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RBS (REGULATORY BUDGET
NEW RULE FORCES INSURANCE CARRIER TO USE SIMPLER LANGUAGE
By: Nicola Crean, CHS Marketing Coordinator
As rules and regulations continue to drop on the health care industry, the Department of Health and Human Services, Labor and Treasury (HHS) have recently approved a new rule for regulating insurance providers. This rule, which originally was proposed in August 2011, will aim at providing consumers with a more concise version of their health plan.
The HHS issued a press release stating that this new rule was enacted to allow individuals receiving or seeking insurance to gain a deeper understanding of what exactly insurance companies will provide. Essentially, this will allow both consumers, including employers, to better compare insurance carriers in order to ensure that they are purchasing insurance that best fits their needs.
According to a recent article in the Centerforplainlanguage.org (“What’s Covered? Clarity in Health Insurance Disclosures”), this rule has the potential to affect 180 million people covered by private health insurance. That signifies a substantial number of people who would instantly become more knowledgeable of their insurance plan.
Although this new rule has passed, it will not be officially implemented until late September 2012. This grace period allows insurance providers to begin adjusting marketing material now in order to comply with the HHS requirements.
So, what changes can both consumers and insurance providers expect come Fall 2012? Ideally, each plan will provide a clear, but detailed listing of what type of charges will or will not be covered. Instead of consumers having to read through endless pages of insurance jargon, companies are obligated to supply an understandable explanation of what they are offering.
The HHS has specific plans for how they would like this information to be relayed to insurance consumers. Creating a standard such as this allows for there to be consistency within the marketplace, making it easier on consumers to compare information for competing companies.
“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” stated HHS Secretary Kathleen Sebelius in the HHS’ press release. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”
An article in CommunicateHealth.com (“Plain Language Comes to Health Insurance Summaries – Finally”) reports that the rule is specially requiring insurance companies to provide a Summary of Benefits and Coverage (SBC) and a glossary of commonly used insurance terms, such as co-pay and deductible.
These documents were ultimately decided upon by utilizing a representative group of people, including patient/consumer advocates and health insurers, to determine the effectiveness of the material.
The SBC is a new document that identifies exactly what services will be paid for, and what individuals should expect in a variety of circumstances. The document also provides “coverage examples” that try to demonstrate how coverage situations would be handled.
The Henry J. Kaiser Family Foundation’s website has posted a sample SBC template for view. Click here to take a look.
The second part of the HHS’ rule is that insurance companies must provide a detailed glossary to explain insurance terminology. The vocabulary that is included in the glossary will be highlighted throughout the SBC document to make readers aware that there is further explanation of them.
There is no doubt that these new standards will create work on the behalf of insurance companies to develop more concise marketing material. However, only time will tell if this action will begin to simplify communication between insurance companies and consumers.
INCORPORATING MOBILE TECHNOLOGY REDUCING OUT-OF-POCKET COSTS
By: Nicola Crean, CHS Marketing Coordinator
In a short time, technology has become a very integral part of the American society, making the process of information sharing a much easier task. Communication now revolves around the use of email and smart phone technology, which allows people to be in constant contact. Society as a whole has transitioned so quickly that it continues to affect every industry.
It has been speculated recently that smart phone technology, in particular, will begin to have a significant impact on the health care front. Mobile applications have gained in popularity as the number of smart phone users continue to rise.
According to an article in AppMuse, it is estimated that there are currently 17,000 health-related applications that are available for users to download. The article goes on to forecast that the number of applications will rise to 500 million by 2015.
This drastic growth indicates a mounting trend in mobile users that are leading them to desire medical-related information to be on hand and accessible. Employers, who are aware that this interest is developing among the public, have looked for a way to incorporate mobile applications into their insurance services in order to reduce costs by producing healthier employees.
An article in the Harvard Business Review (“How Mobile Phone Can Transform Healthcare”) states that by using mobile technology to communicate with employees, companies are attempting to reduce health care costs, specifically pharmaceutical and emergency care expenses. The idea would be that providing insurance consumers with an avenue to conveniently access their health information would ultimately reduce out of pocket expenses for the individual and their employer.
It is important to make medical applications detailed and ensure that they provide useful information. The following is a list of services summarizing an article in the Business & Legal Resources (“Smartphone can Reduce Employer Healthcare Coverage Costs”) that describes what should be available through mobile devices.
- Access to Claim: Users should have access to their health claims in an effort to remain vigil of what is being charged to their insurance in order to reduce the potential for billing errors.
- Communication with Health-Care Professionals: In hopes of lowering emergency room expenses, communication with health professionals would consult and advise individuals on the next appropriate action to take.
- Monitor Prescription Costs: Imagine having an application that will shop around to provide a cost of your prescription at numerous locations. The potential for cost savings with this tool alone is immediate.
- In-Network Directory: Reducing the expense of out-of-network providers can easily be solved by providing employees with an index of approved providers.
Although this type of information may be available to employees in the form of websites or information packets, trends indicate that utilizing mobile applicants is a more effective way to communicate with employees. Additionally, it is evident that more real-time information can be gathered with smart phone technology, which will help reduce costs.
THERE ARE SOME BEHAVIORS
YOU JUST CAN'T REGULATE.
By: Chacko Kurian
Regulations depend on carrots and sticks. If you don’t
pay your taxes, there will be serious consequences – the
stick. If you buy a home with a home loan, we’ll let you
take the interest payment deduction on your taxes – the
carrot. The HITECH Act has a number of sticks associated
with the security of Protected Health Information (PHI). We
at CHS will be addressing the issue of security of PHI in
forthcoming articles. There is, under some circumstances,
one link in the security chain that no regulation can affect
-the uninformed behavior of the user. This article addresses
one method where cyber criminals make unwitting users
partners in a security breach.
Prior to founding
Apple Computers, the Steves (Wozniak and Jobs) could be
found ripping off Ma Bell using a blue box to make long
distance phone calls (domestic and international) for free.
The subculture that reveled in this activity called
“phreaking” was probably the progenitor of the subculture of
hackers who, today, like to hack computer systems just
because they’re there. There is the story of Steve Woz(niak)
actually making a “phreak” phone call to the Vatican and
asking to speak to the Pope while pretending to be Henry
Kissinger with a think German accent. These are the guys who
later found legal ways to take your money.
Before the age of digital telephone switching systems,
telephone switches reset trunk (long distance) lines with a
tone at a specific frequency – 2600Hz. This meant that the
trunk line was disconnected at one end and available for
dialing at the other end. The dialing was also accomplished
by tones at preset multiple frequencies. How did one get
those frequencies? Legend has it that the 2600Hz frequency
was discovered by accident by Joe Engressia, known among
phreakers as ‘Joybubbles’, at the age of 7! He was
apparently able to whistle at that frequency and so attach
himself to the dialing end of an available long distance
But how does one progress from knowing that you could get
a trunk line to using it to make free long distance calls.
In 1954, the then undivided Bell System published an article
in the Bell System Technical Journal about the basics of
signaling using multi-frequency tones. This piece of
information by itself was of little use. The second and
final piece of the puzzle was published, again courtesy of
Ma Bell, in the November 1960. Bell System Technical Journal
in an article called “Signaling systems for control of
telephone switching”. This article published the actual
multi-frequency tones used to control the switches. From
that information to the creation of the reputed “Blue Box”
that became a clandestine product was a short step. With one
of these boxes, anybody was able pick up a phone and make
free long distance calls.
To be able to win this questionable prize, the phreaker
required two pieces of information and they were found in
two locations, but once they were combined, the information
became quite powerful. Today – cybercriminals put two pieces
of information discovered from different locations together
to achieve their nefarious goals..
Spear Phishing is the technique by which pieces of
information stolen from different locations are put
together, by cybercriminals, to steal your identity, your
money and anything of value. How does this work? Unlike the
shot gun approach taken by those Nigerian scam artists who
send out millions of emails, the Spear Phisher is looking
for prey with a small email blast to very targeted
prospects. All they need to start the process is one piece
of information – your email address and sometimes your name.
They don’t need anything like a credit card number, the
password to your on-line bank account or your social
security number– well, not yet. The attack is quick and over
in less than a day, before security and software companies
have an opportunity to react.
A typical Spear Phishing attack starts with an email that
comes to you and looks something like this, courtesy of the
Microsoft Safety and Security center
Remember they already have your email address and
sometimes your name so the “Hello” salutation is not so
innocuous. It looks very familiar but the highlighted items
should make you suspicious. If you examine the links you
will find that they link to unsecured and unfamiliar sites
as shown below:
Once you click on the link and enter the information
they’re asking for, they’ve got you.
Another variation of this technique is to send you an
email making you an offer that sounds reasonable on the
surface, but requires you to open an attachment with the
details of the offer. Again, once you open that attachment,
they’ve got you. What happens behind the scenes is that the
attachment has a robot program that can do almost anything
that they want it to do. It can install a keystroke logger
and send your internet banking or credit card passwords to
the cybercriminal. It can give control of your computer over
to the cybercriminal and so enable more of these schemes to
be run from your computer. The possibilities are endless.
Sometimes the Spear Phisher makes the email look like its
coming from your boss – again remember he has email
addresses and names. The email may require you to give up
password and other authentication information in order to
perform a “security audit” or an “account verification”.
Key to making this criminal endeavor work is that it
requires your participation to either provide the missing
information or open the attachment. So the best defense it
to verify the email by contacting the sender by phone or
alternate method if the email looks suspicious. A good
antivirus program installed on your computer can help
too.Remember for the scheme to work it requires your
We might as well brace for a number of these email
attacks. Recently Epsilon, a division of Alliance Data
suffered an illegal entry on its client’s email databases.
This is the company that processes marketing communications
for loyalty programs like Marriott Rewards, Citibank
Advantage and many other large organizations. Imagine the
rich information for cybercriminals that email addresses,
names and loyalty program associations can provide. If you
belong to the Marriott Rewards program like I do, expect an
incredibly valuable offer to come to you via email. Do not
open the attachment even though the logo looks almost right
and the text has only one or two spelling mistakes.
There’s lots of regulations coming from Washington DC
these days, but I don’t think they can think one up for
CHS SOFTWARE UPDATE
CHS Software you may want to use
Often, we at CHS, are
guilty of not informing you of products or features that we
have implemented over the past year that you may want to
use. This year we have rounded out our individual
enrollment, billing and administration offering with a full
cycle product. If you sell individual policies or sell
voluntary products in addition to your regular employer
sponsored group health offerings, this may interest you.
"Full Cycle" in this context means the following:
i) taking the application for enrollment of the
individual/family on the web, after getting their responses
to qualifying/underwriting questions,
ii) enrolling them in the plan of choice,,
iii) billing their credit card or bank account at the
appropriate frequency, i.e. monthly, quarterly,
semi-annually or annually,
iv) applying the payments received against the appropriate
v) disbursing premium/commission and other payments to
carriers, brokers/agents and other suppliers
vi) updates to Accounts Receivable, Accounts Payable and
General Ledger without manual intervention after set-up.
We would like to say that all of the above happens
"automatically" (a grossly over-used word) but it doesn't.
It happens with minimal, but appropriate, human
intervention. For example, there are checks and balances in
place to make sure that premium billing adjustments owing to
changes in family composition or product choices are made
accurately. The web enrollment product, CHS iCoverNow, has
to be customized with your logo, color palette, questions
and response logic. Users of our product like it. It has
allowed them to grow into areas where they couldn't before.
We believe that this will interest administrators of
individual health plans who sell to the public at large and
may become a valuable tool in the context of health care