The Veil Is Lifted!

I have worked closely with employer groups for over 20 years now.  In that time, I cannot tell you how many times I have been asked by my employer clients:

  • How is our plan doing?
  • What kind of renewal can we expect?
  • Are our employees using the plan we provide?

For employers with fewer than 100 employees, these have always been questions I could not answer.  But, in Louisiana, now that has all changed.  Last year, the Louisiana Legislature passed and Governor Jindal signed into law a Healthcare Transparency Law that requires insurers to provide month by month premium v. claims information as well as large claim information for all groups – down to 2 covered employees.  This means, for the first time in the history of small group health insurance, employers will have mandatory access to this valuable information.

How can this help employers?

This kind of claim information, when properly evaluated, can guide employers to the most effective plan designs available for their specific employee population.  As an example, lower utilization and focused high utilization plans would generally benefit from HSA eligible plans and an education campaign to support them.  Plans with broad and high utilization may benefit from copay driven plans with FSAs.

With the underwriting changes that are coming in 2014 as part of Health Reform, small employers (under 50 employees) will have new options and new rules to consider.  Arming yourself with this newly available information will put you in the best possible position possible to evaluate your benefit alternatives.

As the law states,

A plan sponsor is entitled to receive protected health information under this Section only after an appropriately authorized representative of the plan sponsor makes to the health and accident insurer a certification substantially similar to the following certification:

‘I hereby certify and have demonstrated that the plan documents comply with the requirements of 45 C.F.R. Section 164.504(f)(2) and that the plan sponsor will safeguard and limit the use and disclosure of protected health information that the plan sponsor may receive from the group health plan to perform the plan administration functions.’

I encourage you all to take advantage of this new opportunity to better understand your plan, how it is performing and what you can do to impact that.  I am happy to help you in that cause.


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