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Small Businesses May Be Able to Re-Enroll in Current Coverage

Last week’s announcement the federal government is encouraging states to adopt a transitional rule which would allow insurance carriers to extend individual health insurance plans, which would otherwise be discontinued, into 2014, was only half the story. Only hours after the announcement the Centers for Medicare & Medicaid Services (CMS) released additional clarification on this announcement, advising that small groups are also included in the extension into 2014. By allowing members to remain in their current plans through 2014, they will have additional time to ascertain if they qualify for a subsidy and to find new plans for 2015 that meet the ACA requirements. Under the transitional policy, small group health insurance that is renewed for a policy year starting between January 1, 2014 and October 1, 2014 will not be considered to be out of compliance with certain key Affordable Care Act market reforms (originally scheduled to take effect for plan years starting on or after January 1, 2014), if certain conditions are satisfied. Requirements include:

  • Covering essential health benefits
  • Variations in premiums be limited to age, tobacco use, family size, and geography;
  • Elimination of preexisting condition exclusions;

Where does each state stand? You can follow here.

How much will that medical procedure cost?

Price transparency in healthcare is all the buzz. More than 85% of all medical services are scheduled in advance, giving the participant time to ask the provider questions prior to receiving services. –  But how does an employee access price and quality information? It’s hard to negotiate for yourself.

MyHealthCareGenius helps patients shop for the highest quality, lowest cost healthcare, including physician appointments, laboratory tests, imaging tests and hospitalization. This pre-care access eliminates the disadvantage patients are often at negotiating their own price.

Employees call BEFORE the required services.

  • Tell MYHealthcareGenius what care is needed and if there is a preference where to receive it from.
  • MyHealthCareGenius will negotiate a price for care for the provider and the providers in your area.
  • MyHealthCareGenius will create a personalized price and quality score card!

MyHCG logo

(Excerpts taken from MYHealthcareGenius.)

Useful Apps – Drugs.com Medication Guide

Need help with medication management and adherence?  – Users can lookup drug information, identify pills, check interactions and set up your own personal medication records.

Key Features

• My Drug List – Add your medications to assemble medical information in a simple, easy to read personalized format. Access consumer information, FDA alerts, drug interactions, plus food, allergy and medical condition interactions.

• Complete Drugs A to Z listings – Fast search, accurate suggestion engine and boasts the most comprehensive database of drug information available online.

• Interactions Checker – Provides a list of interactions that may occur when different drugs are taken at the same time. Also checks food interactions automatically!

• Additional Features: Symptom Checker looks up specialized databases for side effects and dosage information. Not quite sure how to spell a drug name? Use the phonetic search. Pill Identifier identifies meds simply by entering an imprint, shape or color.

Pill Identifier App

Know of a useful app in the health care, LTC, Rx or related industry? Send it to us, we may blog about it.

The Wild Card That Could Destroy Your Retirement

Here is an excerpt of an outstanding article we read on Yahoo finance:

Could you withstand a half million dollar or more hit to your retirement savings? Even for many one percenters that could be the difference between a comfortable retirement and destitution. Yet, the odds that you may someday get this hit are uncomfortably high.

Long-term care costs are a wild card that can wipe out the most careful lifetime investment planning. And the event is so random and capricious that it’s difficult to impossible to simulate in a financial plan. And no matter how carefully you have saved, how good your asset allocation plan and investment strategy is, the results may be ruined if you, your spouse, or another family member need long-term care.

Click here for the entire article from Yahoo finance – this link will re-direct you to Yahoo’s site which will open a new tab.

 

Obamaco$t brings Unpleasant Surprise – Focus, Large Group Renewals

Early 2014 large group renewals have come in for fully-insured and self-insured plans. Many employers are going to have an unpleasant surprise. A surprise to many who have had the belief that the postponement of the mandate postponed everything. Are you ready for this?

Example 1: A colleague of mine reports a 400 life group with a 77% loss ratio received an 8.5% increase, but it was actually a 21% increase. – How could this be? Answer: ACA fees are 4.00%, reinsurance fee $5.40 pmpm and insurer fee of 2.5%; no surprise, this was expected. Here is the surprise; 7.5% benefit adjustment added on top of the premium for the benefits to become ACA compliant – meaning all medical and RX expenses now apply to the maximum out-of-pocket limit. ACA by itself accounts for an 11% increase. My colleague’s client knew the benefit adjustment was coming but was expecting it next year since pay or play was pushed back. – Without Obamacare the increase was 8.5%.  With Obamacare the renewal increase is 21%!

Example2: A self-funded plan with 531 enrolled has done well managing costs with no increase to health insurance premiums in 2013 or deductible changes. They report beating the national averages in all but one of the last 6 years. The additional reinsurance fees, taxes, etc. alone will add over $131,000 dollars to their plan. The group has a cost sharing arrangement with their employee that includes the premium, deductible, and coinsurance.  The cost share will equal $85,000; and will need to be passed on in addition to any cost trend. That is $160 on each enrolled associate, before cost trend.

In announcing the postponement, the IRS took pain to note that only the employer shared responsibility mandate was postponed, everything else would become effective in accordance with the law’s requirements.

Let us know what you are experiencing.

Obamaco$t comes with Obamacare

Have you heard federal officials sate “Premiums before tax credits will be more than 16 percent lower than projected?” They are referring to the weighted average of the second lowest cost silver plan for 48 states (including DC) based on the ASPE-derived Congressional Budget Office.

