Wed, 04 Aug 2021 16:23:55 +0000 en-US hourly 1 Colorado Standardized Health Insurance Plan (HB21-1232) – State of Reform Mon, 02 Aug 2021 18:22:30 +0000

Colorado’s elected officials made their state the third to pass legislation requiring strictly regulated health insurance offers. As was the case in Washington and Nevada, the push came from supporters of a “public option,” although the final bill (HB21-1232) takes advantage of private coverage, not private coverage. public insurance.

None of the three states adopted a pure version of the public option due to the operational and political challenges of having a state-administered plan in place. Instead, they demanded the state’s existing private insurers comply with various requirements. In the Colorado case, state officials instructed carriers to offer a new “standardized health benefit” alongside their other policies on terms drafted by the insurance commissioner.

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Colorado’s law is controversial because of the wide latitude given to state officials to intervene in the plan. The general approach was to impose a set of general (and politically attractive) requirements without being prescriptive about the methods to achieve them. The State then has a substantial new power to intervene if private insurers do not respect the commitments of the law.

State health insurers claim the scheme is designed to fail because the numbers cannot add up. The law requires insurers to offer a generous benefit package, include many providers in their networks, and pay minimum fees for hospital services, while reducing their premiums.

The hospital association was neutral on the final bill after it was amended to place floors on their reimbursement levels. The state medical corporation was also neutral after the Senate removed the requirement for doctors to participate in the plan.

The following is a brief summary of the main provisions of HB21-1232:

  • From 2023, health insurers are required to offer standardized health plans in the same markets in which they sell individual and small group policies. New plans must be offered both on and outside of the Affordable Care Act (ACA) exchange.
  • Benefit design will be consistent across the industry and build on ACA metal levels with an expansion of pediatric services covered. The specific benefit requirements will be drafted by the state’s insurance regulator after a consultation process with industry and advocates. Primary care and behavioral health must be fully covered even before annual deductibles are met.
  • The premiums for new plans are capped. In 2023, insurers must offer coverage at least 5% cheaper than the average premium they billed in 2021 (after taking into account medical inflation in 2022 and 2023). In 2024, the savings on premiums must be at least 10% and, in 2025, 15%. In 2026 and beyond, premiums cannot increase faster than medical inflation.
  • Insurers must comply with extensive network adequacy rules to ensure easy access to care, including for populations that have historically been faced with obstacles when seeking services.
  • Insurers who fail to meet government targets need to identify the barriers preventing compliance. The commissioner is then authorized to conduct a public inquiry and impose a solution, which may involve forcing hospitals to participate and accept in payment the full level of reimbursement that the state deems appropriate.
  • Insurers must pay minimum fees to various categories of hospitals related to Medicare tariffs. The base floor for all hospitals is 155 percent Medicare. Essential access hospitals receive at least 175% Medicare, while pediatric facilities receive a minimum of 210%. Hospitals serving an above-average number of Medicare and Medicaid patients must be paid at least 185 percent of Medicare rates.
  • Participating practitioners, including physicians, must be paid at least 135% of Medicare rates.
  • Hospitals refusing to adhere to the standardized plan can be fined up to $ 10,000 per day for the first 30 days of non-compliance, and $ 40,000 per day thereafter.
  • State officials are authorized to submit a Section 1332 waiver to the federal government for any additional federal funding that may be available to support the plan.
  • The governor should appoint an advisory board with a diverse membership to provide commentary on the emerging plan.

With three states now pursuing similar plans, a pattern is emerging. The creation of a new state-administered insurance scheme – a true public option – is not possible at this time. A more achievable goal is to impose strict cost reduction requirements on existing private insurers.

The challenge will come when the goals come into open conflict. State officials want more generous coverage, broad access to providers (with payment rates far higher than Medicare pays), and lower premiums. Insurers say it is not possible to have all three, and something has to give. The only sure bet is that the debate will continue.

James C. Capretta is a columnist for State of Reform and is a senior fellow at the American Enterprise Institute.

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7th Circuit rules for masonry workers in dispute over employee benefit plans Tue, 27 Jul 2021 17:17:53 +0000

Does the priority limitation found in the Bankruptcy Code apply to every fund that solicits unpaid contributions? Or do the claims of all funds sponsored by the bankrupt employer have to be aggregated?

The 7e The Circuit Court of Appeal sided with more than a dozen masonry workers in answering this question in a ruling on Monday, finding that section 507 (a) (5) of the code does not does not require the collective evaluation of separate benefit plans.

The appeals court upheld the decision of the U.S. District Court for the Northern District of Indiana in In Re: Algozine Masonry Restoration, Inc., Algozine Masonry Restoration, Inc., v. Local 52 Chicago Area Joint Welfare Committee for the Pointing, Cleaning and Caulking Industry, et al., 20-3384, finding that the text of section 507 (a) (5) unambiguously supports the conclusions of the lower court.

Algozine Masonry Restoration Inc., a masonry grouting and restoration company, employed members of the Chicago Area Grouting, Cleaning and Caulking Industry Union, Local 52. In a collective agreement with the union , Algozine was required to make contributions to three employee benefit funds. on behalf of employees who have performed work covered by the CBA, including welfare, retirement and annuity funds. All of the funds were multi-employer benefit funds that were administered under the Employees Retirement Income Security Act 1974.

