Robert Slayton & Associates

Friday, May 31, 2013

Affordable Care Act Open Enrollment FAQ for the Individual Market

Good stuff from BCBS of IL on when an individual can enroll in a health insurance plan.

May 29, 2013

Legislative Update
Affordable Care Act Question of the Week: Exchange Open Enrollment [All Markets]

We have received a number of questions about the initial open enrollment period for the Affordable Care Act (ACA). Beginning Jan. 1, 2014, most U.S. citizens and legal residents will be required to have a minimum level of health care coverage. If you have a general question about an ACA provision, contact your account representative.

Q: If an uninsured does not enroll through a health insurance exchange (also known as a health insurance marketplace) during the open enrollment period for coverage effective Jan. 1, 2014, under what circumstances may an individual enroll and receive coverage during 2014?

A: The initial open enrollment period for the exchange begins Oct. 1, 2013, and extends through March 31, 2014.

If an individual does not enroll during the initial open enrollment period or future enrollment periods (for plan years beginning on or after Jan. 1, 2015, the annual open enrollment period begins Oct. 15 and extends through Dec. 7 of the preceding calendar year), they can enroll if circumstances triggered one of the following events:

A qualified individual and any dependents losing other minimum essential coverage.
A qualified individual gaining or becoming a dependent through marriage, birth, adoption or placement for adoption.
An individual, not previously lawfully present, gaining status as a citizen, national or lawfully present individual in the United States.
A qualified individual experiencing an error in enrollment.
An individual enrolled in a Qualified Health Plan (QHP) adequately demonstrating to the exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract.
An individual becoming newly eligible or newly ineligible for advance payments of the premium tax credit or experiencing a change in eligibility for cost-sharing reductions.
New QHPs offered through the exchange becoming available to a qualified individual or enrollee as a result of a permanent move.
The individual is an Indian, as defined by the Indian Health Care Improvement Act. (We solicited comment on the potential implications on the process for verifying Indian status for purposes of this special enrollment period.)
A qualified individual or enrollee meeting other exceptional circumstances, as determined by the Exchange or Health & Human Services (HHS). Loss of coverage does not include failure to pay premiums on a timely basis, including COBRA premiums prior to expiration of COBRA coverage.
Unless specifically stated otherwise, an individual or enrollee has 60 days from the date of a triggering event to select a plan. Note: This 60-day Special Enrollment Period (SEP) window applies to the individual market. Group market is 30 days for the SEP window.

Wednesday, May 29, 2013

Latest News on the Affordable Care Act

I've compiled a series of interesting articles this week about different aspects of the Affordable Care Act.

First, this piece on the Federal Pre-Existing Condition Insurance Plan’s solvency (or lack thereof). The Federal Government totally under estimated the claims of those people who went on it.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/index.html

Second is a study of the current cost of health insurance. Please look at the dollars that are currently being spent and tell me whether this is sustainable.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/2.html

Third is Chicago Politics as its best. What do politicians do once they are elected? They hire all of their supporters of course. It looks like if you’d like a job as an assister, go talk to HHS.

http://newsmanager.commpartners.com/nahuw/issues/2013-05-24/3.html

Oops, the Government forgot that some people don’t have bank accounts with which to pay for their premiums.

http://www.npr.org/blogs/health/2013/05/21/184814772/latest-health-hurdle-buying-insurance-without-a-bank-account

Here’s something that came to my attention last week. This is in California, but may apply to other states. Doctors may be stuck with paying for patients’ care due to non-payment of health insurance premiums.

http://www.sacbee.com/2013/05/21/5438115/loophole-in-health-care-law-could.html

Unions are figuring out that they are being treated like everyone else in regards to Health Reform. Businesses don’t get special treatment, but Unions believe they should.

http://thehill.com/business-a-lobbying/300881-labor-unions-break-ranks-on-health-law

Here’s an interesting study on the impact of increasing premiums and young adults purchasing insurance. Note that this is from an organization that doesn't like the ACA.

http://americanactionforum.org/topic/young-adults%E2%80%99-insurance-decisions-dependent-cost

Wednesday, May 1, 2013

Small Group and the Affordable Care Act - Do I really need to comply? NO!!!

