Health Care Reform with our HR platform

email us at info@amsinsure.com  , subject HR_ACA HR Demo    The Patient Protection and Affordable Care Act (PPACA) contains comprehensive health insurance reforms that require compliance by employer-sponsored group health plans. The material and links on this page is designed to help employers review their plan's compliance with the major health care reform requirements and to learn more about the topic. For even more information on Health Care Reform, please visit our library of trainings available for immediate viewing in the Training On-Demand section of the Training & Education tab above. Currently we have Health Care Reform trainings for small employers and large employers as well as a separate training all about the Employer Mandate. Please note that the lists on this page are for general reference purposes only and is not all-inclusive. These lists are also subject to change based on new government requirements or directives. If you have any questions regarding your company's obligations with respect to health care reform, please consult with an HR Professional or benefits insurance provider for specific guidance. Get our free HR platform and stay up to date and informed, its easy. info@amsinsure.com    subject   HR_ACA

Private health insurance exchanges gain traction with employers

Employers, others ditch old benefits model

For decades, the way employers offered health insurance coverage to their employees and retirees changed little. Now more and more companies are moving to a new health benefits delivery model using private health insurance exchanges.


Under the old model, employers, often with the assistance of consultants, brokers and agents, decided the insurers from which they would purchase coverage, the number and types of health plans they would offer employees, and how much they would contribute toward the cost of the coverage.
In addition, employers were deeply involved in plan administration, arranging and holding open enrollments for employees to choose one of the plans offered.


By contrast, with private insurance exchanges, employees and retirees select from a variety of health care plans and designs, with the employer's role largely limited to deciding how much of the premium it will pay.


While the move to private exchanges is not entirely new, there has been an accelerated shift in the past year, said Michael Thompson, a principal with PricewaterhouseCoopers L.L.P. in New York.
In the past few weeks, big and well-known industry-leading employers, including IBM Corp. and Walgreen Co., have disclosed that, starting next year, their employees or retirees will choose health care plans offered by insurers participating in private exchanges.


Rethink your companies choices and look to the Private Exchanges.

Those penalties can be stiff if you become a target of the IRS

The Internal Revenue Service has threatened employers with Affordable Care Act penalties of $36,500 per employee, per year, nondeductible. Makes those $2,000 and $3,000 penalties look like small potatoes, right?

The targets of this particular Q&A are employers who maintain “non-integrated” “employer payment plans.” These are new terms, which include reimbursement plans such as health reimbursement arrangements (HRAs, excluding retiree-only and excepted benefits HRAs). Those should generally have been eliminated by Jan. 1, 2014, or amended to be integrated with group health coverage.
The federal agencies dropped this bomb on employers on the cusp of open enrollment season last year, and many employers had to scramble into compliance. You could have done the math on the $100 per day excise tax. But the IRS puts this $36,500 figure into a Q&A for a reason: it wants to scare you. And employers need to know that a non-integrated employer payment plan is just one of many potential triggers of these potentially devastating excise taxes.


When I first blogged about health care plan self-audit, self-correction, and self-reporting compliance issues on Form 8928, no one seemed too interested. It’s time to get interested.


Caresani, a partner Porter Wright Morris & Arthur’s Cleveland/Akron, Ohio area, focuses her practice on employee benefits, ERISA and executive compensation. As editor of the firm’s employee benefits blog — Employee Benefits Law Report — and the ERISA preemption chapter of ERISA, A Comprehensive Guide (published by CCH), Caresani consistently reviews recent cases, legislation, regulations, and other employee benefits law developments and helps our clients understand how these changes may impact their organizations.

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

Exchange Rx may cost more than employer sponsored plans.

Silver plans offered through the exchanges may require patients to pay more than twice as much out of pocket for prescription medicines as they would under a typical employer plan, offering employers a prime opportunity to use health care benefits as retention and recruitment tools for their employees.

