Daily Insurance Report
Wednesday 04/21/21 Walt Podgurski 440-773-1108 E-Mail
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Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds - KHN / NPR
By Fred Schulte / KHN / NPR / / Read Article

A Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were, according to a new federal audit, which seeks to claw back the money.

The Health and Human Services Office of Inspector General’s recommendation to repay, if finalized, would be “by far the largest” audit penalty ever imposed on a Medicare Advantage company, said Christopher Bresette, an HHS assistant regional inspector general.

“This [money] needs to come back to the federal government,” he said in an interview.

Humana sharply disputed the findings of the audit, which was set for public release Tuesday. A spokesperson for the company said Humana will work with Medicare officials “to resolve this review,” and noted the recommendations “do not represent final determinations, and Humana will have the right to appeal.”

This Job Could Save America
Dave Chase – Author, Relocalizing Health / LinkedIn / / Read Article

There is one job that plays a central role to fixing the healthcare mess: the benefits consultant. No one has a bigger influence over health purchasing than benefits advisors. We’ve been fortunate to work with the most forward-looking benefits advisors in the country. What's more, the greatest percentage of healthcare purchasing is done by the private sector.

In this article, I refer to my book, The CEO’s Guide to Restoring the American Dream. You can get it on Amazon or download it for free here.

Benefits consultants only need to look at real-life examples like Enovation Controls (see case study in the book) who found solutions that resulted in huge savings to the company and employees. While most employers and employees have seen their costs massively spike, Enovation Controls employees have had their benefits costs stay flat over the last 10 years. The company absorbed some cost increases but those were managed as well. Enovation Controls spends 30% less per capita on healthcare than comparable companies.

SIIA advocates balanced IRS approach to captives following the latest warning
Captive Insurance Times / / Read Article

The Self-Insurance Institute of America (SIIA) says that while the Internal Revenue Service (IRS) continues activities related to captive insurance, it must also move towards recognising what an appropriate structure is, and issue appropriate guidelines to that purpose.

Earlier this month, the IRS urged participants in ‘abusive micro captive insurance arrangements’ to exit these transactions as soon as possible.

SIIA explains that it continues to be supportive of curbing abusive practices within the industry and urges participants within potentially abusive transactions to heed the IRS’ advice.

However, at the same time, it notes that a vast majority of captive participants are utilising the structure to protect themselves against appropriate risks, as the tax code intended.

Among these captive participants are American small- and medium-sized businesses that are utilising Internal Revenue Code 831(b) to mitigate risks associated with COVID-19, from business interruption, to loss of customers and supply chain interruption.

Uninsured or underinsured? Stimulus funding has boosted affordability of Affordable Care Act
93,000 people in Jacksonville alone have no health-care insurance
Beth Reese Cravey / Florida Times-Union / / Read Article

The expanded federal assistance not only brought health care within reach for uninsured people with low incomes, but can reduce the monthly premiums of existing users or allow them to upgrade coverage for no additional cost. Also, the stimulus plan mandated that no one will pay more than 8.5 percent of their income on insurance premiums.

According to Florida Blue:

• Most of the area's 136,000 uninsured qualify for a zero or low-cost plan.

• About 90 percent of people who get a subsidy will now have lower premium payments for their current plan or will be able to upgrade to a plan that offers better out-of-pocket costs.

• For three out of four people in the United States, federal assistance will bring the monthly cost of a 2021 Affordable Care Act plan to $10 per month.

• Many premiums will decrease on average by $50 per person per month and $85 per policy per month.

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Keys to unlocking employee financial well-being
By David Kilby / / Read Article

Employees wanted and needed to save. In the New York Fed’s Survey of Consumer Expectations report conducted this past June, 35% of households used their federal stimulus payment to pay off debt, and 36% saved the payment. In August, a follow-up survey asked what consumers would do if they received a second stimulus payment, and 45% of respondents said they would save it.

Despite the vaccine rollout, remote work remains the norm. Virtual roll-out of benefits can be a big challenge for employers that previously had most employees onsite. Many employers have adjusted their benefit plans to better support their remote workforce. With unforeseen hardships brought on by the pandemic, many employees are facing new challenges that require the support of different benefit programs. Financial wellness is one such benefit.

Carriers Pulse Independent Agents on Long-Term Pandemic Impact
channel harvest research / / Read Article

If 2020 was no picnic for independent insurance agents and brokers, 2021 is a big question mark. Agents across the nation need the partnership and support of their carrier partners more than ever.

That’s why Channel Harvest Research has launched its annual quantitative survey to learn how thousands of agents across the U.S. are adapting to the new realities of customer and carrier engagement in the post-pandemic world.

“Issues like adoption of digital marketing and servicing, distributed workforce and customer touch have eclipsed underwriting appetite and claims service,” says Kevin Jenné, Channel Harvest research director. “We had extensive discussions with our carrier partners on evolving dynamics in the independent agency channel and how they can best help their agents. They’re eagerly awaiting the results of the research.”

This is the 14th annual survey by Channel Harvest, which counts Allstate, Foremost, The Hartford, Liberty Mutual and Safeco among its carrier partners. The survey was launched recently and will remain online until the end of March. Independent agents are encouraged to take the survey if they haven’t done so already.

