Friday, September 23, 2011

PPACA: Should I Care About a Wellness Program for My Company?

The answer to this is maybe.  Many carriers offer some version of a wellness program.  Some may even customize to your population.  They can be very helpful pin-pointing certain illness' that can truly affect your claims. Perhaps a walking program or a smoking cessation campaign would be helpful to your employees.  Much of the time it's about showing your employees that you care.  You care about their physical health, mental health, morale etc.  By doing this you may create a more effective and productive employee who wants to come to work and do a great job.  And at the same time may be reducing your claims exposure which ultimately lowers medical premiums. 

Except if you are in the fully-insured small group market in Maryland.  Since there is no pre-existing condition limitation it doesn't matter how healthy or sick you are and your rates are primarily based on a community pool.  However, if you have a relatively healthy group, you may want to consider partially-self insuring.  These plans protect you from claims like a traditional health insurance plan does, except if you are healthy and use less claims, you may get a refund.  In addition, the initial premiums are typically less costly.  If you have a bad claims year, you are not on the hook for any additional premium and if the renewal is high, you can move back to the fully-insured market.  Besides being friendly to you employee's, wellness programs can help your bottom-line especially if you are partially or fully self-insured. 

In addition, through Health Reform there may be grants for employers who currently haven't established a wellness program.  Also, the success to any wellness program is that the senior management be fully-on board and that there is high participation within the employees.  Wellness programs can be crafted to encourage employees to participate by way of rewards or penalty.

If you haven't had a conversation with your consultant about wellness or partially self-insured plans, you should.  If the are unfamiliar, please give me a call at 410-239-5009.  I'd be happy to discuss.


Tuesday, September 6, 2011


Under the Affordable Care Act each state has been given the authority to evaluate every instance where carriers are requesting increases of greater than 10% in the individual and small group market.  "Rate review will help bring down the cost for small businesses and consumers.  According to, "Rate review assesses whether proposed increases in health insurance premiums are based on reasonable estimates, reflecting medical cost trends and health care utilization instead of unjustified assumptions that serve to increase the price to the consumer."  Thanks to grants from the Affordable Care Act, Maryland was able to reduce premium increases in 10 of the 22 rate filings approved during the third quarter of 2010.  On September 1, 2011, HHS (Health and Human Services) issued an amendment that extended the above provision to all individual and small group health plans that are sold through associations effective November 1, 2011.