Silver plans — the second highest coverage tier on the Affordable Care Act’s public health insurance exchanges — impose 130% higher cost sharing for prescription medicine, along with a combined deductible, than typical employer-sponsored plans, according to a new report by the Seattle, Wash.-based Milliman Inc., a consulting company. The Milliman report also notes that silver plans are nearly four times more likely to have a single combined deductible for medical and pharmacy benefits (46% of the time) compared to typical employer-sponsored plans (12%).
See related story: Access to Rx drugs challenged by the exchanges
Employees with chronic conditions requiring the use of medications could be motivated to seek out employers offering high quality health care coverage rather than those that have opted to send their employees to the exchanges, says Brenda Gagnon, a pharmacy-focused benefit adviser and president and CEO of the health care consulting firm B.M Gagnon Associates.
“Employers have started recognizing that offering great health care coverage has become an attraction tool for high quality talent and retention for current employees,” she says. “This movement started in mid-year 2013 and will pick up speed faster this year.”
She adds: “Advisers that don’t take this knowledge and bring it into their business practice will be left behind.”
“Americans participating in the exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” says John Castellani, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), the Washington, D.C.-based trade association that commissioned the report.
“Patients face hurdles in accessing the medicines they need to manage their conditions, which is particularly problematic for Americans trying to control their chronic diseases,” he adds.
According to Milliman’s analysis, the typical deductible for silver plans is $2,000.
Previous studies have found that higher out of pocket costs reduce patients’ likelihood of taking prescription medicines to manage chronic conditions. The result is an increase in hospitalizations and higher health care costs overall, a common reason employers often exclude pharmacy benefits from deductible requirements — in the long-term it saves the employer money on increased medical costs.
Programs that encourage better adherence to medication management for chronic conditions have also been found to reduce emergency department visits, hospitalizations and other preventable, costly care, the Milliman report adds.
According to a 2012 Health Affairs study, improved medication adherence for patients with diabetes has the potential to save $8.3 billion each year.
The Milliman report analyzed the differences between common health care benefit designs offered to individuals through the exchanges and typical employer-sponsored plans. The report looked at silver plans because they were the most popular in the enrollment period that ended March 31 of this year.

COBRA SEP in CA?

Posted: 16 May 2014 06:21 AM PDT

**Question**: Is the COBRA SEP adopted by CA the same as the feds? **Answer**: No. The COBRA SEP in CA extends from May 15 to July 15 (SEP in fed exchanges ends July 1st)So people **currently enrolled** in COBRA coverage have until July 15 to apply for coverage through Covered California or off-exchange in a ACA compliant plan.

Uninsuree rate at five year low while ACA remains unpopular

Uninsured rate at five-year low while ACA remains unpopular

Obamacare reduced the percentage of U.S. adults without health insurance to its lowest point since 2008 even as the law remains unpopular with the public, separate surveys showed. READ MORE »

ACA effects on employers still to come

All of the delays related to the Affordable Care may be seen a sign of the law's failure, but one employment law expert said Monday employers can view the delays as a good thing – an extra year or more to figure out what to do. READ MORE »

Feds: Employers must notify laid-off employees of exchange option

Laid-off employees are eligible to continue participating in employer-sponsored health plans after they are laid off, but employers must now also inform employees that they can enroll in a plan through an Affordable Care Act exchange, under recent guidance from the departments of Labor and Health and Human Services. The Wall Street Journal (tiered subscription model) (5/2)

California Employee Benefits from AMSINSURE.COM: 2015 to see expansion by some Health Insurance Car...

California Employee Benefits from AMSINSURE.COM: 2015 to see expansion by some Health Insurance Car...: Major insurers to expand Obamacare markets in 2015   Despite dire predictions on...

2015 to see expansion by some Health Insurance Carriers in the State Exchanges

Major insurers to expand Obamacare markets in 2015

Despite dire predictions on insurers’ future in the public exchange, two leading carriers are actually expanding their presence.

Read more April 17, 2014     Committed to news, opinion and business analysis

Off exchange enrollmetn does well, and little noticed with eyes on the health care exchanges

All eyes were fixed on final 2014 HIX enrollment numbers in the waning days of March and what they would mean for adverse selection and future monthly premium pricing. But such data has eclipsed significantly important details about the post-health care reform marketplace that have been largely overlooked.

