LegalShield helps mitigate issues for Employers


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LegalShield helps mitigate issues for Employers


What Individuals with ACA Health plans Need To Know:

Now that you have enrolled in an ACA Compliant Health plan
Your Responsibility is not over:
Please make sure that you follow the below steps “regularly” to insure you are not terminated:
        1.  Check your accounts online frequently to insure the carriers have not made mistakes on your account, and that all payments are being applied before the due date.  [We have found that many Individual/Family plan (IFP) members are either being terminated for non payment, even though they state their payments were sent on time; or are receiving delinquency letters past the 30 day grace period allowed by the ACA.]
        2.  We “Highly Recommend” that you enroll in Auto Pay.  Below are the links to various carrier sites.  [You will need to check your online accounts regularly to make sure payments are being drawn monthly and on time, to avoid delinquency letters or worse Termination.]
  • Click on the name of your carrier to get information about setting up an auto pay:
Kaiser Permanente
Blue Shield of CA Health Net

        3.  Due to new ACA regulations it is extremely difficult to re-instate accounts and you will open yourself up to potential penalties under the ACA. [Remember Grace Periods are only 30 days for IFP accounts that are direct with the carrier, and 90 days for accounts enrolled via Covered Ca. The Grace Period is accumulative and starts from the day you did not  make a payment].
        4.  Please Do NOT wait until the last minute to pay on your accounts. Carriers are showing little to no compassion for late or missed payments.  *Check with your Carrier to confirm the due date of your bill.
We Highly Suggest:
  1. Paying your bill several days prior to the due date listed on your bill.
  2. Calling your carrier to confirm and memorize your billing due date.
  3. Try and send your payment in at least 10 days prior to the due date, to insure it is processed and applied to your account in time.
  4.   If possible,  have 1 months pre-payment paid on your account, incase a payment is not received in time.  
  5. Never let your account go beyond the 30 day grace period.
  6. Don’t Wait to receive a delinquency letter. Grace period letters seldom arrive in time to make your payment,within the 30 grace period allowed under the ACA.
       5.  If you are enrolled in a Covered CA account, Please Do NOT Forget:
    • Submit your income & tax information on time, before the April 15th deadline.  [You must contact  1-800-300-1506 to Fax or upload your taxes to your personal portal.  Covered CA will assist you with setting up your online account and give you the access code you need to do so.  Once logged in they will walk you through the upload process.]
    • Remember: ANY CHANGE IN INCOME (of + or – 10%) MUST BE REPORTED online via the Covered CA site.
        6.  Most of you will receive Obamacare-related tax forms [1095A’s] this year, if you haven’t already. Unfortunately, some Medi-Cal and Covered California enrollees are discovering errors on their forms – but corrections won’t come quickly.  The below link explains who will receive the forms, called 1095A’s, and what to do if they contain inaccuracies. To read the update, please click here.

NAHU Press Statement on Graham-Cassidy Proposal 

NAHU Press Statement on Graham-Cassidy Proposal 

NAHU has met with bipartisan leadership in the House and Senate, as well as other industry stakeholders, to promote bipartisan measures for market stability. Unfortunately, we do not believe the current Graham-Cassidy proposal serves to stabilize the individual health insurance market and we have significant concerns that the lack of adequate guardrails for states applying for waivers could create instability in the employer-sponsored health plan market.

The proposal would dramatically restructure the ACA from the federal government to the states. While some level of returning decisions to the states is desirable, the scope of restructuring allowable under this proposed legislation is likely to have untended consequences, including a larger number of uninsured individuals, without actually taking the steps needed to stabilize the individual health insurance market.

The proposal would redirect ACA funds back to the states as block grants, allowing states broad authority to determine how to apply these funds. Theoretically, states could take actions that would eliminate important consumer protections rather than just those that impose unnecessary costs in the system, but could also go entirely in the opposite direction and go far beyond ACA requirements, such as adopting single-payer or a public option for one or more markets in the state.

