McConkey Insurance, a locally owned and independently operated insurance agency established in 1890, said the acquisition is part of its growth plan.
“The acquisition of Gallen Insurance Agency not only expands McConkey’s geographic footprint but also reinforces its mission to support neighboring communities by providing them with comprehensive insurance coverage,” McConkey said in a statement.
Gallen Insurance Agency, which has operated in Berks County since 1957, has established a strong reputation for its client-centric approach and commitment to excellence, McConkey said.
“As a locally owned and operated agency, we are committed to serving our community and supporting our neighbors,” said Michael Harter, president and CEO of McConkey Insurance. “We are thrilled to welcome Gallen Insurance Agency to the McConkey family, as their dedication to exceptional service and client satisfaction aligns perfectly with our own values. We look forward to expanding our reach and delivering top-notch insurance solutions to clients in Berks County.”
In its statement, McConkey Insurance said, “Recognizing the shared values and a mutual dedication to exceptional customer service, McConkey identified Gallen Insurance Agency as a perfect fit for its expansion strategy.”
The York firm said the acquisition allows it to leverage its local expertise and resources to benefit clients in the Berks County and Greater Reading communities. By combining the strengths of both agencies, McConkey said it can provide a broader range of insurance options that address the unique needs of businesses and individuals in the area.
“Having been an active and devoted member of the Berks County community for 45 years, Gallen Insurance has truly embraced the spirit of giving back,” said Ann Gallen Moll, of Gallen Insurance. “Through forming meaningful business relationships, volunteering tirelessly, and supporting numerous community events, we have made a lasting impact. Choosing to embark on this new journey alongside the McConkey team is a genuine blessing; a testament to our devotion to our staff and clients, as we continue to uphold our legacy of positive impact and service.”
In the United Sates, we take it as a given that employers provide employees with health care insurance. This wasn’t always the case, though. In fact, it wasn’t until the 1940’s that this employee expectation started to become a baked-in convention.
During World War II, there was a shortage of workers due to the fact so many men and women of working age had been summoned to serve our nation in the war effort. By war’s end, this number had grown to a staggering 16 million. In addition, to combat inflation the federal government passed the 1942 Stabilization Act to limit employers’ ability to raise wages. To attract and retain employees, companies began offering health insurance. During the years following the war this practice spread. Employees eventually grew to expect employers to include health-care insurance in their package of benefits, as the practice became a standard feature of the US employment system.
Fortunately, this new convention didn’t come without advantages to employers. In fact, as the following demonstrates it would be a win-win for both employers and employees. Employer contributions to employee health care insurance are generally tax-deductible expenses for the employer. Plus, the value of the health care insurance benefit provided to employees is not treated as taxable income. These tax advantages make it more cost-effective for employers to offer health care insurance rather than providing salaries when trying to attract and retain talent. Win-win for both parties.
Since there is no universal health care system in the United States, access to affordable health care insurance coverage is highly valued by prospective and current employees. Providing health insurance is seen as a valuable benefit that can set a company apart from its competitors and help attract and retain skilled workers.
Statistics pointing to the importance of employer-sponsored health care insurance are compelling. Forbes Advisor found that 40% of employers say workers leave their job to find a role that offers better employee benefits according to a 2023 survey of employed workers and employers. What’s more, respondents listed employer-covered health care as the most desired benefit when asked to list the top five benefits they want from employers. 67% of employees and 68% of employers went on to indicate employer-covered health care is the most important benefit.
Forbes has also reported the somewhat obvious conclusion effective medical, ancillary and wellness benefits help to keep a workforce healthy, reduce absenteeism, increase morale and job satisfaction, cause staff to feel cared for and appreciated and boost overall worker productivity. Moreover, providing health care insurance to employees – and allowing team members the liberty of seeking medical care when they are ill – is simply the right thing to do for valued employees. As famed University of Alabama football coach Bear Bryant once observed, you need chickens to make chicken salad. Let’s add the fact you don’t want sick employees spreading illness to other workers. This last note becomes particularly relevant in the post-COVID workplace.
There are also legal requirements for employers to consider when regarding employer-sponsored health care insurance. Under the Affordable Care Act (ACA), also known as Obamacare, companies with fifty or more full-time employees are required to provide affordable health care insurance to their employees. This legal obligation incentivizes companies to offer health insurance to comply with the law and avoid penalties.
