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Elimination of Co-Payments for Screenings and Preventive Care
Starting in September of 2010, employer-sponsored (and other) group health plans and Texas health insurance issuers are prohibited from requiring co-pays for all preventive services recommended by an independent expert panel, the United States Preventive Services Task Force. Co-pays are also eliminated for certain recommended immunizations, breast cancer screenings and other preventive care/screenings for women and children. However, this requirement does not apply to “grandfathered” health plans, which are defined in PPACA as any plan in which at least one individual was enrolled as of March 23, 2010.

Note: Pay careful attention to the cost-sharing requirements for office visits under this rule.

Employee Wellness Discounts
Starting January 1, 2014, PPACA enhances such wellness discounts by permitting group health plans to give reductions of up to 30 percent of the cost of premiums to employees who participate in such wellness programs. This may be expanded to 50 percent subject to the discretion of the Secretary of Health and Human Services (HHS).

Break Time for Nursing Mothers
Effective immediately, the PPACA also provides that employers covered by the Fair Labor Standards Act must provide reasonable break time and a private space – other than a restroom – for nursing mothers for up to one year after the birth of a child. Employers are not required to compensate employees during such break times. Additionally, employers with less than 50 employees may qualify for exceptions if it can be proven that the requirement would impose an undue hardship on the employer.

Posting of Nutritional Requirements
By March of 2011, the Secretary of HHS must publish regulations requiring all chain restaurants (defined as any establishment that has 20 or more locations operating under the same name) to disclose the nutritional content of all menu items. Specifically, the number of calories for each item must be disclosed on menus, menu boards and drive through menu boards, and such menus must also feature “a succinct statement concerning suggested daily caloric intake.”  This requirement also extends to buffet items, and vending machines maintained by companies that operate 20 or more machines.

Government Funding for Wellness Programs
In addition to the specific provisions outlined above, PPACA also creates a “Prevention and Public Health Fund” which will be administered through HHS and will support prevention and public health programs.  Beginning with the fiscal year 2010, $500 million will be appropriated to various programs within HHS, with the amount of appropriations increasing each year to $2 billion in the fiscal year 2015 and each year thereafter. Under PPACA, the funds are to be used for activities such as prevention research and health screenings, the Community Transformation grant program (designed to fund state and municipal wellness programs by creating walking paths, nutrition awareness programs, etc.), Education and Outreach Campaign for Preventive Benefits (a planned public-private partnership to raise awareness on preventive care), and immunization programs.

Additionally, school-based health centers (facilities that provide primary health care to students on school campuses) will receive $50 million per year in grant funding through 2013. These grant monies are to be used only for expenditures on facilities and equipment, not for hiring personnel.

·     The HDHP generally costs less than traditional health care coverage. Money saved on the insurance premium can be put into the HSA. – Texas Health Insurance

·        Contributions to your HSA are tax deductible. IRS guidelines in 2010 & 2011 allow max contributions up to $3050 for individuals and $6150 for a family plan. If you are over 55, you can contribute an additional $1000 to your HSA. If you have a spouse who is over 55, you must open a second account in order to take advantage of the catch up contribution. – Texas Individual Health Insurance

·        After age 65, HSA funds can be used for non qualified expenses without penalty. Only income tax is assessed. Texas Health Insurance

·        Use the pre-tax funds in your HSA to pay for current medical expenses or expenses that your insurance may not cover including dental expenses, vision care, Medicare expenses, and long term care. See publication 502 on the IRS website for a complete list of qualified expenses. Texas Individual Health Insurance

·        Save the money in your HSA for future medical expenses.

·        No use it or lose it philosophy – the HSA funds remain in the account from year to year. Even if your HSA compatible coverage ends, you can still use the funds tax free for qualified medical expenses. Texas Health Insurance

·        You are in control of your HSA. Funds belong to you even if you switch jobs, become unemployed, or change your medical coverage. Texas Individual Health Insurance

Texas Health Insurance – Here is an overview of how the new legislation will affect health savings accounts in the future.

Does the new law eliminate HSA’s?

No, HSA’s will not be eliminated with the new law and you can continue to use your HSA like you have until the end of 2010. Texas Individual Health Insurance

What will happen in 2011 with my HSA?

Beginning in 2011, the tax levied on non qualified HSA distributions (withdrawals taken before age 65 that are not qualified medical expenses) will increase from 10% to 20%. If you continue to use the HSA for qualified medical expenses, this penalty will not affect you. Also, HSA funds can no longer be used to purchase over the counter medication, unless they are prescribed by a health care professional. Texas Health Insurance

What are the contribution limits in 2011?

