CSI NY : CORPORATE WARRIORS
clip video : episode 2x04 "Corporate Warriors"
When the goal is eliminating those PUBLIC STATE HEALTH SYSTEMS of tiered insurance policies, there are a few ways to do this FAST.
One is to make the lower tiers impossible to access or not affordable that people leave for other insurance resources. Our US MEDICARE---best in world history in public senior health access and quality was attacked this way with a PRIVATE MEDICARE ADVANTAGE in the wings to replace that public system. Same happening today with those AFFORDABLE CARE ACT state health insurance systems.
Today, we will look again at NARROW HEALTH SYSTEMS----designed to be OFF these state health insurance systems and made to be THE ONLY GAME IN TOWN for more and more and more US 99% WE THE PEOPLE trying to INSURE ourselves AND FAMILIES.
'The federal penalty for not having insurance will disappear in 2019 (although some states have their own penalty), and new rules are expanding some types of coverage that don't meet the ACA standards. Such policies may have lower premiums, but they also shift more risk to you. "I would look at these alternative options very cautiously. It's very much a buyer-beware market," says Sabrina Corlette, research professor at the Georgetown University Center on Health Insurance Reforms'.
'Even with the subsidy, their coverage was becoming unaffordable.
The full price for their policy was set to rise to $3,200 per month in 2018, which would still cost them $1,800 with the subsidy'.
Health Care & Insurance
How to Get the Best Individual Health Policy in 2019
More insurers are offering individual policies compared to previous years. Here's what you should know.
By Kimberly Lankford, Contributing Editor
October 3, 2018
The options are very different if you are buying insurance on your own. After a tumultuous few years -- when many insurers stopped selling individual health insurance or repeatedly boosted premiums by double digits -- the market is turning around. More insurers are selling individual policies again or expanding into new counties and states, and now fewer areas are left with only one insurance option.
"It hit bottom last year, when we had a lot of exits from big insurers," says Katherine Hempstead, senior policy adviser with the Robert Wood Johnson Foundation, which studies the health insurance market. "But the carriers who stayed in the market have figured out how to make money and develop different provider networks, and they understand the customer better." For example, many counties in Ohio and Pennsylvania had only one insurer in 2018, but more areas will have two or three insurers selling individual coverage in 2019, she says.
Paul and Nancy Melquist of Shoreview, Minn., started buying their own coverage in 2017, after Paul retired at age 58 from a career in the defense industry. Because the Melquists don't have many regular medical expenses, they chose the plan that had the lowest premium but also a $6,600 deductible for each person. Even so, the Melquists paid $1,250 per month in premiums. Their only medical expense for the year ended up being their annual physicals. "We paid $15,000 for two physicals, which was not a satisfying financial transaction," Paul says. They did contribute money to an HSA. Their premiums went down slightly in 2018, to about $1,165 per month, and they're hoping they'll have some lower-cost options for 2019.
The average rise in premiums for individual policies is expected to slow in 2019, to about 5% -- and average premiums are even going down in a few states, such as Tennessee, says Hempstead. You may have more insurers to choose from and more low-cost options during open enrollment this year, which runs from November 1 to December 15 (although a few states have extended the deadline).
Strategies for people with higher incomes.
People who earn too much to qualify for a subsidy to purchase a policy on a state exchange may face sticker shock -- especially if they're in their fifties or early sixties and have to pay up to three times what a younger person might pay. You qualify for a subsidy if your income is below 400% of the federal poverty level (which is $48,560 for singles, $65,840 for couples and $100,400 for a family of four). In that case, you should generally buy insurance on your state's health insurance exchange; go to www.healthcare.gov for links.
Policies are still pricey, but fortunately, most buyers have more options in 2019 than before. The best strategy is to "leave no stone unturned when it comes to evaluating all of the plans available in your zip code," says Bernard Health's McCostlin. You can shop for policies on your state exchange even if you don't get a subsidy. Or you can go through a Web broker, such as eHealthInsurance.com, or buy directly from the insurer. You can also work with a health insurance agent (find one in your area at www.nahu.org).
It's best to buy coverage through your state's health insurance exchange if there's any chance that your income could qualify you for a subsidy. But you may have some options off the exchange that aren't eligible for a subsidy but still meet the Affordable Care Act standards (which specify 10 essential health benefits, no maximum coverage limit and no preexisting-condition exclusions). Some insurers may offer off-exchange policies with different premiums, cost-sharing or provider networks than their on-exchange versions.
It's particularly important to look at off-exchange options if you're interested in a silver-level policy. The plans sold on the state insurance exchanges fall into four different levels based on the amount of coverage they provide, with bronze policies generally having the highest deductibles (and lowest premiums), silver policies providing slightly lower deductibles and co-payments, and gold and platinum providing even more coverage.
