Healthcare

Even though the employer shared responsibility provisions of the Patient Protection and Affordable Care Act (PPACA) were delayed and will not take effect until January 1, 2015, employers should have prepared for their compliance strategies in 2013. However, if you were a procrastinator now is the time to review.

Business owners and payroll personnel will want to determine if the employer mandate will apply to their company. If PPACA’s ‘shared responsibility’ provisions do apply, employers need to prepare in 2014 to ensure a smooth transition in 2015. Several issues need to be addressed to mitigate any potential challenges, covering issues such as how the baseline measurement period is calculated and the adequacy of coverage requirements are met.

Here are some of the most common questions employers have:

• Will my company have to comply with employer-shared responsibility provisions?
• What kind of insurance will my company have to provide?
• To whom will I have to provide insurance?
• What about seasonal, per diem, or part-time employees?

Employee Benefit Advisors has a FTE Worksheet to help companies determine these answers. Contact us if you’re interested in using it to help evaluate your course of action.

• Health Benefit Exchanges – state exchanges move from enrollment to covered phase
• Individual Mandate – requires each person to have minimum essential coverage
• Essential Health Benefits – requires new plans to cover 10 essential health benefits
• No Pre-Existing Conditions – prevents plans from limiting benefits on pre-existing conditions
• Clinical Trials – plans cannot limit routine costs for those in clinical trials
• Dollar Limits on Essential Health Benefits – PPACA ends annual limits on essential health benefits
• Guaranteed Availability/Renewability – carriers must accept all groups or individuals that apply for coverage
• Waiting Periods –reform requires waiting periods to be no more than 90 days
• Auto Enrollment – large employers enroll full-time employees in a health plan
• Health Care Excise Taxes – new taxes for health insurance and pharmaceutical companies, plus medical devices

Health Care Reform Updates – Hear are a few of the changes announced in the last weeks starting with Transition Policy.

Transitional Policy provides the Option to Keep Existing Coverage in 2014 – State agencies responsible are encouraged (but not required) to adopt the transitional policy. If the state allows, health insurers have the option of continuing small group coverage that would otherwise be terminated or cancelled.

Online Enrollment Delayed One Year for Federally-Facilitated SHOP (Small Business Health Options Program) Marketplace Further – Small Employers Must Continue to Apply Offline Until November 2014.

Enrollment Deadline Extended for Individual & SHOP Marketplace – Individuals and Small Businesses have until December 23rd to sign up. Coverage would begin January 1, 2014.

Temporary Hardship Exemption from Individual Mandate for Individuals with Cancelled Plans – The Hardship Exemption allows individuals to purchase catastrophic plans. One such exemption is for individuals with cancelled plans who have difficulty paying for coverage in the individual marketplace. (How ironic – exemption granted to those who cannot afford insurance under the Affordable Care Act.)

Effective for the plan year beginning on or after Jan 1, 2014 the new federal maximum 90-day waiting period limit applies to all group health plans, fully insured and self-funded, grandfathered and non-grandfathered. (States may mandate shorter waiting periods.)

Compliant waiting periods include: 

• No waiting period
• Date of Event: 1 to 90 calendar days; 1 or 2 months
• First of Month: Following the event, such as date of hire, 1 or 2 months or 1 to 60 calendar days.

We anticipate most employers declaring the eligibility to be ‘first of the month following…’, to minimize (if not eliminate) partial billing, with wording ‘not to exceed 90 days’.

A health savings account (HSA) is a tax-advantaged savings account available to those who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual.

HSA 2014 annual contribution limits
HSA annual contributions limits – Single $3,300 / Family $6,550
HSA catch-up contributions – $1,000 for an accountholder age 55 or older

Plan Design Requirements
Minimum deductible  –   Single $1,250 / Family $2,500
Maximum out-of-pocket expenses – Single $6,350 / Family $12,700

(Other HSA-eligibility criteria apply including: cannot be enrolled in Medicare, have received VA medical benefits in the past three months, or be eligible to be claimed as a dependent on someone else’s tax return.)

HealthCare.gov website users should know that the issues with the website were not just a result of a very large amount of traffic pinging it in one go.

The security flaws in the website were quite primitive. Flaws you don’t really expect someone to have overlooked. For instance, the site relayed personal information without encryption and the e-mail verification could be easily bypassed – even if you did not have access to the e-mail account. Also, the amount of cookie data the site maintained was more than required and likely not tested under high loads. And these are only a few of the issues.

The site is a prime target for an account being hijacked. A malicious hacker has a vulnerable site where millions of victims are “coming” because the government mandated it. The holes in the website allow the hacker to compromise a very large amount of sensitive information about a lot of people, all in one shot.

There are certain precautions that website users can take…but the website has to be iron-clad to begin with. There are a lot of security tests, assessments, and penetration tests that the website, its servers, the supporting databases, and the entire infrastructure it was built on, need to undergo.

 Website users should take precautions to ensure they don’t become victims of identity theft. The Federal Trade Commission (FTC) offers some good guidelines –http://www.consumer.ftc.gov/features/feature-0014-identity-theft.

The public needs to demand the equivalent level of information security from the ACA infrastructure as the Government would expect from a large hospital or healthcare associate via the HIPAA regulations.

Thanks to Enterprise Risk Management, www.emrisk.com, for help with the blog. ERM performs Penetration Testing and Security Implementation to Protect Businesses. By simulating an attack on your computer system or network, you determine if your information infrastructure is strong enough to withstand a real data security breach from both external and internal threat.

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.