Gray & Troy Insurance Services, Inc.

The Department of Health and Human Services (HHS) recently finalized rules defining Essential Health Benefits which  must be introduced into all health plans beginning January 2014.

The final ruling expanded coverage to include rehabilitative care, mental health and substance use disorder services, pediatric vision and dental care, which was not previously offered in most plans.  These benefits must be included in plans offered both inside and outside of the exchanges.

A “metal rating” will be used to assist with the comparison of similar plans, premiums, and other costs within the exchange.  The law also places an annual limit on the amount an individual will pay, which will prevent those insured from facing high costs, associated with an injury or illness.

More plan details should be released by early summer.  Gray & Troy will continue to provide updates as they are released.  To learn more about Essential Health Benefits, contact Gray & Troy Insurances Services, Inc.

The requirement to provide Notice of Exchanges to Employees has been extended from March 2013, to late summer or early fall of 2013, in order to provide a smoother implementation. In a recent release from the Department of Labor (DOL), this extension will ensure that employers receive proper information and guidelines, as well as provide employers with additional time to prepare.  The timing will coincide with the open enrollment period for the Exchanges.

The notice must be provided to all current employees and new hires.  The information that must be included in the notices as stated in the Fair Labor Standards Act (FLSA) is as follows:

•  To inform employees of the existence of their local exchange, the services provided and the contact information;
• Purchasing insurance through the exchange, may cause the employee to lose the employer contribution of the premium; And
• The employee may be eligible for a premium tax credit or a cost sharing reduction if the employer plan does not meet certain requirements.

With the additional guidelines that are to be provided by the DOL, they may also provide a sample Notice of Exchange.

Gray & Troy will continue to keep you informed of updates to these guidelines as they become available. If you have any questions, call us at (805) 540-7010.

When the Affordable Care Act (ACA) is fully implemented in 2014, one provision will significantly impact young adults, ages 21-29; age band compression.  The premise of age band compression is that young adults pay more for their premiums, allowing for older adults to pay less.   A recent Contingencies study found that premiums for the 21-29 age group could rise as much as 42%.  Those in the 30–39 age groups could see a premium increase averaging 31%.

Another provision of the ACA taking effect in 2014 is the availability of catastrophic coverage for adults under the age of 30, a plan that may become a viable affordable option.   Young adults will also be considering the individual mandate.  Starting in 2014, there will be a penalty for being without health insurance.  The penalty will be $95 per adult and $47.50 per child with a maximum of $285 per family, or, 1% of family income; whichever is greater.

There are several options to consider and understand while preparing for the ACA 2014 changes. Gray & Troy Insurance is available for assistance, to help evaluate all options, for each individual’s specific needs.  As 2014 draws near, please contact Gray & Troy Insurance at (805)540-7010 to review.

To read the complete Contingencies article and study, visit: Age Band Compression Under Health Care Reform.

The Affordable Care Act initiative brought several changes in 2012, for both employers and individuals alike.  Changes in 2012 ranged from provisions on how employers manage W2-Reporting, to an increase in free preventative services for women. Although the most significant changes will not take place until January 1, 2014, the following is a summary of significant changes that occurred in 2012.

First Quarter

• Government issued final regulations on Summary of Benefits and Coverage (SBC), and Medical loss Ratio [MLR].

More information:
Summary of Benefits and Coverage  and Uniform Glossary
Medical Loss Ratio

• W-2 reporting requirements suspended for groups under250.

More Information:
Notice 2012-9

• Health Reform Goes Before the Supreme Court.

Second Quarter

• Blue Shield Announced its Medical Loss Ratio for 2011.

• Blue Shield met the medical threshold for fully insured employer groups, and individual and family plans, regulated by the California Department of Managed Health Care (DHMHC). Over $10 million in rebates were returned to approximately 240,000 Blue Shield Life IFP plan subscribers (average rebate: $45).

• Supreme Court Upholds the Affordable Care Act.

Third Quarter

• Preventative services at no additional cost for women.

More information:
Women’s Preventative Services

• Blue Shield begins issuing SBCs.

More changes and actions will take place in 2013, especially to prepare for major changes in 2014.

The Summary of Benefits and Coverage (SBC) document is a requirement of the Affordable Care Act, to provide to consumers any time it is requested (for plan years after 9/23/12) and at specific trigger times. For example, an SBC must be provided during open enrollment, or 30 days prior to a renewal date, if there’s no open enrollment. If the renewal is automatic, the SBC must be provided within 7 days of the determination of benefits. For New Group business, the SBC is not provided during the shopping process, however, once a plan is selected, it will be provided within 7 days. Fully insured Anthem plans can access the SBC at find-sbc.com, when shopping for plans, during renewal, and anytime there are plan changes.

For more information please visit Anthem Blue Cross: Essentials of SBCs.