We also have serious concerns with the retention of the Cadillac/excise tax and the Health Insurance Tax (HIT), which, once they are retained in this proposal and redirected to the states in block grants, will effectively make them permanent as states will grow dependent on these funds for implementing their health reforms. The Cadillac tax will impose a 40% excise tax on health plans that exceed certain cost thresholds beginning in 2020, while the HIT is currently under a one-year moratorium and is set to take effect again next year, adding an additional $500 to average premiums per affected family every year.

States would also have greater authority under the proposal to implement changes through the ACA’s state waivers. While NAHU seeks greater flexibility for states to innovate on health reform, we do not believe that the flexibility proposed under Graham-Cassidy is appropriate. The expansion of state waivers without any of the guardrails in effect under the ACA’s current 1332 waiver program could undermine employer-based coverage governed by ERISA, which is one of the indispensable pillars of the employment-based system. We have strong concerns about the potential effect on multi-state employer plans. While some loosening of 1332 waiver restrictions is desirable, some minimum standards are needed to ensure that outcomes are positive rather than detrimental to markets that are not currently at risk.

Finally, the proposal would lead to a chaotic patchwork of 51 different versions of health reform, one for each state plus the District of Columbia. While some state flexibility beyond what is currently allowable is needed, establishing 51 completely different versions of healthcare systems would not only eliminate provisions that protect consumers but would also cause an enormous compliance burden for employers attempting to navigate the various health systems and their corresponding regulations and requirements.

Ensuring private health insurance market stability and competition, as well as improving health coverage affordability, are among NAHU’s top goals. As such, we are unable to support the Graham-Cassidy-Heller-Johnson proposal as it lacks what we believe are the key tenets of market stabilization. We look forward to working with Congress and the administration on bipartisan efforts to improve our healthcare-coverage system and ensure access to high-quality affordable healthcare.

Who is NAHU.Org:   The National Association of Health Underwriters represents more than 100,000 licensed health insurance agents, brokers, general agents, consultants and benefit professionals through more than 200 chapters across America. 

NAHU’s Washington Update

NAHU’s Washington Update is on hiatus this week. In lieu of our usual collection of articles and podcast, we are summarizing the most recent regulatory action affecting our industry.


On Wednesday, February 15, the Trump Administration released its first significant health policy action, a proposed rule intended to stabilize the individual and small group private health insurance markets for 2018. The 71-page proposal released by the Centers for Medicare and Medicaid Services (CMS) includes the following significant components:

  • A proposed change to the planned individual market open enrollment period for 2018. Currently, the individual market open enrollment period is slated to be the same as this year, November 1, 2017-January 31, 2018. The rule proposes to change the 2018 period to November 1-December 15, 2017, which would not only reduce the enrollment time by half, but also make the period overlap significantly with the Medicare annual enrollment period as well as with open enrollment time for the many employer-sponsored plans that operate on a calendar-year renewal cycle.
  • Proposed changes to actuarial value (AV) calculations, which should impact plans available in both the individual and small group markets nationally in 2018. Generally, the proposed rule would expand the variation allowed of the AV of metal level (bronze, silver, gold and platinum) plans of -4/+2 percentage points, rather than +/- 2 percentage points. This proposed change would impact all non-grandfathered individual and small group market consumers whose purchasing options are composed of metal level plans. Under the proposed standard, for example, a gold plan could have an AV between 76 and 82%, which would expand the range of cost-sharing options available. The proposed rule would not change the de minimis range for the silver plan variations (the plans with an AV of 73, 87 and 94%) available on the federal exchange at this time. The de minimis variation for a silver plan variation of a single percentage point would still apply. Also, bronze plans already had an expanded allowable variation, so the change for expanded bronze plans would be from +5/-2 percentage points to +5/-4 percentage points.
  • A proposed requirement that all new consumers who seek to enroll in exchange coverage during a special enrollment period (SEP) via complete expanded pre-enrollment verification (currently only 50% were slated to be subject to expanded verification). This expanded eligibility verification would begin on July 1, 2017. Consumers with SEPs would be able to submit their applications and select a plan and coverage start date, but the consumers’ enrollment would be “pended” and their information would be held by and not released to the issuer until SEP eligibility was confirmed. Consumers would have 30 days to provide documentation, and they would be able to upload documents into their account on or send their documents in the mail. The proposed rule urges state-based exchanges to take similar action and requests comment as to whether they should be compelled to do so.
  • A planned tightening of SEP eligibility requirements relative to people who have a previous history of nonpayment of premiums, documentation of a move, and gaining a SEP for a marriage. In addition, CMS indicates it will impose a more rigorous test for future uses of the exceptional circumstances SEPs, including requiring supporting documentation where practicable, and will also include a review of the current list of exceptional circumstances.
  • The proposal would ban metal plan changes during the coverage year for individual market consumers generally and limit special enrollment coverage options available via to prevent adverse selection. The rule asks for comments as to whether state-based exchanges should have to act similarly.
  • If an individual was behind on premium payments and then reenrolled in coverage, the proposed rule would allow issuers to apply a premium payment to an individual’s past debt owed for coverage from the same issuer enrolled within the prior 12 months.
  • To make it easier for issuers to build networks, CMS proposes a write-in process to identify essential community providers (ECPs) who are not on the Department of Health and Human Services list of available ECPs for the 2018 plan year and lower the ECP standard to 20% (rather than 30%).
  • New deference to state reviews for network adequacy in states in which a federally facilitated exchange is operating, provided the state can demonstrate their authority is at least equal to the “reasonable access standard” outlined in the law and that they have means to assess issuer network adequacy, regardless of whether the exchange is a state-based or federal exchange.
  • Finally, the proposal contains a commitment to soon issue a revised timeline for health insurance issuers to decide if they would like to participate as qualified health plans in the individual and SHOP exchange marketplaces for plan year 2018. The revised timeline is intended to provide issuers with additional time to implement the market reform changes proposed in this rule and give them a greater incentive to compete in the individual and small group marketplaces.

