Question: In 2014, will an employee’s nonworking spouse be eligible for premium credits or subsidies on the Exchange if (1) the employee’s employer does not offer medical coverage to employee’s spouse or (2) the employer offers medical coverage to the employee spouse’s but does not pay for any portion of the premium for such spouse’s coverage?
Answer: Under Treasury Regulations Section 1.36B-2(c)(3)(v)(A)(2), an eligible employer-sponsored plan will be affordable for related individuals (family members) if the cost of self-only coverage does not exceed 9.5% of the employee’s household income. In other words, for purposes of determining whether family members are eligible for premium tax credits, the cost of family coverage is not taken into account-all that matters is whether the cost of self-only coverage is affordable to the employee.
Therefore. if an employer offers coverage to the employee’s spouse, but does not pay for any part of his or her premium, he or she will not eligible for credits and subsidies if the coverage offered to the employee is affordable.
If an employer does not offer coverage to the employee’s spouse, he or she would be eligible for credits and subsidies depending on the family’s household income.
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Nov. 26, 2013 – The Department of Health and Human Services (HHS) announced on November 22, 2013 that individuals will have an extra week to enroll in coverage effective January 1, 2014.
The delay is to account for technical issues experienced with the website healthcare.gov. The original December 15th deadline for individuals applying for coverage effective January 1st has been extended to December 23rd.
The delay does not change the 2014 open enrollment period which began October 1, 2013 and runs through March 31, 2014.
The extension will allow the federally run Marketplace more time to prepare for the next open enrollment period and allow insurers to make appropriate rate decisions.
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From: BenefitsPro By Kathryn Mayer, October 31, 2013
Nov. 26, 2013 – Use-it-or-lose-it is no more.
The U.S. Department of the Treasury and the IRS on Thursday issued a notice modifying the longstanding “use-or-lose” rule for health flexible spending arrangements. Participants now can carry over up to $500 of their unused balances
remaining at the end of a plan year.
The rule will go into effect for the 2014 plan year.
Effective immediately, employers that offer FSAs that don’t include a grace period will have the option of allowing employees to roll over up to $500 of unused funds at the end of this plan year.
An employer cannot offer a FSA carryover provision and an FSA grace period at the same time, officials said.
For nearly 30 years, employees eligible for FSAs have been subject to the use-it-or-lose-it rule, meaning any account balances remaining unused at the end of the year are forfeited.
FSAs allow employees to contribute pre-tax dollars to pay for out-of-pocket health care expenses – including deductibles, copayments, and other qualified medical, dental or vision expenses not covered by the individual’s health insurance plan.
Health savings accounts, on the other hand, are similar vehicles, but allow participants to build up savings over time.
The move, the departments announced, is making “FSAs more consumer-friendly and provide added flexibility.”
“Across the administration, we’re always looking for ways to provide added flexibility and commonsense solutions to how people pay for their health care,” Treasury Secretary Jacob Lew said in a statement. “Today’s announcement is a step forward for hardworking Americans who wisely plan for health care expenses for the coming year.”
The change responds directly to more than 1,000 public comments the Treasury fielded. Employers and employees complained about the difficulty for employees to predict future needs for medical expenditures. Many FSA users said they scrambled at year end to spend the remaining amounts, often buying unnecessary medical supplies.
IRS officials said they believe a $500 rollover cap is appropriate because most employees who lost money under the rule lost far less than that amount.
Bob Natt, executive chairman of Alegeus Technologies, a health and benefits payments firm, said he’s grateful the administration has “eliminated the most significant barrier to FSA participation – namely consumers’ fear of losing their money.”
He said that though more than 85 percent of large employers offer FSAs, only about 20 percent of eligible employees actually enroll, mainly for “fear of forfeiting unused funds at the end of the plan year.”
“With this new provision in effect, there is really no reason for eligible employees not to enroll and contribute to an FSA,” Natt said. “All contributions are tax-free, the employee’s full election is available on the first day of the plan year, and now unused funds up to $500 can be rolled over to the next plan year.”
