Important Dates to Remember

The following checklist provides insurance agents/brokers, employers and benefits and payroll professionals key upcoming dates and deadlines related to health benefits. This reminder list does not constitute all of the deadlines applicable to employers and some deadlines may be different based on variations in plan year or plan design.

To see the full calendar, click here.

Understanding Account-based Plans

FSA. HDHP. HRA. HSA. CDHP.

These five acronyms require only eight letters of the English alphabet, but their mixture is far from simple. How do these terms fit together? Let’s look at them one at a time.

A Health FSA is a flexible spending arrangement that is sponsored by an employer. Employees and employers can contribute to it. Major restrictions include use-or-lose, uniform coverage and a prohibition on reimbursing individual premiums. The FSA typically reimburses out-of-pocket expenses not covered by a major medical plan.

Click here to read about the rest of these plans.

10 things to know if you’re helping someone on Medicare

If you're helping someone on Medicare, you may want to learn the basics of Medicare and the different plans available. The right Medicare plan can provide protection and help save money. Here's a review of 10 key things to know.

1. If you qualify for Medicare, you can enroll in Original Medicare Parts A and B through the federal government. Part A helps cover hospital costs, and Part B helps cover doctor costs.

Click Here for the complete list and to continue reading.

After health reform decision: What’s next for employers?

June 28, 2012 by Christian Schappel

After one of the most important Supreme Court decisions in recent memory, companies can now start focusing on complying with the next wave of healthcare reform provisions.

The healthcare reform law was upheld by the Supreme Court by the slimmest of margins — a 5 to 4 vote.

The mandate that individuals obtain health insurance or pay a penalty — the centerpiece of the entire law — was deemed a violation of the Commerce Clause of the Constitution. But five of the justices ruled that the penalty for enforcing the mandate is actually a tax, and the implementation of it does not overstep Congress’ taxing power. So it will stand on those grounds.

Click Here to continue reading.

Health insurers to issue more than $1B in rebates to customers, employers

April 30, 2012 by Christian Schappel

If you sponsor a health plan, and you’re not self-insured, you could be getting a nice fat check from your insurance carrier this August.

Beginning in the 2011 calendar year, the healthcare reform law has required insurers spend at least 80 cents of each premium dollar they take in over the course of a year — 85 cents for plans in the large group market — on medical care and healthcare quality improvement.

If they spent less than that, they have to pay the amount back to policy holders — either by issuing them checks or by reducing future insurance premiums. 

As a result, insurers are expected to refund between $1.2 billion and $1.3 billion dollars in profits this August, according to two research groups.

This is the first time insurers have to issue rebates due to the healthcare reform law rule, most commonly referred to as the medical loss ratio requirement.  

Click Here to continue reading.

Feds’ new rules & deadline for health summaries

February 14, 2012 by Christian Schappel

The healthcare reform law requires employers who sponsor health plans to provide workers with “summaries of coverage.” But after some delays, the feds just published the final rules, deadline and sample documents.

Under the final rules, insurance companies and plan sponsors with plan years that start September 23, 2012 or later will have to supply the documents during their next open enrollment. 

Originally, employers were tasked with providing the documents beginning March 23, 2012.

The two documents the healthcare reform bill says plan participants must receive from insurers and plan sponsors:

1. A short, easy-to-understand Summary of Benefits and Coverage (SBC) , and 
2. A glossary of terms commonly associated with health insurance, such as “deductible” and “co-pay.”

Click Here to continue reading and find important links.

Florida Readies Its Own Health Insurance Exchange

By Phil Galewitz

KHN Staff Writer

OCT 09, 2011

ORLANDO, Fla.--Florida, which is fighting to overturn the federal health overhaul, is preparing to launch an insurance marketplace early next year that looks like a distant cousin of the ones being created under the federal law.

Florida's version aims to give small businesses – those with 50 or fewer employees – an online tool where they can easily shop for health plans offered in their county. The idea, backers say, is to entice employers who otherwise wouldn’t bother to offer coverage.

Florida would be the third state – and by far the largest — with an insurance exchange, following Massachusetts and Utah. The Florida program is a public-private partnership.

But there are key differences between Florida's exchange and the type that will be available in 2014 in all states through the federal law:

--Florida’s exchange is open only to small employers, not to individuals.

--The federal law provides subsidies to help lower-income individuals buy coverage through the exchange, and tax credits to some small businesses that cover their workers. Florida does not.

--The federal law requires health plans to offer certain "essential health benefits." Florida does not.

Participation in Florida's exchange is voluntary for both insurers and small businesses. But it is drawing only tepid support from health plans and insurance agents. That’s because both would pay a price for participating: Health plans would pay the exchange 2 percent of the premium for every policy sold through the exchange, and agents would pay $300 a year to sell policies through the exchange.

Ken Stevenson, a Tallahassee, Fla., insurance agent, says these extra costs, which would likely be passed on to employers, could end up making health coverage in Florida's exchange more expensive than policies sold outside it.

"It defeats the whole purpose of having this," he said.

Michael Garner, CEO of the Florida Association of Health Plans, said the insurance industry supports the concept of the marketplace, although key details have to be worked out. "There's no silver bullet, but anything that offers more alternatives to employers can make it more likely they will take up coverage," he said. 

Still, a top official with a large Florida insurer said the industry remains unconvinced that selling coverage through the exchange would offer any advantages over selling outside. He spoke on the conditionof anonymity because his company is part of an exchange advisory group.

For the past three years the Sunshine State has had the third highest uninsured rate in the country, after Texas and New Mexico, according to Census data. More than 21 percent of Florida residents under 65 are uninsured, or about 3.8 million people.

