Archive for April, 2013

Terrorism coverage and understanding TRIPRA

Officials take crime scene photos two days after two explosions hit the Boston Marathon in BostonTwo weeks after the Boston Marathon bombings, questions surrounding terrorism coverage have become a cause for concern for many businesses impacted by the tragedy. Some are confused over whether or not their policies offer protection from business interruption and property losses related to terrorist attacks. Although the event has yet to be determined as an official act of terror, it’s important for businesses to become familiar with the current version of the Terrorism Risk Insurance Act (TRIA) (now known as the Terrorism Risk Insurance Program Reauthorization Act, or TRIPRA, of 2007) as well as to review the specific language of their policies.

Following September 11, 2001, terrorism losses were widely excluded from business interruption policies in order to protect insurers from exorbitant costs in the event of future terrorist attacks. In response, U.S. Federal lawmakers passed the Terrorism Risk Insurance Act (TRIA) of 2002 in order Read more…

Zip codes added to Massachusetts Consumer Protection Law

consumer-protectionThe Massachusetts Supreme Judicial Court (SJC) recently ruled that retailers may now be sued if they record consumer zip codes during credit card transactions and use the information for business purposes. The decision stems from a recent case, Tyler v. Michaels Stores, Inc. in which the plaintiff claimed the retailer (Michael’s) used her zip code to find her address and telephone number and send her unsolicited marketing materials. The woman said she was told she needed to provide her zip code when making a credit card purchase at the store, when in fact it was not required by the credit card issuer. In the case’s final ruling, the Court asserted that zip codes are “personal identification information” subject to the restrictions of The Massachusetts Consumer Protection Law governing credit card and check transactions. Chapter 93, Section 105(a) of the law states Read more…

Expatriate health plans temporarily excused from PPACA requirements

expatOn March 8th, 2013, the Departments of Labor, Health and Human Services, and the U.S. Treasury issued a Frequently Asked Questions (FAQs) indicating a temporary delay for fully insured expatriate health plans to comply with most Patient Protections and Affordable Care Act (PPACA) provisions.  Self-funded plans must comply with all applicable PPACA provisions.

The guidance specifically notes the challenges Expat plans may have in complying with the need for independent review organizations (that may not exist abroad), as well as the difficulty of providing for certain required preventive services – or even identifying certain services as preventive – given the varied medical terminology and code sets used around the world. Additionally, in some countries Expat plans require in-country governmental regulatory approvals that may conflict with aspects of the rules Read more…

FDA asks medical device developers for feedback on new draft guidance

Medical2“Recall” or “product enhancement” – the distinction between the two terms can be tricky, especially for medical device manufacturers aiming to comply with current industry codes and regulations. In the case of a recall, developers face serious financial and reputational damage; product enhancements, on the other hand, rarely cause bad publicity and tend to only involve improvements made to a product.

The U.S. Food and Drug Administration (FDA) recently issued draft guidance to help clarify when a change to a product constitutes a recall or a product enhancement, and the difference between the two. The FDA has asked companies to review the draft guidance and submit feedback by May 23, 2013. Read more…

The latest Obamacare tactic in Massachusetts: Boiling the frog slowly

April 10, 2013 1 comment

opEd-frogLast Friday the Massachusetts Division of Insurance attempted to do right by Mass employers in requesting a demerging of the individual and small group market for healthcare. As my previous blog indicated, Massachusetts employers with up to 100 employees face significant rate increases due to the 2007 decision to merge the individual and small group markets. Under Obamacare rules, this merged market disallows rate savings to most employers, and HHS denied a waiver to continue as is.

The Mass DOI was informed on Friday April 5, 2013 by HHS that they could not demerge the markets and were expected to implement the new rating changes over a 3 year period. Unfortunately, the response the DOI received is the worst possible outcome for Mass employers with white-collar employees and/or between 50-99 covered employees, but the new rules Read more…

Mid-sized employer product and pricing trends amidst looming health care reform

April 9, 2013 Leave a comment

GSachsLast month I was honored to again be the featured speaker on Goldman Sachs Equity Research’s annual “industry expert conference call”, providing perspective on 2013 pricing and product trends for employee benefits programs at mid-sized companies.  I’ve participated in these calls for over 10 years, offering industry-specific insight to institutional investors in managed care equities about the health plan buying decisions of mid-sized employer groups (generally, those with 50 to 5,000 employees).

Read more…

Today could be Obamageddon for Massachusetts employers

opEd-massStateIn an ironic twist, today Massachusetts employers and local health plans await news that the Massachusetts Division of Insurance will attempt to rescue us from a nightmare scenario created by Obamacare. Today, April 5, The Mass DOI must notify HHS of our intentions to “unmerge” our group health plans from our individual market. Failure to do so will mandate that all Mass employers under 100 employees be priced and treated like a single person entity. Specifically:

  • No discounts for industry
  • Every plan must renew on January 1
  • Every employee will be individually priced on the monthly bill based on age/sex
  • No discounts for wellness programs
  • Rates will increase over 25% for many employers

Sadly, Massachusetts merged the markets in 2007 to help bring the individual pricing rates down Read more…