The NYS Department of Financial Services has reviewed individual and small group health carriers’ rate increase requests for 2015, and announced the results of their review.
Interestingly, North Shore LIJ Care Connect was the only insurer to request a rate reduction. With significant expansion steps they are well positioned for Wescthester, Bronx, NYC, SI, Queens and LI. These numbers are across the board and specific plan rate renewal may vary.
Reminder: Individual Exchange Marketplace opens Nov 2015. Rates will be posted upon Health Insurer’s release, check our site.
Individual Market
On average, insurers requested a 12.5 percent increase in health insurance rates for 2015 in the individual market. DFS reduced that average increase more than in half to 5.7 percent – which is below the approximately 8 percent average increase in health care costs.
Small Group Market
On average, insurers requested a 13.9 percent increase in health insurance rates for 2015 in the small group market. DFS reduced that average increase more than in half to 6.7 percent – which is also below the approximately 8 percent increase in health care costs.
You may view the DFS press release, which includes a recap of the increases requested and approved by clicking here.
For specific details on all available health plans in 2015, contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Employers incentivizing fitness by lowering lower insurance premiums in exchange for wearing fitness tracking bracelets. Bloomberg reports that BP Plc drive for occupational wellness offered an employee’s spouse the option “to wear a fitness-tracking bracelet from FitBit Inc. to earn points toward cheaper health insurance,” which is “an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit.
” The article notes that UnitedHealth Group Inc. (UNH), Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have developed similar programs, in which “consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.” The article notes, however, that “the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates,” one of whom notes that “when financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate.”
Wear This Device So the Boss Knows You’re Losing Weight
To fight rising medical costs, oil company BP Plc (BP) last year offered Cory Slagle — a 260-pound former football lineman — an unusual way to trim $1,200 from his annual insurance bill.
One option was to wear a fitness-tracking bracelet from Fitbit Inc. to earn points toward cheaper health insurance. With the gadget, the 51-year-old walked more than 1 million steps over several months, wirelessly logging the activity on the device. Twelve months later, Slagle has added to his new exercise regimen by trading burgers for salads and soda for water, dropping 70 pounds (31.8 kilograms) and 10 pant sizes in the process.
“I can see my toes now,” said Slagle, a middle-school administrator whose wife, Kristi, works for BP in Houston. The company’s program, he said, is “pushing me to get off the couch and make the right decisions.”
Slagle’s wife is thrilled with his thinner frame — as is BP. His once-high blood pressure and cholesterol are now in a normal range, significantly lowering BP’s risk of covering treatments related to heart trouble or other medical problems.
Slagle’s experience is an example of how companies, facing rising health expenses, are increasingly buying or subsidizing fitness-tracking devices to encourage employees and their dependents to be more fit. The tactic may reduce corporate health-care costs by encouraging healthier lifestyles, even as companies must overcome a creepy factor and concerns from privacy advocates that employers are prying too deeply into workers’ personal lives.
Source: Cory Slagle via Bloomberg
Cory Slagle wore a fitness-tracking bracelet from FitBit Inc. to earn points toward… Read More
Insurers Too
Apart from BP, insurers includingUnitedHealth Group Inc. (UNH),Humana Inc. (HUM), Cigna Corp. (CI) and Highmark Inc. have also created programs to integrate wearable gadgets into their policies. The aim is to get people more invested in taking care of themselves. Consumers wear the device and the activity data is uploaded to an online system so it can be verified to give a person their reward.
“What employers want is the person to take an active role in their health,” said Dee Brock, who has incorporated wearable devices into wellness programs for Pittsburgh-based HighMark.
Privacy Flags
The adoption of wearable devices by companies and insurers is increasing as spending on corporate wellness incentives has doubled to $594 per employee since 2009, according to a study by Fidelity Investments and National Business Group on Health. Technology is creating new forms of wellness programs to measure whether employees are making improvements, similar to a trend in the car-insurance industry where drivers who put a monitoring sensor on their vehicle can earn lower rates based on how well they are driving, instead of their driving history.
Source: Cory Slagle via Bloomberg
Cory Slagle lost 70 pounds after starting to wear a FitBit given to him by energy…Read More
Yet the moves also let employers and insurers gather more data about people’s lives, raising questions from privacy advocates. Wearable gadgets are advancing beyond tracking steps, with sensors to monitor heart rates, glucose levels, body temperature and other functions.
“The focus on preventive health at the expense of privacy is dangerous,” said Pam Dixon, founder of the World Privacy Forum in San Diego, which focuses on health privacy issues. “Right now it’s tracking steps per day, and the reach isn’t that far with these devices, but in time it will be quite sophisticated.”
When financial incentives are involved, Dixon said it forces employees’ hands and narrows the question of whether or not they should participate. The gathering of health data also opens the door for people to eventually be charged more or less based on the information, she said.
Security Requirements
These are among the ethical questions still to be addressed about the appropriateness of companies tracking the physical activity of employees, said Harry Wang, a researcher for Parks Associates who has been studying the market. With wearable devices, collecting more sensitive information is likely to bring tougher government oversight, he said.
“There will be high levels of privacy, security and compliance requirements,” Wang said. “There will be high expectations from consumers about how the data will be used.”
Companies and insurers said they protect the privacy of people using wearable gadgets, and comply with federal laws that prevent employers from seeing certain health information about employees without consent. The wearable programs are voluntary and often administered by third-party vendors like StayWell, which works with BP.
Aggregated Only
As part of the BP program, employees who use a Fitbit to log 1 million steps earn half of the 1,000 points needed each year to qualify for lower co-pays, deductibles and out-of-pocket health expenses. BP bought 25,000 Fitbit devices for North American employees, including those at refineries and drilling rigs. Points can also be earned by getting an annual physical, taking an online health class and other initiatives.
“We think the device is easy to use, gets people aware of how little they are walking and helps trigger people to get active,” said Karl Dalal, director of health and wellness benefits at BP. “BP doesn’t see any of the data except in the aggregate.”
The market for wearable devices is small — about 2 percent of the 1 billion smartphones shipped globally last year — so creating interest from employers and insurance companies is key to growth. Some 22 million fitness-tracking devices will be sold this year, and 66 million by 2018, with about a third coming from corporate-wellness programs, according to Parks Associates. The incentives an employer or insurance company can offer is a way to keep people using the gadget, instead of throwing it in a drawer once the novelty wears off.
Targeting Businesses
Under the Affordable Care Act, the new national health-care law, companies can spend as much as 30 percent of annual insurance premiums on rewards for healthy behavior.
Technology companies are taking note. Apple Inc. (AAPL), which has new health-tracking software called HealthKit that will be released this year and is said to be developing its own wearable device, has talked with UnitedHealth, the biggest U.S. insurer, and Humana, about its health initiatives, executives at the insurance providers said. The companies wouldn’t provide specifics about the conversations. Apple declined to comment.
Fitbit has a sales force dedicated to pitching employers and insurance companies, and touts software to make it easier to log the activity of workers, down to specific individuals if a company wants, said Amy McDonough, who coordinates deals for Fitbit with companies. Other makers of wearable devices, including Jawbone, Samsung Electronics Co. (005930) and iHealth Lab Inc., have also targeted businesses.
Samsung leads the smart wearable-band market, according to a report today from Canalys. The researcher estimated the wearable band market grew almost eightfold in the first half of 2014 from a year ago.
Insurance Link
Some employers are encouraging the use of wearables without the gadgets being tied to lower insurance rates. Houston Methodist, owner of a chain of hospitals in the Houston area, got about 6,000 Fitbits this year and is offering employees the chance to win $10,000 if they walk more steps than the company’s top executives. Fitbit said it also works with Time Warner Inc. (TWX) and Autodesk Inc. (ADSK)
“Walking alone isn’t going to beat diabetes, but it’s certainly going to help,” said Marc Boom, chief executive officer of Houston Methodist. “Being more active results in better health. That’s indisputable.”
Scotty’s Brewhouse
At Scotty’s Brewhouse in Indianapolis, where the $15 “Big Ass Brewhouse Burger” includes four quarter-pound beef patties and American cheese, owner Scott Wise offers an extra day of vacation for managers at his 11 restaurants who use a Jawbone UP device to log an average of 10,000 steps a day for three months. That has some managers like Brian Winnie exercising more to earn time off for a trip he wants to take to Memphis, Tennessee.
“Outside of work, I picked up riding my bike to add extra steps that way,” Winnie said in an interview.
Despite some early enthusiasm, many companies are waiting to see whether the use of wearables is a fitness fad. No major research has been done that shows the use of these devices leads to lower health-care costs and many employers want to know “if this is something that’s a passing trend or something that has staying power and can have proven results,” said Eric Herbek, who runs digital engagement for Cigna.
The gadgets have been worthwhile for Chris Barbin, CEO of Appirio Inc. in San Francisco. He said about 40 percent of his staff, which numbers around 1,000, participates in a voluntary fitness program that includes uploading their activity with Fitbit.
$300,000 Discount
While health costs weren’t the priority for the program, Barbin said that by sharing the data with the company’s health care provider he negotiated $300,000 off his company’s roughly $5 million in annual insurance costs by showing his staff is getting healthier. He said privacy protections are in place for those who want to keep the data secret. The program has become one of the most popular forums on Appirio’s internal social network, he said.
“We had an initial batch of data about people who had lost weight, and people who had moved from high risk to moderate risk,” he said. “When we could show all that information to our insurer, that’s pretty powerful.”
Kristi Slagle, whose husband slimmed down through BP’s program, isn’t concerned about privacy with the gadgets. She said the program injects more fairness into the system because those who are healthier currently end up shouldering more costs for those who aren’t.
“I like that BP is making people more accountable,” she said.
