HHS To Allow Automatic Re-Enrollment Under ACA

The majority of those who enrolled in the Patient Protection and Affordable Care Act plans through the exchanges will be auto-enrolled in the same health plan they selected in 2014 this coming enrollment period, as well as receive the same subsidies, if applicable, the administration said Thursday.

The rule was proposed by the Centers for Medicare and Medicaid Services.

“As we plan for open enrollment in year two and continue to build a sustainable long-term system, we are committed to simplifying the experience for consumers by allowing auto-enrollment,” HHS Secretary Sylvia Mathews Burwell said in a news release. “We are working to streamline the process for consumers wishing to remain in their current plan.”

Basically, under the new guidelines, most of the law’s customers “would be able to renew subsidized health insurance coverage without filing an application and without going back to HealthCare.gov, the website that frustrated millions of consumers last fall.” New HHS Secretary Sylvia Mathews Burwell, who issued the rules Thursday, said, “We are working to streamline the process for consumers wishing to remain in their current plan.”

Administration announces proposal to clarify availability of Health Insurance Marketplace coverage to workers eligible for COBRA

On May 2, 2014, the Obama administration announced updates to model notices informing workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health Insurance Marketplace.

“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping workers and families maintain coverage after a job loss, and it is important that workers know that in some cases there is a Marketplace option as well.”

New Law Repeals Deduction Limits for Small Employer Insured Health Plans

On April 1, 2014, President Obama signed the "Protecting Access to Medicare Act of 2014" into law. The new law mainly focuses on Medicare reimbursement rates for doctors. A small, easily-overlooked provision of the law retroactively eliminates the Affordable Care Act's (ACA) annual deductible limit for health plans in the small group market.

Final 2015 Notice of Benefit and Payment Parameters and Actuarial Value Calculator

On March 6, the Department of Health and Human Services (HHS) provided the 2015 actuarial value calculator and issued final regulations on the 2015 Notice of Benefit and Payment Parameters. While HHS changed a few items from the proposed rule – namely the open enrollment period and cost-sharing limits – many provisions remain the same.

Open Enrollment Period
The 2015 open enrollment period for individual and family plans has been extended by 30 days and will be held November 15, 2014 – February 15, 2015.

2015 Cost-Sharing Limits
The 2015 maximum annual out-of-pocket limits for all non-grandfathered plans will increase by 4.21 percent, lower than originally proposed. The confirmed 2015 amounts are $6,600 for individual coverage and $13,200 for family coverage. The maximum 2015 deductibles for insured non-grandfathered small group plans are $2,050 individual and $4,100 family.

HHS Releases 2014 Federal Poverty Level Guidelines

HHS has released 2014 federal poverty guidelines.  Updated annually for inflation, the 2014 guidelines will set the income thresholds for subsidy eligibility on exchanges for 2015. The threshold (in the 48 contiguous states and DC) for one person will be $11,670, an $180 increase over the 2013 level.  An employee's receipt of exchange subsidies could trigger an employer shared responsibility penalty starting in 2015.  IRS proposed rules include an employer affordability safe harbor based on the federal poverty level.

Marketplace Enrollment Numbers

The U.S. Department of Health and Human Services released the most detailed information on people who enrolled in health plans through either the federally run marketplace or exchanges operated by 15 states and the District of Columbia.

Almost 2.2 million people enrolled in health plans through Dec. 31 in the federal and state marketplaces. (No data has been released on how many enrollees have secured their enrollment with their first premium payment.) Most residents enrolled in December.

Of the almost 2.2. million:

Individual mandate penalty delayed

The part of the Affordable Care Act (ACA or health care reform law) with the biggest impact – the individual mandate – is getting a lot of attention lately. Under the law and regulation as written, people who buy health insurance as individuals (an individual plan) can go three months without health insurance and not have to pay the individual mandate penalty. Now that individual market open enrollment goes until March 31, 2014, coverage can start as late as May 1. The Obama Administration felt like it needed to fix the problem where someone who buys insurance in the last 45 days of open enrollment still would have ended up paying part of the penalty. Because of a change to the regulation this week, this will no longer be the case in 2014. As long as people buying individual plans are signed up for insurance by March 31, 2014, they will not get hit with the penalty.

