SHOP Exchange Clarification

April 26, 2013

You may have read news headlines this week saying implementation of the Small Business Health Options Program (SHOP) exchange has been delayed until 2015.

The delay is only in allowing individual employees the opportunity to shop for their health plan from among multiple carrier plans offered on the SHOP exchange. The exchange would then collect the premium and send it to the carriers. This is referred to as an employee choice model.

Instead, the SHOP exchange will initially be built as an employer choice model that allows the employer to make a plan purchase for all of their employees. The premium billing will be done by the carriers.

The news media references to a delayed SHOP exchange are based on this delay in employee choice. Additionally, this delay is specific to the exchanges that will be run, in full or in part, by the federal government.

Overview: ACA Federal Taxes and Fees

When the Affordable Care Act (ACA) became law, various taxes and fees designed to help pay for the changes to mandated coverage and care also became legal requirements. While most are effective in 2014, employers, agents, individuals, and insurers are all starting to see these taxes and fees.

We’ve developed a chart to help you understand the who, what, when, and how related to ACA taxes and fees. Log in at Your Health Alliance to view the chart, or contact your client consultant for a copy.

Partnership Exchange in Illinois Conditionally Approved for 2014

February 15, 2013

On February 13, the Department of Health and Human Services (HHS) gave conditional approval of Illinois’ request to operate a state-federal partnership exchange in 2014. HHS Secretary Kathleen Sebelius and Governor Pat Quinn announced the approval at an appearance in Chicago.

According to a press release issued by HHS and the governor’s office, Governor Quinn said, “Here in the home state of President Barack Obama, we are forging ahead to make the promise of the Affordable Care Act a reality. Access to decent health care is a fundamental right. Hundreds of thousands of people in Illinois will gain quality health coverage through the health insurance marketplace.”

The approval requires agreements regarding plan management functions and consumer outreach activities. The plan management agreement must be signed by March 1, and the consumer outreach agreement must be reached by April 1. As always, we will keep you posted.

HMO with Deductible Plans Soon Available in Illinois

On January 24, 2013, Governor Quinn signed Senate Bill 3233, amending state law to allow HMO plan designs to include deductibles. We initiated this legislation, supported by various insurance carriers and employer groups. Insurance carriers must submit form changes to the Illinois Department of Insurance for review.

Under the federal Affordable Care Act, states will define the Essential Health Benefit (EHB) plans for their exchange. Without this legislation in Illinois, HMO plans would have only been affordable in the platinum (highest cost/richest benefit) metal category in the exchange. Nearby Iowa, Indiana, Michigan, and Wisconsin have offered HMOs with deductibles for years.

For our CEO Jeff Ingrum, it was important that HMO plans remain a viable, affordable option for Illinois individuals and employer groups.

“HMO plans give members a medical home through physician-directed care and referrals to specialists,” said Ingrum. “Managed care has a proven track record of fostering quality health outcomes, which impacts the bottom line for all taxpayers.”

We plan to debut new HMO plan designs later in 2013. In the meantime, contact your client consultant with any questions.

A New Year and a New Look for 2013 Plan Details

January 31, 2013

We’ve changed many of our member mailings so all the important information is in one place.

Instead of members getting loose papers and fliers, both fully insured and individual members will receive a bound booklet of plan details, either when they enroll or at renewal.

We’ll also offer these books as PDFs at Your Health Alliance. These will include policies, additions, and riders, along with our cost-saving and health-focused extras. When this feature begins, we’ll let you know.

We hope our members appreciate the ease of these useful new books.

Note: Because of the nature of self-funded plans, these members will still receive their plan details in the usual format.

ACA Update: Employee Notification of Public Exchange Plans

January 25, 2013

We’ve been getting questions from employers and agents alike about the Affordable Care Act requirement that, beginning March 1, 2013, makes employers responsible for educating their employees about public exchange plan options. The requirement applies to employers in general, whether using a fully insured or self-funded health plan.

This week the U.S. Department of Labor (DOL) issued an FAQ delaying the enforcement date because specific exchange information is simply not available yet/ In their notice, DOL stated the new date for informing employees will likely be late summer or fall 2013, to coincide with the Open Enrollment Period for exchanges.

We will keep you aware of developments in this employer requirement.

Form W-2 Guidance

ACA requires employers report the aggregate cost of employer-sponsored health coverage on employees’ Form W-2s. The reporting is for informational purposes to show employees the value of their health care benefits.

The IRS website provides specific guidance and a chart depicting the who, what, when, where, and how of reporting health care benefit value. For instance, the reporting requirement is optional for employers filing fewer than 250 Form W-2s, until further IRS guidance is issued. We recommend employers consult with a trusted tax professional regarding this and any other tax matter.