Federal Trade Commission To Investigate 6 Largest Pharmacy Benefit Managers: The Federal Trade Commission announced today that it will launch an inquiry into the prescription drug middleman industry, requiring the six largest pharmacy benefit managers to provide information and records regarding their business practices. The agency's inquiry will scrutinize the impact of vertically integrated pharmacy benefit managers on the access and affordability of prescription drugs. As part of this inquiry, the FTC will send compulsory orders to CVS Caremark; Express Scripts, Inc.; OptumRx, Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc

As reported by The Washing Post, your medical records are a big market and may be sold. How is this happening? Often when "signing in" at a doctor's visit, a person signs forms agreeing to certain things. Within the "small writing" of those forms, you may be agreeing to share you information with 3rd parties. Another way is "patient portal ap" maybe sharing your information with facebook or other parties that sell consumer date.

Travel COVID-19 Tests Eliminated:

Say goodbye to those pre-flight Covid tests before boarding an airplane into the US. As of Sunday, June 12, the government has suspended that requirement. Since January 2021, travelers flying into the country have had to show proof of a negative Covid test taken within 24 hours of their fights. Proof of vaccination against Covid-19 will still be required of non-US nationals. Looking for travel insurance?

2023 Wellmark of Iowa Individual and Family Premium Increase Filing

6/30/2022

2023 Wellmark of Iowa Individual and Family Premium Increase Filing

Recently, Wellmark Blue Cross and Blue Shield filed a proposed average base rate increase for their individual and family plans (IFP) with the Iowa Insurance Division (IID). Wellmark's IFP plans make up a small portion of Wellmark's total business in Iowa - about 4.8 percent. The IFP population consists of

Grandfathered (GF) members: plans bought before March 23, 2010
Grandmothered (GM) members: pre-ACA plans purchased between March 23, 2010, and Jan. 1, 2014
Information about Wellmark's Affordable Care Act (ACA) rates and 2023 products will be released in August.

2023 Proposed base rate changes and rate hearing notices.
The 2023 proposed base rate changes vary by plan type. If approved by the IID, and IFP rates will effect Jan. 1, 2023. Wellmark members who receive the notice can give their feedback to the Iowa Insurance Commissioner at the rate hearing on Aug. 20, 2022.

Trends impacting the grandfathered and grandmothered population
Similar to prior years, this population continues to require more health care services to treat high-cost and complex conditions. While several factors add to the rate increase, the key drivers include:

A 7.2 percent increase in cost and use of medical services and prescriptions.
A 9 percent increase in high-cost claimants - the number of members who have greater than $100,000 in claims increased.
A 15 increase in retail pharmacy costs.

Medica Announcement on Abortion Coverage

6/27/2022

On June 24, the U.S. Supreme Court ruled that each state will decide if elective abortion services can be performed within its borders. States will be issuing guidance on their decisions in the coming weeks.

Today's Supreme Court decision may impact access to abortion services in states within our service area, but it does not affect the services covered or excluded under the plan. If your plan covers abortion, members may seek services with an in-network provider in a state that allows elective abortion services. Self-funded employers served by Medica may continue to define the services covered under their plans.

Premier Health Insurance of Iowa Receives Platinum Agency Award:

Premier Health Insurance of Iowa Receives Platinum Agency Award:

6/16/2022

Premier Health Insurance of Iowa recently received the Platinum Award for top life and health insurance advisory firm in Iowa by Professional Insurance and Planners and Consultants.

Wellmark Blue Cross has requested the following rate increases for the 2023 plan year from the Iowa Insurance Division:

6/14/2022

Wellmark Blue Cross has requested the following rate increases for the 2023 plan year from the Iowa Insurance Division:

Wellmark BCBS of Iowa PPO Pre-Affordable Care Act Plans: 4.5%
Wellmark Health Plan of Iowa HMO Premier Affordable Care Act Plans: 7.8%

TRENDS IMPACTING PREMIUM INCREASES
Similar to prior years, this population continues to require more health care services to treat high-cost and complex conditions. While several factors add to the rate increase, the following are key drivers:
A 7.2 percent increase in cost and use of medical services and prescriptions.
A 9 percent increase in high-cost claimants - the number of members who have greater than $100,000 in claims increased.
A 15 percent increase in retail pharmacy costs.

Hawk I & Medicaid Renewals & Terminations To Begin:

5/31/2022

Hawk I & Medicaid Renewals To Begin:

On March 3, 2022, the Centers for Medicare & Medicaid Services (CMS) provided states with additional guidance and tools as they plan for whenever the COVID-19 Public Health Emergency (PHE) does conclude. When the PHE does eventually end, states will be required, over time, to redetermine eligibility for all people enrolled in Medicaid and CHIP. This is especially notable for parents with children enrolled in Hawk I.


Update your contact information - Make sure the state Medicaid or Hawk I program has your current mailing address, phone number, email, or other contact information. This way, they'll be able to contact you about your Medicaid or CHIP coverage.
Check your mail - The state Medicaid or Hawk I program will mail you a letter about your Medicaid or Hawk I coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or Hawk I.
Complete your renewal form (if you receive one) - Fill out the form and return it to the state Medicaid or Hawk I program right away to help avoid a gap in your Medicaid or Hawk I coverage.

Pre-Affordable Care Act Plans Extended Indefinitely

5/19/2022

Pre-Affordable Care Act Plans Extended Indefinitely: For those with the lower-priced plans purchased prior to the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) is allowing customers to continue these plans indefinably. Many of you know these plans were originally to be terminated 1-1-2014 per Affordable Care Act requirement. That date was then extended to 12-31-2015, 10-1-2016, 12-31-2018, 12-31-2020 and then 12-31-2022. However, keep in mind that CMS can continue to require changes in these plans.

President Biden's $1 Trillion Tax Proposal To Include Taxing Certain Health Insurance Claim Payments: Under President Biden's $1 Trillion Proposal in new taxes, some of those taxes are coming from indemnity health insurance claims. The taxed amount will be based on claims from dental, vision, accident, cancer, critical illness, hospital plans, etc. Example: Let's say you have an accident that costs $5000. You also have an accident plan, that covers the $5000 so you pay nothing out of pocket. Under the new tax proposal, you will be taxed on the $5000. We will keep you posted on how this will affect your claims if it goes into affect.

President Biden Signs Executive Order To Fix the Dreaded "Family Glitch"

5/6/2022

President Biden Signs Executive Order To Fix the Dreaded "Family Glitch":
As many of our customers know, under the Affordable Care Act, employer coverage for a family was deemed "affordable" based on whether or not the employee's premiums was "affordable." The meant even though an employee's portion of insurance was relatively inexpensive, it didn't matter the cost of the employee's family.. It would be deemed "affordable" under the Affordable Care Act. Often costing more than $1000 per month just to cover a spouse and children. President Biden signed an executive order on April 5th to change that. Starting January 1st 2023, if a family's coverage (not just the employee) costs more than 10% of the household income, the household will be eligible for a tax credit under the individual Affordable Care Act plans.

With federal funds COVID relief funds running out, uninsured program is no longer accepting new claims for testing, treatment and administering vaccines on since April.

New Special Enrollment Period For Those With Incomes Less Than 150% FPL Now Active

4/19/2022

New Special Enrollment Period For Those With Incomes Less Than 150% FPL Now Active:

If your income is equal or less than 150% of the Federal Poverty Limit you will qualify to enroll in or change your Affordable Care Act plan starting with April 1st 2022 effective dates. This has actually been effective prior to this. However, the Marketplace / Healthcare .gov did not have the logistical capability of doing so. If you would like to apply or change your plan, please reach out to us. To the right is a chart of what your HOUSEHOLD income is required to be at or below to qualify for this Special Enrollment Period.