While the benefits attributable to employer-sponsored health care insurance may be obvious, it remains a complex subject requiring experience and expertise. Your trusted risk management, human capital and insurance professional can provide both.
Chris Van Buren is a Partner, Benefits and HR Consulting Division at KMRD Partners, Inc., a nationally recognized risk and human capital management consulting and insurance brokerage firm located in the Philadelphia region serving clients worldwide. Chris can be contacted at [email protected]
Independence Blue Cross (Independence) and Sun Life U.S. are teaming up to provide Stop Loss insurance for Independence’s self-funded group customers.
Independence said Friday that Stop Loss insurance can protect self-funded employers who take on the financial risk of providing health insurance for employees against large, unpredictable, or catastrophic losses from higher-than-anticipated claims.
“We selected Sun Life after a strategic search where we evaluated their capabilities and partnership approach against other national carriers,” said Mike Sullivan, executive vice president and president of diversified markets at Independence. “In the end, it was a shared vision on how to best meet the needs of our customers that made this the right fit for Independence. With Sun Life, we can add even more value to our employer groups plans.”
The Independence collaboration with Sun Life for Stop Loss insurance will have:
customizable solutions with competitive pricing and reduced fees for Independence Blue Cross groups;
reporting with actionable insights to make it easier for employers to make decisions about their Independence self-funded plans;
cash flow solutions with an advance funding program to pay claims at the time they are received, rather than waiting for a reimbursement check after they are paid; and
other new program features to be introduced in the future as Independence establishes Sun Life as the company’s exclusive Stop Loss partner.
“We are excited to partner with Independence Blue Cross on a risk-share agreement,” said Jen Collier, president, Health and Risk Solutions, Sun Life U.S. “Sun Life’s Stop Loss coverage helps employers manage the high costs of care while continuing to offer comprehensive health coverage for their employees. Working with Independence Blue Cross will give self-funded employers in southeastern Pennsylvania a Stop Loss insurance option that helps drive both excellent care and efficient cost outcomes.”
The Independence and Sun Life collaboration will be effective January 1, 2024. Select benefits will be available now through the end of 2023 for new Independence self-funded employer groups who choose Sun Life for Stop Loss insurance.
A change in Medicaid will allow certain medical providers to offer care outside a clinical setting to beneficiaries experiencing homelessness.
The Pennsylvania Department of Human Services (DHS) Wednesday said the program, known as street medicine, will allow providers to use physical and behavioral health services to address the needs of people experiencing unsheltered homelessness, reducing overall costs.
“As a physician, I understand that people experiencing homelessness often have complex needs and face many barriers to health care,” said DHS Secretary Dr. Val Arkoosh. “At DHS, we are consistently working to improve access to care and to ensure that all Pennsylvanians receive high-quality and compassionate health care that can stabilize circumstances and help improve their overall quality of life.”
Arkoosh said by creating a path for Medicaid, also known as Medical Assistance in Pennsylvania, to cover street medicine, DHS is making it easier for health care providers to meet people where they are, and to provide the care they need.
Street medicine seeks to build trust and ease barriers to care with the goal of increasing utilization of services and follow through on care, Arkoosh said.
Medical services are provided by health care professionals who are equipped with portable medical equipment. Services could include primary care, vaccine administration, wound care, preventive services, counseling, medication for the treatment of opioid use disorder, and diagnostic services, such as rapid blood screening for diabetes and high cholesterol, rapid COVID-19 and flu testing.
This change applies to Medicaid enrolled physicians, certified nurse midwives, certified registered nurse practitioners, physician assistants, psychologists, and mobile mental health treatment providers, who render services in the Medicaid Fee-for-Service or Managed Care delivery systems.
According to DHS, investments in street medicine will provide life-saving health care while also building trust within one of the state’s most vulnerable populations.
People experiencing homelessness in the U.S. die, on average, three decades earlier than their peers with housing, most commonly due to preventable and treatable chronic medical conditions, DHS said.
By allowing providers to bill for services rendered during visits with people experiencing homelessness, DHS aims to increase access to care for Medicaid beneficiaries and improve health outcomes.