OK so this may not be the catatonic movie of our favorite State starring Zach Braff and Natalie Portman but just the same Oxford couldn’t resist using the same logical name for the new network. Starting Sept 1, 2014 Oxford will be offering the Oxford Garden State Network on all size NJ group business. The 18,000 Doctor and 65 hospitals network will answer the call for a flexible lower cost plan option.
Judging by the #1 selling plan – Oxford Liberty HMO the market supports a smaller lower cost quality network. Taking the same playbook Oxford unveiled their plan last Friday. The plan will cover members outside NJ only on emergencies. Unlike the Liberty HMO some plans options are non-gated plans not needing referrals to for access to a Specialist Doctor.
The Garden State Network provides access to the 21 New Jersey counties only.The Garden State Network does not provide national access to the UnitedHealthcare Choice Plus network. For NJ 1-50, up to 4 plan options can be selected and the Garden State products can be paired with Liberty and Freedom network options. With this network, employers can select which of the 13, in-network only plan designs available will work best for their needs and for the needs of their employees.
Oxford/United has been purchasing Provider groups since 2011 , see our post UnitedHealthcare Buying Medical Groups? This strategy of late is by no means exclusive to this Insurer but it is worth pointing them out as they are a national leading health Provider and worth paying attention to.
Some highlights of the plan designs available with the Oxford Garden State Network are below:
∙ Routine, in-network preventive care covered at 100 percent
∙ In-network only coverage
∙ Choice between 11 non-gated and two gated plan designs (gated plan designs will require a referral)
∙ Plan designs with copayments, deductible and coinsurance, and Health Savings Accounts (HSA) are available.
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
IRS Releases Draft of Employer Reporting Form for Health Reform Law Compliance
Business Insurance Story by Matt Dunning
Click Above
July 28, 2014
The Internal Revenue Service has issued draft versions of the reporting forms most employers will begin using next year to show that their group health insurance plans comply with the health care reform law.
The long-awaited draft forms, posted late Thursday afternoon to the IRS’ website, are the first practical application of employers’ health care coverage and enrollment reporting obligations under the Patient Protection and Affordable Care Act since the regulations were finalized in March.
The forms are the primary mechanism through which the government intends to enforce the health care reform law’s minimum essential coverage and shared responsibility requirements for employers.
Beginning in 2015, employers with at least 100 full-time employees will be required to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage and that their employees’ contributions to their premiums comply with cost-sharing limits established under the reform law. Smaller employers with 50-99 full-time employees are required to begin reporting in 2016.
Additionally, self-insured employers will be required to submit documentation to ensure compliance with minimum essential coverage requirements under the reform law’s individual coverage mandate.
“In accordance with the IRS’ normal process, these draft forms are being provided to help stakeholders, including employers, tax professionals and software providers, prepare for these new reporting provisions and to invite comments from them,” the IRS said in a statement released Thursday.
The IRS said it expects to publish draft instructions for completing the reporting forms by late August and that both the forms and the instructions would be finalized later this year.
Last year, the Obama administration announced it would postpone implementation of employers’ minimum essential coverage and shared responsibility obligations under the reform law for one year, largely due to widespread complaints about the complexity of the reporting requirements.
Though several months have passed since the administration issued a simplified set of information reporting rules, many employers have delayed preparations for meeting the requirements until the forms and instructions are available for review, said Richard Stover, a principal with Buck Consultants at Xerox in Secaucus, New Jersey.
“A lot of employers really haven’t been doing anything about reporting requirements, even with the final regulations in place, because they were waiting for these forms,” Mr. Stover said. “This is something they’ve been anxious to see.”
Try These Natural Tricks to Fall Asleep More Easily
Seeing a physician for help with your sleeping problems? You might want to try complementary medicine as another way to help you get back to restful slumber.
Complementary medicine refers to forms of non-invasive therapies that a patient can use alongside conventional Western medicine. Nearly 40 percent of Americans use this approach for specific conditions or overall well-being, says the National Institutes of Health (NIH).
“Many complementary therapies have been shown, through high-quality scientific evidence, to be safe and effective,” says integrative medicine specialist Melissa C. Young, MD. She sees patients at Cleveland Clinic’s Center for Integrative Medicine.
Complementary therapies for insomnia comprise four categories: mind-body therapies, body-based therapies, biologically based therapies and cognitive-behavioral therapy.
Here’s a rundown of the four categories and how you can leverage them to get back to sleep:
Mind-body therapies
The mind is a key player when it comes to how easily you fall asleep and stay asleep. This is why people should try mind-body techniques first when they experience insomnia, Dr. Young says.
Examples of mind-body techniques include meditation, hypnosis, guided imagery, tai chi and yoga. These practices can help to calm people’s thoughts and help them to relax. They are particularly helpful for older adults.
Body-based therapies
Body-based therapies can relax the body enough so that it is ready for sleep. These include massage and acupuncture, as well as energy techniques for stress reduction. Massage benefits everyone from infants to older adults and cancer patients. Acupuncture enhances sleep quality, especially if you’re feeling pain. Energy techniques include reiki, healing touch and therapeutic touch.
Biologically based therapies
Biological supplements aren’t sleeping pills. They help to balance your body’s chemistry and rhythm naturally, and make it easier to fall asleep.
Dr. Young says the most effective and popular biological treatments are:
Magnesium, a mineral supplement
Melatonin, a hormone that plays a role in sleep
Chamomile tea
I-theanine, a naturally occurring amino acid
Cognitive-behavioral therapy
Cognitive behavioral therapy for insomnia is a group of strategies that can help you to fall asleep faster, stay asleep and improve your sleep quality. At the same time, these strategies increase the overall amount of time you sleep. Cognitive-behavioral therapy is effective in the short- and long-term, and has minimal side effects.
Limit the time you spend awake in bed. If you find yourself still awake after 15 to 20 minutes, leave the bedroom and return when you feel tired. You should associate your bedroom only with sleep — not TV, emails from work or worry.
Create a sleep schedule—and stick to it. Wake up at the same time each day, no matter your nightly experience. This will help your body regulate its internal 24-hour sleep-wake cycle, otherwise known as your biological clock or circadian rhythm.
Practice good sleep hygiene. Part of getting good sleep is having healthy habits. Get regular exercise (but not too close to bedtime), develop a pre-bedtime relaxation routine, avoid or limit caffeine, avoid or limit naps to 30 minutes and limit your intake of alcohol.
Study up on sleep. It’s easier to change sleep habits when you know how and why people sleep, and which beliefs, behaviors and outside influences affect your sleep.
Consider cognitive therapy. Five mental processes influence insomnia: worry, selective attention and monitoring, distorted perception of sleep and daytime deficits, unhelpful beliefs about sleep and counterproductive safety behaviors. Cognitive therapy helps you to reverse these mental processes. Cognitive therapy is especially helpful in preventing relapse.
Relax. This is often easier said than done. This is why relaxation training from a sleep psychologist or a professional trained in services such as meditation, guided imagery or hypnosis may help. Results are not immediate, but last a lifetime.
Painful wait times at the doctor’s office… It’s an old story with few exceptions.
As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (My wife did it once, I think, then she promptly retired from this job.). However, waiting at the pediatrician is not something I have to do. So, I can’t truly empathize with you on this one….
Because you guys know me and know I’m not one to defend the status quo…I’m going to go ahead and defend the status quo a little bit. Or, at least, sound like I am (whether I am or not).
Here are some (in my mind) acceptable reasons why wait times are long:
Scheduling – Doctors, pediatricians specifically, are often over-scheduled. We generally come out of school with the same amount of debt as our doctor friends who have entered more “lucrative” specialties. The only way to make up some of the difference (and pay back our loans) is to see more patients. Thus, patients are scheduled closer together. This normally does not cause problems…but stuff happens.
Emergencies – If you have a doctor with hospital privileges (especially one who goes to deliveries), emergencies will happen. Getting called to a C-section can ruin an entire afternoon for a busy pediatrician. Great partners (like the ones I had in Abilene) will try to pick up the slack while you are gone but it is a strain on the whole system. What about other little “emergencies”? The teenager who reveals during their well child exam that they are depressed and suicidal. The 6-year old getting an MRI for headaches that turn out to have been caused by a brain tumor. Yes, I could assign those conversations to someone else by referring to the ER or the specialist, but wouldn’t you want it to be your pediatrician walking you through that?
Here are some (in my mind) unacceptable reasons why wait times are long:
Too Much Time Out-of-Room for the Doctors – I heard a story once about a doctor whose patients complained that his wait times were too long. He in turn complained to his staff that they were too slow. Come to find out, every morning, before he saw any patients, he sat down at his desk and read the entire paper, cover to cover. He had patients waiting 15 minutes completely ready for him to see but was sitting in the back office. 15 minutes might not be terribly inconvenient but that 15 minutes, on a bad day, will turn into 30-45-60 minutes that could have been avoided. Reading the paper may not be much of a temptation these days, but spending time on the computer doing other stuff is huge. I have to make a point not to be on Facebook, Twitter and other social media during patient care time. I do my social media and blogging before patients arrive and at lunch.
Poor Work-Flow in the Office – In Abilene, I had a very hard working MA and LVN (shout out to Nikea and Beth!) that understood how important this issue was to me. There are other ways to know if work-flow is the problem but one thing is certain: if you can’t see your first patient of the day in time, then there’s something wrong.
Chronic Over-Scheduling – While I do understand the issues related to scheduling, I don’t excuse the doctor for always having a schedule such that they run behind every day. Something can be done.
Now, you can read over this and take it however you want, but keep this in mind: you almost always have a choice in medical care. Unless your child needs a specialist for which there is only one in town or you live in such a rural area that there is only one provider, you have a choice. When we make any choice, we prioritize what’s important…someone might choose to see a doctor they love and tolerate the fact that their wait times are longer (but continue to complain on Facebook about it-I get it, it’s ok). Other people might drive more miles to see one they love. The choice still lies in the hands of the parents.
Ultimately, waiting anywhere is hard. Waiting in the doctor’s office is especially hard when you have a sick child, no one slept the night before, and the only appointment available was right in the middle of nap time.
I promise to keep working on those things that I can do in order to shorten your wait time and you can stay tuned for tomorrow’s post:
Justin Smith is a pediatrician who blogs at DoctorJSmith. He can be reached on Twitter @TheDocSmitty.
This post has absolutely little to do with employee benefits but more with the unprecedented lopsided score. With the World Cup 2014 lopsided score of 7-0 making history I cannot restrain myself. It is well worth pointing out that I have an incredible respect for the game of Soccer and its beauty. The cerebral parallels of battlefield strategy and true international game is inescapable. Besides this sport deserves more the moniker “Football” than American Football.
Having said that, Soccer will simply never take off in USA. In any sport a team can trail and have a shot of a comeback. Perhaps this meritocracy or a “can-do spirit” is what makes this country great. Americans should be able to make progress in any game, overcoming obstacles and changing rules. Americans are an optimistic people. We like scoring too much to enjoy a game that is more about preventing success than achieving it.
Maybe this is also why the underdog is beloved. Regardless, if a team is down in Baseball by 3 runs its possible to come back in the last inning. How many times has Joe Montanan engineered a comeback victory down by 10+ points and 5 minutes left?
In the beautiful game of soccer there is NO shot! Say a team trails by more than a goal with even 20 minutes left a come back is virtually an impossibility. The opponent can contract and play super D. There is NO redemption.
From a broadcasting revenue standpoint its a major snooooze fest when a team is down by 1+ score. After-all, in the United States we vote with our dollars do we not?
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), an individual who was covered by a group health plan on the day before the occurrence of a qualifying event (such as a termination of employment or a reduction in hours that causes loss of coverage under the plan) may be able to elect COBRA continuation coverage upon that qualifying event. Individuals with such a right are referred to as qualified beneficiaries.
Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights. A group health plan must provide each covered employee and spouse (if any) with a written notice of COBRA rights “at the time of commencement of coverage” under the plan (general notice). A group health plan must also provide qualified beneficiaries with a notice which describes their rights to COBRA continuation coverage and how to make an election (election notice).
General Notice: The general notice must be furnished to each covered employee (and their spouse if covered under the plan) not later than the earlier of: (1) 90 days from the date on which the covered employee or spouse first becomes covered under the plan or, if later, the date on which the plan first becomes subject to the continuation coverage requirements; or (2) the date on which the administrator is required to furnish an election notice to the employee or to his or her spouse or dependent.
Election Notice: The election notice must be provided to the qualified beneficiaries within 14 days after the plan administrator receives notice that a qualifying event has occurred. Some qualified beneficiaries may want to consider and compare health coverage alternatives to COBRA continuation coverage, such as coverage that is available through the Health Insurance Marketplace (Exchange). Qualified beneficiaries may be eligible for a premium tax credit (a tax credit to help pay for some or all of the cost of coverage in plans offered through the Exchange) and cost-sharing reductions (amounts that lower out-of-pocket costs for deductibles, coinsurance, and copayments), and may find that Exchange coverage is more affordable than COBRA.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) specifies that an employer that maintains a group health plan in a State that provides premium assistance for the purchase of coverage under a group health plan is required to notify each employee of potential opportunities currently available for premium assistance in the State in which the employee resides.
The Department of Labor has model notices that plans may use to satisfy the requirement to provide the general notice and election notice under COBRA, and the notice regarding premium assistance under CHIPRA. The COBRA model election notice was revised on May 8, 2013 to help make qualified beneficiaries aware of other coverage options that would soon become available in the Marketplace. Recently the DOL issued a Notice of Proposed Rulemaking, as well as updated versions of the model general notice and model election notice that reflect that the Exchange is now open and that better describes special enrollment rights in Exchange coverage. The DOL is also issuing a revised CHIPRA notice with similar updates related to Marketplace coverage.
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
Adding a one-month orientation period may help an employer avoid complying with the new health benefits. Federal agencies are offering employers a benefits-free 30 day orientation period option in final regulations. There is also clarification on how employers must treat certain categories of new hires, as either FT , PT or Seasonal employees
The Final Regulations
These final regulations provide that the one month period would be determined by adding one calendar month and subtracting one calendar day, measured from an employee’s start date in a position that is otherwise eligible for coverage. For example, if an employee’s start date in an otherwise eligible position is May 3, the last permitted day of the orientation period is June 2. Similarly, if an employee’s start date in an otherwise eligible position is October 1, the last permitted day of the orientation period is October 31.
The new regulations implement part of the “employer shared responsibility mandate” provisions created by the Patient Protection and Affordable Care Act (PPACA). In all categories of new hire the e final regulations provide that one month is the maximum allowed length of an employment-based orientation period. For any period longer than one month that precedes a waiting period, the 90-day period begins after an individual is otherwise eligible to enroll under the terms of a group health plan.
When must an employer offer coverage:
The final regulations continue to provide that if a group health plan conditions eligibility on an employee’s having completed a reasonable and bona fide employment-based orientation period, the eligibility condition is not considered to be designed to avoid compliance with the 90-day waiting period limitation if the orientation period does not exceed one month and the maximum 90-day waiting period begins on the first day after the orientation period.
These final regulations apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2015.
When the Employer Might be Subject to a Penalty:
If at least one full-time employee of the employer buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy (either a premium tax credit or a cost-sharing reduction), the employer must pay a penalty.
There are two different types of penalties.
)The IRC section 4980H(a) penalty applies if a large employer offers coverage to less than 70% of its full-time employees in 2015 (or to less than 95% after the 2015 plan year). This penalty is $2000 annually or $166.67/month times the total number of “full-time” employees minus the first 80 (minus the first 30 after 2015). The penalty calculation does not include variable hour or seasonal employees who are in their measurement or administrative periods, even if they in fact worked on average at least 30 hours/week or 130/month during those periods. Nor does it include those who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period.
IRC section 4980H(b) penalty. It applies if a large employer offers coverage to at least 70% of its full-time employees (95% after 2015), but for some full-time employees the coverage is either not “affordable” or does not provide minimum value. This penalty is $3,000 annually or $250/month for each full-time employee who buys health insurance in a public Exchange (Marketplace) and qualifies for a subsidy and for whom the employee cost for self-only coverage under the lowest-cost option available from the employer is more than 9.5% of the employee’s household income (or one of three safe harbors), or for whom the employer coverage offered does not provide at least minimum value. Again, the penalty calculation does not apply if the employee who qualified for a subsidy was a variable hour or seasonal employee who was in his/her measurement or administrative periods, nor does it include those employees who are in their stability periods but who did not qualify for coverage based on their hours worked during the associated measurement period. Additionally, the (b) penalty cannot be more than the (a) penalty would have been had it applied.
Summary and Employer Action Items
The bottom line is this:
If you hire a non-seasonal employee whom you reasonably expect (at date of hire) to work at least 30 hours/week or 130 hours/month, you must track hours each calendar month and offer benefits by the first day of the fourth month if the employee averages at least 130 hours/month for the first three months. This applies even if you hire this employee for a short-term position or a summer internship (unless you take the position, upon advice from your legal counsel, that a summer intern is a “seasonal” employee).
If you hire a non-seasonal employee and you cannot reasonably determine at date of hire if they will work on average at least 30 hours/week (130 hours/month), you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period,” if the employee averaged at least 130 hours/ month during the measurement period. The stability period might not begin until 13-14 months after the date of hire.
If you hire an employee who meets the new definition of a “seasonal employee,” you can track their hours over their “initial measurement period” and not offer benefits until the associated “stability period” if they averaged at least 130 hours/month during the initial measurement period. You do not have to offer benefits by the first day of the fourth month.
A copy of the final regulations can be obtained by clicking on the link below:
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
COBRA members have a special enrollment period extension according to new CMS guidance. If you have individuals eligible for, or currently enrolled in COBRA you can enroll them on the Individual Exchange through June 30th 2014. Direction from The NY State of Health confirms that current COBRA Eligible Individuals have been granted a one-time open enrollment window.
Therefore, anyone who does not like his or her current COBRA coverage or cost, can now switch to Individual Exchange!
ASpecial Enrollment Period (SEP) is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Eligible individuals have 60 days to enroll after their Qualifying Life Event.
Individual or dependent loses minimum essential coverage due to: job loss; employer no longer offers coverage; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan is decertified
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Other exceptional circumstances, as defined by HHS
To ensure your clients get great health insurance get in Contact us at (855)667-4621!
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance
HDHP Minimum Annual Deductible (No change from calendar year 2011):
Single – $1,300 (up from $1,250 in 2014)
Family – $2,600 (up from $2,500 in 2014)
HDHP Out-of-Pocket Maximum:
Single – $6,450 (up from $6,350 in 2014)
Family – $12,900 (up from $12,900 in 2014)
HSA/HDHP Market Growth
HSA holders own the assets in the accounts and can build up substantial sums over time. Enrollment in HSA-compatible insurance plans has increased to 10 million earlier this year, from 1 million in March 2005, according to, America’s Health Insurance Plans (AHIP), a trade group.
HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market.
The number of people with HSA/HDHP coverage rose to more than 11.4 in January 2011, up from 10.0 million in January 2010, 8.0 million in January 2009, and 6.1 million in January 2008.
30 percent of individuals covered by an HSA plan were in the small group market, 50 percent were in the large-group market, and the remaining 20 percent were in the individual market.
14% of all workers in the private sector that have access to a Health Savings Account acc. to Bureau of Labor Statistics.
States with the highest levels of HSA/HDHP enrollment were California, Ohio, Florida, Texas, Illinois and Minnesota.
HSA Advantages:
Opportunity to build savings – Unused money stays in your account from year to year and earns tax-free interest. The HSA also gives you an investment opportunity.
Tax-free contributions and earnings – You don’t pay taxes on contributions or earnings.
Tax Free Money allowed for non traditional Medical coverage– As per IRS Publication 502, unused moneys can be used for dental,vision, lasik eye surgery, acupuncture, yoga, infertility etc. Popular Examples
Portability – The funds belong to you, so you keep the funds if you change jobs or retire.
Our overall experience with HSAs have been positive when employer funding is at minimum 50% using either the HSA or an HRA (Health Reimbursement Account-employer keeps unspent money). Traditional plans trend of higher copays and new in network deductibles has also led to the popularity of an HSA.
Is your HSA compliant? Which pre-tax qualified HSA, FSA, HRA spending card is right is right for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.. Stay tuned for updates as more information gets released. Sign up for latest news updates.
(Note that a health plan will not fail to qualify as a high deductible health plan merely because it provides certain preventive health services without a deductible, as required under Health Care Reform.)
A: You are eligible for our Travel Medical Insurance plan if you reside outside of the U.S. or have a good faith intent to reside outside of the U.S. for six months or more in a calendar year. Please note that Travel Medical Insurance does not meet the definition of “minimum essential coverage” under PPACA. Travel Medical Insurance is not intended to provide U.S. citizens residing in the U.S. with health insurance. While your Travel Medical Insurance plan for worldwide coverage will not be affected by PPACA, you should review the information below to see if you are exempt from the requirements of PPACA or not, and whether you will have to pay a tax penalty or not. Under PPACA, all U.S. citizens, nationals and resident aliens will be required to purchase minimum essential coverage (PPACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. The exemption applies to a U.S. citizen who has a tax home (main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and is a bona “de resident of a foreign country. See details under the IRS foreign earned income exclusion test. If a person was required to purchase minimum essential coverage and did not, she/he would be required to pay a tax penalty for not purchasing PPACA coverage (if she/he “les a U.S. tax return). In many cases, this tax is far less than the premiums that a person would pay for obtaining PPACA coverage.
Travel Medical Insurance is not intended to provide U.S. Citizens residing in the U.S. with health insurance. While your Travel Medical Insurance plan for worldwide coverage will not be affected by PPACA, you should review the information below to see if you are exempt from the requirements of PPACA or not, and whether you will have to pay a tax penalty or not.
Under PPACA, all U.S. citizens, nationals and resident aliens will be required to purchase minimum essential coverage (PPACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S.
The exemption applies to:
A U.S. citizen who has a tax home (your main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and
has been a bona fide resident of a foreign country or countries for an uninterrupted period that includes an entire taxable year; or
» is present in a foreign country or countries during at least 330 full days in a twelve month period. See details under the IRS foreign earned income exclusion test.
Even if a person was required to purchase minimum essential coverage and did not, she/he would only be required to pay a tax penalty for not purchasing PPACA coverage (if she/e/she’s a U.S. tax return). In many cases, this tax is far less than the premiums that a person would pay for obtaining PPACA coverage.
Penalty Tax
Q: What will my tax be if I am required to have PPACA coverage, but do not purchase it?
A: Tax Calculations:
Taxes begin in 2014 and rise in years following. In each year, the tax consists of the higher of a dollar amount or a percentage of household income. For a given household, the tax applies to each individual, up to a maximum of three. Following is the schedule of taxes:
2014: The higher of $95 per person (up to 3 people, or $285) OR 1.0% of taxable income.
2015: The higher of $325 per person (up to 3 people, or $975) OR 2.0% of taxable income.
2016: The higher of $695 per person (up to 3 people, or $2,085) OR 2.5% of taxable income.
After 2016: The same as 2016, but adjusted annually for cost-of-living increases.
Tax Examples
2014 – family of 2; taxable income = $26,000; tax = $260 because $260 ($26,000 x 1%) is higher than $190 ($95 x 2 persons).
2014 – family of 3; taxable income = $26,000; tax = $285 because $285 ($95 x 3 persons) is higher than $260 ($26,000 x 1%).
Non-U.S. citizen With Global Medical Insurance
Q. I am a non-U.S. citizen that will be temporarily traveling to the U.S. Do I need PPACA coverage?
A. Travel Medical Insurance short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. If you are a U.S. citizen, national or legal resident alien in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
However please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
U.S. Citizen – Short-Term Travel Medical Insurance:
Q. I am a U.S. citizen that will be temporarily traveling outside of the U.S. Do I need PPACA coverage for this?
A. IMG’s short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. However, since most PPACA plans do not provide the types of international benefits and assistance that travelers need, you should strongly consider purchasing an international travel medical plan such as IMG’s Patriot Travel Medical Insurance for coverage while you travel outside of the U.S.
If you are a U.S. citizen, national or an “alien lawfully present” in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
However, please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
Q: I am an individual residing outside of my home country and covered under an employer group plan. Does PPACA apply to me?
IMG’s short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. However, since most PPACA plans do not provide the types of international benefits and assistance that travelers need, you should strongly consider purchasing an international travel medical plan such as IMG’s Patriot Travel Medical Insurance for coverage while you travel outside of the U.S.
If you are a U.S. citizen, national or an “alien lawfully present” in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
Individuals with a coverage gap of less than 3 months.
Individuals who cannot afford coverage (i.e. required contribution exceeds 8% of household income).
Individuals with a religious conscience exemption (applies only to certain faiths).
Members of a health care sharing ministry.
Incarcerated individuals.
Individuals with income below the tax filing threshold; and
Members of Indian tribes.
In general, PPACA does not govern short-term limited duration insurance, like IMG’s short-term travel medical insurance programs.
However, please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
Expatriate Groups (GEO)
Q. I am an individual residing outside of my home country and covered under an employer group plan. Does PPACA apply to me?
On March 8, 2013, the Departments of Labor, Health and Human Services and Treasury issued a Frequently Asked Question (FAQ) announcing that, for expatriate plans, compliance with most PPACA provisions is being delayed until January 1, 2016. The relief from compliance applies for plan years 2014 and 2015 on plans that meet the following definition:
“Insured group health plans with plan years ending on or before December 31, 2015, in which enrollment is limited to individuals residing outside of their home country for at least six months of the plan year and any covered dependents.”
Q: I am a non-U.S. citizen and an international student. Will PPACA’s individual mandate affect my IMG plan?
As non-resident aliens, international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for 2 years (out of the past six).
Since international students are not subject to the mandate, they are not required to purchase a plan that meets PPACA requirements and can purchase an appropriate IMG plan.
International Students – Exempt as Non-Resident Aliens
Under the IRS international student exemption, anyone “temporarily in the United States on an “F”, “J”, “M”, or “Q” visa for the primary purpose of studying at an accredited academic institution or vocational school (and certain family members of students), and who substantially complies with the requirements of that visa,” is exempt from being treated as a resident alien, and is therefore exempt from the individual mandate as a non-resident alien.
Even after 5 years in the U.S., an international student may continue to be a non-resident alien for tax purposes under the “Closer Connection” exception if they can prove that they still have a closer connection to their home country than to the U.S.
The Individual Mandate and Alien / Non-Alien Status
The IRS provides a questions and answers page on the individual mandate. Question 11 asks whether all individuals living in the U.S. are subject to the mandate. The answer is that U.S. citizens and permanent legal residents are subject to the mandate, as are “foreign nationals who are in the U.S. long enough during a calendar year to qualify as resident aliens for tax purposes.” Thus, non-resident aliens are not subject to the individual mandate, even if they have to file a tax return.
Under IRS Publication 519, Tax Guide for Aliens (the green card test), green card holders are resident aliens for tax purposes. The substantial presence test uses a formula to count the number of days present in the U.S. over the past 3 years. Generally, you a resident alien after six months of presence in the U.S. – unless you are exempt.
Resources
For Travel Insurance questions and to discuss options please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
NY makes the top 25 list again but not the right one. According to the results of an independent study commissioned by New York Life’s Long-Term Care Operations, the average cost for nursing home care in the U.S. has climbed significantly in the past five years, up 20% to $95,706 per year from $79,935 in 2009. In addition, the need for care is growing, with current estimates that seven in ten Americans over the age of 65 will become cognitively impaired or unable to complete at least two activities of daily living over their lifetimes.
The staggering costs of nursing homes have led to a 50% home care surge not surprisingly.
Study Results:
The top 25 most expensive markets, ranked by the daily cost of a private room in a nursing home in the U.S., are:
Rank in 2014
Market
Nursing Home Private Room Annual Rate
Rank in 2009
1
Bridgeport-Stamford-Norwalk, CT
$159,359
2
2
Anchorage, AK
$156,950
1
3
New York-Northern New Jersey-Long Island, NY-NJ
$155,180
4
4
Poughkeepsie-Newburgh-Middletown, NY
$155,180
5
5
Hartford, CT
$154.118
3
6
Boston-Worcester-Lawrence, MA
$146,372
6
7
Rochester, NY
$141,244
8
8
San Diego, CA
$135,554
15
9
Seattle-Tacoma-Bremerton, WA
$131,750
20
10
San Francisco-Oakland-San Jose, CA
$130,283
12
11
Philadelphia-Wilmington-Atlantic City, PA-NJ-DE
$129,239
9
12
San Jose-Sunnyvale-Santa Clara, CA
$127,130
13
Albany-Schenectady-Troy, NY
$126,932
7
14
Portland, ME
$121,910
11
15
Honolulu, HI
$121,154
14
16
Washington-Baltimore, DC-MD
$120,709
18
17
Sacramento-Yolo, CA
$120,322
22
18
Boise, ID
$118,475
19
Milwaukee-Racine, WI
$118,005
16
20
Manchester-Nashua, NH
$117,264
13
21
Miami-Fort Lauderdale, FL
$116,931
25
22
Buffalo-Niagara Falls, NY
$116,577
10
23
Los Angeles-Riverside-Orange County, CA
$115,165
19
24
Detroit-Ann Arbor-Flint, MI
$114,716
25
Portland-Salem, OR
$111,909
24
Long-term care costs continue to increase with the following national averages:
National Averages
2014
2009
Percent Change
Nursing Home Private Room Annually
$95,706
$79,935
20%
Assisted Living Room Monthly
$4,139
$3,100***
34%
Hourly Home Healthcare
$21.86
$21
4%
Assistance for Long-Term Care Planning
New York Life recently launched a Cost of Long-Term Care Services by Area tool atwww.newyorklife.com/ltccosts to help consumers begin to better understand the current, average long-term care costs in their region. The tool allows users to select from over 160 metropolitan areas that are searchable by state and view the current nursing home, assisted living facility and hourly home care rates for the area they selected.
For LTC questions and to discuss options please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
Congratulations – you just signed up successfully for Obamacare! You made it right before the March 31st deadline and avoided the individual penalty and getting blocked out for 2014. Don’t relax just yet. If you’re one of the many people who applied on the first open enrollment it’s smart to expect some bumps over the next few weeks. Shifting deadlines and technical glitches have left many insurance companies scrambling to catch up to the flood of requests. To make sure you start things right, here are some easy ways to stay vigilant:
Pay the premium –Until you pay for the plan you do not truly have a plan just yet. Some states and insurance companies have extended the deadline to pay, but its best to do this as soon as possible. For maximum peace of mind, get written confirmation from your new insurance company. If you go to the doctor before you pay your premium, you may end up footing that medical bill if the insurance company doesn’t have a record of your premium payment.
Member ID Cards –in about 1–2 weeks after you receive your first bill you will receive your Member ID card from your carrier after you’ve made your first premium payment. This is the card you’ll share with medical providers and pharmacies when you receive service. Your carrier may allow you to print a temporary ID card if you need care prior to receiving your Member ID card(s). Your insurance card will (hopefully) arrive in your mailbox in early January. You’ll present it wherever you need services: at the pharmacy, doctor’s office or hospital. Since insurance companies had a very short turnaround time to process new members, you may see a delay. Don’t panic! Go to the insurance company’s website to see if you can print a temporary ID card. (This is a lifesaver!) If you turn up empty, call the company’s customer service number to confirm that you are in their system as an enrolled member.
Don’t rush to the doctors – If you have an immediate need for a prescription or an appointment, by all means take care of it asap. But if you can, wait a few weeks before scheduling your doctor’s visit. This will give time for the insurance companies and doctors to update their systems with all the new plans and enrollees. This way, you help ensure that the medical claim for your doctor’s visit will be processed accurately – and that you dodge some of the early-stage craziness.
Double check – that your doctor is in your new plan’s network . Most of the new insurance plans also came with new provider networks. Its smart to double check that your favorite doctor is in the network for the exact plan you just enrolled in. There are specific networks for different insurance products, so make sure you are checking the right one. If your doctor is not in the network, keep in mind that you may have to pay significantly more money to see an out-of-network doctor, so you may consider switching. See States Pushing Back Against Smaller Networks
Keep records – Keep a record of your payments, calls, emails with your insurance company and physicians. Just in case of a technical glitch in the insurance or doctor’s computer systems, you can show evidence of your payment or confirmations from your insurance company.
Obamacare 2014 Deadline Nearing. You are now more knowledgable than most after reading this article. Given all the new changes thanks to the new insurance plans, new enrollees, and changing deadlines, being aware of these simple tips will help you avoid unnecessary headaches. And remember, if you are still shopping for insurance, you only have until March 31st to enroll in a plan.
For enrollment help before the deadline information please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Qualifying Events for Marketplace Special Enrollment Period
After March 31, 2014, what are considered qualifying events for individuals to buy coverage from the Exchange Marketplace outside of the annual enrollment period?
Please note that the open enrollment for Marketplace coverage ends March 31, 2014. See more at: Obamacare 2014 Deadline Nearing. The next proposed open enrollment period is November 15, 2014 – January 15, 2015. According to the Healthcare.gov site, most special enrollment periods last 60 days from the date of the qualifying life event.
Whats is a Qualifying Event?
A Special Enrollment Period (SEP) is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Eligible individuals have 60 days to enroll after their Qualifying Life Event.
Individual or dependent loses minimum essential coverage due to: job loss; employer no longer offers coverage; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan is decertified
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Other exceptional circumstances, as defined by HHS
Approximately 50% of all enrollments occur outside of Open Enrollment due to Qualifying Life Events. If you are uninsured do not miss your chance to enroll before March 31!
When do I need to complete my application to avoid a federal tax penalty?
You need to complete your application by 11:59pm on Monday, March 31, 2014 to avoid a federal tax penalty. However, if you give us your word that you tried to apply for health insurance and were not able to enroll through no fault of your own, you will have until 11:59pm on Tuesday, April 15, 2014 to complete your enrollment.
I forgot about the enrollment deadline. Can I still buy health insurance through the Marketplace this year?
No. Unless you are Medicaid eligible or you are buying insurance for a child, you must have a major life-changing event called a qualifying life event to be eligible to buy insurance through the Marketplace this year after the deadline. If you don’t have a qualifying life event, you must wait for the next open enrollment period that begins on November 15, 2014 for coverage that starts on January 1, 2015.
When is my next chance to buy insurance through the Marketplace if I am not eligible for Medicaid?
The next open enrollment period for individuals and families begins on November 15, 2014 for coverage that starts on January 1, 2015.
Are there any exceptions to the open enrollment period?
Enrollment in Medicaid, Child Health Plus and the Small Business Marketplace continues all year.
Have a Qualifying Event?
Enroll Now using our online shopping tool
where you can compare plans and prices and enroll
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance. Qualifying Events for Exchange Marketplace. 76 percent of the uninsured are unaware of the looming March 31 sign-up deadline. Contact us at (855)667-4621.
According to a recent Kaiser Poll the majority of uninsured do not know they have until March 31st to buy health insurance or pay a penalty. The new Kaiser poll found 76 percent of the uninsured are unaware of the looming sign-up deadline. Only 24 percent could name the date correctly. It is worth pointing out that the Individual Mandate has NOT been delayed. The initial 6 month open enrollment is about to end by March 31, 2014.
This is troubling as the first open enrollment’s generous 6 month opportunity tightens up to only 3 month for 2015. The public has always had a weak grasp of ObamaCare’s provisions, but the administration’s tendency to shift deadlines has added to confusion about when patients must act to gain coverage. The poll found that 56 percent now view the law unfavorably while 22 percent view it favorably.
Approximately 50% of the population prefer a plan that allow stem to see more doctors even if it costs more. The network strength is not as wide as on the better risk group marketplace. Yet the majority of the uninsured preferred lowers costs even if this means a smaller network. See States Pushing Back Against Smaller Networks.
For enrollment help before the deadline information please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
No discrimination in favor of highly compensated individuals – awaiting further guidance and definitions
Health plan claim and appeals protections
Patient protections, including the selection of primary care provider, coverage of emergency services, and access to pediatric, obstetrical and gynecological care providers
Importantly, the excise tax will not be assessed if an employer can demonstrate that it did not know, and exercising reasonable diligence would not have known, of a violation. Further, the excise tax will not be assessed if the failure is due to reasonable cause and not willful neglect and it is corrected within the 30-day period beginning on the first date an employer knows, or exercising reasonable diligence would have known, that the failure existed. This limited correction window makes identifying and promptly correcting any potential errors of utmost importance.
For more information on compliance please contact our team at Millennium Medical Solutions Corp (855)667-4621.
A humorous take on Affordable Care Act by the site thelibertyactivist.com asks – What would it be like if buying coffee was handled just like Obamacare.
Obamacare Midsize Employer Mandate Delayed Till 2016.
For small businesses employing 50-99 the Treasury Dept is not requiring compliance of the Employer Mandate until 2016. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
The large group employer mandate had been originally delayed until 2015 in July 2013 see- Obamacare Employer Mandate Delayed, More Guidance. Employers with the equivalent of 50 full-time workers or more had to originally offer coverage or pay a penalty starting at $2,000 per worker beginning in 2014.
Employers with 100 or more full-time employers will have to comply with the Internal Revenue Code Section 4980H “play or pay” provision Jan. 1, 2015. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
Under the new rules, companies would be allowed during the phasing-in year to offer coverage specifically to a subset of employees, such as those working 35 hours or more a week, the Treasury said.
Treasury also set new rules for how the requirement would apply to workers such as volunteers and seasonal employees, saying that employers wouldn’t be penalized for failing to offer those people coverage, regardless of the number of hours they were working. Teachers, however, wouldn’t be considered part-time workers even if they were away over the summer, and adjunct faculty would have a special arrangement for how their classroom hours should be counted.
The penalty the employer pays would be based on the number of full-time workers that the employer employs. For purposes of calculating the penalty, the employer would not have to include part-time and seasonal workers in the calculations. Under PPACA, only workers who are not offered group health coverage are eligible to apply for exchange coverage.
The coverage must encompass a core set of benefits and be affordable – which the law defines as premiums costing no more than 9.5 percent of an employee’s income – and the employer must pay for the equivalent of 60 percent of the cost of coverage for workers but not their dependents.