Problems arose for Algozine when it fell behind in its contributions to the funds and, in November 2016, filed for Chapter 11 bankruptcy. The funds filed separate evidence of claims under Section 507 (a) (5) for unpaid Algozine contributions on behalf of 15 employees each for provident and retirement funds, requesting $ 65,658.83 and $ 56,057.90 respectively. They also filed employee claims for the annuity fund, seeking $ 34,621.36.

The funds then amended these requests to $ 21,334.30, $ 18,453.40 and $ 11,607.16, for a total of $ 51,394.86. But Algozine argued that the funds did not account for payments made by Algozine or third parties in the 180-day period leading up to the bankruptcy application.

Either way, Algozine unsuccessfully argued that the total amount should be reduced to $ 5,556.34, claiming that the funds erred in applying the priority cap that appears in section 507 (a) ( 5) to the claims of each fund rather than to the aggregate claims of the funds.

“Despite Algozine’s best efforts to cover their tracks, Article 507 (a) (5) is straightforward. It allows “each of these” employee benefit plans to file priority claims for services rendered within the applicable time frame. The priority limit is determined by multiplying the number of employees covered by “each of these plans” by $ 12,850. From that number, the plan must subtract the total amount paid under section 507 (a) (4) in addition to payments made to any other benefit plan, ”Circuit Judge Diane Wood wrote for the 7e Circuit.

Noting that none of Algozine’s employees made a claim under section 507 (a) (4), on 7e Circuit therefore ignored this variable. The net result, he found, was that each fund’s individual priority claims were well within the limits of section 507 (a) (5) (B).

“As the bankruptcy court observed, Section 507 (a) (5)” clearly provides that in a single bankruptcy case more than one “benefit plan” may file a claim. , ie “contribution claims” and that the priority limit set out therein applies to “each of these plans”; who could only refer to – each claim filed in the case by or on behalf of an employee benefit plan. ‘ We have nothing to add to this reasoning, ”concluded Wood.

On a final point, the Appeal Board found no indication that section 507 (a) (5) relates to the actual hours worked by each employee. It made this decision in response to Algozine’s waiver argument that some employees who received benefits from the funds did not render services within the applicable timeframe and, therefore, did not work enough time. ‘hours to be included in the priority claims of the funds.

” On the contrary : ‘[a] a simple reading of § 507 (a) (5) shows that it provides an overall limit of recovery under this provision[,]’related to the total number of employees,’ the panel wrote.

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The Hilb Group, LLC acquires Plan Benefit Services, Inc. Fri, 18 Dec 2020 08:00:00 +0000

RICHMOND, Virginia., December 18, 2020 / PRNewswire / – The Hilb Group, LLC (“THG”) today announced that it has acquired Caroline from the southPlan Benefit Services, Inc. (“PBSI”). The transaction became effective on December 1, 2020.

Plan Benefit Services, Inc. is an independently owned and operated employee benefits consulting, management and brokerage company since 1986. In connection with the transaction, Branford Armstrong and PBSI Associates will join THG’s South East operations and continue to work from their current location in British Columbia, South Carolina.

“With our tradition of excellence, we are confident that joining THG will allow us to provide our clients with additional resources and the support of a national brokerage,” said Branford Armstrong. “While they will continue to work with a team they know and trust. “

“We look forward to partnering with the innovative team of professionals at PBSI,” said Ricky spiro, CEO of THG. “PBSI is committed to providing tailored benefits solutions and sound advice; this corresponds perfectly to the values ​​of THG. “

About THG: THG is a leading property and casualty insurance and employee benefits brokerage and advisory firm headquartered in Richmond, Virginia. THG is a holding company of The Carlyle Group, a global investment firm. THG seeks to grow through strategic acquisitions and by leveraging its resources and expertise to drive the organic growth of its acquired branches. The company has more than 100 offices in 20 states. Please visit our website at:

Media contact:
Ally Barbour
[email protected]

Contact mergers and acquisitions:
Ryan havermann
[email protected]

SOURCE The Hilb Group, LLC

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Credit Cards With Travel Benefits: Spend Your Way To Travel For Free – Here’s How Sat, 22 Aug 2020 07:00:00 +0000
Customers should divert all their spending to different credit cards for maximum benefits.

These are uncertain times: 5 months of pandemic already and it will not go away anytime soon. Covid has eaten away at summer vacation this year; everyone was forced to reschedule the trip, except critical. While it is not safe to plan unnecessary travel until the pandemic is under control, one can spend wisely to earn nearly free vacations once travel resumes. Yes, you read that right – free vacations!

Credit cards, especially travel benefit cards, when played well, can be very rewarding. There are over 150 variations of credit cards at 28 banks available in India; Over 25 cards offer travel benefits.

The best travel maps are below. Go choose the card that suits you the most.

