Tag Archive: minimum actuarial value

Insurers nervous about Obamacare ‘fix,’ say it could upset markets – Health Exchange – MarketWatch

Insurers nervous about Obamacare ‘fix,’ say it could upset markets – Health Exchange – MarketWatch.

Some health plan issuers didn’t like grandfathering of pre-3/23/10 plans, concerned about the actuarial and risk pool impact of splitting the individual market into two segments: the “old” and the “new” markets as termed by President Obama at today’s briefing.  The old market can operate under pre-Affordable Care Act standards, which mandate specific benefits and minimum actuarial value for all plans sold after January 1, 2014.

Now that states will have the option of temporarily extending post- 3/23/10 plans as Obama announced today, plan issuers complain actuarial projections upon which they based their new offerings on are being thrown out of kilter. They also worry those buying new plans subject to the ACA standards for benefits will be those more likely to use them, threatening the actuarial stability of the risk pool for those covered under the new plans.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Employer health benefit exchange notice requirement takes effect March 1

Effective March 1, 2013, employers must notify new and existing employees in writing about their state’s health benefit exchange and advance premium tax credits available through the exchange to help them purchase individual coverage.

The requirement is contained in Section 218b of the federal Fair Labor Standards Act of 1938.  The U.S. Department of Labor (DOL) is charged with issuing regulations providing more specific guidance on the notice but has not yet done so.  Section 218b requires the following information be included in the notice:

  1. A description of the services provided by the exchange and the manner in which the employee may contact the exchange to request assistance.
  2. If an employer provides employer-sponsored health coverage that does not provide minimum actuarial value (60 percent of expected costs for benefits provided under the plan), the employee may be eligible for a premium tax credit and reduced cost sharing (deductibles, copayments, and coinsurance) if the employee purchases individual coverage through the exchange.
  3.  If an employee purchases a qualified health plan through the exchange, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for federal income tax purposes.

Update: On January 24, DOL issued guidance stating employers are not required to comply with the employee notification requirement until the rules are issued.

In the meantime, DOL said it is considering “model, generic language” among alternative methods for employers to comply with the notice requirement, adding that forthcoming guidance will provide employers flexibility and adequate time to comply with the requirement.  DOL added it expects the timing for distribution of notices will be the late summer or fall of 2013 to coordinate with the exchange open enrollment period beginning October 1, 2013.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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