IRS limits PPACA group tax credit relief
Originally posted December 18, 2013 by Allison Bell on https://www.benefitspro.com
A few U.S. counties might have a slightly easier time using the federal health insurance tax credit next year.
The Internal Revenue Service has temporarily eased the qualification rules for the tax credit – but only for employers in five counties in Wisconsin and 37 of the 39 counties in Washington state.
The IRS will let small employers in those counties use the tax credit in 2014 without offering a health plan from a public health insurance exchange, according to IRS Notice 2014-6.
Carriers in the affected counties won’t be offering any small-group exchange plans in 2014, officials say.
Section 1421 of the Patient Protection and Affordable Care Act created the tax credit by adding Section 45R to the Internal Revenue Code.
Before 2014, any small employer with modestly paid employees could use the tax credit.
Once the Small Business Health Options Program exchange plans open, employers are supposed to use the credit to pay for SHOP exchange plan coverage.
What’s ahead in 2014 for PPACA
Originally posted December 18, 2013 by Nathan Solheim on https://www.benefitspro.com
Let’s be honest. In the history of American health care, the year 2013 won’t exactly go down as a time that went as smoothly as one of President Barack Obama’s campaign speeches.
At mid-year, most observers could see some of the downsides: rising premiums and dropped policies. Deadlines had to be pushed back, and some parts of the law demanded rewrite.
And by October — when the exchanges rolled out — there were (are) glitches with state websites and www.healthcare.gov, which prompted calls for Silicon Valley to rescue the $600 million mess. Tea Party Republicans partially closed the government in an attempt at political blackmail, while Democrats quickly distanced themselves from the program’s failures. It was difficult for any good news about PPACA — such as reduced premiums for some consumers and the ability for people with pre-existing conditions to buy coverage again — to cut through the media morass.
But even though PPACA implementation has been bumpy, it will continue — and 2014 will prove to be a pivotal year. Much of the law’s major provisions take effect next year, and yes, there are likely to be more delays or problems. Brokers can count on clients, employees and HR managers turning to them for advice on coming into compliance with the law and helping make decisions in the uncertain business environment ahead.
“In some respects, someone who’s new to insurance and is learning the new scheme — they’ll have an advantage because the stuff we used to know doesn’t apply anymore. It’s all new,” says Pamela Mitroff, director of state affairs for the National Association of Health Underwriters. “I answer the bulk of compliance questions from our members. I get 20–30 a day, and they’re not just one simple question. Many of them will have a page of questions.”
Here’s a look at what’s ahead in 2014 for PPACA:
The individual mandate
Beginning Jan. 1, 2014, Americans must buy health insurance from a private insurance provider or through a public program. While the glitch-marred exchange website debuted in October 2013, individuals must have insurance by Jan. 1 in order to comply with the new regulation. The penalty for failing to do so is either $95 or 1 percent of a person’s income — whichever is higher.
Market reforms
PPACA includes a bevy of market reforms — the most notable being that carriers will have to cover people with pre-existing conditions. Others include prohibiting lifetime limits, defining small employer groups as between 1–100 employees (some states can define as 50 employees until 2016), and limiting annual deductibles to $2,000. Brokers and agents point to PPACA’s edict on modified community ratings as a major factor in potential increases in the cost of plans. PPACA mandates a 3:1 community rating, while some states are as high as 8:1. Carriers also will not be able to charge more for women.
“You’ll see younger people with plans that go up in price, and the older folks, in all likelihood, stay where they were,” says Zach Zinser of Zinser Benefit Service in Louisville, Ky. “They’re going to raise the bottom up.”
Tax credits begin
Because of the individual mandate, Obamacare also includes tax subsidies for individuals to help them afford the cost of health insurance. However, the tax credits are dependent on annual income and access to private plans. Brokers have answered a lot of questions from employees about whether they qualify for a tax credit and will continue to do so.
“The No. 1 question I get is, ‘Am I eligible for a subsidy?’” says Trish Freeman of Trish Freeman Insurance Service in Gonzalez, La.