Who is eligible? Clients are eligible for this SEP if they fit both of these criteria:
Have an estimated annual household income at or below 150% FPL (See above chart) and are otherwise eligible for an Advanced Premium Tax Credit.

What are the effective dates? This monthly SEP will follow accelerated effective date rules, which means you can enroll any day of the month and have coverage start the first day of the next month. For example, if you enroll in a plan on 3/30/22, their coverage will begin on 4/1/22.

How long will the Special Enrollment last? For now, this SEP only exists for this year. It will only be extended if American Rescue Plan Act subsidies are extended.

Insurance Advisors & Agents No Longer Able to Provide Insurance Cards for ACA Plans

4/11/2022

Insurance Advisors & Agents No Longer Able to Provide Insurance Cards for ACA Plans: As a by-product of insurance regulation change due to the Consolidated Appropriates Act, insurance advisors and agents are no longer allowed to provide temporary or regular insurance cards. Instead, we can provide a coverage letter proving the individual does have coverage, along with their policy numbers, etc. until the regular insurance card is received in the mail. Individuals may also login to their insurance company consumer portal to access their digits cards. You may register or access your insurance portal below.

President Biden Signs Executive Order To Fix "Family Glitch"

4/5/2022

President Biden Signs Executive Order To Fix "Family Glitch": As many of our customers know, under the Affordable Care Act, employer coverage for a family was deemed "affordable" based on whether or not the employee's premiums was "affordable." The meant even though an employee's portion of insurance was relatively inexpensive, it didn't matter how much the employee's family's cost was. It would be deemed "affordable" under the Affordable Care Act. Often costing more than $1000 per month just to cover a spouse and children. President Biden signed an executive order on April 5th to change that. Starting January 1st 2023, if a family's coverage (not just the employee) costs more than 10% of the household income, the household will be eligible for a tax credit under the individual Affordable Care Act plans.

Plastikon Healthcare, LLC is voluntarily recalling three (3) lots of Milk of Magnesia 2400 mg/30 mL Oral Suspension, one (1) lot of Acetaminophen 650mg/ 20.3mL, and six (6) lots of Magnesium Hydroxide 1200mg/Aluminum Hydroxide 1200mg/Simethicone 120mg per 30 mL to the hospital, clinic and patient level. The products are being recalled due to microbial contamination and failure to properly investigate failed microbial testing.

Risk Statement: This product potentially could result in illness due to intestinal distress, such as diarrhea or abdominal pain. Individuals with a compromised immune system have a higher probability of developing a wide-spread, potentially life-threatening infection when ingesting or otherwise orally exposed to products contaminated by micro-organisms. To date, Plastikon has not received any customer complaints related to microbial concerns or reports of adverse events related to this recall.

Product indication, lot numbers, expiration dates and NDC information are listed in the link below. The product is packaged for institutional use and is sold to clinics and hospitals nationwide in single use cups with a foil lid. The affected lots were distributed to Major Pharmaceuticals Distribution Center (wholesaler) between 5/1/2020 and 6/28/2021, who shipped to hospitals, nursing homes, and clinics nationwide. The products are private labeled for Major Pharmaceuticals.

Plastikon Healthcare places the utmost emphasis on patient safety and product quality at every step in the manufacturing and supply chain process. Plastikon Healthcare has notified its direct customers via a recall letter to arrange for return of any recalled product. Anyone with an existing inventory of the lots which are being recalled should stop use and distribution, and quarantine immediately. Return all quarantined product to the place of purchase. For clinics, hospitals, or healthcare providers that have dispensed product to patients, please notify patients regarding the recall.

Consumers with questions regarding this recall can contact Plastikon by phone at 785-330-7109 or email address (sdixon@plastikon.com) Monday through Friday from 9 am to 4 pm CST. Patients are advised to contact their doctor or healthcare provider if they have experienced any problems that may be related to taking or using this drug product.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

Complete and submit the report Online
Regular Mail or Fax: Download form or call 1- 800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

Learn How To Read a Wellmark Blue Cross Explanation of Benefits

Learn How To Read a Wellmark Blue Cross Explanation of Benefits

3/24/2022

How to read your Explanation of Benefits

We've made it easy to understand:

1. Patient account number
Your account number with your health care provider.

2. Amount charged
The total amount charged by a health care provider for services you received, whether or not the services are covered under your health plan.

3. Network savings
5. The amount you saved by receiving services from a health care provider within your health plan's network.

4. Amount paid by health plan
The amount paid to you or your health care provider.

5. Deductible
The fixed dollar amount you pay for certain covered services before benefits are available. Your health care provider may bill you for these charges.

6. Copayment
The fixed dollar amount you pay for certain covered services. Your health care provider may require this payment when you receive services.

7. Coinsurance
The amount, calculated using a fixed percentage, you pay for certain covered services. Your health care provider may bill you for these charges.

8. Amount not covered
The portion of the charges not covered under your health plan.

9. Other insurance paid
If you have coverage with another health plan, this is the amount that the other plan has agreed to pay.

10. Amount you are responsible for
Your share of the cost of the services shown on the EOB. You should use this information to coordinate your payment(s) with your providers.

What do I need to do with my EOB?
You don't need to pay anything when you receive your EOB. Because your EOB is not a bill, you don't need to pay anything when you first receive it. If your EOB shows that you are responsible for some of the cost, your health care provider will bill you. Once you receive the bill from your provider, compare the charges on the EOB to the charges listed on the provider bill to confirm that the services and charges listed are correct. If they aren't right, verify with your provider.

Pfizer Recalls Popular Blood Pressure Prescriptions

3/22/2022

Pfizer is voluntarily recalling Accuretic (quinapril HCl/hydrochlorothiazide) tablets distributed by Pfizer as well as two authorized generics distributed by Greenstone (quinapril and hydrochlorothiazide and quinapril HCl/ hydrochlorothiazide) to the patient (consumer/user) level due to the presence of a nitrosamine, N-nitroso-quinapril, above the Acceptable Daily Intake (ADI) level. Pfizer will recall six lots of Accuretic tablets, one lot of quinapril and hydrochlorothiazide tablets and four lots of quinapril HCl/ hydrochlorothiazide tablets.

Nitrosamines are common in water and foods, including cured and grilled meats, dairy products and vegetables. Everyone is exposed to some level of nitrosamines. These impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time.i

These products are indicated for the treatment of hypertension. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. ii The products have a safety profile that has been established over 20 years of marketing authorization and through a robust clinical program. To date, Pfizer is not aware of reports of adverse events that have been assessed to be related to this recall. Pfizer believes the benefit/risk profile of the products remains positive based on currently available data. Although long- term ingestion of N-nitroso-quinapril may be associated with a potential increased cancer risk in humans, there is no immediate risk to patients taking this medication. Patients currently taking the products should consult with their doctor about alternative treatment options.

The NDC, Lot Number, Expiration Date, and Configuration details for these products are indicated in the tables below and photos of the products can be found at the end of this press release. The product lots were distributed nationwide to wholesalers and Distributors in the United States and Puerto Rico from November 2019 to March 2022.