Street medicine visits will provide low-cost, high-impact resources that will also divert people from costly visits to frequently overwhelmed emergency rooms, DHS said.
The commercial property insurance market is experiencing one of its most challenging times in history. Rates have risen for 20 consecutive quarters. Business owners can expect rate increases of 8% on average with some older properties or coastal properties increasing by up to 25%.
A “perfect storm” has hit the property insurance market:
There has been an increase in catastrophic weather and natural disasters.
Flood prone areas – Urban development has increased the size and frequency of flood hazards. New construction removes vegetation and soil. Grading the land surface and constructing drainage networks increases runoff to streams from rainfall and snowmelt. Roads and buildings constructed in flood-prone areas are exposed to increased flood hazards, includinginundation and erosion. FEMA cannot update flood maps quickly enough.
Unprofitability – Insurance companies, especially re-insurers, have not been profitable. Low interest rates have not provided proper investment income, although this is starting to change with the advent of Federal Reserve consecutive rate hikes.
Re-Insurance Rates – Losses in the Ukraine-Russia conflict coupled with catastrophic weather has put tremendous pressure on re-insurance renewals. Property catastrophe reinsurance rates for loss-hit U.S. accounts saw 45% increases with some catastrophic prone accounts witnessing 100% increases on January 1 renewals.
Capacity – A pull back from insurers is not just occurring on catastrophy prone accounts. We can attest to fewer and fewer insurers wanting to take risk. Accounts with poor loss history, older buildings or frame construction are experiencing the most pressure. In the past we saw capital in the form of new entrants in the market. However, that hasn’t been the case recently, especially in the re-insurance market.
Valuation / Inflation – 40-year record high inflation; supply chain disruption; climate change; rising material costs and labor shortages are affecting reported property values. As a result, many businesses find themselves either underinsured or with large gaps in their property insurance programs. This is evidenced in a recent study of property appraisals by Kroll, which revealed that 68% of buildings valued from 2020 to 2021 were underinsured by 25% or more. 19% were underinsured by 100%. In total, close to 90% of the appraised buildings were undervalued. Insurance underwriters are running valuation reports on all submitted properties and adjusting values before quoting. In 2023 most carriers have begun adjusting rates to account for inflation, with some carriers offering scheduled limits rather than blanket limits.
Which strategies can you deploy to lower or keep property insurance costs static?
Loss Limit Approach - Larger spread-out property portfolios can insure to a limit of theprobable maximum loss rather than an actual total property value. As an example, a manufacturer may have 10 locations at varying values totaling $100 million, while the largest location may be valued at $30 Million. Because no single storm, earthquake, or fire is likely to destroy any two properties in one occurrence, you could reasonably purchase a policy with a loss limit of $30 Million. Caveat: This would not be a good approach if your locations are all coastal or located in the same vicinity, as a large storm or event could “take out” multiple locations.
Reporting Values and Improvements and Betterments - Take adequate time to document proper values and any improvements performed to your building. Remember, the value is not your property’s market value. Instead, use the replacement cost of the building, taking into consideration material and labor costs, code upgrades required at the time of the loss and market conditions that might influence the availability of contractors or materials. Additionally, be sure you receive credit for all protective features on your properties. These can include sprinkler systems, central station smoke and burglar alarms, recently inspected fire extinguishers, multiple means of egress and more. Similarly, if you’ve recently upgraded a building, replaced a roof, or obtained an updated appraisal, let your insurance broker know.
Business Continuity Plan - When was the last time you have updated your Business Continuity Plan? Do you even have a formal plan? Do you have generators on site? Have you built a relationship with or hired a disaster recovery company to aid when large losses occur? Some companies for a small fee will provide power at the ready, workstations, server back-ups and alternative work space.
When was the last time you’ve analyzed your business interruption limits? Are they adequate? The insurance market calls it business income coverage but it’s really loss of profits plus extra continuing expenses. I recently analyzed a company’s business interruption limit only to find they were over insured by 60% during the past few years due to revenue declines from the pandemic.
