Medical Insurance news, January 2020

$3.2M Sober Living Scheme Shut Down

24 January

It was announced in a Jan. 17 press release that a joint effort by the Orange County District Attorney's Office and the California Department of Insurance shut down an alleged $3.2 million healthcare fraud ring which preyed on vulnerable substance abuse patients in order to bilk an insurance company out of millions.

Steven Lomonaco, 61, of Laguna Beach; Mahyar "Christian" Mohases, 37, of Santa Ana; Robert Williams, 41, of Murrieta; Nicholas Reeves, 42, of Aliso Viejo; and James Frageau, 29, of Temecula have been charged with multiple felony counts including insurance fraud and money laundering in connection with the scheme.

Mohases, Williams, Reeves, and Frageau have each been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, two counts of money laundering in excess of $150,000, four counts of money laundering, and one enhancement for aggravated white collar crime over $200,000.

Lomonaco has been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, one count of medical insurance fraud, and one enhancement for aggravated white collar crime over $200,000.

"These suspects trafficked vulnerable substance abuse patients to California just to make a quick buck from the insurance company, with no regard for their lives, health or recovery. Thanks to the efforts of Department of Insurance investigators, and our close work with District Attorney Todd Spitzer's office, there is one less fraud ring preying on unsuspecting patients."

"Instead of helping these patients, these individuals preyed on extremely susceptible people and exploited their addictions for profit. Working closely with the California Department of Insurance, we are cracking down on these criminals and their predatory operations in order to protect substance abuse patients from unknowingly being trafficked, as protect their loved ones and insurance companies from these unscrupulous operators."

In order to pay the insurance premiums, the defendants are accused of developing a massive money laundering scheme in which they filtered money through nonprofit, StopB4UStart, by providing "Donations" from Mohases, Frageau, Williams and Reeves under their corporation, Nationwide Recovery.

Read the full story at Laguna Beach Independent

Health And Medical Insurance Market in Indonesia predicted to grow at a CAGR of 7.7% during the forecast period

21 January

The report provides an in-depth analysis future trends and developments, profiles of leading players, key restraints and drivers, Indonesia Health And Medical Insurance Market segmentation and forecasting.

The report highlights the market size and CAGR of the important segments, thus providing quick relevant information of the global Indonesia Health And Medical Insurance market.

This market research report also provides a brief summary of the global Indonesia Health And Medical Insurance market.

The report consists of several aspects that affect the growth of the Indonesia Health And Medical Insurance market.

The report will make detailed analysis mainly on the development environment, market size, and development trends of Indonesia Health And Medical Insurance market on the basis of current situation of the industry in 2020 so as to get a holistic understanding of the competition in Indonesia Health And Medical Insurance Market Carrier.

The Indonesian health and medical insurance market is expected to register a healthy CAGR of 7.7% during the forecast period.

Comprehensive assessment of all opportunities and risk in the Indonesia Health And Medical Insurance market.

Read the full story at Dagoretti News

China sees further improved medical, health care system

20 January

Chinese authorities have taken multiple measures to improve the country's medical and health care system, in order to realize the goal of improving people's health and wellbeing.

As of January 2020, a total of 1.35 billion people have participated in the basic medical insurance program nationwide, keeping the healthcare coverage rate above 95 percent.

Seventy new drugs, including 22 anti-cancer drugs, were included in the national medical insurance catalog in November 2019, with their prices slashed by 60.7 percent on average.

Efforts have also been made to reform the centralized drug procurement system in 2019, with prices of the first batch of 25 drugs brought down by an average of more than 50 percent in April.

A new plan to set up a state catalog for medicines in short supply to strengthen early warning on medicine shortage and ensure drug supply was announced by China's National Health Commission.

New medical service models have been rolled out, allowing patients in need to pay after receiving treatment and to enjoy the direct settlement of trans-provincial medical expenses, which streamlines the process and eases the burden of medical treatment for people.

China's healthcare security system has been continuously improved, with the goal of universal coverage of medical care achieved, said Fu Wei, an official with the NHC.

