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Taxpayers Who Lost Health Insurance Due To Tax Compliance May Be Eligible For Special Enrollment Period With Federal Marketplace

Consumers who tried but were unable to enroll in 2016 health insurance coverage through the federal marketplace and receive an Advance Premium Tax Credit (APTC) may now be able to re-apply and enroll in affordable health insurance coverage through a special enrollment period ending March 31, 2016.

H&R Block (NYSE: HRB) advises taxpayers who received APTC for 2014 to file complete and accurate 2014 returns to qualify for this special enrollment period. To ensure access to the APTC to help pay for coverage on the federal marketplace next year, taxpayers should file a complete and accurate 2015 tax return by April 18.

The federal marketplace special enrollment period will help taxpayers who were denied APTC in 2016 and dropped coverage or declined to enroll because they could not afford coverage. Taxpayers who received the APTC in 2014 and did not file a complete 2014 tax return are ineligible for the credit in 2016. Now, these taxpayers can re-apply for the APTC and enroll in 2016 coverage if:

  • they were not enrolled in health insurance coverage through the federal marketplace as of January 31, 2016,
  • they file their 2014 tax return and reconcile their 2014 APTC and
  • they attest to the marketplace that they filed a 2014 return reconciling their APTC.

"Thanks to this special enrollment period, consumers who had to cancel their 2016 health insurance because it was too expensive without the APTC can now re-apply and enroll in coverage, but only if they file their 2014 return and reconcile the APTC they received in 2014," said Mark Ciaramitaro, vice president of H&R Block taxes and health care services. "The key to getting affordable health insurance through this special enrollment period is a correctly filed tax return. Once again, we see that taxes and health insurance go hand-in-hand."

Taxes are the key to affordable health insurance now and in the future

This year is the first year when taxpayers could lose their APTC if they had failed to file a complete tax return for a previous year they received the credit. Because this is the first year consumers are facing this issue, the federal marketplace is offering a special enrollment period to help consumers understand and meet the requirement.

"Consumers not only need to file their 2014 return to qualify for this year's special enrollment period, but they also need to make sure they file a 2015 return so that they do not find themselves in the same boat next year, when the marketplace is less likely to extend a special enrollment period," said Ciaramitaro.


Uninsured Texans Say Cost Of Health Insurance Too High

Almost 70% of uninsured Texans said the high cost of health insurance is the reason they remain uninsured, according to a report released by Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation (EHF). The report found less than 20 percent of uninsured Texans said they simply don't want health insurance.

Previous studies by the Baker Institute and EHF showed almost 20 percent of adult Texans are uninsured. This latest report shows cost was cited as the primary reason across all ethnic groups, income levels and ages for not having health insurance. Researchers found just 6 percent of uninsured Texans said a lack of information about health insurance options prevented them from becoming insured.

"An important finding of this survey is there's no significant information barrier for Texans who still don't have health insurance," said Elena Marks, EHF's president and CEO and a nonresident health-policy fellow at the Baker Institute. "Just two years ago, it was a much different story. As the Affordable Care Act (ACA) coverage options went into effect, lack of information about the law and the new health insurance options was widespread."

Funding from the federal government, some local governments and philanthropy supported successful efforts to educate the public about the ACA health insurance marketplace plans, Marks said.

"More than 1 million eligible Texans enrolled in health insurance through those plans," Marks said. "The significant drop in the state's uninsured rate is not surprising in light of those efforts. But as this latest report shows, Texas still has a long road ahead to be able to benefit from ACA coverage opportunities. Medicaid expansion alone would allow more than 1 million additional Texans to have health insurance."

Researchers found that cost was cited as a prohibiting factor of getting health insurance slightly more often among the oldest (ages 50-64) and youngest (ages 18-30) groups than the middle-aged (ages 31-49) group -- 75 percent compared with 64 percent.

"Premiums are on average higher for older groups than their younger counterparts, which would make affordability a more significant issue," said Vivian Ho, the chair in health economics at the Baker Institute and director of the institute's Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "Overall, young people earn less than older people, so even well-priced insurance plans seem less affordable."

The report also found 27 percent of uninsured adults between the ages of 31 to 49 said they did not want health insurance. This rate was more than double that of older and younger groups in Texas.

The report is the 18th in a series on the implementation of the ACA in Texas co-authored by Marks and Ho.

The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This report is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and September 2015.

The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health-insurance coverage and related health outcomes. The Baker Institute and EHF are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas).

The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.


8 Million U.S. Employees Enrolled In Private Health Insurance Exchanges

The number of people who enrolled in private health insurance exchanges – an online marketplace for people to choose their employer-sponsored benefits – for 2016 increased 35 percent from last year, to approximately 8 million, up from [approximately] 6 million in 2015.

