HHS offers another Obamacare extension to avoid ‘canceled’ health plans

ImageThe Obama administration will   allow some health plans that fall short of Obamacare coverage requirements to   continue past the November elections and through most of President Barack   Obama’s second term.

 The decision, announced   Wednesday by federal health officials, extends for two years an earlier   decision by the White House to let people keep their existing health plans   through 2014, even if those plans fell short of Affordable Care Act   requirements. Under the new policy, some people could renew plans in 2016,   meaning they’d be covered into 2017.

Without the change, Democrats   worried that another wave of canceled health policies would hit just weeks   before the November 2014 midterm elections, setting off more recriminations   over Obama’s earlier pledge that people can keep their plans if they like   them. 

The new policy could have a   limited practical impact. The extension is optional for both states and the   health plans themselves. To date, only about half the states have allowed the   older, often skimpier, plans to continue. And some insurers want to scrap   them to maximize enrollment in the new health insurance exchanges. And   officials predict more Americans will migrate to the new plans, particularly   if they qualify for subsidies.

One official said the number of   people in plans that have been extended is “falling quite rapidly.”

Republicans quickly lambasted   the move as blatant 2014 politics and another sign that the administration   just can’t get the law to work.

“The Obama   administration’s announcement today that it will continue to allow insurers   to sell health care plans that don’t meet Obamacare minimum coverage   requirements is not only another reminder of the president’s broken promise   that you can keep your plan if you like it but represents a desperate move to   protect vulnerable Democrats in national elections later this year,”   Senate Minority Leader Mitch McConnell said in a statement.

The Obama administration said   the move, revealed in a conference call with senior administration officials,   isn’t politics. “The goal is to implement the Affordable Care Act in a   common-sense way and to try to provide a smooth transition for consumers and   employers,” an official said on the call.

Documents accompanying the   announcement reveal that the changes were crafted “in close   consultation” with a large contingent of vulnerable Democrats, including   Sens. Mark Warner, Mary Landrieu, Jeanne Shaheen and Mark Udall as well as   Reps. Tim Bishop, Elizabeth Esty, Carol Shea-Porter, Gary Peters, Scott   Peters, Ann McLane Kuster, Kyrsten Sinema, Ann Kirkpatrick and Ron Barber.

The changes, part of new   regulations and guidance issued by the Department of Health and Human   Services, will give some consumers an extra two years to remain on health   plans that would otherwise be canceled for failing to meet Obamacare’s   minimum coverage requirements. Many of those plans had already been given a   one-year reprieve in November 2013, but now they could be sold through 2016.   It also extends the offer to people in small group health insurance plans,   where small businesses could also have faced plan cancellations in the coming   year.

The insurance industry has   worried that the move to “un-cancel” plans could make it harder for   the new markets to succeed, and some strong backers of the law also worry.   Sen. Tom Harkin (D-Iowa), for instance, said in an interview that he’d rather   see people in the newer policies with stronger coverage.

“We’ve been through this   before. They made that decision – fine,” Harkin said. “A lot of   people say they have policies that they don’t pay very much for but I put it   this way: they’re great policies as long as you don’t get sick.”

A new rule also requires that   an Obamacare program intended to protect insurers from unexpected costs is   fully funded by the insurance industry, rather than by taxpayers. Republicans   have said that taxpayers could be on the hook for an insurance industry   “bailout” through these provisions.

The rule also outlines the   administration’s plan to implement SHOP exchanges for small businesses. The   federal one had been delayed a year. The Treasury Department also said it was   streamlining some of the paperwork for employers. 

Source: Kyle Cheney, Politico   Pro

House panel OKs easing health reform law’s definition of full-time worker


A panel of the House of Representatives approved legislation Tuesday to ease the health care reform law’s definition of a full-time employee, shielding more employers from a stiff financial penalty imposed by the law.

Under the Patient Protection and Affordable Care Act, employers are required, effective in 2015, to offer qualified coverage to full-time employees – defined as those working an average of 30 hours per week – or be liable for an annual $2,000 penalty per employee.

The legislation, H.R. 2575, introduced by Rep. Todd Young, R-Ind., and approved by the Ways and Means Committee on a 23-14 vote, would change the definition of full-time employees to those working an average of 40 hours per week.

