Health Care Reform Summary

Health Care Reform Summary

Part I.

Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:

IMMEDIATELY:

• Federal rate review. The Department of Health and Human Services (HHS) will establish a process for federal review of fully insured premium rate increases.

IN 90 DAYS:

• Internet portal. By July 1, an Internet portal will be created for consumers and small businesses to shop for health Insurance.

• High-risk pool. $5 billion has been appropriated to create a temporary high-risk insurance pool to help adults with pre-existing conditions get coverage if they have been uninsured for six months. The program will be effective through 2013.

• Reinsurance for early retirees. A temporary reinsurance program will be established for employers providing coverage to early retirees over age 55 who are not eligible for Medicare. The federal government will provide $5 billion to fund the program. Participating employers or insurers will be reimbursed 80 percent of retiree claims between $15,000 and $90,000. The program will be effective through 2013.

IN SIX MONTHS:

Effective for new private health insurence plans or health insurance plans renewed six months after the enactment date unless otherwise noted (includes “grandfathered plans”):

• Lifetime and annual limits. Plans may not impose lifetime limits on the dollar value of essential benefits. Annual limits will be restricted (to be determined by HHS).
• Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
• Health Insurance Coverage for adult children. Children may stay on their parents’ policies until age 26 if health insurance coverage isn’t available through their work, regardless of their marital status. Any employer contribution toward the insurance premium is a tax-deductible business expense for the employer and not taxable income for the employee.
• Pre-existing conditions. Health Insurance Plans may no longer impose pre-existing condition exclusions for children under 19.

Effective for new small business group health insurance plans or health insurance plans renewed six months after the enactment date (does not include “grandfathered plans”):

• Preventive services. New health insurance policies must cover the full cost of preventive care as recommended by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care for women
• Appeals. New minimum requirements for internal and external health insurance claims appeals processes.
• Patient protections. Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization or increased cost-sharing for emergency services is also prohibited.
• Nondiscrimination rules. Nondiscrimination rules that apply to self-funded health insurance plans are expanded to group fully insured health insurance plans. Plans cannot base an employee’s eligibility or continued eligibility on hourly or annual salary.

This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.

Growing Problem of Small Business Health Insurance

Growing Problem of Small Business Health Insurance

The costs associated with health insurance plans have soared over the past several years and so have the number of consumers taken advantage of by insurance scams. Dishonest companies selling phony insurance policies have collected premiums, but failed to pay medical providers. The consumer is often left with large medical bills and no coverage. Individuals and small-business owners, who can’t negotiate better rates with legitimate insurers, are often targets.

How does this scam work? According to the National Association of Insurance Commissioners (NAIC), a typical fraudulent health insurance scam attempts to recruit as many local insurance agents as possible to market the coverage. Agents are told the coverage is regulated by federal law, not state law. In fact, this is illegal. The coverage is typically offered regardless of the applicant’s health condition and at lower rates and with better benefits than can be found from licensed insurers. The scam seeks to collect a large amount of premium as rapidly as possible.

While claims may be paid initially, the scam operation will soon begin to delay payment and offer excuses for its failure to pay. Unsuspecting consumers who thought they were covered for their medical needs are left responsible for huge medical bills. Employers who sign up for these illegal plans may be liable for the medical bills of their employees as well.

The best way to avoid becoming a victim of insurance fraud is to know the facts, ask questions and do some research. The Better Business Bureau, along with the NAIC, offer the following tips:

• If you are not familiar with the company offering the health plan, check them out with your state insurance department and the BBB. Carefully read all materials and scrutinize web sites.
• Make sure your insurance agent is selling a state-licensed insurance product. If an insurance agent is trying to sell you an “ERISA” (plans governed by the federal Employee Retirement Income Security Act of 1974) or “union” plan, report them to your state insurance department.
• Be suspicious if coverage seems unusually cheap, is issued with few questions about the applicant’s health, or refers to coverage as “stop-loss insurance.”
• Deal with reputable agents. If the person trying to sell you coverage says he or she does not need a license because the coverage is not insurance or is exempt from regulation, be cautious.

For more information or to report suspected fraud, contact your state insurance department.

IQHSA.com offers the best small business health insurance plans at the guaranteed lowest rates available. If you would like a free no obligation assessment of your needs please contact us today at 602-510-7507 or info@iqhsa.com.

Small Business Group Health Insurance Companies

Small Business Group Health Insurance Plans

The following is a list of group health insurance companies offered by IQHSA.com:

Aetna Health Insurance Plans: Aetna offers a full suite small business group health insurance plans and large group health insurance plans.

United Healthcare Golden Rule Insurance: United Healthcare offers a full suite of small business group health insurance plans and large group health insurance plans to business.

Humana: Humana offers a full suite of small business group health insurance plans and large group health insurance plans to business.

Blue Cross Blue Shield of Arizona health insurance: Offers a full suite of small business group health insurance plans and large group health insurance plans.

Healthnet of Arizona: offers a full suite of small business group health insurance plans and large group health insurance plans.

Assurant Healthcare: offers a full suite of small business group health insurance plans.

Cigna Health Insurance of Arizona: offers a full suite of small business group health insurance plans and large group health insurance plans.

IQHSA.com offers the best small business health insurance plans at the guaranteed lowest rates available. Health insurance for small business in Arizona can be either group employer sponsored coverage or private health insurance plans. If you would like a free no obligation assessment of your needs please contact us today at 602-510-7507 or info@iqhsa.com.