“As administering health benefits becomes increasingly costly and complex, employers will explore new models to reduce cost and meet consumer demand for greater choice and more robust digital experiences,” said Rich Birhanzel, managing director of Accenture’s Health Administration Services. “The extent to which private exchanges succeed at differentiating themselves and proving their value over traditional benefits delivery plans will ultimately determine their future growth.”

Accenture’s research indicates that the growth of private health insurance exchanges continues to be fueled by midsize companies with 100 to 2,500 employees. The rate of adoption among large employers did grow slightly in 2015, but many have been on the fence in determining whether to adopt private health insurance exchanges.

“Private health insurance exchanges have a unique opportunity to capitalize on the market and regulatory forces that are compelling employers to change their approach to benefits,” Birhanzel said. “If current vendors can deliver on the key elements of a private exchange, they can capture share in a market that will continue to grow. If they cannot deliver meaningful differentiation, legacy providers will evolve to meet the market and regulatory needs that are driving the demand for private exchanges.”


For the fourth consecutive year, Accenture conducted an analysis of U.S. enrollment in private health insurance exchanges, focusing on individuals and dependents under the age of 65 who receive group health insurance through an employer. 2015 enrollment was calculated by assessing enrollment activity in private health insurance exchanges through December 31, 2015.



Significant Storm Events In The U.S. And U.K. Contribute To $4bn December Insurance Bill

Aon Benfield's catastrophe model development team launches the latest edition of its monthly Global Catastrophe Recap report, which evaluates the impact of the natural disaster events that occurred worldwide during December 2015

The study will be shortly followed by Impact Forecasting's Annual Global Climate and Catastrophe report – scheduled to be launched on January 13 – which will offer a comprehensive analysis of the natural disaster events of 2015, and whose preliminary data reveal that despite a higher than normal number of disasters, overall losses were below normal on both an economic and insured loss basis. The United States accounted for 60 percent of all global insured losses in 2015.

The December catastrophe report reveals that a complex weather pattern impacted multiple regions of the United States, killing at least 64 people. Parts of the Midwest, Plains, Southeast, Rockies and Northeast were all impacted by the inclement weather, though the states of Missouri, Texas, Illinois, Arkansas, Oklahoma, Mississippi, Tennessee, Alabama,Kentucky and Indiana were among the hardest-hit.

Preliminary estimates suggest that total economic losses from the weather events during the month will exceed USD4.0 billion, with insured losses likely to approach or exceed USD2.0 billion. The Insurance Council of Texas reported losses of USD1.2 billion in the Dallasmetropolitan area alone.

The severe weather pattern resulted in at least 58 tornado touch-downs, historic flooding in the Mississippi Valley and Midwest, and record snowfall and ice that led to extensive travel disruption, as well as hail and damaging winds.

Meanwhile, rainfall from a series of North Atlantic storm systems led to extensive flooding across the United Kingdom and Ireland throughout the month. The arrival of windstorms Ted and Eckard – also known locally as Desmond and Frank – brought even more flood and wind damage. The hardest-hit areas included a large swath of southern Scotland, northernEngland, and Wales, where thousands of homes endured varying levels of flood inundation.

Various published reports, including from the Association of British Insurers, indicated that preliminary insured losses in the UK were expected to exceed GBP1.5 billion (USD2.2 billion), while overall economic losses were forecast to be around GBP2.8 billion (USD4.0 billion).

Further natural hazard events to have occurred during December include:

  • Areas of Argentina, Paraguay, Uruguay and Brazil endured their worst flooding in at least 50 years, which killed at least 16 people and resulted in preliminary economic loss estimates in excess of USD200 million.
  • Typhoon Melor made multiple landfalls in the Philippines, killing at least 42 people and injuring 24 others. The Philippines' National Disaster Risk Reduction and Management Center reported economic damages to agriculture and infrastructure alone at PHP6.5 billion (USD140 million).
  • A wildfire in the Australian state of Victoria destroyed at least 116 homes. The Insurance Council of Australia declared an insurance catastrophe, with preliminary insured losses listed at AUD53 million (USD38 million), and total economic losses expected to exceed USD100 million.
  • The Ethiopian National Risk Management Coordination Commission announced that it sought USD1.4 billion to deal with its worst drought in 30 years. At least 10 million people were affected.

To view the full Impact Forecasting December 2015 Global Catastrophe Recap report, please follow the link:  

Along with the report, users can access current and historical natural catastrophe data and event analysis on Impact Forecasting's Catastrophe Insight website, which is updated bi-monthly as new data become available:


Rate Regulation Needed To Protect California Policyholders From Crushing Medical Debt

A Kaiser Family Foundation/New York Times survey showing that one-in-five working-age Americans ran into serious financial difficulties trying to pay medical bills despite being insured is yet more evidence that California needs health insurance rate regulation.

