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Timeline on the new US health insurance law starting in 2010

Friday, November 5th, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work.  Many critical details of this new insurance law will be clarified in the months and years to come. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Note:  Updated 10-20-2010

The implementation timeline reflects the provisions of the Patient Protection and Affordable Care Act, which President Obama signed on March 23, 2010, as well as provisions in the Health Care & Education Reconciliation Act, which was signed on March 30, 2010.  The following timeline provides implementation dates for key provisions in the law.

2010

Insurance Reforms
  • Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. (Effective 90 days following enactment until January 1, 2014)
  • Provide dependent coverage for adult children up to age 26 for all individual and group policies.
  • Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prior to 2014, plans may only impose annual limits on coverage as determined by the Secretary. Prohibit insurers from rescinding coverage except in cases of fraud and prohibit pre-existing condition exclusions for children.
  • Require qualified health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.
  • Provide tax credits to small employers with no more than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees.
  • Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. (Effective 90 days following enactment until January 1, 2014)
  • Require health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers for the amount of the premium spent on clinical services and quality that is less than 85% for plans in the large group market and 80% for plans in the individual and small group markets. (Requirement to report medical loss ratio effective plan year 2010; requirement to provide rebates effective January 1, 2011)
  • Establish a process for reviewing increases in health plan premiums and require plans to justify increases. Require states to report on trends in premium increases and recommend whether certain plan should be excluded from the Exchange based on unjustified premium increases.

Medicare
  • Provide a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 and gradually eliminate the Medicare Part D coverage gap by 2020.
  • Expand Medicare coverage to individuals who have been exposed to environmental health hazards from living in an area subject to an emergency declaration made as of June 17, 2009 and have developed certain health conditions as a result.
  • Improve care coordination for dual eligibles by creating a new office within the Centers for Medicare and Medicaid services, the Federal Coordinated Health Care Office.
  • Reduce annual market basket updates for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals and units.
  • Ban new physician-owned hospitals in Medicare, requiring hospitals to have a provider agreement in effect by December 31; limit the growth of certain grandfathered physician-owned hospitals. 

Medicaid
  • Create a state option to cover childless adults though a Medicaid state plan amendment.
  • Create a state option to provide Medicaid coverage for family planning services up to the highest level of eligibility for pregnant women to certain low-income individuals through a Medicaid state plan amendment.
  • Create a new option for states to provide Children’s Health Insurance Program (CHIP) coverage to children of state employees eligible for health benefits if certain conditions are met.
  • Increase the Medicaid drug rebate percentage for brand name drugs to 23.1% (except the rebate for clotting factors and drugs approved exclusively for pediatric use increases to 17.1%); increase the Medicaid rebate for non-innovator, multiple source drugs to 13% of average manufacturer price; and extend the drug rebate to Medicaid managed care plans.
  • Provide funding for and expand the role of the Medicaid and CHIP Payment and Access Commission to include assessments of adult services (including those dually eligible for Medicare and Medicaid).
    Require the Secretary of HHS to issue regulations to establish a process for public notice and comment for section 1115 waivers in Medicaid and CHIP.

Prescription Drugs
  • Authorize the Food and Drug Administration to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed.

Quality Improvement
  • Support comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute.
  • Establish a commissioned Regular Corps and a Ready Reserve Corps for service in time of a national emergency.
  • Reauthorize and amend the Indian Health Care Improvement Act.

Workforce
  • Establish the Workforce Advisory Committee to develop a national workforce strategy.
  • Increase workforce supply and support training of health professionals through scholarships and loans.

Tax Changes
  • Impose additional requirements on non-profit hospitals. Impose a tax of $50,000 per year for failure to meet these requirements.
  • Limit the deductibility of executive and employee compensation to $500,000 per applicable individual for health insurance providers.
  • Impose a tax of 10% on the amount paid for indoor tanning services.
  • Exclude unprocessed fuels from the definition of cellulosic biofuel for purposes of applying the cellulosic biofuel producer credit.
  • Clarify application of the economic substance doctrine and increase penalties for underpayments attributable to a transaction lacking economic substance.

2011

Long-term Care
  • Establish a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).

Medical Malpractice
  • Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations.

Prevention/Wellness
  • Eliminate cost-sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests. Authorize the Secretary to modify or eliminate Medicare coverage of preventive services based on recommendations of the U.S. Preventive Services Task Force.
  • Provide Medicare beneficiaries access to a comprehensive health risk assessment and creation of a personalized prevention plan and provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
  • Provide grants for up to five years to small employers that establish wellness programs.
  • Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nation’s health.
  • Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.

Medicare
  • Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begin phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
  • Provide a 10% Medicare bonus payment to primary care physicians, and to general surgeons practicing in health professional shortage areas. (Effective 2011 through 2015)
  • Restructure payments to Medicare Advantage plans by setting payments to different percentages of Medicare fee-for-service rates.
  • Prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
  • Provide Medicare payments to qualifying hospitals in counties with the lowest quartile Medicare spending for 2011 and 2012.
  • Freeze the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple. 
  • Create an Innovation Center within the Centers for Medicare and Medicaid Services.

Medicaid
  • Prohibit federal payments to states for Medicaid services related to health care acquired conditions.
  • Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. Provide states taking up the option with 90% FMAP for two years for health home related services including care management, care coordination and health promotion.
  • Create the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services.
  • Establish the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.

Quality Improvement
  • Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.
  • Establish the Community-based Collaborative Care Network Program to support consortiums of health care providers to coordinate and integrate health care services, for low-income uninsured and underinsured populations.
    Establish a new trauma center program to strengthen emergency department and trauma center capacity.
  • Improve access to care by increasing funding by $11 billion for community health centers and by $1.5 billion for the National Health Service Corps over five years; establish new programs to support school-based health centers and nurse-managed health clinics.

Workforce
  • Establish Teaching Health Centers to provide payments for primary care residency programs in community-based ambulatory patient care centers.

Tax Changes
  • Exclude the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a health reimbursement account or health flexible spending account and from being reimbursed on a tax-free basis through a health savings account or Archer medical savings account.
  • Increase the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the disbursed amount. 
  • Impose new annual fees on the pharmaceutical manufacturing sector.

2012

Medicare
  • Make Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care.
  • Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program.
  • Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions.
  • Reduce annual market basket updates for home health agencies, skilled nursing facilities, hospices, and other Medicare providers.
  • Create the Medicare Independence at Home demonstration program.
  • Establish a hospital value-based purchasing program in Medicare and develop plans to implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.
  • Provide bonus payments to high-quality Medicare Advantage plans. 
  • Reduce rebates for Medicare Advantage plans.

Medicaid
  • Create new demonstration projects in Medicaid to pay bundled payments for episodes of care that include hospitalizations (effective January 1, 2012 through December 31, 2016); to make global capitated payments to safety net hospital systems (effective fiscal years 2010 through 2012); to allow pediatric medical providers organized as accountable care organizations to share in cost-savings (effective January 1, 2012 through December 31, 2016); and to provide Medicaid payments to institutions of mental disease for adult enrollees who require stabilization of an emergency condition (effective October 1, 2011 through December 31, 2015).

Quality Improvement
  • Require enhanced collection and reporting of data on race, ethnicity, sex, primary language, disability status, and for underserved rural and frontier populations.

