Principles of Insurance

Size: px
Start display at page:

Download "Principles of Insurance"

Transcription

1 Principles of Insurance "Took a physical for some life insurance...all they would give me is fire and theft." Henny Youngman At the conclusion of this session, you will: 1. Understand the historical background behind private health insurance. 2. Understand the conditions under which an event is insurable. 3. Have a working knowledge of some key health insurance terms. 4. Understand the tradeoffs in pricing and selection of health insurance policies. 5. Have an appreciation of the coverage dilemmas facing employers and governments which mandate health care benefits. As governments have cut back on many of their benefits and shifted more cost to individuals, a market has arisen for private health insurance. Read the health insurance chapter section and article by Beichl et al. Understand the major points in these readings. Review the Newhouse article. I. History A. European Guilds B. U.S. 1. Mutual Benefit Associations and Fraternal Beneficiary Societies These organizations charged members regular dues for benefits. The earliest example in the U.S. was La Societe Francais de Bienfaisance Mutuelle de San Francisco, which was founded in 1851 and built a hospital in Other similar plans developed in California. By the late 19th century, associations developed at the workplace and were sponsored by employees, employees and employers, and, rarely, solely by employers. The main purpose of these associations was to provide cash payments for disability and death; rarely were medical benefits provided. Physicians were hired by these associations for advice and certification of disability. As these plans evolved into medical care plans, physicians were hired on a prepaid basis to care for members (more about this trend when we discuss HMO's). An early example of this type of plan was the Pacific Railway Beneficial Association, 1882.

2 2. Labor Unions In the late 19th century unions provided disability and death benefits from dues. Only several decades later were medical benefits offered. Q: Why do you think insurance developed in this way, i.e., first disability and death benefits then coverage for medical care? 3. Commercial Health Insurance In 1910, Montgomery Ward & Co., replaced its "Employee Establishment Fund" with an insured contract; this event is generally regarded as the first group health policy. By the 1920's more companies had their plans underwritten by commercial insurance companies. Not all benefits emerged simultaneously. During the 1930's, hospital expense insurance expanded; surgical expense insurance became more prevalent in the late 1930's; medical (non-surgical) benefits became more common in the early 1940's. Two events occurred during WWII which provided the major impetus for growth of commercial insurance. First, because of wage and price freezes, healthcare benefits became part of collective bargaining. Second, the IRS code was modified to make healthcare benefits tax deductible for the employer and tax exempt for the employee. Q: What effect did these events have on shaping the way we currently view payment for healthcare and the cost escalations we face today? 4. Blue Cross The origins of these plans were in the Depression -- hospitals set up their own insurance programs to assure income and payment for services. The problem with these plans was that they were limited to individual institutions; state insurance commissions wanted more freedom for consumer choice. To solve the problem, in 1933 the AHA sponsored multi-hospital programs in return for non-profit status for the plans -- Blue Cross plans were formed at the state level with a national organization comprised of its member plans. Three features characterized these plans: community rating, open enrollment and provider contracts. The national plan provides the following functions: Public relations, solicitation and maintenance of national accounts, research, advice on premium and reimbursement rates, and data processing. The problem with having special status was that the plans were regulated like utilities; for example, they were unable to raise rates or charge appropriately for benefits (group versus individual rates). Plans could not remain competitive with the traditional commercial insurers. Many Blue Cross plans have converted from

3 their special status to a traditional insurance corporation. A current trend is for individual plans to convert to full for-profit status. As of early 1999, Blue Cross and Blue Shield plans covered approximately 73 million members or about 26% of the entire U.S. population. As of year end 2003, Blue Cross and Blue Shield plans covered approximately 88.8 million members. There is also a trend among Blues plans themselves to merge and acquire non-blues plans. As of June 30, 2004 combined enrollment for the 41 independent affiliates of Blue Cross/Blue Shield was 91 million members for a total revenue for the first half of 2004 of $116.3 billion dollars and net income of 3.7 billion dollars. 5. Medicare and Medicaid We will discuss these programs in detail in subsequent classes. The importance of these programs is that commercial plans often follow government guidelines. 6. Self-Insured Plans Over half of all persons insured through employers are covered under these types of plans. A major piece of legislation which enabled employers to set up such programs was the Employee Retirement and Income Security Act (ERISA) of The real purpose of this act was to insure that workers entitled to private pension benefits actually received them when they became eligible. One of the "loop holes" (Section 514) allows employers exemptions from state laws pertaining to employees welfare benefits. The advantages to self-insurance include the following: a. No state insurance premium tax (2-3%) b. Exemption from state mandated benefits c. Exemption from financing reserve requirements d. Exemption from contributions to state risk pools e. Full access to claims data (which commercial insurers frequently do not and cannot often provide their clients) f. Ability to pay claims after they are received (enables the employer to "play the float" on reserves) g. No broker commissions h. Standardize benefits across states for multi-state companies (See Brown, R.E.: Access to Health Insurance in the U.S. Medical Care Review 46: , 1989.) Q: Can you think of any disadvantages to self insurance?