Most insurers continue to "silver load" their premiums -- that is, they charge a lot more for silver plans on the exchanges now that the government no longer reimburses them for cost-sharing subsidies, which help pay deductibles and co-payments for lower-income people. But a few insurers, including Kaiser Permanente, offer an off-exchange version of the silver plan with a much lower premium.
If you're retiring early or leaving your job, check out the cost of continuing your current coverage under COBRA, a federal law that lets you keep your employer's coverage for up to 18 months after you leave your job. You have to pay the employer's and employee's share of the costs, but that could be your best deal, says Wayne Sakamoto, a health insurance agent in Naples, Fla.
The federal penalty for not having insurance will disappear in 2019 (although some states have their own penalty), and new rules are expanding some types of coverage that don't meet the ACA standards. Such policies may have lower premiums, but they also shift more risk to you. "I would look at these alternative options very cautiously. It's very much a buyer-beware market," says Sabrina Corlette, research professor at the Georgetown University Center on Health Insurance Reforms.
For example, starting in October, insurers may offer short-term plans that last for up to 12 months (short-term plans had been limited to three months) and may be renewed for up to three years at the insurer's discretion. "But the insurer can look at your health status and decide whether or not to renew it," says Corlette. Some states have imposed stricter rules.
The premiums for short-term policies can be a lot less than they are for ACA-compliant policies, but they don't have to cover the ACA's 10 essential health benefits (such as maternity care), and they can exclude preexisting conditions or reject you because of your health. Short-term policies generally don't cover prescription drugs, but they may provide a drug discount card, says Paul Rooney, of eHealthInsurance.com, which sells both short-term and ACA-compliant policies. They can also have annual or lifetime caps on coverage, such as $500,000 or $1 million, says Sakamoto, who generally only recommends them for a few months.
Strategies to qualify for the subsidy.
If your income is close to the cutoff, you may be able to lower your income to qualify for a subsidy. Contributions to a 401(k), a health savings account, or a health care or dependent care flexible spending account can help reduce your modified adjusted gross income, which is used in the subsidy calculation. Early retirees -- who pay some of the steepest premiums without a subsidy -- often have flexibility to reduce withdrawals from tax-deferred retirement savings.
Leanne and Carl Bryson have been buying health insurance on their own since Carl retired from Apple four years ago, at age 59. When the Sacramento couple looked at eHealthInsurance.com to compare rates for policies with and without a subsidy, they decided it was worthwhile to tighten their belts to qualify for the subsidy until they are old enough for Medicare. They are withdrawing less money from their 401(k)s and IRAs in order to keep their modified adjusted gross income below the $65,840 cutoff. They also cut back on travel and gifts to their grandkids.
Even with the subsidy, their coverage was becoming unaffordable. The full price for their policy was set to rise to $3,200 per month in 2018, which would still cost them $1,800 with the subsidy. They went back to eHealthInsurance.com during open enrollment last fall and looked into alternatives. "In California, we're lucky that we have a lot of options, but they can be pricey," Leanne says. The couple switched to an HMO that cost them $850 per month after the subsidy, in exchange for a smaller provider network.
Use the calculators at www.healthcare.gov to compare the after-subsidy costs of policies you're shopping for. Estimate your income carefully. If you end up earning more than the cutoff, you'll have to pay back the subsidy when you file your taxes; if you earn less, you’ll get extra money back at tax time.
In addition to comparing post-subsidy premiums, estimate your out-of-pocket costs for the type of care you use and prescription drugs you take, and compare the plan's maximum out-of-pocket spending limits and provider networks. Don't assume your doctors will still be covered by the plan's network in 2019. "In our survey, 36% of carriers said they're planning to restrict their networks next year," says Rooney, of eHealthInsurance.com, which has a provider search tool to look up which plans your doctors belong to.
You may be able to lower your premiums by switching to a plan with a smaller network, but you'll have to pay a lot more if you go out of network -- and a growing number of plans don't provide out-of-network coverage at all, except for emergencies. Check to see whether the hospitals you want to use are still included.
After shopping for a new policy on his state's insurance exchange, Ross Volpe found a plan that cost him just $60 a month. Photo by Ryan Donnell
Ross Volpe, 34, a professional disc jockey who lives in Arlington, Va., has income from a variety of sources: DJ gigs (he just won a national competition), private lessons, and teaching classes and camps at the Beat Refinery in Bethesda, Md.
Even though he qualifies for a subsidy, his share of the premiums after the subsidy have still increased steadily every year -- from $45 per month for a CareFirst Blue Cross Blue Shield PPO plan in 2014, to $212 per month in 2017. His premiums were about to go up to $320 per month in 2018 -- after a $200 subsidy.
"I couldn't do that anymore," he says. He shopped around for other options during open enrollment last year and found a Kaiser Permanente HMO plan that cost him just $60 per month with the subsidy.
When shopping for coverage, he looked not only at the premiums but also at the deductibles, co-payments and the insurer. A few plans with lower premiums were with companies he didn't know and had much higher deductibles and co-payments.
