You probably have heard about healthcare reform. I have been working on a new timeline of some of the changes. Please take a look. Mark
Immediate Changes:
Small businesses that have no more than 25 fulltime employees and pay average annual wages of less than $25,000 are eligible for a tax credit.
2010 Changes:
High risk pool program established for people who cannot obtain individual coverage due to pre existing conditions.
Group plans will be required to comply with IRS Code 105 that prohibits discrimination in favor of highly compensated individuals.
There will be no lifetime limits on the dollar value of benefits for fully insured and self insured plans.
All group and individual plans will have to cover dependents up to age 26. Dependents can be married.
All group and individual plans will have to cover pre existing conditions for children 19 and under.
All group and individual plans will have to cover specific preventive care services with no cost sharing.
2011
Employers of all sizes must include on W2′s the cost of employer sponsored health programs for informational purposes.
Tax penalties on distributions from a health savings account that are not used for qualified medical expenses increase from 10 to 20 percent.
Over the counter drugs can no longer be purchased with funds from a Health Savings Account or a Flexible Spending Account.
All employers will be required to enroll employees in a new national public long term care program unless the employee opts out.
2012
All group and individual insurers must provide a summary of benefits to all enrollees when they apply for coverage. There is a $1,000 per enrollee fine for willful failure to provide the information.
All group and individual plans will have to submit annual reports to Health & Human Services on whether benefits under the plans meet certain criteria. They want to determine if the plans improve health outcomes and prevent hospital readmissions.
2013
New federal premium tax on fully insured and self insured health plans. It imposes an annual fee equal to two dollars for each individual covered.
Flexible Spending Account contributions will be limited to $2500 per year.
Medicare payroll tax increase of .9% on self employed individuals and employees who individually earn more than $200,000 for above $250,000 for people who file jointly.
All employers must inform employees of the existence of state based insurance exchanges.
2014
Individual mandate requirement to purchase health insurance for all citizens and legal residents takes effect. Penalties for non compliance will either be a flat dollar amount per person or a percentage of the individual’s income.
Employer responsibility requirements take effect for companies that employ more than 50 fulltime employees. Fulltime employees work at least 30 hours per week. The non compliance fine is $2000 per year for each employee that does not have coverage.
Waiting periods for new employees can be no longer than 90 days.
Individual states are required to have their exchanges up and running.
Premium taxes on health insurers based on premium volume take effect.
Premium assistance tax credits for individuals and families making up to 400 percent of the federal poverty level begin. These credits are for individual coverage only purchased through a state exchange. Not employer sponsored coverage.
That’s it for now. If you have any questions, please feel free to contact our office.
This is an important reminder for all United Health Care members. Starting May 15th, 2010 UHC will pay claims for covered services from out of network labs at the out of network benefit level even if your in network doctor referred the service.
Previously UHC was lenient on this. But not any more. Make sure you ask your provider where they send your lab work. If you are with United Health Care, use LabCorp. Please call the office if you have any questions on this.
President Obama recently signed H.R. 4851. This extends the COBRA subsidy for people who are terminated between now and May 31st 2010. This provides a 65 percent subsidy of insurance premiums for people who have involuntarily lost their jobs. This program has been extended a couple of times already. I’ll keep you posted.
The dust is starting to settle a little. I have been reading about this and just walked out of a 90 minute seminar sponsored by the National Association of Health Underwriters. I am a proud member. You will see some of the main points below.
This is 2500 page bill. There are still a lot of questions that need to be answered. Some of this is already being challenged in court. But for now this is what we know.
- You can keep your current coverage. However, if you make a plan change you will be required to purchase your coverage through an exchange run by state governments.
- By 2014 each state will be required to have the exchanges up and running. Exchanges will be shopping places for people to purchase insurance. They may just be websites where you can purchase your coverage.
- New high risk pools will be available soon for people who cannot buy coverage because of their health conditions. Missouri already has a high risk pool.
- Within 6 months lifetime limits on insurance policies will be gone. Many policies now have a five million dollar lifetime limit.
- Children will be able to stay under their parents coverage until age 26 regardless of student status. Missouri and Illinois already have laws similar to this.
- In 2014 there will be no more pre existing condition limitations. Within six months there will be no more pre existing condition limitations for children under age 19.
- Waiting periods for new hires will be no longer than 90 days.
- The government will establish a federal review board for insurance premium increases.
- The government will establish medical loss ratios for insurance companies.
- Health Savings Accounts are still available. However, the penalty for non medical withdrawls is going up from 10 percent to 20 percent. You will not be able to purchase over the counter drugs with money from your health savings account.
- Employers will be required to offer employees a public long term care program. However, employees will not be repuired to purchase it.
- In 2011 employers will be required to include the cost of insurance on the employees W2 form. This is for informational purposes only and is not taxable to the employee.
- There will be a two dollar federal tax per enrollee enrolled in a health plan. There will also be a .9% Medicare Hospital Insurance tax. There is also a 3.8% Medicare tax for single people making more than $200,000 and married couples making more than $250,000.
- Your contributions to your Flexible Spending Accounts will now be limited to $2500 a year.
- In 2014 insurance will be issued on a guaranteed issue basis. No pre existing conditions. Rates will be based on age and tobacco use.
- In 2014 there will be an individual mandate to purchase coverage or face a fine. The exact amount of the fine is undetermined. But it could be anywhere from 1 to 2.5 percent of gross household income. Exceptions to the mandate are as follows: Religious objectors; Can’t afford it; Members of indian tribes; Illegal aliens and people with no income.