2013

Insurance Reforms
  • Create the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of non-profit, member-run health insurance companies in all 50 states and the District of Columbia to offer qualified health plans. (Appropriate $6 billion to finance the program and award loans and grants to establish CO-OPs by July 1, 2013)
  • Simplify health insurance administration by adopting a single set of operating rules for eligibility verification and claims status (rules adopted July 1, 2011; effective January 1, 2013), electronic funds transfers and health care payment and remittance (rules adopted July 1, 2012; effective January 1, 2014), and health claims or equivalent encounter information, enrollment and disenrollment in a health plan, health plan premium payments, and referral certification and authorization (rules adopted July 1, 2014; effective January 1, 2016). Health plans must document compliance with these standards or face a penalty of no more than $1 per covered life. (Effective April 1, 2014)

Prevention/Wellness
  • Provide states that offer Medicaid coverage of and remove cost-sharing for preventive services recommended (rated A or B) by the U.S. Preventive Services Task Force and recommended immunizations with a one percentage point increase in the federal medical assistance percentage (FMAP) for these services.

Medicare
  • Begin phasing-in federal subsidies for brand-name prescriptions filled in the Medicare Part D coverage gap (to 25% in 2020, in addition to the 50% manufacturer brand-name discount).
  • Establish a national Medicare pilot program to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

Medicaid
  • Increase Medicaid payments for primary care services provided by primary care doctors for 2013 and 2014 with 100% federal funding.

Quality Improvement
  • Require disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biological, and medical supplies.

Tax Changes
  • Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes; waive the increase for individuals age 65 and older for tax years 2013 through 2016.
  • Increase the Medicare Part A (hospital insurance) tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and impose a 3.8% assessment on unearned income for higher-income taxpayers.
  • Limit the amount of contributions to a flexible spending account for medical expenses to $2,500 per year increased annually by the cost of living adjustment.
  • Impose an excise tax of 2.3% on the sale of any taxable medical device.
  • Eliminate the tax-deduction for employers who receive Medicare Part D retiree drug subsidy payments.

2014

Individual and Employer Requirements
  • Require U.S. citizens and legal residents to have qualifying health coverage (phase-in tax penalty for those without coverage).
  • Assess employers with 50 or more employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. Employers with 50 or more employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees from the assessment.  Require employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employer.  Employees may opt out of coverage.

Insurance Reforms
  • Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage.
  • Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.
  • Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:
    • 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family in 2010);
    • 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family in 2010);
    • 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family in 2010).
  • Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits.
  • Limit any waiting periods for coverage to 90 days. 
  • Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.
  • Require the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.
  • Permit states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.
  • Allow states the option of merging the individual and small group markets.
  • Create a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals. 
  • Require qualified health plans to meet new operating standards and reporting requirements.

Premium Subsidies
  • Provide refundable and advanceable premium credits and cost sharing subsidies to eligible individuals and families with incomes between 133-400% FPL to purchase insurance through the Exchanges.

Medicare
  • Reduce the out-of-pocket amount that qualifies an enrollee for catastrophic coverage in Medicare Part D (effective through 2019).
  • Establish an Independent Payment Advisory Board comprised of 15 members to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. 
  • Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increase payments based on the percent of the population uninsured and the amount of uncompensated care provided. Require Medicare Advantage plans to have medical loss ratios no lower than 85%.

Medicaid
  • Expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (MAGI) and provide enhanced federal matching for new eligibles.
  • Reduce states’ Medicaid Disproportionate Share Hospital (DSH) allotments.
  • Increase spending caps for the territories.

Prevention/Wellness
  • Permit employers to offer employees rewards of up to 30%, increasing to 50% if appropriate, of the cost of coverage for participating in a wellness program and meeting certain health-related standards. Establish 10-state pilot programs to permit participating states to apply similar rewards for participating in wellness programs in the individual market.

Tax Changes
  • Impose fees on the health insurance sector.

2015 and later

Insurance Reforms
  • Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. (Compacts may not take effect before January 1, 2016)

Medicare
  • Reduce Medicare payments to certain hospitals for hospital-acquired conditions by 1%. (Effective fiscal year 2015)

Tax Changes
  • Impose an excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage. (Effective January 1, 2018)

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.   Visit Good Neighbor Insurance at www.gnazhealth.com /  www.gnhealthplan.com/  and www.onlineglobalhealthinsurance.com/trip-cancellation/ for Arizona and international travel insurance coverage.

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Posted in 2010 updates |

US Health care reform and the important milestones from 2010 – 2018

Wednesday, September 29th, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work.  Many critical details of this new insurance law will be clarified in the months and years to come. 

These six major coverage options are:

(1) Individual or family coverage ( www.gnazhealth.com/azhealthinsurance.asp )

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards  (www.gnazhealth.com/senior_health_plans.asp)

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

The president signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010. Additionally, he signed the Health Care and Education Reconciliation Act of 2010 on March 30, 2010, which made amendments to the PPACA law. The president’s signature on the reform bills triggered a series of major changes to the health care system that will affect every American. There were several changes that became effective upon President Obama’s signature. The rest of the changes are scheduled to become effective at varying times over the next several years.

The law is wide-reaching and encompasses more than 2,700 pages and many more pages of expected new regulation. Many of the specific details are yet to be finalized by federal agencies and state officials. This guide outlines some of the major sections of the law, and we’ve indicated when guidelines are pending from the United States Department of Health and Human Services (HHS) and other federal or state agencies. These guidelines will help all health insurance companies comply more completely with the reforms.

Reforms in Effect on and after Sept. 23, 2010

Coverage of adult children: Allows children up to age 26 to receive dependent coverage under a parent’s group policy as long as they do not have access to insurance through their employer.

After 2014, no group may exclude from coverage a dependent age 19 to 26 even if the dependent has access to his or her own employer coverage. The adult child does not have to live at home or be a student and can be married. According to the PPACA, this goes into effect Sept. 23, 2010 or at the start of your group’s next plan year on or after Sept. 23, 2010.

Early retiree reinsurance: Employers may apply to receive reinsurance coverage if they provide health insurance coverage to early retirees, ages 55 to 64. The reinsurance covers 80 percent of claims between $15,000 and $90,000. The program expires in 2014 or when the $5 billion appropriation is exhausted. To be eligible, the employer’s plan must generate cost savings for people with chronic conditions, provide claim documentation, and the employer must apply to HHS for the coverage.

Network access:

• Emergency room – Out-of-network cost-sharing amounts must be the same as in-network cost sharing amounts for emergency room visits. A requirement for prior approval of emergency room visits is prohibited.

• Primary care – Insurance customers must be able to select any network primary care physician they want to see.

• OB/GYN – Women must have direct access to their network OB/GYN without requiring a referral from a primary care physician.

Appeals: Insurance customers will be able to object to coverage and payment decisions through internal and external appeals processes. Arizona law has long had similar requirements for insured business, but the external review provisions are new to self-funded plans.

Elimination of pre-existing condition exclusions for children: The law says children under age 19 can no longer be subject to pre-existing condition waiting periods. New HHS regulations amend   the definition of pre-existing condition so that plans may no longer deny an application of coverage to an individual under 19 due to a pre-existing condition. Additionally, waivers or pre- existing condition waiting periods to these individuals will not be applied. This regulation applies to all group plans and only non-grandfathered individual plans. It does not apply to grandfathered individual plans. The term grandfathering means policies that were in effect on March 23, 2010, are exempt from many of the health care reforms.

Prevention services: The law prohibits cost sharing (deductibles, copays, coinsurance, etc.) for certain prevention and wellness services. Specific guidelines on these exact services are still pending from HHS.

Rescissions: Insurers may not rescind – or void – a policy without a showing of fraud or intentional misrepresentation.

Lifetime limits: Insurance policies will no longer be allowed to require a specific dollar cap on essential benefits. New regulations also permit individuals who previously reached a lifetime maximum and who are otherwise still eligible for coverage an opportunity to re-enroll. The prohibition on lifetime limits applies to all group and individual plans.

Annual limits: This provision restricts and later prohibits insurance policies from imposing dollar amount-based annual limits on essential benefit plan services. Annual limits are restricted for plan years beginning on or after Sept. 23, 2010 and prohibited for plan years beginning on or after Jan. 1, 2014. The limitation on annual limits does not apply to individual grandfathered plans. The term grandfathering means policies that were in effect on March 23, 2010, are exempt from many of the health care reforms. Specific guidelines for what is defined as essential benefits are pending from HHS.

