Employer mandate delay, minimum value, out-of-pocket maximum cost sharing: Is there a connection?

Recent headlines from certain news outlets are leading some to think that the out-of-pocket maximum and minimum value plan certification parts of the Affordable Care Act (ACA, or health care reform law) have been delayed until 2015. This is not true. The delay is for combining a shared out-of-pocket maximum for plans that have “multiple service providers” (like a separate pharmacy benefits manager). Medical plans, new and renewing January 1, 2014, and later do need to have out-of-pocket maximums that are not more than $6,350 for single coverage and $12,700 for coverage of spouse or family. Our plans and systems are being updated so that cost shares do not go over the out-of-pocket maximum.

To help sort out the facts from fiction, read this fact sheet that tells what the link is among the employer mandate, the parts that were delayed, the minimum value plan certification requirement and the out-of-pocket maximum cost sharing rule.

Article Courtesy:  Anthem BCBS

New fact sheets answer questions about Health Reimbursement Arrangements

An FAQ issued by the Department of Labor on January 24, 2013 stated that stand-alone HRAs used to buy an individual policy is not considered combined employer-sponsored coverage that follows the annual dollar limit requirement. If employees are offered an HRA and employer-sponsored coverage and turn down the employer-sponsored coverage, the stand-alone HRA will violate the law. The FAQ does allow amounts already in a stand-alone HRA before January 1, 2014 to be drawn on after that time if certain standards are met.

Anthem HRA Fact Sheet

HHS Releases Final Regulations on Essential Health Benefits Standards

On February 20, 2013, the Department of Health and Human Services (HHS) released a final rule that helps consumers shop for and compare health insurance options in the individual and small group markets by promoting consistency across plans, protecting consumers by ensuring that plans cover a core package of items that are equal in scope to benefits offered by a typical employer plan, and limiting their out of pocket expenses.

The Final Rules include details on:

• Essential Health Benefits (EHB) benchmark and default plans
• Determining Actuarial Value (AV) and Employer Mandate Minimum Value (MV)
• Preventive care
• Cost sharing requirements

W-2 reporting communication for employees

As part of the Affordable Care Act (or health care reform law), W-2 forms must show the cost of employer-sponsored health coverage. Anthem has provided this suggested communication below that would come from the employer to notify employees of this new entry on their W-2s :

Health Insurance Exchanges 101 Guide

As part of the Affordable Care Act (ACA or health care reform law), starting in 2014 ALL Americans must have a minimum amount of health insurance or be taxed by the government. The law also requires each state to have a health insurance exchange where people can buy health insurance coverage. People who don’t get health insurance at work, or can’t afford it, may be able to get it through an exchange. The exchanges do not replace buying health insurance privately. They are simply a new place to shop and buy.

Article:  Health Insurance Exchanges 101 Guide

Navigating the next phase of health care reform

Benefit changes. Coverage requirements. Tax credits. Exchanges. When it comes to health care reform, there’s a lot to know – and a lot to do. Here are some key provisions that will affect you through 2018.

Anthem Article: Navigating the next phase of health care reform; Your guide to making strategic decisions