The contribution limits will remain the same as 2010. If you are covered under an individual plan the maximum IRS contribution is $3050. If you are covered under a family plan, the maximum IRS contribution is $6150. If you are over 55, you can make an additional $1000 catch up contribution. If you have a spouse who is over 55 you must open a second account in order to take advantage of the catch up contribution. Texas Individual Health Insurance

Can I still use my HSA for over the counter drugs?

Yes, for the remainder of 2010. In 2011, you are no longer allowed to purchase over the counter medications, unless they are prescribed by a health care professional. This is the last year to buy over the counter medications tax free with your HSA, so this might be something to take advantage of in 2010 while it lasts. Texas Health Insurance

What happens to my HSA if I am no longer eligible to contribute? (Switched to a non-qualified HSA plan, loss of employment, etc)

You can continue to use the funds in your HSA for qualified medical expenses or save it for the future even if you are no longer eligible to contribute more to your HSA. Texas Individual Health Insurance

Texas Health Insurance – The $1-million grants, which went to all but five states, will help many expand public access to information about rate hikes and hire experts to review proposed charges.

Reporting from Washington — The Obama administration is sending $1-million grants to state insurance regulators to help increase oversight of rising health insurance premiums, a key step in implementing the new healthcare law. Texas Individual Health Insurance

The grants announced Monday, which went to all but five states, will enable many to expand public access to information about rate hikes and to hire experts to review what insurers want to charge.

More than a dozen states also plan to seek additional authority to block insurance premium increases they deem unjustified, according to the U.S. Department of Health and Human Services.Texas Health Insurance

Fewer than half of state insurance commissioners have comprehensive “prior approval” authority, which gives them the power to review insurance company records and stop proposed rate increases in the individual and small-group markets.Texas Individual Health Insurance

Some states do not even require insurers to publicly report proposed rate hikes.

The Obama administration and many consumer advocates had hoped that the new healthcare law would give all states full rate review authority. But, blocked from including such a provision in the final legislation, the administration has urged state leaders to push forward on their own.Texas Health Insurance

Commissioners in several states with a history of minimal oversight such as Alabama, Illinois, Louisiana and Montana are doing just that.

And many states that already have prior approval authority — including Florida and Maryland — are taking steps to strengthen their oversight.Texas Individual Health Insurance

The District of Columbia also will receive a grant.

Secretary of Health and Human Services Kathleen Sebelius said the grants would “restore some basic fairness to the health insurance market.”

But expanding government power remains controversial in many states. And the insurance industry, which opposes prior approval authority for regulators, has been a powerful force in many state capitols.Texas Individual Health Insurance

Arizona, Connecticut, Missouri, Ohio, Pennsylvania, South Carolina and Virginiahave no comprehensive authority to block rate hikes and do not plan to seek legislation to bolster their oversight powers, according to the Health and Human Services Department.Texas Health Insurance

Alaska, Georgia, Iowa, Minnesota and Wyoming did not did not receive grants because they did not seek them.

In California, Gov. Arnold Schwarzenegger’s administration specifically ruled out seeking prior approval authority.Texas Individual Health Insurance

Consumer Watchdog, a Santa Monica-based advocacy group, urged the administration to reject California’s grant application, saying the grant would “prevent, not develop, any effective state regulation of health insurance rates.”

California nonetheless received its grant, which is to be used to streamline collection of data on proposed rate hikes.Texas Health Insurance

Sebelius, herself the former insurance commissioner of Kansas, said Monday that the administration would continue to work with states to enhance their oversight even if they did not apply for grants.

But she cautioned that the federal government would step in if insurance companies try to pass along “unreasonable” rate hikes to consumers. The administration is still developing regulations dictating how this would be done.Texas Health Insurance

-LA Times

Looking for the best information and the best rates on Texas Health Insurance–visit www.texashealthandlife.com or give us a call at or 512-246-9955

Texas Health Insurance– An Iowa egg producer is recalling 228 million eggs after being linked to an outbreak of salmonella poisoning.

The federal Centers for Disease Control and Prevention said eggs from Wright County Egg in Galt, Iowa, were linked to several illnesses in Colorado, California and Minnesota. The CDC said about 200 cases of the strain of salmonella linked to the eggs were reported weekly during June and July, four times the normal number of such occurrences. Texas Individual Health Insurance

State health officials say tainted eggs have sickened at least 266 Californians and seven in Minnesota.

The eggs were distributed around the country and packaged under the names Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemp.Texas Health Insurance

The Food and Drug Administration is investigating.

