Feds release rules for exchange navigators

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The Obama administration in February released a proposed ruleoutlining the standards for navigators who will help consumers shopfor health insurance in new exchanges set up by the PatientProtection and Affordable Care Act.

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Navigators are organizations that will provide unbiasedinformation to consumers about health insurance, the new healthexchanges, qualified health plans, and public programs includingMedicaid and the Children's Health Insurance Program.

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“Navigators will be an important resource for consumers who wantto learn about and apply for coverage in the new marketplace,”Centers for Medicare & Medicaid Services Acting AdministratorMarilyn Tavenner said in a statement.

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For those unfamiliar with health insurance, have limited Englishliteracy, or living with disabilities, the administration saysnavigators will serve an “important role in ensuring peopleunderstand the health coverage options available to them.”Navigators will provide accurate and impartial assistance toconsumers shopping for coverage plans in the new marketplace.

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In regulations released Wednesday by the Department of Healthand Human Services, navigators cannot select a plan for theirclients and are not in charge of determining whether customers areeligible for federal subsidies.

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They do, however, play an “important role in facilitating aconsumer's enrollment by providing fair, impartial and accurateinformation that assists consumers with submitting the eligibilityapplication, clarifying the distinctions among qualified healthplans, and helping qualified individuals make informed decisionsduring the health plan selection process.”

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In its 63-page rule, HHS says “holding an agent or brokerlicense is neither necessary, nor by itself sufficient, to performthe duties of a navigator, as these licenses generally do notaddress areas in which navigators need expertise, including thepublic coverage options that would be available to someconsumers.”

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Navigators also may not be paid by insurance companies.

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In addition to navigators, consumers will have access toassistance through services such as a call center, where customerservice representatives can provide referrals to the appropriatestate or federal agencies, or other forms of assistance programsincluding in-person assistance personnel, certified applicationcounselors and agents and brokers.

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Open enrollment in exchanges begins Oct. 1, with coverage tobegin Jan. 1, 2014.

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Richer health benefits cost 47 percent more

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Average monthly premiums for individual health insurance plansare 47 percent higher than average when they cover a comprehensivelist of eight health benefits, but they also yield lowerdeductibles, a new industry report reveals.

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The report by eHealth, the parent company of eHealthInsurance,is the latest to predict higher premiums for health coverage comingnext year when the bulk of the Patient Protection and AffordableCare Act kicks in.

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The report examined the cost of about 30,000 individual plansthat included eight health benefits and were purchased across 32states through eHealthInsurance. The benefits include laboratoryand X-Ray; emergency services; prescription drugs; chiropractic;maternity; OB/GYN; periodic exams; and well baby care. Similarly,the PPACA created a list of 10 essential health benefits that allmajor medical health insurance plans must cover at an actuarialvalue of 60 percent or more in order to fulfill the federal mandatefor health coverage, beginning in January 2014.

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 “These data provide valuable insight into the cost ofhealth insurance plans as consumers prepare to enroll in the morecomprehensive health plans that will become available with theAffordable Care Act,” said Robert Hurley, eHealth senior vicepresident of carrier relations.

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Hurley noted the report doesn't provide an “apples to applescomparison of plans that cover the essential health benefitsestablished in the PPACA,” but it does indicate potential problemswith affordability with new benefits standards.

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The eHealth report said its average premium for an individualpolicy covering the eight benefits was $279 a month compared to$190 a month without that full coverage. The annual deductible onthe more comprehensive policy was $2,257 versus $3,079 on the otherpolicies, a 27 percent decrease.

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The average premium for a family was $605, compared to $412. Theaverage family deductible will drop 16 percent when a plan coveredall of the benefits tracked in eHealth's Cost and Benefits report($3,422 vs. $4,079).

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Employers turning to incentives to improve workerhealth

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Employers are increasingly offering rewards to their employeesto persuade them to make better decisions about their health. Butit isn't all fun and games—a growing number of companies are alsopenalizing workers who do not make healthy choices.

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According to an Aon Hewitt survey of nearly 800 large andmid-sizeU.S.employers, 83 percent offer incentives to employees forparticipating in programs that help them become more aware of theirhealth status. Of those, 79 percent offer incentives in the form ofrewards while 5 percent impose penalties. Sixteen percent offer amix of both.

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Almost two-thirds (64 percent) of employers offer monetaryincentives of between $50 and $500, and nearly one in five offermonetary incentives of more than $500, the survey finds.

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A growing number of employers are beginning to link incentivesto sustainable actions and results, as opposed to having employeessimply participate in a program.

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More than half (56 percent) of the companies offering incentivesrequire employees to actively participate in health programs,comply with medications or participate in activities like healthcoaching, while 24 percent offer incentives for progress toward orattainment of acceptable ranges for biometric measures such asblood pressure, body mass index, blood sugar and cholesterol. Andmore than two-thirds say they are considering this approach in thenext three to five years.

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Though some groups argue that programs that seek to penalizeworkers by charging them more, several large employers have adoptedsuch policies. For example, CVS Caremark, the pharmacy anddrug-benefit provider, said it would require its employees toreport their weight, blood sugar and cholesterol or be forced topay an annual penalty of $600.

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“Employers recognize the first step in getting people on a pathto good health is providing employees and their families with theopportunity to become informed and educated about their healthrisks and the modifiable behaviors that cause those risks,” saysJim Winkler, chief innovation officer for health and benefits atAon Hewitt.

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