Volpe picked a silver plan because of the balance between cost and coverage. He has to use a limited provider network with Kaiser, but he doesn't go the doctor much, and he had Kaiser insurance when he was a kid, so he was used to it. "It's in the building I went to when growing up," he says.
There's an added bonus for picking a silver plan if you earn less than 250% of the federal poverty level ($30,350 for singles, $41,150 for a couple and $62,750 for a family of four). Below that income level, you qualify for an additional "cost-sharing subsidy," which helps reduce your deductible and co-payments -- but only for silver policies. The cost-sharing "might drop the deductible to $200 per year, more like a gold or platinum policy," says Karen Pollitz, senior fellow with the Kaiser Family Foundation. The typical silver plan has a deductible of about $3,500 per person, she says.
Even though the federal government stopped reimbursing insurers for providing this cost-sharing subsidy, insurers are still required to offer it to consumers. As a result, many insurers increased their premiums for silver-level policies a lot more than they did for the other levels in 2018 and are expected to do so again in 2019. But higher silver premiums mean that policyholders get a larger subsidy, so most people getting a subsidy haven't been affected by the increase. The size of the subsidy is based on the silver plan premiums, but you can use the subsidy on any type of plan. "It significantly increased the number of people who were eligible for zero-premium bronze plans," says Pollitz.
What States Are Doing
As the federal government rolls back sections of the Affordable Care Act, the type of coverage you can buy and how much it will cost are increasingly determined by where you live. Some states have introduced legislation to bolster their insurance marketplace, while others have embraced Congress's moves to weaken the ACA. For a better sense of the trends playing out around the country, consider how the health insurance marketplace is changing in these four states.
The state has worked with insurers to maintain as much stability in its individual health insurance marketplace as possible, says Rabah Kamal, a policy analyst with the Kaiser Family Foundation. State lawmakers are currently considering a bill to limit the sale of short-term insurance policies and association health plans that lack robust consumer protections. Blue Shield of California and Kaiser Permanente control the largest slice of the market, but most shoppers have other options, with 11 companies selling policies on the exchange. Still, people in some rural areas of northern California have a slimmer menu -- or in some cases, a single plan. Premiums for policies on the exchange are expected to rise by less than 9% on average for 2019.
The Hawkeye State has used changes at the federal level as an opportunity to weaken the ACA and deregulate its individual health insurance marketplace, says Sabrina Corlette, research professor at the Georgetown University Center on Health Insurance Reforms. The state has given the green light to a controversial Iowa Farm Bureau Federation plan to sell policies that don't comply with ACA regulations. The plans offer limited benefits, do not meet benchmarks required by the ACA, and can deny coverage to people with preexisting conditions or charge premiums based on a person's health.
Those who buy their own health insurance in Iowa will have three choices of carriers for 2019, after having only one option this year. After sitting out 2018, WellMark Blue Cross and Blue Shield will return to the individual marketplace for 2019. Medica continues to offer individual coverage and will expand its coverage to include a broader network of health care providers. Premiums, after increasing 57% last year, are expected to remain flat or decrease up to 5%.
After large rate decreases in 2018, people who buy health insurance from the state's individual marketplace will likely see premiums fall an additional 3% to 12% for 2019. What's driving the decrease? The state's reinsurance program, which pays insurers who sell plans to people with high medical costs. But that program is scheduled to expire at the end of 2019, which would cause rates to spike again. All four of the state's carriers that sell insurance on the exchange primarily offer narrow-network plans, but two companies, UCare and Medica, have plans with a broader network of providers.
Before the Affordable Care Act, New Jersey had among the most robust insurance regulations in the country, but the state largely rejected the ACA in recent years, says Corlette. Now, with a new governor at the helm, the state has added a state-level mandate requiring residents to have health insurance or pay a penalty (after the penalty to enforce the individual insurance mandate was repealed at the federal level). In 2019, the state will charge residents without health insurance 2.5% of their annual household income, or a per-person fee of up to $2,085, whichever is higher.
So, as global banking 5% freemason/Greek players CLINTON/BUSH/OBAMA continue to install AFFORDABLE CARE ACT policies with goals of KILLING health insurance access to all except those rich PLATINUM tier policies------the structure designed to do that is called NARROW HEALTH PLANS. NARROW HEALTH PLANS are being embraced as CORPORATE HEALTH CARE PLAN policies defining NARROW as preventative and wellness.
NARROW health plans are cheaper because they SKIRT the requirements of AFFORDABLE CARE ACT. Supposedly, no health plan on STATE HEALTH INSURANCE systems could SKIRT these ACA requirements said to protect most population groups having highest risk. Who KNEW these OFF-STATE HEALTH SYSTEM plans called NARROW HEALTH PLAN corporations would follow only a few years after ACA was installed?
CLINTON/BUSH/OBAMA------but let's blame TRUMP for all these losses of access to health care for our US 99% WE THE PEOPLE black, white, and brown citizens.