Avoid Accepting Co-insurance or Reductions in Coverage - As property rates go higher and the economy falters it may be easy to cut coverages to reduce costs. Resist the urge. Co-insurance is your insurance company’s way of encouraging you to insure your buildings and contents and business income limits to accurate replacement value. Insurers will apply a coinsurance penalty, essentially reducing the amount they will pay for a claim if the coinsurance minimum is not met. In cases in which the property is underinsured, the insurer will reduce coverage proportionally, even if the loss is less than the limits of insurance. The carrier gets to make this determination after a loss. Make sure your broker is negotiating “agreed value” on your behalf.
Similarly, don’t accept protective safeguard warranties, water exclusions, margin clauses, or monthly limits of indemnity. Reducing costs shouldn’t equate to reducing value.
Increase Your Deductible - This might be common sense but ask for higher deductible options if you can afford to take on more risk. You can also raise your deductible on problem areas of your portfolio, such as wind/hail. As an example, it may be a wise choice to have an increased deductible on wind/hail if you had prior losses.
Improve Risk Profile – Have you ever had a thermal infrared scan on your buildings? Some carriers will perform the service for free. A scan can detect “hot spots” which could mean electrical issues and stop fires before occurring. “Cold spots” could indicate wetness or leaks. Some insurance companies offer water sensors which detect leaks (and alert your smart phone) before they occur.
Depending on your insurance carrier, hardwired smoke detectors, central station alarms, sprinkler systems, electrical improvements, new roof and more may generate discounts of up to 25%. Of course, an ROI calculation needs to be performed to discover if the costs = longer term benefits. Some carriers refuse to quote buildings with roofs older than 20 years.
Parametric Insurance - covers the probability of a predefined event happening instead of indemnifying actual loss incurred. Possible events are earthquake, flood, wind speed, precipitation, power outage and crop yield. A pre-agreed pay-out may occur if the parameter is reached or exceeded, regardless of actual physical loss sustained.
For example, $10 million if a category 5 storm occurs in a defined area, or $50,000 for every millimeter of cumulative rainfall above a certain threshold.
The threshold is usually set to align with a client’s own business continuity plan and risk tolerance.
Parametric insurance is not designed to replace but to complement traditional insurance. It can fill protection gaps left by indemnity insurance like higher deductibles, excluded perils, dependent property coverage concerns or scarce capacity.
Require Renter’s Insurance - For residential rental property owners – you can require a clause in the lease requiring the tenant to carry renter’s insurance.
Bottom Line - As capacity continues to shrink and rates increase, business owners must look at other avenues to protect their hard assets and balance sheets. Once you reach a certain size and level of complexity, it’s not about rate shopping to get the best insurance for the dollars spent. By putting in a little extra time, resources and effort you should yield a better result in the long run.
Your trusted broker who has the benefit of expertise and experience can be your valued ally.
Brian Heun –
Brian Heun is the Sales and Relationship Manager and a Partner at KMRD Partners, Inc., a nationally recognized risk and human capital management consulting and insurance brokerage firm located in the Philadelphia region serving clients worldwide. Brian can be contacted at [email protected].
HNL Lab Medicine is now an in-network provider with Ambetter from PA Health & Wellness.
“At HNL Lab Medicine, our steadfast commitment lies in expanding access to superior lab services for individuals throughout our region. With this collaboration alongside Ambetter, we have made significant strides towards ensuring that care is not only accessible but also more cost-effective,” said Martin K. Till, president and CEO.
“This agreement benefits patients across our region who were previously unable to receive care at HNL Lab Medicine facilities,” Till said. “It provides them with the chance to take advantage of the exceptional healthcare services available at any of our locations.”
The HNL Lab Medicine agreement with Ambetter is effective immediately. Ambetter from PA Health & Wellness is Centene Corporation’s Health Insurance Marketplace product in Pennsylvania.
Hellertown, Northampton County-based Weiss-Schantz Agency Inc., an independent insurance agency, has been acquired by Hub International Limited, a leading global insurance brokerage and financial services firm headquartered in Chicago.
Terms of the deal were not disclosed.
Covering eastern Pennsylvania, Weiss-Schantz serves commercial insurance and municipal insurance clients. Tim Schantz Sr., president; Tim Schantz Jr., vice president; and the rest of the Weiss-Schantz team will join Hub Three Rivers in Wormleysburg, a release said.
On its website, Weiss-Schantz said it offers “a comprehensive suite of insurance solutions to protect you from the unexpected. We don’t just sell insurance. We work closely with clients to help them make important and informed decisions every day when it comes to protection and their future.”