Read the full story at

Ninety-seven percent of Kazakh population included in compulsory health insurance database

20 January

Ninety-seven percent of the Kazakh population is included in the compulsory health insurance database, reported PrimeMinister.

Since Jan. 1, hospitals nationwide have provided medical care according to the guaranteed volume of free medical care and compulsory social health insurance.

"The work will continue with the remaining 3 percent, or about 550,000 people. More than 88 percent of people already have insurance status, including 54 percent or 10 million people that belong to the preferential categories of people, and others are employees, sole proprietors, persons working under civil agreements and self-employed citizens. The number of self-payers is 2.2 million people, or 12 percent of the population," according to the release.

Employers will pay 2 percent of employee salaries this year and 3 percent after 2022.

1 percent will be deducted from salaries this year and 2 percent in 2021.

Thirty percent is designated for pension savings, 40 percent for the Social Health Insurance Fund and 10 percent for income tax.

All other population categories contribute 5 percent from their minimum salary.

Read the full story at The Astana Times

Medical insurance premiums to go up by 30% in Malaysia

16 January

Malaysians could pay by up to 30% more for medical insurance this year, as major insurance companies point out a rise in healthcare costs.

According to a report by Free Malaysia Today, both insurers and agents have said that rapid inflation in medical and hospitalisation costs in recent years made the increase "Inevitable".

"With the number expecting to rise further and outpace the general inflation rate, we have to make the necessary adjustments to your medical plan's premiums so that they can keep up with healthcare inflation," said a notice sent by AIA Malaysia to its clients.

"We have to make the necessary adjustments to your medical plan's premiums so that they can keep up with healthcare inflation".

A 2019 survey on medical trends by Willis Towers Watson found that Malaysia had among the highest expected increases in medical costs in Southeast Asia, the report said.

"If healthcare costs are not contained, the increase in premiums for medical and health insurance will be inevitable," PIAM had said.

"If medical insurance is no longer affordable, it will drive more patients to seek treatment at government hospitals," it added.

Read the full story at International Investment

Prudential chooses IMG to boost travel assistance offerings and introduce new product

15 January

International Medical Group, an award-winning global insurance benefits and assistance services company, has been chosen by The Prudential Insurance Company of America to provide increased travel assistance offerings and a new insurance product to Prudential agents and members.

Starting in 2020, Prudential's travel assistance services offerings will include emergency medical transport, medical assistance, travel assistance, and security assistance services provided by IMG."While Prudential Group Insurance has offered travel assistance services for many years, new features from IMG allow us to bring an even greater array of financial wellness solutions to the individuals we serve," said Jessica Gillespie.

In addition to robust travel assistance services, Prudential will add a new insurance product to its portfolio designed to protect individuals who may experience an unexpected illness or injury while outside their home country.

IMG has provided global benefits and assistance services to millions of customers since 1990.

A leader in the travel insurance, travel medical insurance, and international private medical insurance industries, IMG boasts extensive experience coordinating and managing care through vast health networks as well as complex medical transports and assistance cases.

"Prudential's selection of IMG's service and product offerings is a testament to the market-leading capabilities IMG has been responsible for providing to its members and other enterprises for many years," said Steve Paraboschi.

A leader in the global benefits and assistance services industry, IMG offers a full line of international medical insurance products, as well as travel insurance plans, medical management services, and 24/7 emergency medical and travel assistance.

Read the full story at Yahoo!

New Health Insurance Requirements For U.S. Visitors Are Creating Confusion

15 January

A surprise presidential proclamation on health insurance requirements for U.S. visitors issued late last year could have a significant effect on visitors to the United States in 2020.

Visitors to the United States can meet that requirement by buying health insurance or a visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days or until the beginning of planned, extended travel outside the United States, according to the government.

While the administration's health insurance requirements for U.S. visitors affect mainly immigrants, they are also bringing a greater awareness of insurance to travelers who visit the United States for vacation.

There's plenty of confusion about the proclamation and the resulting health insurance requirements for U.S. visitors.

