Cavalcade of Risk #191: Call for submissions

Julie Ferguson hosts next week's Cav. Entries are due by Monday (the 2nd).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Open wide and say...Yikes!

One of the "core" elements of the train wreck's Essential Health Benefits mandate is the requirement to provide pediatric dental benefits.

FoIB Jeremy from Assurant Employee Benefits has some news about how that's going to play out in real life. As with so many aspects of the ObamaTax, there's little guidance from Capital City as to what's going to actually be enforced come January. It appears that large groups (ie over 50 employees) probably won't have to make any changes to their plans to remain in compliance.

Small groups, though, will see "pediatric dental EHB services embedded in their medical plan...but those will generally be only dental services for the pediatric population (under age 19)." [ellipses in original]

But what are these services? In general, they'll mirror current coverage available with the SCHIP program, with perhaps some broader coverage available for additional screenings.

But the truly scary part is what's going to happen to the cost of orthodontia.

Hunh?!

One of the key "features" of the dental benefit is coverage for "medically necessary orthodontia." But FoIB Fred of Companion Life wonders, since "a definition of medically necessary orthodontia has not been yet established, it is unclear" how many ortho claims will fall in that category?

It's perfectly clear how many such claims will fall under that rubric: 100% of them. Count on it. And, as we have seen in, for example, the higher education, when the government subsidizes something, its cost always skyrockets.

Sounds like the brace-fitters, at least, have reason to rejoice.

Oscar-care

Need health insurance? Think transparency. Think lower health care costs. Think lower health

insurance premiums. Think Oscar-care. 

Oscar-care is a start-up health insurance company making their debut on the New York health insurance exchange in a few weeks.

Oscar will have one plan in each of the ACAs metal-tiered categories, and additional plan options for the Bronze and Silver tiers. Although Oscar will have some of the familiar pillars of the health care industry like co-pays and deductibles for in-person visits, it introduces new elements like free telemedicine, free generic drugs and online price comparisons. Oscar health insurance will pioneer “a consumer experience, not a processor of claims,” explained Nazemi, with the goal of simply guiding individuals through the complex health system in an integrative and safe way.

Forbes

This is a great idea. Color me skeptical, but if it delivers anywhere close to the promise, Oscar should run for public office.

New York mayor comes to mind . . .

For frequent conditions or issues, patients will be able to find treatments right on the website and have 24/7 access to a physician through their unique partnership with the telemedicine company, TeleDoc. Additionally, the creators claim there will be no need to discuss prescription refills in-person with an expensive physician when a user can have “one-click refills” through a health records feed that resembles a Twitter timeline.

Oscar will also offer services at many hospitals and retail locations such as New York CVS CareMark. The partnership that Oscar and CVS have is so strong that CVS is building sites for Oscar. 

One concern to me is, HIPAA privacy. Just how secure is this?

The founders of Oscar claim that consumers will have access to a doctor by phone within 20 minutes of a request, with no co-pay. Perhaps the concept is not revolutionary, but if it works, the behavioral changes associated with seeking care could be seismic. Currently, not many patients log onto insurance carrier webpages before seeing a doctor, unless they are seeing if the doctor is in-network. Oscar, however, wants patients to start their care with the insurer, not just use it for payment submission.

Someone put a lot of thought into this.

We've got Answers!

Recently, I was invited to apply for the position of Content Expert Writer (CEW):Insurance for Answers.com. The process was interesting: an intense, comprehensive on-line writing and editing test and a requirement to craft real answers for several Answers.com entries (both within and without my subject area).

They took a few weeks to evaluate the candidates (there were apparently several); I have been offered the position ("there can be only one").

I am very flattered, and eager to begin.

Needless to say, this position is in addition to my real job and InsureBlog, so I'll be learning (re-learning?) some time management skills. Fortunately, I have the best co-bloggers on the 'net, so if I end up slacking in my IB duties for a brief while as I come up to speed, I know that our readers won't be neglected - Thank you all!!

Obamacare for Dummies: Navigator Edition

Navigator grants have been awarded! HHS announced that funding would be $67 million spread across 33 states. As Mike noted in his post earlier, the funding magically increased from $54 million thanks to the Prevention and Public Health Fund Obamacare Slush Fund  that authorizes Kathleen Sebelius free reign over how to use it.

Anywho, with funds distributed, the hiring should begin and Navigators will soon be able to go online and complete their required training. In fact, they can already get a head start on the educational part.

Today CMS released a 217 page Standard Operating Procedures Manual for Navigators. The manual includes important stuff such as: making sure you smile, occasionally nod, say thank you, and most importantly, become an expert...in 34 days.

This is going to run so smoothly...

Such a deal!

I'm from the Government and I'll take you to the New World. Trust Me. Uh, do you happen to have a map?

In Connecticut, "Navigators" have been designated in each county -  after a nominally competitive bidding process - to manage "assisters" in the county who will actually be responsible for helping people enroll in Obamacare.  Connecticut is operating its own Exchange.   More info here. 

Here is Connecticut's definition of "Navigators"

The following organizations can qualify as Navigators:

• Community and consumer¬focused nonprofit groups
• Trade, industry and professional associations
• Unions
• Resource partners of the Small Business Administration
• Indian tribes, tribal organizations, urban Indian organizations
• Other public or private entities that meet Navigator requirements

The following organizations cannot be Navigators:

• Health insurance issuers
• Subsidiaries of health insurance issuers
• Associations that include members of the insurance industry or that lobby on behalf of the insurance industry

Actual advice to real people will be doled out by the "Assisters".  Connecticut promises this:

Assisters are individuals in your community – they work at nonprofits, small businesses, faith-based and other community organizations . . .  Assisters will be:

• Certified with training in the Affordable Care Act, Access Health CT, providing appropriate support based on language and culture, and more
• Trusted community members who have undergone thorough background checks
• Ready to help individuals, families and small businesses during the initial enrollment period (October 1, 2013-March 31, 2014)

Assisters apparently cannot be licensed insurance agents unless they happen to work for one of the specified community organizations.  So it appears Connecticut is not allowing anyone to become either a Navigator or an Assister who might actually, you know, have expert insurance knowledge but instead intends to employ people who must learn everything they need to know about Obamacare in what? - 30 days?  But - don't worry! - they will all be "certified" and "trusted" and they will all have undergone "thorough background checks."   All information they give you will be "based on language and culture".  Oh,  "and more".

Well, what can possibly go wrong?