Health Insurance

1/6/2011 © Health News Florida
By Carol Gentry

Most policies for individuals and small groups in Florida had double-digit rate increases last year, according to a study released today. That level would be considered unreasonable under a proposed federal rule.

The double-digit increases were reviewed and approved by the Florida Office of Insurance Regulation.

Of the 28 approvals, according to an analysis by consumer group Florida CHAIN, only three were below 10 percent -- not counting added cost for deductibles or co-pays.

The proposed rule, which is to take effect July 1 if approved, requires more scrutiny and publicity for rate hikes that exceed 10 percent in the individual and small-group market (the large-group market is not affected). The idea was part of the new health law, the Patient Protection and Affordable Care Act, but setting the percentage was left to health officials to determine by the rule-making process.

If it is approved, rate increases over 10 percent could still go through, but companies would have to justify them and post them on the Internet.

The CHAIN analysis of last year's rate hikes for individual and small-group plans that consisted of at least 1,000 members showed two with rate hikes of more than 20 percent: a Humana plan with more than 49,000 members went up 21.8 percent; and an American General plan with around 1,600 customers, 25 percent.

The three plans that had rate hikes under 10 percent were sponsored by Colonial Life, Florida Health Care Plan, and Central United Life.

A press release from CHAIN and several other consumer groups sent out this morning said that most of the pending rate increases for the coming plan year also exceed 10 percent. The average certificate-holder, it said, will face an increase of 12.8 percent.

Double-digit rate hikes for individual and small-group plans are in fact the norm in Florida. OIR officials have explained to Health News Florida in the past that their main job is making sure rates are actuarily sound so that companies can pay claims and not go under,  leaving customers with big bills and no coverage.

Plans that have members who are unconnected to  one another -- individuals, families, or workers in small firms -- tend to have higher rate hikes than those comprised of large employers' workers and families, for a number of reasons. One is that large groups have more clout in deal-making; another is that insurers keep forming new groups for individuals and small firms, and these new group plans have initial low rates that attract healthy people. That leaves less-healthy members who can't jump ship paying  premiums that go up and up in a process called the "death spiral."

The differences in rates between large-group and small-group plans could even out after 2014, when companies will no longer be able to deny coverage to those who have health problems. The new law has so far extended that protection only to children.

--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.

October 14, 2010
From the Florida Tribune, an Internet site maintained by Lobbytools

A program set up more than two years ago as a virtual health care marketplace to help businesses purchase affordable health insurance is inking a deal to establish the web system needed to compare benefit plans.

Florida Health Choices Chief Executive Officer Rose Naff said three companies were making final presentations to the association's board of directors at its board meeting in Tallahassee on October 15. The companies are ACS Health Administration, Ceridian Exchange Services and HealthPlan Services.

Seven companies responded to an invitation to negotiate that the Health Choices Board issued in September. A subcommittee of the board of directors narrowed the bids down to the three finalists.

Florida Health Choices was championed by former House Speaker Marco Rubio in 2008 and despite a budget shortfall was given a $1.5 million appropriation from the state. It was part of the same legislation that created a rival program -- pushed by Gov. Charlie Crist -- called Cover Florida. There were 6,219 people enrolled in the Cover Florida program through June 30.

Both have had problems while the number of uninsured residents in the state continues to rise.

Florida Health Choices has yet to cover any people. Two HMOs have pulled out of the Cover Florida program. Additionally, United Healthcare -- one of two companies authorized to sell the plans statewide -- announced that it has temporarily stopped selling new policies until it gets a ruling from the federal government as to whether the insurance reforms in the Affordable Care Act apply to the Cover Florida program, including changes that prevent companies from placing lifetime dollar limits on plans. Other changes included prohibiting cost sharing requirements for preventive services.

The Florida Office of Insurance Regulation maintains the insurance reforms that kicked in September 23 should not impact the Cover Florida program because it's not an insurance product and has sought advice from the federal government.

A federal official told the Florida Tribune that "we are still analyzing the details of the matter and are working quickly and carefully to come to a final decision."

Naff, meanwhile, refused to opine when Florida Health Choices would offer its first policy saying she won't know until the board of directors decides on which vendor to hire.

Sen. Durell Peaden, R-Crestview, said that despite the slow start he knows it will be a success and he believes that it could serve as a health insurance exchange as laid out in the federal health care overhaul. Florida has received a $1 million planning grant to study the feasibility of establishing an exchange.

"We've been working our fannies off day and night round and round, moving along," said Peaden. "We've done a lot of the mundane work. I hope by some Democratic method we're given some credit for the work we've done."
Thursday, September 23, 2010
Contact:         Jack McDermott                          Brittany Benner
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TALLAHASSEE, Fla. – Today marks the six-month anniversary of the Patient Protection and Affordable Care Act (PPACA) signed into law by President Obama on March 23, 2010. The Office is using this opportunity to provide an update on the status of Florida’s implementation of this new law, as there are several important provisions that become effective today.

Some of the new requirements for plans issued by health insurers and health maintenance organizations include:
Ø  A prohibition of rescissions except for cases of fraud
Ø  A requirement to provide first-dollar coverage for certain preventive services
Ø  An elimination of “lifetime limits” for the dollar value of benefits
Ø  Coverage up to age 26 for dependents
Ø  A prohibition from including pre-existing condition exclusions for dependents

These changes are applicable to group health plans and a health insurance issuer offering group or individual health insurance coverage in Florida, and in other states. The Office outlined these changes and other changes in the law in an Informational Memorandum released to the public on May 12, 2010.

“I would like to commend our staff for handling the increase in form and rate filings associated with the change in the federal law,” remarked Commissioner Kevin McCarty. “The overall rate increases associated with these changes appear to be relatively modest at between a 0.5 percent to 2.0 percent. This is consistent with what has been reported by regulators in other states; however, I am concerned about the new law’s affect on child-only policies.”

Earlier this year, several large health insurers in Florida announced they would discontinue writing “child-only” policies due to uncertainties in the law. The states have been in consultation with the Department of Health and Human Services (HHS) regarding this issue. For more information about the effects of the federal Affordable Care Act on Floridians, please visit the “Health Care Reform” section of the Office’s website: http:/