“When people hear Affordable Care Act or they hear comments from [The Department of] Health and Human Services or the president, they’re expecting something affordable,” says Darlene Tucker, owner of Darlene Tucker Insurance and Financial Planning in Scotts Hill, Tenn. “And they may or may not find it affordable. We’re going to see a lot of people where the premium is not affordable. And I think we’ll still see people who can’t afford the premium who aren’t eligible for the subsidy.”
New tax No. 1
To help pay for it, architects of the law built in several new taxes and fees on carriers. Perhaps the most expansive is called the Health Insurance Tax, which is expected to generate $8 billion in 2014 and more than $100 billion over 10 years, according to America’s Health Insurance Plans. Several groups — and unions that have negotiated top-shelf plans for their members — have started lobbying to repeal the tax.
New tax No. 2
Another tax comes in the form of the “transitional reinsurance fee.” A fee of $63 for each life covered on a health insurance plan will be collected yearly from carriers. The fee will be first be collected in 2014, and it will continue being collected through 2016. The fee is supposed to offset the extra cost of covering people with pre-existing conditions.
Brokers and agents credit these two new taxes and others as contributors to premium increases across the country.
“Those are all taxes that will be built into the price now,” Zinser says.
Medicaid expands
Medicaid — the state-federal program that provides health coverage for the poor — will expand to cover individuals whose incomes are 133 percent of the federal poverty level. Some states have opted not to take part in the Medicaid expansion.
Health care co-ops
Co-ops will be allowed to compete for consumers on the exchanges. An Oct. 22 story in theWashington Post, however, reported some co-ops are in trouble and might not have enough funding to adequately begin operations. In some states, though, co-ops have launched.
“Unfortunately, when everyone in Michigan had to submit their rates, it was a guessing game, and [the co-op’s] rates are higher,” says Denise Van Putten, an account executive with the Grand Rapids, Mich.-based Lighthouse Group. “I think a co-op is a good idea if we can get the rates to be competitive.”
Freeman pointed out the relative youth of the co-ops — many of which were created during the time since Obamacare’s passage — could affect consumers’ perception about their quality and affordability.
“In Baton Rouge, there are two companies on the exchange — we have Blue Cross and the Louisiana co-op,” Freeman says. “People are a little leery about companies they don’t know anything about.”
Minimum standards
All health insurance policies must adhere to standards set forth under PPACA. People who’ve lost policies in 2013 and those who will continue to lose coverage in 2014 will do so because their existing plans don’t meet 10 minimum standards mandated under PPACA.
Those standards include:
- ambulatory patient services
- emergency services
- hospitalization
- maternity and newborn care
- mental health and substance use disorder services, including behavioral health treatment
- prescription drugs
- rehabilitative and habilitative services and devices
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric services, including oral and vision care
Waiting periods defined
Also starting Jan. 1, the waiting period for people to sign up for health insurance will be set by PPACA. Waiting periods of more than 90 days will be prohibited for all health plans. Brokers and agents say this provision mainly affects businesses and industries that experience high turnover.
Wellness worth more
PPACA also allows employer-sponsored wellness programs to increase the value of incentives. After Jan. 1, employers can increase the value of incentives to 30 percent of premiums. For reducing tobacco use, employers can increase the maximum reward up to 50 percent.
Factor in the new regulations with parts of the law that are already in effect, and brokers and agents agree that there has been a profound impact on the individual and small-group markets. Some warn that the market could disappear, while others say the market can withstand Obamacare’s regulations.
“For brokers that work in the small-group arena, the vast majority of groups with under 50 employees are going to look at dropping their coverage,” Tucker says. “That’s been my opinion since the law passed, and nothing has happened to change my mind.”
Van Putten says that among the more than 500 small groups he manages, less than 10 percent will drop their coverage.
“The rates out there for individuals are high,” she says, “so they’re completely different from the group plans.”
So as 2014 looms, brokers around the country are continuing to advise clients. But they’re also looking around for new opportunities and developing strategies to keep their own businesses afloat. Some have advised a wait-and-see approach, while others have been more aggressive.
Freeman says at the end of the day, it’s about helping clients.
“I can’t bail on them,” she says. “I can’t leave them with a navigator — someone who’s had 20 hours of training when I’ve had 20 years of training. I will get my clients through this, and as long as I don’t lose money in the future, I’ll be here.”
