Health Care Reform – History Of Fiscal Folly
Health Care Reform – History Of Fiscal Folly
Healthcare Reform Bill Summary
Healthcare Reform Bill Summary
Part VII
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers
Medicare and Medicaid-related provisions
- Retiree drug subsidy. Beginning in 2013, employers may no longer deduct the retiree drug subsidy when offering qualified coverage under Medicare Part D.
- Part D donut hole. Provides $250 rebate for Part D enrollees who enter the “donut hole” coverage gap (2010 only); 50 percent brand discount on drugs in the gap beginning in 2011. The donut hole is eliminated by 2020.
- Medicaid. Beginning in 2014, states are required to provide health insurance premium assistance and wrap-around benefits to any Medicaid beneficiary who is offered employer-sponsored coverage, if it is cost-effective to do so.
Other
- Administrative simplification. The law also requires HHS to adopt a single set of operating rules for electronic transactions to create uniformity (e.g., health insurance claims or equivalent encounter information, eligibility and claims status, enrollment and disenrollment, premium
payments, and referral certification and authorization). Group health plans will have to certify compliance with these standards.
- CLASS Act. Creates a new government-run voluntary long-term care insurance program (CLASS Program). Employers must automatically enroll employees and facilitate payroll deductions. Employees may choose not to participate.
Revenue-raising provisions
- Starting July 1, 2010, impose a 10 percent tax on tanning services.
- Beginning in 2011, the pharmaceutical industry will pay annual industry fees. The fee will be phased in and will hold steady at $2.8 billion a year after 2019.
- Beginning in 2013, manufacturers of medical devices will pay a 2.3 percent excise tax on sales of medical devices.
- Beginning in 2013, the Medicare payroll tax rate will increase by 0.9 percent for individuals who make more than $200,000 and couples that make more than $250,000.
- A new 3.8 percent tax will be added on income from interest, dividends, annuities, royalties and rents for those at the same income threshold.
- Beginning in 2014, a non-deductible health insurance premium tax will be imposed on insurers ($8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.3 billion in 2018. After that, it will increase in an amount proportional to overall health insurance premium growth).
Not to be used for implementation purposes
IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law’s provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Facts About Healthcare Reform Bill
Facts About Healthcare Reform Bill
Part VI
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
High-Level Overview Health Reform Law: Key Provisions for Large Employers IN 2011:
- Medical loss ratio (MLR). An insurer must publicly report on its MLR and spend at least 85 percent of large group health insurance premiums on medical services or provide rebate payments to enrollees.
- Spending accounts. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may no longer be used to purchase over-the-counter drugs unless prescribed by a doctor. increases tax for nonqualified HSA withdrawals from 10 percent to 20 percent, and for Archer MSA withdrawals from 15 percent to 20 percent.
- HHS studies. HHS is required to study the group health insurance plan markets to compare employer characteristics and determine whether the new health insurance market reforms are likely to cause adverse selection in the large group market or to encourage small and midsize employers to self-insure. HHS and the Department of Labor must also collect information on self-funded health insurance plans. These studies could lead to additional employer reporting requirements.
- Uniform explanation of coverage. Within 12 months of the law's enactment, HHS, in consultation with the National Association of Insurance Commissioners, will develop uniform standards and definitions for summaries of benefits and coverage explanations. Within 24 months of enactment, group health insurance plans must provide enrollees and applicants with coverage documents that meet these standards. Additionally, enrollees must be notifi ed 60 days in advance of any material modification to coverage that wasn't included in the most recent summary.
IN 2012:
- Comparative effectiveness fee. A new fee is imposed on group health insurance plans to fund comparative effectiveness research ($1 per participant through 2013; $2 through 2019).
- Release of Medicare claims data. The private sector may purchase standardized data extracts of Medicare Parts A, B and D claims data to combine with their own claims data to evaluate provider performance measures on quality, efficiency, and the effectiveness of care.
IN 2013:
- FSA contributions. Contributions to flexible spending accounts are limited to $2,500 a year.