Administrative cost caps or medical loss ratio: Health plan administrative costs will be limited to 5 percent for large group products and 20 percent for individual and small group business. Beginning in 2011, plans will have to issue rebates to customers if they exceed these administrative expense caps. HHS will develop the definitions and calculations to determine the administrative cost after consulting with state insurance commissioners.

Reforms in Effect Starting in 2011

Health savings accounts and flexible spending accounts: Penalties for unqualified withdrawals from health savings accounts (HSAs) increase. Spending on over-the-counter products will no longer be permitted for HSAs and flexible spending accounts.

Employer wellness discounts: Allows employers to offer wellness premium discounts up to 30 percent of employee-only premium and provides grants to small employers to establish wellness programs.

Employer obligations:

• Employers must inform new hires of the exchange and their potential eligibility for subsidies in the exchange.

• Must disclose value of benefits on W-2 form.

Reforms in Effect Starting 2012

Uniform coverage documents: Health plans will be required to publish a description of the policy in a uniform format and provide it to enrollees upon enrollment and renewal. The document must be no more than four pages, use 12-point font and include definitions and examples.

Quality: Insurers must report to HHS and enrollees on their ability to promote quality of care. F or example, insurers must provide incentives for hospitals to reduce the number of readmissions. Consumers will also find it easier to compare how well their health plan is performing in the areas of promoting quality health care and wellness.

Reforms in Effect Starting 2013

Flexible spending account limits: The maximum amount of flexible spending accounts becomes $2,500.

Medicare tax: The hospital insurance tax will increase 0.9 percent for upper income individuals and will extend to investment income. Single taxpayers with income exceeding $200,000 and married taxpayers who file joint returns with income exceeding $250,000 are considered upper income.

Medical expense deductibility: Increases the threshold for deducting medical expenses from 7.5 percent to 10 percent of adjusted gross income.

Medicaid expansion: The legislation expands Medicaid eligibility nationwide to those earning up to 133 percent of the federal poverty level (FPL).

Comparative effectiveness research: Research will begin on assessing the best treatments for certain conditions and disseminating that information to health care providers. To fund this research, a fee of $2 ($1 until 2014) per insured life will be assessed to the policyholder.

Reforms in Effect Starting September 2014

Guaranteed issue: The new law requires insurance companies to issue coverage even if the applicant has a pre-existing condition. Community rating: Under the new law, insurers can only vary premiums based on where the person lives, family size, smoking status and age. The amount of variation is strictly limited.

Exchange: The federal government creates a new health insurance marketplace to enable individuals and small businesses (and large businesses, if a state elects) to compare and purchase policies and apply for subsidies. There will be a fee for using the exchange. A person must buy insurance through the state-based exchange to be eligible for subsidies (described below).

Individual mandate: Almost all Americans will be required to have health insurance, whether it is through an employer, a government program or the individual insurance market. The law penalizes people who fail to carry insurance. The penalty is phased in. When it is fully implemented in 2016, a person who fails to buy insurance will be subject to a penalty of $695 or 2.5 percent of their income, but not more than the cost of the lowest cost policy sold through the exchange. Penalties for uninsured children are half the adult penalty. Employers and insurers will report policy information to the Internal Revenue Service, which will play a role in enforcing the mandate. Subsidies: The law also offers subsidies to people who might have a difficult time buying insurance. Subsidies are available to those with household incomes of up to 400 percent of the federal poverty level (FPL). For a family of four, 400 percent FPL is $88,200. The subsidy is set up so that a person pays no more than a certain percentage of his or her income for health insurance. Subsidies are also available for cost-sharing expenses such as deductibles and copays. A person must buy insurance through the exchange to be eligible for subsidies. Employer requirements: The law requires employers to provide minimum essential coverage for full-time equivalent employees and dependents. Employers with more than 50 full-time employees (FTEs) that have any FTEs receiving subsidized coverage in the exchange are subject to penalties.

• If the employer does not offer coverage, the fine is $2,000 per FTE.*

• If the employer does offer coverage, but the coverage has less than 60 percent actuarial value, or the FTE’s share of premium exceeds 9.5 percent of income, the fine is $3,000 per FTE with subsidized coverage or $2,000 per FTE, whichever is less.*

* The penalties based on overall number of FTEs exclude the first 30 employees

Other employer obligations include:

• Employers with more than 200 employees must automatically enroll new full-time employees in coverage. • “Provide free choice vouchers.” Requires employers with more than 50 FTEs and who provide coverage to issue free choice vouchers to qualifying employees. Qualifying employees have a household income less than 400 percent of the FPL and their share for coverage is 8 percent to 9.8 percent of their household income. The free choice voucher enables the employee to buy coverage in the exchange with the employer’s usual contribution amount.

Employers issuing free choice vouchers are not subject to penalties. • Larger employers must report employee coverage information to the government. • Waiting periods in excess of 90 days are not allowed. Benefit requirements: Small group and individual policies sold on the exchange will have to meet federal standards. One of these standards is based on the policy’s actuarial value. Actuarial value represents the amount the insurer pays for an average claim versus the amount the customer pays in the form of cost sharing, such as deductibles and copays. The base level, or Bronze product, is established at 60 percent actuarial value. Richer benefit packages will also be available as follows:

• Silver – 70 percent actuarial value

• Gold – 80 percent actuarial value

• Platinum – 90 percent actuarial value

An insurer must offer the Silver and Gold plans if it wants to participate in the exchange. In addition to the actuarial value requirements, all policies, whether offered through the exchange or not, will have to cover “essential benefits.” The policies must contain specific coverage provisions, including:

• Mental health benefits comparable to health benefits

• Policies cannot deny participation in certain clinical trials or associated routine patient costs

• The rest of the major provisions in the essential health benefits list, which are pending clarification from HHS Even products that are not sold through the exchange, must meet cost-sharing limitations. They cannot exceed $2,000 for single coverage and $4,000 for family coverage.  These amounts will increase with inflation.

Insurer tax: Insurers will be assessed a new phased-in tax. This is an industry-wide assessment based on market share. When fully implemented in 2018, the tax is expected to cost the insurance industry $14.3 billion. Similar taxes will apply to drug and device manufacturers. Name-brand drug manufacturers will pay, on average, a $2.8 billion per-year assessment beginning in 2011. Medical device manufacturers will pay a 2.3 percent tax on non-retail sales beginning in 2013. All of these assessments will add to the costs of health care for consumers.

Reforms in Effect Starting September 2018

“Cadillac plan” tax: A new tax on high-value insurance policies will become effective in 2018. If the premium for a group insurance policy exceeds $10,200 for a single policy or $27,500 for a family policy, the excess amount will be subject to a 40 percent excise tax.

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care information with him at all times when he travels (check out his diving travels at www.douggulleson.com).  Keep our blog close by you, www.gntravelinsurance.com , for continual updates on the changes with the US health care system.

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Posted in 2010 updates |

Understanding the new US health insurance high risk pool

Saturday, August 21st, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work.  Many critical details of this new insurance law will be clarified in the months and years to come. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Note:  Updated 8-20-2010

High-risk pools are temporary and will morph into Exchanges starting 1-1-2014.  States may run their own high-risk pool or have the US federal government carry out the program which will be similar for all states.  The high risk-pool has started on 7-1-2010 and will continue till 12-31-2013.  Currently twenty-one states have asked the federal government to run their high-risk pool.

Eligibility

Individuals who have a pre-existing medical condition and have not had creditable coverage for the previous six months.

Benefits

The Secretary of HHS will determine the minimum benefits that must be included and plans must cover at least 65% of health care costs.