Be careful about what constitutes affordable care
Originally posted December 13, 2013 by Keith R. McMurdy on https://eba.benefitnews.com
When considering what constitutes affordable coverage under the Affordable Care Act, some employers have come to me and said “Well, I will just charge everybody 9.5 percent of employees’ pay.” And on its face, that seems to be what the rule permits. But, as with other components of the ACA, Congress may have overlooked that our old friend ERISA already has a little something to say about what employees can be charged as a contribution.
Generally, ERISA does not require plans to provide the same benefit coverage to all employees. But the plan’s offerings have to be made in a manner that is non-discriminatory. HIPAA makes it illegal to charge different contributions to employees based on health factors. Specifically, an employer cannot charge some employees more than any other similarly situated individuals based on medical conditions, claims experience, receipt of health care services, genetic information or disability. But HIPAA does allow an employer to make other distinctions in benefits that are offered in the cost to employees, provided the distinctions are not discriminatory.
In order to avoid discrimination, plans have to limit their distinctions between employees to “bona fide employment-based classifications.” The most common examples are things like full-time or part-time status, geographic locations and salaried versus hourly employees. In some instances, it may even be permissible to charge different rates based on time of service, but employers have to be wary of age discrimination rules. However, what is clear is that the plan has to define the rules and explain how the rules apply to each classification of employee.
What employers should be considering as they prepare their compliance program for 2015 is how they define these job classifications. For example, take two employees who do the exact same job, but one makes $10 per hour and the other makes $10.50 per hour simply because they have been employed a year longer. If the employer charges both of these employees 9.5% of their wages for health insurance contributions, there would be discrimination between them because they are similarly situated employees being charged two different rates for the same benefit coverage. Absent plan rules that explain the distinction, this difference in contributions would be discriminatory and arguably impermissible under ERISA.
So before assuming that everyone can be charged 9.5% of box 1 of their W-2s, consider what ERISA already has in place. It is not that it can’t be done this way, it is only that it has to be done properly, with the right plan language and with the correct limits in place. The ACA compliance is also ERISA compliance and employers should seek assistance for staying in line with both.
The information in this Legal Alert is for educational purposes only and should not be taken as specific legal advice.
Healthcare Reform Curbs Full-Time Hiring
Originally posted December 12, 2013 by Jon Jimison on https://medcitynews.com
Almost half of U.S. companies are wary of taking on full-time employees as a result of the Affordable Care Act.
And 20 percent are likely to hire fewer employees while 10 percent may actually lay off employees in response to what's been dubbed "Obamacare."
That's according to the findings from Duke University/CFO Magazine's Global Business Outlook Survey, which was concluded Dec. 5.
The survey found American chief financial officials indicated that because of the Affordable Care Act, they may reduce employment growth or even shift toward part-time employees. In fact, more than 40 percent of companies will consider targeting part-time workers for future employment, the survey found.
"These are some negative, perhaps, unintended consequences of the Affordable Care Act that companies are wrestling with right now that might dampen the hiring horizon a bit," said John Graham, Duke Fuqua School of Business finance professor and a director of the survey.
There was, however, a silver lining in the survey. It found that underlying economic conditions are expected to improve next year. Fifty-two percent of U.S. business leaders believe economic conditions for their firms will be better in 2014.
There will still be some expected employment growth, but health care reform has reduced that growth from what it could have been, Graham reported.
Capital spending among businesses might fare better, increasing up to 7 percent next year.
President Barack Obama's signature 2010 health care law requires many companies to provide insurance to all full-time workers, which the law defines as those who work 30 or more hours per week. Some businesses reportedly have given part-time schedules to their former full-time staffers to skirt insurance requirements.
Larger companies that employ 50 or more people are required to provide health insurance under the law. Smaller companies can opt out.
"The inadequacies of the ACA website have grabbed a lot of attention, even though many of those issues have been or can be fixed," Graham said. "Our survey points to a more detrimental and potentially long-lasting problem. An unintended consequence of the Affordable Care Act will be a reduction in full-time employment growth in the United States. Companies plan to increase full-time employment by 1.4 percent in 2014, a rate of growth which is down from last quarter and unlikely to put a dent in the unemployment rate. CFOs indicate that full-time employment growth would be stronger in the absence of the ACA."