The move will provide Weiss-Schantz with access to Hub’s resources, services and industry-leading specialists – including risk management, employee benefits, retirement and innovative technology tools – to continue growing the business.
Hub is the world’s fifth largest insurance broker, according to its website, with more than 530 offices across North America.
Pittsburgh-based Highmark Health Monday announced net earnings of close to $47 million for 2022.
David Holmberg
The company, with offices in Allentown and Easton, said consolidated financial results for the 2022 fiscal year, included $26 billion in revenue, an operating gain of $440 million, and a net loss of $346 million.
The insurance business units, which include Highmark Health Plans, United Concordia Dental and HM Insurance Group, posted positive results, Highmark Healthcare said.
In addition, Allegheny Health Network showed increased patient volumes year-over-year, but faced cost pressures due to supply chain issues, inflation and higher labor costs and shortages, the company said.
“Despite facing multiple challenges, Highmark Health is in a strong, stable position. This strength and stability allows us to deliver on our Living Health promise to build a health, coverage, and care ecosystem that works better for everyone,” said David Holmberg, president
Janine Colinear
and CEO of Highmark Health. “We continue to deliver on a longstanding promise to play a leading role in strengthening the health and economic resilience of the communities we serve. And we have confidence in our financial performance and capital plan, our Living Health strategy, and our people.”
Highmark Health maintained a strong balance sheet with $11 billion in cash and investments and net assets of $9 billion as of December 31, 2022.
The organization’s strong financial performance allowed Highmark Health to provide more than $300 million in community support, including charity care, uncompensated care, and corporate giving, and direct more than $900 million toward capital investments to support building the organization’s blended health model, Highmark Health said.
“What we said, and proved, during the pandemic, is just as true in this economic environment: Highmark Health is built for this. In good times or bad, we have the strength and flexibility to adapt to challenges and continue providing exceptional service to our customers, members, patients and communities,” Holmberg said.
“Highmark Health experienced headwinds from staffing challenges, equity portfolio performance, and supply chain issues throughout 2022, and we expect some of those challenges will continue into 2023,” said Janine Colinear, senior vice president of finance and interim CFO and treasurer of Highmark Health. “However, the diversity of our business model, our continued growth through partnerships and affiliations, and strong performance will allow us deliver on our mission to create a remarkable health experience, freeing people to be their best.”
Roseann Humphrey, manager, retail center, and Mike Crnovic, Capital Blue Cross director, retail services, welcome customers at the Capital Blue Cross Connect Center at Promenade Shops at Saucon Valley. PHOTO/CRIS COLLINGWOOD
Capital Blue Cross opened its first Connect Center in Lehigh Valley more than 10 years ago with the idea of helping people navigate new insurance programs.
Since then, the Connect Centers have become community-oriented sites where people can learn about nutrition, get baseline health screenings, and take exercise classes.
Dave Skerpon, Capital Blue Cross senior vice president, sales and marketing, said, “Prior to the passage of the Patient Protection and Affordable Care Act (PPACA) in March of 2010, the number of uninsured Americans continued to grow year over year, particularly during economic downturns. By 2013, the year before the major coverage provisions of the ACA went into effect, more than 44 million Americans lacked coverage. “
Skerpon said the PPACA effectively boosted consumer participation in healthcare choices. Capital Blue Cross, he said, wanted to offer assistance to its members in understanding the challenges and opportunities with the new law.
“We saw an opportunity to offer a face-to-face experience to help people shop for individual Medicare, and small group insurance. Because Lehigh Valley represented a significant portion of our market share, we selected Saucon Valley as our first location, and in December 2012 opened our first Capital Blue Cross Connect Center in the Promenade Shops” Skerpon said.
The success of the Connect Center in Center Valley has led the company to open Connect Centers in Enola, Chambersburg, York and at its headquarters at 1221 Hamilton Street in Allentown.
The idea to offer face-to-face insurance information to anyone, not just Capital Blue Cross members, quickly drew feedback that the community wanted more, said Mike Crnovic, Capital Blue Cross director, retail services, who runs the Connect Centers.
Customers also wanted quality of life choices. Crnovic said people asked about nutrition while seeking insurance advice, so Capital Blue Cross hired a nutrition counselor to meet with them.
