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COMPLIANCE SELLING POINTS

Focused on the end result, Alex Assaley puts 401(k) participants on the path to secure retirement

RETIREMENT PLAN ADVISER OF THE YEARO

ctober 2012 E

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enef it Adviser: RETIREM

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DVISER O

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How mountain climbing equates to bene!t brokering

Specialty drugs may negate generic drug savings

Hope remains for FSA !x; bene!ts communication pet peeves

Traditional health plan satisfaction falls, while high deductible plans gain favorability

What the best companies do best in bene!ts

“Blind squirrels” are vital to the growth of the DC market

Fixing health care with an IT mindset

Surviving the PPACA tsunami

Push employers’ fear buttons to sell and renew business

How to develop a business plan for success

The secret to more sales

Consultants, industry groups question transparency in PBM practices

Despite PPACA regulations, it’s no free ride on women’s preventive services

Combining voluntary and permanent life to help employees

Breaking the 401(k) process down for plan participants

ERISA 408(b)(2) fee disclosure may lead to less service, options

What holds producers back?

How the downside of technology affects your business

Using interactive applications to help plan participants

Scott Sherman goes from broker to San Diego City Hall representative

Ari Fischman balances client meetings, family, social media

Employee Bene!t Adviser (ISSN 1545-3839) Vol 10 No 10 is published monthly. $89.00 in US and $119 a year in all other countries by SourceMedia, Inc., One State Street Plaza, 27th Floor, New York, NY 10004, 212-803-8200. Change of Address: Notice should include both old and new address, including ZIP code. Postmaster: Please send all ad-dress changes to Employee Bene!t Adviser/P.O. Box 530 Congers, NY 10920. Periodicals postage paid at New York, NY, and additional mailing o!ces. © 2012 Employee Bene!t Adviser and SourceMedia, Inc. All rights reserved.

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Women’s preventive services may now be covered at 100%, but experts say it’s no free ride

lthough eight new prevention-related health care services for women included in the Patient Protection and A!ordable Care Act are now available at no cost

to female patients, insurance brokers and industry experts are left wondering about the real price tag.

Tanya Boyd, owner of Sunnyvale, Texas-based Tanya Boyd & Associates, believes the Department of Health and Human Services and the Obama admin-istration should not tout the word “free” when talking about health care coverage. “It is completely misleading,” she says.

Free is more of a fallacy and should be replaced with the more appropriate word “covered,” when talking about health care services covered for women, adds Reid Ras-mussen, owner of McKinney, Texas-based Bene"t Brainstorm. “While many call these

o!ering group or individual health insur-ance coverage must provide coverage for preventive care without any cost-sharing requirements such as co-payments, co-in-surance or deductibles, as long as services are administered by physicians and other health care professionals who participate in the plan’s network.

Group health plans and issuers that have maintained grandfathered status are not required to cover these preventive ser-vices. In addition, certain nonpro"t reli-gious organizations, such as churches and schools, are also not required to cover these services.

HHS and the Obama administra-tion feel con"dent about the services that are now being provided to women. “Presi-dent Obama is moving our country forward by giving women control over their health care,” says HHS Secretary Kathleen Sebe-lius. “#is law puts women and their doc-tors, not insurance companies or the gov-ernment, in charge of health care decisions.”

But Boyd claims that the services were already readily available to women who needed and wanted them. “Many women who put health care at the top of their pri-ority list have always had the services done, whether they paid a co-pay, found a clinic that provided services for free, or paid 100% out of their pocket,” Boyd says. “Now insur-ance companies are forced to pay for these services, which will be re$ected in the pre-miums we all pay.”

Boyd doesn’t doubt that early detec-tion through preventive care is in the best interest of everyone involved, but the reality is, “that no one can force anyone to do any-thing,” she says.

In the insurance industry there is al-

‘free’ services, there is still a cost that’s being shared by Americans who are buying insur-ance,” he says.

As of Aug.1, 2012, the new rules in the health care law requiring coverage of these services take e!ect at most health insurance plans’ next renewal date.

#e services are expected to cover 47 million women, and the total number of prevention-related health care services for women climbs to 22, rising from 14 that be-came e!ective in September 2010, accord-ing to the federal government. #e eight new prevention-related services are based on recommendations from the Institute of Medicine, which polled independent phy-sicians, nurses, scientists and other experts, as well as evidence-based research, to de-velop its recommendations (see sidebar on p.54 for a list of the new covered services).

Non-grandfathered group health plans

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ways a lot of cost-sharing and cost-shifting to support the introduction of new covered lives, or new bene!ts, but it’s too soon to tell how these costs will be re"ected, adds Robin Gelburd, president of New York City-based FAIR Health, a national nonpro!t ad-vocating health care transparency.