Premiums and Cost-Sharing

Set premiums as if for a standard population and not for a population with a higher health risk. Allow premiums to vary by age (4:1), geographic area, and family composition. Limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.

Funding

$5 billion currently

Q AND A

Who is eligible for coverage through the temporary high-risk pool?

U.S. citizens and legal residents who have a pre-existing medical condition and have not had creditable health coverage for the previous six months are eligible for coverage.

What benefits will high-risk pool enrollees receive?

The high-risk pools will cover a range of benefits, including primary and specialty care, hospital care and prescription drugs. The health plans will be required to cover pre-existing medical conditions upon enrollment. The high-risk pool programs must cover at least 65% of the health care costs for a standard population.

How much will high-risk pool health coverage cost?

The premium cost for high-risk pool coverage will be established for a standard population in the non-group market and will not be based on the health status of enrollees. Premiums will be allowed to vary by age (by a 4 to 1 ratio), geographic area, and family composition. Premiums for the high-risk pool operated by the federal government will be available on July 15, 2010. Yearly out-of-pocket costs will be limited to $5,950 for individuals and $11,900 for families, excluding premiums.

How will the high-risk pool be funded and administered?

The health reform law allocates $5 billion to administer the national high-risk pool. This funding will go toward health care claims and administrative costs that exceed the premiums collected for the high-risk pool.  On April 2, 2010, U.S. Department of Health and Human Services Secretary Kathleen Sebelius issued a letter that gives states the following options for operating the temporary high-risk pool: (1) Operate a new high-risk pool alongside an existing state high-risk pool; (2) Establish a new high-risk pool if the state does not currently have one; (3) Build upon other existing coverage programs designed to cover high-risk individuals; (4) Contract with current HIPAA insurance carriers or insurers of last resort to provide subsidized coverage; or (5) Do nothing, in which case the U.S. Department of Health and Human Services would carry out the coverage program in the state.

When does the high-risk pool go into effect?

The federal high-risk pool will begin taking applications on July 1, 2010 and coverage will begin on August 1, 2010. States operating their own high-risk pools will also aim to begin coverage relatively soon, but may not all meet the August 1 date for coverage. The high-risk pools will terminate on January 1, 2014 when the state-based American Health Benefit Exchanges are established and other insurance market reforms go into effect, providing new coverage options for people with pre-existing health conditions.

Given that this is a temporary form of coverage, what happens to people when the high-risk pool terminates in 2014?

When the temporary national high-risk pool terminates on January 1, 2014, high-risk pool enrollees will transition into receiving health coverage through the state-based American Health Benefit Exchanges. Procedures will be developed to ensure that there are no lapses in coverage. Individuals without employer health coverage and small businesses with up to 100 employees will be able to purchase coverage through the Exchanges. Premium and cost-sharing subsidies will be available for individuals with incomes between $14,404 – $57,616 and for families of four with incomes between $29,327 – $88,200. People will also be able to choose to purchase coverage in the individual market. As of 2014, insurers will not be able to deny adults coverage or charge higher premiums based on health status.

How many high-risk pools currently exist in the United States and what will happen to enrollees?

Currently, 34 states operate high-risk pools that provide health coverage to nearly 200,000 individuals. State high-risk pools share a common structure and some similarities but differ by state in many ways including eligibility, benefit design, pre-existing condition exclusions, premium costs and cost-sharing, and administration, among other areas. People who currently obtain health coverage through a state high-risk pool will maintain their current coverage. In 2014, these individuals will likely transition into the state-based American Health Benefit Exchanges. Given that the Exchanges would prohibit people from being denied coverage or charged more based on health status and would limit cost-sharing, current state high-risk pool enrollees may receive more affordable coverage in the Exchanges than they currently have in the high-risk pool.

Additional information

Twenty-two of the states told the Department of Health and Human Services that they did not want to run their own risk pool and requested the US Federal government run it which is allowed in the new US health law signed in March 2010.  You may see the US federal government high-risk pool plan by going to www.pciplan.com.

*          The very minimum an individual will pay if you’re under 35 is right around $12,340 a year.  This is including monthly premium, deductible, and co-insurance.  The co-insurance part of the policy holder is $5,950 in-network or $7,000 out-of-network.  There is no lifetime maximum or cap on the amount the plan pays for your care.

*          HHS (United States Department of Health and Human Services), contracted out to a private insurance company called the Government Employees Health Association; the Government Employees — the insurance plan is called the GEHA / Government Employees Health Association. This plan is an HSA (health savings account) qualified high deductible health plan.  The plan gives you greater control over how you use your health care benefits, and they want you to open an HSA account.  The applicant must also show proof of US citizenship when applying for this US federal government high-risk pool plan.

*          There are no benefits payables for anything other than preventive diagnoses until you pay out of pocket $2500.  This means there is a $2,500 deductible before any benefits is paid besides preventative coverage.  The next part is the co-insurance part which is an 80-20 split for in-network (maximum of your part of the coinsurance is $5,950) / 60-40 (maximum of your part of the coinsurance is $7,000) split out-of-network until you have paid out of your pocket, not including the $2,500 in-network deductible / $3,000 out-of-network deductible. 

To recap;  Part 1 is your deductible which you are fully responsible for.  Part 2, you and the insurance company share the cost of medical care called coinsurance.  When you see 80/20 that means you pay 20% of the medical bill and the insurance company will pay the 80% part.  Once you meet $5,950 out of your pocket for your 20% of the coinsurance part then you are going into part 3.   Part 3 is where the insurance company pays the full amount there-after for the duration of the calendar year.   

So your maximum out of pocket for medical care is going to be your deductible + your co-insurance part and if you are using all in-network medical facilities, in this example, you would be spending a total of $8,450 + any copays annually; this is on top of your monthly premium.  This starts over each January 1st of the following year.  You may view the schedule of benefits or what we call “looking under the hood of your insurance plan” at www.pciplan.com/forms/pdfs/BenefitsSummary.pdf . 

*          Here are the monthly PCIP premium rates for Georgia by the age of an enrollee.

  Ages 0 to 34: $323

Ages 35 to 44: $387

Ages 45 to 54: $495

Ages 55+: $688

Here are the monthly PCIP premium rates for Arizona by the age of an enrollee.

Ages 0 to 34: $323

Ages 35 to 44: $387

Ages 45 to 54: $495

Ages 55+: $688

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.   Visit Good Neighbor Insurance at www.gnazhealth.com  and www.gninsurance.com/tripcancellation for Arizona and international travel insurance coverage.

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Posted in 2010 updates |

New rules on health insurance claims and appeals process

Wednesday, August 4th, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Note:  updated 8-2-2010

On 7-22-2010, HHS released Final Interim Rules enhancing a plan’s claims and appeals process.  The new appeals regulations were issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury. Consumers in new health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans. This includes the right to appeal decisions made by a health plan through the plan’s internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage.  The newly issued rules apply to both group plans and individual policies.  They do NOT apply to grandfathered plans, as long as the plan remains grandfathered.  The effective date for these rules is the first day of the first plan anniversary following September 23, 2010.

General information:

All group and individual plans must comply with the ERISA regulations, even if the plan itself is not subject to ERISA (i.e. government or church plans).

Coverage Pending Outcome of Appeal – Benefits for an ongoing treatment cannot be reduced or terminated with advance notice as well as an opportunity for advance review.

 Linguistically and Culturally Appropriate – Relevant group plan notices must be provided in a foreign language as requested, if the employer’s population meets a certain threshold of non-English speaking employees.  In addition, a statement offering the non-English version must be included in all English language notices.  Once a person has requested a non-English notice, all future notices to that person must be in their language of choice.

 Individual Plans – If a certain percentage of the population of a county are literate only in the same non-English language, the notices must be provided in that language upon request.

