Thursday, February 1, 2018

My take on the Amazon, Berkshire Hathaway, JPMorgan Chase foray into health insurance

Okay, so a lot of people are freaking out about this thinking that the 3 power house combo is going to actually do something significant in the marketspace. Health insurer stocks tumbled, investors are jittery.

It's all BS.

How many times have I used this term in my posts?


Why am I saying this?

Because what people think will save money won’t. I can take their group TODAY, and change their medical spend TODAY, freeing up massive amounts of cashflow TODAY. Guaranteed or I don’t get paid (I only get paid after I demonstrate results).

The best that they can do is the create something similar to what Kaiser has done in California. It’s a great system, but nothing new. Here are several reasons why.

1.       There is a floor to how much you can pay doctors. Any less and they will work for someone else.
2.       There is a floor to how much you pay hospital staff. Any less and they will work for someone else.
3.       My personal opinion is that 30% of ALL studies that modern medicine is based upon are either fake (artificially generated results) or not able to be replicated. More of bad medicine means sicker people, not healthier.
4.       They will buy into the three darlings of large brokerages:
a.       Population Health Management
b.       Wellness
c.        Analytics
These WILL NOT dramatically impact the severity and frequency of claims THIS YEAR. They will save a little money, but no more than “dust on a peanut” for a large employer.
5.       They will listen to “experts” who will tell them that cost increases due to “trend” are inevitable and PAY them money when their rates go up by millions of dollars (and think it’s okay).

Technology will NOT solve these problems.
Technology will NOT dramatically reduce the severity and frequency of claims.
My best guess is that they will NOT allow alternative medicine into the mix (acupuncture, naturopathy, etc). If they do, good for them. But it will still NOT reduce the severity and frequency of claims.

Have I made myself clear enough?

Friday, May 5, 2017

New Health Insurance Bill (HR 1628) Has Issues

Everyone has heard that the House passed some form of a health care repeal bill (HR 1628). Here is more stuff surrounding this bill to consider.
1. The Senate has already said that if they pass a bill, it will be different than the House version. Some have even hinted that they'd start with a fresh page and then build up a bill from there.
2. It will be difficult to have all 52 Republicans agree to vote in the Senate for any bill. If they lose just 2 votes, the bill is DOA.
3. Insurers have until June 21st to say whether they will be in or out of the exchanges. With so much up in the air, don't be surprised if there are several areas of the country that won't have any insurers participating (areas in TN and IA are the most at risk at this point in time). But if there is just one carrier, they can set whatever rates they choose. Welcome back to monopolies. Note that one part of a Senate bill may be to allow subsidies from carriers outside of the exchange, but that doesn't mean that insurance companies would want to take those subsidies.
4. The bill that passed harms medicaid recipients most, those with pre-existing conditions second. Having friends with special needs children agonize over this has been painful. My cousin, Fran Cannon Slayton spoke about her fears in a New York Times article this week as being a cancer survivor.
5. What needs to be fixed is the underlying problem. The COST of healthcare is too much. The QUALITY of healthcare is questionable (my estimate is that 40% of the studies that doctors rely on to indicate what care to give are either falsified, cannot be replicated, or do not actually apply to the population they are applying them to). If you read all of the problems with studies and what the academic world is doing to fix this, you'll see what I mean. My family has been the recipient of BAD healthcare as recently as 6 weeks ago (luckily we got a second opinion). It is out there, it is prevalent, it needs to be fixed.

Tuesday, March 7, 2017

Many Business Owners Overpaying for Health Insurance by 40% - 60% (Small Business)

Written by Peg Reid.

Robert Slayton, of Robert Slayton & Associates, Naperville, reports, “My small business clients regularly report premium savings of 40-60%.”  For the same or better plan.  With additional savings and benefits to the business.

How do I save 40% - 60% on my Health Insurance Premiums?

His small business owner clients opened up a group health insurance plan.
Along with the lower premiums, small employee groups enjoy more choices, better choices and broader networks. 

If You’ve Ever Run Into one of these Problems? The Solution is Simple.

  • ·         My employee said she would have to resign so she could get a job with health benefits.
  • ·         I make too much to get a subsidy so my premiums are outrageous.
  • ·         My employee would prefer to work for me full-time (and I’d love to have him) but he has to keep his other job because it offers a health plan.
  • ·         My personal premiums are more than my mortgage payment!
  • ·         My wife can’t see her doctor at Northwestern without being in an HMO (we want a PPO) with a PCP out of Winfield or St Charles.  We live in the city, a few blocks from Northwestern!
  • ·         My twenty years of mammogram films are at Rush and now I have to go to someone who doesn’t know my history.