NARROW NETWORKS are tied to a few health care providers---one being KAISER PERMANENTE----tied to global hedge fund JOHNS HOPKINS AND CATHOLIC CHARITIES MERCY HOSPITALS AND JEWISH SINAI HOSPITALS.
'March 28, 2015 01:00 AM
Network squeeze: Controversies continue over narrow health plans
“Many patients are simply accepting pure cash pricing for procedures—as if they had no insurance coverage at all--because it is cheaper than if they were to stick with their narrow-network options.” Dr. Allen Kamrava (right), Cedars-Sinai Medical Center, Los Angeles with a patient
He recently performed a gastrointestinal procedure on a patient at a local hospital. Both he and the hospital were in-network providers for the patient's plan. But unbeknownst to him and the patient, the anesthesiologists and pathologists involved in the procedure were not. So the patient ended up on the hook for $3,000 for those out-of-network provider services. Had the patient gone to a nearby out-of-network outpatient surgery center and paid for the entire procedure out of pocket, the total bill would have been less than $1,000'.
'The New Health Care
Savings? Yes. But Narrow Health Networks Also Show Troubling Signs'.
'Employers May Adopt ‘Narrow Networks’ of Health Care Providers
www.shrm.org/.../health-plan-narrow-networks.aspx The use of "narrow networks," which limit to a handful the number of health care providers covered in-network by a health plan as a way to keep costs in check, has not been embraced by most ...'
'Volpe picked a silver plan because of the balance between cost and coverage. He has to use a limited provider network with Kaiser'
EVERYONE knows these narrow networks are BAD-----they are not sustainable----they have no intention of meeting DO NO HARM/HIPPOCRATIC OATH Western standards of US public health care. BUT, say global 1% -----they do operate as they did in 1000BC.
The Problem with Narrow Networks
According to a Consumer Reports survey, 44 percent of those who bought an Affordable Care Act (ACA) plan for the first time in 2015 reported that they did not know the network configuration associated with their plan.1 Purchasing a health plan without understanding its health care provider network could be medically or financially detrimental.
Should a network not provide an enrollee access to the health care providers they wish to visit, the enrollee will be faced with foregoing care or being charged potentially high out-of-network costs. Nearly 70% of all ACA plan networks are narrow, meaning they include 25% or less of the physicians in the area. 2 Those enrolling in such narrow network plans should protect themselves by understanding how these plans work and the pros and cons associated with them.
SILVER PLANS which people are fighting to attain the most today are of course front-loading these plans with NARROW HEALTH SYSTEM structures.
What is a Narrow Network?
To understand a narrow network, it is important to understand what a network is in the first place. A health care provider network limits enrollees to a specific pool of health care providers (e.g. doctors, hospitals, labs, pharmacies, etc.) with whom the insurance company has negotiated contracted rates for medical services. McKinsey & Company define a “narrow network” as one that provides an enrollee access to less than 70 percent of hospitals in a rating area.3
Insurance companies use narrow networks to trim enrollee costs in an effort to compete for consumers with less expensive premiums.
In exchange for delivering many enrollees to a narrow network, the narrow network gives the insurer more favorable rates for medical services. Consequently, the premiums for narrow network plans are on average 17 percent cheaper than premiums for broad network plans,4 and the most important factor for a consumer when choosing a plan is enrollee costs (i.e. deductibles, copays, and coinsurance).5
Although consumers are often swayed in purchasing these plans because of their lower premiums, they should be aware of the network restrictions associated them and how these restrictions can potentially affect care and out-of-pocket costs.
Obtaining Health Care in a Narrow Network
If you are enrolled in a narrow network plan, you will benefit fully from its cost-sharing if you stay in-network for medical care. However, a narrow network increases the risk that the you may seek care out-of-network if you develop a medical condition where the best care is not available in-network. Depending on the type of health plan in which you are enrolled, you may or may not have a cost-sharing agreement for seeing out-of-network providers. Below are examples of two common health plan models and their respective rules for out-of-network coverage.
- HMO (Health Maintenance Organization) – Limits an enrollee to in-network providers. Any out-of-network medical expenses will generally not be covered by the plan except in the case of an emergency6 or a scenario where the plan was petitioned for out-of-network care and the plan formally approved the petition
- PPO (Preferred Provider Organization) – Allows the enrollee to choose between in- and out-of-network providers but there are higher out-of-pocket costs associated with out-of-network care7
When searching for health insurance plans on a public marketplace, you will have access to the provider directories associated with each plan. The Affordable Care Act mandates that an insurance company provides an up-to-date directory of providers associated with a plan, which must be accessible via the public website on which the plan is listed.8 Consumers should use this before purchasing a marketplace plan to ensure that they will have access to the providers that they need. Purchasing a plan without researching its network could potentially be detrimental by severely limiting a enrollee’s access to affordable providers.