Air India SBI Signature Card

Ideal for big spenders, this card costs Rs 4,999 (+ GST) per year. The card is optimized at 20 lakh spent per year, which allows the cardholder to accumulate at least 200,000 Flying Returns miles equivalent to 6 Delhi-Singapore tickets or 20 Delhi-Mumbai one-way tickets on the Air India network. Miles can also be redeemed for Star Alliance members, but the appeal varies by airline. Points are accumulated on all expenses (ex wallets) regardless of the merchant category. Additional benefits include 8 free visits to domestic airport lounges per year. No special privilege from Air India is a drag, but it is easily offset by other benefits.

Club Vistara SBI Card Prime

Ideal for moderate spenders, this card costs Rs 2,999 (+ GST) per year. Spending is optimized at 8 lakh per year, which earns the cardholder 9 one-way Vistara tickets (5 Premium Economy + CV miles equivalent to 4 Delhi-Mumbai tickets). The cardholder also receives a Yatra hotel voucher of 10,000 for reaching the spending milestone of 8 lakh. 12 visits to airport lounges (8 national + 4 international) are free each year. The cardholder also benefits from a free membership in Club Vistara Silver which offers benefits such as separate check-in counters, 5 kg of additional baggage, etc. Points are accumulated on all expenses (excluding wallets), regardless of the merchant category.

HDFC Bank Diners Club black credit card

More of a lifestyle card, Diners Black still offers some good travel benefits to get a place on this list. Although the perks have been gradually reduced over the past year and are now paltry compared to what they were before, this super premium card still has a big impact.

The card is billed at 10,000 rupees per year (+ GST; exempt on annual expenses of 5 lakh) and offers base rewards equivalent to 3.3% on all expenses (old wallets and EMI). A cardholder can earn up to 10 times more rewards (33% value) on the HDFC Bank “SmartBuy” portal capped at 7,500 points per month. SmartBuy offers a wide assortment ranging from Amazon, Flipkart, over 100 branded vouchers and travel bookings. Reward points can be redeemed for travel subject to a cap of 70% of the value of the reservation. Cardholders also get a number of free subscriptions like Zomato Gold, Times Prime, Amazon Prime, etc. Upon reaching the spending threshold of 80,000, the cardholder has the right to select 1,000 merchant vouchers each month. The cardholder gets unlimited lounge access and limited golf privileges. The profit quotient of this card is directly proportional to the quantum of 10X rewards transactions. This card is best suited for big spenders with a minimum annual spend of 10 lakh with at least 25% 10X rewards. A huge handicap is the limited acceptance by merchants for Diners Club cards.

American Express Platinum Travel Credit Card

A simple non-airline card with good travel benefits, suitable for small spenders. The annual fee of Rs 3,500 (+ GST) and the optimal benefits translates into an annual expenditure of 4 lakh with travel vouchers worth 15,800 and a Taj Hotels voucher worth 10k. The card holder also benefits from 4 free visits to the lounges per year. No reward points on fuel, insurance, utilities, and point-of-sale EMI conversion. Like Diners, the low acceptance of American Express cards by merchants plays a role of spoiler.

The above cards, when used on their own or in smart combination with other credit cards, can lead to accelerated rewards and significant savings on travel. Customers should divert all their spending to different credit cards for maximum benefits. If they fail to meet spending milestones, I recommend cardholders explore paying rent through various websites (Cred, NoBroker, etc.) where the only requirement is bank account and details of the PAN of recipient with money instantly credited. These websites charge a fee of 1% to 1.6% offering a direct rewards arbitrage opportunity as well as a 45 day free credit period. HDFC and SBI also have many other merchant refund offers etc. over American Express and therefore are preferred. These dream vacations are much closer than we think, they just need smart planning and spending.

(By Ashish Lath, Vice-President-Strategy & Marketing, Clix Capital)

Disclaimer: This is the personal view of the author.

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Springfield, MO’s Group Benefit Services (GBS) maintains an average claim turnaround time of less than a day for an entire year Wed, 01 Nov 2017 16:39:21 +0000 Springfield, MO, October 5, 2011 – ( – Group Benefit Services (GBS) today announced that they successfully completed a year in which their claims processing time was less than one (1) day .

GBS initially achieved its goal of processing all complaints within an average of less than a day in October 2010. Since then, GBS has maintained an average turnaround time below this threshold.

James Deren, President and CEO of GBS, reports that the company’s actual turnaround time from October 2010 to September this year was 0.67 days.

GBS ‘goal of fast turnaround times has not come at the cost of precision or quality. Mr. Deren reports that the treatment accuracy rate during this same period was 99.98 percent.

Asked about the next major goal on the horizon for GBS, Mr Deren said; “We are looking at various ways to get closer to the supplier. We cannot process claims any faster, so moving closer to the supplier level will reduce lag factors and thus reduce the liability of the plan for our clients. He further states, “Due to our claims handling results, stop-loss carriers designate GBS as a preferential TPA which offers our customers special reduced reinsurance rates.”

Group Benefit Services (GBS) is an employee administration and benefits technology company located in Springfield, MO. GBS provides employer-based services, which include benefits advice and claims administration, project-based services that include the creation and management of Association Group and Trust programs, and also provides employment services. outsourcing for the insurance sector.

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