“This legislation restores a common understanding in America, spanning over half a century, of what constitutes full-time work. In other words, it restores a basic American value,” Rep. Dave Camp, R-Mich., the committee’s chairman, said in a statement prior to the panel vote.

In addition, even before the provision’s 2015 effective date, employers are cutting back employees’ hours below the 30-hour penalty trigger, Rep. Camp said.

But ranking member Rep. Sander Levin, D-Mich., said the bill would be a “tremendous step backwards for millions of hard-working Americans.”

The health care reform law’s “use of a 30-hour standard to define full-time was set to minimize gamesmanship and incentives that might tempt some employers to reduce hours in order to avoid their responsibility to offer affordable coverage,” Rep. Levin said in a statement.

The measure now goes to the full House. A similar bill, S. 1188, introduced last year in the Senate by Sen. Susan Collins, R-Maine, has been referred to but not acted on by the Finance Committee.

Source: Business Insurance Magazine, February 4, 2014

The Importance of Getting a Broker for Health Care Coverage

The Importance of Getting a Broker for Health Care Coverage.

Our Tuesday “Chuckler” : “The Affordable Boat Act” …. Enjoy!

The Affordable Boat Act

The U.S. government has just passed a new law called: “The affordable boat act” declaring that every citizen MUST purchase a new boat, by April 2014. These “affordable” boats will cost an average of $54,000 to $155,000 each. This naturally does not include taxes, trailers, towing fees, licensing and registration fees, fuel, docking and storage fees, maintenance or repair costs.

Buying the ObamaBoatThis law has been passed, because until now, typically only wealthy and financially responsible people have been able to purchase boats. This new law ensures that every American can now have an “affordable” boat of their own, because everyone is “entitled” to a new boat. If you purchase your boat before the end of the year, you will receive 4 “free” life jackets, not including monthly usage fees.

In order to make sure everyone purchases an affordable boat, the costs of owning a boat will increase on average of 250 to 400% per year. This way, wealthy people will pay more for something that other people don’t want or can’t afford to maintain. But to be fair, people who can’t afford to maintain their boat will be regularly fined and children (under the age of 26) can use their parents’ boats to party on until they turn 27, then must purchase their own boat.

If you already have a boat, you can keep yours (just kidding; no you can’t). If you don’t want or don’t need a boat, you are required to buy one anyhow. If you refuse to buy one or can’t afford one, you will be regularly fined $800 until you purchase one or face imprisonment.

Failure to use the boat will also result in fines. People living in the desert, ghettos, inner cities or areas with no access to lakes are not exempt. Age, motion sickness, experience, knowledge nor lack of desire are acceptable excuses for not using your boat.

A government review board (that doesn’t know the difference between the port, starboard or stern of a boat) will decide EVERYTHING, including; when, where, how often, and for what purposes you can use your boat along with how many people can ride your boat and determine if one is too old or healthy enough to be able to use their boat. They will also decide if your boat has outlived its usefulness or if you must purchase specific accessories (like a $500 compass) or a newer and more expensive boat. Those that can afford yachts will be required to do so … it’s only fair. The government will also decide the name for each boat. Failure to comply with these rules will result in fines and possible imprisonment.

Government officials are exempt from this new law. If they want a boat, they and their families can obtain boats free, at the expense of taxpayers. Unions, bankers and mega companies with large political affiliations ($$$) are also exempt.

Are you aware that there are Whistle Blower Protections under the ACA?

Filing Whistleblower Complaints under the Affordable Care Act

ImageEmployees are protected from retaliation for reporting alleged violations of Title I of the Affordable Care Act. Employees are also protected from retaliation for receiving a federal health insurance income tax credit or a cost sharing reduction when enrolling in a qualified health plan.

Summary Affordable Care Act (ACA) contains various provisions to make health insurance more affordable and accountable to consumers. To further these goals, the Affordable Care Act’s section 1558 provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a health insurance tax credit or cost sharing reductions as a result of participating in a Health Insurance Exchange, or Marketplace.

Title I includes a range of insurance company accountability requirements, such as the prohibition of lifetime limits on coverage or exclusions due to pre-existing conditions. Title I also includes requirements for certain employers.   Many of the provisions in Title I are not effective until 2014. Click Here for further informationImage

This request is urgent and requires your immediate action.

