Innovations Designed to Elevate Benefits Strategy and Support Employee Engagement
Businessolver / PRNewswire / / Read Article

Businessolver®, a leader in SaaS-based benefits technology and services, today announced its most recent product innovations, specifically designed to help employers reduce overall claims costs, monitor workforce safety regarding COVID-19, streamline retiree benefits administration, and leverage financial wellness programs to retain and recruit talent.

Personalized Navigation connects employees with their benefits when they need health care services, such as booking an appointment, processing a claim, or managing a chronic condition. Activation Paths further engage employees via personalized alerts and nudges to activate non-electable benefits, including telemedicine, cost-transparency tools, and employee assistance plans. Early client adopters with the Care Navigation tool are already seeing a +30% increase in employee engagement; 2022 will see continued growth for Businessolver's Personalized Navigation suite, including its Claims-Based Personalization tool that provides member-specific communications based on health care cues.



Acorn Finance Raises $8.4M in Series A Funding Led by MassMutual Ventures
Investment will accelerate enhancements of embedded lending marketplace, double Acorn Finance team, improve customer experience
Acorn Finance / PRNewswire / / Read Article

Acorn Finance, the world's first embedded lending marketplace for home improvement financing, has raised $8.4 million in Series A funding led by MassMutual Ventures. Moderne Ventures and previous investors Vestigo Ventures, Accomplice and MetaProp also participated in the round. A prior $4 million in seed financing brings the company's total funding to $12.4 million.




 





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Archives
Monday, 01/10/22 - Mental Health, Digital Solutions Top List of Employee Wellness Trends for 2022, According to Wellable Labs Report

Tuesday, 01/11/22 - 'Huge, huge numbers:' insurance group sees death rates up 40 percent over pre-pandemic levels

Wednesday, 01/12/22 - Biden Requires Insurance Companies To Cover Free At-Home Covid Tests Starting This Weekend

Thursday, 01/13/22 - Washington State’s Celebrated Long Term Care Program Is Headed Towards Trouble

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Editorial Mission Statement: The goal of this publication is to provide readers a broad selection of what is being written about the insurance industry and related issues. Some articles may have a “tilt” towards a particular perspective one way or another. Inclusion in this newsletter is not an endorsement of any views or content; but report the various and differing views appearing in media.