Comments are due on this proposed rule by March 7, 2017. NAHU is currently evaluating the provisions of the proposal and how they may impact our members, their clients and the stability of the individual and small group markets. CMS has also asked for additional market stabilization ideas to be submitted, so NAHU will provide them with a detailed letter on behalf of the membership about both the potential of the proposed rule and our additional ideas to improve the private individual and group marketplaces.


National Association of Health Underwriters       1212 New York Ave NW, Ste 1100, Washington, DC 20005

Ph. 202.552.5060       Fax 202.747.6820

Views 9 questions for the Trumpcare architects

Views 9 questions for the Trumpcare architects
By  Perry Braun


“Addressing affordability
As a new plan is presented for debate and discussion by the Trump administration — with the goal of building an affordable plan — here are my questions:

  1. With respect to healthcare costs, there are two key drivers. One is consumption, which is defined as the number of medical services and prescription drug services are consumed. The second is the price for each service. The equation is units times price equals cost. How is any new plan going to manage the units consumed — short of rationing or establishing a que system to receive services as a strategy?
  2. Price per unit is a function of costs borne by the provider of a service or the producer of product. Short of price controls as a strategy, what is the detail in the plan to control costs?
  3. As to affordability: What tax credits/deductions or subsidies exist in the future to fund the goal of insurance for everyone? What will be the insurance market reforms (specifically those that address premium rate setting and benefit mandates, which are linked to one another) in the local markets? What will be the insurance carrier reforms (selling across state lines, for example) and the state regulator involvement in the future? How will this affect the networks that consumers/patients can access? What prohibitions will exist, if any, as it relates to health savings accounts?
  4. Employer and employee stakeholder groups: What mandates, regulations, penalties and reporting requirements are they to own and meet?
  5. Individuals participating in the individual marketplace: What financial relief will be provided to purchase a product and to access their benefits? Will they be able to tailor their benefits to fit their needs or are they subject to mandated benefits?
  6. Hospitals and physicians: From the financial standpoint, what impact, if any, will this have on their uncompensated care costs, costs that work their way back into the insurance payment system? How is the ‘patients first’ concept translated in improvements into cost and quality?
  7. State insurance regulators: What level of authority will they have over the insurance reform provisions in their state?
  8. Technology companies (payroll, benefit administration) have made tremendous investments to conform to the rules and requirements. What happens next?
  9. For advisers: How do they adjust to the new world and what is the impact to their business models?