4 7. Consolidated Omnibus Reconciliation Act (COBRA) 1985 This act enabled workers and their dependents to extend group coverage when the covered member is terminated from employment, dies or divorces or separates from a spouse. (See the "Continuation of Coverage" page in the casepacket). 8. Health Insurance Portability and Accountability Act (HIPAA), 1996 There were two parts to this act. The first, was called Health Insurance Reform. Among other things, it provided workers some enhanced portability of healthcare benefits, e.g., if a waiting period was satisfied on a previous job then one need not wait again to access health insurance in a new job. Of course, this law only helps if someone both comes from and goes to a job and employer who provides health insurance. The second part of this law is called Administrative Simplification. We will discuss this portion in more detail in the section on information systems. II. Purposes of Insurance A. For the insured: Can budget for healthcare expenses by protecting against catastrophic events. B. For the insurer: Make money from premiums and investments. In the past, health insurance made money for the insurer as a loss leader by allowing the company to sell more profitable policies, e.g., life insurance, with it. III. Conditions for an event to be insurable A. It must be neither too frequent nor too rare (issue of frequency). Q: What would be the premiums at these two extremes? B. It must be accidental and sporadic, i.e., a random, unpredictable event (issue of unpredictability). Q: What would happen if the event were predictable? C. It must be statistically measurable and computable, or at least estimable (subject to actuarial study). D. From the insurer s viewpoint, large numbers of subscribers are needed who must make sufficient and regular payments.

5 IV. Definitions INSURANCE IS A NUMBERS GAME A. Insurance: Coverage by a contract where one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril. Webster s Dictionary B. Indemnify: To secure against hurt, loss or damage. -- Webster s Dictionary C. Cash Payment vs. Payment for Services D. Indemnity Plan vs. Service Plan We will discuss other definitions found in the glossary in the casepacket. Please refer to this glossary throughout the course and in the future should you have any questions about healthcare terms. V. Types and prevalence of health care products. We will discuss the different types of health care products, i.e., traditional indemnity insurance, indemnity insurance with utilization review, PPO s, point of service plans, and HMO s, as well as the trends concerning each. Detailed discussion of PPO s, point of service plans, and HMO s will occur in the lectures on managed care. VI. Tradeoff Hypothesis for Health Insurance Other than quality services (which we will discuss in a later class), people want four features from their health insurance: A. First dollar coverage B. Low premiums C. Freedom of choice of providers D. Comprehensive coverage Q: How many of these features can you design into an insurance policy and still make it economically feasible for the insurer? VII. Outcomes based on different types of plans Read the articles by Pauly et al and Barnum et al. Understand the tradeoffs among different payment mechanisms a country can implement. VIII. Read the article by Mattoo and Rathindran. Understand the major point they make about insurance coverage for international healthcare.

6

7

Effective Date: The date on which coverage under an insurance policy begins.

Effective Date: The date on which coverage under an insurance policy begins. Key Healthcare Insurance Terms Agent: A person who represents an insurance company and solicits or sells the company s insurance products. An agent may represent a single company or multiple companies.

More information

FUNDAMENTALS OF HEALTH INSURANCE: What Health Insurance Products Are Available?

FUNDAMENTALS OF HEALTH INSURANCE: What Health Insurance Products Are Available? http://www.naic.org/ FUNDAMENTALS OF HEALTH INSURANCE: PURPOSE The purpose of this session is to acquaint the participants with the basic principles of health insurance, areas of health insurance regulation

More information

Kansas Health Policy Authority Small Business Health Insurance Steering Committee

Kansas Health Policy Authority Small Business Health Insurance Steering Committee How Health Coverage Works: Coverage Delivery, Risk Assessment, and Regulation The following summarizes the document How Private Health Coverage Works: A Primer 2008 Update published by the Kaiser Family

More information

Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law

Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Updated July 2014 Note: This information was developed to provide consumers

More information

Your Right to HealthCare Coverage When Leaving or Switching Jobs

Your Right to HealthCare Coverage When Leaving or Switching Jobs Your Right to HealthCare Coverage When Leaving or Switching Jobs Part of PHLP s Healthcare For Workers Publication Series A Consumer s Guide to Accessing Health Care Through Employment Copyright 2007 The

More information

HEALTH INSURANCE. Types of Health Plans and How They Operate. Reimbursement and Fixed Allowance Insurance Plans (Department of Insurance Jurisdiction)

HEALTH INSURANCE. Types of Health Plans and How They Operate. Reimbursement and Fixed Allowance Insurance Plans (Department of Insurance Jurisdiction) HEALTH INSURANCE Illness for non-work related injuries can be financial devastating. Insurance can help protect against disastrous health care expenses and lost wages. If you have a job, your employer

