What Is Happening in Health Care Reform?


 What Is Happening in Health Care Reform?

Georgia Bar Journal | December 2011 | Volume 17 | Number 4

By Earl C. “Chip” Trefry, Jr. CLU

We all know that change is coming to the health care industry, but more precisely change is coming to the way people access health care. Although the most sweeping changes to health insurance do not arrive until 2014, many important provisions of the health care reform legislation have already taken effect. There is growing uncertainty regarding how each state will interpret the federal legislation and which states will be prepared for implementation in 2014. Some states have not even begun setting up their health care exchanges which are a primary part of the plan to give people access to health insurance.

A key provision already in effect is the Medical Loss Ratio (MLR) provision. This section of the law requires a minimum percentage of each premium dollar be applied to pay “claims and expenses that improve health care quality.” Agent compensation has been designated as administrative costs rather than health care improvement costs. As a result, commission payments affect insurance carrier loss ratios causing many carriers to either reduce or eliminate commission payments for agents. To cope with lower income levels, agents are being forced to realign their agencies and many that have sold and serviced health insurance in the past are no longer doing so. When you combine the reduction of agents with the constant updates to the reform legislation by regulators, you have a situation that makes it very difficult for consumers to get clear and current answers to their questions.

For many law firms, health insurance is their second highest expense after payroll. Managing the costs is very difficult and recent changes to health care legislation have only made that process more complicated. Health care reform brought a long list of items for employers to consider as they provide health insurance benefits for employees.

Questions such as whether or not to maintain “grandfathered” status and what disclosures and notifications need to be sent to employees are just a few of the questions that lawyers are asking about their coverage. As we move closer to 2014, when some plans will no longer be allowed, employers will be faced with even more difficult decisions when balancing cost and benefit.

The State Bar of Georgia Member Benefits Committee and the State Bar of Georgia’s recommended broker, Member Benefits Inc, are committed to helping attorneys with their health insurance needs. Member Benefits Inc continues to work to find beneficial options available in the marketplace. Concepts involving Multiple Employer Welfare Arrangements (MEWA), individual policies with concessions and association group plans are all continuously investigated in an effort to find good solutions for lawyers and their firms. All of these options have the potential to provide members savings for health insurance.

Currently, one option designed to offer value for small employers and individual members is a program called HealthPlan Advantage. HealthPlan Advantage uses the concept of spreading risk between multiple carriers to lower the overall premium. The ability to spread the risk is accomplished because of the use of an exclusive GAP group insurance plan that was developed by Member Benefits Inc. The final product offers benefits that are equal or better than many current plan benefits, but very often offer a lower premium. HealthPlan Advantage also utilizes a program called Consult-A-Doc. This benefit allows members and their employees to access physicians through a toll-free line to receive care for many day-to-day ailments. For a $10 copay, you will speak to a licensed physician in Georgia who in many cases will diagnosis your problem, recommend options for treatment and, if appropriate, send a prescription to your pharmacy. The service is available 24 hours a day, seven days a week. The Consult-A-Doc service is included in the HPA package.

If you would like to learn more about the program offered by the State Bar of Georgia’s recommended broker, please contact Member Benefits at 1-800-282-8626. You can also visit them online at www.gabar.memberbenefits.com

Earl C. Trefry Jr., president of Member Benefits Inc, began his career in the insurance industry shortly after receiving his B.S. degree in Business Administration from the University of Florida in 1972. He later acquired his CLU designation in 1983 from the American College. Trefry is a 37-year qualifying member of the Million Dollar Round Table (MDRT) and an 11-year member of the Top of the Table. He is a frequent guest speaker at industry associations and has also written many articles published in insurance publications and journals. Trefry has previously served on several insurance company’s advisory councils and is the recipient of more than 45 insurance company production awards.