Why Might You Need Out-of-Network Care?
Although your health care costs may be significantly reduced by enrolling in a narrow network, your access to quality affordable health care may be as well. Those enrolled in a narrow network may find themselves needing to go out-of-network for care for various reasons. For example, if you develop a life threatening cancer and the best cancer treatment centers are not in-network you may be tempted to go out-of-network.
Some of the plans on the marketplace offer limited access to in-network specialists. Researchers at the Harvard T.H. Chan School of Public Health examined 135 Silver health plans being sold in 34 states on the HealthCare.gov website. They discovered that 15 percent of the plans had an absence of a physician in at least one specialty.9 This could be a serious issue for individuals with complex medical conditions. Accordingly, individuals should carefully research a plan’s provider directory before enrolling to ensure that they will have affordable access to the specialists they need to visit.
For those without complex pre-existing conditions, limited access to specialists could be a serious issue as well. There is always the risk that an individual will develop a health complication after enrolling in a plan. Should the plan they are enrolled in not have an in-network specialist in the area they need care, they may be faced with the prospect of high out-of-network costs.
Sometimes, at no fault of their own, enrollees receive ‘surprise’ medical bills for out-of-network costs. According to a Consumer Reports survey conducted in 2015, 30% of privately insured Americans received a surprise medical bill in the past two years.10 Surprise medical bills often happen when a patient undergoes a procedure and was not informed beforehand that an out-of-network provider would be involved. For example, a patient may go to an in-network hospital for a surgery but receive added out-of-network costs because the anesthesiologist was out-of-network. Although the hospital may be in-network, this does not guarantee all doctors within the hospital are in-network. Unfortunately, communication between the hospital, doctors, insurance company, and patient can be imperfect and lead to errors in coverage.
Problems When a Narrow Network Is Combined with No Out-of-Network Coverage
Typically, an insurance company limiting patients to in-network health care providers is only required to pay out-of-network costs in the case of emergency care or prior authorization. In the case of emergency care, the Affordable Care Act requires insurers to treat patient cost-sharing as it would for in-network charges. If seeking prior authorization for a health service, you or your doctor must complete an application to the insurance company. While it may be in the patient’s best interest the see an out-of-network health care provider, the insurance company has the economic incentive to direct the the patient to in-network providers.
For those cases that are not pre-authorized or qualify as an emergency, an enrollee may be responsible for paying all out-of-network costs with no assistance from insurance. Out-of-network care does not adhere to the negotiated rates of in-network care. For instance, HMO plans often have no out-of-network cost-sharing agreements or annual out-of-pocket maximums associated with out-of-network care.
Out-of-network costs can be substantial. According to a study by the AHIP Center for Policy and Research, prices out-of-network medical services in 2013-14 were on average 300 percent higher than the average Medicare rates for 97 common medical procedures.11 For some of these procedures, the price difference between out-of-network and Medicare was drastic. For instance, the average out-of-network charge for lower back disc surgery was $9,426, 938.5 percent that of the corresponding Medicare fee of $1,004.12
It is not rare for individuals to go out-of-network for health care so consumers should not think of such situations as fringe scenarios. The previously discussed study by AHIP, which compared out-of-network and Medicare costs for 97 medical procedures, was conducted by analyzing 18 billion health claims. AHIP estimated that the out-of-network costs for the 97 medical procedures alone was $3.2 billion.13 The national costs for out-of-network care is significant and consumers should be smart in protecting themselves from accruing such costs.
Short Term Health Insurance and Network Breadth
While more than half of ACA plans lack out-of-network coverage,14 all short term insurance plans offered through AgileHealthInsurance have broad network coverage ensuring that an enrollee has access to quality health care providers. If an enrollee goes out of network and finds that the provider does not accept their short term insurance, in many cases, the enrollee can get reimbursed by submitting their claim to the insurance company. To be sure, enrollees should check with their insurance company first.
Short Term insurance plan premiums are also significantly less expensive than unsubsidized premiums for health plans sold on the exchanges. Compared to the average costs for 2016 Obamacare bronze plans for individuals aged 30, 40, and 50, short term insurance plans are 25 percent less expensive. Savings are greater for younger individuals without pre-existing conditions. For healthy males, aged 30, a short term insurance premium is 54.93% less expensive than an Obamacare Bronze plan.15
It should be noted that unlike ACA plans, short term insurance plans do not cover medical conditions that existed prior to enrollment.
It should be noted that unlike ACA plans, short term insurance plans do not cover medical conditions that existed prior to enrollment.
Considering the prevalence of ACA insurance plans with narrow networks, consumers should heavily research plans before enrolling to ensure that they are not putting themselves at risk for high out-of-network costs.
For those needing broad coverage, short term insurance may be a good option. 100 percent of short term insurance plans sold on AgileHealthInsurance have out-of-network coverage. Enrollees in these plans can be ensured that they will have access to high quality providers without incurring unknown and potentially sizable costs.
