Health Care Reform: Common Acronyms

There are a growing number of acronyms used in health care reform-related materials today. Use this handy reference to view the different acronyms and the definitions for each.

health insurance 300x147 Health Care Reform: Common Acronyms


ACA: The Affordable Care Act. Used to refer to the final, amended version of the health care reform legislation.


CDC: The Centers for Disease Control and Prevention.


CHIP: The Children’s Health Insurance Program. Program that provides health insurance to low-income children, and in some states, pregnant women who do not qualify for Medicaid but cannot afford to purchase private health insurance.


DOL: United States Department of Labor.


EBSA: Employee Benefits Security Administration. A division of the DOL responsible for compliance assistance regarding benefit plans.


EPO Plan: An exclusive provider organization plan. A managed care plan that only covers services in the plan’s network of doctors, specialists or hospitals (except in an emergency).


ERRP: The Early Retiree Reinsurance Program. A temporary program created under health care reform to provide coverage to early retirees.


FPL: Federal poverty level. A measure of income level issued annually by HHS and used to determine eligibility for certain programs and benefits.


FLSA: The Federal Fair Labor Standards Act. Amended by PPACA to incorporate health care reform-specific provisions.


FSA: Flexible spending account.


HCERA: The Health Care and Education Reconciliation Act of 2010. Enacted on March 30, 2010, to amend and supplement PPACA.


HCR: Health care reform.


HDHP: High deductible health plan.


HHS: United States Department of Health and Human Services.


HMO: Health maintenance organization. A type of health insurance plan that typically limits coverage to care from medical providers who work for or contract with the HMO.


HRA: Health reimbursement arrangement or account.


HSA: Health savings account.


IRO: An independent review organization. An organization that performs independent external reviews of adverse benefit determinations.


MLR: Medical loss ratio. Refers to the claims costs and amounts expended on health care quality improvement as a percent of total premiums. This ratio excludes taxes, fees, risk adjustments, risk corridors and reinsurance.


NAIC: The National Association of Insurance Commissioners.


OCIIO: The Office of Consumer Information and Insurance Oversight. A division of HHS responsible for implementing many of the health care reform provisions.


OOP: Out-of-pocket limit. The maximum amount you have to pay for covered services in a plan year.


PCE: Pre-existing condition exclusion. A plan provision imposing an exclusion of benefits due to a pre-existing condition.


PCIP: The Pre-Existing Condition Insurance Plan. A temporary high-risk insurance pool to provide coverage to eligible individuals until 2014.


POS Plan: Point-of-service plan. A type of plan in which you pay less if you go to doctors, hospitals and other health care providers that belong to the plan’s network. POS plans require a referral from your primary care doctor to see a specialist.


PPACA: The Patient Protection and Affordable Care Act. Enacted on March 23, 2010, as the primary health care reform law.


PPO: Preferred provider organization. A type of health plan that contracts with medical providers (doctors, hospitals) to create a network of participating providers. You pay less when using providers in the plan’s network, but can use providers outside the network for an additional cost.


QHP: Qualified health plan. A certified health plan that provides an essential health benefits package. Offered by a licensed health insurer.


SHOP Exchange: The Small Business Health Options Program. A program that each health insurance exchange must create to assist eligible small employers when enrolling their employees in qualified health plans offered in the small-group market.

Check Your Group Health Plan Compliance for 2015

The Affordable Care Act (ACA) has made a number of significant reforms to group health plans since it was enacted in 2010. Many of these changes became effective in 2014, including health plan design changes, increased wellness program incentives and reinsurance fees. More changes will take effect in 2015 for employers that sponsor group health plans. To prepare, review the new requirements and develop a strategy for compliance.


First, do you have a grandfathered plan? It must be one that existed when the ACA was enacted on March 23, 2010. If so, determine whether it will maintain its grandfathered status for the 2015 plan year. If you make certain changes to your plan that go beyond permitted guidelines, your plan is no longer grandfathered. If your plan will lose its grandfathered status for 2015, confirm that it has all of the additional patient rights and benefits required by the ACA.


Next, review your plan’s out-of-pocket maximum to make sure it complies with the ACA’s limits for the 2015 plan year: $6,600 for self coverage and $13,200 for family coverage. Also, make sure your plan limits an employee’s annual pre-tax salary reduction contributions to a health flexible spending account (FSA) to $2,500. Watch for an announcement later this year from the IRS on what the health FSA limit will be for 2015.


Review the health coverage you provide to your employees to determine if it is subject to reinsurance fees for 2015. Both health insurance issuers and self-funded group health plans must pay fees to a transitional reinsurance program for the first three years of the Exchanges’ operation (2014-2016). The fees will be used to help stabilize premiums for coverage in the individual market. Fully insured plan sponsors do not have to pay the fee directly, and certain types of coverage are excluded.


The Benefits Firm Check Your Group Health Plan Compliance for 2015Make sure your health plans files a statement with the Department of Health and Human Services certifying compliance with HIPAA’s electronic transaction and operating rules. The ACA has extended the first deadline to Dec. 31, 2015, although small health plans may have additional time to comply.


Determine your status as an applicable large employer (ALE). ALEs that do not offer health coverage to their full-time employees and dependents will be subject to “employer shared responsibility” or “pay or play” penalties if any full-time employee receives a government subsidy for health coverage through an Exchange. The IRS has delayed the penalties and related reporting until Jan. 1, 2015.