Case in point: It has been estimated that millions of Americans who aren’t eligible for HIX subsidies chose health insurance options off the exchanges, including young and healthy adults who are most desirable in any insurance risk pool.
The potential implications of this phenomenon are worth noticing. While only about 25% of those between the ages of 18 and 34 signed up for coverage on public exchanges, according to the federal government’s most recently released enrollment figures, about 40% of that same age group bought off-exchange plans in the fourth quarter through the online comparison-shopping site eHealth. A survey of eHealth customers found that 63% mistakenly thought that they could only enroll in HIX plans through government exchanges.
Health insurance carriers also say that a fair number of new signups do not involve HIX options. WellPoint, for example, recently reported that about 20% of the roughly one million customers it expected to enroll new plans nationwide would be off the exchanges. The number was even higher for Highmark, which noted that approximately 30% of 133,000 members who enrolled as of the middle of last month chose coverage outside the exchanges.
The trend is understandable. Jay Jensen, a managing member of Insight Benefits Group, LLC, says carriers that have shunned the HIX model are able to offer competitive pricing off the exchanges by targeting healthier customers with higher incomes who are going to have a better claims experience than unhealthy lower-income earners who could trigger adverse selection.
His employee benefits and risk management firm has partnered with two Web-based entities, Quotit and Norvax, to help employees shop for health insurance on or off the exchanges with the help of licensed professionals.
Consumers may barely notice any differences between HIX and off-exchange options, aside from whether they’re eligible for federal subsidies. The same plans available on public exchanges often can be purchased off those exchanges through a local health insurance agent, according to Brian Mast, vice president of communications for eHealth Inc. “In some cases there may be more options outside of exchanges because certain carriers have opted out of state exchanges, but are still offering ACA plans,” he says.
Whatever the final enrollment numbers for both HIX and off-exchange options turn out to be, industry analysts surely will comb through every detail for the most accurate picture of how the new online marketplace might evolve.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, says the focus needs to be broader than just the number of people enrolling and also include, as suggested, the age and health status of enrollees. Another critical point is that the impact of enrollment will vary by state. “What may happen in Illinois with this risk pool isn’t going to have the same impact as, say, California,” she says.
Shutan is a Los Angeles freelance writer.

Bill bumping ACA to 40-hour work week passes House

Bill bumping ACA to 40-hour work week passes House   The U.S. House of Representatives on Thursday passed legislation that would modify the Affordable Care Act’s definition of a full-time employee from one who works 30-hours a week to one who works 40-hours a week. READ MORE »

More employers embracing ACA provisions in health plan designs

More employers embracing ACA provisions in health plan designs

While it’s not surprising that in 2013 the trend of employers shifting rising health care costs to employees continued to grow, it also appears employers have begun to design health care plans with looming Affordable Care Act provisions in mind. READ MORE »

