SeeChange Health Reports Substantial Growth in Value-Based Businesses, Projects a 600% Increase in Revenue for 2012

Innovative Provider of Value-Based Benefit Design Solutions for Employers Achieves 250% Growth Rate in SaaS-Based Health Solutions Business and 300% Growth Rate in California Health Insurance Business

SAN FRANCISCO, CA–(Marketwire -01/24/12)- SeeChange Health (www.seechangehealth.com), an innovator in value-based benefit design solutions to improve health and reduce health care costs, today announced that the company’s growth is accelerating and is on pace to exceed $50 million in revenue over the next 12 months.

SeeChange Health offers value-based benefit design solutions to meet the needs of businesses of all sizes. SeeChange Health Insurance provides value-based benefit plans to fully insured employer groups in California and is the first to bring this unique approach to small and midsize companies. SeeChange Health Insurance is now the fastest-growing health plan in the market, as brokers and employers alike are embracing the value-based model. Read full article here.

Anthem Blue Cross Small Group: April 2012 rate changes

April 2012 Rate Change Overview:

EmployeeElectTotal

  • PPO 3.2%
  • HMO 6.9%
  • CDHP 12.8%

EmployeeChoice – 7.9%
BeneFits – 3.5%
Total – 5.0%
(These rates are for Small Group ONLY, the EmployeeElect 51-99 portfolio as well as the Small Group MHP compliant plans have slightly different rates than the Small Group portfolio.)
*These rate adjustments are averages and will vary by plan and region..

HMO Rate Adjustments –April 2012
The HMO plans within the Small Group EmployeeElect Portfolio will see a new business average increase of approximately 6.9%*.   All HMO plan families will receive an approximate 6.9% quarterly increase on average.

Quarterly increases on the HMO plan families will be as follows*:

  • HMO 100% – 7.6%/Select HMO 100% – 3.8%
  • Classic HMO – 7.5%/ Select Classic HMO – 3.8%
  • Saver HMO – 7.5%/ Saver HMO – 3.7%

Renewal” increases are as follows:

  • HMO 100% – 15.2%/Select HMO 100% – 11.1%
  • Classic HMO – 16.3%/ Select Classic HMO – 12.1%
  • Saver HMO – 15.2%/ Saver HMO – 11.4%

*These rate adjustments are averages and will vary by plan and region.

PPO Rate Adjustments –April 2012
The PPO plans within the Small Group EmployeeElect Portfolio will see a new business average increase of approximately 3.2%*.

The PPO Increases will be as follows (quarterly/renewal)*:

  • The PPO Premier Plans will receive an average increase of 3.5%/12.1%
  • The PPO Copay Plans will receive an average increase of 3.5%/12%
  • The Solution PPO Plans will receive an average increase of 3.3%/7%
  • The GenRx PPO Plans will receive an average increase of 2.5%/3.2%
  • The Elements Hospital PPO Plans will receive an average increase of 2.7%/2.9%
  • The EPO Plans will receive an average increase of 3%/10.3%

*These rate adjustments are averages and will vary by plan and region.

RAF Promotion Update
The basic promotion will remain intact, however, Anthem will also now allow for the following:

  • Groups with 6 or more enrolling subscribers, with a minimum of 50% participation in either the Gen Rx PPO plans and/or any of the Select Network HMO plans will receive an automatic .90 RAF –There will be no qualifying renewal RAF required on those groups.
  • Groups with 6 or more enrolling in our BeneFitsplan portfolio will also receive an automatic .90 RAF -There will be no qualifying renewal RAF required on those groups.

IRS Issues Updated Guidance on W-2 Reporting

On January 3, 2012, the IRS issued additional interim guidance on the W-2 reporting requirement that is part of health care reform. In this guidance, the IRS confirms that employers filing fewer than 250 W-2s are not required to report the value of health benefits. This guidance extends that relief until further guidance is issued.

Additionally, the release indicates that specialty coverage, if included with medical benefits, must be reported.

The guidance reaffirms that this is a reporting requirement only and does not impact employees’ taxable wages.

Wellness Ideas to Reduce Employer Health Insurance Costs

There are some new approaches to wellness that employers are starting to utilize to reduce their spending on health insurance premiums.  Some of the new ideas to reduce costs by using a wellness program include:

1. Employers may require that employees pass biometric screenings to receive discounts on their health insurance premiums. Those who don’t meet the necessary biometric levels would have to enroll in a wellness program and after achieving a healthy body mass index and other biometric numbers, would then be eligible for the discounts.