Seeing the need for nutrition advice, the company decided to offer biometric screenings for things like cholesterol, body mass index and more. The screenings, he said, are just that. People are referred to their primary care physicians for advice on any results.
He said that a variety of health seminars, wellness programs, and exercise classes are also offered onsite and virtually to help people improve their health.
The Promenade location, the largest of the centers, is an open floorplan intended to make people feel comfortable talking about not so comfortable issues, Crnovic said. A recent makeover after the pandemic makes the space feel open with natural lighting and neutral décor.
“People can walk in and ask a simple question or get information on a variety of plans and how to know what’s included and what’s not and compare prices,” he said. “Not everyone chooses Captial Blue Cross plans, but most do.”
While the floor plan is open, Capital Blue Cross incorporated private rooms for more in-depth insurance conversations.
“Our licensed representatives meet face to face with customers to simplify the process, explain their options, and help enroll them in a plan that best meets their needs and budget. Our representatives also help members with questions about their Capital Blue Cross health coverage, including questions about claims, out-of-pocket costs, searching for providers, and more,” Crnovic said.
“The key differentiator is our face-to-face experience. We strive to go the extra mile, and our success has been confirmed with strong scores on our satisfaction surveys,” Skerpon said. “In addition, we have a full 360-degree experience with our customers. We foster and build relationships because customers that have Capital Blue Cross insurance can meet with the same representative to have questions answered, service issues resolved, and be referred to a health coach for guidance and a plan to achieve their health goals.”
Both Crnovic and Skerpon said store traffic can vary significantly throughout the year.
“Our stores see the highest traffic during the annual open enrollment periods, from October through January, when consumers may make changes to their existing coverage or enroll in new Medicare or individual under-65 health plans for the coming year,” Skerpon said.
Outside of open enrollment, customers visit to learn about Medicare, enroll in other health plans like dental or vision, visit with a registered dietitian or certified health coach, participate in a fitness class, or attend a seminar or community event.
“We’ve also responded to the community impact our centers have had by adding the community events and needs as key components of our center,” Skerpon said. “Local non-profits have used our facility for
committee and board meetings, recognition events, fundraising campaign kickoffs, and promotion of their services.”
Skerpon added, “Each year, our sales, service engagements, care consultations, and community events increase significantly.”
Danville-based Geisinger is being asked to take corrective action by the state after receiving citations for a series of violations from 2015 through 2018.
An Affordable Care Act market conduct examination by the Pennsylvania Insurance Department (PIC) found violations within claims processing primarily involving mental health and substance use disorder services by Geisinger Health Plan and Geisinger Health Options.
Acting Insurance Commissioner Michael Humphreys said Wednesday the examinations identified violations within claims processing, includingclaims being denied when they should have been paid.
These denied claims were largely processed by behavioral health vendors, until 2019, when the company brought all behavioral health operations in-house, Humphreys said.
“The Insurance Department’s top priority is consumer protection within the marketplace, and these examinations are an opportunity for the department to ensure that companies are held to high standards and consumers are receiving the benefits to which they are entitled,” said Humphreys. “The results of the exam will see some consumers receiving restitution, as well as expected process improvements within the company.”
Humphreys said Geisinger was cooperative during the examination, which covers the period from January 1, 2015, to March 31, 2016, and January 1, 2017, to March 31, 2018. A second claims experience period was added because the company indicated that it made several systems changes from 2016 to 2018, including the implementation of a new medical claims processing system.
Geisinger issued a statement in response to the citation.
“We appreciate the opportunity to partner with the Insurance Department on opportunities to improve, which is very much aligned with Geisinger’s mission to make better health easier for the communities we serve. The review period for this most recent Market Conduct Exam dates back as far as January 2015, and we’re pleased to share that the violations cited in the report have either already been remediated or we are in the process of addressing them.”
The examination also reported additional Unfair Insurance Practices Act violations relating to unclear communications with members, maximum out-of-pocket miscalculations, and incomplete claim files, PID said.
In addition, the exam found mental health parity violations, as complete and timely quantitative and nonquantitative treatment limitation (QTL and NQTL) analyses were not available, nor were QTLs and NQTLs applied correctly in some plans.