Premiums for a family health plan in Florida offered by employers with fewer than 50 workers increased 21 percent from 2003 to 2009, according to a report by the Commonwealth Fund. That is below the 29 percent national average. But Florida is one of 16 states and the District of Columbia where the average annual premium for family coverage equaled 19.9 percent or more of median household income, the fund stated.

Florida's Republican leaders are staunchly opposed to the federal health law. Then-Attorney General Bill McCollum was quick to file suit against it last year and 25 other states joined in the effort. Gov. Rick Scott turned away millions of dollars in federal health law grants, including money that would help establish a state insurance exchange that meets federal requirements. Florida is also seeking a waiver from the law's requirement that insurers spend at least 80 percent of premium revenue on health costs.

Efforts by states to set up an exchange under the federal health law have been slow getting off the ground. So far about a dozen states have passed legislation enabling an exchange, and Rhode Island is establishing one through executive order.

Massachusetts' and Utah's exchanges, which have been running for a couple years, are quite different. The Massachusetts exchange, known as the Connector, solicits bids from insurers and negotiates prices and benefits to keep costs down and requires insurers to offer standardized policies. The Utah exchange accepts any health plan as long as they meet some minimal requirements and doesn't restrict the products they offer. Florida is being modeled after the Utah exchange.

The Florida initiative, which officials refuse to label an exchange, predates the federal law. The program, known as Florida Health Choices, was created in 2008 at the urging of then-Florida House Speaker Marco Rubio, a Republican who is now a U.S. senator.

The program initially languished, but in recent months a company was hired to administer it, insurers have begun to submit benefit and cost data, and officials plan to make the site live in early 2012, according to Rose Naff, executive director of Florida Health Choices.

"We are making significant progress," she said.

The exchange will sell policies to employers with four to 50 workers. Employers will be able to get a base premium from the Web site but will have to work with a participating agent to get exact prices, which vary based on the age and health of employees. 

Naff cited two big advantages of the exchange: Employers can fill out one application to apply for coverage at multiple insurers, and they will be able to offer up to four different health plans to their workers.

Yet small businesses are not showing much enthusiasm for Florida Health Choices. Bill Herrle, executive director of the Florida chapter of the National Federation of Independent Business, said it will still be difficult to compare plans, because there are no standard policies for carriers to offer. In addition, he said, the exchange won't directly lower premium costs.

"It will have minimal effect," he said. 

Naff acknowledges that her exchange could be short lived or forced to make major changes in 2014, when the federal government will offer an exchange meeting requirements of the ACA in states that fail to do so on their own. "There are a lot of unanswered questions. … If there is a federal exchange in Florida, we may have to evolve into something else," she said.

Click here for links related to this article and more information.

Feds exempt HRAs from reform’s annual limit requirements

The feds just announced health reimbursement arrangements (HRAs) are exempt from the annual limit restrictions in the healthcare reform law until Jan. 1, 2014.

Back in June, the Centers for Medicare & Medicaid Services (CMS) issued guidance that required HRA plans to renew or apply for a waiver by Sept. 22, 2011 if they wanted to be relieved from complying with the reform law’s restrictions on annual dollar limits.

But the Center for Consumer Information & Insurance Oversight has just issued new guidance rendering the CMS renewal/application process unnecessary.

It says HRAs have been deemed exempt from having to comply with the annual limit restrictions through 2013, as long as they comply with existing record retention and annual participant notice requirements.

Under the Patient Protection and Affordable Care Act (PPACA), group health plans need to start phasing out annual dollar limits on health benefits provided.

The reform law says plans cannot:

• impose limits lower than $750,000 for plan years beginning on or after Sept. 10, 2010
• impose limits lower than $1,250,000 for plan years beginning on or after September 23, 2011, and
• impost limits lower than $2,000,000 for plan years beginning on or after September 23, 2012.

By Jan 1, 2014, HRAs and health plans will not be allowed to impose any spending limits.

The CCIOO’s reasoning for allowing HRAs to be exempt from the limits until 2014: Requiring mini-med HRA plans to comply with the limits would likely result in a significant increase in mini-med premiums, which would cause many employers to drop coverage and leave workers without even minimal insurance coverage.

The new guidance also says any coverage that’s “integrated” with an HRA must meet the reform law’s annual limit requirements or obtain a waiver by Sept. 22, 2011.

However, no clear guidance was given as to when/how coverage is “integrated” with an HRA.

Click here for the original article and more information.

A Shift Toward Smaller Health Insurance Networks - (Los Angeles Times)

Thousands of employers in California and nationwide are opting for 'narrow network' HMOs, which offer notable savings on insurance premiums but also offer fewer medical providers.

California, with nearly 21 million people in health maintenance organizations, is driving the rapid expansion of these networks. More than 10,000 California employers and public agencies have enrolled, mostly since the recession struck in 2008.

While many workers welcome the cheaper HMOs, the savings come at the price of fewer healthcare choices.

Read the whole article here...

High-Deductible Plans: When Spending Less on Health Care Isn't Always Better (Henry J. Kaiser Family Foundation)

This column is a collaboration between KHN and Jonathan Cohn, Senior Editor of The New Republic.

Conservatives think traditional health insurance provides too much financial protection from medical expenses. They also think that the Affordable Care Act will make this situation worse. That's one reason they want to repeal it.

Redesigning insurance in a way that actually lowers spending and, by the way, promotes good health, is a lot more complicated than merely giving people 'more skin in the game,' as conservatives like to put it. A new study by researchers affiliated with the Rand Institute suggests why.  

Read the whole article here...