Any business can have a substance abuse issue.
Lionrock is the only telehealth provider that works directly with employers, as well as their benefit brokers, to offer the robust level of care specifically required to effectively treat SUDs, formerly known as addiction.
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Integrity Continues to Innovate Insurance with Acquisition of Data Analytics Company Deft Research
PRNewswire / / Read Article

Integrity Marketing Group, LLC ("Integrity"), the nation's largest independent distributor of life and health insurance products, announced today its acquisition of Deft Research, LLC ("Deft Research"), the healthcare industry's leading source for consumer and market data. As part of the acquisition, Deft Research Co-Founders Randy Herman, Dan Freier and Rich Hamer, along with Executive Vice President George Dippel and Senior Vice President Tim Brousseau, will become Managing Partners in Integrity. All of Deft Research's employees will continue in their current positions. Financial terms of the transaction were not disclosed.

Over the last 15 years, Deft Research has developed a full suite of market research services that offer invaluable insights into the senior and commercial market as well as overall healthcare industry trends. Initially founded to better understand seniors transitioning to Medicare, Deft Research now helps all health insurance stakeholders make confident, educated decisions, create new product offerings and set higher standards of care. Deft Research gives a voice to the consumer in ways that were previously unheard of in the health insurance industry.

Insurance Technologies Acquires IXN
BUSINESS WIRE / The Argus-Press / / Read Article

Insurance Technologies, LLC, a leading provider of sales automation solutions for the life and annuities insurance industries, announces the acquisition of IXN, the leading provider of digital data exchange solutions for the life insurance industry. The combined company will fully integrate both companies’ proven systems to offer the most comprehensive and efficient single platform capabilities and experience for sales automation in the life and annuities insurance industries.

The insurance industry is in the midst of a major digital transformation, demanding more and more from market participants to create specialized software to modernize the overall sales and operations process. To operate in today’s competitive distribution world, advisors, agents, distributor firms, and carriers need a modern, simple, cohesive, one-stop digital shop to manage all aspects of the sales process.

Insurance Technologies identified IXN as a dynamic disrupter in the life insurance ecosystem, as proven by their widely adopted cross-platform digital solutions and recent launch of the LifeDX solution, an open API data exchange solution. IXN pioneered the concept of “putting an Agents’ business in their pocket” by launching and becoming the industry leader for mobile applications within the life insurance space. IXN also developed a multi-carrier sales automation solution that is becoming the platform of choice for life insurance distributors and carriers.

Pineywoods Benefits Expands With First Strategic Partnership
PRNewswire / / Read Article

Tampa-based Pineywoods Benefits (PWB) announced today its purchase of the employee benefits division of Blu Sky Benefits, an employee benefits and 401(k) advising firm located in Tampa.

Pineywoods Benefits invests in technology and creative communications solutions for increased client education, convenience and efficiency. Online enrollment platforms and benefits communications aimed at education are created, distributed and maintained in "digital formats." Rather than relying on traditional paper processing, multimedia microsites enable online enrollments, interactive video guides, voiceover enrollment meetings, text enrollments, and password-protected portals for other digital resources.

Wills.com Launches Online Estate Planning Platform
BUSINESS WIRE / / Read Article

Wills.com today announced the launch of its online estate planning platform dedicated to providing secure, affordable, fast, and easy-to-complete wills. Wills.com provides peace of mind that final wishes are honored, and survivors’ interests and important estate planning documents are secure and protected.

“When my dad passed away he did not leave us a will or instructions of any kind. The complications due to this proved to be a tremendously emotional and financial rollercoaster for our family for many years”

More than half of the U.S. population do not have a valid estate plan, according to Caring.com’s 2021 wills and estate planning study. This can be because they don’t like to think about their own mortality, feel they don’t have the financial resources or believe that they don’t own assets worthy of proper planning and thus do not pursue creating a will.

Intelliversity Announces the Jericho Center of Medical Diplomacy to Screen and Treat Breast Cancer in the Middle East
Robert Steven Kramarz / LinkedIn / / Read Article

Intelliversity, a Delaware non-profit business training and consulting corporation, announces that the Jericho Center of Medical Diplomacy will focus Phase 1 operations on screening and treating breast cancer in the Arabic-speaking Middle East. To this end, the Intelliversity team is planning to construct a unique medical tourism center in the biblical town of Jericho, on the West Bank of the Jordan River, an area currently administered by the Palestinian National Authority.

This center, to be called the Jericho Center for Medical Diplomacy, will provide breast cancer screening and treatment both for the local Palestinian population (residents of the West Bank and Gaza), as well as the rest of the Arabic-speaking Middle East. This includes nearby Jordan, Lebanon, and Syria, and the affluent Gulf States, including Saudi Arabia, the United Arab Emirates, Iraq, Kuwait, Bahrain, Qatar, and Oman.

Photo Of The Day

Monday, 04/19/21 - - Report to Congress - Annual Report on Self-Insured Group Health Plans

Tuesday, 04/20/21 - -
Reimagining the Future Of Insuretech In 2021

Wednesday, 04-14-21 - - Health care for $1 a month? Covered California touts massive subsidies from COVID relief

Thursday, 04-15-21 - - 
98% of leaders plan to change employee benefits post-pandemic: 5 details

Friday, 04-16-21 - -
WEX agrees to acquire Illinois benefits administration company for $275M

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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.