Accuretic™ (quinapril HCl/hydrochlorothiazide) tablets, 10/12.5 mg
Accuretic™ (quinapril HCl/hydrochlorothiazide) tablets, 20/12.5 mg
Accuretic™ (quinapril HCl/hydrochlorothiazide) tablets, 20/25 mg

NDCLot NumberExpiration DateStrengthConfiguration/Count
0071-3112-23FG537908/202410/12.5 mg1 x 90 count bottle
0071-0222-23EA668604/202210/12.5 mg1 x 90 count bottle
0071-5212-23FG538108/202420/12.5 mg1 x 90 count bottle
0071-0220-23EA666504/202220/12.5 mg1 x 90 count bottle
0071-0220-23CN064004/202220/12.5 mg1 x 90 count bottle
0071-0223-23ET697402/202320/25 mg1 x 90 count bottle

quinapril and hydrochlorothiazide tablets, 20/25 mg
quinapril HCl/hydrochlorothiazide tablets, 20/12.5 mg
quinapril HCl/hydrochlorothiazide tablets, 20/25 mg

NDCLot NumberExpiration DateStrengthConfiguration/Count
59762-5225-9FE371402/202320/25 mg1 x 90 count bottle
59762-0220-1DN693103/202320/12.5 mg1 x 90 count bottle
59762-0220-1ED390403/202320/12.5 mg1 x 90 count bottle
59762-0220-1ED390503/202320/12.5 mg1 x 90 count bottle
59762-0223-1DP341402/202320/25 mg1 x 90 count bottle

Pfizer places the utmost emphasis on patient safety and product quality at every step in the manufacturing and supply chain process. Pfizer has notified direct consignees by letter to arrange for return of any recalled product.

Wholesalers and distributors with an existing inventory of the lots, listed in the table above, should stop use and distribution and quarantine the product immediately.

If you have further distributed the recalled product, please notify any accounts or additional locations which may have received the recalled product from you. Please conduct a sub-recall to those accounts and communicate this recall information immediately. Please request they immediately cease distribution of the affected product and promptly contact Sedgwick at 888-843-0247 (Mon.-Fri. 8:00 am - 5:00 pm ET) to obtain a Business Reply Card (BRC) to initiate the return process.

Patients who are taking this product should consult with their healthcare provider or pharmacy to determine if they have the affected product. Patients with the affected product should contact Sedgwick at 888-843-0247 (Mon.-Fri. 8:00 am - 5:00 pm ET) for instructions on how to return their product and obtain reimbursement for their cost.

Healthcare Professionals with questions regarding this recall can contact Pfizer using the below information.

Contact CenterContact InformationArea of Support
Pfizer Medical Information

Pfizer Drug Safety800-438-1985, option 3
(Mon.- Fri. 8 am-9 pm ET)
800-438-1985, option 1For medical questions regarding the product

To report adverse events and product complaints

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

Complete and submit the report Online
Regular Mail or Fax: Download form or call 1- 800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800- FDA-0178
This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

References:
i https://www.fda.gov/drugs/drug-safety-andavailability/information-about-nitrosamine-impurities-medications
ii William B, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:30213104. doi:10.1093/eurheartj/ehy339.

New Special Enrollment Period For Those With Incomes Less Than 150% FPL

New Special Enrollment Period For Those With Incomes Less Than 150% FPL

3/11/2022

New Special Enrollment Period For Those With Incomes Less Than 150% FPL: If your income is equal or less than 150% of the Federal Poverty Limit you will qualify to enroll in or change your Affordable Care Act plan starting with April 1st 2022 effective dates. This has actually been effective prior to this. However, the Marketplace / Healthcare .gov did not have the logistical capability of doing so. If you would like to apply or change your plan, please reach out to us. To the right is a chart of what your HOUSEHOLD income is required to be at or below to qualify for this Special Enrollment Period.

Healthcare. gov / Marketplace Should Mail 1095s: The Affordable Care Act required those with Affordable Care Act plans to file a IRS Form 1095 with their taxes to prevent being required to pay the "Obamacare Penalty Tax" (Shared Responsibility Tax). However, the "Trump Tax Law" (Tax Cuts & Jobs Act) eliminated any penalty tax for not enrolling in an Affordable Care Act plan. However, if you have an ACA plan, you will still receive an IRS Form 1095 to file with your taxes. This will need to be done, especially if you are receiving an Advanced Premium Tax Credit. By law, the Marketplace should be mailing these out to you in January. Unfortunately, every year the Marketplace fails to mail 1095s to a large segment of people due to a "glitch in the system". (They have a lot of "glitches"!) If you did not receive a 1095 and are enrolled on an Affordable Care Act plan you can Create An Account at our private exchange to view your 1095, plan, premiums, eligibility, etc. If you have not yet created a password or forgot yours, click "Forgot Password" and enter the email you used when enrolling. You may also reply to this email with your full name and we can email it to you.

United States Fire Insurance Company Withdrawing New Health Insurance Coverage:

2/10/2022

Many of you have never heard of them. However, some of our customers have asked about the US Fire "Simple Term" health insurance and we advised avoiding them. Why? Because when US Fire originally contacted us to offer their plans, they could not answer direct and easy questions. Questions such as what and how are specific claims covered, what constitutes as "preventative care", when and how are premiums billed, etc. This was a bad sign and it now shows as US Fire is no longer offering their "Simple Term" health insurance plans.

Clients just need to present their insurance card at the pharmacy counter as if they were receiving medication. Tests purchased out-of-pocket by your client on or after Jan. 15 are eligible for reimbursement, too.

If you or your clients have questions, we've got answers. Simply visit this comprehensive landing page or forward clients' this email. FAQs are below!

Q: Which tests are eligible?
A: FDA authorized tests are eligible. Common ones include,

Abbott BinaxNOW
SD Biosensor COVID At Home Test
Siemens's CLINITEST Self Test
iHealth COVID-19 Self Test
Access Bio's CareStart Self Test
BD Veritor At-Home Test
InBios SCov-2 Detect Self Test
OraSure InteliSwab Rapid Test
Cellitrion DiaTrust Home Test
QuickVue At Home Test
ACON Flowflex Home Test
Ellume Home Test
Detect COVID-19 Test
Lucira Check-it COVID-19 Test
Cue Covid-19 at home test
Q: What are the reimbursement requirements?
A: The following are reimbursement requirements:
Your tests must be purchased on or after January 15, 2022.

Your tests must be FDA authorized.
You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn't apply to Medicare Advantage plans.
You will be reimbursed for up to 8 tests (not 8 test kits) per member per 30 day period. Ideally, the receipt should only include the purchase of tests and no other items (i.e. a receipt that includes only the at-home COVID test(s) purchased and not other non-reimbursable purchases) is preferred as it will allow us to process your request more quickly.

The federal government has recently created a website for every U.S. household to order up to four free at-home COVID-19 test kits. Test kits can be ordered at COVIDtests.gov and orders will ship for free.

Where can I obtain at-home COVID-19 tests?

If you go to the pharmacy counter, you may be able to present your member ID and ask them to bill your insurance just like you would a medication. This will help avoid having to pay out of pocket entirely.
Please note that many pharmacies are still working to set up this process and may require that you pay out of pocket for now. If that happens please see below for how to get reimbursed.
Additionally, you are able to order up to 4 tests for free directly from the federal government via this site: https://www.covidtests.gov/
You can obtain a test through our network of pharmacies. Find one near you.

I paid for my at-home tests out of pocket. How do I get reimbursed?