More information

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy. Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should

More information

Illinois Insurance Facts Health Insurance Continuation Rights Dependent Children. Illinois Department of Insurance

Illinois Insurance Facts Health Insurance Continuation Rights Dependent Children. Illinois Department of Insurance Illinois Insurance Facts Health Insurance Continuation Rights Dependent Children Illinois Department of Insurance Revised July 2014 Note: This information was developed to provide consumers with general

More information

UNDERSTANDING INDIVIDUAL HEALTH INSURANCE

UNDERSTANDING INDIVIDUAL HEALTH INSURANCE UNDERSTANDING INDIVIDUAL HEALTH INSURANCE Continuing Education Provider #S10725 Imperial Training Services, Inc. Post Office Box 8 Garner, North Carolina 27529 Instructor: Cliff Davis MBA, CLU Phone: (919)

More information

Deciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA INTRODUCTION

Deciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA INTRODUCTION Deciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA Notice 98-12 INTRODUCTION A key decision that millions of Americans face each year is whether to elect COBRA 1

More information

Illinois Insurance Facts Health Insurance Continuation Rights -- COBRA. Illinois Department of Insurance

Illinois Insurance Facts Health Insurance Continuation Rights -- COBRA. Illinois Department of Insurance Illinois Insurance Facts Health Insurance Continuation Rights -- COBRA Illinois Department of Insurance Updated July 2014 Note: This information was developed to provide consumers with general information

More information

Illinois Insurance Facts

Illinois Insurance Facts Illinois Insurance Facts Health Insurance Continuation Rights -- Illinois Law Revised December 2003 With the high costs of medical care, maintaining health coverage is very important to most individuals

More information

Health Insurance. A Small Business Guide. New York State Insurance Department

Health Insurance. A Small Business Guide. New York State Insurance Department Health Insurance A Small Business Guide New York State Insurance Department Health Insurance A Small Business Guide The Key Health insurance is a key benefit of employment. Most organizations with more

More information

Initial Notice of COBRA Continuation Coverage Rights Time Inc. Ventures Group Benefits Plan and Cafeteria Plan

Initial Notice of COBRA Continuation Coverage Rights Time Inc. Ventures Group Benefits Plan and Cafeteria Plan Initial Notice of COBRA Continuation Coverage Rights Time Inc. Ventures Group Benefits Plan and Cafeteria Plan Introduction You are receiving this notice because you have recently become covered under

More information

Insurance Terminology for Brokers

Insurance Terminology for Brokers Terminology for Brokers Terms and Definitions Group insurance contracts provide coverage to a number of persons under a single contract that is issued to someone other than the persons insured. The group

More information

Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law

Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Updated July 2009 Note: This information was developed to provide consumers

More information

Comparison of Federal and Louisiana Continuation Laws

Comparison of Federal and Louisiana Continuation Laws COBRA LOUISIANA Comparison of Federal and Louisiana Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) Continuation Period FEDERAL (COBRA) Group health

More information

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line INSURANCE FACTS for Pennsylvania Consumers A Consumer s Guide to Health Insurance 1-877-881-6388 Toll-free Automated Consumer Line www.insurance.pa.gov Pennsylvania Insurance Department Website Increases

More information

Chapter 21 Employee Benefits: Group Life and Health Insurance Coverages

Chapter 21 Employee Benefits: Group Life and Health Insurance Coverages Chapter 21 Employee Benefits: Group Life and Health Insurance Coverages Overview This chapter and the next chapter are devoted to employee benefits. Employee benefits are often taken for granted and you

More information

Health Insurance in West Virginia

Health Insurance in West Virginia Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.disabilityrightslegalcenter.org

More information

Guide to Counseling on Employer- Sponsored Health Coverage

Guide to Counseling on Employer- Sponsored Health Coverage Guide to Counseling on Employer- Sponsored Health Coverage February 2012 Table of Contents Introduction... 1 Assessing Current Health Coverage and Needs... 2 Understanding Employer-Sponsored Group Health

More information

CONTINUATION AND CONVERSION POLICIES

CONTINUATION AND CONVERSION POLICIES CHAPTER 5 CONTINUATION AND CONVERSION POLICIES What are they? Who are they for? How to obtain coverage INTRODUCTION Continuation and conversion policies are for certain people who lose their group health

More information

Employer Health Insurance Forum. Presentation by the South Dakota Division of Insurance

Employer Health Insurance Forum. Presentation by the South Dakota Division of Insurance Employer Health Insurance Forum Presentation by the South Dakota Division of Insurance Employer Assistance Program Zaniya Task Force Recommendation HB1027 allows agents/insurers to provide insurance related

