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Please be aware that there is backlog at the county offices in processing Medi-Cal applications. If you need to find out the status of your enrollment, please click on the link below and contact your local office for information.
The Obama Administration announced yesterday that the Play or Pay mandate will be delayed, for employers with 50-100 employees, until 2016. Employers will 100 or more employees will still be subject to the mandate for calendar year 2015.
The administration laid out a three-tier approach:
1. Large employers with 100 or more employees, 70% of employees must be offered coverage in 2015, and in later years at least 95% of employees must be offered coverage. Employers that do not meet these standards will be subject to tax penalties.
2. Employers with 50 to 99 employees will have an extra year, until 2016, to provide coverage or pay tax penalties.
3. Nothing has changed in connection with small businesses with fewer than 50 employees. These companies will not be required to provide coverage.
What is it?
Beginning in Janary 1, 2014, the Affordable Care Act (ACA) requires a new rating structure for health insurance carriers issuing coverage to small businessess to rate those health plans at the member's age rather than the subscriber's or employee's age.
The Obama Administration announced on July 2, 2013 that the employer mandate under the Patient Protection and Affordable Care Act (Affordable Care Act) will be delayed until 2015, thus giving employers an extra year to comply with the law’s complicated hours-tracking and health insurance reporting rules.
Under the Affordable Care Act, an employer with 50 or more full-time equivalent employees is liable for monetary penalties if the employer does not offer affordable, minimum value health care coverage to a full-time employee and that employee obtains subsidized health care coverage from a health insurance exchange. Under yesterday’s announcement, those penalties, along with the insurance reporting requirements imposed on employers under the Affordable Care Act, will not be enforced against employers until 2015.
The delay means that employers will have an additional year to offer health insurance coverage to their full-time employees before the Internal Revenue Service (IRS) will assess penalties, known as the employer shared responsibility payment. Employers also will have an additional year to comply with the information reporting provisions required under the Affordable Care Act. These provisions require employers to provide information to the IRS regarding the health insurance coverage offered to their full-time employees. That information will, in part, determine whether those employees are entitled to subsidized health insurance and whether employers are liable for an employer shared responsibility payment. Proposed rules on these reporting requirements are expected to be published later this summer.
The announcement does not delay the effective date for other provisions of the Affordable Care Act, such as the requirement that individuals purchase health insurance or pay a penalty.
Official guidance on this transition relief will be published within the next week, according to the Treasury. - Aon Hewitt
CMS Publishes Interim Final Rule on Pre-Existing Condition Insurance Plan Program
On May 17, 2013, the Department of Health and Human Services (HHS) and the CMS released an interim final rule on the Pre-Existing Condition Insurance Plan (PCIP), as established under the Affordable Care Act. The interim final rule establishes the payment rates for covered services furnished to individuals enrolled in the PCIP program administered by HHS beginning with covered services furnished on June 15, 2013. The interim final rule also prohibits facilities and providers who, with respect to dates of service beginning on June 15, 2013, accept payment for most covered services furnished to an enrollee in the federally-administered PCIP from charging the enrollee an amount greater than the enrollee’s out-of-pocket cost for the covered service as calculated by the plan. Comments are due by July 22, 2013. -AONHewitt
CMS Issues Final Rule on MLR Requirements for Medicare Advantage and Medicare Prescription Drug Program; Updates Reporting Deadline to December
CMS Issues Final Rule on MLR Requirements for the Medicare Advantage and Medicare Prescription Drug Program; Updates Reporting Deadline to December
On May 17, 2013, the CMS released a final rule that implements new medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program (Part D) established under the Affordable Care Act. The MLR represents the percentage of revenue used for patient care, rather than administrative expenses or profit. Under the final rule, Medicare Advantage and Part D sponsors are subject to financial and other penalties for failing to meet an MLR of at least 85%. The final rule primarily follows the proposed rule released in February 2013. However, CMS did agree with commenters on the proposed rule who recommended that the reporting deadline should be December, not July. In the final rule, CMS states that “We agree with the commenters that the best balance between beneficiary protection and calculating MLRs based on the most complete data is to require that, in general, MLR reporting for a contract year will occur in the December following the contract year, on a date and in a manner specified by CMS.” The final rule becomes effective on July 22, 2013. --AON Hewitt
CMS Releases Frequently Asked Questions on Health Insurance Exchanges
On May 14, 2013, the Centers for Medicare and Medicaid Services (CMS) released frequently asked questions (FAQs) on health insurance Exchanges (marketplaces). The federal and state Exchanges are to become operational in 2014 and are intended to provide individuals and small businesses with the opportunity to purchase affordable, quality health insurance options, as part of the Patient Protection and Affordable Care Act (Affordable Care Act). The FAQs address:
- The oversight of premium stabilization programs, advance payments of the premium tax credit, and cost-sharing reductions;
- Issuers’ ongoing compliance with Exchange-specific standards and oversight;
- State-based Exchange reporting requirements;
- Privacy and security standards for state-based Exchanges and non-Exchange entities (e.g., Navigators, agents, brokers, etc.);
- Cost-sharing reductions and health savings accounts (HSAs);
- Eligibility and enrollment; and
- Issuer withdrawal from the small group or large group market. -- AON Hewitt
Your Pharmacy Immunization Program Makes Getting Your Flu Shot Easy and Convenient!
Your employees can get their flu and pneumonia shots fast and easy through their Pharmacy Immunization Program, included in your prescription drug benefit through our health plan.