 External Review:  

  • State Laws – Plans must comply with state external review requirements.  However, states have a transition period until July 1, 2011 to amend their current requirements to comply with the federal requirements.
  • Federal Law – If a state law does not exist, plans must comply with the federal external review process.  This has yet to be defined.

 Six New Requirements:  

1.   The definition of “adverse benefit determination” has been revised to include rescission of coverage. 

2.   The notification of determination (either approval or denial) for an urgent care claim must be made within 24 hours after receipt of the claim.  This presumes all necessary information has been received.

3.   Claimants must also now be provided any additional or new evidence that was considered or relied upon or generated in connection to the claim prior to a     decision being made.

4.   All claims and appeals must be in a manner designed to ensure the impartiality of the person making the decision.

5.   A notice of denial must include enough information to sufficiently identify.  The claim involved:

                   Reasons for denial

                  Documentation of the appeal and review process

                 Contact information for any office of health insurance consumer assistance or ombudsman

                 Model notices will be issued in the near future

6. If the plan does not strictly follow all internal claims and appeals processes, the claimant will be allowed to proceed to external review and pursue other options under the law.

Additional Requirements for Individual Plans:

1.  The Department of Labor claim and appeal regulations will also apply to “initial eligibility determinations”.

2.  Individual plans are only permitted to have one level of internal appeals, after which the individual can proceed to an external review.

Questions and Answers:

Q- A client of ours is asking about hourly vs. salary employees. Would you provide me an answer or where I can go? From my readings both will have equal access. This group has only management on one plan and the employees on another option.

A – Then both plans need to be tested independently.

Q – Concerning the various services that are available at no cost beginning Sept. 23, 2010, how are the services obtained? Who pays? How? When?

A – The plans will be changed by the carriers, unless the plan is grandfathered. These will be plan changes, so any non-grandfathered plan will include these specific preventative services with no co-pays (in-network).

Q- If an employer currently has a “carve-out” in force and upon renewal in 2011 can’t pass 105(h) can the employer drop the “carve-out” coverage?

A – They can drop their coverage; but, please keep in mind, if this employer has more than 50 FTE’s, in 2014 they may be subject to a penalty for not offering coverage.

Q – On September 23 can an under 19 child with pre-existing conditions come off their parents group plan and qualify for an individual plan? Or do they have to wait for group open enrollment?

A – They can; however, the concern is whether or not the carriers will continue to offer “child” only policies or even “adult” policies for an 18 year old. I would not make this recommendation until we are certain there will be something for them to purchase.

Q – In regard to the Section 105 Non-discrimination testing:

1) If a medical carve-out group adds a second plan (dual option) at their 09-01-2010 renewal, will both plans (employer) be subject to discrimination testing at the 2011 renewal or just the new plan?

A – Just the new plan, assuming the other plan remains grandfathered.

2) If the same group waited to add a second option until the 2011 renewal, would both plans (employer) immediately become subject to discrimination testing?

A – Same as above.

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.  He knows through experience never to leave home without his travel insurance and credit card too.   Visit Good Neighbor Insurance at  www.gnazhealth.com and www.gninsurance.com/tripcancellation for Arizona and  international travel insurance coverage.

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Posted in 2010 updates |

All individuals are required to have health insurance or be fined starting in 2014

Tuesday, August 3rd, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work.  Many critical details of this new insurance law will be clarified in the months and years to come. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Note:  Updated 7-30-2010

Beginning in 2014, all individuals are required to maintain “minimum essential coverage.”

Failure to maintain coverage for the entire year will result in a penalty or tax. The penalty is on a sliding scale for three years and is described as 1/12th of the greater of: 

For 2014: $95 per uninsured adult in the household or 1% of the household income over the filing threshold,

 For 2015: $325 per uninsured adult in the household or 2% of the household income over the filing threshold,

 For 2016: $695 per uninsured adult in the household or 2.5% of the household income over the filing threshold

 *           The penalty will be ½ of the amounts listed above for individuals under the age of 18.

*           The total household penalty may not exceed 300 % of the adult penalty or the national average annual premium for bronze level health coverage offered through the Exchange (the Exchange is another mandate scheduled for 2014).

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.   Visit Good Neighbor Insurance at www.gnazhealth.com and www.gninsurance.com/boomer/   for Arizona and international travel insurance coverage.

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Posted in 2010 updates |

Preventative services update for individual/family and group health insurance in the US

Thursday, July 29th, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid based mostly on financial criteria 

On July 14, the Departments of Treasury, Labor, and Health and Human Services jointly released Interim Final Rules (IFRs) for group health plans and health insurance issuers related to coverage of preventive services under the Patient Protection and Affordable Care Act (PPACA).

DHHS also identified the preventative services for which there will be no cost sharing beginning with the first day of the plan year following September 23, 2010.  Below are the services included:

Screening for abdominal aortic aneurysm
Screening and counseling to reduce alcohol misuse
Aspirin to prevent CVD
Screening for bacteriuria
Screening for high blood pressure
Mammography
Chemoprevention of breast cancer
Interventions to support breast feeding
Screening for cervical cancer
Screening for chlamydial infection
Screening for cholesterol abnormalities
Screening for colorectal cancer
Chemoprevention of dental caries
Screening for depression
Screening for diabetes
Counseling for a healthy diet
Supplementation with folic acide
Screening for gonorrhea
Screening for hearing loss
Screening for hemoglobinopathies
Screening for hepatitis B
Screening for HIV
Screening for congenital hypothyrodism
Screening for Anemia
Iron supplements in Children
Screening and Counseling for Obesity
Screening for Osteoporosis
Screening for PKU
Screening for Rh incapatability (during pregnancy
Counseling for STIs
Screening for Syphilis
Counseling for tobacco use
Screening for visual acuity in children

Under the regulations, plans must cover without copay, coinsurance or deductible – certain preventive services that have “strong scientific evidence of their health benefits.”

These are interim final rules (IFRs), which means final rules may eventually differ, but these rules are final in the interim.

General highlights of new regulations:

  • Grandfathered plans are exempt for as long as they remain grandfathered.
  • Non-grandfathered plans (i.e., plans either not in effect on 3/23/10 or that made changes since then resulting in loss of grandfathered status) must comply with the no-cost-sharing requirement beginning with the first plan year on or after September 23, 2010.
  • Preventive services are to be covered without any cost-sharing requirement when delivered by a network provider.
  • Employers and insurers are not required to provide coverage for recommended preventive services delivered by an out-of-network provider or may impose cost-sharing for recommended preventive services delivered by an out-of-network health care provider.
  • If a guideline for a recommended preventive service does not specify the frequency, method, treatment, or setting for the service, the plan or issuer may use “reasonable medical management techniques” to determine any coverage limitations on the service.

General list of services to be offered without copay, coinsurance or deductible:

Evidence-based preventive services: This list of items is taken from the current recommendations of the United States Preventive Services. They are included only if they have a rating of A or B. This broad list generally includes:

  • Breast cancer and cervical cancer screenings
  • Colon cancer screenings
  • Screening for vitamin deficiencies during pregnancy
  • Screenings for diabetes, high cholesterol and high blood pressure

Routine vaccinations: A list of immunizations – recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention – are included in the rule. They are considered routine for use with children, adolescents, and adults and range from childhood immunizations to periodic tetanus shots for adults.

Prevention for children: The rule includes preventive care guidelines for children – from birth to age 21 – developed by the Health Resources and Services Administration with the American Academy of Pediatrics. Services include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity. 

Prevention for women: The regulation mandates certain preventive care measures for women. These recommendations will be in place until new requirements for prevention for women are issued by the United States Preventive Services Task Force or appear in comprehensive guidelines supported by the Health Resources and Services Administration.