Top Stories in Health Care Reform

In a sign of just how difficult it is to rein in out-of-pocket costs, 35% of 2014 bronze-level plans in the Small Business Health Options Program had deductibles that exceeded suggested annual caps under the Affordable Care Act. READ MORE » For millions of low-income Americans, the road to health care reform in 2014 could prove to be a jagged line through which they bounce between public exchanges and Medicaid as their income fluctuates over the year. While the effect on care consistency, quality and cost generates concern for those forced to switch health plans or doctors, it may pale in comparison to the “churning” phenomenon long seen in Medicaid when program eligibility is lost and then regained. “The challenge historically has been that people have churned between coverage and nothing, and that’s a big problem,” explains Matt Salo, executive director of the National Association of Medicaid Directors. “Now while churn is still a problem, it’s a much better problem to have as people are moving between Medicaid coverage and exchange coverage.” He acknowledges key differences in terms of cost sharing and benefits, as well as movement among different provider networks, but points to a number of solutions aimed at encouraging a segmented industry to straddle these lines. Examples include Nevada’s requirement that Medicaid managed care companies offer a comparable HIX plan, Washington’s program to create seamless plans with identical networks and Delaware’s plan to ease any HIX transition from Medicaid by covering approved medical treatment and medications. There’s also bipartisan legislation, sponsored by two Texas congressmen, U.S. Rep. Gene Green, a Democratic, and U.S. Rep. Joe Barton, a Republican, to help stop churning. Their plan would require states to guarantee a year of continuous eligibility to people on Medicaid – a requirement in about two dozen states for children on Medicaid and the Children’s Health Insurance Program. “Do Medicaid-only plans want to start offering coverage in the exchange and do predominantly private-sector plans want to start playing in Medicaid?” Salo asks. “If you can make that happen, you drastically minimize churn if you can move an individual from a company’s Medicaid product into that company’s exchange product, or vice versa. “Plans should want to do this, and some already are,” he continues. “Compelling them to do so is technically a tool that states can utilize, but it’s a pretty drastic one, and most states won’t pursue that. Other states are looking at less invasive policies, such as requiring that any plan cover a previous plan’s therapeutic or pharmaceutical plans of care for some period of time after the churn, even if those aren’t in the plan’s benefit package.” An estimated nine million people are expected to shift between the exchanges and Medicaid during 2014, Matthew Buettgens, a senior research analyst at the Urban Institute, noted in a recent Kaiser Health News story produced in association with The Washington Post. While nearly 30 million Medicaid beneficiaries are enrolled in private managed care plans, Medicaid expansion plans under the Affordable Care Act are expected to make millions more eligible for such coverage. The report suggested that convincing these health plans to sign up for both markets to help avoid any churning remains a challenge, with just 16 of 60 Association for Community Affiliated Plans members having joined the exchanges. One such explanation is differences between Medicaid contracts and state health insurance rules for commercial plans. Bruce Shutan is a Los Angeles freelance writer.

Affordable Private Exchange

Premier Carriers ApplaudCaliforniaChoice for its Broad Selection, Affordability and Focus on CustomerService
As government-run healthcare exchanges continue to grab the national spotlight, employers in California are increasingly seizing the opportunity to enroll in the...

California rejects Obama plan to extend canceled healthcare policies Los Angeles Times | November 21, 2013 | 2:15 PM California's health insurance exchange voted unanimously Thursday against an extension of canceled health policies affecting about 1 million consumers in the state. The decision ends a weeklong drama over what would happen for policyholders who will lose their existing coverage Dec. 31 and face finding replacement insurance that may cost more. The 5-0 vote by the state exchange marks a break with the president since California has been a strong supporter of the Affordable Care Act. For the latest information go to

IRS change could make health FSAs more popular

The Internal Revenue Service has altered the "use-it-or-lose-it" rule for medical flexible spending accounts, allowing workers to roll over $500 from year to year, write Robert Bloink and William Byrnes. FSAs could become more valuable than ever under the Affordable Care Act because of greater out-of-pocket expenses for many people, Bloink and Byrnes write.

Sorting out ACA subsidies and credits

People with incomes higher than 400% of the federal poverty level may purchase health insurance plans from an Affordable Care Act marketplace, but they will not qualify for federal subsidies, and people whose incomes rise might have to pay back any subsidies they received the prior year. People who have health insurance through an employer do not qualify for subsidies unless that insurance meets the definition of unaffordable, and subsidies are calculated based on the cost of a silver-level plan but may be applied to a lower- or higher-tier plan. Subsidies to help with deductibles and copays are available to people making less than 2.5 times the poverty level, but they apply only to silver-level plans.

Section 125 rule change

The Internal Revenue Service announced last week in IRS Notice 2013-71 additional loosening of rules around cafeteria plans, all size employers with non-calendar year cafeteria plans have the option to amend their cafeteria plans and allow for one off-year election change. Generally, Section 125 cafeteria plan elections must be made before the start of the plan year, and are irrevocable during the plan year, with limited exceptions, including certain changes in status. Under existing regulations, the availability of health plan coverage through an Exchange beginning with 2014 calendar year does not constitute such a change in status. As a result, employees would not be able to change their salary reduction elections for health coverage during a plan year in order to, for example, cease their salary reductions and Section 125 cafeteria plan coverage and purchase coverage through an Exchange. The original transition rule allowing for one off-year election change was published in the employer mandate regulations and only applied to applicable large employers. IRS Notice 2013-71 expands the transition rule to all size employers.