By Frank Lewis
August 24, 2013
PDT Staff Writer
Portsmouth Insurance Agency, the company that handles both the Scioto County and the city of Portsmouth health insurance has merged with TAH Benefits out of West Union, Ohio. That merger took place last December, and Gary Duzan says services for that company’s clients will not change, will still involve their local office on Scioto Trail in Portsmouth and the nine employees who work there. But at the center of all insurance discussions these days is the new federally mandated Health Care Reform Act and what it means to people and businesses in the region.
Portsmouth Insurance focuses on employee benefits and health insurance, and the exchanges which will be created out of the Act. Duzan said Medicaid will be a part of that, as will Medicare and prescription drug plans.
Duzan said a little over a year ago, their company began looking into dealing with the Health Care Reform Act, even before it became law.
“We were looking at how we come together with folks to provide additional services and be at the level we need to be at to consult and broker with clients on health care reform health insurance and employee benefits in the whole arena,” Duzan said. “Jay (Hazelbaker) (TAH Benefits) and I go back a lot of years from our industry experience in the Ohio Association of Health Underwriters. We have been in a lot of meetings there. There are similar philosphies. Jay is from West Union, so he’s a southern Ohio guy, and it just kind of came together - and it made a lot of sense to look at how can we come together as a merger and provide health care services and employee benefits going forward, not only to our clients here, but all the way up (U.S.) 23 into Columbus, because he has business down this way and I have business up that way, and in between there’s business.”
Hazelbaker said TAH Benefits began in the mid-70s, and largely worked with association health plans all over the state. He joined the company in 2003 and took over as president in 2006.
“Knowing Gary, knowing the challenges that we both face as far as the future of health care and being able to pull together, it’s nice when you have the same philosophy on how you want to take care of clients,” Hazelbaker said. “You want to be face-to-face with them. This insurance world is complex enough as it is, and health care reform has done nothing to simplify that.
“The cost of health care, how to manage it, that has been the challenge for years. That’s nothing new,” Hazelbaker said. “What is new is, since health care reform was passed in 2010, and upheld last year by the (U.S.) Supreme Court, it’s really really changing how plans and how people are going to buy or be provided health care plans. It has changed both how insurance carriers have to operate, and it has changed how consumers are required to buy coverage now. There’s an individual mandate. There are penalties to larger employers (over 50 employees) if they don’t offer coverage.”
Hazelbaker said the penalties on the employers portion of the Health Care Reform Act has been postponed, but the mandate to individuals to obtain coverage is in effect.
“We’ve been working on this for 18 months to two years to really try to understand all there is to know so that we can go out and help clients and tell them how they need to approach this,” Hazelbaker said. “It’s really the passage of the law that has made it more of a challenge than it already was.”
Can the average person fully understand the new health care reform plan and how it affects their coverage and lives?
“We spend our time educating our new clients on what their options are, how the plans work, and then, in the end, as they become our clients, make sure the plans work,” Mike Turney of TAH Benefits said. “Because the last thing I want for my client is to have to call the insurance company. They can call us to get their claims problems solved but when you look at it, it is sort of a three-pronged deal - education, bring that client on, make sure they know what they have, and then when they start using it to make sure it works for them properly.”
Turney said, while the employer mandate has been postponed to 2015, some of the reporting is still in place.
“You move down to the smaller employer, the two to 50-size employer, technically they have no mandate for have coverage for their employees,” Turney said. “However, starting Jan. 1, everybody is going to be mandated to have health insurance coverage. So what we’re really coming up on is health care reform at its fullest mandate starting Jan. 1. Therefore, on Oct. 1, what is called the Open Enrollment period to enroll in plans is going to be kicked off. And that will run from Oct. 1 of this year to March 31 of next year.”
Turney said the new insurance world, called an “exchange” is going to be introduced to the public. He said the exchange is also now being called the “marketplace.”
“Within that marketplace the consumer will be able to go out and find out if they are eligible for a subsidy to help them pay for their insurance coverage; if they are eligible for Medicaid coverage and what plans are available to them in their area,” Turney said.
Duzan said, once the employee mandate kicks in, that employee will be able to make a choice to provide health care coverage for all of his or her employees, or to pay a $2,000 penalty for each employee for the right not to provide insurance. There is another penalty if anybody wants to go out on the exchange and purchase the insurance. That penalty has also been delayed until January of 2015.
Why has the employer mandate been postponed, but the employee mandate put into effect?
“There’s no answer to that other than it’s still in play,” Duzan said. “Everything else is still there.”
Duzan said there are 82 time lines that have to be met for health care reform and 41 have already been missed.
What effect will the recent health care reform have on people who have been working and have had insurance coverage they are satisfied with?
“At a minimum, even if you work for a really large employer that has a self-funded plan, that will change in terms of cost because there are new fees and new taxes that apply to companies who have a self-funded plan,” Hazelbaker said. “Even your Fortune 500 companies now are paying taxes and fees that didn’t previously exist. So there’s a cost impact to everybody, directly or indirectly, that way. And as you move into smaller groupings you go from self-funded to fully insured. Now, if it’s a fully insured plan, even if it’s a large employer, you now have those taxes, but you also now have coverage mandates, and there are certain minimums that have to be accomplished or established in order for the plan to be compliant. Then you move from that scenario down into an even smaller level of fully insured plans, and those fully insured plans now have a minimum coverage standard, and they have new taxes, and they have to be made affordable.”
Duzan said it is important for people to know that the staff at their office is there to answer individual questions in order to fine tune the process so that each person can know fully how the changes will affect them.
“We’re still local doing the things we’ve always done,” Duzan said.
Frank Lewis may be reached at 740-353-3101, ext. 252, or at firstname.lastname@example.org. For breaking news, follow Frank on Twitter @FrankLewisPDT.