Alegeus Technologies has been lobbying for four years to modify the use-it-or-lose-it provision, he said.
Wageworks, a benefits management provider of consumer-directed benefits, has also been pushing the administration for flexibility on FSA provisions. The company’s CEO, Joe Jackson, said it’s a very “positive change” and a long time coming.
“The timing of this change could not be better, as most companies are now in their open enrollment period,” Jackson said. “We encourage all eligible employees to take advantage of this change and sign up for an FSA and lower their health care expenses.”
The rule will have far-reaching effects: An estimated 14 million families participate in FSAs.
Under the Patient Protection and Affordable Care Act, the amount an employee can set aside in an FSA dropped to $2,500 this year. The $500 carryover won’t reduce the $2,500 maximum a worker can contribute to a FSA each year, Treasury officials said.
President Obama announced on November 14, 2013 that the Administration will allow health insurers to continue certain coverage in the individual and small group market which would have not otherwise met the market reform requirements of the Affordable Care Act (ACA). This change raises significant questions and operational problems for issuers, providers, employer sponsors of health plans, and other organizations operating in the health care industry.
In conjunction with the President’s announcement, the Centers for Medicare & Medicaid Services of the Department of Health and Human Services (CMS) has issued a letter to state insurance commissioners (CMS Letter) detailing the Administration’s new “transitional policy” in regard to this issue. The CMS Letter provides some guidance regarding health insurance policies that now may be continued, and specifies the necessary conditions under which these policies may be continued. However, there remains much uncertainty as to whether issuers will be able to continue to offer these policies, as well as the overall impact on the insurance market.
Every state is still making their determination on how the announcement will affect them, On Nov. 22, 2013 Governor Rick Snyder announced that he will allow the President’s ACA fix on existing health plans in the State of Michigan. This announcement allows carriers to decide if they are able to do this as the ACA plans are being implemented.
MBPA President and CEO Jennifer Kluge noted that the Association supports the Governor’s action and hopes that “small business can keep their coverage. The question becomes, is it feasible for the carriers to turn the ship around without negatively impacting rates. If not, it might be best for some small businesses/individuals to keep the new ACA compliant plans.”
Summary of the CMS Letter
The transitional relief described in the CMS Letter applies to health insurance coverage in the individual and small group market that is renewed for a policy year between January 1, 2014 and October 1, 2014 and “associated group health plans of small businesses.” In order to take advantage of the relief, the following conditions must be met:
•The coverage must have been in effect on October 1, 2013, and the relief applies only to individuals and small businesses with coverage under the policy as of that date. In other words, if a policy is extended under the relief, it cannot be sold or offered to new insureds.
•The issuer sends a new notice to all individuals and small businesses that received (or would have received) a cancellation notice with respect to the coverage, informing them of the following: (1) any changes in the options that are available to them; (2) which of the specified market reforms would not be reflected in any coverage that continues; (3) their potential right to enroll in a qualified health plan offered through an Exchange and possibly qualify for financial assistance; (4) how to access such coverage through an Exchange; and (5) their right to enroll in health insurance coverage outside of an Exchange that complies with the specified market reforms.
If individuals or small businesses have already received a cancellation notice, the issuer must send this notice as soon as reasonably possible. If the cancellation notice has not yet been sent, the issuer must send the notice by the time it would have otherwise had to have sent the cancellation notice.
Under the relief, eligible policies will not have to comply with the following market reforms which otherwise would be mandated by the ACA for 2014:
•the prohibition on using factors other than rating area, actuarial value, age, tobacco use, and individual/family status to determine premium rates;
•guaranteed availability of coverage;
•guaranteed renewability of coverage;
•the prohibition of pre-existing condition exclusions or other discrimination based on health status, with respect to adults (except with respect to group coverage);
•the prohibition of discrimination against individual participants and beneficiaries based on health status (except with respect to group coverage);
•the prohibition of discrimination against health care providers acting within the scope of their license and state laws;
•the requirement to provide essential health benefit packages;
•the prohibition on discriminating against an individual who requires treatment for cancer or another life-threatening condition because the individual chooses to participate in a clinical trial.
