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Tag: Affordable Care Act

Implementing Health Reform: Provision Of Summary of Benefits and Coverage

One of the most important insurance reforms imposed by the Affordable Care Act is a requirement that insurers and self-insured group health plans make available to applicants and enrollees a Summary of Benefits and Coverage (SBC) that concisely, uniformly, and accurately describes health plans that applicants are considering or in which enrollees are enrolled. The SBC allows shoppers to compare side-by-side plans that they are considering purchasing, and also helps enrollees understand their coverage once they are enrolled.

The ACA required the Departments of Labor, Treasury, and Health and Human Services, which are charged with implementing the SBC requirements, to consult with a stakeholder group convened by the National Association of Insurance Commissioners in drafting the SBC rule. The original final SBC rulewas not published until 2012, after recommendations were received from that body.

When the 2012 SBC rule was published, however, and again in the months following its publication, the departments released a series of frequently asked question which generally provided plans and insurers flexibility in complying with the requirements of the rule. In December of 2014, the departments published a proposed rule (covered here) to modify the original rule.

The proposed rule contained provisions governing how insurers and group health plans were to make SBCs available, as well as changes to the content of the SBC itself — the SBC template and instructions and uniform glossary of coverage terms.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group Warrenton Health Insurance Broker and Agent

New Evidence Health Spending Is Growing Faster Again

Like Californians waiting for the record drought to lift, health cost watchers like me have been waiting for health spending to begin to grow more rapidly again as the economy strengthens. It looks like that may now be beginning to occur.

The U.S. Census Bureau has published new estimates of health spending based on their somewhat obscure but important Quarterly Services Survey. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. Greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. People are beginning to use more physician and outpatient services again as the economy improves. The number of days people spent in hospitals also rose.

Overall, as the chart above below, the increase was much larger in first quarter of 2015 than in the first quarters of 2014 or 2013.

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The quarterly reports from the Census don’t tell us how rapidly health spending will continue to grow in the future. However, the fact that spending has been growing at higher rates over the last four quarters  suggests that the lowest of the lows of the health cost slowdown are now in the rear view mirror. Equally importantly, despite the fanfare surrounding current efforts to reform the delivery and payment in health care and the progress that has been made, it may also suggest that greater efforts will be needed in the future to keep cost increases manageable.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group Warrenton Health Insurance Broker and Agent

Preventive Services Under ACA Covered by Private Health Plans

A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services under ACA without any patient cost-sharing.1

Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective.2

However, costs do prevent some individuals from obtaining preventive services (Figure 1). The coverage requirement aims to remove cost barriers.

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ACA Requirements for Coverage of Preventive Services

Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services.3 These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status. In order to have been classified as “grandfathered,” plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions). In 2014, 26% of workers covered in employer sponsored plans were still in grandfathered plans,4 and it is expected that over time almost all plans will lose their grandfathered status.

The required preventive services come from recommendations made by four expert medical and scientific bodies – the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project, and HRSA and the Institute of Medicine (IOM) committee on women’s clinical preventive services. The requirement that insurers cover preventive services recommended by the USPSTF, ACIP, and Bright Futures program went into effect for non-grandfathered plans with plan-years beginning on or after September 23, 2010. The coverage requirements for women’s clinical preventive services became effective for plans starting on or after August 1, 2012. New or updated recommendations issued by these expert panels are required to be covered without cost-sharing in the plan year that begins on or after exactly one year from the new recommendation’s issue date.5 Individual and small group plans in the new health insurance marketplaces are also required to cover an essential health benefit (EHB) package – in addition to the full range of preventive requirements described in this fact sheet. There is some crossover as several of the specific preventive services fall into the EHB categories. However, only preventive services recommended by one of the four groups discussed in this fact sheet are covered without cost-sharing.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Cosby Insurance Group Warrenton Health Insurance Broker and Agent