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Category: Health Care Reform

Health Reform Update: Issuer Renewal and Discontinuation Notices Guidance

Health Reform Update:

Under guaranteed renewability requirements that date back to the Health Insurance Portability and Accountability Act of the 1990s, health insurers have had to give covered employers and individuals at least 90 days notice before discontinuing an insurance product. The 90-day notice requirement gave enrollees time to make other arrangements when their coverage was being discontinued.

Individual coverage is now provided on a calendar year basis. Open enrollment for 2016 does not begin until November 1, 2015. Coverage alternatives should be readily available in most markets as of that date. Moreover, it would be difficult for insurers to give enrollees notice 90 days before December 31, 2015 when coverage ended (that is, by October 3, 2015) because, given the time frame for plan certification for 2016, replacement plans may not be finally approved by that date.

And enrollees may be confused if they receive notices of plan discontinuance before replacement plans are approved. The 90-day notice requirement does not, therefore, make sense for marketplace plans.

For these reasons, the Centers for Medicare and Medicaid Services (CMS) decided in 2014 to waive enforcement of the 90-day notice requirement for 2015. On July 7, 2015, CMS announced that it will again waive enforcement of the 90-day requirement for non-grandfathered, non-transitional for 2016 coverage.

Insurers are only required to provide a notice of discontinuance for these plans before the first day of open enrollment, that is before November 1, 2015. Insurers intending to discontinue transitional or grandfathered plans must give 60-days notice.

The 90-day discontinuance notice requirement continues to apply to group plans, which have continuous open enrollment. Insurers that intend to completely withdraw from a market must continue to give 180 days notice (and may not return to the market for 5 years).

The July 7 guidance further provides that insurers should continue to use standard notices for product discontinuances and renewals provided in earlier guidances.

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

Agencies Issue Final Rule Amending Summary of Benefits and Coverage Requirements

On June 16, 2015, the Departments of Health and Human Services, Labor and Treasury (the “Agencies”) jointly published a final rule amending current guidance governing the Summary of Benefits and Coverage (“SBCs”) (“Final Rule”). 80 Fed. Reg. 34292. This rule finalizes the guidance issued in the Agencies’ proposed rule dated December 30, 2014 (“Proposed Rule”). 

While the rule primarily codified previous guidance and FAQs related to SBCs, and we expect that the biggest changes related to SBCs will be seen when the Agencies finalize the template and instructions, issuers in particular are subject to new requirements under the rule, including a requirement to post the actual certificates of coverage. Entities that rely upon others to provide the SBC now also have a duty to monitor that performance. Please see the attached memo for further information.

What Actions You Should Take

While the rule primarily codified previous guidance and FAQs related to SBCs, and we expect that the biggest changes related to SBCs will be seen when the Agencies finalize the template and instructions, issuers in particular are subject to new requirements under the rule, including a requirement to post the actual certificates of coverage. Entities that rely upon others to provide the SBC now also have a duty to monitor that performance.

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

Implementing Health Reform: The Supreme Court Upholds Tax Credits In The Federal Exchange

The Supreme Court has spoken, and the Affordable Care Act (ACA) has survived yet another near-death experience. In a decisive opinion, written for six of the Court’s nine justices, Chief Justice Roberts upheld the Internal Revenue Service (IRS) rule that allows low-and moderate-income Americans access to tax credits, regardless of whether they live in states where the federal or state government operates the marketplace.

The Background

King v. Burwell is one of four cases that have been brought by ACA opponents asking the courts to invalidate an Internal Revenue Service rule that allows federally facilitated exchanges (FFEs, also called federally facilitated marketplaces) to make available advance premium tax credits to help Americans purchase health insurance.

The Affordable Care Act reformed health insurance underwriting to prohibit insurers from considering preexisting conditions in deciding whether to cover individuals and determining how much enrollees are charged in premiums. It also required individuals who could afford coverage to get coverage or pay a penalty. To ensure that insurance was affordable, the ACA offered premium tax credits to low- and moderate-income people.

These tax credits were offered through entities that were called “exchanges” in the legislation, and are now called marketplaces. The exchanges were intended to increase competition among insurers and augment the choices available to enrollees, but also to provide an access point through which tax credits could be made available to help pay premiums as they became due on a monthly basis.

The Senate version of the ACA — which was eventually adopted by both houses with modifications that could be made through the Health Care and Education Reconciliation Act — located the exchanges in the states. It provided, however, that if a state chose not to establish its own exchange, the Department of Health and Human Services would provide “such exchange” for the states.

Dozens of provisions in the ACA indicate that the federally facilitated exchanges were supposed to function just like the state-operated exchanges. One provision of the law, however, which added section 36B to the IRS code to provide for the tax credits, twice refers to enrollment through an “Exchange established by the State” as a seeming condition of eligibility for tax credits.

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

ACA Taxes and Fees Chart

The Affordable Care Act (ACA) affects health care benefits and costs for businesses and employees. One of the ACA provisions involves federally-required fees and taxes. These apply to all health insurance carriers.

This ACA Taxes and Fees chart will help you explain the various taxes and fees, proration and other changes affecting your group clients’ plans and premiums.

If you have any questions, please contact your sales representative.

This article applies to:

  • Virginia
  • Small Group and Large Group

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