Note that this list does not encompass all of the market reforms under the ACA; for example, the relief does not extend to the prohibition on waiting periods that exceed 90 days, or the prohibition against establishing lifetime or annual limits on the dollar value of benefits.
The CMS Letter states, at its conclusion, that “State agencies responsible for enforcing the specified market reforms are encouraged to adopt the same transitional policy with respect to this coverage.” In other words, while the CMS Letter reflects the Obama Administration’s policy, CMS acknowledges that state insurance regulators will dictate whether this relief will be available for any particular state.
Takeaways
My initial reactions to the Administration’s announcement and the CMS Letter are as follows:
•The threshold question is whether state insurance regulators will be willing, or able, to let insurers take advantage of the relief.
The transitional relief is only available to the extent state insurance regulators are willing to go along with the Administration’s proposed policy. This will be determined on a state-by-state basis, based at least in part on political considerations. The status of Exchange enrollment within the state may also be a factor.
Initial reaction to the proposed relief has been mixed. According to press reports, regulators in Florida, Hawaii, Kentucky, North Carolina, Ohio, and Texas have indicated that they are receptive to allowing insurers to continue eligible plans. Rhode Island, Vermont, and Washington have already stated they will not allow insurers to continue non-compliant policies, regardless of the Administration’s position. Other states are apparently reviewing the proposal. However, it seem likely that some states will adjust their initial positions based on their success in enrolling individuals on the Exchanges. States with low enrollment may be more likely to allow for the continuation of otherwise non-compliant policies in the hopes that it will lower the number of individuals with no coverage at all.
There are other problems at the state level. A number of states have adopted laws mirroring the ACA market reforms, effective as of January 1, 2014. Insurance regulators in these states may not have the flexibility to allow non-compliant policies to be renewed, absent action by the state legislature to amend the relevant laws. At least one state, California, has entered into contracts with issuers offering Exchange products requiring them to discontinue non-grandfathered coverage that does not comply with ACA market reforms. Such contracts would also have to be modified.
•Even if the states are willing to “play ball,” insurers are under no obligation to continue these policies. Insurers will have to take into account significant business and logistical considerations in deciding how to proceed.
Under the current guidance, a health care insurer has no obligation to continue any particular health insurance policy, regardless of whether it is eligible for the transitional relief. If the policy is potentially eligible to be extended, the issuer will have to take into account a number of factors in determining whether it is feasible to continue a policy that it anticipated terminating. First, the issuer will have to make a business decision regarding whether it is in its financial interest to continue the policy, given the changes in the insurance market. Many issuers have significantly altered their internal programming for administering claims in anticipation of the implementation of the market reforms, and they will have to determine if they can now modify that programming to accommodate the reinstatement of these other policies. Also, since the carriers did not anticipate the existence of these policies, they presumably have not filed for the appropriate premium rates. That will require the carrier to take the time to determine what premiums are appropriate and then file the policies with the appropriate state regulators for approval. Finally, issuers will have to comply with the notice requirements set forth in the CMS Letter and do so in a timely manner, and give policyholders ample time to decide whether to renew their policies. Working through all of these issues will pose challenges for many issuers.
•Not every policy that is non-compliant with the ACA market reforms can be “saved” by this relief. Notably, it appears “mini-med” policies cannot take advantage of the relief and therefore are no longer viable.
While the CMS Letter would allow the continuation of some policies that otherwise would be out of compliance with the market reforms, the excepted “specified market reforms” as laid out in the transitional relief are not inclusive of all the market reforms in the ACA. As a result, at present it appears that certain policies simply cannot be saved, regardless of the relief. Most notably, it appears that “mini-med” policies, which provide for inexpensive premiums but typically cap benefits at a relatively low annual limit, are not eligible for the relief, since the elimination of annual limits is not one of the excepted “specified market reforms” set forth in the CMS Letter.