Sounds good, until you dig deeper. The key word is projected. It does not say the cost will decrease; only the cost are going up, but not as much as anticipated.

What they fail to mention are the reasons. One big reason, insurers are significantly limiting the choices of doctors and hospitals available to consumers. In most states, Individual Medical premiums will soar for the under-50 crowd, including the vast majority who maintained continuous coverage and maintained their health. Some of those people simply cannot afford Obamaco$t, and in 2014 will drop their health insurance.

How much are cost going increasing and why? According to a study cited by America’s Health Insurance Plans (AHIP), it is estimated that in 2014, restrictions on age rating could result in premium increases up to 42 percent for people aged 21 to 29 and up to 31 percent for people aged 30 to 39. In addition to age rating restrictions, ACA also imposes new taxes, fees, and required benefits that could result in further premium increases. Making matters worse is a study from the Columbia School of Business that found more than 80 percent of consumers unknowingly will choose a higher cost health care plan than they need.

Adding to the cost, the US Treasury has ruled that an individual who is covered by an eligible employer-sponsored plan would not be eligible to receive a premium tax credit. According to the letter, an individual cannot benefit from both the exclusion from taxable income for employer-provided health coverage and the premium tax credit provided by the ACA. The law also would not allow an employee who was offered minimum essential coverage under an eligible employer-sponsored plan that provided minimum value and was deemed “affordable” to receive a premium tax credit, even if the employee declined the coverage.

Two Court Cases pose significant threat to PPACA

Employee Benefit Advisors has been following two court cases that have been falling under the radar. These cases could dismantle health care reform as we know it.

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Excerpts from Employee Benefit News September 27, 2013 by Serena Yee and Christie Daly

The ACA requires the creation of a health insurance exchange in each state that will serve as a competitive marketplace where individuals and small businesses can purchase private health insurance. If a state refuses to establish an exchange then the federal government is taking over the implementation.

Section 1401 of the ACA provides that premium assistance is available to taxpayers who are enrolled in coverage through an exchange established by the state under Section 1311 of the ACA. Nonetheless, the Internal Revenue Service promulgated a regulation that bases eligibility for premium assistance subsidies on enrollment in coverage through any exchange, including a federally-established exchange. Specifically, the regulation states that subsidies shall be available to anyone “enrolled in one or more qualified health plans through an exchange,” and subsequently defines an exchange to mean “a state exchange, regional exchange, subsidiary exchange and federally-facilitated exchange.”

Potential impact

Since a majority of the states, 34 to be exact, have refused to establish a state exchange, a ruling in favor of the plaintiffs could seriously jeopardize the future of the ACA since the subsidies are key to the operation of other parts of the law, including the calculation and collection of the individual and employer mandate penalties.

read full article»

PPACA: It’s Oct 2 – Now what?

October 1 was a very significant date for the implementation of PPACA as the individual exchanges went live. However, there were reports from many states with problems with the rollout and not all exchanges were activated on schedule. Both the online small business markets known as SHOP exchanges and the Spanish language exchange are delayed. Going forward, there are several key provisions that will impact employers.

2014
Guaranteed availability/renewability – requires carriers to accept all groups applying for coverage
Waiting periods – requires waiting periods to be no more than 90 days
Auto enrollment – employers enroll their full-time employees in a health plan
Health care excise taxes – New taxes for health insurance and pharmaceutical companies, plus medical devices

2015
Originally effective 2014, employers with more than 50 Full Time Equivalent employees are now required to offer affordable health insurance

2018
PPACA imposes the Cadillac excise tax on rich benefit plans

2020
Medicare Part D coverage gap is reduced to 25 percent

Reminder: Medicare Part D Creditable Coverage Notice Due by October 15th

With all the attention to the ACA requirements for 2013 and 2014 it’s easy to lose sight of other benefit and human resource requirements.

The Medicare Part D Creditable Coverage Law affects all employer-sponsored group health plans. Entities are required to notify Medicare eligible policyholders whether or not their prescription drug coverage is creditable.

Creditable Coverage means that the coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage. Notice is due by October 15th.

There are two required disclosure notices for qualifying entities:

  • The first requirement is to provide a written discloser.
  • The second requirement is for entities to complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan.

Employee Benefit Advisors is able provide links to model notices.

Useful Apps – HealthAdvocate

ad·vo·cate (verb – used with object)  to act in support or in behalf of another; intercessor
Synonyms – champion, proponent, backer

Do your employees need help navigating the healthcare system? Are they spending valuable time on hold trying to manage their health care needs? Family member needs? Losing productivity? This App is for you. Use the app to explore:

  • Finding the right doctors
  • Scheduling appointments
  • Help resolving insurance claims
  • Assistance with eldercare
  • Obtaining cost estimates
  • Working with insurance companies
  • Answering questions
  • Assistance in transferring medical records

No smartphone? No problem! Health Advocate members can access Health Cost Estimator and other features online through their member website, or by calling Health Advocate for personalized support.

Bonus – Services are extended to employee, spouse, dependent children, parents and parents-in-law.

healthadvocate-app-logo

Know of a useful app in the health care, LTC, Rx or related industry? Send it to us, we may blog about it.

(Excerpts taken from Health Advocate marketing material.)

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