The Priority Partners HealthChoice
is simply one of these NARROW health system plans which without coincidence is a major health structure here in BALTIMORE tied to global hedge fund JOHNS HOPKINS/MERCY/SINAI hospital systems.
- Baltimore Medical System
- CCI Health & Wellness Services
- Chase Brexton Health Care
- Chesapeake Health Care
- Choptank Community Health
- Greater Baden Medical Services
- Johns Hopkins Bayview Medical Center
- Johns Hopkins Children's Center
- Johns Hopkins Community Physicians
- Johns Hopkins Health System
- Owensville Primary Care'
If we look at what is a system of basically PREVENTATIVE/WELLNESS CARE we can easily see where this NARROW HEALTH system will look just like UNITED NATIONS/WORLD HEALTH/INTERNATIONAL LABOR ORGANIZATION -----several decades of global labor pool health care for all.
Summary of Benefits & CoverageThe Priority Partners HealthChoice plan includes coverage for the Medical Assistance For Families/Maryland Children’s Health Program (MCHP), a program for pregnant women and children.
As a Priority Partners HealthChoice member, your benefits include:
- Medical visits with a primary care physician (PCP)
- Dental services
- Oral exam and cleaning twice per year
- Limited x-rays
- Simple and surgical extractions
- Vision services
- 1 eye exam per year
- 1 pair of glasses or contact lenses every 2 years
- Pharmacy coverage
- Outreach services
- Help with transportation or scheduling doctor appointments
- Call 1-888-500-8786
- Mental health and substance abuse services
- Call 1-800-888-1965
- Care Management services
- For diabetics, pregnant women, and those with various other illnesses
- No- or low-cost childbirth classes
- You will get reimbursed in part or in whole once the classes are over.
- Access to the program “Partners with Mom”
- For members with a high-risk pregnancy
- Outreach assistance
- Locating OB physicians and keeping OB appointments
MOVING FORWARD ONE WORLD ONE INTERNATIONAL LABOR POOL HEALTH CARE FOR ALL------global health systems as TIER 1 AND TIER 2 producers and suppliers of health care will not allow sovereign US state health insurance systems to EXIST------there will be no such structure. This is the reason why NARROW HEALTH PLANS outside of these state systems are growing FAST.
EVERYONE KNOWS NARROW HEALTH PLANS are BAD----not quality---not accessible-----nothing like US MEDICARE----
YET, they are the health insurance structure growing fastest in each US state.
'Many Healthcare Providers Not in ObamaCare Networkswww.thenewamerican.com/usnews/health-care/item/... The narrow-network strategy is “a desperate attempt by the insurance companies to try to keep premiums down under ObamaCare,” Josh Archambault of the Foundation for Government Accountability ...'
What we see are the same GLOBAL BANKING 1% OLD WORLD KINGS ----KNIGHTS OF MALTA---TRIBE OF JUDAH-----THE HOSPITALLERS----------claiming what is all of US public health system structures for 99% of citizens. Meanwhile, private global health systems gearing to treat only that global 1% and their 2%----you know, those able to afford that PLATINUM HEALTH PLAN----as today's PLATINUM rates grow and grow.
October 16, 2017 10:34 AM
Priority Health signs narrow network contracts with St. John Providence, St. Joseph Mercy
- Priority makes deals with St. John Providence, St. Joseph Mercy
- Narrow networks keep costs low if patients stay within network
- Premium savings can hit 20 percent
Priority Health has signed narrow network contracts with St. John Providence Health System in Warren and St. Joseph Mercy Health System in Ann Arbor and will offer individual health insurance products when open enrollment begins Nov. 1, the Grand Rapids-based company announced.
Narrow network plans offer members lower premium rates if they stay in their assigned provider network. But if they go outside the network for care, with the exception of an emergency or a preauthorized reason, they pay those medical costs out of pocket.
Despite rising premiums in the individual market in Michigan that will average 27 percent in 2018, Priority Health has carefully been developing narrow networks that it says can reduce premiums by as much as 20 percent.
Over the past three years, Priority Health has offered three other narrow network insurance products in western Michigan that offer customers 15 percent to 18 percent lower premiums in exchange for seeing a limited number of hospitals, physicians and other health vendors, said Marti Lolli, Priority's senior vice president of commercial markets.
"We are really excited about it. Our goal is to offer affordable health insurance where consumers can expect savings in premiums" and receive their care in high-performing networks with quality providers, Lolli said.
The health insurance products, sold under the MyPriority product line, are tied to geography and providers. For example, the St. John Providence narrow network, called St. John Providence Health Network, covers their affiliated providers in Oakland, Wayne and Macomb counties. St. Joseph Mercy's narrow network, called St. Joseph Mercy Health Network, covers their network affiliates in Oakland, Wayne, Macomb, Washtenaw and Livingston counties.
