Daily Insurance Report
Thursday 04/22/21 Walt Podgurski 440-773-1108 E-Mail
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Google launches new certification for U.S. health insurance advertisers
Sara Fischer / AXIOS / / Read Article

Google is launching a new certification program for health insurance advertisers in the U.S. that will only allow government exchanges, first-party providers and licensed third-party brokers to run ads across its platform.

Why it matters: The policy is meant to curb any misinformation, confusion and fraud around health care being provided to consumers via ads.

Details: In order for an advertiser to be certified to run ads, it will need to provide documentation showing it is permitted under state law to sell health insurance, per the new policy.

"This includes plans for individual health insurance coverage, short-term coverage and Medicare, among others," Google says in a blog post.
"Additionally, for private-sector providers promoting Affordable Care Act-compliant health plans, we will also require proof they are registered with the U.S. government to do so."

Blue Cross Blue Shield Antitrust Litigation - Further Settlement Details Given
Marsh & McLennan Agency / / Read Article

In late 2020, Blue Cross Blue Shield Association (BCBS) reached a settlement in an antitrust case
totaling $2.67 billion. A nationwide class of subscriber members initiated the lawsuit in 2012, alleging
that BCBS’ use of trademarks unlawfully hindered competition and increased the cost of healthcare
coverage for its members.

$1.9 billion of this settlement is expected to go to employer groups and members, with the rest covering
legal and administrative costs.

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UVA Health Will Wipe Out Tens of Thousands of Lawsuits Against Patients
By Jay Hancock / KHN / Washington Post / / Read Article

KHN reported in 2019 that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. (JULIA RENDLEMAN FOR KHN)
University of Virginia Health System, which for years has sued thousands of patients annually for unpaid bills, said Monday it will cancel a massive backlog of court judgments and liens resulting from those lawsuits dating to the 1990s.

Combined with reforms UVA announced in 2019, the move is likely to benefit tens of thousands of families and make UVA Health’s collections policies much more generous than those of many hospital systems, said scholars who study health care finance. The decision to wipe out liens that can drain home equity years after a hospital visit is extremely rare, they said.

UVA had been suing patients for decades, many with unpaid bills in the tens or hundreds of thousands of dollars, KHN reported in 2019. Once the health system won cases in court, it could seize wages and the value of patient homes when they were sold. UVA limited its collections lawsuits after KHN’s investigation.

Stanford Health Care sues Anthem, alleges breach of implied contract
Morgan Haefner / BECKER'S PAYER ISSUES / / Read Article

Stanford (Calif.) Health Care filed a lawsuit against Anthem, claiming its subsidiary Blue Cross Blue Shield of Indiana didn't pay the proper amount for services given to patients.

The lawsuit, filed April 16 in the U.S. District Court for Northern California, accuses BCBS of Indiana of only paying $78,771 of more than $2 million in charges for medically necessary care.

Feds rescind health care funding agreement that would have paid for care for uninsured, poor Texans after 2022
The Washington Post, citing two federal health officials, said the decision was a bid to push Texas toward expanding Medicaid.

The Biden Administration rescinded what's called a 1115 waiver that would have extended for 10 years Texas’ health care safety net for uninsured residents. The existing waiver expires next year. Credit: Michael Stravato for The Texas Tribune
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The Biden administration on Friday rescinded changes to a federal funding agreement, known as a 1115 waiver, that would have extended for 10 years Texas’ health care safety net for uninsured residents — teeing up a new round of negotiations before the existing waiver expires in 2022.

The Centers for Medicare and Medicaid Services said in a statement that it erred in exempting the state from the normal public notice process before granting an extension to the waiver in the waning days of the Trump administration.

The agency "has rescinded the extension approval, which corrects this oversight with as little impact as possible to the people of Texas, since the original demonstration remains intact through September 30, 2022," it said in a statement.

bUILT iN CHICAGO / / Read Article

How can companies make benefits packages work for every employee, regardless of location?

Recently, Affirm tackled its biggest benefits challenge yet: The company announced it has shifted to a remote-first model of work. A majority of employees will have the ability to choose if they want to work in-person or continue working remotely. But how can one company’s benefits package support in-person and remote employees living all over the United States and Canada?