More information

Health Insurance in Ohio

Health Insurance in Ohio Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org

More information

407-767-8554 Fax 407-767-9121

407-767-8554 Fax 407-767-9121 Florida Consumers Notice of Rights Health Insurance, F.S.C.A.I, F.S.C.A.I., FL 32832, FL 32703 Introduction The Office of the Insurance Consumer Advocate has created this guide to inform consumers of some

More information

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line INSURANCE FACTS for Pennsylvania Consumers A Consumer s Guide to Health Insurance 1-877-881-6388 Toll-free Automated Consumer Line www.insurance.state.pa.us Pennsylvania Insurance Department Website Increases

More information

Health Insurance in Kentucky

Health Insurance in Kentucky Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.disabilityrightslegalcenter.org

More information

General Notice. COBRA Continuation Coverage Notice (and Addendum)

General Notice. COBRA Continuation Coverage Notice (and Addendum) University Human Resources Benefits Office 3810 Beardshear Hall Ames, Iowa 50011-2033 515-294-4800 / 1-877-477-7485 Phone 515-294-8226 FAX General Notice And COBRA Continuation Coverage Notice (and Addendum)

More information

SECTION 6.25 HEALTH INSURANCE Last Update: 06/09

SECTION 6.25 HEALTH INSURANCE Last Update: 06/09 SECTION 6.25 HEALTH INSURANCE Last Update: 06/09 Types of Insurance and Specific Carriers Health insurance is provided through Wellmark Blue Cross and Blue Shield. Blue Cross and Blue Shield coverage is

More information

INSIDE. Manage Complexities, Help Avoid Penalties. ibx.com/cobra. An Employer s Guide to COBRA

INSIDE. Manage Complexities, Help Avoid Penalties. ibx.com/cobra. An Employer s Guide to COBRA Manage Complexities, Help Avoid Penalties The recent ruling by the Supreme Court of the United States upholding the Health Care Reform Act does not affect an employer s obligation to offer COBRA continuation

More information

Health Insurance Coverage

Health Insurance Coverage Protecting Your Health Insurance Coverage This booklet explains... Your rights and protections under recent Federal law How to help maintain existing coverage Where you can get more help For additional

More information

FAQs for Employees about COBRA Continuation Health Coverage

FAQs for Employees about COBRA Continuation Health Coverage FAQs for Employees about COBRA Continuation Health Coverage U.S. Department of Labor Employee Benefits Security Administration March 2011 Q1: What is COBRA continuation health coverage? Congress passed

More information

THE STATE FARM INSURANCE COMPANIES GROUP HEALTH AND WELFARE PLAN FOR UNITED STATES EMPLOYEES SUMMARY PLAN DESCRIPTION. Effective January 1, 2012

THE STATE FARM INSURANCE COMPANIES GROUP HEALTH AND WELFARE PLAN FOR UNITED STATES EMPLOYEES SUMMARY PLAN DESCRIPTION. Effective January 1, 2012 THE STATE FARM INSURANCE COMPANIES GROUP HEALTH AND WELFARE PLAN FOR UNITED STATES EMPLOYEES SUMMARY PLAN DESCRIPTION Effective January 1, 2012 This document, together with the attached documents listed

More information

Laborers Metropolitan Detroit Health Care Fund

Laborers Metropolitan Detroit Health Care Fund Laborers Metropolitan Detroit Health Care Fund A VERY IMPORTANT NOTICE ABOUT CONTINUATION OF YOUR GROUP HEATH CARE COVERAGE TO: ALL EMPLOYEES AND DEPENDENTS PARTICIPATING IN THE LABORERS METROPOLITAN DETROIT

More information

Continuation Coverage Rights Under COBRA

Continuation Coverage Rights Under COBRA Continuation Coverage Rights Under COBRA If you have and/or will become covered under the Bowling Green State University (BGSU) Group Insurance Plan (the Plan) it is important to know your COBRA rights.

More information

FAQs about COBRA. FAQs About COBRA Continuation Health Coverage. 1 Discovery Benefit Solutions (DBS): 888 490 7530

FAQs about COBRA. FAQs About COBRA Continuation Health Coverage. 1 Discovery Benefit Solutions (DBS): 888 490 7530 FAQs About COBRA Continuation Health Coverage What is COBRA continuation health coverage? Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in

More information

Frequently Asked Questions About The Health Insurance Market in Vermont

Frequently Asked Questions About The Health Insurance Market in Vermont Vermont Department of Banking, Insurance, Securities and Health Care Administration Division of Health Care Administration 89 Main Street, Drawer 20, Montpelier, VT 05602 Telephone: (802) 828-2900 Fax:

More information

A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA

A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA Published by the Arizona Department of Insurance Janet Napolitano, Governor Charles R. Cohen, Director of Insurance August 2003 1 Table of Contents

More information

Arizona Health Care Cost Containment System Issue Paper on High-Risk Pools

Arizona Health Care Cost Containment System Issue Paper on High-Risk Pools Arizona Health Care Cost Containment System Issue Paper on High-Risk Pools Prepared by: T. Scott Bentley, A.S.A. Associate Actuary David F. Ogden, F.S.A. Consulting Actuary August 27, 2001 Arizona Health