This request is urgent and requires your immediate action.

ImageProposed draft regulations for Covered California SHOP Exchange includes language that will codify a 0, 30 or 60 day waiting period into state regulations. It is our position that it is allowed within the intent and the language of AB 1083 and ABX1 2 to allow for the Exchange to adopt language that would match ACA’s 90 day waiting period.


Please make the time right now to send this email to the SHOP and ask that the waiting period rule be amended to be consistent with the waiting period language in the Affordable Care Act.

Please don’t wait. Please act now!

Click the link below to log in and send your message:

Out-of-Pocket Limits Delayed to 2015

ImageOut-of-Pocket Limits Delayed to 2015

AUGUST 13, 2013 – 12:34 PM

Author:  Michael Gomes,  Executive Vice President, BenefitMall

On August 13, the New York Times reported that the Obama Administration has delayed the out-of-pocket cost limits that protect individuals and families to 2015. This delay allows health plans one more year to offer plans with more lenient out-of-pocket cost restrictions. These limits represent one of the most publicized “insurance market reforms” contained in the Patient Protection and Affordable Care Act (PPACA) and this delay follows a string of recent announcements by the administration postponing portions of its signature health insurance reform law.

Delay Announced in February

The delay of out-of pocket limits for many health plans was explained in a February 2013 FAQ issued by the U.S. Department of Labor (DOL) but did not receive attention until recently, when DOL officials confirmed the delay.  Since the passage of PPACA, DOL, as well as the Internal Revenue Service (IRS) and the U.S. Department of Health and Human Services (HHS) have often issued far-reaching decisions in FAQ’s. DOL alone has published 15 separate FAQ sections since PPACA’s passage answering a total of 137 questions.

Details of the Delay

PPACA restricts out-of-pocket cost limits, including deductibles and copays, at $6,350 for individuals and $12,700 for families. The one-year delay to 2015 allows some health plans to “set higher limits, or no limit at all on some costs.”  Health plans can require enrollees to pay $6,350 for services like doctor and hospital services and another $6,350 for prescription drugs. The New York Times article notes that the delay on these limits was justified because employers and health plans use different companies to administer coverage. These companies often have “separate computer systems” for medical coverage and drug coverage “that cannot communicate with each other.” The delay gives these companies more time to upgrade their computer systems to accommodate the new federal requirements.

The following is the DOL FAQ that led to the delay:

Where a group health plan or group health insurance issuer utilizes more than one service provider to administer benefits that are subject to the annual limitation on out-of-pocket maximums under section 2707(a) or 2707(b), the Departments will consider the annual limitation on out-of-pocket maximums to be satisfied if both of the following conditions are satisfied:

a. The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and

b. To the extent the plan or any health insurance coverage includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies with respect to prescription drug coverage), such out-of-pocket maximum does not exceed the dollar amounts set forth in section 1302(c)(1).

This statement essentially means that a consumer may have to pay the maximum out-of-pocket costs for “major medical care” and then pay the same maximum costs for prescription drug coverage.

Impact of the Delay

One immediate impact of the delay is the extra costs it will impose on Americans with chronic illnesses, disabilities, or unexpected health conditions. Prescription drugs and medical treatments for conditions like cancer, diabetes and multiple sclerosis can cost tens of thousands of dollars a year or more. The limit on out-of-pocket costs was supposed to prevent individuals from having to bear large portions of these costs. This delay will, at least through 2014, compel many Americans to continue paying for these treatments.

Despite the close attention being paid to implementation of PPACA, it is impossible to grasp every aspect of the law’s enforcement. As a result, this provision has gone almost unnoticed for the past six months. With the hundreds of FAQ’s, dozens of regulations and all other relevant information regarding PPACA’s implementation, questions remain regarding what other provisions of this law have escaped the notice of the health care industry and the public at large.

We will continue to monitor this issue and keep you informed of any new developments. In the meantime, please visit www.BeWellInsurance.com to view past blogs and Legislative Alerts. Or, you may visit www.HealthcareExchange.com for more blog posts, polls, surveys and numerous resources.The views expressed in this post do not necessarily reflect the official policy, position, or opinions of Be Well Insurance Solutions. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.

To view the February 2013 FAQ, click here.

To view the DOL that led to the delay, click here.

For the New York Times report, click here.