You know how things kind of ruminate in the back of your mind for awhile before you "suddenly" have a realization? That's what happened to me a last week.

If your company is less than 50 employees (combining Full Time and Full Time Equivalents), then you are considered a "Small Group" under the definition set out by the Affordable Care Act. While everyone is talking about 30 hours this, Bronze, Silver, Gold, Platinum medal plans that, penalties for not offering minimum coverage and cost, etc. The reality is that you will not be subjected to the employer mandate and therefore will not face any penalties if you do not comply with that mandate such as not offering coverage, not making it "affordable", or not offering compliant coverage (Note that there are other items which you must comply with such as providing a Summary of Benefits of Coverage to each employee).

To be straight, I'm not talking about plan designs or things outside of your control. I'm talking about changing the amount you contribute to your employee's premium, number of hours they are required to work before they are considered full time, etc.

You don't have to offer a plan that meets one of the Medal plans even though the probability of a plan being available that doesn't meet the guidelines is close to zero. You don't have to offer coverage to dependents (BTW, spouses are, by ACA definition, NOT dependents). Of course you may not be able to

You don't have to make sure that the employee only pays no more than 9.5% of their income towards employee only coverage on your lowest compliant plan to meet "Safe Harbor." As a matter of fact, it's probably NOT in your best interest to do this. You may harm your employees unknowingly. For example, if you do offer a "Bronze" level plan and meet the "Safe Harbor" of the above for the employee and offer coverage to their dependents, then your employee is NOT ELIGIBLE FOR A SUBSIDY. If you have lower income employees, this could be bad as a plan within the individual/family exchange may be less expensive and cover more than the plan you offer. For higher income employees who are close to or over the 400% Federal Poverty Level for income, this doesn't impact them much.

What does this mean? It means you have more flexibility that you know. If you have 5 or more employees (for Illinois at least - every state is different, in New York, only employers with over 50 employees are allowed to look at the following plans), and your workforce is younger and healthy, then you may want to explore a "level funded benefit" plan. This is partially self-funding. In the eyes of the government, it is considered self funded and not subject to some of the restrictions of the ACA. In the eyes of your employees, it looks and works exactly like a fully insured plan except with the possibility of receiving money back after your plan year if claims were less than expected.

Also, if your agent hasn't mentioned that you can do an early renewal (this means renewing this year, then renewing again on 12/1/2013) to push off the reforms (including changes in plan designs) until the end of 2014, call and ask them about it.

In general, work with your agent, roll up your sleeves and see what works best for your business first, then employees (understanding that without happy employees, your business will go down the drain).

Tuesday, April 30, 2013

Obama Administration simplifies, significantly shortens application for health insurance

By Larry Grudzien, Attorney-At-Law

April 30, 2013

The Centers for Medicare & Medicaid Services (CMS) today announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduce by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.

In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children's Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

The applications released today, which can be submitted starting on October 1, can be found here:

http://cciio.cms.gov/resources/other/index.html#hie

"Consumers will have a simple, easy-to-understand way to apply for health coverage later this year," said CMS Acting Administrator Marilyn Tavenner. "The application for individuals is now three

The online version of the application will be a dynamic experience that shortens the application process based on individuals' responses. The paper application was simplified and tailored to meet personal situations based on important feedback from consumer groups.

Consumers can apply online, by phone or paper when open enrollment begins October 1, 2013. There will be clear information provided about how to complete the application, and how to access help applying and enrolling in coverage.

This consumer-focused approach will facilitate the enrollment of millions of Americans into affordable, high quality coverage while minimizing the administrative burden on states, individuals and health plans.

For more information about the Health Insurance Marketplace, visit: www.HealthCare.gov pages, making it easier to use and significantly shorter than industry standards. This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year."

For More Information:

If you have any comments or questions regarding any of above information, please do not hesitate to contact me at 630-779-1144 or Larry at (708) 717-9638.

Wednesday, February 20, 2013

Noncalendar Plan Years & the Employer Mandate in 2014

February 20, 2013

By Larry Grudzien

Attorney-At-Law

An employer's health plan's plan year begins on September 1 each year. If the employer is a "large employer" under health care reform, when is the employer subject to the employer mandate, January 1, 2014 or September 1, 2014?