IN 2014:
- Pre-existing conditions. Group health insurance plans can no longer impose pre-existing conditions exclusions for any person of any age.
- Annual limits. Annual limits on essential health benefits are prohibited.
- Guaranteed issue. Health insurance companies must accept every employer who applies for health insurance coverage.
- Clinical trials. Coverage of routine patient care costs is mandated for participation in approved clinical trials (does not apply to grandfathered plans).
- Exchanges. State health insurance exchanges are up and running for small businesses and individuals. States can allow large employers to participate beginning in 2017. (Note: the federal definition of a large employer is an employer with 101 or more employees. States can modify the definition to 51 or more employees until January 1, 2016).
- Cost-sharing limits. Cost sharing imposed under group health insurance plans is limited to current health savings account amounts (does not apply to grandfathered plans).
- Waiting periods. Waiting periods cannot exceed 90 days.
- Wellness. Expands health insurance plan wellness incentives up to 30 percent of total coverage costs (up to 50 percent with HHS approval).
- Essential benefits. Essential benefit plan is created, which mandates the level of benefits that must be included in health insurance plans offered in the exchange, as well as in the individual and small group health insurance markets outside the exchange. (Self-funded health insurance plans and grandfathered plans are exempt from this requirement).
- Reinsurance. A temporary reinsurance program will be established for the individual market and funded by individual and group health insurance plan assessments ($25 billion in 2014-2016).
IN 2018:
- Taxes. A new excise tax goes into effect for high-value, "Cadillac" health insurance plans: 40 percent for amounts over $10,200 for individuals and $27,500 for family plans, paid by health insurance companies and plan administrators.
Not to be used for implementation purposes IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law's provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Summary About Health Care Reform
Summary About Health Care Reform
Part II.
Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:
IN 2011:
• Medical loss ratio (MLR). A Health insurer must publicly report on its MLR and spend at least 80 percent of small Business group premiums on medical services or provide rebate payments to enrollees.
• Spending accounts. Health savings accounts (HSAs) and flexible spending accounts (FSAs) may no longer be used to purchase over-the-counter drugs unless prescribed by a doctor. Increases tax for nonqualified Health Savings Account (HSA) withdrawals from 10 percent to 20 percent, and for Archer MSA withdrawals from 15 percent to 20 percent.
• HHS studies. HHS is required to study the group health insurance plan markets to compare employer characteristics and determine whether the new health insurance plan market reforms are likely to cause adverse selection in the large employer group health insurance market or to encourage small and midsize employers to self-insure. HHS and the Department of Labor must also collect information on self-funded plans. These studies could lead to additional employer reporting requirements.
• Uniform explanation of coverage. Within 12 months of the law’s enactment, HHS, in consultation with the National Association of Insurance Commissioners, will develop uniform standards and definitions for summaries of health insurance benefits and health insurance coverage explanations. Within 24 months of enactment, group health insurance plans must provide enrollees and applicants with coverage documents that meet these standards.
IN 2012:
• Comparative effectiveness fee. A new fee is imposed on group health insurance plans to fund comparative effectiveness research ($1 per participant through 2013; $2 per participant through 2019).
IN 2013:
• FSA contributions. Contributions to flexible spending accounts are limited to $2,500 a year.
IN 2014:
The federal definition of a small group employer is defined as an employer with 1-100 employees. States can modify the definition to 1-50 employees until January 1, 2016.
• Pre-existing conditions. Group health insurance plans can no longer impose pre-existing condition exclusions for any person of any age.
• Annual limits. Annual limits on essential health insurance benefits are prohibited.
• Guaranteed issue. Health insurance companies must accept every employer who applies for health insurance coverage.
• Rating restrictions. Rating restrictions go into effect for new fully insured small group health insurance plans. Insurance companies cannot base premiums on health status, claims experience or gender. Health Insurance Premiums can only vary by:
– Age (no more than 3:1)
– Geography
– Family size
– Tobacco use (no more than 1.5:1)
• Merged markets. States are allowed to merge the individual and small group health insurance markets.