Billing and Office Visits:

If a recommended preventive item or service is billed separately from an office visit, then cost-sharing may be applied to the office visit

If a recommended preventive item or service is not billed separately from an office visit and the primary purpose of the office visit is the delivery of such item or service, then cost-sharing requirements may not be imposed with respect to the office visit.

If a recommended preventive item or service is not billed separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, them cost-sharing made be applied to the office visit.

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.  He knows through experience never to leave home without his travel insurance and credit card too.   Visit Good Neighbor Insurance at www.gnazhealth.com  and www.gninsurance.com/tripcancellation for Arizona and international travel insurance coverage.

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Posted in 2010 updates |

Individual, Family, and Employer responsibilities in the new health insurance law

Tuesday, June 29th, 2010

Good Neighbor Insurance, Inc, www.gninsurance.com and www.gnazhealth.com, is keeping up with the changes in our US health care system and will be, over the course of the next months and years, expanding this section with up-to-date information.   Health care overhaul will bring change but it is going to happen slowly.  There will be a lot of minor as well as major changes over the course of the next few years with a bulk of these changes happening in 2014 and the last parts being implemented by 2018. 

There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. 

 These six major coverage options are:

 (1) Individual or family coverage (private health insurance)

 (2) Employee/employer group option for small businesses (typically under 50 employees)

 (3) Employee/employer group option for large businesses (typically larger than 50 employees)

 (4) Exchange options, two or more plans, through the state you are residing in (fully integrated 1-1-2014) are quasi-government and private insurance coverage combined

 (5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards, www.gninsurance.com/medicare.asp

 (6) Full government health plans like Medicaid, CHIP, Veterans insurance, and others based mostly on financial criteria

 Overview

The health reform package is made up of two parts: a bill that passed the Senate on Christmas Eve, passed the House on March 21, and was signed into law by the President on March 23, and a second piece of legislation: the House’s reconciliation bill, which makes changes to the original law, passed both chambers on March 25, and was signed by the President on March 30.

Many of the provisions in the law will not take effect for several years. At the earliest, provisions that affect employer-sponsored health plans will take effect six months from the date of enactment – in late September. Even then, those early provisions will not affect plans until they renew for the next plan year.  The health reform law has thousands of pages and hundreds of provisions. So it’s important to remember that before many of those provisions are put in place, additional laws and regulations will need to be developed. That could be a lengthy process.  Here are some highlights of the major provisions.

Individual responsibility

Starting in 2014, everyone must have coverage or pay a penalty, which will be enforced by the Internal Revenue Service. The penalties will be phased in over time:

• In 2014, an individual without insurance must pay whichever amount is greater:  $95 or 1 percent of income.

• For 2016 and beyond, that penalty rises to $695 or 2.5 percent of income, whichever is greater (the $695 is indexed from 2016 on).

• Families will pay half the penalty for children, with a cap of $2,085 per family.

• There will be exemptions to this requirement, such as in cases of financial hardship and other limited circumstances. Subsidies to buy insurance in new state exchanges will be available in the form of tax credits and cost-sharing assistance for people above Medicaid eligibility but below 400 percent of the federal poverty level. Medicaid eligibility will be increased to 133 percent of the federal poverty level.

Employer responsibility

New employer penalties and obligations

Starting in 2014, employers don’t have to offer their employees health insurance coverage, but most of them with more than 50 employees will pay an assessment if they don’t, or if they offer coverage that isn’t affordable. Full-time and part-time employees are included when determining whether an employer has 50 employees (based on current full-time employee equivalency rules).

• Employers with 50 or more employees that do not offer “minimum essential coverage” will pay $2,000 for each employee over the first 30 employees if one of their employees gets a tax subsidy to buy insurance under an exchange.

• Employers with 50 or more employees that do offer minimum essential coverage but have at least one full-time employee receiving subsidized coverage under an exchange will pay whichever is less: $3,000 for each employee receiving a premium credit, or $2,000 for each full-time employee. 

*Employers must provide “free choice” vouchers to employees with incomes below 400 percent of the federal poverty level if the employee’s contribution to coverage is between 8 percent and 9.8 percent of income and the employee chooses to purchase coverage in the exchange.  No penalties will be imposed on employers with respect to employees who receive these vouchers.

*Employers with more than 200 employees that offer coverage must automatically enroll new full-time employees in coverage. Employees may opt out.

New employer reporting requirements

• Beginning in 2011, employers will be required to disclose the value of health care benefits on an employee’s annual W-2.

• Employers will be required to notify employees:

– About the availability of the exchange

– for new employees, at the time of hiring;  for current employees, by March 1, 2013

– They may be eligible for a subsidy under the exchange if the employer’s contribution to the plan is less than 60 percent of total allowed costs of the benefits;

– If the employee purchases coverage in the exchange, he or she will lose the employer’s coverage contribution.

• In 2014, large employers will be subject to expanded 5500 reporting requirements to include information on the health insurance coverage of their employees.

Small business tax credits

Beginning in 2010, small businesses with fewer than 25 employees and average wages of less than $50,000 get a tax credit for their contributions to buying health insurance for employees.

The tax credit starts at up to 35 percent and increases to 50 percent in 2014 when the exchange is operational. A full tax credit may be available to small businesses with fewer than 10 employees and average wages of less than $25,000.

Taxes and fees on small business

*Starting in 2014, a small business (when talking about the new health insurance law the US government states that small businesses employ 2 to 49 employees) that already offers group insurance can pay a $3,000 per-year tax on each employee if that employee qualifies and accepts government health care premium subsidies or government-run health care. Thus, if the employee takes the government-run plan over the employer’s plan even for one month of the calendar year the employer will have to pay a $3,000 annual tax. This can happen even though the employer’s plan may have stronger benefits than the government-run plan. Government-run plans can be Medicare, Medicaid, CHIPS, Veteran, and other possible State government plans including exchanges.  This also is applicable if your employee’s spouse takes any government-run plan you as an employer will be liable for this $3,000 tax.  Thus, the employer of your employee’s spouse and you will be paying a total of $6,000 annual tax if one takes any government-run insurance plan.

*Businesses electing not to have group coverage for their employees will be charged an 8% tax on payroll.  This tax will be applied for each employee not meeting the government’s minimal coverage requirement.

*A small business could incur two types of taxes for the same employee if the employer does not provide group insurance and if an employee receives premium subsidies from the government to help pay for health insurance.

Doug Gulleson loves to scuba dive overseas. He makes sure he always takes his credit card AND international travel insurance. Visit Good Neighbor Insurance at  www.onlineglobalhealthinsurance.com/trip-cancellation for your next overseas trip and get a FREE quote.

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Posted in 2010 updates |

Health plan changes in the US from 2010 to 2018

Monday, June 28th, 2010

Good Neighbor Insurance (www.gninsurance.com and www.gnazhealth.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. 

These six major coverage options are:

(1) Individual or family coverage

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid based mostly on financial criteria

HEALTH PLAN CHANGES 

Under the new law, individuals and employers/employees have the right to keep the coverage they had as of March 23, 2010 and are exempt from many reforms. These individual and group health plans are considered “grandfathered plans.” Collectively bargained plans that were ratified before the date of enactment are grandfathered until the date that the last collective bargaining agreement related to coverage ends.

Health plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years (Starting 3-23-2010):

IMMEDIATELY:

• Federal rate review. The Department of Health and Human Services (HHS) will establish a process for federal review of fully insured premium rate increases.

I N 9 0 DAYS:

• Internet portal. By July 1, an Internet portal will be created for consumers and small businesses to shop for health Insurance.

• High-risk pool. $5 billion has been appropriated to create a temporary high-risk insurance pool to help adults with pre-existing conditions get coverage if they have been uninsured for six months. The program will be effective through 2013.

• Reinsurance for early retirees. A temporary reinsurance program will be established for employers providing coverage to early retirees over age 55 who are not eligible for Medicare.  The federal government will provide $5 billion to fund the program. Participating employers or insurers will be reimbursed 80 percent of retiree claims between $15,000 and $90,000.  The program will be effective through 2013.