2. More employers may use the services of a health care advisor to teach employees how to make better treatment choices, find quality providers and make better use of their employers’ health management programs, thereby reducing health care costs.

3.Employers may begin to  use social media to reinforce healthy behaviors, such as  losing weight, exercising more and  becoming healthier.

4.In spite of the economic downturn, one-third of employers plan to increase their  spending on wellness programs  in order to reduce overall premium expenditures.

Our President, Gary Whiddon is well workplace certified from Welcoa University.  He would be happy to assist in the implementation of any employer wellness program.  Please call him at (888) 474-6627 x 116, or email him at gary@hpo.biz

 

UnitedHealthcare (CA small group) Multi-State Guidelines

UnitedHealthCare is modifying the CA Small Business 2-50 underwriting requirements as follows: 

Per AB 1672, groups with 51% of the eligible employees employed in the State of California are considered guaranteed issue groups. 

Groups with more than 49% of the eligible employees employed outside the state of California are considered non-guaranteed issue in California. These groups require health statements and are not eligible for the RAF promotion. 

Underwriting will approve or decline these groups in accordance with the underwriting guidelines.

IRS Guidelines for W-2 Health Coverage Reporting

 The Patient Protection and Affordable Care Act requires employers to report the aggregate cost of employer-sponsored health coverage on the W-2 forms for their employees.  The IRS issued notice 2012-9, which includes some of the information below:

 Exemption for small employers. Employers filing fewer than 250 Forms W-2 for the preceding calendar year are not required to report the aggregate cost of coverage.

Stand-alone dental and vision plan reporting. The Notice clarifies that the standard for determining whether the cost of coverage under a dental plan or vision plan is included in the aggregate cost is the same standard for determining whether such coverage is an excepted benefit under HIPAA. Thus, certain stand-alone dental and vision plans may be exempt from the reporting requirement.

Excess reimbursement for highly compensated individuals. The reporting requirement does not apply to the cost of coverage includible in income under Section 105(h) of the Internal Revenue Code, or payments or reimbursements of health insurance premiums for a 2% shareholder-employee of an S corporation that is required to include the premium payments in gross income.

Coverage under employee assistance program or similar program. An employer that does not charge a premium for an EAP, wellness program or on-site medical clinic to COBRA-qualifying beneficiaries is not required to include the cost of such coverage in the aggregate reportable cost. For arrangements that are not subject to any federal continuation coverage requirements (such as church plans), the employer is not required to include the cost of such coverage on the Form W-2.

Optional reporting of exempted benefits. Employers may, for convenience, include in the aggregate reportable cost the cost of coverage that is not required to be included (e.g., cost of coverage under a Health Reimbursement Account, provided that certain conditions are satisfied.

Reporting non-applicable employer-sponsored coverage. Employers may use any reasonable method to determine the relative allocation of cost for benefit programs that make available both applicable employer-sponsored coverage (e.g., group health plans) and other coverage (e.g., long‐term disability programs).

Employee election changes after year-end. The aggregate reportable cost for a calendar year reported on a Form W-2 may be based on the information available to the employer as of December 31 of the calendar year, without regard to any election or notification made or provided in a subsequent calendar year that has a retroactive effect on a previous year’s coverage.

Payroll periods crossing two taxable years. The Notice provides employers with various options for reporting the aggregate reportable cost for a payroll period that spans two taxable years.

Hospital indemnity/specified disease insurance. Employers are required to include the cost of coverage in the aggregate reportable cost on Form W-2 if the employer makes any contribution to the cost of coverage that is excluded from the employee’s income, or if the employee purchases a policy on a pre-tax basis under a cafeteria plan. However, if the employer provides the opportunity for employees to purchase an independent, non-coordinated fixed indemnity policy and the employee pays the full amount of the premium with after-tax dollars, the cost of coverage provided under that policy is not required to be reported on Form W-2.

Third-party sick pay. The aggregate reportable cost is not required to be reported on a Form W-2 furnished by a third-party sick pay provider. However, a Form W-2 furnished by the employer to an employee must include the aggregate reportable cost, regardless of whether that Form W-2 includes sick pay, or whether a third-party sick pay provider isfurnishing a separate Form W-2 to report sick pay.