•A number of entities are raising concerns about how this new relief could affect the health insurance risk pools. Further guidance addressing this issue is likely.
Health insurance industry leaders are already expressing the concern that the continuation of non-ACA compliant health insurance policies will result in healthier (lower-cost) individuals retaining less expensive coverage that otherwise would have been canceled, while less healthy (higher-cost) individuals will purchase coverage on the Exchanges. That could result in the premiums that were approved for Exchange coverage not covering the cost of providing benefits for this population. The CMS Letter acknowledges this issue, stating, “though this transitional policy was not anticipated by health insurance issuers when setting rates for 2014, the risk corridor program should help ameliorate unanticipated changes in premium revenue. We intend to explore ways to modify the risk corridor program final rules to provide additional assistance.” The risk corridor program is a temporary program that HHS will implement during 2014 through 2016. Under the risk corridor program, funds are distributed from those qualified health plans sold in the Exchanges that have better than expected experience to the qualified health plans with worse experience, in order to stabilize risk. Concerns about disruption of the risk pools are likely to continue, and further guidance addressing this issue is likely to be forthcoming as well.
•The CMS Letter leaves open the possibility that the transitional relief could be extended.
Notably, the CMS Letter states, “We will consider the impact of this transitional policy in assessing whether to extend it beyond the specified timeframe [eligible coverage renewed for a policy year starting between January 1, 2014, and October 1, 2014].” This suggests that CMS could extend the relief into future policy years. Of course, legislation is also under consideration in Congress that could also affect whether these policies will continue to be viable
Larry Grudzien is an attorney practicing exclusively in the field of employee benefits. He has experience in dealing with qualified plans, health and welfare, fringe benefits and executive compensation areas. He has more than 35 years of experience in employee benefit law and is an adjunct faculty member of John Marshall Law School’s LL.M. program in employee benefits and at the Valparaiso University School of Law, where he teaches a number of courses.
By Bonnie Bochniak
Vice President, Government Relations
MBPA/MFBA
Nov. 26, 2013 – The office of Governor Rick Snyder has submitted the waiver amendment needed to expand Michigan’s Medicaid eligibility, capturing individuals with incomes up to 133 percent of the federal poverty level, which is roughly $15,000 a year for a single person. This waiver also fosters healthy behaviors to help decrease the rate of chronic diseases and to encourage overall health.
Background:
What kind of coverage will be provided?
Coverage will include access to primary care doctors, preventative care and routine checkups.
How much will it cost Michigan?
There is no net cost to the state over the next 21 years, and Michigan will save $320 million in uncompensated care costs by 2022 and $206 million in General Fund costs in 2014 alone.
Who will pay for the expansion?
Federal funds will cover 100% of the cost of Medicaid expansion from 2014 to 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and subsequent years. With the Medicaid expansion, the federal government will cover expenses Michigan pays for today, saving the state $206 million in in General Fund costs in 2014 alone. The proposed budget deposits $103 million of those savings into a new health savings fund to cover Michigan’s future health care liabilities.
Will Michiganders who already have insurance benefit?
Yes. Today, uninsured citizens often turn to emergency rooms for non-urgent care because they don’t have access to primary care doctors – leading to crowded emergency rooms, longer wait times and higher cost. By expanding Medicaid, those without insurance will have access to primary care, lowering costs and improving overall health.
Will businesses benefit?
Yes. Under the Affordable Care Act, the federal government is mandating that businesses either provide health care to their employees or pay a $2,000-per-employee penalty. By expanding Medicaid, Michigan can provide an affordable option that will help businesses stay open.**
Michigan’s Medicaid Expansion will provide eligibility to about 450,000 people state-wide, once it is enacted on April 1, 2014. Michigan Community Health Director Jim Havemen said the state department had been holding discussions with the Center for Medicare and Medicaid Services (CMS) since August and is confident of its approval before the end of this calendar year. CMS is an arm of the U.S. Health and Human Services (HHS) Department, tasked with administering sections of the Affordable Care Act.
