Affordable Care Act Implementation: Examining How to Achieve a Successful Rollout of the Small Business Exchanges

The Committee on Small Business and Entrepreneurship held a hearing on Wednesday, November 20, 2013 at 10:00 a.m. in SR428 entitled “Affordable Care Act Implementation: Examining How to Achieve a Successful Rollout of the Small Business Exchanges.”

 

 

 

Archived Webcast

 

 

 

 

Witness Panel 1

 

Mr. David Allen
President & CEO
David Allen Enterprises, LLC

 

Sheila A. Salter
Founder & CEO
early2surg

 

Ms. Connie Evans
President & CEO
Association for Enterprise Opportunity

 

Mr. Drew Greenblatt
Owner
Marlin Steel Wire Products

 

Mr. Martin Hickey, MD
CEO
New Mexico Health Connections

 

Ms. Mila Kofman
Executive Director
DC Health Benefit Exchange Authority

 

Mr. William Nold
Deputy Executive Director
Office of the Kentucky Health Benefit Exchange

 

 

Witness Panel 2

 

The Honorable Phyllis C. Borzi
Assistant Secretary
Employee Benefits Security Administration

 

Mr. Gary Cohen
Deputy Administrator & Director
Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Service U.S. Department of Health & Human Services

 

Ms. Marianne O’Brien Markowitz
Regional Administrator
U.S. Small Business Administration

Now some KY Anthem customers can choose to keep their current plans for another year

Anthem individual members and small group employers who have not moved to an ACA-compatible plan to keep their current health plans (and network of doctors) under new guidance from the federal government about the Affordable Care Act allows for another year. Individuals and small groups with renewals starting July 1 will be extended this offer.

 

Upon their renewal, Individual members were mailed ‘transition’ notices and small group clients were mailed ‘discontinuance’ notices from Anthem prior to this ruling informing them that their current legacy plan would be discontinued upon their 2014 renewal date and that they would be automatically transitioned into an ACA-compliant plan. The notices for July and August clients have already been mailed because Anthem is mandated to mail such notices 90 days in advance of the renewal date. It is important for you to know however, that those individuals and small group clients (with a July-December renewal) do not have to transition into an ACA-compliant plan and are therefore eligible to grandmother their current plan.

 

The Benefits Firm Now some KY Anthem customers can choose to keep their current plans for another year

Your clients may experience a rate increase at renewal, if they choose to stay on their current plans but, their plan will be exempt for another year from the ACA product changes that went into effect January 1, 2014. Clients will also gain more time to understand how health care reform may work for them.

 

When your clients are mailed their renewals from Anthem, they will get more details. Here are sample letters for individual members and small group employers explaining the new offer. This required notice from the Centers for Medicare & Medicaid Services (CMS) for individual members and small group employers is also included in the communication.

 

If your client wants a different plan, or for more information please contact The Benefits Firm.

 

Ph: (502) 451-4560

info@thebenefitsfirm.com

620 S. 3rd Street, Suite 102 Louisville, KY 40202

ACA does away with annual deductible limits for small health plans

As part of the Protecting Access to Medicare Act of 2014 signed by President Obama on April 1, the Affordable Care Act’s (ACA) annual deductible limit for small group health plans has been eliminated. This change is retroactive to March 2010.

 

What this means is that small employers will have more flexibility to control premium costs by selecting health plans with higher deductibles. However, the out-of-pocket maximum (including the deductible amount) and other ACA requirements will continue to limit cost-sharing opportunities in these small group plans.

 

The ACA originally included an annual deductible limit for the small group market for plan years beginning on or after Jan. 1, 2014. The annual deductible was not to exceed $2,000 for single coverage and $4,000 for family coverage. The ACA required the deductible limit to be adjusted annually. For 2015, the Department of Health and Human Services (HHS) had announced that the annual deductible limit would increase to $2,050 for single coverage and $4,100 for family.

 

untitled ACA does away with annual deductible limits for small health plans   Small employer health plans that have started their 2014 plan years were already required to include the ACA’s annual deductible limit and will not be affected by the repeal until their 2015 plan years. But small group health plans that have not started their 2014 plan years may be able to avoid the ACA’s deductible limit altogether.

 

The ACA’s out-of-pocket maximum still applies to all non-grandfathered health plans and places an annual limit on total enrollee cost-sharing for essential health benefits for plan years beginning on or after Jan. 1, 2014. This includes self-insured health plans and insured health plans of any size.

 

Effective for 2014 plan years, a non-grandfathered health plan’s out-of-pocket maximum may not exceed $6,350 for single coverage and $12,700 for family coverage. For 2015, that the out-of-pocket maximum will increase to $6,600 for self-only coverage and $13,200 for family coverage. The maximum will continue to increase annually. HHS is providing transition relief for 2014 plan years for plans that use more than one service provider to administer benefits.

 

To learn more about how this policy change may affect you, please contact The Benefits Firm.
 