More information

March 9, 2016. Update on the Affordable Care Act and Student Insurance

March 9, 2016. Update on the Affordable Care Act and Student Insurance March 9, 2016 Update on the Affordable Care Act and Student Insurance Agenda 2 Background ACA Impact to Student Health Plan Student Health Options UNC Student Health Insurance Offerings Legislative and

More information

Employee Benefits Report

Employee Benefits Report Employee Benefits Report 1000 25th Street North Great Falls, MT 59406 (406) 727-4969 (800) 406-4097 Fax (406) 727-4979 www.bphealthmt.com Compensation January 2011 Volume 9 Number 1 Sizing Up an Employee

More information

Health Insurance in Georgia

Health Insurance in Georgia Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org

More information

SOUTH COLONIE CENTRAL SCHOOLS HEALTH INSURANCE REGULATIONS JULY 1, 2015

SOUTH COLONIE CENTRAL SCHOOLS HEALTH INSURANCE REGULATIONS JULY 1, 2015 SOUTH COLONIE CENTRAL SCHOOLS HEALTH INSURANCE REGULATIONS JULY 1, 2015 I. Types of Plans (availability is dependent upon employee bargaining unit contract) Blue Shield of Northeastern New York 907 Plan

More information

Health Insurance / Learning Targets

Health Insurance / Learning Targets Health Insurance / Learning Targets Compare the basic principles of at least four different health insurance plans Define key terms pertaining to health insurance Health Insurance I have a hospital bill

More information

Health Insurance in Missouri

Health Insurance in Missouri Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org

More information

HOPE COLLEGE EMPLOYEE BENEFIT PLAN INITIAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS

HOPE COLLEGE EMPLOYEE BENEFIT PLAN INITIAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS HOPE COLLEGE EMPLOYEE BENEFIT PLAN INITIAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Introduction Hope College (the "College") provides COBRA continuation of health care coverage ("COBRA coverage")

More information

ARRA COBRA PREMIUM REDUCTION PROVISION SUMMARY AND FREQUENTLY ASKED QUESTIONS

ARRA COBRA PREMIUM REDUCTION PROVISION SUMMARY AND FREQUENTLY ASKED QUESTIONS **UPDATE** On December 19, 2009, Congress amended the ARRA by extending the COBRA premium reduction eligibility period from December 31, 2009, until February 28, 2010, and increased the maximum period

More information

Chapter 25 - Payroll. 25.50 Payroll Deductions and Reductions

Chapter 25 - Payroll. 25.50 Payroll Deductions and Reductions Chapter 25 - Payroll 25.50 Payroll Deductions and Reductions 25.50.10 Payroll Deduction Administration March 18, 2005 25.50.20 Mandatory (standard) deductions March 18, 2005 25.50.30 Voluntary deductions

More information

SUMMARY PLAN DESCRIPTION FOR THE WILLAMETTE UNIVERSITY CONSOLIDATED WELFARE BENEFITS PLAN

SUMMARY PLAN DESCRIPTION FOR THE WILLAMETTE UNIVERSITY CONSOLIDATED WELFARE BENEFITS PLAN SUMMARY PLAN DESCRIPTION FOR THE WILLAMETTE UNIVERSITY CONSOLIDATED WELFARE BENEFITS PLAN TABLE OF CONTENTS INTRODUCTION... 1 Type of Plan... 1 Plan Sponsor... 1 Purpose of the Plan... 1 Purpose of this

More information

Planning Your Service Retirement

Planning Your Service Retirement Planning Your Service Retirement California Public Employees Retirement System Planning Your Service Retirement If you re planning to retire, you have some important decisions to make. This brochure includes

More information

Self-Insured Health Plans for Beginners. 2011, Coastal Management Services

Self-Insured Health Plans for Beginners. 2011, Coastal Management Services Self-Insured Health Plans for Beginners Funding: Funding is simply the means by which an employer pays for employee benefit programs The funding spectrum can range from Fully Insured (premium payment)

More information

INSURANCE DICTIONARY

INSURANCE DICTIONARY INSURANCE DICTIONARY Actuary An actuary is a professional who uses statistical data to assess risk and calculate dividends, financial reserves, and insurance premiums for a business or insurer. Agent An

More information

Health Reimbursement Arrangements (HRA) As a Tax Free Employee Benefit

Health Reimbursement Arrangements (HRA) As a Tax Free Employee Benefit CHILDCARE SOLUTIONS 2101 Richmond Road Beachwood, Ohio 44122 216-831-7333 info@4inhomecare.com Health Reimbursement Arrangements (HRA) As a Tax Free Employee Benefit Internal Revenue Service Department