 IN 6 MONTHS:

Effective for new plans and plans renewed six months after the law’s enactment date, unless otherwise noted (includes “grandfathered plans”):

• Lifetime and annual limits. Plans may not impose lifetime limits on the dollar value of essential benefits. Annual limits will be restricted (to be determined by HHS). Restricted annual limits do not apply to grandfathered individual plans.

• Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.

• Coverage for adult children. Children may stay on their parents’ policies until age 26 if coverage isn’t available through their work, regardless of their marital status. Any employer contribution toward the premium is a tax-deductible business expense for the employer and not taxable income for the member.

• Pre-existing conditions. Plans may no longer impose pre-existing condition exclusions for children under 19 (does not apply to grandfathered individual plans).

Effective for new plans and plans renewed six months after the law’s enactment date (does not include “grandfathered plans”):

• Preventive services. New policies must cover the full cost of preventive care as recommended by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care for women.

• Appeals. New minimum requirements for internal and external claims appeals processes.

• Patient protections. Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization or increased cost-sharing for emergency services is also prohibited.

• Nondiscrimination rules. Nondiscrimination rules that apply to self-funded health plans are expanded to group fully insured health plans. Plans cannot base an employee’s eligibility or continued eligibility on hourly or annual salary.

I N 2011:

• Medical loss ratio (MLR). An insurer must publicly report on its MLR and spend at least 85 percent of large group premiums and 80 percent of individual and small group premiums on medical services, or provide rebate payments to enrollees.

• Spending accounts. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may no longer be used to purchase over-the-counter drugs unless prescribed by a doctor.

Increases tax for nonqualified HSA withdrawals from 10 percent to 20 percent, and for Archer MSA withdrawals from 15 percent to 20 percent.

• HHS studies. HHS is required to study the group health plan markets to compare employer characteristics and determine whether the new insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure. HHS and the Department of Labor must also collect information on self-funded plans. These studies could lead to additional employer reporting requirements.

• Uniform explanation of coverage. Within 12 months of the law’s enactment, HHS, in consultation with the National Association of Insurance Commissioners, will develop uniform standards and definitions for summaries of benefits and coverage explanations. Within 24 months of enactment, group health plans must provide enrollees and applicants with coverage documents that meet these standards.

 I N 2012:

• Comparative effectiveness fee. A new fee is imposed on individual and group health

plans to fund comparative effectiveness research ($1 per participant through 2013; $2 per participant through 2019).

• Release of Medicare claims data. The private sector may purchase standardized data extracts of Medicare Parts A, B and D claims data to combine with their own claims data to evaluate provider performance measures on quality, efficiency, and the effectiveness of care.

 I N 2013:

• FSA contributions. Contributions to flexible spending accounts are limited to $2,500 a year.

 I N 2014:

The federal definition of a large employer is an employer with 101 or more employees, whereas a small employer is defined as 1-100 employees. States can modify the definition of a large employer to 51 or more employees and small employer to 1-50 employees until January 1, 2016.

• Pre-existing conditions. Individual and group health plans can no longer impose pre-existing condition exclusions for any person of any age (does not apply to grandfathered individual plans).

• Annual limits. Annual limits on essential health benefits are prohibited (does not apply to grandfathered individual plans).

• Guaranteed issue. Health insurers must accept every individual and employer who applies for coverage.

• Rating restrictions. Rating restrictions go into effect for new individual and fully insured small group plans. Insurance companies cannot base premiums on health status, claims experience or gender. Premiums can only vary by:

– Age (no more than 3:1)

– Geography

– Family size

– Tobacco use (no more than 1.5:1)

• Merged markets. States are allowed to merge the individual and small group markets.

• Clinical trials. Coverage of routine patient care costs is mandated for participation in approved clinical trials (does not apply to grandfathered plans).

 • Exchanges. State health insurance exchanges are up and running for small businesses and individuals to buy insurance. States can allow large employers to participate beginning in 2017.

• Brokers. HHS will establish procedures, which may include rate schedules for broker commissions, for a state to allow brokers to:

– Enroll individuals in any qualified health plans in the individual or small group market as soon as the plan is offered through an exchange in the state;

– Assist individuals in applying for premium tax credits and cost-sharing assistance for plans sold through an exchange.

• Essential benefits. Essential benefit plan is created, which mandates the level of benefits that must be included in plans offered in the exchange, as well as in the individual and small group markets outside the exchange. Deductibles are limited to $2,000 for individuals and

$4,000 for families in the small group market (self-funded plans and grandfathered plans are exempt from this requirement).

• Cost-sharing limits. Cost sharing imposed under health plans is limited to current health savings account amounts (does not apply to grandfathered plans).

• Waiting periods. Waiting periods cannot exceed 90 days.

• Wellness. Expands health plan wellness incentives up to 30 percent of total coverage costs (up to 50 percent with HHS approval).

• Reinsurance. A temporary reinsurance program will be established for the individual market and funded by individual and group health plan assessments ($25 billion in 2014-2016).

 I N 2016:

• Health choice compacts. States can form health choice compacts to allow insurers to sell individual policies in any state participating in the compact.

I N 2018:

• Taxes. A new excise tax goes into effect for high-value, “Cadillac” health plans: 40 percent

for amounts over $10,200 for individuals and $27,500 for family plans, paid by insurance companies and plan administrators.

 Medicare and Medicaid

• Part D donut hole. Provides a $250 rebate for Part D enrollees who enter the “donut hole.”

coverage gap (2010 only). Beginning in 2011, there will be a 50 percent brand discount on

drugs in the gap. Members will pay less for generic drugs in the gap as well: 93 percent in

2011, which phases down to 25 percent by 2020. The donut hole is eliminated by 2020.

• Retiree drug subsidy. Beginning in 2013, employers may no longer deduct the retiree

drug subsidy when offering qualified coverage under Medicare Part D.

• Medicaid. Beginning in 2014, states are required to provide premium assistance and

wrap-around benefits to any Medicaid beneficiary who is offered employer-sponsored

coverage, if it is cost-effective to do so.

• Medigap. The National Association of Insurance Commissioners will create new model plans

for benefit packages C and F that include nominal cost sharing. The new models will be available in 2015.

Other

• Administrative simplification. The law also requires HHS to adopt a single set of operating rules for electronic transactions to create uniformity (e.g., health claims or equivalent encounter information, eligibility and claims status, enrollment and disenrollment, premium payments, and referral certification and authorization). Group health plans will have to certify compliance with these standards.

• CLASS Act. Creates a new government-run voluntary long-term care insurance program (CLASS  Program). Employers must automatically enroll employees and facilitate payroll deductions. Employees may choose not to participate.

Revenue-raising provisions

• Starting July 1, 2010, imposes a 10 percent tax on tanning services.

• Beginning in 2011, the pharmaceutical industry will pay annual industry fees. The fee will be phased in and will hold steady at $2.8 billion a year after 2019.

• Beginning in 2013, manufacturers of medical devices will pay a 2.3 percent excise tax on sales of medical devices.

• Beginning in 2013, the Medicare payroll tax rate will increase by 0.9 percent for individuals who make more than $200,000 and couples that make more than $250,000.

• A new 3.8 percent tax will be added on income from interest, dividends, annuities, royalties and rents for those at the same income threshold.

• Beginning in 2014, a non-deductible premium tax will be imposed on insurers ($8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.3 billion in 2018.  After that, it will increase in an amount proportional to overall premium growth).

Doug Gulleson totally adores scuba diving and travels overseas throughout the year with his underwater camera in one hand and a cup of coffee in the other.  He knows through experience never to leave home without his travel insurance and credit card too.Visit Good Neighbor Insurance at  www.gninsurance.com/multi-trip  for your next overseas trip and get a FREE quote.

