Recently the Obama Administration compromised to allow waivers for religious organizations to restrict paying for contraceptives on their health plans.
What does that mean for most religious groups that offer health benefits? Unless a group is self funded and writes their own plan, it will be difficult to change things. As we have discussed in earlier blogs posts, 98% of all employers purchase fully insured plans from insurance companies. Insurance companies file their plans and, for the most part, are abiding by the original requirements in ACA on what to cover. Therefore, if a group is fully insured, they cannot just change their plan.
It is possible that the insurance carriers may roll out plans that give these types of groups a chance to change their plan. However, at this point that is not possible and we usually see insurance companies move slowly on these events.
The administration rolled this out to allow for waivers. The carriers will probably wait and see if there are a lot of requests and then decide if they will react.
To read more on this topic, please read Administration Offers Contraception Compromise for Religious Employers, an article that appeared on WSJ Online.
First, congrats on hosting the Tonight Show gig. You’ve made us laugh and we’ve enjoyed your work for a number of years now. Way to go!
Undoubtedly, recent events related to healthcare reform and Obamacare have provided you and your late-night talk show colleagues with an endless supply of comedy material. Nevertheless, in case you needed more material, we thought we’d pass along a prime example of a day in the life of today’s health insurance and business world.
Here’s an all too common, truth-is-stranger-than-fiction scenario that’s playing out with insurance companies and many small businesses across the country. It’s a direct result of the mass confusion surrounding the roll out of the Affordable Care Act. It centers on the scenario that many small businesses faced at the end of 2013 — “You Can Keep Your Plan. Wait! No, You Can’t Keep Your Plan. OK. Now, Yes. You Can Keep Your Plan Again Even Though the Clock is About to Strike Midnight.”
It reminds me of the the classic Abbott and Costello “Who’s on First” comedy skit. It would be really funny to those of us in the insurance business, except that it is generating real frustration and proving to be a major productivity drain on small businesses and their owners. Unfortunately, it’ s playing out like this all across the country.
Our Client Services Manager, one of the best and brightest around, was able to help an exasperated and frustrated client, a construction company executive. Despite the fact that insurance companies often earn the scorn of their policyholders, they clearly are not to blame this time. It’s the unorganized “Keystone Cops” style roll out of the Affordable Care Act that gets the blame here.
Okay, here we go…a real, honest-to-goodness scenario that would most certainly make Abbot and Costello proud:
Dear Joe (not his real name):
Attached is the worksheet – sorry about the roughness of it, but I am no rocket scientist. I think if this continues, we are going to need rocket scientists to do the figuring! Anyway, the worksheet shows more or less how everything was figured on the previous invoices…I tried the best I could to make some sense out of it. I was able to get copies of your 2013 invoices, so I have also attached them for your convenience.
(Jimmy, this is where it really gets good)
Here goes my explanation:
Your invoices for November 2013 and the prior invoices reflected the premiums for medical and dental effective with your renewal date and the renewal rates.
– Then, in December 2013, the invoice reflected the new medical rates effective 12/01/13, plus the OLD dental rates.
– Then, in January 2014, the invoice reflected the new medical rates, plus the ACA taxes put into effect 1/01/14.
– Then, in February, the invoice reflected the same rates and taxes as January. At that point your insurance carrier thought they had it right.
– BUT, after they sent the February invoice, they realized that they had been billing you for the OLD dental rates.
– So they sent a February “revised” invoice that reflected the premium adjustment from December 2013 and January 2014, plus the revised rates for February. Those differences are shown in the retro fee adjustment section of the revised February 2014 invoice. The current charges on the revised February 2014 reflect the difference between the old premiums and the new ones effective 12/01/13 – PLUS the adjustment on the taxes.*
*On this revised February 2014 invoice, the premium adjustment for one employee’s dental coverage does not come out exactly right, but it seems to even out. It looks like they under charged (by a few dollars) the retro fee adjustment, but they seemed to have overcharged (again, by a few dollars) on the taxes for January. I could not get the exact answer for that, (maybe they need to hire a rocket scientist!). But, it appears to even out in the end.
Finally, the March 2014 Invoice is supposedly correct going forward reflecting the correct premiums for both medical and dental coverage and with the correct amount of ACA taxes figured in (fingers crossed!).
There is a caveat there, though, per your carrier: The fees/taxes percentage/calculated does not change.The only issue is if the group dynamics change, then the costs will be different.
If this is not clear, I am happy to go over it with you. Feel free to call me.
Thanks for your patience!
Mary (not her real name)
Well, there you have it Jimmy. We hope your comedy writers can do something with this. We are all still scratching our heads…
Interested in finding what official online resources are available from the federal government for learning about the various requirements and other aspects of healthcare reform? With implementation of the major pieces of healthcare reform around the corner and the complexity seemingly growing with each passing day, I was. A cursory investigation led to these six main government-sponsored websites, no doubt there are many others. Here are the big six for those who might want a handy reference:
Official Site of the Affordable Care Act
U.S. Department of Health & Human Services (HHS)
The Internal Revenue Service (IRS)
U.S. Department of Labor (DOL)
U.S. Small Business Administration
The White House
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- Tom Barrett
- October 9, 2013
- ACA, act, affordable, answers, care, confusion, government, healthcare reform, help, Obamacare, resources
- 0 Comments
ACA Prescribed Limits Are Still on Track for Most Plans in 2014
Out-of-Pocket (OOP) maximums of $6,350 for individuals and $12,700 for families will still apply for most customary fully-insured health insurance plans in 2014 (coinciding with renewal/anniversary dates; new plan year effective dates). Many publications and other news sources have created some confusion by reporting that the Affordable Care Act provision limiting maximum out of pocket costs has been delayed until 2015. The delay only impacts those plans that carve out certain benefits (e.g. pharmacy, mental health benefits) for administration by separate third-party providers. In those cases, a health plan’s medical benefits and its carved out benefit(s) may apply toward separate out-of-pocket maximums in 2014. This appears to be a one year exception for carve-outs and all plans are expected to aggregate out-of-pocket maximums beginning in 2015.
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- Tom Barrett
- September 18, 2013
- ACA, affordable, carve-outs, confused, confusion, mandate, maximum, OOP, out, pocket
- 0 Comments