Can’t See Your Doctor? Can’t Go to the Hospital of Your Choice?

Were you frustrated that you couldn’t get access to the providers you wanted?  Small group PPO options include hospital systems such as Northwestern Medicine and NorthShore University Health System not widely available in the individual market or in the case of Rush University Medical Center, not at all. 

I Thought I Couldn’t Qualify?

The old rules around plan sponsorship which had caused small business owners to reject the idea out of hand have become more accommodating.   Participation requirements have largely been eliminated; businesses with as few as one employee are eligible with certain carriers, even if only the owner opts into the plan.  In a few cases, businesses with no employees can qualify to open a plan.  And the contribution requirement (which varies by carrier) is often dwarfed by the small business owner’s personal savings, savings to the business and gain in competitive advantage.  Corporation, S-Corp, LLC or sole proprietor can all be eligible.

Slayton himself was on an individual family health insurance plan paying $880/month.  His renewal was $1543/month - over $600/month more for the same coverage.  He opened a small group health insurance plan for his business covering only his family (his two employees aren't eligible as part-timers but even if they were, they would have waived group coverage as they have their own coverage) and the new cost was $839/month – less than his 2016 cost!  If he had wanted the larger network that included all of the doctors and hospitals, it would have been $1100/month, still significantly less than his current plan renewal.

I Thought I could only sign up during open enrollment?

You can start a group health plan at any time during the year.  You and your employees can drop your current plan if the group plan makes more sense.  The best part is that when you are looking for quality hires, you will be on a more level playing field with larger companies when it comes to recruitment and retention.   If you start your plan May 1st, your rates are fixed until May of next year.  If you decide not to renew the plan next year, you will qualify for a special enrollment to return to individual coverage.

Contact Peg Reid at, 630-779-1144 x103, for a worksheet to estimate your savings. If Peg is out of the office, contact Robert Slayton at x101

Thursday, October 13, 2016

Individual Health Insurance Rates Skyrocket for Health Exchange Market ( for Illinois

I just got back from a professional association meeting where a person from the department of insurance was presenting. What he presented is grim at best (slides are from that presentation). Below is a preliminary cut. I don't have the actual rates available to quote (they are coming any day), but by the look of the items below, it will be worse than bad. See my analysis at the end.

1. Selection of insurance companies available is less. Seven counties have one company available.

2. Rates for the LOWEST Bronze Level plan are going up 10% - 60%.

3. Rates for the second lowest silver plan (for which subsidies are based upon) are going up 25% - 60%

4. Rates for the lowest Gold are going up 40% - 70% with several counties not offering any gold plans at all.

What does this mean?

1. If you receive a subsidy, you will be protected for a majority of the increase due to your subsidy being dramatically increased. You may still pay more money.

2. Your choices are dramatically curtailed. Your best option will most likely be an HMO plan. Most carriers are driving towards that eventuality as it is the only way that they feel they can break even. Pretty much BCBS of Illinois (in my opinion) will be the only game in town as a quality carrier with decent rates. Cigna is joining the market in a few areas, but I don't have specifics.

3. If you need multiple specialists from multiple medical groups or the teaching hospitals (e.g. Northwestern Memorial, or a Northshore Hospital). You may not be able to access them via the exchange and would have to consider either a direct policy or if you have your own business, you may qualify for coverage (you no longer need two employees on the plan, but you do either need to have a husband/wife partnership that filed that way last year or at least one W2 employee - whether full or part time) that will give you access to the larger PPO networks. Contact me for specific details.

4. If you don't receive a subsidy, going outside of the exchange may give you more choices. Harken is leaving the Exchange market, but is still around if you go directly to them.

5. Some of you reading this won't be able to afford ANYTHING. If you fall into this category, I have several non-insurance programs that will avoid the penalty and typically cost significantly less (1/2 to 1/5 the cost of insurance). They do cover your bills, but you need to agree to their principals. Some have holes in the plan that need to be filled with another product, but overall, something is better than nothing.

Use this link to schedule a 15 minute call to discuss your situation.

Robert Slayton

Tuesday, August 23, 2016

Options Limited for Health Insurance in 2017

If you buy individual health insurance (especially via, your options WILL be limited this upcoming year.