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Posted in 2010 updates |

What the new health insurance law of 2010 means to you

Wednesday, April 14th, 2010

Good Neighbor Insurance is continuing to update our clients on the new health insurance laws to you, our clients.  It may seem confusing at first but as we “walk” through these laws we will learn the “upside” and the “downside” of what it means to us.  With all the changes on the horizon, one of the most common questions asked us at Good Neighbor Insurance, www.gninsurance.com, is “what do these health care laws mean to me”?  The simplest answer is:  It all depends on how old you are and for whom you work.   These changes may seem overwhelming, but a quote from Lao Tse says it all, “the journey of a thousand miles begins with a single step.”  So listed below are several steps to help you understand the health care changes which were signed into law on March 22, 2010.

YOUNG ADULTS (26 YEARS AND UNDER)

The Upside:

  • If you are 26 years old or younger you may stay on your parents’ insurance policy until the grand age of 27. 
  • If you buy coverage on your own in the exchanges (see Definition below) you may have access to cheaper health care coverage.
  • If you buy the traditional health plans (see Definition below), you will pay less than those older than you.

 

The Downside:

  • Traditional insurance plans in the exchanges may cost more than what you may buy now.
  • You must be covered or else you will be fined / penalized.   The current fine is under $700 a year for a single person but will be going up each year.

NOTE:  As of 2009, 30 percent of Americans ages 19 -29 are now uninsured.

 

AGES 65 AND UP (MEDICARE AGE)

 The Upside:

  • You will receive free preventative services under Medicare. 
  • If you have Medicare Part D (see www.gninsurance.com/medicare.asp), you will pay less when you reach the coverage gap now known as the donut hole.

 

The Downside:

  • If you have Medicare Advantage plan (see www.gninsurance.com/Arizona/senior_health_plans.asp), your Rx company may cut your extra benefits or increase your co-pays.
  • Until 2019, Medicare beneficiaries earning $85,000 or more, will pay higher Medicare Part B premiums.

NOTE: 10 million seniors now in Medicare Advantage (one of two options in Medicare Part C) plans.

 

SMALL BUSINESS OWNERS (TYPICALLY BUSINESSES WITH 2-49 EMPLOYEES)

The Upside: 

  • Starting 2010, if you have 25 or fewer employees, you may be eligible for a tax credit to help you buy coverage for your employees.  Check with your accountant to see when and how you may receive this tax credit.
  • Starting in 2017 you will be able to purchase group insurance in two ways: (a) by going the normal group option of a group plan or (b) going onto the exchange (see Definition below) with other businesses, thereby purchasing group insurance collectively.

 

 The Downside:

  • After 2014 businesses will only be eligible for a possible two-year tax credits to help them purchase coverage.
  • Starting in 2014, for those with fewer than 50 employees the employer will be fined around 8 percent of payroll.  The fine may be a little lower for those with less than 25 employees. It currently is slated to be between 3-4 percent of his total payroll. This fine will help pay for the “exchange” plans (see Definition below) that his employees may purchase.
  • Forty nine employees is the maximum number a company may have without providing group health insurance internally. However, if an employer with less than fifty employees does not provide health care for his employees, the IRS will request a fine of 4-8 percent of his total payroll, depending on the number of employees he has.
  •  Please realize that every person must have health insurance by 2014. If they do not purchase an individual plan, or through an individual exchange plan, or through an employer group plan, or through one of the federal government plans like Medicare, Medicaid, etc, then that individual will be fined each year by the IRS.
  • If one of your employees receives financial health insurance benefits from the US government you as the business owner will be charged a $3000 tax. This tax will even be charged to the business even if your employee’s spouse receives government health insurance benefits.  This tax is triggered when your employee or spouse of your employee falls under 1.33 of the poverty chart. It can also be triggered if they receive health insurance benefits from the exchange plan(s) the State has created.  This $3000 business tax will be taken out even if the employee or spouse of the employee receives government help for 1 month out of a calendar year.

 

LARGER COMPANIES (TYPICALLY 50 OR MORE EMPLOYEES)

 The Upside:

  • In 2014, companies with 50 employees or more will be required to provide their employees with health insurance or face a fine.  The fine starts at $2,000 annually per employee for employees #31 and up.
  • Group insurance through your employer will have a limit on out-of-pocket spending, which will allow for richer plans than normal. 
  • However,  on the “Cadillac” plans (see Definition below), there will be a 40 percent tax on individual plans that cost over $10,200 annually and over $27,500 annually for a family plan.  The tax will apply only to the amount above these two annual figures. 

 

 The Downside: 

  • Premiums will increase due to federal minimum benefits.  This will apply on all plans whether purchased through a private insurance carrier, through an individual private health plan, through the exchange, or through small and large group plans.  One of the main reasons for premium increases is because all pre-existing conditions will be covered on all government and private health care plans starting for children.  These increases will start on September 23, 2010 for children and January 1, 2014 for adults.
  • If you do not qualify for subsidies or entrance into an exchange, you may be stuck with your employer’s group plan.

 NOTE:  Presently, companies with 200 or more employees, 98 percent  now offer health benefits.

 

LOW INCOME EARNERS

The Upside:

  • If you are among the lowest wage earners, even if you do not have children or a disability, you will become eligible for Medicaid.
  • If you earn less than 400% of the poverty level, about $88,000 in 2009 for a family of 4, you may be eligible for some subsidies to help you buy coverage.  Please realize that some of these federal subsidies are taxable as income if you receive them.

 

The Downside:

  • Buying insurance may strain your budget even if you do get subsidies. However, you will have to purchase and maintain coverage unless you qualify for a hardship waiver.

NOTE: By 2014, 16 million low-income Americans will be added to Medicaid.

 

PEOPLE WITH A PRE-EXISTING CONDITION 

 The Upside:

  • Starting in 2014, you will be able to purchase insurance from any company who sells in your area, and you will pay the same as everyone else in your age group.  The company will not be able to place annual or lifetime limits on your coverage, and regulations will limit your out-of-pocket spending.

NOTE:  In 2007, 36 percent of Americans were turned down or charged higher premiums because of their pre-existing conditions. 

Traditional health plans:  Plans that are provided by private health insurance companies such as Blue Cross, Health Net (www.gnazhealth.com), United Health Care, Humana, Aetna, etc.  These plans are your typical HMOs, PPOs, HSAs, and no co-pay plans.

Exchanges:  An organized marketplace for the purchase of health insurance set up as a governmental (usually State government) or quasi-governmental entity to help individuals and business purchase the most cost-effective plans in that State.  The US federal government has mandated each State to have at least two exchange plans available for individuals and businesses.   The exchanges will bring together private health insurance companies through government minimum requirements to compete for business among individuals and businesses.  Exchanges are another option for health insurance and will be predominately run by private health care companies with State and Federal government overseeing the process.

Cadillac plans:   These are also called “gold-plated” insurance plans.  They are usually defined by the total cost (what you pay for a non-group plan or what the employee and employer pay collectively for a group plan) rather than what the insurance covers.  Starting in 2014, there will be a 40 percent tax for individuals whose insurance plan costs over $10,200 annually and for a family whose plan cost over $27,500 annually. Monies over those two annual amounts will be taxed.  For example, if your family plan costs $30,000 annually (what you and your emp0loyer pay together for the year), than you will be taxed 40 percent on $2,500 (the difference of what your total cost minus the $27,500).

Doug Gulleson loves to scuba dive overseas and he makes sure he always takes his Amex card AND international travel insurance.  Visit Good Neighbor Insurance at  www.gnazhealth.com  Arizona and US coverage or if you are going overseas grab one of our travel plans at www.gninsurance.com/tripcancellation/ .

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Posted in 2010 updates |

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