In a statement, company officials said the FDA is “on-site to review records and inspect our barns.” The officials said they began the recall Aug. 13.Texas Individual Health Insurance

The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight hours to 72 hours of eating a contaminated product. It can be life-threatening, especially to those with weakened immune systems. Texas Health Insurance

Texas Health Insurance - Two studies published recently suggest there could be something wrong with the way ADHD is diagnosed in young children in the US, one found that nearly 1 million kids are potentially misdiagnosed just because they are the youngest in their kindergarten year, with the youngest in class twice as likely to be on stimulant medication, while the other study confirmed that whether children were born just before or just after the kindergarten cutoff date significantly affected their chances of being diagnosed with ADHD.

Dr Todd Elder, assistant professor of economics at Michigan State University, looked at a sample of nearly 12,000 children from the Early Childhood Longitudinal Study Kindergarten Cohort, which is funded by the National Center for Education Statistics. He analysed the difference in ADHD diagnosis and medication rates between the youngest and the oldest children in a kindergarten grade. - Texas Individual Health Insurance

He found that the youngest children were significantly more likely to be diagnosed with ADHD and to be prescribed behavior-modifying stimulants such as Ritalin than their older classmates. He told the press that the “smoking gun” was that the diagnoses depended on the children’s age relative to classmates and the teacher’s perceptions of whether they had symptoms. Texas Health Insurance

Elder-”If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6. There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD,” he urged. Texas Individual Health Insurance

Elder said medicating such children inappropriately was a cause for concern not just because of the effect of long term stimulant use on their health but also because it costs a lot of money: he estimated about 320 to 500 million US dollars is being wasted on unnecessary medication of young children for ADHD, of which 80 to 90 million is funded by Medicaid. Texas Health Insurance

From his analysis, Elder found that the youngest kindergarten kids were 60 per cent more likely to be diagnosed with ADHD than the oldest in the same grade, and also, by the time those groups reached the fifth and eighth grades, the youngest were more than twice as likely to be on prescription stimulants. Texas Individual Health Insurance

Elder estimated that overall in the US, the misdiagnosis rate is about 1 in 5, that is around 900,000 of the 4.5 million children currently diagnosed with ADHD have been misdiagnosed.
Like the researchers in the second study, Elder used kindergarten eligibility cutoff dates to distinguish between the youngest and the oldest kids in a grade. While this date differs among states in the US, the most commonly used one is that used by 15 states to rule that kids must be 5 years old on or before 1st September to be eligible for kindergarten. Texas Health Insurance

He found the same definitive pattern both in the case of individual states and when he compared across states.

Michigan for example has a cutoff date of 1st December for kindergarten attendance. Elder found higher rates of diagnosed ADHD among Michigan kids born on 1st December than born on 2nd December. Those born on the 1st December would have been the youngest in their grade, while those born on the 2nd, just one day later, because of the cutoff date, would have enrolled a year later and therefore been among the oldest in their grade.Texas Individual Health Insurance

Elder remarked that even though these kids were only born a day apart, they were assessed differently because they were being compared with classmates of a different age set.

Looking across states, Elder gave the example of Illinois and Michigan. In Illinois, where the cutoff date for kindergarten is 1st September, August-born kids were more likely to have been diagnosed with ADHD than Michigan kids born in August of the same year.Texas Individual Health Insurance

Elder’s study defined a diagnosis of ADHD as including evidence of multiple symptoms, including inattention and hyperactivity sustained for six months or more observed in two settings, for instance the home and school, before the age of seven.

Although a mental health professional performs the diagnosis, the opinions of teachers often influence whether a child is sent for evaluation in the first place, said Elder.Texas Individual Health Insurance

“Many ADHD diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a kindergarten classroom,” said Elder, but the “symptoms” that teachers perceive may “merely reflect emotional or intellectual immaturity among the youngest students”.

ADHD is the most commonly diagnosed behavioral disorder for kids in the United States, and currently there are no neurological markers for ADHD (such as a blood test for example). Experts disagree on how common it is, hotting up public debate about whether it is under- or over-diagnosed, said Elder.

In the second paper, researchers at North Carolina (NC) State University, Notre Dame and the University of Minnesota drew very similar conclusions to those of Elder’s study.Texas Individual Health Insurance

Co-author Dr Melinda Morrill, a research assistant professor of economics at NC State, told the press that:

“The question we asked was whether children who are relatively young compared to their classroom peers were more likely to be diagnosed with ADHD.”

Morrill and colleagues looked at kids born just before the kindergarten eligibility cutoff date and those born shortly after and found large discrepancies in rates of ADHD diagnosis and treatment based on small differences in birth dates.

For the study they analyzed data from two national health surveys and a national database of private health insurance claims. The data covered several periods between 1996 and 2006.