“In making these preventive ser-vices available to women there’s a recog-nition and a paradigm shift, not just due to PPACA, but in general.

“People have been remarking that our health care is really ‘sick care’ and in order to make it ‘wellness care’ we should put emphasis on preventive services,” she says. “At the end of the day, there could be some cost reductions that one could point to for introducing these new services.”

#is is part of the White House’s ar-gument. An April 2012 report, “Keep-ing America’s Women Moving Forward,” notes a study that !nds “more than 50% of women delayed seeking medical care be-cause they couldn’t a$ord it, compared to 39% of men.”

Such delays can prove costly when as a result of waiting too long the patient now needs more extensive (and expensive) treatment.

Familiar services In his role at global insurance brokerage Willis, Jay M. Kirschbaum helps employers maintain plan compliance. “Adding low-cost mandates is just another item on the checklist,” says the practice leader for the national legal and research group at Willis’ human capital practice.

And o$ering these preventive services free of charge to women seems to be more costly than it’s worth, Kirschbaum believes. He believes that none of the services cost women a large amount of money out-of-pocket, at the most a couple hundred dol-lars for a well-woman visit, which he be-lieves is not a lot of money.

#ese new services look familiar to Jo-seph Berardo, CEO and president of New York City-based MagnaCare. Most em-ployer-based health care, Medicare risk plans and Medicaid risk plans cover pre-ventive health care services already, at least 80% to 90% of plans, he says.

Bene!t Brainstorm’s Rasmussen agrees. “Although PPACA legislates some

great wins for many Americans, includ-ing women, some of the eight new services were included under many medical plans pre-PPACA,” he says.

In addition, Rasmussen believes that “many women don’t need or won’t take ad-vantage of these services.”

But for those who do take advantage of the opportunity, insurance companies will need to fund the services all the same, lead-ing them to spread the costs across all pol-icy holders, he says.

Unforeseen costs During her presentations throughout Louisiana and Mississippi, B. Ronnell Nolan, president of Baton Rouge, La.-based Nolan Group and lobbyist for the Louisiana Association of Health Underwriters, is very vocal when it comes to her stance on health care reform.

“You will always hear me say, ‘#ere is nothing a$ordable in the Patient Pro-tection and A$ordable Care Act,’” she says. “#e cost was not addressed, and health in-surance premiums are expensive because health care is expensive.”

Women need to be informed pur-chasers of health care, says FAIR Health’s Gelburd. “Education is important when it comes to a$ordable services,” she says.

FAIR Health, an independent, not-for-pro!t corporation, was established in Octo-ber 2009, as part of the settlement of an in-vestigation by then New York State Attorney General Andrew Cuomo into the health in-surance industry’s methods for determin-ing out-of-network reimbursement.

“Will we see increases in utilization to show that women are availing themselves of these new services so there is a public health bene!t with less strain on the health care system?” Gelburd asks.

Although the services are free, Gel-burd emphasizes that employees must know which procedures !t into preventive-related health services coverage. “Trans-parency of costs has to move to the front to ensure [women] are not in an unsuspecting way lured in and think that these [proce-dures] will be free,” she adds.

Questions for the future #ese additional preventative health care services for women have been in the works since August 2011, when HHS issued an interim !nal rule that required most health insurance plans to cover preventive health services for woman, including recom-mended contraceptive services without charging a co-pay.

Since that time, insurance compa-nies have been planning for the additional costs, Rasmussen says. However, he says the problem with mandating speci!c cov-erage is that it removes freedom of choice from the equation — as well as the ability to choose di$erent plans with less cover-age (and lower costs). “Mandated coverage drives up all insurance costs because you can [no longer] create di$erentiated plans for a di$erentiated America,” he says.

Nolan agrees. “Insurance companies cannot a$ord to give away bene!ts for free. While [employees] may not pay up front de-ductibles and co-payments, [they] are pay-ing on the back end, guaranteed,” she says.

Boyd echoes the sentiment that one way or the other Americans are going to pay for the preventive-related health care ser-vices: “All of this ‘free’ stu$ is going to be very expensive.” EBA

1. Well-woman visits

2. Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases

3. Domestic and interpersonal violence screening and counseling

4. FDA-approved contraceptive methods, and contraceptive counseling and education

5. Breastfeeding support, supplies, and counseling

6. HPV DNA testing, for women 30 or older

7. Sexually transmitted infections counseling for sexually-active women

8. HIV screening and counseling for sexually-active women

Source: Department of Health and Human Services

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