"I doubt the advocates of this legislation would have foretold the negative impact on employment," said Campbell Harvey, finance professor at Fuqua and a director of the survey. "The impact on the real economy is startling. Nearly one-third of firms may either terminate employees or hire fewer people in the future as a direct result of ACA."
Health care in a top local concern as well, officials have said.
Changes to health insurance requirements top the list of concerns for local businesses, Christy Proctor, Wilson Chamber of Commerce chairwoman-elect, previously said.
Most Americans will be required to have health insurance in 2014 under the Affordable Care Act. The law requires coverage and includes fines for not getting insurance. There are subsidies for people who fall below certain income levels. Under the law, residents can't be refused coverage for a pre-existing condition.
The issue has become a heated political debate.
Republicans are quick to point out problems with the government-run website. They also point out Department of Health and Human Services enrollment data showing that fewer than 9,000 North Carolinians enrolled from Oct. 1 to Nov. 30.
Democratic Sen. Kay R. Hagan said she and others called for an investigation into the contracting process related to healthcare.gov">healthcare.gov. HHS Secretary Kathleen Sebelius on Wednesdsay announced that the inspector general of the agency will conduct such an investigation.
"I am pleased that the administration has agreed to investigate the contracting process related to healthcare.gov as I urged them to do last month," Hagan said in a statement. "There is no excuse for not having the website ready from day one, and we must learn whatever lessons we can to ensure we never again have an issue like the initial failures of healthcare.gov">healthcare.gov. I will continue to monitor the progress of this investigation to ensure it is completed in a timely and transparent manner."
Another PPACA deadline delayed
Originally posted December 12, 2013 by Allison Bell on https://www.benefitspro.com
The Obama administration has issued new regs that public exchanges – and participating carriers – can use to cope with startup problems. Most importantly, it pushes the selection and payment deadline for Jan.1 plan coverage to Dec. 23.
The Centers for Medicare & Medicaid Services has given the batch of “interim final regulations” the title “Maximizing January 1, 2014, Coverage Opportunities” and is preparing to publish the regs in the Federal Register next week.
The Dec. 23 deadline applies to all sorts of exchange plans, including Small Business Health Options Program QHPs, multi-state plans and standalone dental pans, officials said. The original deadline was Dec. 15.
Insurers selling commercial plans through the exchanges with coverage dates starting Jan. 1 now must accept premium payments as late as Dec. 31.
State-based exchanges can set later deadlines for either individual or SHOP coverage.
Managers of state-based exchanges who want to offer more flexibility can push the payment deadline for coverage that starts Jan. 1 back to Jan. 31, “if a QHP issuer is willing to accept such enrollments,” officials said.
Officials also included rules for provider directories.
If a QHP issuer has trouble keeping its provider directory up to date, it should add consumer safeguards, such as using the version of a provider directory available to consumers in a given month to determine whether care from a provider will be classified as in-network care, officials said.
It was the second PPACA-related delay a day after HHS Secretary Kathleen Sebelius testified before Congress.
2013 rise in employer health costs lowest in years
Originally posted November 20, 2013 by Dan Cook on https://www.benefitspro.com
Is it the lull before the storm?
Employers, it appears, worked hard to hold down health plan cost increases this year. A Mercer study released Wednesday reported that the increase — just 2.1 percent over last year — was the lowest hike since 1997.
But don’t count on another new low in 2014.
Employers told Mercer they expect health plan costs to jump 5.2 percent next year if they keep on looking for – and finding -- ways to restrain health costs.
If they chucked all those efforts, employers say, the increase next year would be more along the lines of 8 percent.
Let’s not rain on the cost-reduction parade quite so quickly. Employer health costs have been reined in of late, and the efforts should be recognized.
The best performance came from the employer group represented by those with 10 to 499 employees. Their costs nudged up just 1 percent this year over last. Even large employers experienced just a 3.7 percent increase — still lower than the overall 4.1 percent increase in 2012 vs. 2011.
