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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

In U.S., Uninsured Rate Lowest Since 2008

In the U.S., the uninsured rate dipped to 15.6% in the first quarter of 2014, a 1.5-percentage-point decline from the fourth quarter of 2013. The uninsured rate is now at the lowest level recorded since late 2008.

The uninsured rate has been falling since the fourth quarter of 2013, after hitting an all-time high of 18.0% in the third quarter — a sign that the Affordable Care Act, commonly referred to as “Obamacare,” appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage. Even within this year’s first quarter, the uninsured rate fell consistently, from 16.2% in January to 15.6% in February to 15.0% in March. And within March, the rate dropped more than a point, from 15.8% in the first half of the month to 14.7% in the second half — indicating that enrollment through the healthcare exchanges increased as the March 31 deadline approached.

The results from the first quarter are based on more than 43,500 interviews with U.S. adults from Jan. 2 to March 31, 2014, as part of the Gallup-Healthways Well-Being Index.

Fewer Americans Across Age Groups Uninsured in 2014

The Obama administration has made young adults’ enrollment in a health insurance plan a top priority, as healthcare experts say 40% of new enrollees must be young and healthy for the Affordable Care Act to be successful. However, Gallup’s quarterly trends indicate the uninsured rate dropped by about the same amount among adults aged 26 to 64 as it did among those aged 18 to 25 — two points. The uninsured rate among 18- to 35-year-olds fell to 21.7% in the first quarter; the rate fell to 26.4% among those aged 26 to 34, and to 16.1% among those aged 35 to 64.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Managing Workforce Health Helps Employers Improve Their Overall Bottom Line

A growing body of evidence suggests that employers’ motivations for improving the overall health of their employees should extend far beyond the need to control the inflation of their medical costs.

Poor workforce health management costs employers an estimated $576 billion a year, only 40% of which is attributable to medical costs, according to the San Francisco-based Integrated Benefits Institute. The remaining 60% of those costs represents lost productivity and wage replacement expenses driven by short- and long-term disability and workers compensation claims resulting from untreated or undertreated chronic conditions.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.