As reported in Washington Post: “Administration officials said that organizations with a large number of volunteer employees – such as firefighters and first responders – would not have to provide coverage, along with those hiring seasonal employers who work six months or less in a given year. Teachers will not be considered part-time just because they do not work for three months during the summer, officials added, while the status of adjunct faculty will be calculated on a formula where they would receive credit for 2¼ hours of service per week for each hour they spent teaching or in the classroom.”
Many Employers are asking for flexibilities of defining FT as higher than 30 hours. The law has already had unintended consequences with shift in employment hours especially in industries such as dining, entertainment, services and construction.
Other transitional relief contained in the regulations include:
For employers with between 50 and 99 employees, the employer mandate is delayed until 2016. Note that an employer must provide a certification to take advantage of this relief.
Employees in positions for which the customary annual employment is six months or less generally will be considered seasonal employees and not full-time employees.
When employers are first subject to the employer mandate, they can determine whether they had at least 100 full-time employees in the previous year by referencing a period of six consecutive months, rather than an entire year.
For purposes of determining coverage in 2015 only, employers may use a measurement period (the period used to determine whether a variable-hour employee is a full-time employee) of six months, with respect to a stability period (the period following the measurement period, during which the variable-hour employee must be offered coverage) of up to 12 months.
Employers with non-calendar year plans must comply with the employer mandate at the start of their 2015 plan year, rather than on January 1, 2015.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
With less than 45 days before the first Affordable Care Act Open Enrollment set to end its important to understand the role of both Brokers and Navigators. The Patient Protection and Affordable Care Act (PPACA) requires States to establish a “Navigator” Program to help educate consumers about Health Exchange marketplace. With the new health insurance exchanges a broker can act either as a traditional broker or a navigator (but not both). The info-graph below illustrates how navigators will differ from brokers.
Specifically, agents and brokers play a vital role in the developing health insurance exchanges nation wide. As the individuals with the education and expertise to advise and help select health insurance products for families and businesses large and small, health insurance agents, brokers and consultants occupy a unique place in the health care coverage system.
We educate consumers on their health care coverage choices, help them select the most appropriate plans for their specific needs, and serve as their advocate if problems should arise. Subject to strict state licensing laws and education requirements, agents, brokers and consultants are critical to not only the health insurance enrollment process, but also in serving the healthinsurance coverage needs of individuals and employers after the point of sale.
Benefit specialists design benefit plans, explain coordination issues of public and private benefits to individuals and employees, and solve complex claims and billing issues. We help design and implement cutting-edge health promotion and wellness programs and help our clients comply with state and federal laws like newly enacted PPACA, HIPAA, COBRA and ERISA.
Professional agents, brokers and consultants continue to assist individuals and small businesses with their coverage needs long after the point of sale. Whereas a travel agent is finished with a client after the travel is completed, benefit specialists continues to serve as compliance experts, health and wellness promoters and the prominent contact for complex claims and billing issues. Health insurance coverage is a longstanding commitment for American consumers and often requires guidance from benefit specialists when dealing with a complex healthcare system.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Whether you’re evaluating your company’s current dental benefits or preparing to offer a plan for the first time,
choosing the best program can be a bit of a balancing act. The challenge of achieving this balance is made more difficult when you consider the options available in the dental benefits marketplace today.Dental carriers typically offer one or more of three basic types of plans:
1. Fee-For-Service (or Indemnity) Plan
The original dental benefits plan and the one which continues to dominate the market is the fee-for-service plan. Under this type of plan, employers and/or their covered employees pay a monthly premium to an insurance carrier, which is responsible for reimbursing dentists for the services they provide. Fee-for-service plans allow employees the most freedom in choosing their dentists, which is why they remain a popular choice. If the main concern for you or the employees you’re covering is the ability to choose a certain dentist, a fee-for-service plan is probably your best choice.
2. Dental PPO
Dental preferred provider organizations (PPOs) are a good option for groups seeking lower cost advantages while providing enrollees with a high level of freedom of choice in selecting providers. Enrollees have the freedom to visit any dentist who is part of a network
Preventive Care Usually Includes:
Annual bite wing x-rays.
Semiannual cleaning, polishing, and possibly semiannual fluoride.
Treatment for employees and their dependents 18-years-old and younger.
Basic Dental Care Includes:
Restorations and basic oral surgery.
Major Care Includes:
Crowns, root canals and prosthetics.
Complex restorations and advanced oral surgery.
established by the dental benefits company or, for higher out-of-pocket costs, can visit any non-network dentist.
3. Dental HMO
Dental health maintenance organizations (DHMOs) give subscribers access to a select group of dentists, with even greater cost savings. This type of program is a good choice for groups seeking lower costs with an emphasis on prevention and a pre-selected network of dentists from which to choose.
Whether it’s a fee-for-service, PPO or DHMO plan, coverage of specific services can vary. Some dental benefits programs cover diagnostic and preventive services only. Others cover the full range of dental services, from preventive to basic and major care. (See right-hand box.)
Riders:Many insurers also offer riders for popular extras, like coverage for orthodontics or cosmetic dentistry. For a little additional cost, riders enable you to customize or supplement a basic dental benefits package.
In the end, finding the right dental benefits program is a combination of many factors. In addition to matching a plan with your company and employees, look closely at other issues such as cost management, rate stability, the network of participating dentists, ease of administration, customer service and company reputation.
Knowing what to ask and how to communicate your company’s wishes makes it more likely your dental insurance will do what it’s meant to do — attract good employees and help them preserve their oral health.
IMPORTANT: A great value is a discounted dental plan. Our very own Bonus Card extends the Aetna Dental Access PPO negotiated rates to members. There are NO pre-existying conditions, NO annual deductibles & NO annual maximums. Cosmetics such as orthodontia and implants are covered. The Bonus Card also covers Vision with Coast to Coast, Rx discount and Telemedicine for $10/month!
Sample Discounted Fees and Savings
Procedure Description
Usual Fee
Discounted Fee
Member Savings
% Savings
Routine 6 Month Check-Up
$43
$24
$19
44%
In Depth Check-Up
$69
$37
$32
46%
Full Mouth X-Rays
$114
$65
$49
43%
Four Bitewing X-Rays
$55
$25
$30
55%
Panoramic Film
$97
$50
$47
48%
Adult Teeth Cleaning
$83
$44
$39
47%
Child Teeth Cleaning
$62
$32
$30
48%
Protective Sealant / Tooth
$46
$26
$20
43%
1 Surface White Filling
$135
$71
$64
47%
Single Crown Porcelain
$981
$566
$415
42%
Molar Root Canal Treatment
$919
$522
$397
43%
Perio Scaling and Root Planning
$217
$123
$94
43%
Full Upper Denture
$1,353
$725
$628
46%
* Actual Costs and savings vary by provider and geographical area. * Dental benefit not available to Vermont residents.
Insurance Versus Dental Cost Examples
The following is a comparative example between a typical insured dental plan versus the Aetna Access Dental discount plan. This illustrates the possible out of pocket costs for each.
Insurance Charges
First 12 Months Premium (Family)
$627.12
Adult Cleaning
$5.00
Child Cleaning
$5.00
Routine Check-Up
$5.00
Four Bitewing X-Rays
$5.00
Composite (white) Filling
$10.00
Crown
$878.00
Molar Root Canal
$855.00
Extraction (single tooth)
$11.00
Total Insurance Charge:
$2,401.12
Total Savings:
$988.12
Discount Charges
Annual Member Fee
$33.00
Adult Cleaning
$54.00
Child Cleaning
$38.00
Routine Check-Up
$28.00
Four Bitewing X-Rays
$32.00
Composite (white) Filling
$78.00
Crown
$604.00
Molar Root Canal
$474.00
Extraction (single tooth)
$72.00
Total Discount Charge:
$1,413.00
Percent Savings:
41%
The select regional average fee represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the Estimate the Cost of Care tool as of November, 2005.
* Insurance plan based on the Aetna DMO Plan. * Actual costs and savings vary by provider and geographical area. Numbers given are regional average fees.
Sources: http://newbenefits.com – New Benefits Dental Care and Aetna Dental Access® Marketing Materials and FAQ http://cdc.gov/OralHealth – Centers for Disease Control and Prevention (statistics) http://moreinformationplease.com – Dental Care Program Information http://adha.org – Oral Health Statistics and Facts http://dentalplans.com – Aetna Dental Access® Nationwide Dental Discount Program (savings information)
There have been plenty of reports in the media of employers having their group insurance plans canceled by health insurance carriers due to health care reform. While there have been plenty of issues, complications, and confusion in regard to group health insurance plans as a result of health care reform…cancelation of group health insurance plans is not one of them.
There are many circumstances where a specific health insurance plan design is being terminated by an insurance company and an employer’s plan is being “routed” to a new plan design. While this may be viewed as problematic for an employer and their employees, it has been happening for years. This issue is most likely not being caused by health care reform, but is likely being exacerbated by it.
The reasons for these routings of plans are several and include:
Normal year to year changes that insurers implement based on many circumstances.
Restructuring of plans so that they can be classified in an appropriate Metal Level category (Platinum, Gold, Silver, Bronze).
Pricing – some plans were not going to be able to continue in the present format.
Employers now have a new alternative if they are being routed to a new health insurance plan for which they are not comfortable. The new alternative is individual health insurance. While there are many items that need further clarity (i.e. circumstances in which an individual may enroll mid-year, pre-tax / post tax, employer deductibility, etc.), it is clear that in many situations the individual health insurance plans are comparatively priced to other small group plans. In addition, the new individual health insurance plans are now Guaranteed Acceptance with no pre-existing condition qualifications.
We’re here to help!