To count your employees, determine whether you will use the entire 2014 calendar year or an acceptable period of at least six consecutive calendar months during 2014. Calculate the number of full-time employees or full-time equivalents (FTEs) for each calendar month in the period using either a monthly measurement method or look back method. If your result is 50 or more, you are likely an ALE for 2015.


If you have a non-calendar year plan, determine whether you qualify for the transition relief that allows you to delay complying with the pay or play rules until the start of your 2015 plan year. Also confirm whether all full-time employees are covered by the transition relief.


Finally, review your health plan design. Confirm that health plan coverage will be offered to all full-time employees and their dependent children in 2015. Review the cost of your health plan coverage to determine whether it’s affordable for your workers.


To learn more about compliance for group health plans in 2015, please contact The Benefits Firm.


Ph: (502) 451-4560

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

ObamaCare Premiums to Rise by an Average of 7.5%

According to a new analysis, premiums on ObamaCare’s health insurance exchanges will rise by an average of 7.5% next year.


The Health Research Institute (HRI) at PricewaterhouseCoopers compiled data and found modest changes in premiums for 27 states and the District of Columbia.


The Benefits Firm2 ObamaCare Premiums to Rise by an Average of 7.5%The national increase average of 7.5% is “well below the double-digit increases many feared,” HRI Managing Director Ceci Connolly wrote in an email.


Indiana has the highest average price increases under ObamaCare, some consumers will see prices rise by 15.4%.


The average individual monthly premium for next year, before any subsidies are applied, is $384,” Connolly wrote. “And insurance commissioners get a chance to weigh in on rates before fall enrollment.”


For the insurance industry the healthcare law’s first enrollment period was a big test. Premium prices were set with little information about who might sign up for coverage.


2015 rates shed light on how well insurance company’s guesses will pan out.


Prices are generally being raised by companies if their new customers will use more medical care than projected, are older or sicker.


On the other hand, firms with a healthier pool have an incentive to lower premiums.


ObamaCare’s second enrollment period begins Nov. 15.
For more information please contact The Benefits Firm.
Ph: (502) 451-4560

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

California’s Healthcare Premiums Increased by 22%-88% Over the Past Year, Kentucky’s Only 9.9%

According to an annual report detailing the rise of healthcare premiums in the state, the four largest insurers in California raised individual’s premiums between 22% and 88%. These numbers are determined by factors such as age and location.
In Kentucky, the highest filed rate increase On-Exchange was 9.9% with the Kentucky Co-Op. Humana’s increase is roughly 5.7% On-Exchange, Bluegrass Family Health On-Exchange for SHOP is 5.1%, and Anthem On-Exchange is -5%. Anthem now has Norton and Kosair as part of their network and will also offer new products with out-of-state coverage beginning January 2015.
The Benefits Firm California’s Healthcare Premiums Increased by 22% 88% Over the Past Year, Kentucky’s Only 9.9%

What we anticipate going into Open Enrollment 2015…
There will also be at least two new carriers offering plans On-Exchange in Kentucky for the 2015 year. With this change consumers will have more options to choose from, creating a more competitive market compared to the last Open Enrollment.


We predict that due to their familiarity and decrease in premium costs, Anthem may acquire more business among shoppers. Humana, whose rates are similar to the Kentucky Co-Op, may take the lead in the cheapest rates of the three carriers. And lastly, the newly state funded carrier, the Kentucky Co-Op thrived this year taking approximately 75% of the business but with new competition only time will tell if they will continue to lead the market.
For more information please contact The Benefits Firm.
Ph: (502) 451-4560

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

NAHU’s Annual Convention and Exhibition

Destination: Excellence


Louisville, KY – The National Association of Health Underwriters (NAHU) held its 84th Annual Convention and Exhibition on June 29-July 2 in Scottsdale, AZ. Over 700 health insurance professionals from across the country gathered to learn about products, attend training for licensure renewal, and get the latest information on federal and state legislation.


John Jennings and Griffin Meredith attended this conference that focused on assisting health insurance professionals to continue servicing clients through the legislative and regulatory changes affecting the health insurance market. They received the latest information on state and federal legislation and attended continuing education courses on how to assist clients with ­­­­­­­­­­­­­­ACA Compliance and Human Resources Consulting and ERISA Compliance.  Griffin also received his NAHU Self Funding Certification. He has been a NAHU member for 10 years; this was his 7th convention. He serves as President of the Greater Louisville Association of Health Underwriters and this coming year he will become the Secretary/Treasurer of the Kentucky Association of Health Underwriters, one of over 200 NAHU chapters across the country.


Convention’s guest speakers included many industry and business leaders speaking about healthcare reform and business strategies.


“Because of their dedication to continuing education and vast experience in the changing health insurance market, NAHU members are the most highly trained, best qualified health insurance professionals in America,” said NAHU CEO Janet Trautwein. “NAHU’s convention offers more continuing education credits, new product information and legislative updates than any other industry meeting.”


“In the current state of healthcare the only power we can control is knowledge of what has happened, what is happening, and attempt to prepare for the changes that will happen.  Attending this event allowed us to interact with the people who make these decisions and changes and we were placed in the best educational position possible” said Griffin Meredith.


The National Association of Health Underwriters represents 100,000 professional health insurance agents and brokers who provide insurance for millions of Americans. For more information, please contact:


John Jennings

Ph: (502) 451-4560

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


Griffin Meredith

Ph: (502) 451-4560

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