Priority is offering customers MyPriority Silver and MyPriority HSA Bronze plan types in the St. John Providence and St. Joseph Mercy networks. Silver and bronze plans are the two of the four types of Obamacare plans. Bronze plans cover about 60 percent of costs and silver plans 70 percent. Gold and platinum plans cover 80 percent and 90 percent, respectively.
"When (the Affordable Care Act of 2019) first started, there were a lot of issues" with narrow networks, Lolli said. "We made sure we were careful to make sure members understand the products. We do not want customers to be caught in unexpected" out-of-pocket costs.
Lolli said Priority's experience has shown few problems with members stuck with out-of-pocket costs.
Many insured patients in Michigan and other states already use a variation of a narrow network. For example, half of the plans sold on Obamacare's health insurance marketplace, or HealthCare.gov, offer narrow networks in an effort to keep costs low.
One way health insurers can offer lower premiums is because providers cut their prices up to 20 percent to insurers in exchange for a higher volume of patients that makes up for the lower unit prices.
Several other health insurers in Michigan offer narrow networks. They include Health Alliance Plan, Meridian Health and Blue Care Network.
Paul Harkaway, M.D., chief accountable care development officer with Trinity Health in Livonia, said narrow networks can offer patients better coordinated care options if they stay within their networks where doctors and hospitals can more easily share data and patient information. Trinity Health is the parent company of St. Joe's.
"With open networks, you lose the ability to coordinate care," he said. "Patients are now motivated to keep care in the network ... where facility prices are lower."
Harkaway said St. Joe's, St. John and Priority are discussing rolling in the individual contracts into Together Health Network, a clinically integrated network with 29 hospitals and 5,900 physicians. Together is co-owned and managed by Ascension Michigan and Trinity Health Michigan, the parent companies of St. John and St. Joe's, respectively.
In a statement, Gwen MacKenzie, senior vice president and market executive for Ascension Michigan, said the company is happy to work with Priority Health.
"St. John Providence, and all Ascension Michigan hospitals, are focused on continuing to create these types of collaborations with our insurer partners to provide the highest quality care to numerous communities across the state," MacKenzie said in a statement.
Priority has similar narrow network product in Kent County in partnership with Spectrum Health called Spectrum Health Partners. Spectrum Health owns Priority Health. It has contracts with Bronson Healthcare in Kalamazoo, Calhoun and Van Buren counties under Bronson Healthcare Partners.
"For the 2017 plan year, 68 percent of Kent County members enrolled in a Priority Health individual plan chose Spectrum Health Partners, up by 14 percent from the previous year," Priority Health CEO Joan Budden said in a statement. "Additionally, 65 percent of Priority Health's individual members in the Kalamazoo area chose Bronson Health Partners."
Here we see it's all TRUMP'S FAULT----that almost all US SENIORS are already being pushed into NARROW NETWORKS through MEDICARE ADVANTAGE private MEDICARE. We discussed in detail why privatized MEDICARE ADVANTAGE was BAD and how we need to fight for our ALL-AMERICAN 20TH CENTURY MEDICARE.
'Nearly one in three Medicare Advantage enrollees are in a plan with a narrow network',
The above shows why global banking 1% tie ONE WORLD ONE INTERNATIONAL LABOR POOL health care to our US MEDICARE FOR ALL.
There was NEVER any intent of any state health insurance system to go INTERSTATE-------so this is FAKE NEWS------saying TRUMP wanted to expand these state structures across lines. What we will get under TRUMP is a replacement of AFFORDABLE CARE ACT ---STATE HEALTH SYSTEMS with all those TIERS-----with what will be ONE NARROW NETWORK into which US 99% of WE THE PEOPLE will fall .
NARROW NETWORKS are simply United Nations World Bank International Labor pool third world health structures already in place in overseas FOREIGN ECONOMIC ZONES.
There goes US MEDICARE!
Oct 8, 2017, 09:31am
How Narrow Networks Doom Trump's Plan For Insurance Sales Across State Lines
Pharma & Healthcare I write about healthcare business and policy
If Donald Trump signs an executive order as early as this week allowing insurance companies to be able to sell health plans across state lines, it’s unlikely to have any takers willing to prop up medical provider network in new regions.
The trend in insurance is to narrow – not expand – networks of doctors and hospitals.
U.S. President Donald Trump makes remarks prior to signing a National Manufacturing Day Proclamation in the Oval Office of the White House on October 6, 2017 in Washington, DC. (Photo by Ron Sachs - Pool/Getty Images)
“Insurance companies have not been very interested because we are moving to these network based plans,” Sabrina Corlette, professor with the Center on Health Insurance Reforms at Georgetown University said last week during a Commonwealth Fund briefing. “Since the 1990s, health insurance has evolved and has been a network driven product.”
It’s unclear exactly what will be in Trump’s executive order, which he mentioned within days after the failure of the latest Republican attempt to replace and replace the Affordable Care Act.