They found that kids who were “relatively old-for-grade”, that is those born just after the kindergarten cutoff date, were 25 per cent less likely to have received a diagnosis for ADHD than their the “relatively young-for-grade” peers, that is kids born just before the cutoff date.Texas Individual Health Insurance

As their premise was that children born a few days apart should have the same underlying risk of developing ADHD, finding a significant discrepancy based on small differences in age suggests the problem is inappropriate diagnosis, concluded the researchers.

“This indicates that there are children who are diagnosed (or not) because of something other than underlying biological or medical reasons,” said Morrill.Texas Individual Health Insurance

“We believe that younger children may be mistakenly diagnosed as having ADHD, when in fact they are simply less mature,” she added, drawing the same conclusion as Elder in the first study.

However, she wished to stress that their study is “not downplaying the existence or significance of ADHD in children”.

“What our research shows is that similar students have significantly different diagnosis rates depending on when their birthday falls in relation to the school year,” she pointed out.Texas Individual Health Insurance

“The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates.”
Todd E. Elder
Journal of Health Economics, In Press, Corrected Proof, Available online 17 June 2010
DOI:10.1016/j.jhealeco.2010.06.003

“Measuring Inappropriate Medical Diagnosis and Treatment in Survey Data: The Case of ADHD among School-Age Children.”
William N. Evans, Melinda S. Morrill, Stephen T. Parente
Journal of Health Economics, In Press, Accepted Manuscript, Available online 4 August 2010.
DOI:10.1016/j.jhealeco.2010.07.005

– Journal of Health Economics

Sources: Michigan State University, North Carolina State University.

Written by: Catharine Paddock, PhD

Looking for the best information and the best rates on Texas Health Insurance–visit www.texashealthandlife.com or give us a call at or 512-246-9955

Texas Health Insurance -The first changes under the new health care law will start rolling out next month, affecting a range of issues from coverage of pre-existing conditions, to the maximum age children can remain on their parent’s health care plan. But not all Americans should expect to see those benefits right away. In fact, some may not see them until well into next year.

Insurance companies are obligated to include the new measures when Texas health insurance policies are renewed, starting on or after Sept. 23, 2010. Which means that if an Texas individual insurance policy is renewed on Sept. 1, those covered under the policy may not be eligible for the benefits under the new law until Sept. 1, 2011.

Additionally, several provisions may vary depending on where people live. The way high risk pools are implemented vary from state to state, for example, as do the limits on how much insurance companies can raise their premiums.

The health care changes come at a time when states are grappling with increased economic stress and lower budgets, leading many to look toward the federal government for assistance.

Texas Individual Health Insurance- Twenty-five members of the House have asked federal health regulators to ensure a role for licensed insurance agents in the web portal that will be used to aid consumers in comparing coverage options.

The Department of Health and Human Services unveiled the web portal July 1 on a trial basis. An update with more comprehensive information is scheduled to be in place as of Oct. 1.

The web portal is seen as a precursor to the Texas health insurance exchanges that will be launched in 2014 under the Patient Protection and Affordable Care Act.

“We strongly encourage you to include the ability for consumers to contact certified, state-licensed independent health insurance agents and brokers for assistance when comparing coverage options,” a letter from the House members said.

“It is important the consumer’s options to contact independent and state-licensed health insurance agents and brokers be included no later than Oct. 1,” the letter said.

Rep. Charlie Melancon, D-La., originated the letter, and eight Democrats and 17 Republicans signed it.

“It is our belief that consumers will benefit from this arrangement and will respond positively to the new portal method of purchasing health insurance if they are able to access the personalized service of an insurance agent or broker,” the letter said.

Only three Democrats who voted for the legislation signed the letter: Rep. Leonard Boswell of Iowa; Rep. Baron Hill of Indiana; and Rep. Adam Smith of Washington.

An official of the National Association of Health Underwriters confirmed that NAHU played a role in having the members sign the letter.

John Green, NAHU vice president of congressional affairs, said Texas health insurance agents should certainly play a key role in counseling people about their health insurance options going forward.

“Providing consumers with the option to choose a local agent at the ZIP code level to assist them in choosing the right coverage for the individual or family makes sense,” he said.

“You wouldn’t want to call Washington to find out your home or car insurance options; you want someone you can look in the eye and call in the middle of night,” he said.

The agents have launched an aggressive campaign to ensure a role in providing health insurance to consumers going forward.

They are also lobbying state regulators who are playing a key role in implementing the new health care system going forward to ensure that the medical loss ratio provision scheduled to go into effect by year-end doesn’t end their role in servicing the small group and individual health insurance market.

On the portal issue, the 25 members of Congress noted that in writing the health care reform law, “Congress made sure to explicitly include provisions to give consumers access to independent and state-licensed health insurance agents and brokers in a reformed health insurance marketplace, both inside and outside health insurance exchanges.”