Don't sweat - if you purchased the tests on or after January 15, 2022, you'll still be able to get reimbursed. Just follow the steps below:
(Note: If you're a Cigna + Oscar or Cigna Administered by Oscar small group member, we'll share more info soon about how you'll be reimbursed. You won't be reimbursed if you follow the process below.)
Please visit Caremark.com and sign in or register. Be sure to have your member ID available if you haven't previously created an account with Caremark.
Select "Plan & benefits"
Select "Submit a prescription claim" and follow the prompts listed there

What are the requirements for reimbursement?

Your tests must be purchased on or after January 15, 2022.
Your tests must be FDA authorized.
You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn't apply to Medicare Advantage plans.
You will be reimbursed for up to 8 tests (not 8 test kits) per member per 30 day period. Ideally, the receipt should only include the purchase of tests and no other items (i.e. a receipt that includes only the at-home COVID test(s) purchased and not other non-reimbursable purchases) is preferred as it will allow us to process your request more quickly.

Reimbursement guidelines:

FDA Authorized OTC COVID self-tests will be reimbursed and include the following.

Abbott BinaxNOW
SD Biosensor COVID At Home Test
Siemens's CLINITEST Self Test
iHealth COVID-19 Self Test
Access Bio's CareStart Self Test
BD Veritor At-Home Test
InBios SCov-2 Detect Self Test
OraSure InteliSwab Rapid Test
Cellitrion DiaTrust Home Test
QuickVue At Home Test
ACON Flowflex Home Test
Ellume Home Test
Detect COVID-19 Test
Lucira Check-it COVID-19 Test
Cue Covid-19 at home test

Medica Provides Guidance On Covering At-Home-Covid Testing

1/18/2022

Effective Jan. 15, 2022, and for the duration of the national public health emergency, Medica members enrolled in individual plans and commercial fully and self-funded plans have coverage for OTC FDA-authorized COVID-19 antigen tests without a prescription from a qualified health professional.

Coverage includes up to eight FDA-approved OTC COVID-19 antigen home tests for each member per month covered under a subscriber's plan.
Tests can be obtained through a network pharmacy at no cost.*
Tests obtained at an out-of-network pharmacy or retailer are eligible for reimbursement at $12 per OTC test. Members will be required to submit a claim form to process reimbursement.
OTC tests purchased prior to Jan. 15, 2022 are not eligible for reimbursement.
Tests purchased to fulfill employer-directed testing requirements are not eligible for reimbursement.

*If the network pharmacy is unable to directly submit the claim for the member's OTC antigen tests, they can complete and submit a Pharmacy Claim Submission form. Completed forms and receipt(s) should be mailed to the following address for reimbursement:

Express Scripts
ATTN: Commercial Claims
P.O. Box. 14711
Lexington, KY 40512-4711

Or members can fax their claim form and receipt(s) to 1 (608) 741-5475.

Federal agencies (Department of Labor, Health and Human Services and the IRS) jointly issued guidance on Monday (Jan. 10th, 2022) afternoon as directed by the Biden Administration that requires all issuers and group health plans (including grandfathered plans) to begin covering over-the-counter (OTC) COVID-19 tests with no member cost share. Along with health insurers and third-party administrators across the country, Wellmark Blue Cross and Blue Shield is currently working to implement the specifics of this newly-released guidance. This overview will provide an update about Wellmark's coverage of OTC COVID-19 tests, our plans for direct coverage and member-submitted claims, and details regarding where members can go to get more information about obtaining OTC COVID-19 tests and how to submit member-submitted claims for these tests.

Here is what Wellmark can currently share:

With pharmacies playing a large role in the access and sale of these OTC COVID-19 tests, Wellmark has partnered with CVS, its pharmacy benefits manager, to provide members with a streamlined purchase experience where members will not have to pay anything up-front for the OTC COVID-19 test and Wellmark will be billed through CVS for the test. Starting tomorrow (Jan. 15, 2022), members will be able to get tests in person at most pharmacies, as well as order them online through national retail pharmacy chains like CVS and Walgreens, without up-front payment.

To find an in-network pharmacy, members can visit the link below.

Wellmark will cover OTC COVID-19 tests that have received an Emergency Use Authorization from (or are approved by) the Food and Drug Administration (FDA), subject to certain limitations:

The OTC COVID-19 test must be purchased on or after Jan. 15, 2022. Wellmark will not reimburse members for OTC COVID-19 tests that are purchased before that date.

Covered OTC COVID-19 tests are limited to the tests for when specimens are self-collected and are read at home by the test-taker (not dropped off at or mailed to a laboratory for processing). There are currently 13 tests that qualify for this coverage. A resource to help members figure out whether a test qualifies as an OTC COVID-19 test will be available on Wellmark.com.

Coverage and reimbursement of OTC COVID-19 tests is limited to eight OTC COVID-19 tests per member per month. As an example, if a family has five members on the same health plan, the family is eligible to be reimbursed for up to 40 OTC COVID-19 tests per month. (Some test kits are sold with multiple tests in a single package. The limit number is based on individual tests.)

Coverage of OTC COVID-19 tests is limited to the duration of the Public Health Emergency Declaration (PHE) issued by HHS.

Members who purchase OTC COVID-19 tests from out-of-network pharmacies or from non-pharmacy retailers are still eligible for reimbursement. However, Wellmark strongly recommends that members obtain OTC COVID-19 tests from an in-network pharmacy, as the member will pay nothing out-of-pocket. OTC COVID-19 tests must be purchased from the pharmacy counter to be covered with no out-of-pocket costs. Members purchasing the test at a regular checkout will need to pay for that test at the retail price and submit a claim to CVS for reimbursement. Members purchasing the test at a regular checkout will need to pay for that test at the retail price and submit a claim to CVS for reimbursement. If the member does decide to go to an out-of-network pharmacy or a non-network retailer, the member's reimbursement may be limited to $12 per test (or $24 for a box of two tests).

If members paid for a qualifying OTC COVID-19 test, they will need to submit a claim form to CVS. Members should visit CVS's website for more information about CVS's member-submitted claim process for OTC COVID-19 tests.

Wellmark will only cover OTC COVID-19 tests that are for the personal use of the policy holder and their dependents on the same health plan. The OTC COVID-19 tests for which members are reimbursed should only be used by the policy holder and their dependents on the same health plan.

Wellmark will not cover OTC COVID-19 tests used for employment purposes, meaning that if your employer tests you for COVID-19 weekly or other routine basis, members should not be purchasing those and submitting them to Wellmark for reimbursement.

This is a rapidly evolving situation, but Wellmark will provide additional updates as new information is available.

On Jan. 10, 2022, the U.S. Departments of Health and Human Services, Labor and Treasury ("the Tri-Agencies") released FAQ, Part 51, regarding coverage for COVID-19 testing by health insurers and group health plans. The guidance instructs on the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), and the Affordable Care Act (ACA).
The Tri-Agencies provided further clarification on how - during the public health emergency (PHE) - members in group or individual health plans can seek reimbursement from their plan or issuer for U.S. Food and Drug Administration (FDA)-authorized diagnostic home tests purchased on or after Jan. 15, 2022, and what a health plan or issuer should do to facilitate that.
• The revised guidance will apply through the end of the PHE.
• Coverage will begin for claims submitted with dates of purchase on or after Jan. 15, 2022.
• Members do not need an order from a health care provider or clinical assessment to purchase a home test, but tests must still be primarily for individualized diagnosis or treatment of COVID-19.
• The policy applies to fully insured, self-funded (ASO) and Level Funded health plan customers.
• Tests are limited to eight tests per 30 days for each member in a subscriber's plan. In applying the quantity limit of eight tests, plans and issuers may count each test separately, even if multiple tests are in one package.