Employers should still seek qualified professional benefits guidance if they considering moving their health insurance programs to an individual platform. Planning, implementation, and ongoing support are just as important as with a traditional group plan. Benefit Consultants that are adapting their practices to the Health Care Reform law such as Millennium Medical Solutions Inc. will be able to help. For more information on individual health plans, please call us as 1-855-667-4621.
Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs.
The plans don’t start offering coverage until January but they’re facing regulatory action, possible legislation, and in at least one case involving a high-profile children’s hospital, litigation.
The pushback against “narrow” provider networks recalls the backlash against managed care and health maintenance organizations in the 1990s. Protests from consumers and hospitals eroded those attempts to restrain expenses by narrowing provider networks.
Now criticism of limited networks has risen as consumers realize that, despite President Barack Obama’s pledge that they could keep their doctors, their Affordable Care Act insurance may not include the physicians or hospitals they’ve been seeing.
The critique feeds into the politically damaging outcry over the millions of people whose health plans were cancelled. It’s unclear whether the limited choice of doctors and other providers will be as much of a concern to uninsured people who will be gaining subsidized coverage through the state-based marketplaces.
Still regulators and elected officials in a few states have already forced changes. Others are weighing legislation that could expand the networks. Legal fights are brewing. In some cases, the officials are responding to complaints of health care systems or providers that were excluded.
In Maine, state regulators prohibited Anthem BlueCross BlueShield from switching some customers to a network sold through the Affordable Care Act’s marketplace that excluded six of the state’s hospitals.
In Washington State, the insurance commissioner initially banned several health plans from the online exchange for what he called inadequate caregiver networks. Some of the plans have broadened networks; the dispute continues with others.
In New Hampshire Anthem’s 2014 marketplace plans exclude more than a third of the state’s hospitals. Lawmakers have written legislation that would force insurers to expand choice.
Anthem will “use the excuse, ‘Well, we’re going to save money by having a narrow network,’” said State Rep. Bill Nelson, a Republican who sponsored the bill pendingin the New Hampshire legislature. “Sure that could happen for some people, but other people are going to be losers. Imagine having to change the doctor you’ve had for years.”
South Dakota, Pennsylvania and Mississippi are discussing measures similar to Nelson’s, known as “any-willing-provider” laws that would force insurers to accept more participants in the networks.
Broader choice comes with a price. The ability to sell less-expensive plans with limited choices of doctors and hospitals helps contain medical inflation, health economists argue. Looser networks could. mean higher prices.
“We had narrow networks in the ‘90s. Health-care prices not only moderated, but actually there was one year where they fell,” said Northwestern University professor David Dranove, who specializes in the health care industry. “Then we had the HMO backlash and we had broad networks [again], and health care prices went through the roof.”
In a typical narrow network, offered in many states under the new ACA rules, caregivers agree to lower prices in expectation of more patients. Insurers pass some of the savings to consumers. Done correctly, limited networks can also save money because family doctors, specialists and hospitals who are all part of the same network do a better job of coordinating care, many health policy experts believe.
Excluding certain hospitals from Anthem’s New Hampshire narrow plan would allow premiums to be 25 percent lower than they otherwise would have been, a company spokesman said. Anthem’s narrow Maine plan would save 12 percent, he said.
Insurers are supposed to compete side-by-side in the health law’s subsidized, online exchanges. Under the ACA, they must all now offer certain basic health benefits and they must cover anyone, regardless of pre-existing conditions.
On this new legal terrain, they compete by offering their best combination of price and providers directly to individuals and families who lack other coverage. Adjusting caregiver rosters is one of the few remaining ways insurers can lower costs, limited-network advocates say.
But others argue that these narrow networks can force patients to switch doctors or drive long distances for care if a key hospital is left out of the plan, especially in states such as Maine and New Hampshire with few insurers selling through the ACA marketplace.
“Whenever you have an extremely narrow network there are potential problems for patients with cancer and for patients with any chronic condition, particularly when it requires the patient to go out of network,” said Kirsten Sloan, senior director of policy for the American Cancer Society Cancer Action Network.
Leaving a network to seek specialized care can lead to enormous out-of-pocket bills, she said.
In extreme cases networks could be too small to serve all the plan members they sign up.
“It’s no good making a narrow network that nobody can get in to see,” said Sander Domaszewicz, a senior benefits consultant at Mercer.
Insurers began unveiling ACA marketplace plans with narrow networks in recent months for coverage that starts in January 2014. Policymakers soon challenged them in several states, often pushed by excluded hospitals and their patients.
Maine Insurance Superintendent Eric Cioppa blocked Anthem from switching several thousand existing subscribers to a plan that excluded Central Maine Medical Center and partner doctors and hospitals. Anthem argued that shrinking its network would provide less-expensive but still high-quality care.
This summer Washington Insurance Commissioner Mike Kreidler blocked five insurers from selling through the exchange, in several cases because of network problems. One plan, he said, would have required people to drive nearly 50 miles to see a cardiologist and more than 100 miles to see a gastroenterologist.
Four plans protested Kreidler’s ban. Three reached settlements, some by adjusting networks. An administrative judge ruled in favor of another, Coordinated Care, whose network doesn’t include a children’s hospital.
Seattle Children’s Hospital, left out of networks including Coordinated Care’s, then sued Kreidler, alleging he failed to ensure adequate access to care.
In New Hampshire, Anthem’s decision to leave hospitals out of its network has prompted at least one to threaten litigation, and Nelson to introduce his bill. Anthem’s network could force some patients in his district to drive a dozen of miles or more to get routine care, he said
In few places has the fight over networks been fiercer than in Mississippi. BlueCross Blue Shield of Mississippi cancelled in-network contracts over the summer with Health Management Associates, a for-profit chain with 10 hospitals in the state.
Blue Cross isn’t selling insurance in 2014 through Mississippi’s federally run ACA marketplace, but many expect it to come on board later.
In response HMA took to the airwaves in protest and pitted the insurance commissioner, who wanted only four hospitals reinstated, against the governor, who ordered the insurer to take back all 10.
“I’ve been practicing law for 36 years and I have never seen as aggressive an effort to sway public opinion as these guys engaged in,” said David Kaufman, an outside lawyer for BlueCross BlueShield of Mississippi said of the hospital chain. “You could not go to your mailbox, pick up a newspaper, watch TV, listen to the radio or answer your home phone without hearing that Blue Cross is the devil.”
Blue Cross sued Gov. Phil Bryant, arguing the order was unconstitutional, noting that his daughter works for HMA’s law firm and pointing out that HMA is one of his top campaign contributors. Bryant backed off but ordered Insurance Commissioner Mike Chaney to hold hearings. He refused. Bryant and Cheney, both Republicans, have clashed repeatedly over the federal health law.
Now Mississippi, too, is talking about an any-willing-provider law, which typically requires insurers to take any hospital, clinic or doctor under terms accepted by other participants.
Such a rule would tell Blue Cross that “it can’t kick somebody out of the hospital of their choice,” HMA executive Paul Hurst told WFMN radio’s Paul Gallo on a show broadcast statewide.
But in any state, making every insurer accept every hospital, “is going to throttle competition,” said Dranove, the Northwestern professor who specializes in the health industry. “And this is a healthcare reform that depends entirely on competition. So the people who are fighting for broad networks… are ultimately fighting for the demise of Obamacare.”
Millennium Medical Solutions Inc. will continue to monitor and report on narrow net- work plans and other efforts by insurers to control costs in the PPACA environment.
NYS Health Exchange FAQ Jan 1 Enrollments. NYS of Helath has provided a helpful Frequently Asked Questions for recent enrollees. We have attached the document for your use.
IMPORTANT: How can I pay my premium bill for January 1st coverage?
You need to pay your health plan – not NY State of Health – no later than 10 days after you receive your invoice (bill) from your plan. You can pay your bill by mail. Some plans may accept payment online or over the phone. Plans must accept the following forms of payment: paper checks, cashier’s checks, money orders, electronic funds transfer (EFT), and all general-purpose pre-paid debit cards. Contact your health plan for more information about payment options or if the due date is a problem for you.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
The holiday season is approaching and you may be wondering whether your company is required to provide time off or holiday pay. Here’s a look at some frequently asked questions and answers
.1. Are employers required to provide employees time off for a holiday?Although not generally required by federal or state law, many employers choose to grant employees time off for certain holidays or to close the business altogether on those days.Companies with 15 or more employees are subject to federal religious discrimination laws and may need to allow employees time off for religious observance. Employers should also consult their state’s nondiscrimination laws to learn if there are similar requirements for time off related to religious observances for employers of fewer than 15 employees.
2. Do employers have to pay their employees if the business is closed for a holiday? Federal law and most state laws do not require employers to pay employees if time off for holidays is granted. Whether or not employees are paid for holidays is generally a matter of company policy. Employers need to be careful when it comes toexempt employees, though–as a general rule, if an exempt employee performs any work during a workweek, he or she must be paid the full salary amount
.3. What about employees scheduled to work on a holiday if the business remains open? Extra compensation (above and beyond an employee’s regular rate of pay) for work on holidays is also generally a matter of company policy, although employers must comply with any specific state law requirements regarding holiday pay. Although some companies pay employees at a special rate (such as time-and-a-half) for holiday shifts, generally an employee is only entitled to his or her regular pay, plus any overtime.Remember that states will generally enforce an employer’s written policy regarding holiday pay, so it’s important to follow company policy and to apply the rules consistently and fairly to all employees. For questions about the specific requirements in your state, contact your state labor departmentor a knowledgeable employment law attorney. Our section on Leave and Time Off features more information on both mandatory and voluntary leave.
Jan 1 Deadline is Today. Attention last minute health insurance shoppers you have until midnight to purchase a policy on the Health Exchange.