Humphrey said Geisinger hired an outside consultant in 2019 to help address mental health parity.
The department has ordered Geisinger to take corrective action to address the violations. Claims that were incorrectly processed must be reprocessed and accurately paid with applicable interest.
PID said the company must adjust internal controls to address required claims notifications, accuracy and clarity in its communications with members, and oversight of producer appointments and terminations.
The company must also reprocess all claims for which incorrect visit limits or cost-sharing were applied and provide restitution to policyholders that were required to pay more than that policy allowed. The company must provide proof of payment, including applicable interest, to the department as claims are reprocessed.
Geisinger is ordered to pay a $125,000 penalty.
To date, approximately 60,000 Pennsylvanian consumers have received $5.87 million in restitution as a result of the department’s ACA market conduct examinations of other major health insurers.
The department said it will continue to monitor and verify that Geisinger’s corrective actions have taken place, including through quarterly reporting, as well as through a reexamination process in the future.
More people looking for Affordable Care Act insurance coverage are opting for better coverage this year.
Bill Tuthill, vice president of marketing for federal markets for Highmark, said expanded subsidies available through 2025 are making it more attractive for people to choose plans that offer lower or no deductibles than in previous years.
And, he said, more people aged 60-64 are looking for coverage because many have opted for early retirement.
Highmark membership in ACA plans has grown 200% since 2019, Tuthill said. “We launched new products which translated to growth.”
People shop on price and what it they get for it, he said. “Many are used to what they got when they were in an employer offered plan and want to keep those benefits.”
Tuthill said the high-water mark for ACA plans hit in about 2014 when the rates were rising 40% and companies were withdrawing for participation. A lot of people stopped shopping for them because of the price increases and increased deductibles.
From 2016 to 2019, things got even worse because premiums continued to rise when the government wasn’t paying some carriers. “Some pulled out of the market. We stayed in but narrowed our offerings until 2020 when we could put out a broad network plan competitively,” he said.
That worked because employer plans often offer broadband products where people have more choices for doctors and hospitals in network. “People were used to that and wanted to keep it,” he said.
“You may have looked before but look again. You might be surprised at what you see,” he suggested.
That’s because with the government subsidies, premiums are a little bit higher but significantly less than other goods. And most carriers are offering more broadband policies.
The expanded subsidies have brought premiums down from $250 a month to $150 or even $125, he said. “Those are lifesaving amounts and 90% of people qualify for the subsidies,” he said. “In fact, 50% to 60% of people are opting for plans with zero deductibles.”
Highmark has seen more people opting for gold plans, which cost more but offer zero deductibles. Tuthill said there are bronze, silver and gold plans. The tradeoff is price, he said.
Previously, Tuthill said a lot of people were “too rich” to qualify for subsidies, referring to people making $53,000. Now, with the limits lifted, people making $80,000 and up may qualify.
Tuthill said the rates and qualifications are all based on a mathematical formula based on income, family size and age. Eligibility is easy to check, he said. The information can be found on most insurance company sites or at Pennie. Com.
Seltzer Group Partners has restructured to meet the demands of the insurance industry, manage continued growth and maintain its commitment to clients.
The company, with offices in Emmaus, Reading, Myerstown and Schuylkill County, named former president Steven Stramara as CEO. He will focus on strategic and financial planning, acquisition strategies, sales mentorship, and continued membership/participation on the Keystone Agency Advisory Board and other industry affiliations, the company said.
Peter Krammes, former senior vice president was named president and will be responsible for the day-to-day operations, integrating acquisitions, executing the Seltzer strategic plan, and corporate culture.
John Campomizzi, continuing in his duties overseeing and managing service, has been named COO. Robert Schmidt, continuing in his role as sales manager, has
Peter Krammes –
been named chief sales officer.
During his tenure as president, Stramara led the agency’s growth, more than
doubling its revenue from $5,000,000 to over $10,000,000 in under five years.
“I was honored in 1997 to be designated as The Seltzer Group’s first ever vice president by my former partners, Bruce Krammes and Robert Seltzer.” Stramara said. “I am just as honored to be its first CEO in 2023.”
Krammes said, “I look forward to meeting the challenges of my new role and responsibilities and leading the Seltzer team into the future.”
We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience.
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
Sign In
Free Newsletter