The best part of getting a flu shot from your pharmacist is the convenience. Your employees can avoid having to schedule their shots at the doctor's office and instead go directly to a participating retail pharmacy that offers the shots. Many are open after hours or on the weekends with no appointment necessary. Your employees simply choose the location and pick a time that works best. Most are usually close by.
The coverage is the same as at the doctor's office. Your employees simply present their health plan ID card at the pharmacy and then receive the shot. No prescription is necessary. And in many cases, there may be no copay. Not all pharmacies offer flu shots, so the best way to find out is to visit a pharmacy and ask.
Not all plans include the option of receiving flu shots at a retail pharmacy, so your employees should call the Customer Service number on the back of their member ID card for details.
You'll find more details in this flier that your employees may find helpful. Or, contact your Pharmacy account manager for more details about the Pharmacy Immunization Program.
Finding the right one for your company can be a daunting task. Here's a great way to figure out which one will work for you:
- Provider Network - One should first determine that their dental provider accepts the dental plan they are looking to purchase. Dental carriers have multiple dental plans and providers may pick and choose which ones they will accept. It is a common mistake to assume that a dental provider accepts all plans from a particular carrier. Typically, dental providers choose plans that command a high reimbursement rate.
- Plan Waiting Period - Some dental plans place restrictions on major services such as orthodontics, root canals, bridges, etc. Sometimes this waiting period can last from no waiting period to up to 12 months before major services will be rendered.
- Rollover benefits - As an enticement for members to seek preventative care, some dental plans roll over additional preventative care benefits to a member as an incentive. For example, if a member has a $ 1,500 dental benefit and the member uses at least $750 for preventative care, the carrier will roll over the remaining $750 of the unused benefit to the following calendar year. Ultimately, this raises the maximum benefit level to $2,250 rather than $1,500.
The federal health care reform law changed the way health plans and issuers approach rescissions in both the group and individual markets. Group health plans are affected whether they are insured or self-insured.
It's important to understand what constitutes a "rescission" for federal health care reform, as opposed to another type of coverage termination. A rescission is broadly defined as a retroactive termination of a member's coverage.
However, there are some important exceptions from this broad definition. For example, termination of coverage because of nonpayment of premium or contribution (either by the group or the member) is not a rescission. It is not considered a "rescission" when the member's coverage is retroactively canceled to the last paid-to date if the member pays no premiums or contribution for periods of time after termination of employment or eligibility. The member's coverage can be retroactively canceled to the last paid-to date.
For information on the restrictions on rescissions and clarification on which coverage terminations qualify as rescissions, refer to the Affordable Care Act Implementation FAQs - Part 2.
Are you looking for a quick and easy way to see whether they're eligible for the new health insurance tax credit?*
Look no further!
As you know the new health reform law is now allowing an unprecedented tax credit of up to 35% on health coverage for qualifying small groups.
And it rises to 50% in 2014!
Blue Shield just launched a new website for you that features a tax estimator powered by H&R Block.** Use this new tool to help estimate how tax credits could mean big savings for you.
Visit bscataxcredit.com to calculate your potential savings today!
Small businesses may be eligible this year for a tax credit up to 35 percent of the cost of providing health insurance for their employees."
Don't Leave Money on the Table!
There's a lot of discussion about how and when the health law is going to be taking effect. If you missed it, it's already started to roll out. And if your business is not getting on track wtih what tax subsidies and provisions there are that have ALREADY kicked in, you could be leaving MILLIONS of dollars on the table!
According to a January 4th article put out by Reuters, "Here are some of the law's major provisions and when they were implemented or are set to take effect:
- Several consumer protection rules took effect in September, including allowing children to stay on their parents' health insurance plan until age 26, banning lifetime coverage limits and ending denial of coverage for children because of pre-existing health conditions.
- A temporary insurance program was created to help provide coverage to "high risk" patients with pre-existing conditions.
- A phase-in of tax credits began for certain small businesses that provide health insurance to workers."
And even more provisions kick in during 2011! For a full list of what is coming up and what you need to know at a glance,click here to download this Provisions Timetable.
We've been hearing about Health Care Reform for some time. Most business, both big and small, are confused and concerned about what the changes will mean to them. The following are some of the ways health care reform will begin to impact your business, you, and your family:
- Adult children on your policy.
- Pre-existing conditions.
- “Grandfathering” for all policies.
- Changes to Health Care Savings Accounts.
- Subsidies for employers with Health Care plans.
How do you know what to expect? Where do you turn? Well, look no further! Vanasek Insurance Services has just released Reform Readiness Review™. This is a proprietary, complimentary, and no obligation service. Your personalized Reform Readiness Review™should take no longer than 3-5 minutes to complete. Once we recieve your information, we will be contacting you within 2-3 business days to review your Health Care Reform report customized for you and your company.
Information is Power! Know your rights! Find out exactly how this reform wil be impacing you, your business, and your family TODAY!
Follow this link to start your Reform Readiness Review™: http://www.reformreadinessreview.com
The new healthcare reform law gives a tax credit to certain small employers that provide healthcare coverage to their employees, effective with tax years beginning 2010.
The IRS has released a simple, 3-step worksheet for employers to use to determine if they qualify for the Small Business Health Care Tax Credit.
We believe this is good information for you to share with your clients and could prove to be a valuable prospecting tool as well.
Click here to visit the Warner Pacific website. The worksheet can be found in the article titled Small Business Health Care Tax Credit, located under "News & Updates."
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