In the survey, 62% of those who had medical bill problems say the bills were incurred by someone who was insured, with 75% saying that the amount they had to pay for their insurance copays, deductibles, or coinsurance was more than they could afford. They reported skipping or putting off other health care in the past year because of the cost, such as postponing dental care, skipping doctor-recommended tests or treatments or not filling a prescription. For out-of-network charges, 69% said they were unaware that the provider was not in their plan's network when they received the care.

Consumer Watchdog said that PPO health insurance policies with very narrow provider networks and extremely limited out of network coverage are a new form of "junk insurance." The nonprofit, nonpartisan group said patients looking for choice in these PPO polices increasingly cannot find competent "in network" doctors then face huge medical bills due to extraordinarily limited coverage for out of network services.

"New PPO policies with very limited providers in-network and extraordinarily low benefits out of network are creating new express lanes to bankruptcy for families," said Jamie Court, president of Consumer Watchdog, who has sought reforms to stop premium increases and benefit changes with state approval. "Until insurance companies are forced to justify that their premiums, co-pays and policy benefits are reasonable, too many families will be forced to choose between paying medical bills and other necessities of life, like paying their mortgage. These findings should shake up the statehouse and revive the regulation debate."

In 2014, Consumer Watchdog sponsored Proposition 45, which would have allowed the state's elected insurance commissioner to make health insurance companies justify their rate hikes under penalty of perjury, and to reject excessive rate increases. Insurance companies spent $56 million to defeat the measure that would have regulated the rates the way auto, home and business rates are inCalifornia, and received 41% of the vote, despite a record-low voter turnout.

Auto, home and small business insurance rates are regulated in California under Proposition 103, which was also sponsored by Consumer Watchdog, which has saved ratepayers over $100 billion since it took effect, according to the Consumer Federation of America.

Other findings in the Kaiser/New York Times survey include:

  • Among the insured with problem medical bills, a quarter (26%) say they received unexpected claim denials; and about a third (32%) say they received care from an out-of-network provider that their insurance wouldn't cover.
  • Among those with private insurance, those in higher deductible plans are more likely to report medical bill problems than those in plans with lower deductibles (26% versus 15%).
  • Most (61%) of those with medical bill problems say they've had difficulty paying other bills as a result of their medical debt, and more than a third (35%) say they were unable to pay for basic necessities like food, heat, or housing. Almost six in ten of those with problems paying medical bills (58%) say they've been contacted by a collection agency in the past year.

Read the Kaiser Family Foundation/New York Times survey here.



USA Travel Advice: Changes To Visa Waiver Programme (VWP)

18 December 2015 and the US Congress passed a Bill updating the requirements for the Visa Waiver Programme (VWP). Under the new rules, with effect from 1 April 2016, all travellers wishing to enter the US under the VWP will need to hold a passport with an integrated chip.

Around 3.8 million British nationals visit the United States every year. Most visits are trouble free. Take out comprehensive travel and medical insurance before you travel.

The US Visa Waiver Programme (VWP) allows most British Citizen passport holders to visit the US for up to 90 days without a visa, but you may need to get authorisation from the Electronic System for Travel Authorisation (ESTA) before you travel. If you don’t qualify for the VWP, you’ll need to apply for a visa from the nearest US Embassy or Consulate. 



UPMC Health Plan Wins Excellence In Analytics Award

UPMC Health Plan was recognized for excellence in analytics by the International Institute for Analytics (IIA) at its annual Chief Analytics Officer Summit held in Las Vegas, Nev., last month.  

UPMC Health Plan was awarded the IIA's annual Excellence in Analytics Award, which acknowledges trailblazing companies that go above and beyond to develop advanced analytics capabilities. UPMC Health Plan was chosen for its "Learning Engine" tool, which provides continuous improvement of the analytics that optimize the quality of care for UPMC Health Plan members.    

"UPMC Health Plan is delighted to receive this honor and humbled to be in the company of the other outstanding finalists," saidPamela Peele, Ph.D., Vice President, Health Economics and Chief Analytics Officer for UPMC Health Plan. "It is rewarding to be acknowledged for an innovative tool that helps our members and enables our clinicians."

Other finalists for the award included Dignity Health, Dow Chemical, Enova International, and XL Catlin. Past winners of the award have included the Ford Motor Company, Proctor & Gamble, UnitedHealth Group, and Intermountain Healthcare.

"UPMC Health Plan is a shining example of how to advance analytics and derive measurable impact," said Jack Phillips, Co-Founder and CEO of IIA. "We salute Dr. Peele and her team and congratulate them on winning."