The State of Michigan will soon provide information to the public through websites and toll-free numbers in the upcoming weeks. Michiganders eligible to sign up will begin receiving benefits on April 1st, 2014, and in the meantime, may utilize an employer sponsored plan, or the federal exchange.
As always, MBPA’s legislative team will keep you up to date as more information is announced. Please feel free to contact our team with any questions at 586-393-8800 or by email: BBochniak@michbusiness.org
*Information provided by Michigan.gov/MiBudget2014
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Nov. 26, 2013 – The Departments of Labor, Health and Human Services and the Treasury on Nov. 8, 2013 jointly issued a final rule increasing parity between mental health/substance use disorder benefits and medical/surgical benefits in group and individual health plans.
The final rule issued implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and ensures that health plan features like copays, deductibles and visits limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits.
This action also includes specific additional consumer protections, such as:
• Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings;
• Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law;
• Clarifying that parity applies to all plan standards, including geographic limits, facility-type limits and network adequacy; and
• Eliminating an exception to the existing parity rule that was determined to be confusing, unnecessary and open to abuse.
In January, as part of the President and Vice President’s plan to reduce gun violence, the administration committed to finalize this rule as part of a larger effort to increase access to affordable mental health services and reduce the misinformation associated with mental illness. As the President and Vice President have made clear, mental illness should no longer be treated by our society – or covered by insurance companies – differently from other illnesses.
The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act and requires coverage of mental health and substance use disorder services as one of ten essential health benefits categories. Under the essential health benefits rule, individual and small group health plans are required to comply with these parity regulations.
“New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders,” said Labor Secretary Thomas E. Perez. “These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices and increase health plan transparency. Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.”
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” said Health and Human Services Secretary Kathleen Sebelius. “Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”
“Americans deserve access to coverage for mental health and substance use disorders that is on par with medical and surgical care,” said Treasury Secretary Jacob J. Lew. “These rules mark an important step in ending the disparities that exist in insurance plans, and will provide families nationwide with critical coverage and protections that fulfill their health needs.”
The final Mental Health Parity and Addiction Equity Act rule was developed based on the departments’ review of more than 5,400 public comments on the interim final rules issued in 2010.
Nov. 26, 2013 – The concept of “affordable” coverage comes up frequently when trying to navigate the complex rules under the Patient Protection and Affordable Care Act (“PPACA”). While it is a defined term, it has different meanings depending on whether you are trying to understand compliance with the employer shared responsibility provisions, determine whether an individual will be eligible for subsidized marketplace/exchange coverage, or understand the exemptions from the individual mandate penalties.
Employer Shared Responsibility Provisions
For an Applicable Large Employer to avoid employer shared responsibility penalties beginning in 2015, the employer must provide “affordable”, minimum value coverage to at least 95% of its full-time workforce and their dependent children to age 26. In this context, the term “affordable” means that the cost of self-only coverage (regardless of the coverage level in which the individual is actually enrolled) does not exceed 9.5% of the individual’s household income (the modified adjusted gross income of the employee and any members of the employee’s family, including spouse and dependents, who are required to file an income tax return). Instead of using an employee’s household income, the IRS permits employers to use one of the following safe-harbors:
• W-2 Wages: Coverage will be deemed affordable so long as the cost to employees for self-only coverage does not exceed 9.5% of the employee’s W-2 wages with that employer. (Note: Many employers do not prefer this method as it does not take into consideration any pre-tax contributions to benefit plans and, therefore, could actually produce a lower base to determine affordability.)
• Rate-of-Pay: Coverage will be deemed affordable so long as the cost to employees for self-only coverage does not exceed 9.5% of the employee’s monthly “rate-of-pay” which is calculated by taking the employee’s hourly rate multiplied by 130.