• Clinical trials. Health Insurance Coverage of routine patient care costs is mandated for participation in approved clinical trials (does not apply to grandfathered plans).
• Exchanges. State health insurance exchanges are up and running for small businesses group health insurance and private individuals health insurance to buy coverage.
• Essential benefits. Essential health insurance benefit plan is created, which mandates the level of health insurance benefits that must be included in plans offered in the exchange, as well as in the private individual health insurance and small group health insurance markets outside the exchange. Deductibles limited to $2,000 for individuals and $4,000 for families in the small employer group health insurance market (self-funded plans and grandfathered plans are exempt from this requirement).
• Cost-sharing limits. Cost sharing imposed under group health insurance plans is limited to current health savings account amounts (does not apply to grandfathered plans).
• Waiting periods. Waiting periods cannot exceed 90 days.5
• Wellness. Expands health insurance plan wellness incentives up to 30 percent of total coverage costs (up to 50 percent with HHS approval).
• Reinsurance. A temporary reinsurance program will be established for the private individual health insurance market and funded by individual and group health insurance plan assessments ($25 billion in 2014-2016).
This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.
Business Owner on Health Care: “I’m Confused”
CNBC Correspondent
Madelyn Alfano is no dummy. This native of Hoboken has spent the last 25 years building up a successful chain of restaurants in Los Angeles called Maria’s Italian Kitchen. She’s President of the LA chapter of the California Restaurant Association.
But ask her what she’s supposed to do next to expand healthcare coverage from 50 fulltime employees to all 400 of her workers, and she draws a blank. “I just read a 30-page summary of what the healthcare bill is supposed to do and mean,” she says. “And I read it again. I read it two times, I was so confused.” She knows that within four years she will need to provide coverage, but she has a lot of questions. For example, if she has a part-time waiter who works a second job at another restaurant, “Who pays for that?” She’s also concerned that she’ll be paying workers comp, sick days, general liability, AND healthcare. “Something’s gotta give.”
The situation has her pausing expansion plans.
Alfano is just one of many business owners now trying to figure out what’s next. Here’s more of what she had to say.
The new healthcare law also mandates that any restaurant chain with at least 20 outlets must supply calorie information to customers. Alfano says that’s already the law in California, and the restaurant association supports this. But she’s worried she might get sued. Here she explains why:
Finally, the restaurant industry has been one of the hardest hit businesses in this recession. Madelyn Alfano explains how she managed to turn a profit and not lay off a single employee.
The people we work with are saving an average of $2,208/year on their health insurance premiums without sacrificing benefits. You owe it to yourself to find out how a HSA can benefit you. Contact us today at 602-510-7507 or info@iqhsa.com. To receive quotes for individual/family health insurance in Arizona click here.
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.
Health Savings Insurance Provides Access To The Uninsured
HSA health plans are playing a role to help provide access to the uninsured, promote preventive health services and show individuals and families where their hard-earned money is going in the health care system.
- HSA premiums have been growing at a slower rate than traditional insurance premiums.
- HSAs offer the advantage of portability – if you change jobs or your employment status changes, you keep the money in your HSA and continue using it to pay for your health care.
- Most HSA plans provide incentives for you to stay engaged in your overall health and well-being and almost all HSA plans offer first-dollar coverage for preventive services.
- HSA health plans play a vital role in providing health care coverage to millions of Americans who might otherwise be uninsured. A study by America’s Health Insurance Plans found that 27 percent of those buying HSA health plans in the individual market previously did not have health insurance.
- Health savings accounts encourage individuals to take a more active role in determining how they receive health care by choosing how to spend their health care dollars. When health care decisions are made by patients based on quality, effectiveness, and cost, money is being spent more efficiently.
The people we work with are saving an average of $2,208/year on their health insurance premiums without sacrificing benefits. You owe it to yourself to find out how a HSA can benefit you. Contact us today at 602-510-7507 or info@iqhsa.com
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.
Who Is Using Health Savings Insurance
Americans choosing Health Savings Account (HSA) coverage represent a wide range of people from all backgrounds and walks of life. Consider the following:
- HSA health plans provide comprehensive health coverage for more than eight million Americans.
