President Biden Moves Forward To Limit Individual Non-Affordable Care Act Options

Please note we are not making political statements, we are simply stating what has happened and how it will affect our customers.

As we previously wrote about, President Biden's proposal to limit Allstate and United Health Care "term" plans to 3 months from President Trump's 3 years, has gone through and will take effect September 1st, 2024 for new plans only. Existing plans will continue for the full 3 years. Many people have taken advantage of the term plans, myself included, to lower their health insurance premiums as much as 75%. The political rhetoric was thick with the President even calling people who enrolled in these plans "suckers." I guess that's me included!

Most of you have renewed your plans over the years as we were not sure when this new rule would take effect, but knew President Biden had signed an order to limit these options. We thank you for your promptness. If anyone would like to renew their coverage again for another full 3 years before this rule takes effect, please reach out to us in July and we will renew your plan for another 3 years effective from August 31st, 2024

We are noticing that the Marketplace / Healthcare .gov has randomly lowered people's tax credit for no reason. Even if you still qualify for the higher tax credit. The good news is that most people still qualify for the higher tax credit. This should be returned when filing taxes. (We are not tax advisors so please consult a tax advisor for this). We can also "renew" your plan by adjusting your income. This typically applies the correct tax credit to your premiums.

If you would like to "renew" your plan by adjusting your income, please reach out to us.

Wellmark Blue Cross Decreasing Premiums January 1st On Affordable Care Act Plans: Wellmark Blue Cross has requested a 7% DECREASE in premiums on Affordable Care Act plans for plan year 2024 for the Iowa Department of Insurance. We fully expect this to happen.

President Biden Moves to Eliminate Individual Health Insurance Options Except for Affordable Care Act plans:

For customers on Allstate (National General) or United Health Care that were effective since 2020, this applies to you.

In a recent statement President Biden stated anything but Affordable Care Act plans are "junk insurance" and that people were "suckers" for purchasing these. For the record, we are NOT making political statements. However, I would be one of those "suckers" as my 3 year term plan provides better coverage than a comparable ACA plan at the price of $438 per month for my family rather than the ACA monthly premiums of $1650. The government is currently taking "comments" for 60 days concerning the cancellation of any of these plans. At the moment, the proposal is to limit the 3 year term plans allowed by President Trump to 3 months with eligibility of renewing for only 1 month. Then the federal government will mandate that your health insurance is cancelled. We will keep you updated as this proceeds. Right now we do not expect the rule to go into effect until 2024. We highly recommend renewing your coverage for a full 3 years January 1st to extend your 3 year time limit as long as possible as the proposed rule will not affect existing plans. For those who would like to make a comment, you can do so Here.

Dan Walterman Invited To Discuss Healthcare.gov in Washington D.C.: On May 24th, Dan Walterman was invited to Washington D.C. by the Centers for Medicare and Medicaid Services (CMMS), along with a handful of other advisors, to discuss Healthcare.gov and the Affordable Care Act. Dan was able to bring forth some of the issues many of our clients have expressed concerning the Affordable Care Act operations. Although Dan has been invited to discuss these topics multiple times before, this is the first time the Biden Administration has invited any advisors to discuss their focus and agenda.

Medicare Breach of Protected Health Information: Not surprisingly, as with many federal agencies, a breach of privacy occurred with Medicare's outsourced Medicare eligibility and entitlement records processing company, Healthcare Management Solutions, LLC. Because of this, Medicare will be mailing new cards to those affected. Protected information involved in the breach include:

Name
Address
Date of Birth
Phone Number
Social Security Number
Medicare Beneficiary Indentifier
Banking Information
Medicare Entitlement, Enrollment, & Premium Information

GoodRx Ordered to Pay $1.5 mm For Sharing Info: As many of you know, we like GoodRx. The discount on generic prescriptions often makes them cheaper than the insurance itself. However, we have always warned NOT to create a GoodRx account or download the ap. Here is the reason why.

IRS Releases Final Rules On "Family Glitch" Tax Credits: October 11, 2022 the IRS released a final rule that changes the way health insurance affordability is determined for member's of an employee's family, starting January 1st 2023. Many employee's find the cost of "family coverage" through an employer is extremely expensive. With the new calculation of "affordability" many of those family members may now qualify for a tax credit to lower their premium.

Insurance Companies Sending Out Renewal Letters: Many insurance companies will be sending out renewal notices within the next 2 weeks for January 1st effective dates. Once you receive your renewal premium, if you have any concerns, please let us know. We can always "shop" all of the major companies available.

Inflation Reduction Act and What It Means To Healthcare:

There is a lot going on with this Act, but we will stick to the healthcare side only. Foremost it has maintained the increased Affordable Care Act tax credits per the American Rescue Plan Act. Without continuing these tax credits, those on Affordable Care Act "Obamacare" plans could expect to see 10- 200% premium increases this fall. Here's a few other points of what it affects:

The enhanced premium tax credits, which eliminated the subsidy cliff and increased the tax credit amount for people at all income levels, will continue another three years. That means that clients receiving financial assistance won't see a big price increase this fall.
Medicare will be able to negotiate drug prices, which should help save some seniors money.
Medicare Rx out-of-pocket costs will be capped at $2,000.
Lawmakers failed to reach an agreement on capping insulin costs for people with private health insurance.

National General was previously purchased by Allstate. They are now rolling out the Allstate name and branding. Clients will receive new cards and all communications will be Allstate branded.

Members will now log in and register accounts at www.MyAllstateHealthSolutions.com

United Health Care Experiences Billing Issues in September: On September 1 and 2, 2022, an error occurred with our payment processing showing some policies as not paid, even though successful payment was collected. This caused some plans to show as terminated in our system. Some members also received a letter automatically generated by this incorrect indicator. About 5,000 Short Term Medical, TriTerm Medical, long term and select ancillary plans were affected.
Summary of action:
We are working to resolve this issue and return affected plans to proper active/paid status. We anticipate having this issue fully resolve by early next week.
Our claims team is reviewing all affected claims to ensure they are properly handled, and applicable benefits applied, if eligible.
No action needed from client(s).

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

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.

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.

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 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: 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":
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:

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: 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": 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.

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.

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.

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

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: 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: 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: 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:

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: 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 (319) 893-5390 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 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: 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: 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!

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 (319) 893-5390 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 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: 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: 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: 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.

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

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 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

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 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 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.

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 (319) 893-5390.

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.

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.

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 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.

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 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.

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"