Right now DuPage County (IL) has 4 options. Aetna, BCBS of IL, Coventry, and United Healthcare. BCBS and Coventry have PPO networks. In 2017, you will have BCBS and Cigna only as Aetna, Coventry, and United Healthcare pull out. Cigna will be an HMO. This means the ONLY PPO network available will be the Blue Choice PPO network via BCBS of IL (assuming they continue this plan, which I think they will). If you need a variety of specialists who are not in the same medical group, you will either have to pay out of pocket or change doctors.

Cook County won't be much better. You have 7 options, but 3 will be going away (see above). Harken Health (who currently has the best PPO network) will be changing the network to either a smaller PPO network or HMO (they haven't told me yet). In 2017, you will probably have Ambetter, BCBS of IL, Harken Health, Humana, and newcomer Cigna. The only two that would possibly have a PPO is BCBS of IL and Harken Health (see above).

Downstate will at least have Health Alliance (as of my writing this article) who offers a POS plan (less restrictive than an HMO, but not quite as flexible as a PPO) in addition to BCBS of IL.

BTW, I didn’t mention the premiums. Go to if you want to see how bad it is going to be.

To help people who can’t afford the cost, I have a new plan that is NOT insurance but is a cost sharing ministry that will be available to those who just can’t afford the new premiums. It avoids the penalty and has some holes, but something is better than going with nothing. If you want more information on this, contact me. The good news is that you can sign up at any time, but it does NOT cover any pre-existing conditions or medications other than generics. View this as a “last resort” plan.

Thursday, August 4, 2016

IRS Issues Draft Instructions for Forms 1094-C and 1095-C for 2016

IRS Issues Draft Instructions for Forms 1094-C and 1095-C for 2016   

August 4, 2016

By Larry Grudzien,, 708-717-9683

On August 1, 2016, IRS released draft instructions for Forms 1094-C and 1095-C for 2016. The following is an overview of important changes to the forms:

Form 1094-C

On line 22, box B is designated "Reserved." The Qualifying Offer Method Transition Relief is not applicable for 2016.

In Part III, column (b), "Section 4980H" was inserted before "Full-Time Employee Count for ALE Member" to remind filers that the Code Section 4980H definition of "full-time employee" applies for purposes of this column, not any other definition that an ALE Member may use for other purposes.

Form 1095-C:

The language "Do not attach to your tax return. Keep for your records." was inserted under the title of the form to inform the recipient that Form 1095-C should not be submitted with the return.
Changes to codes. Code 1I for line 14, and Code 2I for line 16, are no longer applicable and have been reserved.

New codes 1J and 1K have been added for line 14. These codes are used to reflect conditional offers of coverage to an employee's spouse. A conditional offer is an offer of coverage that is subject to one or more reasonable, objective conditions (for example, an offer to cover an employee's spouse only if the spouse is not eligible for coverage under a group health plan sponsored by another employer.

Multiemployer Plan  Interim Rule Relief:  The use Code 2E for line 14 has been extended to 2016.

Form 1094-C and Form 1095-C:

Transition relief. Several forms of transition relief were available to employers for 2015 under Code Sections 4980H and 6056, but only limited transition relief continues to apply in 2016. References to transition relief that applied only in calendar year 2015 have been removed. Descriptions of the remaining forms of transition relief have been amended to clarify for which months in 2016 the transition relief applies.

New Definition: The term "Employee Required Contribution" has been added.  This  term refers to the employee's share of the monthly cost for the lowest cost self-only minimum essential coverage providing minimum value that is offered to the employee by the ALE Member.

For a copy of the instructions, please click on the link below:

Tuesday, July 5, 2016

Employer Notices From the Marketplace - What to do

Many employers received notices last week about employees who are receiving subsidies on the individual exchange. This matters if you are classified as an ALE "Applicable Large Employer" as penalties may be assessed.

  1. If the employee is receiving a subsidy because you did not offer them coverage, then there is nothing you need to do.
  2. If the employee is receiving a subsidy because you did not offer a plan that met minimum essential coverage or affordability, then there is nothing you need to do.
  3. If you did offer coverage that was affordable and met minimum essential coverage, then you have 90 days within which to appeal.

Here is a link to that form:

If you are an ALE and don't know what I am talking about in the above 3 points, then you ABSOLUTELY need to talk to me, your current broker, or your Employment Attorney.

Below is a newsletter about this from a very good Employment Attorney (if you need one). Larry Grudzien (, 708-717-9638).