Health insurance requirements or no, the question remains: If you're visiting the United States, do you need health insurance coverage? Probably.

Jeewanjee, the G1G Travel & Visitors Insurance CEO, agrees that the best way to meet the immigrant health insurance requirements for U.S. visitors is to buy insurance, even if you don't have to yet.

Until the new health insurance requirements for U.S. visitors are sorted out, buying insurance is a safe bet.

Read the full story at Forbes

Services included in Compulsory Medical Insurance Package in Azerbaijan disclosed

14 January

In accordance with the law "On Medical Insurance", medical services under the Services Package will be provided to citizens only if there is medical evidence in medical institutions with which the State Agency for Compulsory Medical Insurance has relevant contracts.

The package of services includes the names of medical services, tariffs, insurance limit, cases requiring co-financing, conditions for the provision of medical services, depending on their type, as well as waiting time.

The amount of co-financing applicable to services provided on an outpatient basis is paid in the following manner: If a citizen comes to a medical institution at the place of registration to get medical services on an outpatient basis within the administrative territory without a family doctor's referral, then a citizen must pay the amount of co-financing worth five manat for each insured event.

If a citizen comes to a medical institution located in another administrative territory within the medical territorial zone to get medical services on an outpatient basis without a family doctor's referral, then a citizen must pay the amount of co-financing worth five manat for each insured event.

If a citizen, without a family doctor's referral, comes to a medical institution located outside the medical territorial zone where he has been registered to get medical services on an outpatient basis, then a citizen must pay the amount of co-financing worth 15 manat for each insured event.

The procedure for paying the amount of co-financing for getting medical services in a hospital is as follows: If a citizen, without a referral from a medical institution situated in the place of registration or residence, comes to a medical institution located in another administrative territory but within a medical territorial zone, then a citizen must pay the amount of co-financing worth 30 manat for each insurance case exceeding 100 manat.

Outside the medical territorial department: if a citizen without referral from a medical institution located in the administrative territory at the place of registration applies for a medical service in a medical institution located outside the medical territorial department where he is registered, then for each insurance case the cost of which exceeds 100 manat, the citizen must pay co-financing in the amount of 90 manat.

Read the full story at Trend News Agency

A billion medical images are exposed online, as doctors ignore warnings

11 January

Hundreds of hospitals, medical offices and imaging centers are running insecure storage systems, allowing anyone with an internet connection and free-to-download software to access over 1 billion medical images of patients across the world.

Two months later, the number of exposed servers had increased by more than half to 35 million patient exams, exposing 1.19 billion scans, and representing a considerable violation of patient privacy.

If doctors fail to take action, he said the number of exposed medical images will hit a new high "In no time."

A decades-old file format and industry standard known as DICOM was designed to make it easier for medical practitioners to store medical images in a single file and share them with other medical practices.

One patient, whose information was exposed following a visit to an emergency room in Florida last year, described her exposed medical data as "Scary" and "Uncomfortable." Another with a chronic illness had regular scans at a hospital in California over a period of 30 years.

One unprotected server at one of the largest military hospitals in the United States exposed the names of military personnel and medical images.

Northeast Radiology, a partner of Alliance Radiology, had the largest cache of exposed medical data in the U.S., according to Greenbone's data, with more than 61 million images on about 1.2 million patients across its five offices.

Read the full story at Techcrunch

China eyes medical insurance system for all

10 January

China will accelerate building a medical insurance system that covers its entire population through a new round of medical insurance reform.

The reform will optimize the current basic medical insurance system, which covers 95 percent of the population, and seek to complement it with other forms of medical insurance, including commercial health insurance, a medical relief system and charity medical donations, said Zheng Gongcheng, head of the China Association of Social Security.

Improvements will be made to medical insurance and relief mechanisms for major and serious diseases, according to the National Healthcare Security Administration.

A meeting of the central committee for deepening overall reform in November 2019 reviewed and approved a document concerning medical insurance system reform, which calls for efforts to speed up the building of a sustainable and multi-tier medical insurance system that covers all residents in urban and rural areas.