• Federal Poverty Line: Coverage will be deemed affordable so long as the cost to employees for self-only coverage does not exceed 9.5% of the annual federal poverty line for a single individual ($11,490 for 2013).
If an employer offers multiple levels of coverage, affordability can be based upon the lowest level of coverage that provides minimum value in accordance with applicable regulations.
It is also important to note that while in order to avoid employer shared responsibility penalties in 2015 and beyond the employer must also offer coverage to the dependent children (until age 26) of its full-time employees, the cost of the coverage for those dependents does not have to be “affordable”. In other words, an employer just has to offer the coverage to dependents and can charge any amount for dependent coverage, even 100% employee paid, and not trigger penalties.
Eligibility for Exchange Subsidies
Beginning in 2014, U.S. citizens and legal residents in families with household incomes between 100% and 400% of the federal poverty level for the individual’s family size, and who are not offered affordable, minimum value coverage through an employer, are eligible to receive a premium subsidy to reduce the cost of purchasing health coverage on the exchange. For these purposes, “affordability” is based on the cost for self-only coverage (regardless of the level of coverage in which the employee is actually enrolled) not exceeding 9.5% of the individual’s household income. The method used by the applicable employer to determine affordability for employer shared responsibility purposes does not determine affordability for purposes of exchange subsidies.
Individual Mandate Penalties
Beginning in 2014, PPACA requires U.S. citizens and legal residents to maintain minimum essential coverage for themselves and any nonexempt family members. Failure to maintain such coverage could subject individuals to penalties unless the individuals are exempt from this requirement. One category of exempt individuals are those that do not have an affordable health coverage option available to them. For these purposes, “affordability” means that the cost of coverage does not exceed 8% of the individual’s household income based on either (1) the self-only premium under an eligible employer-sponsored plan, or (2) the self-only premium for the single lowest cost Bronze level plan available on the exchange serving the area in which the individual resides.
*This article is not intended to give legal advice. It is comprised of general information. Employers facing specific issues should seek the assistance of legal counsel.
Kristi R. Gauthier is a senior attorney in Clark Hill’s Birmingham office and concentrates her practice in Employee Benefits Law. Kristi has represented clients in a wide variety of employee benefits issues involving health and welfare benefits, as well as retirement plans. Kristi is admitted to practice in the State of Michigan, the U.S. District Court for the Eastern District of Michigan, and the U.S. Sixth Circuit Court of Appeals. She also is active in the legal community with memberships in the American Bar Association, the State Bar of Michigan, and the Oakland County Bar Association where she is a member of the Employee Benefits Committee. Kristi also serves as a member of the Clark Hill Diversity and Inclusion Committee. Kristi has lectured on various employee benefits issues, including ERISA compliance, healthcare reform, COBRA, section 125 plans, 403(b) plans and IRS plan correction programs. Kristi is also a co-author of the ABA publication ERISA Survey of Federal Circuits. Kristi was named a “Rising Star” by Michigan Super Lawyers in 2011.
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Nov. 26, 2013 – In the words of actress Lauren Bacall, “Standing still is the fastest way of moving backward in a rapidly changing world.” Businesses today face many challenges in their efforts to keep moving forward. One of the most pressing, especially for companies with their eyes on the future, is to offer a strong employee health and wellness package. Let’s take a look at some of the top promising trends we’re seeing when it comes to corporate health and wellness.
Shifts in insurance coverage
The Affordable Care Act goes into full swing in 2014, which will provide nearly all Americans with affordable, comprehensive health insurance. Past policies in insurance coverage had been shifting more of the burden of health care costs onto the backs of employees. This practice left many workers facing the painful choice of paying their rent or visiting their physician. The new trend offers comprehensive plans that include general wellness, behavioral health, medications, maternity, disease management, and emergency care, while including free preventive care.