Please note that this was recently announced and there is currently very little logistics set up within insurance companies on how to actually handle this as there are no retail store networks, billing codes ,etc. We will keep you posted.

Affordable Care Act Open Enrollment Extended: The Biden Administration has extended the Affordable Care Act open enrollment to January 15th 2022. If you have not enrolled or need to change a plan, you now have more time to do so!

Affordable Care Act Plans Will Automatically Be Renewed: You may be receiving a large amount of SPAM emails from Healthcare. gov stating you need go to their website. You do not. Your plan will automatically renewed if no changes are made by December 15th.

Clients On National General & United Health Care 2 & 3 Year Plans

12/17/2021

Clients On National General & United Health Care 2 & 3 Year Plans: Please contact us if you would like to renew your coverage for a new full 3 year period. As we previously reported, the Biden Administration has issued an executive order "limiting" these annual plans. However, that "limit" has not yet taken place so it would be wise to lock in your plan for another 3 full years if possible.

Open Enrollment is right around the corner for any of those wanting to compare and review coverage. Please contact us for personalized plan information or review options online at our website.

Medica Mailing Out Rebate Checks

10/7/2021

Medica Mailing Out Rebate Checks: Many of you enrolled in Medica in previous years will be receiving a rebate check in the mail for over charged health insurance premiums. Under the Affordable Care Act, health insurance companies are required to pay out 80% of premiums in claims. Any premiums not paid out up to 80% are required to be refunded back to the policy holder. This may create tax issues for those small business owners and self employed people who deduct health insurance premiums. Please consult your tax advisor for questions and concerns.

For those people who were receiving COBRA benefits for a $0 premium through their employer, that $0 premium ended this month as the tax credits were slated to run out in September. Fortunately, the federal government issued a special enrollment for those in this situation. Reach out to us if you would like to review your options!

HealthCare.Gov Updating Tax Credits For September 1st

9/17/2021

HealthCare.Gov Updating Tax Credits For September 1st: Although the Marketplace / Healthcare. gov originally stated that the increased tax credits under the American Rescue Plan Act would be activated January 1st 2022 for those who did not opt for them earlier, they have now decided to update tax credits effective September 1st 2021. Unfortunately, we were not notified about this until just recently. You should notice a lower premium starting on your September premium. Please remember that just because the Marketplace increased your tax credit does not mean you qualify for it. If you have changes in income, please let us know so that we can update your tax credit.

IRS Updates 2022 Health Savings Account Contribution Limits:

8/27/2021

IRS Updates 2022 Health Savings Account Contribution Limits:

Individual Contribution Limit - $3650
Individual Out of Pocket Maximum - $7050
Family Contribution Limit - $7300
Family Out of Pocket Maximum - $14,100

HealthCare.Gov Mailing Tax Credit Forms Urging Consumers to Visit Healthcare .gov - CONTACT US BEFORE DOING ANYTHING

8/2/2021

HealthCare.Gov Mailing Tax Credit Forms Urging Consumers to Visit Healthcare .gov - CONTACT US BEFORE DOING ANYTHING: For those on the Affordable Care Act plans, you may be receiving emails and forms via regular mail from healthcare .gov / Marketplace stating you qualify for increased tax credits due to the American Rescue Plan Act. We reported this increase in our March newsletter. Please contact us with questions prior to doing anything.

Here is the run down:

Increased tax credits were available April 1st. This includes a tax credit for those people with too high of an income to receive a tax credit currently, and an increased tax credit for those already receiving a tax credit.

There are 2 ways to receive the increased tax credit. Here are the options, along with the pros and cons:

1. You may login and update your plan via the Health Sherpa account that was emailed to you when your originally enrolled or contact us at 800-383-6590 or by replying to this email as we can update the tax credit for you.

Pros: Receive a lower monthly premium going forward for the rest of the year. Since the tax credit is retroactive to January 1st, any additional tax credit will be reimbursed to you at the end of the year. You can also select a new plan if you wish.
Cons: If you change your plan or re-enroll, you will be subject to a new deductible and out-of-pocket maximum. That means you are starting over and will need to meet the deductible and out-of-pocket maximum again. Additionally, the deductible and out-of-pocket maximum will start over again on January 1st 2022.

2. You may continue to pay the same premium you are currently, then receive the tax credit when filing your 2021 taxes.

Pros: You will NOT have a new deductible or maximum-out-pocket. Any claims that have been credited to your deductible and maximum-out-pocket will remain.
Cons: You will pay your current premium throughout the rest of this year and receive the tax credit when you file your 2021 taxes. New premiums and tax credits will be assessed January 1st 2022 so you will receive the increased tax credit applied toward your premiums in 2022 even if you wait to receive the 2021 tax credit.

Our Opinion

We believe it will be in most client's best interest to wait until filing their 2021 taxes to receive the increased tax credits as long as they can afford their current premium. This avoids a resetting of deductible and maximum-out-of pockets, as well as avoiding any errors that may occur. These errors may include healthcare.gov not enrolling a plan correctly, submitting the wrong tax credit and premium to an insurance company, or not cancelling out the old plan. For the most part, people do not experience these issues. However, for those who have, it can be very time consuming trying to correct anything with healthcare.gov's customer service.

Wellmark Blue Cross Files for 2022 Rate Increase

7/14/2021

Wellmark Blue Cross has filed for a proposed rate increase with the Iowa Insurance Division. The proposed rates will go into effect on January 1st 2022 and must first be approved by the Iowa Insurance Commissioner. It is important to note that often, increased tax credit subsidies often off-set the increase in premiums on the Affordable Care Act plans. Wellmark states the following reasoning for their rate increase:

Pre-Affordable Care Act Plans
6% Increase in Claims over $50,000
16% Increase in Pharmacy Costs
47% Increase in Dermatology Costs
82% Increase in Specialty Prescriptions

Affordable Care Act Plans
15% Increase in Doctor Visits, Psychiatric Visits & Physical Therapy
18% Increase in Claims over $50,000
83% Increase in Mental Health Services
181% Increase in Ambulance Services

Proposed Rate Increases
Pre-Affordable Care Act Grandfathered HMO plans - 0.0%
Pre-Affordable Care Act Grandmothered HMO plans - 10.0%
Pre-Affordable Care Act Grandmothered PPO plans - 5.9%
Affordable Care Act plans - 11.1%

Supreme Court Upholds the Affordable Care Act As Constitutional

6/28/2021

Supreme Court Upholds the Affordable Care Act As Constitutional: Summary - On Thursday, June 17, the U.S. Supreme Court dismissed a challenge to the Affordable Care Act for failure to show that the individual and state plaintiffs had standing to attack the law's requirement that individuals obtain minimum essential coverage (MEC), otherwise known as the individual mandate. The Court concluded that the plaintiffs failed to show a past or future injury traceable to the federal government's conduct enforcing the MEC provision they attack as unconstitutional. The Court reversed and vacated the Fifth Circuit's judgment in respect to standing and remanded the case back to the lower court with instructions to dismiss.

The case was decided by a 7-2 majority vote, with Justices Alito and Gorsuch dissenting. The Court did not reach the merits of the issue - i.e., whether the "individual mandate" to purchase insurance is unconstitutional with a $0 penalty; however, the fact that neither the states nor individuals have standing to sue should settle this issue. While there may be challenges to the ACA in the future, there appear to be no serious constitutional challenges in the pipeline that would overturn the ACA in its entirety. Therefore, it continues to be business as usual with respect to the ACA, including the employer mandate and form 1094-C/1095-C reporting.

