Is Your Healthcare Plan Covering People It Shouldn’t?

healthcare eligibilityIf you provide an employer healthcare plan, it’s vital to ensure only the correct people are covered. Comprehensive healthcare insurance is one of the most important benefits you provide to employees, so keeping premiums down matters to everyone.

One of the main causes of rising premiums and healthcare costs is when ineligible people continue to be covered on a healthcare plan. For employer-provided health insurance, ineligible people are typically:

  • Former employees who have now left your business.
  • Employees whose status has changed, meaning they are no longer eligible under the plan, or should be on a different plan.
  • Dependents of an employee, where the status of the dependent has changed.

Examples of ineligible people for a healthcare plan

The following situations could all cause people to become ineligible.

  • A dependent child who ages beyond the dependent eligibility requirements in the plan.
  • A former spouse who separated from your employee.
  • An employee who leaves your business.
  • An employee whose status has changed, for example through changing the number of hours worked or moving to a different position, and whose new status requires a different healthcare plan.

Creating a healthcare eligibility audit

You need a process to understand and remove people from your employer-provided healthcare plan. Here’s how to put an “Employee and dependent healthcare eligibility audit” together.

Understand the eligibility requirements of your current employer-provided healthcare plans

Go through any existing employer-provided plans and note down:

  • All employees currently covered by the plan.
  • All dependents currently covered by the plan.
  • Eligibility requirements for employees.
  • Eligibility requirements for employee dependents.
  • Benefits and coverage provided.

You may hold this information internally, or you can get the data from your broker or healthcare insurance provider.

Analyze your existing employee data

Match your existing employee data against the healthcare plan eligibility requirements. Check:

  • Any employee listed as being on the plan is still employed by you.
  • Any dependent listed on the plan is still a dependent on the employee.
  • The type of healthcare plan is appropriate for the status of the employee.
  • All eligibility requirements are being met by any active plan participants.

Find gaps in the data

It’s likely that you will find gaps in the information. You may not have the latest details of dependents or employees. Complete a gap analysis to understand the data you need to ensure only appropriate people are covered by the plan.

Carry out a healthcare eligibility audit to close any gaps

Once you know what data you need, you will need to audit the information with your employees. Approach each employee with the details of their health insurance for them and their dependents and ask if all the information is factual and correct. If it is, get them to sign off on the information.

If the data is incorrect, get it updated and see how it affects healthcare eligibility. Communicate this back to the employee.

Careful communication is key

You will need to communicate carefully throughout this process. Employees may see the eligibility audit as a tool for taking away healthcare coverage. It’s important to manage the message carefully — The audit ensures only appropriate, eligible people are covered. That means less cost-leakage and medical expenses on plans, which keeps premiums down and ensures the right people have the right coverage.

You may want to complete the healthcare eligibility audit every year. This will ensure your records are up to date and reduce the premiums you and your employees need to spend.

Jill Goulet
Risk Management Consultant

healthcare eligibility

CT Hospital Insurance: Lessons from the Dallas Ebola Case

CT Hospital Insurance: Lessons from the Dallas Ebola Case CT Hospital Insurance Lessons from the Dallas Ebola Case

Is the American healthcare system ready for an epidemic? That’s the question on almost everyone’s mind after the U.S. Center for Disease Control and Prevention (CDC) recently confirmed that a man officially diagnosis as having the Ebola virus is being treated at a hospital in Dallas Texas. The diagnosis is the first of its kind on American soil and has generated widespread concern regarding the spread of the deadly disease.

Officials say that because Ebola is only spread through direct contact with a patient exhibiting symptoms, a widespread outbreak like the one happening in West Africa is highly unlikely in the States. However, a widely held consensus remains that an outbreak of the virus on American soil would be devastating to our already strained healthcare system.

The case has also generated public and media attention for another reason. While the CDC and public officials claim to be working on identifying who the man may have come in contact with over the last few weeks, media outlets and Dallas residents are voicing their concern about the lack of available information and the overall handling of the case.

According to reports, the ill man in Dallas was originally turned away from a Texas hospital after his first attempt to seek medical care. There is mounting public concern regarding that fact that the man was turned away, as well as concern over the impacts of this decision. Little is known about why the man was initially refused care, but doing so prolonged his diagnosis and exposed the man’s family members and an unknown number of others to the virus. It is unclear if the original hospital where he sought care will face an investigation.

While public hospitals have the obligation to offer treatment to any individual, privately owned hospitals do have the right to refuse medical care in non-emergency circumstance. However, under the Emergency Medical Treatment and Labor Act, all hospitals that accept payments from Medicare are required to provide emergency health care treatment to anyone needing it regardless of citizenship, legal status, or ability to pay. Due to the current classification as a World Health Organization epidemic, Ebola symptoms would be considered an emergency medical condition which needs immediate attention and quarantine actions.  As such, the hospital’s decision to turn the patient could have severe negative repercussions if negligence is alleged or proven in this case.

The healthcare industry faces a myriad of unique liability concerns, which can lead to increased risk exposures and operational complications. At Sinclair Risk and Financial Management, we specialize in problem solving and finding solutions to the challenges and risks our clients face. We offer a complete portfolio of business insurance products, from malpractice to workers compensation coverage, designed specifically to meet the needs of the Connecticut healthcare industry.  To learn more about our CT hospital insurance programs, give us a call today at (877) 602-2305.

CT Hospital Insurance: Hackers Target Hospitals Most

CT Hospital Insurance: Hackers Target Hospitals MostCT Hospital Insurance Hackers Target Hospitals Most

Malware and cyber-attacks are on the rise in nearly every industry, but researchers from Websense, a cybersecurity programming and research firm, report that hospitals above all other industry sectors are facing the most rampant increase in cybersecurity breaches and attacks. According to recent data, the rate at which hackers have been targeting and implementing successful attacks on hospitals has become unparalleled. Research indicates that attacks on the healthcare industry have increased 600 percent over the last ten months.