Part of the reduction in cost came from the increasing popularity of high-deductible health plans for employees, the study said. Consumer driven health plans are now entrenched in the workplace and offer savings to employers. As the study said:
“Nationally, enrollment in CDHPs rose from 16 percent of covered employees in 2012 to 18 percent in 2013. This is the same portion that enrolled in HMOs. In the Midwest, CDHP enrollment is now more than double that of HMOs (27 percent compared to 10 percent). CDHPs are an important option for employers looking for a low-cost plan to make extending coverage to additional employees more affordable. The average cost of coverage in a CDHP paired with a tax-advantaged health savings account is 17 percent less percent than coverage in a PPO and 20 percent less than in an HMO.”
Employers also point to wellness plans as contributing to lower costs, although most can’t quantify the contribution.
As Mercer’s Julio A. Portalatin, president and CEO, said, “The good news is that employers have already taken decisive action to slow cost growth so they will be in a better position to handle the challenges ahead. But the impact of the ACA on enrollment levels remains a huge question mark.”
Employers pointed to the uncertainties of the implementation of the Patient Protection and Affordable Care Act as drivers for next year’s anticipated uptick.
They expect to be providing coverage for more workers in 2014 as the PPACA kicks in, which will add to their costs. “Next year, because of the individual mandate (contained in the PPACA), it is likely that fewer employees will waive coverage for themselves and more will elect dependent coverage – although the extent of the change is difficult to predict,” the study said.
Tracy Watts, Mercer’s national leader for health reform said “there are a lot of unknowns when it comes to enrollment.”
“A big question is how many employees will enroll for the first time, given that the tax penalty for not obtaining coverage is relatively small. But an employer might wind up covering more dependents if others in the area have made changes to discourage their employees from enrolling dependents,” she said.
Other highlights mined from the Mercer data:
- In 2015 employers, more large employers are going to be required to offer health coverage to workers. Among all large employers, 32 percent say they expect to be affected, while 48 percent of large wholesale/retail companies say they will have to offer coverage.
- Fifty-five percent of respondents said they now include same-sex domestic partners as eligible dependents.
- Twenty-three percent of large employers vary the employee contribution amount based on tobacco-use status or provide other incentives to encourage employees not to use tobacco. That’s up from 19 percent in 2012. Among employers with 20,000 or more employees, 46 percent now use an incentive.
Efforts To Fix Health Care Draw Mixed Reviews
Originally posted November 18, 2013 by Pamela Dockins on https://insurancenewsnet.com
WASHINGTON - U.S. President Barack Obama is taking steps to correct problems that have plagued his health care reform program since its launch in October. There is debate over whether the president has made enough changes to the program to quell discontent.
The Obama administration says it is working to fix problems with the government's health care website.
Many Americans have been frustrated by the site's technical glitches, which have prevented them from buying health insurance.
This past week, Obama offered a fix to another problem that is causing some Americans to lose their health care policies under his new program. The president said insurance companies could now give these people the option of keeping their old plans for an extra year.
"Now this fix won't solve every problem for every person but it is going to help a lot of people," said the president.
Michael Consedine, the insurance commissioner of Pennsylvania and secretary-treasurer of the National Association of Insurance Commissioners, said the president's fix could wind up causing confusion. "That fix is a very temporary one and may ultimately cause far greater harm to the insurance marketplace in allowing different products and different policies to continue in a marketplace where we thought there would be a lot more uniformity."
On Friday, the Republican-majority House of Representatives voted to make even more changes. A bill passed with the support of some House Democrats that would allow insurance companies to sell policies that lack all the health care reform mandates and renew customer policies that had been canceled.
The bill's fate in the Senate is uncertain.
Consedine said rapid changes in insurance policies and rates could become problematic at the state level. "We really are feeling like sort of like a ship out on the waves being tossed and turned. The prevailing winds go one direction one day and another the next."
Anne-Marie Slaughter is a former director of policy planning at the State Department and the current head of the New America Foundation, a public policy institute. On VOA's Press Conference USA, she predicted Obama would be able to weather the health care storm.
