Spring Health Care Reform Updates - Week of 10/6 - 10/12
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Heath care reform updates for the week of October 6-12, 2014. Among the ACA topics we will cover this week are the increase in health insurance options in state and federal exchanges in 2015, changes in HIPAA, changes with the qualifying event requirement for plan enrollment outside of open enrollment, a PCOR fee adjustment and a new CEO for Healthcare.gov.
Transcript of Spring Health Care Reform Updates - Week of 10/6 - 10/12
Proprietary and Confidential©Copyright 2014 Spring Consulting Group, LLC. All rights reserved
LinkedIn: spring-consulting-group-llcTwitter: @SpringsInsight
What You Need to Know About the ACAWeek of October 6-12, 2014
Presented by: George Gonser, CEO Spring Insurance Group
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More Health Insurance Options in State/Federal Exchanges in 2015
Department of Health Human Services announced last week that 77 new carriers will participate in and offer plans on the Exchanges next year.
25% increase from 2014
Open enrollment begins November 15th
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More Health Insurance Options in State/Federal Exchanges in 2015 (cont)
In Massachusetts, United Health Plan will be offering plans for 2015
United has to be a more involved player in the space for 2015 & beyond.
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HIPAA Certificates No Longer Needed
Medical plans will no longer be required to provide Certificates of Creditable Coverage
Certificates of Creditable Coverage showed that a person had previous creditable coverage in order to reduce pre-existing condition restrictions
The ACA prohibits the use of pre-existing condition criteria for most types of health coverage
Thus, negating the need for the certificates
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Qualifying Event Requirement for Plan Enrollment Outside of Open Enrollment
Plan sponsors are responsible to apply their qualifying event eligibility rules
Documentation from employee required to prove qualifying event
Sample qualifying events: Employment status change
Marital status change
Birth of a child
Death of a family member
Relocation
Expiration of COBRA benefits
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PCOR Fee Adjusted
Patient Centered Outcomes Research (PCOR) fee has risen from $2 to $2.08 per covered life for plan years ending on/after 10/1/14 -9/30/15
PCOR is set up to fund research into how to deliver health care that is more efficient, effective and affordable
Insurers pay PCOR fee except in cases of self-funded plans where employers would pay fee;
Fee only applies to non-excepted benefits and is due by 7/31 of the following calendar year after plan end
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New CEO for Healthcare.gov
Kevin Counihan started as new CEO of Healthcare.gov on September 8, 2014;
Counihan joins the federal exchange after overseeing Access Health CT, Connecticut’s state exchange and a stint at the Massachusetts Health Connector
Focused on improving site performance and making it more user-friendly along with implementing a broker-partnership arrangement similar to his successful implementation in Connecticut.