The core task of the new round of reform is to make the development of the medical insurance more balanced and sufficient and to address institutional obstacles, Zheng said.

Read the full story at XinhuaNet

Kenya: Medical Insurance Restored As Nairobi Finally Pays Sh57m

9 January

Nairobi MCAs and staff can now breathe a sigh of relief as the Executive has released funds for their medical insurance cover.

The accrued premium for MCAs' medical cover, under the Nairobi County Assembly Members Group Medical Insurance Scheme, stood at Sh31,149,459.

Minority leader, Mr David Mberia, raised the issue last week, saying members of county assembly and their families were at risk.

Ms Kahiga said on Tuesday that the payments had been made and explained that the delay was due to the assembly's failure to supply details of the cover.

On December 11 that year, the firm wrote a demand notice to the Office of the Clerk of the County Assembly, asking the assembly to facilitate the payment before December 18 for the deal to remain.

First Assurance also noted that all premiums for medical insurance are payable annually at the beginning of the coverage period as per the amendment of Section 156 sub-section of the Insurance Act Cap.487.

"In view of the premium position, we are kindly advising that we shall discontinue all credit arrangements with the service providers unless we receive the premium on or before December 18, 2019. We are afraid the premium must be paid in full for the service to be rendered," stated a letter signed by Rufus Maina.

Read the full story at AllAfrica

Valley woman creates app to manage her medical bills

8 January

A few years ago, Rachel Mertensmyer sat at a table with stacks of medical bills in front of her.

She had suffered a severe injury that resulted in 38 medical bills from 11 different providers.

The third stack, well, Rachel wasn't sure if those bills needed to be paid or not.

"This problem of managing multiple bills across several different providers is much more common than you might think," Mertensmyer said.

It's a mobile app available on the App Store and Google Play, that helps patients understand, manage, and pay all medical bills in one place.

Even with medical insurance, the amount of money patients are responsible for paying is increasing as much as 30% for any given bill.

Rex Pay's customer base includes not only patients, but providers who see it as a streamlined way to get bills paid faster.

Read the full story at ABC15

What Medicare for All Really Looks Like

8 January

anadian health care is publicly funded and privately delivered, approximately the same vision that single-payer enthusiasts have for the American system.

As Americans' life expectancy is dropping and maternal mortality is ranked shockingly high among other wealthy nations, Canadian health outcomes fare better; Canadian women live two more years than their American counterparts, men three.

The federal government supplies about $36 billion in health care funding annually, distributed among each province and territory's Ministry of Health.

"Canada makes you wait because everybody's included," says Dr. Tom Noseworthy, a professor of health policy and management at the University of Calgary, and a former hospital CEO, ICU specialist, and rural GP. "But every nation rations its health care. No one can get everything, everywhere, all the time. One system is explicit in its rationing, Canada, where we howl at our wait times-and the other is implicit, because Americans can only get it if they can afford it."

"The status quo is perpetuating inequities, misery and associated higher health care costs," wrote Josée Lavoie, professor in the Department of Community Health Sciences at the University of Manitoba, and director of Ongomiizwin Research, in a 2018 paper on First Nations health disparities.

As Vik Adhopia, national health television reporter for the Canadian Broadcasting Corporation, explains, "The Canadian system is a series of systems and they are all different. There are significant disparities from province to province." Adhopia has lived in Toronto, northern British Columbia, Alberta, and St. John's, Newfoundland.

Canadian taxpayers put up with a lot to maintain their health care system, but so do Americans, such as the tremendous cost of gun violence.

Read the full story at The American Prospect

Malawi responds to medical insurance fraud in the region

7 January

According to local media reports, more than one-quarter of claims in Malawi paid by health insurance firms are fraudulent Keep on reading.

The Society of Claims Professionals in the UK has released a set of guidelines to help claims professionals better identify fraudulent practices.

Findings from multiple organisations found that fraud, waste and exploitation contribute to a high percentage of erroneous medical claims in the region.

The Board of Health Care Funders of South Africa found that 40 per cent of medical aid schemes' claims in the region are forged; while reports from Medical Aid Society of Malawi and Horizon Health Malawi - both major health insurance providers in the country - also confirmed this, with 25 per cent and 40 per cent of their claims, respectively, being fraudulent, costing them around MWK6 billion a year.

In response to this worrying figure, health insurance funding bodies have come together to tackle medical insurance fraud.

Hfam Interim President Elsie Munthali, who is also CEO for Horizon Health Malawi, said the most common fraud involves schemes' members conniving with service providers to pay them cash, which in turn the service providers claim as if they provided the service.

"That is the most serious fraud we are currently facing as an industry. On our part as Horizon, we calculate that between 40 and 50 per cent of our claims are fraudulent in nature because fraudsters have now become more sophisticated. So, that's why we have come up with this association to start talking and acting with one voice," she said.

Read the full story at International Travel & Health Insurance Journal

Cane farmers request for medical insurance

7 January

Medical insurance was one of the main topics discussed by sugarcane farmers during the consultations in Ba and Lautoka yesterday.

Sugar Cane Growers Fund CEO Raj Sharma says the majority of cane farmers have been requesting medical cover, especially from their family.

Sharma says they've made a proposition for farmers to pay $200 for medical cover per year to which the majority of cane growers have agreed to.

"A farmer would be able to get a medical treatment from any General Practitioner for unlimited number of times to a total of 4 members in a family which means husband, wife, and children below the age of 18 years and if they are university students up to 23 years old they can get that premium at $200 so this sort of things the farmers were requesting and we are able to hold this out for this year."

Other concerns such as cane cutting issues, mill problems, cane harvesting seasons and shortage of labor were raised in the consultation.

Present during the meeting with the farmers was the FSC Chief Executive Graham Clarke, Minister for Lands Ashneel Shudakar and Assistant Minister for Sugar George Vegnathan.

Read the full story at FBC News

Deciphering medical insurance in the New Year

6 January

What's the name of your plan? Know your insurance company.

Then take a note of the type of plan, such as Health Maintenance Organization or Preferred Provider Organization.

What are the tiers of providers? Health insurance companies control cost by encouraging you to see providers who have signed special contracts to charge the insurance plan a discounted rate for medical services.

The providers benefit through the opportunity to serve you and millions of members covered under the plan.

Insurance plans usually divide them into three tiers - preferred; in-network; and out-of-network - in order of low to high cost.

You can search by specialty to get a list of preferred and in-network providers on the insurance company's website.

What services are covered? The Affordable Care Act requires that all health insurance plans cover routine wellness and preventive care, such as a limited number of visits to the primary care doctor, immunizations and cancer screenings.

Read the full story at The State Journal-Register

Kamal Nath government brings medical insurance cover for state employees

5 January

Kamal Nath government on Saturday decided to bring 12.55 lakh state employees, pensioners and their families under medical insurance cover.

The decision was taken at the cabinet meeting headed by the chief minister at the state secretariat on Saturday afternoon.

Minister for health Tulsi Silawat said, "Mukhya Mantri Samohik Swasth Bima Yojana effective from April 1 will make every government employee and his or her family eligible for free medical treatment up to Rs 5 lakh per annum. For some critical diseases, eligibility may be increased to Rs 10 lakh per annum. OPD treatment in hospitals will be free up to Rs 10,000 per annum." Claiming it as a historic decision taken by the state government, Tulsi Silawat said that retired state government employees under previous regimes received free medication worth Rs 288 per annum.

While all employees will be eligible for Rs 5 lakh medical treatment, permission will be necessary from a state-level medical board for approval to increase the insurance cover to Rs 10 lakh for specific critical diseases.

Those who will be covered under the insurance scheme include 5,73,752 state government employees of various departments, another 1,79,470 government school teachers and 4,91,666 retired state personnel.

Implementation of the scheme will incur a financial burden of Rs 756.54 crore on the exchequer.

Portion of the premium will be deducted from employees' salaries and the amount will be determined through the salary grades.

Read the full story at The Times of India

Democrats ask U.S. Supreme Court to save Obamacare

4 January

The Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states.

The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law's "Individual mandate" that required people to obtain health insurance unconstitutional.

The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June.

A district court judge in Texas in 2018 found the entire law unconstitutional.

In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty.

The court defined this penalty as a tax and thus found the law permissible under the Constitution's provision empowering Congress to levy taxes.

In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis.

Read the full story at KFGO

Ontario government eliminates most health insurance coverage for residents traveling outside Canada

4 January

As a cost-cutting measure, effective January 1, the Ontario government eliminated the Out of Country Travellers Program from the Ontario Health Insurance Plan, which is the government-operated health insurance system for Ontario residents.

The only service that Ontario residents will continue to receive OHIP coverage for while out of Canada is kidney dialysis.

This is not the first-time health insurance services for Ontario residents traveling outside the province have been cut.

The Ministry of Health is recommending that Ontario residents who spend time outside of Canada get private insurance to cover their medical expenses.

The Canadian Snowbird Association, which represents Canadians who spend the winter months outside the country, is challenging the Ontario government's decision in court on the grounds that it violates the Canada Health Act, the federal law that states how provinces are to administer the public health insurance system.

Most Canadians who spend considerable lengths of time outside the country usually get additional health insurance.

The elimination of out-of-country OHIP coverage by the Ontario government highlights several things about Canadian health care.

Read the full story at North Country Public Radio

Health coverage changes include mandate to hold medical insurance in 2020

4 January

The new year brings sweeping change to several state health coverage laws, from a health insurance mandate to new coverage opportunities for undocumented young adults.

According to a new tax mandate by California, residents without health insurance this year will pay a penalty on 2021 tax returns.

The penalty fine for not having health insurance for a full year is whichever is higher: either $695 per adult and $347.50 per child, per household, or, if higher, 2.5% of the annual household income above the state tax filing threshold.

A new change to coverage also means that mothers who are diagnosed with a maternal mental health disorder and whose providers leave their insurance network are still able to visit the provider and remain fully covered for up to 12 months.

A separate budget change has extended Medi-Cal coverage to mothers with mental health disorders from 60 days to one year.

A study from the U.S. National Library of Medicine National Institutes of Health in 2011 showed that worldwide, approximately 60% of women with enduring mental health issues have dependent children.

Read the full story at Enterprise-Record

This Is How Many Billions America Wastes On Healthcare Each Year

3 January

Getting medical care is expensive in the United States.

About 71% of all medical expenses are mitigated via private and public health insurance.

There is a lot of money flowing between the medical industry and patients.

According to a new medical study, about $1 out of every $4 is wasted on bureaucracy, processing inefficiencies, and unnecessary procedures.

Another $240 billion is wasted on unnecessarily high prescription medication costs and medical services.

Over $282 billion in waste is created in inefficient outpatient services and in-hospital medical mistakes.

According to Dr. Shrank, recognizing and streamlining established medical bureaucracy inefficiencies now is the best way to eliminate systematic waste.

Read the full story at RealDaily

Victims of Singapore accident to be covered by insurance

3 January

Insurance will compensate the victims of a vehicular accident at the Lucky Plaza mall in Singapore, which led to two fatalities and injured four others.

According to reports by the Straits Times, the accident occurred on the late afternoon of December 29, 2019, when a car crashed into several pedestrians and through a guard rail, landing several metres below on the mall's carpark exit ramp.

The accident, which occurred on the workers' day off, will be covered by the mandatory insurance paid for by their employers.

By law, the employers must purchase personal accident insurance and medical insurance for their domestic workers.

The personal accident cover has a minimum sum insured of SG$60,000, the report said, while medical insurance is worth at least SG$15,000.

There is a separate insurance scheme for them.

Centre for Domestic Employees chairman Yeo Guat Kwang said that the agency will provide assistance to the victims and their families in filing claims under their personal accident insurance policies.

Read the full story at Insurance Business Asia

Washington State Acts Against 2 Non-ACA Health Players

3 January

Mike Kreidler, the Washington state insurance commissioner, has imposed fines on two health insurance market players in the past two weeks.

Kreidler announced today that Health Plan Intermediaries Holdings LLC, an arm of Health Insurance Innovations Inc., has agreed to pay a $1.5 million fine to resolve allegations concerning its appointments with two insurers, its affiliations with 434 insurance producers, the registration of a "Doing business" as name, and the authorization status of some of the products it sold in Washington state.

Kreidler announced Dec. 30 that he has ordered another organization, Trinity Healthshare Inc., to pay a $150,000 fine, and blocking the organization from operating in Washington state after 2020, in connection with the allegation that Trinity has marketed itself as a health care cost sharing ministry without meeting Washington state's legal definition of a health care cost sharing ministry.

The ACA provides exemptions from the usual ACA rules for short-term health insurance and for health care cost sharing ministries.

The administration of President Donald Trump recently gave issuers of short-term health insurance a boost by letting short-term health insurance policies stay in effect for up to 364 days, if a state allows that, and to let consumers use renewals to keep short-term coverage in place for up to three years, if a state and the coverage issuer allow that.

Issuers of ACA-compliant coverage, and many health policy specialists and state insurance regulators, have argued that letting health care payers outside of the ACA-compliant coverage market grow could destabilize the ACA-compliant issuers, by pulling many of the younger, healthier people out of the ACA-compliant coverage market.

Washington state is not the only state action taking action on the health care costing sharing ministry issue.

Read the full story at ThinkAdvisor

Houston Methodist, major insurance company strike out on deal

3 January

Negotiations have failed between UnitedHealthcare and Houston Methodist, meaning patients with that medical insurance could receive a very large bill for care from Houston Methodist doctors or hospitals.

"If you're insured under United and you seek treatment in a Methodist hospital after January 1, 2020, they will not pay for you except at out-of-network rates, which means you could get a very large balance bill," Seth Chandler, a professor with the University of Houston Law Center, told ABC13 in October.

Houston Methodist claimed UnitedHealthcare reduced previously negotiated rates for how much they charge for care.

Houston Methodist had a contract in place with United for 21 years before they abruptly gave notice of termination a few months ago, creating confusion among our 100,000 patients insured by United.

Although Houston Methodist negotiated in earnest, an agreement was not reached by the Jan. 1, 2020 deadline and now those Medicare Advantage and commercial patients must search for new doctors and new facilities.

"Care at Houston Methodist Hospital is significantly more expensive than care at other top-ranked hospitals in Texas as well as some of the most prestigious hospitals in the entire country. Every time we attempted to reach a compromise during the negotiations, Methodist responded with proposals showing that it is intent on maintaining its position as one of the most expensive health systems in the country."

Read the full story at ABC Eyewitness News

Changes to Out-of-Country Medical Coverage Now in Effect

2 January

CAA South Central Ontario is reminding travellers that changes to out-of-country medical coverage in Ontario.

Are now in effect, prompting the need to review travel insurance coverage.

"Travel insurance protects from unexpected and costly emergencies and it's important to evaluate available coverage, based on personal needs, to determine how to best safeguard you and your family. This is even more important now that there is no coverage through OHIP.".

Some of the key things to consider when it comes to buying travel insurance are how many trips you are taking a year; if you want comprehensive coverage or medical-only insurance; and whether or not the insurance provider offers additional assistance such as interpreters, hospital recommendations and other coordination services.

It's important to remember that the intent of travel medical insurance is to treat emergency conditions, and return you to your home province for ongoing treatment once your medical condition is stabilized.

Emergency travel medical insurance may require completion of a medical health questionnaire depending on age.

Medical questionnaires determine premium, NOT coverage.

Read the full story at Bezinga

Medical Billing Outsourcing Market 2020 Size, Statistics, Growth, Revenue, Analysis & Trends Industry Forecast Report -2025

2 January

The report covers detailed competitive outlook including the market share and company profiles of the key participants operating in the global market.