NYS Health Exchange is down again. Not surprisingly a large volume of late comers trying to beat t0morrows deadline for Jan 1, 2014. Last week a 34% enrollment spike in 1 week alone. Despite the 1 week extension the enrollments are still falling short of the original 600,000 projection. A significant percentage have instead been qualified under expanded Medicaid in NYS. At the same time many New Yorkers have had sole prop and husband/wife groups shut out of the small group market place. In addition, popular programs such as Healthy NY have been increased by 25-35% and new $600/single or $1200/family deductibles.
Facts:
Some people mistakenly believe they have until Dec. 31 to enroll in a plan that takes effect on Jan. 1. Others don’t realize they could pay a federal tax penalty if they don’t have health insurance in place by March 31.
Under the Affordable Care Act, most adults will pay a $95 penalty — or 1 percent of income — in 2014 if they don’t have health insurance coverage. The penalty rises to $695 — or 2 percent of income — by 2016.
To avoid the penalty, people must enroll in a plan by Feb. 15 or qualify for an exemption from the penalty.
Consumers who sign up by Dec. 23 and pay the first month’s premium by Jan. 10 will have coverage on Jan. 1, the industry group America’s Health Insurance Plans announced Wednesday.
If you make under $45,960 or your family makes under $94,200, you could get a real break on health insurance costs More low-income people will also be eligible for free coverage under Medicaid For those eligible, the subsidies will cap the amount you pay for your exchange policy at between 2% and 9.5% of your income (on a sliding scale, based on your income). To find out how much you would pay, estimate your income for this year and plug it into any health subsidy calculator. You can also see estimate subsidies with these ”health subsidy charts”.
Important: If the web site is down we can sign up via paper application to avoid the penalty. A surge of 34% enrollments in one week caused some technical delays last week.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
NYS Health Exchange 100,000 Enrolled. According to a USA Today article More than 100,000 enroll in N.Y. health exchange, up a third in less than two weeks according to the state Health Department .
According to the NYS Exchange site www.nystateofhealth.ny.gov– As of today, 100,881 state residents had enrolled in a health insurance plan through the state’s exchange. Additionally, 314,146 people had “completed applications” for coverage. The state did not break down the latest data based on the number of people enrolling in private insurance versus Medicaid. The state’s already “vast” Medicaid system “has been credited with having an easier transition to the health exchange.” New York state plans to enroll a total of 1.1 million people by the end of 2016
New York already has a vast Medicaid program, at an annual cost of $50 billion, it has been credited with having an easier transition to the health exchange. Reuters reported Dec. 4 that about 29,000 people signed up for health insurance through the federal HealthCare.gov website on Dec. 1 and Dec. 2 – eclipsing the 26,000 for all of October.
According to sources and our experience half of the Exchange applicants were to determined not be Medicaid eligible. The article Federal exchange sends unqualified people to Medicaid points out that some qualified Medicaid may not in fact be eligible. “The federal health care exchange is incorrectly determining that some people are eligible for Medicaid when they clearly are not, leaving them with little chance to get the subsidized insurance they are entitled to as the Dec. 23 deadline for enrollment approaches.”
New York State, unlike 36 states, runs its own exchange. The NYS website has had less issues than the troubled Federal health Exchange www.healthcare.gov. Our blog NYS Approves Health Insurance Exchange Rates describes how the new rates lower individual insurance market by 50%.
New York has various tiers of health insurers, and customers can pick from 16 insurers and 10 dental insurers. Quotes can also be viewed on our site. The program also has a small-business marketplace that offers health insurance to businesses with 50 or fewer employees. Large businesses that do not offer employees health insurance could be hit with a fine in 2015.
The exchange also offers tax credits to those who earn less than $45,960 as an individual or $94,200 as a family of four.People without health insurance would be hit with a fine on their income taxes for 2014, starting at about $95 or 1 percent of gross income. The fine can grow to as much as $695 a year , then double in 2015 and grow over time.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
The following companies had health insurance plan rates for the health benefits exchange approved today by DFS. The rates approved today are subject to final certification of the insurers’ participation in the exchange.
Affinity Health Plan, Inc.
American Progressive Life & Health Insurance Company of New York
SHOP Exchange Delayed One Year. The White House just announced that the online Small Business Health Marketplace also known as SHOP Exchange has been delayed until 2015. Small businesses will still have the option to purchase coverage through the new marketplace but will not be able to do so online. Instead, until next fall, employers with fewer than 50 workers will need to work through a broker or agent to buy health plans for their employees.
The Small Business Health Options Program, or SHOP Exchange, has already had a troubled launch with multiple delays as the Obama administration has focused much of its efforts on launching the individual insurance marketplace where Americans can shop for subsidized health insurance coverage.
Small businesses buying coverage will still be eligible for small business tax credits to bring down the cost, according an administration memo. Also, businesses can still purchase the same plans and same rates available on Off-Exchange. Medical Insurance premiums through the business is an ordinary tax deductible expense.
According to NY Times Article, Online Health Law Sign-Up Is Delayed for Small Business – “The announcement of the delay, just before Thanksgiving, is reminiscent of the way the White House announced, just before the Independence Day weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.”
The recent setback is the latest in a stream of missed deadlines, including a postponement for a Spanish language sign-up tool announced this week. The administration also recently pushed back the enrollment deadline for individuals: People who sign up by Dec. 23 can get coverage that starts on Jan. 1. In an earlier delay, businesses with more than 50 workers were given until 2015 to meet the requirement to provide health insurance without paying a penalty. And the deadline date for individuals to avoid penalties for failing to get coverage was pushed back six weeks.
If you should have any further questions regarding the SHOP program or comments about the above or the attached, please let us know. We will continue to monitor this issue and all ACA implementation in an effort to keep you informed of new developments. In the meantime, please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
United Healthcare Dropping Medicare Docs. United Healthcare has notified 10-15% of its Medicare Advantage Providers that they will be dropped from their network this February.
Providers are calling the move by the insurer to increase their star rating in order to increase Medicare (CMS) reimbursements. Quality-incentive payments to insurers under CMS’ five-star rating system for health plans will get stricter in 2014, eliminating payments to any plan earning fewer than four stars. Over the past two years, plans with 3 or 3.5 stars received payments.
According to today’s WSJ article UnitedHealth Culls Doctors From Medicare Advantage Plans – The company said it is managing its network, in part, to provide more value for members, particularly given Medicare’s new five-star rating system that ties bonus payments for insurers to certain measures of cost and quality.”That’s what’s driving our actions,” said Austin Pittman, president of UnitedHealth’s networks. He also said, “It’s no secret that we are under substantial funding pressure from the federal government.”
According to a study by the Kaiser family Foundation, United received $540 million in bonus payments in 2012 — the largest share for any single carrier. United had a CMS rating of 3.17 stars that year, according to the study.
This is important as AARP endorses the popular AARP Medicare Advantage Insurance Plans, insured by UnitedHealthcare Insurance Company. According to WSJ article AARP issued a
statement saying it “has heard from a small number of our members regarding this decision” and was encouraging anyone with concerns to contact UnitedHealth directly.
The article points out “Medicare Advantage, an alternative to traditional Medicare, combines hospital and doctor coverage and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.” Also worth noting, “providers have the right to an appeal within 30 days.”
2014 Medicare Open Enrollment is here. Medicare Open Enrollment for 2014 ends Dec 7th. We, at Millennium Medical Solutions Inc, are working closely with affected members to help them find new providers and that patients enrolled in its commercial, Medicaid and Medicare supplement plans are not affected by the changes. Some members may turn back to original Medicare as a result of possibly losing their Doctors.
Download a Copy Of The Medicare and You 2014 Handbook Here.
Is your Doctor still in the network? Is Medicare Advantage still right for you? Please contact us for immediate review at (855) 667-4621. Please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
Breaking News President Announces Cancelled Policies Fix
Yesterday, the President announced that people with health care coverage that is not Affordable Care Act (ACA)-compliant may be able to keep their plans in 2014. Effectively “Grandfathering” of plans purchased after the original law has passed in 2010 There has been a great deal of concern being reported in the national media around the prospect of millions of people losing their health insurance coverage effective January 1, 2014 because of the Patient Protection and Affordable Care Act (“PPACA” aka “ObamaCare”).
We are awaiting how specifically your State’s Insurance Commissioner will react to this. Questions remain about how this new policy will work, including how insurance commissioners will react, whether insurance companies will choose to continue these policies, what the rates for the policies will be, and whether this grandfathering will extend past 2014.
To be clear, what’s being reported principally has to do with the individual health insurance market in the US which insures approximately 15 million people, or about 5% of the country’s population. Within that segment of the privately insured market, a large percentage, certainly more than half, of individual policies are not considered to be “grandfathered” under the law’s requirements for such status. As a result, to be in compliance with the law’s new mandates and coverage requirements, virtually all “non-grandfathered” policies are scheduled to be terminated January 1st, and it will be up to individuals to replace their existing coverage with new compliant policies after this date.
These recent developments have resulted in
1) President Obama issuing an apology to affected individuals on November 7th.
2) the President’s announcement earlier yesterday during a hastily called press conference at the White House that pursuant to an Executive Order, Americans may keep individual health insurance policies they were told will be canceled because these policies failed to meet requirements established by the new law.
President Obama has left it up to the states to independently determine how they will go about implementing this change which is being characterized as an “administrative fix”. However, since the insurance business is state-regulated, each state will need to determine whether or not they will implement this change, and if they choose to implement it, they will have control over defining some of the specific parameters. Insurance companies will also need to quickly make decisions on how to accommodate this new provision if the change is adapted in a state in which they operate.
In closing, if you should have any further questions or comments about the above or the attached, please let us know.We will continue to monitor this issue and all ACA implementation in an effort to keep you informed of new developments. In the meantime, please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
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