From the Desk of Larry Grudzien

What's up with the Notice from the Marketplace?        

July 3, 2016
Last week, many employers received notice from the Marketplace indicating one of their employees was qualified for advance premium tax credits. Many are asking what  is this notice and how should deal with it. The following explains what the notice is and what steps an employer should take.

What is this Notice?

Under Section 1411(e)(4) of the Affordable Care Act, a Marketplace must notify an employer if any of its employees is determined to be eligible for a premium assistance credit (or the cost-sharing subsidy) because the employer does not provide minimal essential coverage through an employer-sponsored plan, or the employer does offer such coverage but it is not affordable.

Under 45 CFR Section 155.310(h), the notice must:

  • identify the employee, providing the minimum necessary personally identifiable information;
  • state that the employee has been determined eligible for advance payments of the premium tax credit, listing the potential reasons for the determination (instead of the actual reason) and without providing tax return information;
  • indicate that, if the employer has 50 or more full-time employees, the employer may be liable under the employer responsibility rules of Code Section 4980H; and
  • notify the employer of its right to appeal the determination.

Under Section 1411(e)(4)(B)(iii) of the Affordable Care Act, a Marketplace must provide this notice regardless of the size of the employer even though the employer mandate penalties only apply to applicable large employers (ALEs).

In addition to the above notice, a Marketplace may also contact the employer to determine whether its employees are enrolled in or are eligible for affordable, minimum value coverage under an eligible employer-sponsored plan, as provided in 45 CFR Section 155.320(d)(3)(iii)(D).

What should an employer do after it receives this notice?

The employer may appeal a determination that an employee is eligible for advance payments of the premium tax credit based in part on a finding that the employer did not offer qualifying coverage to the employee, as provided in 45 CFR Section 155.310(h). While a Marketplace's determination does not itself trigger the employer mandate penalties (those penalties are assessed by the IRS), employers offering coverage that should not result in the receipt of advance payment of premium tax credits may wish to use the appeals process to ensure, as much as possible, that their employees are not mistakenly receiving such payments.

The appeal may be conducted by either a Marketplace or by HHS if a Marketplace has not established an appeals process.

A Marketplace must allow employers to request an appeal within 90 days from the date of the notice from the Marketplace and permit employers to submit relevant evidence to support the appeal, as provided in 45 CFR Section 155.555(c). An employer may request an appeal by completing an appeal request form. Click on link below to obtain a copy of the request form:

An employer may mail or fax an appeal request.

Under 45 CFR Section 155.555, this appeals process must give employers the opportunity to:
  • present information to a Marketplace for review of the determination, including evidence of the employer-sponsored plan and employer contributions to the plan; and
  • have access to the data used to make the determination to the extent allowable by law.

Under 45 CFR Section 155.555(d), once a Marketplace receives a valid appeal request, it must:
  • timely acknowledge the receipt of the request,
  • provide an explanation of the appeals process,
  • inform the employee of the appeal, and
  • provide the employee with instructions for submitting any additional evidence for consideration by the appeals,

Under 45 CFR Section 155.555(i)(3), the standard of this review is a de novo review. A de novo review means a review of an appeal without deference to prior decisions in the matter.

Under 45 CFR Section 155.555(g), as part of the review process, the employer must be given the opportunity to:

  • provide relevant evidence for review of the determination of the employee's eligibility for advance payments of the premium tax credit or cost-sharing reductions;
  • review the information identifying the employee, information regarding whether the employee's income is above or below the threshold by which the affordability of employer-sponsored minimum essential coverage is measured, and other data used to make the determination, to the extent allowable by law.

The Marketplace's decision is required to be provided to both the employer and employee generally within 90 days of the date the appeal request is received, as provided in 45 CFR Section 155.555(k).
If the employer's appeal is successful, a Marketplace will send a notice to the employee encouraging the employee to update his or her Marketplace application to reflect that the employee has access to or is enrolled in other coverage. Under 15 CFR Section 155.555(k), the employee has the right to appeal the decision.

This appeal decision does not foreclose any future appeal rights the employer may have under the Internal Revenue Code for excise tax liabilities. While an appeal of a notice by the Exchange may be beneficial, employers are not necessarily required to make this appeal to preserve their rights against the later potential assessment of Code Section 4980H liability, as provided under 45 CFR Section 155.555(k)(1)(ii).

For a copy of the employer appeals process regulations, please click on the link below: