October 2014

The Washington Times is reporting  that a new study of insurance policies before and after the implementation of the Affordable Care Act “shows that average premiums have skyrocketed, for some groups by as much as 78 percent.” Average premiums for the 23-year-old demographic rose “dramatically,” with men in that age group seeing a 78.2 percent price increase before government subsidies, and women seeing premiums rise 44.9 percent, according to a report by HealthPocket to be released Wednesday. The study, shared Tuesday with the Times, also found that premium increases for 30-year-olds increased 73.4 percent for men and 35.1 percent for women.

The article says that reasons for the premium increases include the ACA’s “prohibition on rejecting applicants with pre-existing conditions” and the heightened benefit mandate under the law.

Thanks to the NAHU Newswire for forwarding the information from the Washington Times.

The IRS announced two new situations in which a participant may revoke his or her cafeteria plan election in order to purchase coverage through a marketplace (Exchange) established under the ACA.  These provisions do not apply to FSAs.  Change is permitted provided:

Employee Enrolls in Marketplace Coverage

1. The employee is eligible for a special enrollment period during the Marketplace’s annual open enrollment period; and
2. The employee enrolls in Marketplace coverage, effective immediately following the last day of the employer’s coverage.

Reduction in Hours of Service

1. The employee changes from full-time status to part-time status (i.e., reasonably expected to average less than 30 hours per week), even if the reduction in hours does not result in the employee ceasing to be eligible under the group health plan; and
2. The employee enrolls in another plan that provides MEC, effective no later than the first day of the second month following the month the original coverage is terminated.

Cafeteria plans must be amended to provide for the new permitted election changes in accordance with the guidance under Notice 2014-55.

Interim Final Rules related to the coverage of preventive services under the Patient Protection and Affordable Care Act (PPACA) were recently published. A complete list of required preventive services is available from the U.S. Department of Health and Human Services. The following is a partial listing of preventive services required to be covered under Health Care Reform.

For Adults
Blood pressure screening
Cholesterol screening for adults of certain ages or at higher risk
Colon cancer screening for adults over 50
Immunization vaccines (doses, recommended ages, and recommended populations vary)
Obesity and tobacco use screening
Type 2 diabetes screening for adults with high blood pressure

For Children
Autism screening for children at certain ages
Blood pressure screening
Alcohol and drug use assessment for adolescents
Developmental screening for children under age 3
Immunization vaccines from birth to age 18 (doses, recommended ages, and recommended populations vary)
Lead screening for children at risk of exposure
Obesity screening and counseling

Note:
The requirements to cover recommended preventive services without cost-sharing do not apply to grandfathered plans.
Coverage of preventive services does not disqualify High Deductible Health Plans HSA qualifying status.