The scope of the report includes a detailed study of global and regional markets Global Medical Billing Outsourcing Market with the reasons given for variations in the growth of the industry in certain regions.

The Global Medical Billing Outsourcing Market is segmented on the lines of its component, services, application and regional.

1) An overview of the global market for Medical Billing Outsourcing and related technologies.

3) Identifications of new market opportunities and targeted promotional plans for Global Medical Billing Outsourcing Market.

1) Obtain the most up to date information available on all Global Medical Billing Outsourcing Market.

3) Facilitate decision making on the basis of strong historic and forecast of Global Medical Billing Outsourcing Market data.

Read the full story at MarketWatch

Price hikes feared as province scraps OHIP out-of-country coverage

2 January

Ontario residents have lost the majority of their out-of-country coverage through the Ontario Health Insurance Plan, leading some in the travel industry to worry private insurers will raise the cost of their travel plans.

As of Jan. 1, 2020, Ontario has scrapped all out-of-country insurance for medical emergencies, with an exception for dialysis services.

Last summer, Ontario's health minister said the old system was an "Irresponsible use of taxpayer money."

Health Minister Christine Elliott said the funding did "Little in the way of providing meaningful travel coverage," since it only covered a daily maximum of $400 for inpatient treatments, with an additional $50 per day for emergency outpatient services.

Court challenge ahead. The decision to end out-of-country coverage is now being challenged in court, with the Canadian Snowbird Association filing an application for judicial review, arguing the province is violating both the Canada Health Act and Ontario Health Insurance Act.

Shop around, says CAA. The changes to out-of-country coverage may actually help raise awareness about the importance of private health insurance, according to Caitlin Charter, manager of the CAA's Travel Store in Orléans.

Charter said Ontario residents planning to travel abroad should check to see if they have existing travel insurance whether through private insurance plans or their credit cards.

Read the full story at CBC News

China enforces new national medical insurance catalog

1 January

China's new national medical insurance catalog came into effect Wednesday, including 70 new drugs with their prices slashed by 60.7 percent on average.

Eight domestically-produced drugs that are seen as "Major innovations" and have just hit the market in recent years are among the new additions, according to the National Healthcare Security Administration.

Some 22 anti-cancer drugs, seven drugs for rare diseases, 14 for chronic diseases and four for children will be included in the catalog, and the prices of three new drugs for hepatitis C will be reduced by an average of 85 percent, said the NHSA. Most of the additions are new drugs of high clinical value that can be used to treat multiple diseases including cancer, diabetes and tuberculosis, and the prices of most imported drugs will be set at the lowest in the world.

After the price reduction and medical insurance reimbursements, the financial burden on patients will be eased by over 80 percent.

The additions are part of the first adjustments to the catalog since the NHSA was established in 2018.

The 2019 catalog has a total of 2,709 drugs, compared with 2,645 in 2017.

Read the full story at XinhuaNet

Fufa covering medical insurance for Uganda Premier League players

1 January

Federation of Uganda Football Associations has confirmed starting next year, players plying their trade in the Uganda Premier League will get medical insurance cover.

He revealed Fufa have entered into a one-year partnership with AAR Insurance Company with an option of renewal.

"Starting 2020, Fufa will offer medical insurance to all the players in Uganda Premier League by AAR Insurance Company," Magogo is quoted by the Fufa website.

"This will cater for injuries to players and compensation for permanent disabilities as a result of injuries. We have observed over the years some players have sustained career-threatening injuries and clubs failed to help them recover fully. In this arrangement, 400 players will be catered for and the registration is almost done."

Uganda Premier League chairman, Arinaitwe Rugyendo who was also part of the press briefing lauded Fufa for the initiative and believes this is a great stripe in helping players.

I laud Fufa for extending medical insurance to our players and this will help a lot.

It should be noted Fufa also offers medical insurance to delegates, Fufa staff, Uganda Cranes' players and players featuring in the Fufa Juniors League.

Read the full story at Goal

December 2019 news

Xax International logo
 Xax International
 All rights reserved.