More information

Benefit Plans for Small Businesses

Benefit Plans for Small Businesses EBNY Financial, LLC Kevin Kautzmann, CFP Certified Financial Planner 80 Fifth Avenue #1403 New York, NY 212-269-2625 kevin@ebnyfinancial.com www.ebnyfinancial.com Benefit Plans for Small Businesses Page

More information

Section 125 Qualifying Events. Revised June 2013

Section 125 Qualifying Events. Revised June 2013 Section 125 Qualifying Events Revised June 2013 Section 125: Qualifying Events Page 2 of 6 A Section 125 Cafeteria Plan must provide that participant elections are irrevocable and cannot be changed during

More information

and How to Enroll Medical and Vision Care Programs for Pre-Medicare Retirees WE ARE BNSF.

and How to Enroll Medical and Vision Care Programs for Pre-Medicare Retirees WE ARE BNSF. Who Is Eligible and and How to Enroll Medical and Vision Care Programs for Pre-Medicare Retirees WE ARE BNSF. Who Is Eligible and How to Enroll Medical and Vision Care Programs for Pre-Medicare Retirees

More information

GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Fred Hutchinson Cancer Research Center Health & Welfare Benefits Plan

GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Fred Hutchinson Cancer Research Center Health & Welfare Benefits Plan GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Fred Hutchinson Cancer Research Center Health & Welfare Benefits Plan Introduction You are receiving this notice because you are currently covered under

More information

This booklet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Act of 1996.

This booklet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Act of 1996. This publication has been developed by the U.S. Department of Labor, Employee Benefits Security Administration (EBSA), and is available on the Web at www.dol.gov/ebsa. For a complete list of EBSA publications,

More information

This notice provides basic information about a type of employer-provided health

This notice provides basic information about a type of employer-provided health Part III - Administrative, Procedural, and Miscellaneous Health Reimbursement Arrangements Notice 2002-45 PURPOSE This notice provides basic information about a type of employer-provided health reimbursement

More information

There is no problem that 100 years of government reform can t create.

There is no problem that 100 years of government reform can t create. HEALTH REFORM BASICS: There is no problem that 100 years of government reform can t create. Linda Gorman Director, Health Care Policy Center Independence Institute Denver, Colorado IndependenceInstitute.org

More information

City of New York Health Benefits Program Frequently Asked Questions for Retirees

City of New York Health Benefits Program Frequently Asked Questions for Retirees City of New York Health Benefits Program Frequently Asked Questions for Retirees UPON YOUR RETIREMENT YOU WILL BE ENROLLED FOR HEALTH BENEFITS ON THE FIRST DAY OF YOUR RETIREMENT PROVIDED YOUR APPLICATION

More information

What Can We Learn About Federal ERISA Law from Maryland s Court Decision?

What Can We Learn About Federal ERISA Law from Maryland s Court Decision? What Can We Learn About Federal ERISA Law from Maryland s Court Decision? Patricia A. Butler, JD, Dr.P.H. Family Impact Seminar January 24, 2007 Presentation Overview Background on ERISA preemption provisions

More information

Your hours of employment are reduced; or Your employment ends for any reason other than your gross misconduct.

Your hours of employment are reduced; or Your employment ends for any reason other than your gross misconduct. CONTINUATION COVERAGE RIGHTS UNDER COBRA You (as a covered employee, retiree, spouse or dependent) are receiving this notice because you have recently become covered under the Bates College Group Health

More information

Preliminary Health Insurance Landscape Analysis

Preliminary Health Insurance Landscape Analysis Preliminary Health Insurance Landscape Analysis Prior to addressing some of the issues listed under Section 3.1 3.5 of the HRSA State Planning Grant report template, here is some of the information available

More information

UNDERSTANDING HEALTH INSURANCE TERMINOLOGY

UNDERSTANDING HEALTH INSURANCE TERMINOLOGY UNDERSTANDING HEALTH INSURANCE TERMINOLOGY The information in this brochure is a guide to the terminology used in health insurance today. We hope this allows you to better understand these terms and your

More information

FAQs for Employees about COBRA Continuation Health Coverage

FAQs for Employees about COBRA Continuation Health Coverage FAQs for Employees about COBRA Continuation Health Coverage U.S. Department of Labor Employee Benefits Security Administration January 2012 Q1: What is COBRA continuation health coverage? Congress passed

More information

Guide to Purchasing Health Insurance

Guide to Purchasing Health Insurance Guide to Purchasing Health Insurance What are your health insurance choices? Which type is right for you? Sample questions Looking for insurance in specific situations Tips for shopping for health coverage

More information

Healthcare Reform Provisions Unique to Small Employers/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014)

Healthcare Reform Provisions Unique to Small Employers/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014) /Financial and Other Benefits Concerns for All Employers (updated May 2, 2014) Lisa L. Carlson, J.D., Area Senior Vice President, Compliance Counsel Gallagher Benefit Services, Inc. While most healthcare