Health insurance companies in some states can already sell health coverage across state lines, but it hasn’t worked in large part because plans haven’t wanted to spend the money contracting with more doctors and hospitals in areas they have no enrollees.
Six states have enacted laws allowing health plan sales across state lines and “no state was known to actually offer or sell such policies,” National Conference of State Legislatures said in a new report last week.
“In the states that have tried to do this, there has been zero interest from carriers,” Georgetown’s Corlette, who is also the consumer representative to the National Association of Insurance Commissioners.
We discussed LABOR UNION CADILLAC health plans heading under the bus as we knew would happen------below we see yet another private source of health insurance offered by global NGOs----like the GREEK frat and sorority system. We see it is heavily tied to mental health offerings and we see it is tied to a very raging global banking 1% corporation
TALKSPACE. Our 5% freemason/Greek players are already hooked to GROUP SPEAK AND CHATTER----think what TALKSPACE mental health corporation tied to GREEK health plans will do to further that CAPTURE.
We already see GREEK FRATERNITIES selling their members as CORPORATE WARRIORS.
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The Business Of Frats: Shifting Liability For Trauma And Injury
February 25, 20143:32 AM ET
Heard on Morning Edition
Students walk past the Phi Kappa Theta fraternity house at San Diego State University after news that a student had died there on April 20, 2012.
Sandy Huffaker/Getty Images
For those of you keeping track of the headlines detailing sexual assault and hazing at frat houses, it may come as no surprise that fraternities have a dark side. Caitlin Flanagan, a writer at The Atlantic, spent a year investigating Greek houses and discovered that "the dark power of fraternities" is not just a power over pledges and partygoers but one held over universities as well.
With college counselors in short supply, Greek organizations find alternative
Shari Rudavsky, Indianapolis Star Published 10:17 a.m. ET Aug. 16, 2018 | Updated 4:09 p.m. ET Aug. 16, 2018
At the same time more college students report feeling anxiety, getting in to see a college counselor has become increasingly difficult.
In recent years there’s been a 30 percent increase in students needing mental health services, resulting in long wait times for these appointments on many campuses....
'Two years ago the fraternity Alpha Tau Omega became the first Greek organization to offer Talkspace services to its approximately 10,000 members'.
Talkspace announces $50M Series D, expands services to over 5M lives
The company plans to grow its commercial business by launching strategic relationships to improve accessibility to care
News provided by
May 29, 2019, 09:00 ET
NEW YORK, May 29, 2019 /PRNewswire/ --
Talkspace, the global leader in telebehavioral health announced today $50 million in new financing led by Revolution Growth. Existing investors Norwest Venture Partners, Qumra Capital, Spark Capital and Compound Ventures, amongst others, will also participate in the round. Patrick Conroy of Revolution Growth will join the Talkspace board of directors.
Greek Umbrella Organizations
Here is a list of all National Greek umbrella councils for Greek lettered organizations.
For a list of Defunct councils, see Defunct Greek Umbrella Organizations.
North-American Interfraternity Conference (NIC) - Conference formed by 75 National fraternities.
National Panhellenic Conference (NPC) - Conference formed by 26 National Greek lettered sororities and women's fraternities.
National Pan-Hellenic Council (NPHC) - Council formed by the 9 largest and most established Black Greek lettered organizations, the Divine Nine.
National Association of Latino Fraternal Organizations (NALFO) - Association formed by 19 of the largest and most established Latino Greek lettered organizations
National APIA Panhellenic Association (NAPA) - Association formed by 10 of the largest and most established Asian Greek lettered organizations.
National Multicultural Greek Council (NMGC) - Council formed by 10 of the largest and most established Multicultural Greek lettered organizations.
National Interfraternity Music Council (NIMC) - Council formed by 7 of the largest and most established Music fraternities and sororities.
United Council of Christian Fraternities & Sororities (UCCFS) - Council formed by 4 Christian fraternities and sororities.
National American Greek Council (NAGC) - Council formed by 12 regional and local fraternities and sororities.
Association of College Honor Societies (ACHS) - Association of 62 National honors and leadership societies.
Concilio Interfraternitario Puertorriqueño de la Florida (Puerto Rican Interfraternity Council of Florida) (CIPFI) - Council formed by the 5 largest fraternities from Puerto Rico with chapters in Florida.
Professional Fraternity Association (PFA) - Association of 37 National collegiate professional, service and honor fraternities.
Greek umbrella organizations
Association of College Honor Societies
Concilio Interfraternitario Puertorriqueño de la Florida
National American Greek Council
National APIA Panhellenic Association
National Association of Latino Fraternal Organizations
National Interfraternity Music Council
National Multicultural Greek Council
National Panhellenic Conference
National Pan-Hellenic Council
North-American Interfraternity Conference
Professional Fraternity Association
United Council of Christian Fraternities & Sororities
Defunct Greek Umbrella Organizations