Some Hospitals Deliberately Hide Pricing Required By Federal Law: Although Congress passed the No Surprise Act on December 27th 2020,which prevents providers (doctors, hospitals, etc) from billing patients excessive amounts and requires them to make public their pricing for various procedures, some hospitals have been caught deliberately hiding this pricing from the eyes of the public. Methods include anything from not showing the web page on their main website or even decoding the information so that it can not be found by search engines.

Iowa Extends Pre-Affordable Care Act Plans

6/4/2021

Iowa Extends Pre-Affordable Care Act Plans: For those still enrolled in the lower priced Pre-Affordable Care Act plans, the Iowa Insurance Division is allowing these plans to continue until 12-31-2022. At that point, the Affordable Care Act mandates this coverage will be terminated and these people will need to find new insurance. However, this termination mandate has been postponed several times and there is a high probability that will continue. The only 2 insurance companies that continue to offer these plans are Wellmark Blue Cross and United Health Care. Please note the Affordable Care Act prevents anyone enrolling in a Pre-ACA plan as a new customer.

Biden Extends Affordable Care Act "Special Enrollment": Typically the ACA Open Enrollment is from November 1st through December 15th of year. However, President Biden has opened a special enrollment that now lasts through August 15th. This allows anyone to see if they qualify for a tax credit or to switch ACA plans through a substantial amount of the year.

The American Rescue Plan Act Lowers Individual Health Insurance Premiums!

3/25/2021

The American Rescue Plan Act Lowers Individual Health Insurance Premiums!

New and increased tax credits should be available April 1st for May 1st payment dates. This includes a tax credit for those people with too high of an income to receive a tax credit currently, and an increased tax credit for those already receiving a tax credit.

The new tax credits for unemployed people will be available "early July" according to Centers for Medicare & Medicaid Services.

The Special Enrollment Period enacted by President Biden originally ended May 15th. It has now been extended to August 15th.

There are 2 ways to receive the increased tax credit. Here are the options, along with the pros and cons:

1. You may login and update your plan via the account that was emailed to you when your originally enrolled or contact us at 800-383-6590 or by replying to this email.

Pros: Receive a lower monthly premium going forward for the rest of the year. Since the tax credit is retroactive to January 1st, any additional tax credit will be reimbursed to you at the end of the year. You can also select a new plan if you wish.

Cons: If you change your plan, or re-enroll in the same plan, you will be subject to a new deductible and out-of-pocket maximum. That means you are starting over and will need to meet the deductible and out-of-pocket maximum again.

2. You may continue to pay the same premium you are currently, then receive the tax credit when filing your 2021 taxes.

Pros: You will NOT have a new deductible or maximum-out-pocket. Any claims that have been credited to your deductible and maximum-out-pocket will remain.

Cons: You will pay your current premium throughout the rest of this year and receive the tax credit when you file your 2021 taxes. New premiums and tax credits will be assessed January 1st 2022.

Our Opinion

We believe it will be in most client's best interest to wait until filing their 2021 taxes to receive the increased tax credits as long as they can afford their current premium. This avoids a resetting of deductible and maximum-out-of pockets, as well as avoiding any errors that may occur. These errors may include healthcare.gov not enrolling a plan correctly, submitting the wrong tax credit and premium to an insurance company, or not cancelling out the old plan. For the most part, people do not experience these issues. However, for those who have, it can be very time consuming trying to correct anything with healthcare.gov's customer service.

Please remember that information continues to be released and any of this could change.

Stimulus Package & Your Health Insurance

03/12/2021

Stimulus Package and Your Health Insurance:

The American Rescue Plan was signed into law by President Biden. Although there are many details to it, here is how it affects those with Affordable Care Act plans:

1. Larger subsidies for 100-400% Federal Poverty Limit (FPL). Most significantly, enrollees who are within 100 - 150% (FPL) are eligible for a $0 premium silver plan with substantial cost sharing reductions that lower deductibles.

2. Expanded Advanced Premier Tax Credit (APTC) eligibility to those above 400% FPL. The new bill caps the percentage of income paid for a Marketplace benchmark silver premium to 8.5%, which makes ACA coverage significantly more affordable for enrollees who traditionally had too high of an income to qualify for APTC.

3. APTC guarantees for enrollees receiving unemployment compensation. If an enrollee is receiving unemployment compensation, they will qualify for subsidies as if their income is 133% FPL. This means these enrollees are eligible for a silver plan with a $0 premium and significant cost sharing reductions.

4. These subsidies are retroactive to January 1st, 2021.

5. People who underestimated their income in 2020 will NOT need to pay back their APTC when they file their taxes. This is 1 time only.

Please keep in mind while politicians make rules, it takes a while for other federal agencies, insurance companies, etc to enact these rules. We will keep you updated via our newsletters and this progresses.

Congress Passes the No Surprise (Billing) Act on December 27th 2020: President Trump signed into law the No Surprise Act which prevents providers (doctors, hospitals, etc) from billing patients excessive amounts. For an example, someone goes the the emergency room and comes out with a ridiculous bill for which there is obvious price gouging. Effective 1-1-2021, the provider can no longer demand payment from the patient. Rather, they are required to work directly with the insurance company. The patient is only responsible for the copay, deductible or coinsurance that they would normally pay.

Errors in Wellmark Blue Cross Automated Payments:

3/2/2021

Errors in Wellmark Blue Cross Automated Payments: We have had several customers notice that Wellmark Blue Cross has missed their automated bank account payment. Wellmark states that they send out a notice to the member. However, none of our customers have ever received this notice. Please be aware of this situation and make sure that your premiums are withdrawn so that your coverage does not terminate. If you do notice a payment not withdrawn, please notify us right away. Wellmark should draft premiums on either the 1st of 5th of every month.

Biden to re-open Affordable Care Act Marketplace as early as February 1st! Announcement expected to be made this week.

Biden Administration To Reduce Options To Non-Affordable Care Act Plans

1/26/2021

Biden Administration To Reduce Options To Non-Affordable Care Act Plans: Many of you who are enrolled on the new 3 Year Traditional Plans offered by National General and United Health Care via President Trump's executive order are aware of the political drama that plays out with these "Annual Plans." Although they have a substantially lower premium than the Affordable Care Act plans for those who do not qualify for subsidies, we have received word that the Biden Administration will limit these plans as soon as the end of 2021. How much will that limitation be? That information was not provided. However, it was stated that any existing 3 Year Plans will not be terminated early. Meaning you may can continue your coverage for the remainder of the 3 years. At that point, we will need to renew your coverage in an alternative.

IRS Form 1095's Now Available

1/14/2021

IRS Form 1095's Now Available: Everyone on an ACA plan should be receiving a 1095 this month from the Marketplace / Healthcare .gov. You will want to provide the 1095 to your tax preparer. If you do NOT have an individual ACA or Pre-ACA plan you will not receive a 1095. For our customers, we can access your 1095 if you do not receive a copy.

How Will the Election Affect My Health Insurance

Dan Walterman interviewed by Roger Able of the "Behind The Wealth" podcast. What will the election bring for health insurance options? What health insurance options are available for 2021? What health insurance plan is right for me?

Oscar Health Expanding Into Iowa!

10/05/2020

Oscar Health will be the 3rd option available in Iowa as far as Affordable Care Act plans go. While we are still waiting on premium information, we have received the new 2021 plan information. The lowest deductible is $4200 and there are several plans that include various doctor and prescription copays. The plan does utilize a network that is predominantly Mercy providers and hospitals.

