Many in the health insurance and employee benefits space are claiming to have found the next new, innovative and sure fire way to reduce health insurance costs. Actually its an old idea, originally deployed in the retirement/pension area of the overall employee benefits palette, and fairly recently resurrected for use in employer provided health insurance. The next “silver bullet”?
DEFINED CONTRIBUTION
(Remember 401(k)s gradual replacement of many defined benefit retirement pension plans in the eighties?)
Next week (March 2, 2015), the Supreme Court of the United States (SCOTUS) will take up a very important case – King versus Burwell. All politics and rhetoric aside, this case has the potential to virtually upend the Affordable Care Act (ACA), and stakeholders should be informed as to its implications. At the core of the case is whether or not the federal government has the authority to issue subsidies (or tax credits) to otherwise eligible individuals that reside in a state that does not have a “state based health insurance exchange”
As we approach the 5th anniversary of the signing of the Affordable Care Act (ACA) into law, compliance and planning have become more important than ever. Listed below are ACA provisions that have particular relevance this year, and deserve attention and planning… 1) The Individual Mandate went into effect in 2014, with a penalty of $95 or 1% of income (the greater of the two) for non-compliance. As citizens prepare/file their tax returns in early 2015, they will notice new questions relating to health…
Section 1322 of the Affordable Care Act (ACA) allowed for the establishment of “consumer operated and oriented plans” or COOPs. Bolstering the ACA’s goal of expanded health insurance coverage, and borrowing from the agricultural industry’s adoption of COOPs in the 1920s, twenty-four COOPs were approved and funded by the federal government. Specifically, the fed awarded nearly $2 billion to the 24 approved COOPs operating in 24 different states. In theory, the COOPs would bring more competition and choice into the market, which is a welcome change from the hundreds of insurers who have abandoned the health insurance market over the last several years (see Metropolitan Life, Travelers, NY Life, Prudential, Principal, American Chambers Life, and Mutual of Omaha to name just a few).
In the current, post Affordable Care Act (ACA) world, the term – narrow network is often heard, and at times, is a strategy deployed by employers and insurers. There are a variety of other ways to describe narrow networks, such as – carve out network; exclusive provider network; select network; tiered network…you get the idea. From a covered members standpoint, this strategy involves limiting the number of contracted providers plan members can seek care from, and in return, receive the best benefits, and lowest out of pocket costs. From the standpoint of the insurer or employer, narrow networks mitigate risk and reduce expenses.
Sir Isaac Newton’s Third Law of Motion taught us that for every action, there is an equal and opposite reaction. As we near the end of the fourth full year of the [partial] roll out of The Affordable Care Act /Obamacare, it has become increasingly more challenging for people to differentiate action from the equal and opposite reaction. Put another way, some of the things we’re experiencing, required by the ACA, are directly attributable to the law itself (call these actions). And then there are things we’re seeing that are the result of the many requirements, mandates, fees/taxes, expansions associated with the ACA (call these equal and opposite reactions). This will all make more sense when you see the chart at the end of this article.
Readers of this blog (soon to be “resource library”) typically find health INSURANCE, FUNDING, and FINANCING issues addressed here. But occasionally, health CARE issues come to light which I feel compelled to address. With all the media coverage and confusion surrounding the recent outbreak of the Ebola virus, I decided to attempt to clarify some important facts. My primary source of information for this post is the Douglas County Health Department (Douglas County, Nebraska), which under the direction of Dr. Adi Pour, does a fantastic job of data mining and educating, among other things.
The Ebola virus was first discovered in 1976 in the Ebola River…
Self funded health plans face a rapidly approaching compliance deadline of January 15, 2015 relative to the Affordable Care Acts so called “transitional reinsurance fee”. A previous post addressed the various reinsurance (or bailout) programs devised in the ACA (click – http://sstevenshealthcare.blogspot.com/2014/01/acas-insurance-company-bailouts.html).
These programs are sometimes referred to as the “Three R’s”, which are: Reinsurance Program; Risk Corridor; and Risk Adjustment.
The first of these reinsurance/bailout programs – the [temporary] reinsurance program…
As the old saying goes, “the devil is in the details”, and the Affordable Care Act (ACA) has its fair share of DETAILS. Among the rapidly approaching compliance deadlines for many employers is requesting/obtaining a ten-digit Health Plan Identifier or HPID. While ALL employers offering health insurance plans must comply with this requirement, the due date for obtaining the ID, along with determining who is responsible for obtaining it varies based on a couple of factors. Here’s an overview of the whole HPID matter…
As we approach the labor day holiday, human resources officials, brokers, consultants, and others begin to think not as much about the end of summer, but rather, the approaching OPEN ENROLLMENT SEASON! Before we know it, that special time of the year will be upon us. Having been involved with so many open enrollments over the years, as an insurance company executive, third party administrator, wholesaler, consultant, and retailer/broker, I have accumulated some insight as to what employees/enrollees should be considering during this important time of the year. Call these my “open enrollment best practices”, or, put another way, the things enrollees/employees should consider as they enter open enrollment season…
