| Greetings! We
hope that this issue of the PBG Newsletter finds you well and enjoying the summer
months. As always, should you have any questions or would like additional information
on a topic, please contact our office.
On
July 2, 2010 Harvard Pilgrim Health Care and the Massachusetts Division of Insurance
(DOI) reached an agreement on small business (50 or less eligible employees) and
individual premium rates for the remainder of 2010. This settlement comes on the
heels of Harvard Pilgrim winning its administrative appeal with the DOI on the
amount it can charge small businesses and individuals for the second quarter of
2010. The settlement means that: - Base
rate premiums for small businesses and individuals will increase by 7-11% from
2009 levels to fund the benefits given to members but are lower than the 2010
rates originally submitted
- Harvard Pilgrim has removed the 1.3% operating
margin built into its original rate request to fund its reserves
- Harvard
Pilgrim will not 'retro-bill' its customers for premiums in the months of April,
May, June and July of this year.
As a result of
this dispute, Harvard Pilgrim has contacted its high-cost, high-volume providers
informing them that it will reopen contract negotiations, despite the fact that
these contracts are currently in-force and would not ordinarily be ready for renegotiation.
Notice
of Opportunity to Enroll in connection with Extension of Dependent Coverage to
Age 26
Individuals whose coverage ended, or who
were denied coverage (or were not eligible for coverage), because the availability
of dependent coverage of children ended before attainment of age 26 are eligible
to enroll now. The regulation requires a plan or issuer to give such a child an
opportunity to enroll that continues for at least 30 days (including written notice
of the opportunity to enroll), regardless of whether the plan or coverage offers
an open enrollment period and regardless of when any open enrollment period might
otherwise occur. This enrollment opportunity (including the written notice) must
be provided no later than the first day of the first plan year beginning on or
after September 23, 2010. The notice may be included with other enrollment materials
that a plan distributes, provided the statement is noticeable.
The compliance
requirements are the following:
1. Applies to a group health plan,
or a health insurance issuer offering group health insurance coverage.
2.
Notice must be given to any individual whose coverage, or who was denied coverage,
or who was not eligible for coverage, under a group health plan or group health
insurance coverage because, under the terms of the plan or coverage, the availability
of dependent coverage of children ended before the attainment of age 26, and who
becomes eligible under the new rule.
3. The plan and the issuer
are required to give the notice.
4. Both grandfathered and non-grandfathered
plans must comply with this rule and give the notice.
The following
model language can be used to satisfy the notice requirement:
Individuals
whose coverage ended, or who were denied coverage (or were not eligible for coverage),
because the availability of dependent coverage of children ended before attainment
of age 26 are eligible to enroll in [Insert name of group health plan or health
insurance coverage]. Individuals may request enrollment for such children for
30 days from the date of notice. Enrollment will be effective retroactively to
[insert date that is the first day of the first plan year beginning on or after
September 23, 2010.]
Why Is Disability Insurance
Necessary? - Nearly one in three Americans ages 35-65
will become disabled for more than 90 days.
- A 35-year old has a greater
chance of becoming seriously disabled than he does of dying before he reaches
ages 65.
- Once an individual has been disabled for 90 days, the average
length of disability is two years.
- More than 20 million Americans suffer
disabling injuring each year.
- Many people buy life insurance so that
if they die, their families will have a way to pay the mortgage. However, the
odds of mortgage foreclosure due to disability are 16 times greater than the risk
of foreclusure due to death.
What are the Most
Common Reasons for Filing a Disability Claim?
Some of the top causes
of long term disability claims are: - Cancer
- Complications
of Pregnancy
- Joint/Muscle/Connective Tissue Diseases
- Back
Injuries
- Cardiovascular Disease
Why
Should Someone Consider Purchasing Disability Insurance? Health
insurance will cover medical costs, but does not replace lost income.
Workers'
compensation only covers accidents and injuries that occur on the job.
Your
savings can be drained quickly by the costs of a disability or illness.
Social
Security Disability Insurance only pays a limited benefit for severe disabilities
that are expected to last at least 12 months or result in death..
Sincerely,
Maria Eramo
Partners Benefit Group, Inc. | 
