With ACA changes for groups and employees, the Blues are continuing to look at how their current membership is impacted. They know that some members currently treated as groups will shift to individual market coverage post-reform.

 

To help agents keep members Blue, they are developing processes to simplify the transition from employer-sponsored insurance to an individual Blues’ product.

 

What We Know:
As a result of the ACA, some groups will no longer be eligible for group insurance and will only be eligible to purchase coverage in the individual market. These include sol proprietors, husband-wife groups without common law members and direct-billed association members.

 

What the Blues are doing in 2013:
The Blues are making this transition easy. They’re providing groups with the opportunity to select from a number of reform-compliant bronze, silver and gold-tier individual products that will be offered both on and off Marketplace beginning Oct. 1st 2013. These products are not the same as the customized group products some members may have been accustomed to. However, they do have the Essential Health Benefits required by the ACA. Key differences will be seen mainly in medical cost-sharing and the plan’s monthly premium.

 

They want to ensure the group has as much time as possible in advance of Jan. 1, 2014, to shop, select and enroll into the individual product that best meets their needs. If a group has not made a selection by Dec. 15, 2013, they’ll enroll them into an off Marketplace BCBSM or BCN gold-tier product (depending upon where the member currently has coverage). This will ensure that there is no lapse in coverage. The group will simply need to pay the premium bill to accept the change.

 

Blues selected a gold-tier level because for the majority of the membership in question, benefits aside, the medical cost share and monthly premium of these plans are likely the closet to what they currently have.

 

What this means to your customers:
The Blues recognize that this will be a change for some of your customers and in some cases their employees, who may not be familiar with the process of purchasing individual insurance on their own. Agents play a critical part in helping these individuals obtain coverage in this new environment.

 

When you’ll receive more information:
If a client intends to drop coverage or you have specific questions about the transition process and the support available to you, please email groupdropnotification@bcbsm.com or contact your managing agent. You can also call the Health Care Reform Agent Support Center at 1-866-582-5052.

MBPA is actively monitoring the Affordable Care Act’s (ACA) implementation and the impact on Michigan businesses. We urge you to use this brief while conducting final ACA preparations; these are the key ACA provisions you must know about as we approach 2014. Links to files referenced below will be posted on the MBPA member website.

1. Small Business & Individual Healthcare Marketplace Go Live:
In October 2013, the federal government will launch an individual and small group (“SHOP”) health marketplace and begin open enrollment. Initially, only businesses with 50 or fewer employers may elect to purchase health insurance via the marketplace. Key developments you should be aware of:

Michigan decided that the federal government will operate its health marketplace in 2014. In the future, Michigan may play a role in operating the marketplace or assume operational control.

• The federal government is evaluating which insurance carriers (and plans) to offer.
• All health plans will include a baseline set of essential benefits modeled after a benchmark plan that Michigan has selected – Priority Health HMO.
• In 2014, the marketplace will allow small businesses to select one health plan option, rather than offering employees the choice of multiple plans. Multiple options will become available in 2015.
• Small businesses can purchase health insurance on a rolling basis via the marketplace; they are not tied to a specified open enrollment period (like individuals).
• Licensed agents may continue to assist small businesses that choose to purchase insurance via the marketplace. They may do so by using an insurer’s website or the marketplace website. Insurance carriers will pay commissions; agents must register with marketplace and undergo training before assisting customers.
• Some of your employees may be eligible for subsidized health insurance if they purchase individual policies via the healthcare marketplace and earn less than $45,960 ($94,200 for a family of four).

2. Employer Penalty Delayed for Business with 50 or More Employees:
The federal government, due to pressure from MBPA and businesses nationwide, delayed implementation of the employer penalty. Key developments you should be aware of:

The employer mandate and penalty will take effect in 2015 (delayed from 2014).

In 2014, the federal government plans to work with businesses to simplify reporting requirements and allow time for businesses to develop systems for compiling and reporting data.

3. New Insurance Market Rules Take Effect for Small Group Policies:
New requirements for insurance plans have been phasing in since the ACA passed in 2010. In 2014, the final market protections take effect. Key developments you should be aware of:

• Regulations detail how grandfathered health plans maintain their status and which market protections are still applicable. Similarly, the federal government has detailed this for self-insured plans.
• Controversy persists about new community rating rules and their rate impact; in 2014, insurance carriers may only vary rates based on geography, family size, smoking status, and age (age rate differences may only vary by a factor of three).
• 2014 will be closely watched for rate changes driven by additional requirements for individual and small group policies including the requirement to offer a minimum, essential benefit package and implement deductible limits.

 

4. Employee Communications Required:
Before October 1, all employers must notify their employees about the healthcare marketplace. Key developments include: The federal government created model notification forms to ease this communication.

• The requirement to report the cost of employee coverage continues to be suspended for firms with fewer than 250 filed W2 forms until further notice.