The Centers for Medicare and Medicaid Services put out guidance on October 28 that gives more information on the “hardship exemptions” for the individual mandate penalty. The Department of Health and Human Services is putting such an exemption in place for people who sign up for insurance before the open enrollment period ends on March 31, 2014. Without this exemption, individuals would have had to be covered by health insurance by March 31, meaning they would have had to sign up for it by February 15, 2014. Now, people who have signed up by March 31 will be able to claim a “hardship exemption” (without asking for it from the marketplace) on their taxes and not pay the penalty for the months in 2014 that they did not have health insurance.

Homework involved to apply for health insurance

Article from the AP:

WASHINGTON (AP) -- Getting covered under President Barack Obama's health care law might take you more than one sitting. In a media preview, it felt like a cross between doing your taxes and making an important purchase that requires research.

"Nothing like this has ever existed before," said Health and Human Services Secretary Kathleen Sebelius.

You'll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that's right for your needs.

Animation Explains Changes Coming for Americans Under the Affordable Care Act

2014 is coming--are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as "Obamacare," go into effect.

Courtesy: The Henry J. Kaiser Family Foundation.

HHS Releases a Report of Health Insurance Marketplace Premiums for 2014

HHS released a report that summarizes the health plan choices and premiums that will be available in the Health Insurance Marketplace. It contains new information, current as of September 18, 2013, on qualified health plans in the 36 states in which the Department of Health and Human Services (HHS) will support or fully run the Health Insurance Marketplace in 2014. Plan data is in final stages but is still under review as of September 18 and may be revised in HHS systems before being displayed for consumers, so this information is subject to change. 

Online enrollment for federal SHOP will be delayed

In the latest setback for the rollout of Obamacare, the U.S. Department of Health and Human Services announced Thursday that small businesses in 36 states can’t enroll their workers into health coverage through the new federally run insurance marketplaces until at least Nov. 1 – one month later than previously announced.

The delay appears to be the result of computer and information technology problems in the Small Business Health Option Program, known as SHOP, an online insurance marketplace specifically for small employers.

Employers still will be able to compare coverage options and begin the application process on Oct. 1, but they won’t be able to sign up workers for coverage until November.

Explanation of Guidance on HRAs, Health FSA- Clarification?

It appears that the pre-tax reimbursement of individual premiums under a premium only plan (POP) (under Code Section 125) is directly at odds with the prohibition against any annual limit on the dollar amount of essential health benefits under the Affordable Care Act (Act). 

On Friday, September 13, the Departments of Labor, Treasury and Health and Human Services provided guidance on the application of certain provisions of the Affordable Care Act (Act) on health reimbursement arrangements (HRAs), certain health flexible spending arrangements (Health FSAs) and employee assistance programs (EAPs). It was clear from the initial reading of the guidance that individual premiums could not reimbursed by HRAs. In a further reading of the guidance, there appears to be more serious consequences.
 

U.S. relaxes health law income - Health markets to employ honor system

As reported by the Washington Post:

The Obama administration announced Friday that it would significantly scale back the health law's requirements that new insurance marketplaces verify consumers' income and health insurance status.
Instead, the federal government will rely more heavily on consumers' self-reported information until 2015, when it plans to have stronger verification systems in place.

The delay comes after a Tuesday announcement that the federal government would postpone for one year a requirement that employers with 50 or more full-time workers provide health coverage.

"I think that Health and Human Services is doing the best that it can under the circumstances," said Sara Rosenbaum, a health policy professor at George Washington University.

The verification systems are meant to determine who qualifies for new benefits under the Affordable Care Act. The law includes tax subsidies to purchase health insurance for Americans who earn less than 400 percent of the poverty line, about $45,000 for an individual.

Those earning less than 133 percent of the poverty line - about $15,000 - will qualify for Medicaid coverage in the District and 23 states that have decided to expand the program.

The federal government also needs to know who receives health insurance coverage from an employer. Consumers who receive affordable health insurance from their company under a policy that costs less than 9.5 percent of their income do not qualify for tax credits under the Affordable Care Act.

HHS Launches Health Insurance Marketplace Educational Tools

The Obama administration kicked off the Health Insurance Marketplace education effort with a new, consumer-focused HealthCare.gov website and the 24-hours-a-day consumer call center to help Americans prepare for open enrollment and ultimately sign up for private health insurance. The new tools will help Americans understand their choices and select the coverage that best suits their needs when open enrollment in the new Health Insurance Marketplace begins October 1.

"The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families-or their businesses," said Health and Human Services Secretary Kathleen Sebelius.

"The re-launched Healthcare.gov and new call center will help consumers prepare for the new coverage opportunities coming later this year," said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. "In October, HealthCare.gov will be the online destination for consumers to compare and enroll in affordable, qualified health plans."