- About 40 percent of tax filer’s age 19-64 who reported HSA activity on their tax returns had average annual incomes below $60,000. (Government Accountability Office, April 2008).
- About half of enrollees in an HSA-eligible plan are aged 40 and above, and half are below the age of 40. In the individual market, 25 percent of HSA-eligible plan enrollees were younger than age 20.
- The 2009 Kaiser Family Foundation study of employer-based health benefits found that 71 percent of employers that offered HSAs contributed to their employees’ accounts, and that the average contribution for accounts was $1,000 for individuals and $1,640 for families.
The people we work with are saving an average of $2,208/year on their health insurance premiums without sacrificing benefits. You owe it to yourself to find out how a HSA can benefit you. Contact us today at 602-510-7507 or info@iqhsa.com
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.
Having A Qualified Health Insurance Plan Is Not Enough
Having a High Deductible Health Plan (HDHP) is only half the battle. You must also open your Health Savings Account (HSA) before you have eligible expenses. You are not allowed to reimburse yourself for eligible expenses incurred prior to opening your Health Savings Account (HSA).
It is easy to open an account today by visiting our recommended provider American Chartered Bank. Simply open an account online and fund as little as $25 to keep from having problems in the future. Once the account is open you can then make deposits and reimburse yourself for expenses incurred after the account is open.
The people we work with are saving an average of $2,208/year on their health insurance premiums without sacrificing benefits. You owe it to yourself to find out how a HSA can benefit you. Contact us today at 602-510-7507 or info@iqhsa.com.
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.
Tips For Successfully Completing Your Insurance Application
The following are tips to avoid delays in underwriting processing of your health insurance application. Simply by following these guidelines can save you days or even weeks of processing time for your health insurance application.
The top five reasons for delays in processing are:
Verify Height and Weight: Height and weight accuracy, especially for children, is necessary to properly process applications.
» This area of the application amounts to 25% of the call-backs underwriters make for incomplete or inaccurate information.
Specify Diagnosis: A specific diagnosis needs to be provided (e.g. Crohn’s disease) not a general description of health issue (e.g. digestive issues).
Specify Affected Areas: Accurately identify areas of the body that have been treated (e.g. RIGHT foot broken, LEFT knee replaced, etc.).
Specify Treatment Dates: Both beginning and end dates are needed. Also, details about the treatments success, i.e. if the treatment is ongoing or if there has been a complete recovery.
List Medications - Name, Dosage and Frequency: Many medications share similar names and accuracy is key. Specific dosage amounts (e.g. 50 mg) and directions of use (how many times a day) should also be provided.
» If a prescription is taken “as needed” or “seasonal,” please provide information how often it is refilled.
The people we work with are saving 1,000’s of dollars each year without sacrificing benefits. Contact us today at 602-510-7507 to find out how an HSA can benefit you.
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.
Latest On Health Care Reform
In it’s current form the Health Care Legislation includes several provisions that will disadvantage or threaten HSA health plans, including:
- A new premium tax that will cause premiums to rise for individuals, families and small businesses;
- Mandated benefit levels that could eliminate HSA health plans as an option for coverage;
- A rule against using money in your HSAs to buy any over-the-counter drugs, such as allergy medications, that you now get without a prescription; and
- An increased penalty for the use of HSA dollars for non-qualified medical expenses from 10% to 20% of the reimbursement.
The window of opportunity is closing, but there is still time to contact your elected representatives in Congress and to let them know how you depend on your HSA health plan for quality coverage and to save for medical expenses.
Call, email, write or visit your Representative and Senators today. Look up their contact information here.
Get quotes for individual/family health insurance in Arizona here. Contact us today at 602-510-7507 to find out how an HSA can benefit you.
IQ Financial Group, llc. is a licensed insurance agency in the state of Arizona. We offer a complete selection of health insurance, term life insurance, disability insurance, long term care insurance and supplement plans to individuals, families, self-employed and small businesses throughout Arizona. We offer the best in Arizona Health Insurance.
© IQ Financial Group, llc.