One such attack on the health care industry occurred in August and has been deemed one of the largest breaches to hit the industry yet. The attack was on Community Health Systems, a hospital management operation which operates 206 hospitals across 29 states, specifically in rural communities. They self-reportedly suffered a data breach which could compromise the personal information of some 4.5 million patients. In their regulatory filing with the U.S. Securities and Exchange Commission, Community Health Systems claimed that cyber-attacks had transpired during April and June of this year. Upon further investigation, officials have indicated that they believe these and many other cyber-attacks have been linked to a group of militant hackers operating out of China. Chinese authorities deny the allegations.

According to the MIT Technology Review, hackers are likely setting their sights on medical records from hospitals because security firewalls are easy to breach and the payoff can be extremely lucrative. Cyber-attacks often target systems that store large amounts of valuable personal information, such as medical records which can have everything from personal identity information to financial data. Websense has indicated that the Heartbleed bug, which exposed a serious vulnerability of half of a million web servers to last spring, could be a major factor in many of the breaches. The firm warns that a significant amount of patient records are still vulnerable because many hospitals have yet to implement the Heartbleed patch or new encryption tactics.

No matter where you are in the healthcare delivery system, your patient and private data is at risk. With the likelihood of security breach increasing every day it is important that Connecticut healthcare providers take the proper precautions to bot prevent and respond to cyber-attacks. At Sinclair Risk and Financial Management, we specialize in problem solving and finding solutions to the challenges and risks our clients face. We offer a complete portfolio of business insurance products, from malpractice to workers compensation coverage, designed specifically to meet the needs of the Connecticut healthcare industry.  To learn more about our CT hospital insurance programs, give us a call today at (877) 602-2305.

Healthcare Industry Risk Management: Are We Adapting to Telemedicine?

Healthcare Industry Risk Management: Are We Adapting to Telemedicine?Healthcare Industry Risk Management Are We Adapting to Telemedicine

According to industry analysts, telemedicine has the potential to deliver more than $6 billion a year in healthcare savings to U.S. businesses, yet healthcare providers seem somewhat reluctant to adopted telemedicine into their practices. In their recently released poll, the Healthcare Information and Management Systems Society (HIMSS) conducted an inquiry into the state of the healthcare industry, particularly targeting the growing incorporation of telemedicine technologies.  According to the poll conducted by HIMSS Analytics, nearly half of healthcare organizations report some utilization of telemedicine technology through the course of their practice. Some operations report combining as many as four different techniques and technologies to enable remote medical care.

The study found that some 46 percent of respondents deploy up to four telemedicine technologies within their organization. The most widely used and most commonly considered technologies are two-way video/webcam. Nearly 58 percent of current telemedicine providers integrate two-way video component into their practices, and 67 percent of those looking to invest in telemedicine report their interest in video communication technology.

The 2014 U.S. Telemedicine Study polled both hospitals and physician practices to gain a more clear understanding of where the industry stands in relation to offering remote healthcare through digital technology. Telemedicine has become a key component of HIMSS Analytics’ campaign to analyses the healthcare industry and its ability to facilitate cooperative care. The non-profit group tracks how well organizations are able to communicate, collaborate, exchange data and coordinate patient care. Their report on the findings of the study seek understand how and why providers are adopting telemedicine tools. The HIMSS is seeking to identify the product wants and needs of healthcare providers, as well as their timeline and investment strategies to adopt telemedicine over the next two years.

At Sinclair Risk and Financial Management, our objective is to always find new ways to help our clients capitalize on changing market conditions, adapt to industry trends, and navigate their ever-changing regulatory environment. That’s why we specialize in risk management and financial strategizing. Our experienced professionals have the practical experience required to understand the risks and hazards you face as a healthcare provider, and to help determine the best solutions to mitigate those risks. We have years of experience helping medical professionals secure comprehensive insurance solutions that meet their unique needs. Let our healthcare industry risk management specialists help secure your practice, so you can keep secure the health of your community. Give is a call today at (877) 602-2305 to learn more about all our services.

States Refuse to Set Up Healthcare Exchanges

States Refuse to Set Up Healthcare ExchangesStates Refuse to Set Up Healthcare Exchanges

The Obama administration announced last week that more than half of the states refused to set up their own health insurance exchanges.

Last Friday was the deadline for states to notify the federal government of their plans, according to U.S. News. Administration officials had been hoping the re-election would overcome resistance to the new healthcare laws. According to the New York Times, the count was 18 states who intended to run their own exchanges.

The exchanges will be online supermarkets where people can shop for private health insurance. Individuals will also be able to obtain federal subsidies to help alleviate the costs. Each exchange will operate a website where uninsured residents of the state and small employers can compare various health-plan options offered by insurance companies. The exchanges are designed to be similar to the way consumers shop online for hotel rooms and airplane tickets.

The Congressional Budget Office estimated that some 25 million people will be covered under the new exchanges. By default, the federal government will implement health insurance exchanges in the twenty-five states that refused. An additional seven states will operate in federal-state partnerships.

Regardless of the changes, Sinclair Risk & Financial Management can provide you with insurance and risk management strategies to protect the financial strength of your operation, no matter where you are in the healthcare system. We have the skills to find ways to capitalized on the changing market conditions, strict regulatory environment, and help your healthcare organization get the protection it needs.

Our services include risk surveys and assessment, loss prevention, claims monitoring, intervention, and more. Contact Sinclair Risk & Financial Management today for more information about our Connecticut healthcare insurance programs.