Insurance

Self-funding has emerged as an attractive alternative to the traditional fully-insured group health plans where employers and their members pay fixed premiums for coverage. So, what exactly is self-funding, and why are an increasing number of businesses of all sizes opting for this approach? Let’s outline the concept and explore its key benefits. Self-funding, also…

Today, the U.S. Food and Drug Administration approved two milestone treatments, Casgevy and Lyfgenia, representing the first cell-based gene therapies for the treatment of sickle cell disease (SCD) in patients 12 years and older. Additionally, one of these therapies, Casgevy, is the first FDA-approved treatment to utilize a type of novel genome editing technology, signaling…

Cell and gene therapies are curative treatments for diseases such as immune deficiencies, Hemophilia, Leukemia, and more. However, they are also incredibly expensive and potentially catastrophic for self-funded health plans. With our Gene Therapy Protection, Excess Reinsurance can help reduce our clients’ financial risk related to the therapies and put employers in a position to…

The Affordable Care Act (ACA) generally requires group health plans and health insurance issuers that offer group health coverage to prepare and distribute to plan participants and beneficiaries a brief standard summary of the plan’s benefits and coverage. This summary is called the summary of benefits and coverage (SBC). In order to help employers fulfill…

 Q1. Do catastrophic plans currently include coverage for the diagnosis and treatment of COVID-19?  A1. Yes. Catastrophic plans must cover the essential health benefits (EHB) as required by section 1302(b) of the Patient Protection and Affordable Care Act (PPACA), subject to certain limitations. However, the exact coverage details and cost-sharing amounts for individual services may…

The latest in our Insights from the Experts series explores the single-payer health care debate, the administrative costs of Medicare versus the private insurance market, and potential impacts on the quality of health care in the US. Advocates for a centralized single-payer health care system like Medicare-for-All often claim that Medicare, a government-run system, has…

Gene therapy has the potential to have a significant impact on health care costs by decreasing the lifetime expenses associated with organ transplants, hospital stays, and cancer and chronic disease treatments. For example, average undiscounted lifetime health care costs for a 45-year-old with sickle cell disease have reached $953,640. Meanwhile, a 2016 analysis in the…

As presidential candidates gear up for the 2020 elections, health reform (including single-payer systems) will continue to be an overarching and important topic of debate. At the same time, more immediate discussions are shaping benefits compliance trends now, such as expansion of health reimbursement arrangements (HRAs), the constitutionality of the Affordable Care Act (ACA), and…