INSIGHT ON: Health Insurance – Shifting gears

Posted on Apr 1, 2014 :: Health Insurance , Insight On
Posted by , Insight on Business Staff Writer


Chris Hanson is getting used to change.

The owner of Hanson Benefits Inc. in Appleton says once she figures out how the Affordable Care Act – and how it’s being interpreted by insurance carriers – will affect her clients, something changes. “I feel like everything I know now, I will have to relearn in three months,” she says.

That’s generally how insurance providers, agents and customers feel. Deadlines or rules that were part of the ACA are changed, get murkier or their interpretation varies.

Take for example the two-year extension announced in early March allowing individuals to keep health plans that don’t meet the law’s minimum coverage standards. That was supposed to end on Dec. 31, 2013. But then President Obama said, “If you like your plan, you can keep it” and the deadline moved to the end of this year. Now, it’s out to 2016. And that’s just one small part of the complicated law.

“For me, the hardest part is making sure our customers are properly informed,” says Niel Larsen, executive vice president with Maritime Insurance Group in Sheboygan. “They hear a snippet on the news or read a headline that has the word ‘delay’ in it and they think everything is put off or that what’s changing won’t affect them. There’s a lot of education that needs to go on.”

For example, Maritime sends out a legislative update via email to customers when big changes occur, such as the delay announced in early March that businesses with between 50 and 100 employees have until 2016 to offer insurance. “We also try to reach individually to customers as changes happen if we know it will affect them,” Larsen says.

Larsen says employees participate in webinars and weekly calls to go over what the latest changes may mean for customers. “It’s definitely an interesting time to be in insurance,” he says.

Hansen admits that how she does business is also in flux. “How I do business has completely changed. I’ve become more of a boutique insurance consultant and it’s about bringing value to my clients,” she says.

Dustin McClone of McClone Insurance says the ACA led the Menasha-based insurance firm to add staff and resources so more time could be spent on research. “We spend more resources on keeping up with changes and helping clients who are affected by them,” he says. “We also had to decrease the number of clients each account manager had so they could do an adequate job of making sure their clients are informed.”

Maritime, which has offices in Sheboygan, Manitowoc and Plymouth, merged last year with Chicago-based HUB International Company, which provided the firm with more back office support, Larsen says. For example, HUB has designated employees in place who monitor any changes with the ACA and educate staff members about what the changes mean to customers. “Keeping up with the ACA is a full-time job,” he says.

Health insurance companies also need to be nimble in the ever-changing market. Menasha-based Network Health opted not to take part in the exchange, but still offers ACA compliant plans outside of the marketplace. Penny Ransom, chief administrative officer for Network, says getting those plans ready for market took an organization-wide effort. For example, to be ACA-compliant, plans need to include coverage of all preventative care and screenings and extend coverage of pre-existing conditions.

Ransom adds that after the president’s “if you like your plan, you can keep it” comment, the organization worked with customers to help them take advantage of that rather than switching over to a new, ACA- compliant plan.

“While it made for an extremely busy fourth quarter for our staff and the agents who partner with Network Health, it’s always worth the extra effort to help our customers,” she says.

Not as easy as it sounds

Signing up for insurance online isn’t as easy as booking a hotel room or buying a pair of shoes. First, there were the much-documented problems with the federal website

that made it nearly impossible for people to log in and sign up. Now that the site is up and running fairly well from a technology point of view, consumers still have a lot of questions, Hanson says.

“They ask a lot of questions that may not have clear answers, regarding income or dependents, depending on your situation,” she says. “Then there’s the fact that some people don’t realize that their rate is based on what they anticipate their income to be for the year. If it goes up, you may wind up paying the government back at the end of the year. Consumers also may not be aware that if they will receive a subsidy, it’s coming out of their potential tax refund for next year. There are variables.”

How insurance companies interpret the law also varies, Hanson says. “That adds to the confusion. I have folders for each plan I work with since everyone is so different,” she says.

And the online exchange doesn’t have every option available to consumers, McClone says. “We like to say we’re the only real exchange in town – we can help show customers the online options, but we have the other options that aren’t on the exchange. The exchange only has limited options, but does a great job of distributing subsidies to people who need them,” he says.

At a two-person office, Hanson relies on business groups and other insurance agents to help her keep up with the changes.

“There’s a group of us that meet informally and say, ‘I’ve had experience with this’ or ‘have you seen this?’ There are so many variables,” she says. “I also watch the news a lot more to see if another deadline has been moved back.”

McClone anticipates the ACA will be a lot like the Family Medical Leave Act (FMLA) and that it’s difficult for businesses to fully understand all of its components. “There’s no doubt that compliance issues will come into play for businesses and that it’s very difficult to be 100 percent compliant all the time,” he says.