The answer, says Cazares and her coworkers Ni Adesokan and Mahendra Maheshwara, lies in the simplicity of the plans. Created from employee feedback, Affirm has built a flexible, easy-to-use support system that allows its team to excel professionally and personally.

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.
* Help from the privacy of home,
* No work missed,  
* Recovery - 80% abstinet at 16 months.

Paterson police and firefighters lose health insurance ruling
Joe Malinconico / Paterson Press / / Read Article

A state appellate court on Monday gave Mayor Andre Sayegh’s administration a legal victory in a multimillion-dollar battle over the medical benefits the city provides its police officers and firefighters.

The decision will affect the health care for more than 1,000 municipal public safety workers and retirees.

At issue was the Sayegh administration’s 2018 decision to switch all municipal workers from a costly self-insurance program for employee health coverage to the state benefits plan, a move city officials said saved about $20 million per year.

Monday’s appeals court decision negated previous rulings by a state arbitrator and lower courts. The lower courts had said the city had to resume the self-insurance system because Paterson violated its police and fire employment contracts by making the change without union consent. The unions had argued that state plan was not as good as the benefits called for in their contract.

How Deep is the 401k PEP Pool?
Pooled Employer Plans are here, and some 401(k) recordkeepers are jumping right in, believing they can be a true gamechanger. But is the Pooled Plan Provider route right for RIAs?
by Brian Anderson / 401k Specialist / / Read Article

Will a brand-new type of retirement plan, the Pooled Employer Plan (PEP), made possible by the SECURE Act, bring similar frustration to 401(k)-focused advisors by also having to be sold, not bought?

Maybe …particularly when pitching them to smaller employers or those without an existing retirement plan.

A 2020 Cerulli Associates report found at least one quarter of 401(k) plan sponsors are at least somewhat interested in joining a PEP, but more than one-third (36%) of small 401(k) plan sponsors (with less than $5 million in plan assets) expressed “no opinion” on the topic.

“This may be the sign of a knowledge gap related to PEPs in the lower end of the market,” said Shawn O’Brien, a senior analyst with Cerulli. “When addressing smaller employers, more educational discussions related to the costs and benefits of PEPs may be in order.”

U.S. Insurtech Zywave Acquires Risk Management Solutions Provider Enquiron
Samantha Hurst / CROWDFUND INSIDER / / Read Article

U.S. insurtech Zywave recently announced it has acquired Enquiron, a provider of risk management and consultative business solutions. Zywave reported that with the combination of its existing portfolio of solutions, the acquisition reinforces its “leadership” position in these markets.

Founded in 1996, Enquiron notably serves more than 100 of the top P&C, healthcare and HCM organizations in the U.S.

“Enquiron has revolutionized the way risk management services are delivered to and utilized by employer customers of the property and casualty insurance, healthcare and human capital management markets. For nearly 25 years, the company has delivered industry-leading solutions to the P&C insurance carrier marketplace.”

Enquiron also provides on-demand risk management solutions in the areas of human resources, healthcare, retirement, cyber and more.

Gradient AI Secures $20 Million in Series B Financing
BUSINESS WIRE / The Argus-Press / / Read Article

Gradient AI, the leading enterprise software provider of artificial intelligence solutions in the insurance technology space, announced today that it has raised $20.0 million in a Series B financing led by American Family Ventures with participation from principals from Stone Point Capital, and BSC Capital as well as existing investors MassMutual Ventures, Sandbox Insurtech Ventures and Forte Ventures.

Gradient’s artificial intelligence solutions help commercial insurers automate and improve underwriting results, reduce claim costs, and improve operational efficiencies. The Gradient software-as-a-service (SaaS) platform boasts a proprietary dataset comprised of tens of millions of claims, which is complemented with several economic, health, and litigation datasets. This robust aggregation of data provides out-of-the-box claims and underwriting precision for new clients, and it is continuously refined with client-specific data over time.

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, 04-21-21 - - Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds - KHN / NPR

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.