How can medical insurers, and insurers in other health-related markets, not innovate at a time like this?
These days, the bravest, most innovative thing an individual or company in health-related markets can do may be just to keep putting one foot in front of the other on the path to getting out of the chaos.
To sell the products directly affected by the Patient Protection and Affordable Care Act (PPACA) is to gain a deeper understandng of what it was like for Alice to fall down Lewis Carroll’s rabbit hole.
Readers in the health insurance industry might be forgiven for pleading, “Couldn’t we have some plain vanilla products that stay exactly the same for, oh, a week?”
But, for National Underwriter Life & Health’s inaugural “Insurance industry product innovation feature,” we found three categories of products that are, in our opinion, even less like the others than all of the others.
People in the benefits market have been talking about a mysterious new breed of “skinny health plans” for years. Now Fringe Benefit Group has come out with a real-world example: A plan that may not help an employer meet the Patient Protection and Affordable Care Act (PPACA) requirements for providing “affordable” coverage with a “minimum value,” but do help the employer meet the PPACA requirement to provide “minimum essential coverage.” Access to MEC – or benefit plans tailored to shield workers from the PPACA individual mandate penalty – can help moderate-income part-time workers and hourly workers avoid paying the PPACA individual mandate penalty.
Offering MEC can also give an employer some protection against PPACA employer mandate penalties.
PPACA calls for the Internal Revenue Service to impose two types of penalties on large employers with weak health benefits.
The first penalty is a payment equal to $2,000 times the number of full-time workers, minus $60,000, for employers that fail even to provide MEC, if any employee without access to MEC gets coverage from a PPACA exchange.
The second penalty applies to employers that offer MEC, but not access to affordable coverage that covers at least 60 percent of the actuarial value of the PPACA “essential health benefits” package. That penalty is equal to just $3,000 times the number of full-time employees who sign up for PPACA exchange coverage and end up qualifying for PPACA premium tax credits.
Fringe Benefit Group believes its new plan can help employers avoid paying the first type of penalty. The company was previously known for selling mini med plans, or limited benefit health plans, designed for part-time workers and poorly paid hourly workers. PPACA gutted the mini med market by banning lifetime and annual benefits limits, and by requiring every health insurance policy to cover at least 60 percent of the actuarial value of an extensive essential health benefits package.
Fringe Benefit Group is trying to offer a product aimed at the kinds of employers and workers that were using the mini med coverage. The MEC plan would consist mainly of a self-insured MEC plan that covers 100 percent of the cost of the basic PPACA preventive services package. It’s offering the MEC plan in a package that includes a variety of other products, such as hospital indemnity insurance.
Health care sharing ministries
Modern health care sharing ministries have been around since the 1960s, but the PPACA has cast them in a bright new light. The PPACA individual “shared responsibility” provisions call for the IRS to impose a penalty on many individual taxpayers who have no health insurance, or too little coverage, starting this year.
The U.S. Department of Health and Human Services (HHS) has decided that belonging to a health care sharing ministry is one of the ways an individual can get out of paying the penalty without having to buy what HHS would normally classify as a minimum level of health coverage.
Though innovative, the trend is nothing new. Religious groups have been paying for members’ health care for thousands of years.
A modern health care sharing ministry, however, is a nonprofit organization for people who want to share medical expense burdens with others with similar beliefs, according to the ministries’ trade group, the Alliance of Health Care Sharing Ministries. The companies in the Alliance of Health Care Sharing Ministries are following a path blazed by Old Order Amish Church Fund. Today, the ministries are helping 240,000 people share about $180 million per year in medical expenses.
The ministries are not insurance companies, however, and cannot guarantee the payment of any medicals.
Instead, members agree to try to pay a certain amount of other members’ bills each month.
A ministry’s managers send members a monthly newsletter listing the members who need help. The members who can help then send cash.
One alliance ministry, Samaritan Ministries International, serves about 30,000 households, and those households help each other directly with about $84 million in medical bills per year, managers say. The maximum monthly share for a family at that ministry is $370. The maximum “publishable amount” is $250,000. The ministry also has an extra “Save to Share” program that helps members with catastrophic claims over the $250,000 threshold. But the members can do more than cut checks. “They also pray for one another and send notes of encouragement,” Samaritan Ministries says.
Another ministry, Christian Care Medi-Share, says on its website, “Medi-Share is NOT INSURANCE…. It’s Christians Helping Christians – and It Works!” Christian Care offers a disability cost-sharing program as well as medical bill sharing program.
This year, the alliance says, one source of excitement will be seeing how exactly the IRS implements the health care sharing ministry exemption from the PPACA individual mandate penalty.
Virtual reality benefits
Routine access to coverage for virtual reality-based health care is an innovation that has been “coming any day now” for years. Researchers have been studying the use of virtual reality in efforts to treat phobias and other behavioral health problems for some time now.
In 2011, in San Diego, the Virtual Reality Medical Center said it was having good luck with getting insurers to pay for virtual reality behavioral health therapy. But other VR therapy providers say patients may have a hard time getting plans to pay for VR care.
Magellan Health Services, a behavioral health benefits manager, says in a guide for care providers updated this year that it views VR therapy as “promising.” The company says it would like to see more studies of the effects of VR therapy.
But Magellan concludes that VR therapy is still “investigational.” In the area of post-traumatic stress disorder treatment, for example, “one small study … showed that patients receiving virtual reality-graded exposure therapy had greater improvement in PTSD symptoms after 10 weeks of treatment than those receiving treatment as usual,” Magellan treatment evaluators write. “Two other studies found that relative to their pretreatment, self-reported symptoms of PTSD, patients treated with [virtual reality exposure] reported a significant reduction at post-treatment.” But Magellan is not yet ready to cover VR sessions the way it would a prescription for lithium.
VSP, a vision benefits provider, may have given VR benefits a nudge forward in January by agreeing to cover the frames and prescription lenses that go along with the head-mounted Google Glass computer. Many labs and clinics have already been studying ways to use virtual reality systems in medicine but the fact that VSP — a well-known vision benefits provider — has something to do with VR hardware might start to give health insurers more familiarity and comfort with the idea of VR medical benefits.