States to decide which plans are PPACA-compliant
Originally posted November 21, 2013 by Arthur D. Postal on https://www.lifehealthpro.com
States will be the ultimate determinant as to whether they will allow insurers to renew existing health insurances plans in 2014 even though these policies may not comply with the new Affordable Care Act, President Obama and state insurance regulators agreed at a White House meeting last night.
The meeting with several insurance commissioners and Ben Nelson, chief executive officer of the National Association of Insurance Commissioners, was held as the White House continued itsefforts to smooth the troubled political waters caused by the rocky rollout of the federal exchange that will be used by residents of 36 states to buy individual and small group policies mandated by the law.
The state regulators used the occasion to raise other issues with the president, including their relationship with federal insurance regulators given a voice in insurance regulation left to the states for 150 years. A major issue brought up with the president was the role they want to play in establishing international insurance standards.
As for the healthcare, law, under the Patient Protection and Affordable Care Act, everyone must have health insurance by March 31, 2014, or pay a penalty. However, the exchange website unveiled Oct. 1 has proved unequal to its task, and there are questions whether it will be fully up to speed by the end of the month, as promised by the administration.
The inability of people to access the website, plus the realization that the president’s commitment to allow everyone to “keep their existing policies if they like them” contradicts the law’s mandate that each insurance policy must contain certain essential benefits, has generated a major political problem for the president.
These essential benefits include providing insurance to people with pre-existing conditions, free preventative care, maternity coverage and other benefits. Also included is a requirement to provide contraceptives for women.
However, the realization that most existing policies didn’t include such benefits created a major practical problem as insurers notified thousands of affected consumers that their existing policies would be cancelled.
As the meeting was being held, CareFirst BlueCross Blue Shield, which serves Maryland, announced that it would allow more than 55,000 policyholders to retain their policies for one year even though the policies don’t contain some of the essential benefits mandated by the new law. CareFirst acted one day after the Maryland insurance commissioner said he would approve such action. Other health insurers in the state said they would also do so; others said they would not.
Other states, like Florida, said they would also allow consumers to keep their existing policies for one year. But, others, like New York, Washington and Indiana, said they would not comply. CaliforniaInsurance Department officials said they would announce their decision today.
At the meeting, the state insurance regulators emphasized their concern that different rules for different policies would be detrimental to the overall insurance marketplace and could result in higher premiums for consumers, without addressing the underlying concern of gaps in coverage. They also emphasized the importance of deferring to the states to protect consumers, and highlighted the track record of effective regulation by insurance departments across the country.
However, they acknowledged that they are just standard-setters, not policymakers and reiterated, as stated by Jim Donelon, NAIC President and Louisiana insurance commissioner, that PPACA is “the law of the land."
“Since the passage of ACA, state regulators have been working to ensure that plans are compliant with the new rules,” Donelon said at the meeting.
He said the proposed changes announced by the president in an executive order last Thursday in response to the uproar over the cancellations and the difficulty consumers are having buying policies on the federal website has creating “a level of uncertainty that we must work together to alleviate.”
Donelon made clear, however that state regulators “share the President’s goal of affordable coverage for consumers, and we will work with the insurance companies in our states to implement changes that make sense while following our mandate of consumer protection.”
Donelon attended the meeting with NAIC Chief Executive Officer Senator Ben Nelson, Connecticut Insurance Commissioner Thomas B. Leonardi, and North Carolina Insurance Commissioner Wayne Goodwin.
The group discussed practical implications of implementing the delay in enforcement as well as outstanding questions regarding what specific provisions would be impacted, and talked to reporters at length at what was accomplished at the meeting in a conference call afterwards.
Amongst the presidential aides attending the meeting was Kathleen Sebelius, secretary of the Department of Health and Human Services. Sebelius and officials of the Centers of Medicare and Medicaid Services, which oversaw development of the website, have been under intense fire because the website has failed because of the huge numbers of people who sought access to it, and because testing designed to prove it worked was not even started until a week or so before the Oct. 1 rollout.