With the new administration committing to repeal and replace Obamacare, we are all left to wait and see the details of the plan — and adjust accordingly.”

Read Full Article Here:

Memorandum: Interim Guidance Implementing Section 2 of the Executive Order of January 30, 2017, Titled “Reducing Regulation and Controlling Regulatory Costs”

Shared from:  Business Insider
By: Rebecca Harrington

Executive Order, January 20: Declaring Trump’s intention to repeal the Affordable Care Act

One of Trump’s top campaign promises was to repeal and replace the Affordable Care Act, commonly called Obamacare.

His first official act in office was declaring his intention to do so. Congressional Republicans have been working to do just that since their term started January 3, though there’s dissent among Republicans over whether or not to complete the repeal process before a replacement plan is finalized and strident Democratic resistance to any repeal of the ACA.

Read the full text here »

Trump Administration Submits Plan to Stabilize Marketplaces, Issues “Two-for-One” Executive Order


Trump Administration Submits Plan to Stabilize Marketplaces,
Issues “Two-for-One” Executive Order

On Wednesday, the Trump Administration submitted a proposed rule to the Office of Management and Budget designed to help stabilize the ACA marketplaces. Details on the rule are not currently available as it has not yet been published, but it is expected to address a number of immediate fixes to stabilize the marketplaces in the coming year. The administration is also in the process of releasing an executive order directing the Department of Labor to review the fiduciary rule, which currently imposes significant requirements on health savings accounts. NAHU will continue to monitor these regulatory items and will update members as details become available. The proposed rule on stabilizing the marketplace is the first regulation directed at the department of Health and Human Services since President Trump took office two weeks ago.

NAHU has called on the Trump Administration, and previously the Obama Administration, to implement several changes that would improve stability in the individual marketplaces. We have suggested that the administration could restrict the use of special enrollment periods (SEPs) to reduce their abuse and also implement more stringent documentation requirements. Similarly, we have called on reducing the current 90-day grace period for individuals with premium tax credits down to 30 days for non-payment. We also suggest allowing “grandmothered” policies to continue beyond their 2017 expiration date and removing limitations on “grandfathered” policies. And we have called on the administration to simplify the employer reporting requirements. NAHU CEO Janet Trautwein’s testimony before the Senate Health, Education, Labor and Pensions Committee included many of these suggestions.

The proposed rule follows an executive order (EO) issued by President Trump on Monday, which requires that for every new regulation that is issued, two previous regulations must be eliminated. Based on interim guidance released today and a previous executive order from 1993 that is still in effect, the rule will apply to any “significant” regulation that imposes an annual economic cost of $100 million or more. Agencies issuing regulations starting on September 30 will need to identify two existing regulations to eliminate prior to the new regulation being issued, as well as fully offset total incremental cost of the new regulation. Regulations addressing health, safety or financial emergencies may request a waiver from this requirement. This EO order fulfills a campaign pledge that was part of President Trump’s 100-day plan, and follows a listening session last Monday with a dozen business executives from several large companies where he promised to cut regulations by 75%. President Trump has issued seven executive orders and 11 presidential memorandums since taking office on January 20.

NAHU is continuing to work with the Trump Administration and congressional leadership to determine the best approach and timing for change in our healthcare system. We will continue to update you as any other regulatory changes, EOs or legislation are released. In the meantime, all statutes and regulations enacted by the ACA continue to be in place and NAHU members should continue to work with their clients to be in compliance with the law. Additionally, if you have suggestions regarding our work with the Trump Administration and members of Congress on the future plans to reform the ACA that you would like to share with NAHU, you can send your thoughts and ideas to


Get Ready for Hillarycare, Part II

ACA Dr. update

With Obamacare teetering, liberals eye opportunity for full government takeover of health care

Health insurance companies are bailing and co-ops are failing as Obamacare barrels down the road to collapse.

Health policy experts predict the Affordable Care Act will continue to muddle along for the next few years at least. But when the breaking point comes, experts warn the debate will center on whether to move toward a free market system or double down on government takeover of healthcare.  Read More Here:  Get Ready for Hillarycare, Part II

by Brendan Kirby | Updated 16 Aug 2016 at 2:09 PM