The employer mandate is generally effective on January 1, 2014. However, two transition rules apply that may delay the assessment of penalties until the first day of your first plan year that starts on or after January 1, 2014. The transition rules say that if the employer maintained a noncalendar year plan as of December 27, 2012, and all of its full-time employees are offered affordable coverage that provides minimum value no later than that first day of the plan year that starts in 2014, penalties will not be assessed for the months prior to the first day of the plan year that starts in 2014 for:

1. Any employee (whenever hired) that would be eligible for coverage, as of the first day of the first plan year that begins in 2014 under the eligibility terms of the plan as in effect on December 27, 2012; and

2. Any other employees if (a) the employer's noncalendar year plan was offered to at least one third of its employees (full-time and part-time) at the most recent open season; or (b) its noncalendar year plan covered at least one quarter of its employees.

Therefore, for any employees who are eligible to participate in the plan under its terms as of December 27, 2012 (whether or not they take the coverage), the employer will not be subject to a penalty for those employees until the first day of it noncalendar plan year that starts in 2014 if employees are offered affordable coverage that provides minimum value no later than that first day of the plan year that starts in 2014.

For any other employees that were not eligible to participate under the terms of the plan in effect on December 27, 2012, if the employer offered coverage under its noncalendar year plan starting on September 1, 2012 to at least one third of your employees, or if the plan covered at least one quarter of its employees, the employer could avoid liability for a penalty until September 1, 2014 if it expands the plan to offer coverage that is affordable and meets the minimum required value to the full-time employees who had previously not been offered coverage. For purposes of determining whether the plan covers at least one quarter of the employees, the employer can use any day between October 31, 2012 and December 27, 2012 for doing the calculation.

For More Information:

If you have any comments or questions regarding any of above information, please do not hesitate to call Robert Slayton at 630-779-1144 or Larry Grudzien at (708) 717-9638.

Tuesday, February 5, 2013

IRS Issues Guidance on Health Insurance Premium Tax Credit -Clarification

February 5, 2013

By Larry Grudzien, Attorney-At-Law

The IRS issued a final regulations on when an employer-sponsored plan is considered "affordable" for an individual related to the employee for purposes of eligibility for a premium tax credit. Under Health Care Reform, employees may be eligible for a premium tax credit to purchase health insurance through the future health insurance exchanges if, among other reasons, the employer plan is deemed unaffordable.

The final regulations clarify that for taxable years beginning before January 1, 2015, an eligible employer-sponsored plan is affordable for related individuals if the portion of the annual premium the employee must pay for self-only coverage does not exceed 9.5% of the taxpayer's household income.

An employer plan will be affordable for family members if the cost of self-only coverage does not exceed 9.5% of the employee's household income. In other words, for purposes of whether family members are eligible for tax credits, the affordability of family coverage is not taken into account; all that matters is that the cost of self-only coverage is affordable to the employee

For purposes of applying the affordability exemption from the individual

mandate in the case of related individuals, the required contribution is based on the premium the employee would pay for employer-sponsored family coverage.

For an employee eligible under an employer plan, affordability (for individual mandate exemption purposes) will be based on whether the cost of self-only coverage exceeds 8% of the employee's household income. For a related individual (such as a spouse or child), however, affordability for this purpose will be based on whether the cost of family coverage exceeds 8% of household income. Under these rules, members of an employee's family may qualify for an individual mandate exemption, even though the offer of affordable employer coverage to the employee would require the employee to enroll or risk paying a penalty.

These final regulations apply to taxable years ending after December 31, 2013.

For a copy of the final regulations, please click on the link below:

http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02136.pdf

If you have any comments or questions regarding any of above information, please do not hesitate to call me (Robert Slayton) at 630-779-1144 or Larry Grudzien at (708) 717-9638.

Thursday, January 31, 2013

Health Reform Resources

As I'm giving a talk today and hate killing trees, I thought I'd create a listing of helpful resources related to the Affordable Care Act's health reform.