More information

FAQs about COBRA Continuation Health Coverage

FAQs about COBRA Continuation Health Coverage FAQs about COBRA Continuation Health Coverage Q1: What is COBRA continuation health coverage? Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions

More information

An Employer s Guide to Group Health Continuation Coverage Under COBRA

An Employer s Guide to Group Health Continuation Coverage Under COBRA An Employer s Guide to Group Health Continuation Coverage Under COBRA The Consolidated Omnibus Budget Reconciliation Act U.S. Department of Labor Employee Benefits Security Administration This publication

More information

What to Expect When Buying Individual Medical Coverage

What to Expect When Buying Individual Medical Coverage Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals

More information

Your Health Care Benefit Program

Your Health Care Benefit Program Your Health Care Benefit Program HMO ILLINOIS A Blue Cross HMO a product of Blue Cross and Blue Shield of Illinois HMO GROUP CERTIFICATE RIDER This Certificate, to which this Rider is attached to and becomes

More information

Senate Bill No. 2 CHAPTER 673

Senate Bill No. 2 CHAPTER 673 Senate Bill No. 2 CHAPTER 673 An act to amend Section 6254 of the Government Code, to add Article 3.11 (commencing with Section 1357.20) to Chapter 2.2 of Division 2 of the Health and Safety Code, to add

More information

DEFINITIONS OF HEALTH INSURANCE TERMS

DEFINITIONS OF HEALTH INSURANCE TERMS DEFINITIONS OF HEALTH INSURANCE TERMS In February 2002, the Federal Government s Interdepartmental Committee on Employment-based Health Insurance Surveys approved the following set of definitions for use

More information

Oxford New York Small Group (1-100) Underwriting Requirements

Oxford New York Small Group (1-100) Underwriting Requirements Oxford New York Small Group (1-100) Underwriting Requirements ALL GROUPS OXFORD HEALTH INSURANCE, INC. (OHI) & OXFORD HEALTH PLANS (NY), INC. (OHP) The following underwriting requirements apply to all

More information

Same-Sex Spousal Health Benefits

Same-Sex Spousal Health Benefits Same-Sex Spousal Health Benefits January 2015 Contents INTRODUCTION 1 RIGHTS OF SAME-SEX SPOUSES OF PRIVATE SECTOR EMPLOYEES RIGHTS OF SAME-SEX SPOUSES OF STATE, COUNTY AND MUNICIPAL EMPLOYEES RIGHTS

More information

Rationale Insurance systems are used to help finance health care costs.

Rationale Insurance systems are used to help finance health care costs. Insurance Course Principles of Health Science Unit I Health Care Systems & History of Health Care Essential Question Who pays for today s health care? TEKS 130.202(c) 1K, 1M, 1N, 1O, 1P, 1Q Prior Student

More information

IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS

IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS What is continuation coverage? Federal law requires that most group health plans (including this Plan) give employees and their families

More information

Healthcare Programs. Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans

Healthcare Programs. Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans Healthcare Programs Includes: Employee healthcare program Graduate Assistants/Fellows medical and dental plans Excludes: Interns & Residents medical and dental plans International Student medical plan

More information

COBRA Basics January 2014

COBRA Basics January 2014 COBRA Basics January 2014 Peter Antonie Compliance Communications Specialist, CEBS, RHU Employee Benefits Corporation Copyright 2013 Employee Benefits Corporation 2 2 1 Copyright 2013 Employee Benefits

More information

Health Insurance and Women

Health Insurance and Women Health Insurance and Women Q: What is health insurance? A: Health insurance is a formal agreement to provide and/or pay for medical care. The health insurance policy describes what medical services are

More information

Patient Financial Services

Patient Financial Services Acute care Short-term medical care provided for serious acute illness or episode. Patient Financial Services Allowable charges The specific dollar amount of a medical bill that one s health plan, Medicare

More information

Insurance and Perks 1

Insurance and Perks 1 Insurance and Perks 1 People First Responsibilities include, but are not limited to: Process Enrollments of State Benefits Process Qualifying Status Changes (QSC) Verification of dependent eligibility

More information

Family and Medical Leave

Family and Medical Leave University of California This checklist explains how your benefits are affected by an approved family and medical leave under UC policy, the amended California Family Rights Act of 1991, and the Federal

More information

Please complete in blue or black ink only. Section A: Employee Information Last name First name M.I. Social Security no.

