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.

California SB 639 Signed by Govenor effects Health Plans

On September 20, 2013, Governor Jerry Brown signed SB 639 into law.

The bill, introduced by Senator Ed Hernandez (D-West Covina), goes into effect January 1, 2014 and addresses annual deductible and out-of-pocket limits for all non-grandfathered health plans in the individual, small and large group markets.

Essentially, the bill states that any non-grandfathered plan in the individual or small group market that becomes effective or renews on or after January 1, 2014, must limit annual deductibles to $2,000 for individual coverage or $4,000 for families.

Any non-grandfathered plan in the individual, small group or large group market that becomes effective or renews on or after January 1, 2014, must limit annual out-of-pocket costs (for Essential Health Benefits) to $6,500 for Individual coverage, or $12,700 for family coverage.

The exception to this is pediatric care, which will have its own limits. When a non-grandfathered health care service plan or a health insurer in the individual or small group market provides a pediatric oral care benefit meeting the definition as specified in the ACA, the out-of-pocket maximum for the pediatric oral care benefits is $1,000 for one child and $2,000 for more than one child.

Carriers who are not in the Exchange, cannot offer a catastrophic (higher deductible) plan in the Individual market. However, the law allows the DMHC or the CDI higher deductibles for small group products at the bronze level of coverage in order to meet Minimum Value.

Catastrophic plans or policies are defined as “A health care service plan contract or health insurance policy that provides no benefits for any plan year until the enrollee has incurred cost-sharing expenses in an amount equal to the annual limit on out-of-pocket costs, except requires the plan provide coverage for at least three primary care visits.” Catastrophic plans can only be offered if either of the following apply:

• The individual purchasing the plan has not yet attained 30 years of age; or,
• The individual has a certificate of exemption from the federal individual mandate because the individual is not offered affordable coverage or because the individual faces hardship.

The Notice of Exchanges and Subsidies Deadline is Today-By October 1, 2013

Virtually all US employers (regardless of size or whether the employer offers a health plan) are required to distribute a Notice of Exchanges and Subsidies to each employee (regardless of part-time, temporary, full-time or health plan enrollment status). Additionally, beginning on October 1, 2013, this notice must be provided to each new employee within 14 days of the employee’s start date.

There are two model notices available, one for employers that offer a company-sponsored health plan to some or all employees, and one for organizations that do not offer an employer-sponsored health insurance plan. Both of these model notices are available for download in the HR Support Center “Essentials” tab under the “HR Forms” section. (Simply type “Notice of Exchanges and Subsidies” in the Search Box.) There is also an FAQ document regarding this requirement housed in the same location. The purpose of the Notice of Exchanges and Subsidies is to inform employees of the existence of Health Insurance Exchanges (also called Health Insurance Marketplaces) as well as potential federal subsidies available to them in 2014.

Should an employee opt to shop in the Exchange, the employee may use this Notice provided by the employer to enter certain information on the application. The Exchanges are government-provided virtual marketplaces intended to offer individuals and small groups “one-stop shopping” to find and compare private health insurance options.

Open enrollment for health insurance coverage through the Health Insurance Marketplaces begins October 1, 2013 and coverage is available beginning on January 1, 2014.  On September 11, 2013, the DOL announced that there is no specific fine or penalty for failing to provide the notice by October 1, 2013.  However, the DOL or plan participants may bring a civil action against an employer for failure to comply with this notice requirement.
 

Press Release
FOR IMMEDIATE RELEASE

AMSINSURE.COM Receives 2013 Best of Torrance Award

U.S. Commerce Association's Award Plaque Honors the Achievement
NEW YORK, NY, September 10, 2013 -- For the fifth consecutive year, AMSINSURE.COM has been selected for the 2013 Best of Torrance Award in the Employee Benefits Health, Dental, Vision, Pension Insurance category by the U.S. Commerce Association (USCA).
The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.
Nationwide, only 1 in 1000 (less than one-tenth of 1%) 2013 Award recipients qualified as Five-Time Award Winners. Various sources of information were gathered and analyzed to choose the winners in each category. The 2013 USCA Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.

About U.S. Commerce Association (USCA)

U.S. Commerce Association (USCA) is a New York City based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.
The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.
SOURCE: U.S. Commerce Association

CONTACT:
U.S. Commerce Association
Email: PublicRelations@uscaaward.com
URL: http://www.uscaaward.com
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Don Wachtel was determined to take care of his family

by LIFE Happens

Don Wachtel was determined to take care of his family, and purchased a term life insurance policy. As fate would have it, the policy ended up taking care of him. When he was diagnosed with an inoperable brain tumor, he was able to access a portion the death benefit early to help with his care and his family's transition.   view here

Hospitals supersize, fueling rising cost of care, AHIP says

From www.amsinsure.com
Hospitals and medical systems are increasingly merging with or buying competitors, potentially driving up health care prices as they gain negotiating power over payers, experts say. "The rhetoric is all about efficiency. The reality is all about higher prices," said AHIP President and CEO Karen Ignagni. Some 20% of U.S. hospitals are likely to seek mergers within the next five to seven years, Booz & Company analysts say. The New York Times (tiered subscription model)

Eating for Optimal Health now availale

Available now...

The 2013 Wellness Report:
Eating for Optimal Health

With thousands of books ... articles ... websites ... reports ... and clinical studies on eating for optimal health, no single person can keep up with all of the new developments in nutritional research. It would be a full-time job--and you probably already have one of those!

realLIFEstories

LIFE Happens has uploaded realLIFEstories | Life Insurance | Boomer Esiason

Boomer Esiason, retired NFL quarterback and current TV analyst, has a passion for life insurance. His mother died when he was just 7, and money was tight growing up because of it.


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Obama administration launches ACA support tool for businesses

A new government website called the Health Care Wizard gives employers customized information about how the Affordable Care Act applies to them based on company location, size and health insurance plans offered. The tool returns formulas for calculating penalties, compliance dates and new regulations. NEW SITE     AMSINSURE.COM

Easy access tool on Health Care Reform for Business

Health Care Changes: A New Tool for Small Business Owners

We're excited to announce a new, streamlined health care tool , housed at Business USA,  to help you find out exactly what you and your employees need to know about the Affordable Care Act. In a few quick steps, you'll understand the essentials of new insurance options and other health care changes.

> Try the new health care tool