There is more to come on this. I hope this helps and I will keep you all posted. Mark
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The cobra subsidy has been extended again. It now runs through the end of March 2010. If you are involuntarily terminated from your job, the government will pay 65 percent of your cobra premium for 15 months. It may get extended again. I will keep you posted. Mark
Hello. I hope everybody is having a great new year. I ran across this COBRA update and thought it would be helpful. Call us if you have any questions. Mark
FEDERAL (COBRA) & MISSOURI STATE CONTINUATION GUIDELINES
Employers with 20 or more employees on their payroll, for 50% of their typical business days in the previous calendar year, are subject to the Federal COBRA Law.
Employers with 19 or fewer employees on their payroll are subject to the MO State Law. The provisions of MO State Law mirror Federal COBRA Law.
A Qualifying Event (QE) causes loss of coverage. A Qualified Beneficiary (QB) is the person being offered Continuation. Listed below are the eligible Qualifying Events and the eligible Qualifying Beneficiaries for continuation of coverage.
Qualifying Event / Qualified Beneficiary
QB is responsible for paying the premiums for continuation of coverage. Below are the premium amounts that can be charged.
The length of continued coverage varies depending upon the qualifying event. The list below shows the duration of coverage for each qualifying event.
QE Duration of Coverage
*If the spouse is 55 or older at the end of the 36-month Federal continuation he/she may continue group coverage, under a Missouri law, until age 65. (Coverage need not end if the person becomes entitled to Medicare prior to age 65.) Dependent children who were covered may also continue until they reach the limiting age or marry. Up to 125% of the group dues may be charged. This law does not apply to MO Continuation of Coverage groups.
Employers are required to provide a number of continued coverage notifications. Below is a list of the notifications and the timelines required by law.
Notification Required Timeline
Coverage
Coverage of qualifying event
QE’s have deadlines to choose Continuation of Coverage and to make their premium payments as noted below.
Election Period / Payment Due
Coverage available under Continuation of Coverage
Continuation of coverage may stop prior to the maximum duration of coverage for the following reasons.
Conversion to an individual policy after continuation of coverage ends applies as noted below.
If during continuation of coverage an employer changes benefit plans, rates, and/or insurance carriers, continuation participants are affected as noted below.
PROCEDURES FOLLOWING QB NOTIFICATION OF CONTINUATION OF COVERAGE – Important in reducing employer’s liability! Premiums are due as stated by the employer in the Notice, however a 30-day grace period must be allowed.
Season’s Greetings…! President Obama is extending the federal subsidy to help unemployed workers acquire health insurance. President Obama signed the bill into law on 12/21/09.
Here is how it works. The old deadline of 12/31/09 has been extended to 2/28/10. Now employees who are involuntarily terminated between now and 2/28/10 can receive the 65 percent subsidy for 15 months. It used to be just 9 months. That leads me to my next point.
Let’s say we have an employee who was terminated 4/1/09. Their subsidy would be running out at the end of 2009. Those employees will now get an extra 6 months of subsidy.
Here’s the bottom line. The new deadline is 2/28/09. The subsidy now lasts 15 months instead of 9 months. People already on subsidy will get an extra 6 months. If you have questions, please feel free to call the office. Have a great holiday season. Mark
Hello. I’m back from vacation and ready to go to work. This blog is strictly informational. I mainly try to focus on what is going on with the major carriers. I have been trying to stay out of the political side of it. Therefore, I do not talk much about health insurance reform.
But, I belong to the National Association of Health Underwriters and I ran across a link on their website that I thought you might find interesting. It’s a great side by side comparison of the four health reform bills. If you get a chance, take a look. I have enclosed the link below. We certainly do need health reform. Let’s just hope they get it done right. Thanks.
Mark
Link:
This is a reminder for all of our clients. It’s that time of year again. Employers should distribute a notice to medicare eligible group members on whether their prescription coverage is creditable or non creditable.
Most plans are creditable. Generic only plans are non creditable. Plans where drugs are subject to the deductible before copays apply are generally non creditable. These notices are supposed to be sent out by November 15th. That coincides with the start of the Part D enrollment period.
If you are unsure if your plan is creditable, please call us. If your plan is creditable, you can use the notice below as a guide. Let us know if you have questions. We’re always happy to help. Mark
Date:
To: All Employees Covered Under the Company Medical Plan
We are required to provide the attached Medicare Part D Notice to all active and retired employees, and their covered dependents, who participate in our medical/prescription drug insurance plan. This Notice is only applicable if you, or a dependent on your medical plan, are eligible for Medicare coverage.
The purpose of the Notice is to confirm that your present prescription drug plan through our medical insurance plan provides “creditable” coverage. This means that the benefits of our plan meet or exceed the benefits of the Medicare Part D plans that are being offered, and you will therefore not incur a penalty if you choose coverage under a Medicare Part D plan at a date after the initial enrollment period.
Please retain this Notice for future use, if necessary.
Thank you.
Sincerely,
GHP is changing it’s post enrollment process. Beginning November 1 new members will receive enrollment materials via the internet. The company says this will by much faster and more convenient for members. GHP is also trying to go green. Kill less trees. That’s a good thing.
Members that wish to have their enrollment kits sent through the mail can call member services and ask that it be done that way. Otherwise, start using the link below. I hope your life is going well. Thanks for viewing my blog.
Mark
www.coventry-ekits.com