Please complete in blue or black ink only. Section A: Employee Information Last name First name M.I. Social Security no. Employee Enrollment Application For 2 50 Employee Small s Virginia care plans offered by Anthem Blue Cross and Blue Shield and Keepers, Inc. PPO health care plans are insurance products offered by Anthem

More information

Health Pool Comparison Matrix NLC-RISC Trustees Conference, Newport, Rhode Island

Health Pool Comparison Matrix NLC-RISC Trustees Conference, Newport, Rhode Island Pool Size - Member groups - Covered lives - Annual premium - Current surplus 590 covered entities 56,655 covered lives $404.5 million annual contributions $88.7 million current surplus 265 member groups

More information

Federal Continuation Health Coverage Laws

Federal Continuation Health Coverage Laws Provided by: Capital Insurance Group Federal Continuation Health Coverage Laws PROVISION REQUIREMENTS COBRA applies to group health plans maintained by: Covered Employers Private-sector employers with

More information

Your healthcare benefits (Post-1989 associate retirees)

Your healthcare benefits (Post-1989 associate retirees) Your healthcare benefits (Post-1989 associate retirees) Contents Your healthcare benefits...1 About this SPD... 1 Verizon Benefits Center... 3 Changes to the Plan... 3 Participating in the Plan...4 Eligibility...

More information

An Employer s Guide to Group Health Continuation Coverage Under COBRA

An Employer s Guide to Group Health Continuation Coverage Under COBRA An Employer s Guide to Group Health Continuation Coverage Under COBRA The Consolidated Omnibus Reconciliation Act of 1986 U.S. Department of Labor Employee Benefits Security Administration This publication

More information

Reporting and Plan Documents under ERISA and Cafeteria Plan Rules

Reporting and Plan Documents under ERISA and Cafeteria Plan Rules Reporting and Plan Documents under ERISA and Cafeteria Plan Rules The Employee Retirement Income Security Act (ERISA) was signed in 1974. The U.S. Department of Labor (DOL) is the agency responsible for

More information

**CONTINUATION COVERAGE RIGHTS UNDER COBRA** BorgWarner Inc. Flexible Benefits Plan

**CONTINUATION COVERAGE RIGHTS UNDER COBRA** BorgWarner Inc. Flexible Benefits Plan **CONTINUATION COVERAGE RIGHTS UNDER COBRA** BorgWarner Inc. Flexible Benefits Plan Introduction This notice contains important information about your right to COBRA continuation coverage, which is a temporary

More information

ERISA PLANS INTRODUCTION

ERISA PLANS INTRODUCTION CHAPTER 11 ERISA PLANS What is it? ERISA, the federal Employee Retirement and Income Security Act, was enacted in 1974, largely to regulate employee pension funds. Although the law was originally enacted

More information

Overview of Health Insurance & Managed Care Principles & History

Overview of Health Insurance & Managed Care Principles & History This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

What s News in Tax Analysis That Matters from Washington National Tax

What s News in Tax Analysis That Matters from Washington National Tax What s News in Tax Analysis That Matters from Washington National Tax Health Insurance Companies and Employers: There s a New Fee to Consider A new fee may apply to issuers of health insurance policies

More information

HEALTH REIMBURSEMENT ARRANGEMENT

HEALTH REIMBURSEMENT ARRANGEMENT HEALTH REIMBURSEMENT ARRANGEMENT C O M M U N I T Y C O L L E G E S Y S T E M O F N E W H A M P S H I R E S U M M A R Y P L A N D E S C R I P T I O N Copyright 2005 SunGard Inc. 04/01/05 TABLE OF CONTENTS

More information

Affordable Care Act: What The Health Care Law Means for Small Businesses

Affordable Care Act: What The Health Care Law Means for Small Businesses Affordable Care Act: What The Health Care Law Means for Small Businesses August 2013 Indian Country Business Summit These materials are provided for informational purposes only and are not intended as

More information

COBRA Common Questions: Definitions

COBRA Common Questions: Definitions Brought to you by Taylor Insurance Services COBRA Common Questions: Definitions What is COBRA? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA is a federal statute

More information

Health Care Reform 101 for June 3, 2013

Health Care Reform 101 for June 3, 2013 Commercial & Personal Insurance Employee Benefits Retirement Plan Services Wealth Management Health Care Reform 101 for June 3, 2013 Requirements: Pre-HCR vs. Post-HCR Offering/Maintaining Health Insurance

More information

Wisconsin typically ranks among the states with the highest level of health

Wisconsin typically ranks among the states with the highest level of health Health Insurance Marketplace in Wisconsin by Wisconsin Office of the Commissioner of Insurance Staff Wisconsin typically ranks among the states with the highest level of health care coverage for its citizens.

More information

24HourFlex 7100 E. Belleview Ave. Suite 300 Greenwood Village, CO 80111 7/8/2015

24HourFlex 7100 E. Belleview Ave. Suite 300 Greenwood Village, CO 80111 7/8/2015 24HourFlex 7100 E. Belleview Ave. Suite 300 Greenwood Village, CO 80111 Demo Guy & Family 7100 E. Belleview Ave. Ste 300 Greenwood Village, CO 80111 7/8/2015 Dear Demo Guy & Family: As your life events

More information