The White House released a statement saying the state regulators had been given full authority as to whether to accept the grandfathering. According to the statement, Obama said that his executive order requires that health plans that offer such renewals provide consumers with clear information about consumer protections lacking in those plans and their options and possible tax credits through the exchanges. The statements said that Obama acknowledged that, “States have different populations with unique needs, and it is up to the insurance commissioner and health insurance companies to decide which insurance products can be offered to existing customers next year.”
Additionally, according to the White House statement, the president emphasized that he wants to hear any ideas that insurance commissioners “may have as implementation continues to ensure that Americans across the country have the information they need to get affordable, quality coverage for themselves and their families.”
Groups defend small self-insured plans
Originally posted November 14, 2013 by Allison Bell on www.benefitspro.com
Defenders of self-insured health plans testified on Capitol Hill today that the plans are tools for employers to get more control over benefits programs, not get-out-of-federal-health-regulation free cards.
The witnesses — including Robin Frick, a Madisonville, La., benefit plan administrator, who spoke on behalf of the National Association of Health Underwriters, and Michael Ferguson, the president of the Self-Insurance Institute of America, appeared at a hearing on self-insurance organized by the House Small Business Committee health subcommittee.
Some health policy watchers, including Linda Blumberg of the Urban Institute, who also testified at the hearing, have suggested that young, healthy small groups could use self-insurance simply to escape from Patient Protection and Affordable Care Act requirements, and that a flight toward self-insurance could destabilize the small-group health insurance market.
Frick told subcommittee members that most PPACA market protection rules will apply to self-insured groups as well as to insured groups.
"Further, some protections, like non-discrimination testing, already apply to all self-funded plans," Frick said, according to a written version of his remarks posted on the committee website.
The U.S. Department of Health and Human Services is giving more flexibility to insured plans in some areas, such as employee participation requirements, than to self-insured plans, Frick said.
Ferguson gave a list of some of the many PPACA rules that apply to non-grandfathered self-insured plans, including the ban on annual and lifetime benefits limits, preventive services coverage requirements, benefits summary requirements, disclosure requirements, external claim denial review requirements, limits on waiting periods, and an emergency services coverage mandate.
Many of the PPACA provisions that exempt self-insured groups, such as PPACA health insurance rate rules, are irrelevant to self-insured groups, because the self-insured plan sponsors already have an obvious incentive to try to hold down administrative costs, Ferguson said.
Survey: Employees still under-informed on ACA, wellness
Originally posted November 8, 2013 by Tristan Lejeune on ebn.benefitnews.com
Only 15.1% of workers at large employers say they are “knowledgeable” or “very knowledgeable” about health care reform and the Affordable Care Act’s public exchanges, and nearly one in five can’t say for sure if their company has a wellness program or not, according a recent survey. The poll’s results, released this month, speak to a population that has confidence in the communication efforts of their benefits administrators, and that points out some serious shortfalls in that communication.
The survey, which spoke with 400 employees at companies with north of 2,000 each, found that only 29.5% could correctly identify times when they can make changes to their health plans, like open enrollment, according to the Jellyvison Labs. Jellyvision, which created ALEX, a virtual employee benefits counselor, says all but one of the employers involved in the survey offer health insurance, but employees still demonstrate large education gaps on their own benefits.
More than 90% of surveyed workers say it’s at least “somewhat important” to understand ACA and its implications, but less than a fifth actually consider themselves knowledgeable. The good news is employee confidence in their employers’ ability to communicate the necessary information is high: nearly 80% think their companies can properly bring them up to speed, and more than one in three rate their confidence levels on this point at eight or higher on a 10-point scale.
Some 77.6% of those polled agree that it is at least “somewhat important” for their organizations to offer a wellness program, but almost one-fifth don’t know with any certainty whether or not their company does so.
“One of the most important things we learned from this data,” says Josh Fosburg, vice president of business development for the Jellyvision Lab, “is employees aren’t getting everything they need to know about their employers’ wellness programs and other benefits. For instance, nearly half of employees in our survey think they have to pay something in order to take advantage of the wellness programming that will help them manage their weight, stay on top of their prescribed medications, or cease smoking. That’s bananas.”
Jellyvision says employers need to “up their communications game” in order to help employees take advantage of everything included in their benefits offerings.