Head of the judging panel was the notable Tom Davenport, the President's Distinguished Professor of Information Technology and Management at Babson College who has been named one of the top three business/technology analysts in the world and one of the 100 most influential people in the IT industry. He has written or edited seventeen books and over 100 articles for Harvard Business Review, Sloan Management Review, the Financial Times, and other publications and writes a weekly column for the Wall Street Journal's Corporate Technology section.

All award contenders were nominated by IIA's community of analytics experts and practitioners who recognized each organization's use of analytics to drive measurable business impact. IIA, which is based in Altamonte Springs, Fla., is an independent research and advisory firm for organizations committed to accelerating their business through the power of analytics. 


Expanding Health Care Options For Patients With And Without Health Insurance

Vanguard Medical Group has launched a Direct Primary Care (DPC)  program designed to help adults, children and families without health insurance. Those who have health insurance yet want to take more control of their health care-related finances also can benefit from DPC. DPC is available through Vanguard Medical Group’s Cranford, Montville, North Haledon and Verona offices.

It will be available to patients in the Lincoln Park office in the near future.

“Vanguard Medical Group recognizes that one size does not fit all in health care, and is dedicated to offering services and fee structures that accommodate patients with or without health insurance,” said Robert Eidus, M.D., president of Vanguard Medical Group.

“With DPC, patients who do not have medical insurance can engage in a health care program that, for a monthly fee and an annual commitment, entitles them to a range of comprehensive, primary and preventive care in our offices.”

Vanguard’s DPC primary care services include an annual wellness visit, unlimited sick visits, chronic condition management, electrocardiogram testing, select office-based surgical procedures, gynecological care, care for infants and children, office-based lab work, after-hours care, same-day appointments, weekend hours, and providers’ 24/7 on-call services.


Molina Healthcare Completes Acquisition of Providence Human Services and Providence Community Services

Molina Healthcare, Inc. announced that it has completed the acquisition of Providence Human Services, LLC (PHS) and Providence Community Services, LLC (PCS), formerly part of The Providence Service Corporation (NASDAQ: PRSC), expanding Molina’s capabilities in behavioral and mental health services. The two entities, which will operate as a wholly owned subsidiary of Molina Healthcare under the brand name PathwaysSM, represent one of the largest national providers of accessible, outcome-based behavioral and mental health services with 6,800 employees and operations in 23 states and the District of Columbia.

“We are excited to welcome our PHS and PCS colleagues to Molina. The acquisition expands our ability to more closely integrate our members’ physical and behavioral health benefits and manage care in a more effective manner, while directly influencing outcomes for the better,” said J. Mario Molina, M.D., president and chief executive officer of Molina Healthcare. “Molina and Pathways share a common strategic vision and philosophy, making them well aligned to focus on delivering quality health care services to people receiving government assistance.”



State-Of-The-Art Radiation Oncology Centre Opens In Manhattan

NewYork-Presbyterian, with Weill Cornell Medicine, has officially opened the NewYork-Presbyterian/Lower Manhattan Cancer Center, a freestanding, state-of-the-art radiation oncology center located on 21 West Broadway in Manhattan. The NewYork-Presbyterian/Lower Manhattan Cancer Center is the newest site providing cancer care available at the Stich Radiation Oncology Center at NewYork-Presbyterian/Weill Cornell Medical Center and at Weill Cornell Medicine, and is the only radiation oncology center in Lower Manhattan.

“Patients in Lower Manhattan will now have access to the exact same quality of care available at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, without the need to miss work or skip other obligations to receive treatments,” said Dr. Silvia Formenti, radiation oncologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center and the chair of the Department of Radiation Oncology at Weill Cornell Medicine. “This is a unique environment which blends top care with an enhanced patient experience, catering to the busy schedules of residents and workers downtown.”

The NewYork-Presbyterian/Lower Manhattan Cancer Center features the latest radiation therapies, allowing the care team to customize treatment to each individual patient’s unique cancer and individual tumor. Targeted therapies focus treatment entirely on the patient’s tumor, while state-of-the-art radiosurgery technology enables shortened treatment times.

As part of the Department of Radiation Oncology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, patients at the Lower Manhattan Cancer Center will benefit from the ongoing clinical and translational research focused on a variety of treatment areas including precision medicine approaches to radiation oncology, combining radiotherapy with immunotherapy and other modifiers of the tumor environment to personalize care for each patient.

Radiation therapy at the NewYork-Presbyterian/Lower Manhattan Cancer Center occurs in a spa-like atmosphere to ease the anxieties of patients and promote optimal recovery. Complementary cancer therapies include on-site aroma and Reiki therapy, mediation, yoga and acupuncture.

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