Wellmark Blue Cross Announces Rate Decrease on Affordable Care Act Plans

08/25/2020

Wellmark Blue Cross & Blue Shield has announced a 42% DECREASE on their Affordable Care Act plans effective January 1st, 2021!

National General to be acquired by Allstate

07/17/2020

Per National General:

On July 7, 2020, Allstate announced their intent to acquire National General Holdings Corp. The deal is the largest of Allstate's acquisitions to date and will make the combined entity the fifth-largest carrier in the independent agency market. Like National General, Allstate has a record of making acquisitions that complement their strategic objectives and drive growth.

Through this acquisition, we expect the combined entity will leverage National General's leading technology platform for the independent agency and broker channels. The acquisition will capitalize on the best that each organization brings to the market to drive scale through widened product offerings and distribution channels for both P&C and A&H markets.

Additionally, upon close, Allstate intends for National General's leadership to oversee the integration of Encompass into National General. Together, we will build products that will enable Allstate to convert existing AIA relationships to National General.

By leveraging best in class capabilities from each organization, we strive to provide agents and brokers with a leading carrier capable of writing non-standard auto to packaged auto and home to accident and health.

This is an exciting time for National General, with the deal expected to close in the first quarter of 2021. Until then, we will continue to operate and engage with you as we have, and you can expect the same service experience and focus that got us to this important milestone in our company's history.

Wellmark Blue Cross Files For 2021 Premium Increase

06/17/2020

Wellmark has filed proposed rate increases of 0 - 8.7% for plan year 2021 on their Pre-Affordable Care Act plans with the Iowa Insurance Division. If policy holders are forced to move to Affordable Care Act plan, Wellmark states the average rate increase is estimated to be 94.2% for their customers.

Grandfathered plans: 0.00% (Originally purchased prior to March 23, 2010)
Grandmothered plans 8.7%

Part of the reason is that the reinsurance taxes embedded in the premiums you paid, were never paid out as reinsurance to offset the increased claims under the ACA. Instead, it was spent elsewhere. Resulting in insurance companies cancelling plans or having massive triple digit premium increases.

Statement from Medica:

We are committed to ensuring our Individual & Family plan (IFB) members have uninterrupted access to the health care and medications they need during these challenging times. We will be communicating to IFB members that if they are having trouble paying their monthly premium, they can reach out to Medica for help.

If you have any questions, please contact Broker Services at 1-866-752-0945

CARES Act - Additional Health Savings Account Coverage

04/22/2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, contains important updates on the use of health savings accounts (HSAs).

The CARES Act restores the ability to use HSAs, FSAs and HRAs to purchase certain Over-The-Counter drugs and medications that was removed with the Affordable Care Act. These OTC drugs include aspirin and other pain medications, allergy medication, etc., without a doctor's prescription.

For the first time, menstrual care products are considered qualified medical expenses for payment or reimbursement with an Health Savings Accounts, Flex Spending Account or Health Reimbursement Account.

Both provisions for OTC and menstrual products apply to amounts paid or expenses incurred on or after January 1, 2020 and are ongoing without an expiration date.

Wellmark of Iowa and South Dakota to Offer Premium Extension for Those Impacted by COVID-19

04/09/2020

Wellmark will allow Individual and Small Business policyholders to request a 60-day grace period when making premium payments for due dates between March 17th and June 30th. If circumstances change, they may need to revisit the extensions offered. Wellmark will work with any Mid-size or Large groups on a case-by-case basis to determine appropriate and flexible payment timeframes to ensure premium payments are made as timely as possible.

Individual & Family Plans:

Any member who is unable to pay their premiums due to impacts of COVID-19 should send an email to IndividualBilling@wellmark.com, including their full name and subscriber ID. They need to state that they are unable to pay premiums due to COVID-19. A billing representative will reach out to collect further information and work to ensure benefits remain active.

Fully-insured Groups:

The group must request the extension. They need to send an email to FullyInsuredBilling@wellmark.com with the Group ID and Group name. Wellmark will also need the name of a contact person at the group and their email address. They need to state in the email they cannot pay due to the effects of COVID-19. They can also call the billing department directly with this information at 800-348-6430.

Congress Passes $2 Trillion Cares Act (The Coronavirus Aid, Relief and Economic Security Act)

03/31/2020

Congress passed a $2 trillion economic stimulus package by an overwhelming vote in the Senate and the House. President Trump is expected to sign the bill immediately.

Individuals and Businesses: The CARES Act functions largely as an economic stimulus by providing cash payments to individuals below a certain income, providing extra unemployment benefits and allowing self-employed individuals to apply for unemployment. For businesses, aid is provided through emergency grants, forgivable loans and relief for existing loans. These provisions are intended to assist employers to help them stay in business, keep employees on their payroll, and allow them to continue to support employees through employee benefits and health insurance.

Healthcare: The CARES Act also includes $100 billion for hospitals and $150 billion for state and local governments to combat the COVID-19 pandemic. The bill expands coverage beyond what was in last week's Families First bill by requiring health insurers to pay for coronavirus testing beyond those that are FDA-approved, including lab and state-developed tests as well as other tests approved by HHS.

Accessibility for telehealth is also expanded. High-deductible health plans with HSAs may now allow pre-deductible coverage for telehealth and other remote services, as well as allowing the use of HSAs for the purchase of over-the-counter medications without a prescription.

Very limited action was also taken to address surprise medical bills. Under the CARES Act, all health insurance plans would reimburse a COVID-19 test provider at the in-network rate put in place prior to the pandemic. If the provider is out of network, the health plan is to fully reimburse the provider based on the provider's own "cash price," which must be made publicly available while the public health emergency is still declared. Providers that do not post their test price publicly could be fined up to $300 a day.

Our Response to COVID-19

03/20/2020

In response to the current Corona virus (COVID-19) situation, and the requirements / recommendations of both Governor Reynolds and the CDC, the offices of Premier Health Insurance of Iowa will not be open to the public. We feel this is in the best interest of both the clients and staff.

Rest Assured: We are still open and ready to assist you. Please use preference in emailing, faxing to 319-363-3757 or calling our office at 800-383-6590.

At times, we may be working remotely with all calls and contacts still funneling through the office according to the Premier Health Insurance of Iowa contingency plan.

As the world continues to work its way to a solution, we will continue to keep you updated. Please watch our social media posts, or check our Blog for updates.

Governor Kim Reynolds signed a Proclamation of Disaster to assist in battling the Coronavirus.

Good news for those on the lower priced pre-Affordable Care Act plans through Wellmark and United Health Care. Centers For Medicare & Medicaid Services has allowed an extension on these plans until January 1st, 2022 in the state of Iowa until their coverage will be terminated under the Affordable Care Act guidelines.

State of Iowa Offers Free Vaccinations for children who do not have health insurance, or whose health insurance does NOT cover vaccinations, under the Iowa Vaccines for Children program.

Premier Health Insurance of Iowa Recognized by the Marketplace / HealthCare.gov and the Centers For Medicare & Medicaid Services

Premier Health Insurance of Iowa Recognized by the Marketplace / HealthCare.gov and the Centers For Medicare & Medicaid Services

02/06/2020

Premier Health Insurance of Iowa Recognized by the Marketplace / HealthCare.gov and the Centers For Medicare & Medicaid Services: Premier Health Insurance of Iowa & Dan Walterman were recognized by Randy Pate, Deputy Administrator of the Centers for Medicare & Medicaid Services, and the Marketplace / HealthCare.gov for their leading roll in the 2020 ACA Open Enrollment.