HealthCare.gov is the destination for the Health Insurance Marketplace. Americans may now access new educational information and learn what they can do to begin to get ready for open enrollment this fall. The website will add functionality over the summer so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans. For Spanish speaking consumers, CuidadoDeSalud.gov will also be updated to match HealthCare.gov's new consumer focus.

Key features of the website, based on consumer research and online commercial best practices include integration of social media, sharable content, and engagement destinations for consumers to get more information. The site will also launch with web chat functionality to support additional consumer inquiries.

The website is built with a responsive design so that consumers may access it from their desktops, smart-phones, and other mobile devices. In addition, the website is available via an application interface at www.healthcare.gov/developers.

Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection. In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service. Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.
To view the new look and new focus of the website, visit www.HealthCare.gov.

Gov't Report: Smooth Launch Unsure for Health Law

There's no guarantee that President Barack Obama's health care law will launch smoothly and on time, congressional investigators say in the first in-depth independent look at its progress.
But in a report to be released Wednesday, the congressional Government Accountability Office also sees positive signs as the Oct. 1 deadline approaches for new health insurance markets called exchanges to open in each state - in many cases over the objections of Republican governors.

Additionally, the report discloses that the administration had spent nearly $400 million as of March to set up the infrastructure of a sprawling system involving major federal agencies, every state, hundreds of insurance companies, and millions of citizens, among them many individuals seeking coverage for the first time.

"Whether (the administration's) contingency planning will assure the timely and smooth implementation of the exchanges by Oct. 2013 cannot yet be determined," the report concluded. A copy was provided to The Associated Press.

Final Rules on Employment Based Wellness Programs Released

On May 23, 2013, the DOL, Treasury and HHS finalized the HIPAA Nondiscriminatory Wellness Programs Regulations that were proposed in November 2012, clarifying what will work and what will not work for 2014 and beyond.

 

The accompanying news release stated that the “final rules ensure flexibility for employers by increasing the maximum reward that may be offered under appropriately designed wellness programs.”

DOL Releases Guidance on Model Exchange Notice & Model COBRA Election Notice

The Department of Labor released Technical Release 2013-02 on May 8, 2013. It provided guidance for the Model Exchange Notice and the Model COBRA Election Notice. A copy of Technical Release 2013-02 follows:

I. Introduction

This Technical Release provides temporary guidance regarding the notice requirement under FLSA section 18B and announces the availability of the Model Notice to Employees of Coverage Options. This Technical Release also provides an updated model election notice for group health plans for purposes of the continuation coverage provisions under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to include additional information regarding health coverage alternatives offered through the Marketplace.

Departments Issue FAQ on Summary of Benefits & Coverage Changes

On Tuesday, April 23, 2013, HHS, Treasury and the DOL published Part XIV of their FAQs on the Affordable Care Act, focusing on revisions to the Summary of Benefits and Coverage (SBC).

 

The seven-question FAQs introduce two primary changes, which take effect for plan years starting on or after January 1, 2014:

• A statement indicating whether a plan provides minimum essential coverage (MEC)
• A statement answering whether the plan's share of the total allowed costs of benefits meets applicable minimum value (MV) requirements (i.e., at least 60 percent of allowed charges for covered services, also known as bronze level coverage)

Plans may provide this information by either updating their SBCs or providing it in a cover letter. The departments provided sample language in the FAQs. In addition, the SBC template has been updated as well as the sample completed SBC. The uniform glossary remains unchanged.

 

In a previous notice, the departments indicated that more wholesale changes would be likely for 2014, including revisions and additions to the coverage examples. However, these FAQs confirm that the MEC and MV statements are the only required changes. Also, much of the transition relief provided in 2013 has been extended to 2014. See Q/A-5 in the FAQs for additional details.

 

FAQs about the the Affordable Care Act Implementation Part XIV

 

Original article courtesy of Infinisource:  http://newsroom.infinisource.com/post/2013/04/25/Departments-Issue-FAQ-on-Summary-of-Benefits-Coverage-Changes.aspx

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

Sebelius concedes reform could raise premiums

Overview: Years after the insurance industry began warning that premiums will rise due to health reform, the Obama administration acknowledged Tuesday that it might actually be the case.

Health and Human Services Secretary Kathleen Sebelius told reporters at the White House that some people may see their premiums rise under the Patient Protection and Affordable Care Act.

Article:  Sebelius concedes reform could raise premiums