Ph: (502) 451-4560

info@thebenefitsfirm.com

620 S. 3rd Street, Suite 102 Louisville, KY 40202

New Exchange Special Enrollment Periods for Certain Individuals

Each Exchange must have an initial open enrollment period, an annual open enrollment period, and certain special enrollment periods, under the Affordable Care Act (ACA). During one of the permitted enrollment periods individuals will only be able to enroll through an Exchange. The initial open enrollment period is Oct. 1, 2013, through March 31, 2014.

 
The Centers for Medicare & Medicaid Services (CMS) issued two separate pieces of guidance providing the following special enrollment periods (SEPs) in the federally-facilitated Exchange (FFE), on March 26, 2014:

 

SEP for “In Line” Individuals—those who have begun the enrollment process but haven’t finished—as of March 31; and

 

Limited Circumstance SEPs for individuals who were not able to enroll during the initial open enrollment period due to certain limited circumstances.

 
These SEPs allow individuals to enroll in Exchange coverage after the initial open enrollment period closes if certain conditions are met.

 
Overview of Special Enrollment in Exchanges

 
Following certain triggering events, such as marriage or birth of a child, individuals may be allowed an SEP in an Exchange. SEPs permit individuals to enroll in a qualified health plan (QHP) outside of open enrollment.

 
Similar to those applicable during initial enrollment, the effective date of any coverage elected during an SEP follows rules. This means that coverage would generally be effective as of the first day of the month for elections made by the 15th of the preceding month, and on the first day of the second following month for elections made between the 16th and the last day of a given month. Special rules apply when birth, adoption or placement of a child is the special enrollment triggering event, however.

 
The Exchange may set an appropriate effective date, for SEPs that are triggered by mistakes, contract violations, exceptional circumstances and misconduct.

 
nurse New Exchange Special Enrollment Periods for Certain Individuals SEPs for “In Line” Individuals

 

Despite efforts to meet the deadline, CMS has expressed concern over whether high consumer traffic leading up to the March 31 enrollment deadline could potentially keep consumers from completing the enrollment process.

 
CMS will provide an SEP for consumers in the PPF who are “in line” as of March 31, should this occur. This means that consumers who tried to enroll during the open enrollment period, but did not complete the process by March 31, will be allowed a limited amount of additional time to finish the application and enrollment process.

 
As long as consumers who were “in line” pay their first month’s premium on time, it is anticipated that enrollments made in the limited time after March 31 will have a May 1 coverage effective date. This is the coverage effective date that consumers would have had it they were able to complete enrollment by March 31, and is the normal effective date for enrollments between March 16 and April 15.

 
CMS will process paper applications received by April 7, for consumers who were “in line” with paper applications (or whose applications were pending submission or review of supporting documentation) on March 31. These consumers will be able to select a plan through April 30, and coverage will be effective May 1.

 
This guidance applies in FFEs and state partnership Exchanges. State-based Exchanges have the option to offer similar SEPs.

 

For more information please contact The Benefits Firm.

 
Ph: (502) 451-4560

info@thebenefitsfirm.com

620 S. 3rd Street, Suite 102 Louisville, KY 40202

President Obama extends ACA transition policy for current health plans

Millions of Americans received notices in late 2013 informing them that their health insurance plans were being canceled because they did not comply with the Affordable Care Act (ACA). Media and Congress criticized President Obama, saying that this contradicted his promise that consumers could keep their current plans under ACA if they chose.

 

So on Nov. 14, 2013, Obama announced a transition relief policy for 2014 for non-grandfathered coverage in small group and individual health insurance. If allowed by their states, this policy lets health insurers renew enrollees’ current policies without adopting all of the ACA’s reforms for 2014.

 

On March 5, 2014, the Department of Health and Human Services (HHS) extended the original transition relief policy for two years, to policy years beginning on or before Oct. 1, 2016. As a result, individuals and small businesses may be able to keep their non-ACA compliant coverage through 2017. Insurers that issue a policy under transitional relief in 2014 may renew them at any time through Oct. 1, 2016. In addition, affected individuals and small businesses may choose to re-enroll in the coverage through Oct. 1, 2016.

 

dr President Obama extends ACA transition policy for current health plans

Because the insurance market is regulated in large part at the state level, state governors or insurance commissioners have to allow transition relief in their own states. California, Connecticut, Washington, Minnesota, New York, Indiana, Vermont and Rhode Island did not allow insurers to use the original transition policy. Some states are allowing renewals with certain requirements.

 

Policies that are renewed under the extended transition relief will be considered in compliance with specified ACA reforms. Just like in the original transition relief policy, issuers that renew coverage under the extended transition relief must provide a notice to affected enrollees. Transition relief also applies to large employers that currently purchase large group insurance but will be redefined by the ACA as small employers purchasing insurance in the small group market as of Jan. 1, 2016.

 

According to HHS, the transition relief extension is intended to ensure that consumers have multiple health insurance coverage options, and that states will continue to have flexibility in their own markets. Some critics have said that the extension was issued to avoid a new round of policy cancellations shortly before the November 2014 elections.

 

HHS outlined the original transition relief policy in a letter to state insurance commissioners. Click here to read the letter. To learn more about how the policy may affect you, please contact The Benefits Firm.

 

Ph: (502) 451-4560

info@thebenefitsfirm.com

620 S. 3rd Street, Suite 102 Louisville, KY 40202