New Jersey Aids Stop-Loss

supreme-courtIn a recent legislative update from SIIA, it was noted that the New Jersey Department of Banking and Insurance (DOBI) approved regulations lowering minimum stop-loss attachment points for large groups of 51 lives and above, effective in late August.

This move allows the large group individual attachment points to be $20,000 per individual, reduced from $25,000 and sets the minimum aggregate attachment point at 110% of expected claims, down from 125%. These changes broaden the levels of stop-loss or excess risk coverage available to self-funded health plans and brings New Jersey’s definition in line with the NAIC Stop Loss Insurance Model Act.

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Food Allergies Spread

sip-food-allergryAn analysis by FAIR Health, an independent nonprofit that reviews health and dental claims led by individuals, shows that severe allergic reactions to foods like peanuts have increased five-fold in the past 10 years. Studies now show that as many as 8% of children have a food allergy, with nearly 40% reflecting a history of severe reactions. More than a fourth of all claims were linked to peanuts, while tree nuts such as walnuts, pistachios and seeds accounted for 18%. One interesting fact is that a third of all claims were in people over the age of 18.

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Achieving Your Health Goals

sip-wellnessNow is a good time to evaluate the resolutions you set months ago. Sometimes we tend to create goals that are too broad, such as “eat better” or “lose weight”. Rather than focusing on the end goal, it can help to break it down into steps.

Crafting S.M.A.R.T. goals can help you make positive changes that have staying power – here’s how:

Specific: Instead of a vague objective such as “manage stress”, come up with a specific action item, such as “do a 3-minute breathing exercise before work and before bed.”

Measurable: How will you know if you reach your goal? Track your progress in a journal or calendar.

Attainable: If you’ve been sedentary and want to start exercising it’s best to start with something you know you can do, like a 15-minute walk on Mondays, Wednesdays and Fridays, and build on your progress.

Relevant: Do your goals align with your interests and values? Don’t just take up running because your best friend is a runner. Go with something you love and really enjoy, like walking or swing dancing.

Time-specific: Rather than setting a goal to meditate for 15 minutes, 3 times a week for eternity, set an end-point – say, one month. When you reach that goal, assess your progress, make adjustments and set another short-term goal.

It’s never too late in the year to revise your resolutions and establish goals you can achieve.

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Small Businesses Doing More

sip-smallbusinessAccording to Deloitte Consulting LLP, small and medium sized employers with 100 or more workers are contributing considerably more towards the cost of employee and dependent healthcare benefits than legally required – about 73% of the total cost, on average. Regional differences also exist, with companies in the Northeast contributing more toward the cost of family coverage and companies on the West coast contributing more to individual coverage.

Even as healthcare costs continue to increase, consultants agree that employers of all sizes will continue to contribute significantly to healthcare benefits as the job market continues to tighten and retaining top talent remains a top priority.

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Fighting Specialty Drug Costs

Prescription-drugsTo help control rising specialty drug costs, the National Business Group on Health has issued a lengthy report including 5 public policy recommendations they hope will educate the marketplace and encourage effective, strategic partnerships.

According to NBGH officials, plan design is the key to managing the use of specialty prescriptions as well as the costs. The report details progress resulting from the aggressive use of utilization review, case management and prior authorization for specialty drugs. Other measures yielding positive results are the design of a specialty tier into the benefits plan and taking measures to administer specialty prescriptions in a facility separate from the hospital. Prescriptions authorized by a hospital or billed under the medical benefit are harder to track and often more costly.

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Doctors Go Retail

healthIf you live near a large shopping mall, chances are you’ve noticed vacant stores, thanks to the rapid growth of online shopping. Many retail vacancies are being filled by doctors, dentists, physical therapists and other healthcare professionals looking for ways to become more accessible to their communities. To generate more foot traffic, one dental network will open clinics in 36 retail centers this year.

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Paid Sick Leave Bug Spreading

paid-sickAs if businesses in Illinois don’t have enough concerns, the General Assembly has introduced bills mandating a minimum of five (5) paid sick days per year for Illinois workers. Employees would be able to use the time to care for themselves or a family member, attend a medical appointment for themselves or a family member, miss work due to a public health emergency or because they or a family member has experienced domestic violence abuse. The bills were presented for a second reading earlier this spring, with no resolution to date.

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