Custom designed health and wellness plans
Businesses today are better able to take control of the health and wellness resources they offer employees. Savvy leaders are interested in creating strategies that help control costs, measure effectiveness, and incentivize results. Wellness programs, incentives, and health reimbursement accounts that go beyond the basics of conventional health plans are all strategies to accomplish this. Wellness programs are growing outside of the HR department to include leadership, operations, and health providers for more effective engagement and better outcomes. This enables better control and consistency while allowing agility to adjust health plans or third party administrators.
Offering wellness incentives for participation and results
During a time when health care costs are skyrocketing, offering incentives is an excellent way to inspire people to change unhealthy lifestyle and behavioral patterns that will ultimately drive the costs of providing health care higher. Of course, any “outcome” based incentives must be compatible with appropriate laws such as the Americans with Disabilities Act, the Genetic Information Nondiscrimination Act, and the Health Insurance Portability and Accountability Act. Keep in mind, allowances for premium differentials will increase to 30 percent of insurance expenses for compliant wellness programs and to 50 percent for tobacco cessation in 2013 as a result of the Affordable Care Act.
Results-driven rewards for health providers
Many health plans are beginning to offer rewards and limits to health providers based upon efficiency and costs. The Affordable Care Act also instituted a 6-year tax, beginning in 2012 for the purpose of examining and improving medical effectiveness. Providers must offer appropriate health assessments, screenings, and examinations. More importantly, they are going to be held accountable for managing diseases such as high blood pressure, asthma, diabetes, high cholesterol, heart disease, and COPD. Rewards will integrate economic and medical best practices.
Renewed focus on primary and preventive care
The high costs of preventive health in the past left many people skipping it completely. Now the focus has shifted and preventive care, including focus on vaccines, health kiosks, and retail health clinics, is a critical part of the overall efforts to lower costs. Increasing attention toward prevention has positioned primary care physicians as champions to promote and provide proactive care. Although the physician-patient relationship is being emphasized, the shortage of primary care physicians will further increase the role of health and wellness professionals to educate, evaluate and refer treatment. Prevention, after all, remains the best cure.
Transparency in costs
One of the most often cited complaints about health care in the past has been the lack of transparency when it comes to prices. Without transparency, purchasers cannot make responsible decisions about affordability of care and the idea of healthy competition is out the window. Today, providers are offering cost estimators, comparison tools, mobile apps, and countless other tools to keep consumers informed. ??
Improvements in technology and communication
Not only does technology help diagnostics and treatment, but it also can help improve communication. Tablets now fit in physician lab coats to allow convenient e-prescribing and reporting. By 2014, electronic medical records will be required; this allows a completely streamlined approach to the patient experience. Further, standards will be implemented to reduce data silos, integrate records, and reduce redundancy. In addition, the complicated amount of changes will require extra communication to aid delivery and understanding, particularly to a rapidly aging population.
The future of corporate health and wellness is here. Businesses that fail to move their strategy forward stand to be left behind by those that do.
Scott Foster is president of Wellco, a leading Wellness ROI provider based in Michigan. Foster has developed award-winning, results-oriented strategies to fix wellness programs and measurably improve organizational health costs and conditions. He can be reached at scott.foster@wellcocorp.com.
This article first appeared in Corp! magazine online March 7, 2013.
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President Obama announced today that Americans that currently have individual health care policies can keep the policies for a period of one year. The decision is designed to ease the impact on individuals who have received cancellation notices from their health insurance company because the policies do not meet essential benefits requirements under the Accountable Care Act (ACA).
Health Insures will be required to notify individuals that have policies that predate the ACA that other benefit alternatives are available under the ACA and also must specify the areas of their current plan that fall short of ACA essential benefits.
The President’s announcement does not impact employer sponsored health care benefit programs.
https://michbusiness.com/wp-content/uploads/2023/08/MichBusiness_logo_horizontal.png00michbusinesshttps://michbusiness.com/wp-content/uploads/2023/08/MichBusiness_logo_horizontal.pngmichbusiness2013-11-14 13:48:542015-10-08 00:00:00Current Individual Health Care Policies Can be Kept for One Year