Iowa Insurance Division No Longer Allows 3 Month Short Term Plans

01/28/2020

Iowa Insurance Division No Longer Allows 3 Month Short Term Plans. In 2015 President Obama limited short-term "annual" plans from 364 days to 90 days. On October 2nd 2018, President Trump extended these plans out to 3 years. In November 2018 the Iowa Insurance Division eliminated all options longer than 3 months. Now they have extended these plans back out to 3 years and have eliminated any options 3 months or less ....well.....at least we're in the right direction this time!

Dan Walterman interviewed by Adam Sullivan of The Gazette concerning the new 3-year short term limited duration plans offered by President Trump to combat the extreme costs of the Affordable Care Act plans for those who do not qualify for tax credit subsidies. It is interesting that the Kaiser Family Foundation's estimates the lowest priced Silver plan in Iowa is $211 for an individual and $746 for a family of 4. The reality is the lowest priced Affordable Care Act plan for a 45 year old individual is $642 and $1964 for a family.

The Iowa Insurance Division has approved National General to offer the new 3 year short-term limited duration plans. These plans provide a much lower price than the Affordable Care Act plans for those who do not qualify for a tax credit subsidy. A variety of plans are offered, including copay plans and more catastrophic deductible plans. Contact us for quotes and plan information.

I think we can all agree that health care providers should be required to provide the cost of their services and procedures to patients. When we purchase a gallon of milk at the store we know the price. Why can't we receive the price of what a hospital charges until we receive our actual bill? Anyone who has ever tried to inquire about the pricing of a specific procedure knows the run-around one receives between the hospital and insurance companies. Luckily for the consumer, this is about to end. Federal regulations that were finalized November 15th 2019 will require hospitals to make public their prices starting in 2021.

Several healthcare reform proposals being considered would significantly change the way that Iowans receive their health insurance. One of these proposals - Medicare for All - would eliminate private insurance and create a healthcare system fully run by the government. Now, a proposal called the Medicare "public option" is being discussed as an alternative. But this proposal would also have far reaching impacts - and according to a new study, would drive out most of the private plans we know today.

Not only would the public option change the Medicare system as we understand it, the proposal would create government-run plans acting alongside the existing private marketplace. A study by FTI Consulting and the Partnership for America's Healthcare Future further explains:

The public option would create government healthcare plans, which individuals can buy into. These plans would mostly likely be set up with artificial prices determined by the government, forming a "two-tier" system. Because government payments pay providers much lower than private plans, the public option would "crowd out" private coverage and eventually lead to a one-size-fits-all system - just like Medicare for All but on a longer timeline, reducing consumer choice and decreasing quality of care.

The study found that by 2050, Iowa could end up being one of over 30 states to likely lose all private insurance plans. When examining the changes in our healthcare system, it's important to look at the long-term impacts of your own plan.

Centers for Medicare and Medicaid Services has announced the opportunity for certain states to offer additional wellness benefits for those enrolled in Affordable Care Act Plans.

The Surgery Center of Oklahoma has been cutting health care costs since 1997 with few, if any, price increases.

A highly recommended Podcast with Dr. Peter Attia & Dr Marty Makary dissecting the issues with doctors, hospitals, insurance companies, pharmaceutical companies, pharmacy benefit managers and even brokers and agents.

Premier Health Insurance of Iowa Qualifies for Circle of Champions by Healthcare.gov!

9/26/2019

Once again Premier Health Insurance of Iowa has qualified for the Healthcare. gov / Marketplace Circle of Champions by assisting consumers in lowering their health insurance premiums through available tax credits and subsidies.

Listen to an Interview with Jeff Stein of KXEL concerning Medicare-For-All, public option, rising health care costs, and the new 3 year plans available in October.

Iowa Insurance Commissioner states "ACA individual health insurance market has become unaffordable..." All new lower priced 3 year Non-ACA plans with essential benefits will be offered! Contact us for more info!

Iowa has been the center of attention when it comes to healthcare reform. Many proposals, including Medicare for All, a public option, or a Medicare buy-in would drastically change the way our healthcare system works. Not only do many Iowans rely on private or employer health plans, but Iowa also has a low Medicare reimbursement rate that serves as a continued challenge within the state.

A new study covered by the Cedar Rapids Gazette highlights the impact of what one of these one-size-fits-all proposals would look like in Iowa. A public option proposal has been touted as an alternative to single-payer health care, but new challenges would arise within Iowa's healthcare system.


The Partnership for America's Healthcare Future published this study completed by Navigant, which determined that 52 of Iowa's 90 rural hospitals will be at a "high risk of closure" under a public option plan.

Wellmark Requests 0% Rate Increase on Pre-Affordable Care Act Plans in 2020

9/5/2019

Wellmark Blue Cross and Blue Shield has requested a 0% rate increase for the Pre-Affordable Care Act Grandfathered plans. Unfortunately, the Affordable Care Act longer no allows these plans to be purchased. However, those one them experience substantially lower premiums compared to the Affordable Care Act plans when not receiving a tax-credit subsidy. Please be aware, that these plans may still have an age based rate increase.

Medica Files For Rate DECREASE

No, that was not a typo. Medica has filed for an average 11% decrease in their 2020 ACA premiums.

The IRS has allowed additional preventative care benefits for HSA participants to be covered without requiring them to meet a deductible.

Wellmark Files for 2020 Rate Increases

Wellmark has filed a proposed January 1st 2020 rate increase with the Iowa Insurance Division due to additional Affordable Care Act taxes, more significant health conditions, and increased prescription use.

The House of Representatives voted 419-6 to pass H.R.748, the Middle Class Health Benefits Tax Repeal Act of 2019. This bill would repeal the 40% excise tax on health insurance premiums under the Affordable Care Act that is scheduled to take place in 2022.

Per President Trump's Executive Order, the US Departments of Health & Human Services, Labor & Treasury has issued new policy allowing greater access to HRA's. This allows a small-business and self-employed to deduct healthcare expenses.

A public hearing has been scheduled for Wellmark's requested rate increase on their Pre-Affordable Care Act plans.

How Drug Pricing Actually Works

Drug prices are skyrocketing and there is a complete lack of transparency within the industry. This creates high costs to consumers, increases health insurance premiums and finger pointing in every direction. Congress has passed the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act to help combat these high prices. In addition, President Trump is proposing an executive order to create medical transparency and remove the industry's secret negotiations and pricing. We encourage everyone to watch the video below to see how drug pricing actually occurs.

Short Term Limited Duration Plans Extension:

As many of you know, these have been not only a great way to reduce premiums by 50 - 75% of Affordable Care Act plans, but also a hot political debate. President Obama limited them to only 3 months. President Trump extended them to 36 months contingent upon state approval. The state of Iowa allowed 12 month plans for a short time, then limited them back down to 3 months. However, Iowa has now agreed to 36 month plans, and allow them to offer better coverage as well. There are several insurance companies that have filed to offer these plans in Iowa. We are currently waiting for the Iowa Department of Insurance to approve them.

Health Reimbursement Arrangements:

Once eliminated by the Affordable Care Act, these plans allow for employers to provide tax-free reimbursement to employees for health insurance premiums and other health care expenses. US Departments of Health & Human Services, Labor & Treasury issued a new policy allowing for HRAs once again. We will keep you informed of the final rules. For more information "View Here"