 

5. Individual Mandate Takes Effect:
While the employer mandate is delayed, business owners must themselves have health insurance in 2014 or face a penalty. The same is true for your employees. Key developments you should be aware of: 

• The federal government detailed circumstances where a hardship exists and the individual mandate is not in effect.
• The feds outlined what is considered “minimum essential coverage,” which is the standard for satisfying the individual mandate.
• The feds provided applications for individuals who wish to access coverage via the healthcare marketplace; employees may solicit your assistance with key questions on applications particularly concerning existing healthcare coverage and income.

 

6. Expanded Wellness Incentives Available:
Employers may offer employees up to 30% – or where authorized 50% – off of the cost of health coverage if they participate in wellness programs, and in some cases, meet specific health standards. A key development you should be aware of:

• The federal government issued final guidance on the details of expanded wellness programs. Regulations are complex and should be analyzed if you choose to take advantage of these options.

 

Quick Glance Calendar

 

2013
Late Summer

• Expect increased press around the healthcare marketplace launch and speculation on whether the technology infrastructure is sufficient for a smooth launch.
• Expect state community based organizations and the federal government to publicize the health marketplace and offer enrollment assistance to individuals and small businesses.
• Expect the federal government to announce which health insurance carriers and plans will be available for individuals and small businesses via the healthcare marketplace.

 

Early Fall

• Notify your employees about health reform.
• Decide whether to purchase health insurance for employees.
• Decide whether to purchase via the marketplace.

 

October

• The health marketplace launches and open enrollment begins.

 

2014

January

• Coverage purchased via marketplace takes effect.
• New market rules on health reform take effect in individual and small group market.

 

Onward

• Feds work with businesses to finalize employer penalty regulations for 2015 implementation.
• Feds strive to improve the health marketplace for small businesses, specifically working to offer businesses a choice of plans.

The Center for Medicare & Medicaid Services (CMS) has released information regarding navigators that will help uninsured Americans purchase insurance on the healthcare exchanges. CMS states that the federal exchange navigators will have a tough work load, with a pay scale to match certain levels. The client-level navigator/caseworkers should be paid about $20 per hour, while a mid-level project leader will be compensated $29 per hour, and it will top off at $48 per hour for the senior-level executives.

 

The federal navigators hired are estimated to hold about 1.7 million “help” sessions a year, according to CMS. A navigator will spend about an hour per client, with approximately 10 minutes of that hour dedicated to recordkeeping. CMS sees the navigators assisting uninsured individuals, rather than employers as the enrollment process begins.

 

PPACA states that the health insurance exchange navigators cannot be compensated by health insurers, and will be hired in 34 of our 50 states. Navigators are only hired in those states that either have a federally facilitated exchange (FFE) or have a state-federal partnership exchange. Michigan, due to its legislative inaction, is heading towards a federally facilitated exchange. The Department of Health and Human Services (HHS) has dedicated about 54 million to these 34 states, allocating Michigan about 1.9 million dollars.

 

CMS anticipates providing federal exchange navigator organization grants for 264 organizations. Each organization will employ an average of seven caseworkers/staff navigators. At these navigator organizations, the seven caseworkers will allocate about 1,078 hours per year on navigator “help” session recordkeeping.

 

With all these changes yet to take place, we will keep you abreast as it unfolds. We will continue to keep you up to date as more developments arise. As always, please contact our Government Relations team with any questions. By phone: 888-277-6464 or by email: bbochniak@michbusiness.org  we value your feedback.
 

When you write your Blues with sponsored code AL you get enormous value for your clients:

 

• MBPA is proud to reach over 150,000 businesses with the vast array of programs, conferences and educational resources provided to the business community. That’s one out of three businesses in Michigan.
• Health Care Reform Connect™: MBPA’s exclusive tool to help answer all your questions and provide tangible resources and education for your clients. Over 50 health care reform resources available and serviced by the MBPA team.
• Reform Compliant SPDs – Free for all association members.
• Low dues structure – only $75 for the first year – pays for itself in financial value.
• Over 100 member programs and 30 educational conferences per year.

 

Keep sticking with AL and writing your Blues business with the MBPA.

 

In addition to the valuable membership benefits we offer to your clients, the MBPA continues contest and bonus rewards with our program partners. Choose from the following contests:

 

1. Staples Summer Sizzler: For all your new 10+ groups signed up with MBPA membership now through December 31, 2013, receive an extra $100 in addition to the $500 you normally receive. That’s $600 thru 2013!

 

-or-

 

2. BASIC’s COBRA Bonanza: Receive one year of complimentary COBRA Administration for qualifying groups of 20-99 lives, plus a $250 bonus.

 

Retention Rewards:
Agents that continue to keep their clients with the MBPA for renewals are part of our Retention Rewards perks and have opportunities for additional bonuses, contests and prizes throughout the year brought to you by the MBPA Community Partners.

 

CLICK HERE to Stick with AL!