It’s Open Enrollment time again for many companies. Those covered by Small Group plans, are fearful of what this year’s rate changes will bring. Premiums have risen sharply for the past several years. To manage the expense to the organization, increased co-pays and high deductible plans have typically been passed on to your employees. Federal Regulations Bring Change and Clarity Due to The Patient Protection and Affordable Care Act (PPACA, commonly known as “Obama Care”), employers will see changes not only in price and coverage, but in how these changes are portrayed.
Our national health care system has been through some tumultuous changes over the past few years, but this year, we have seen some of the impact - and we have been surprised a few times. Earlier this year, we received a call from a few organizations who had fewer than 50 participants in their health care plan. They had just received a letter of non-renewal from their long-standing (very large) health insurance provider. In fact, that insurer had decided to drop all health insurance policies with fewer than 50 participants.
A mandated revision to the Summary of Benefits Coverage (SBC) takes place on September 23, 2012. After this date, the SBC will be provided to all participants on the 1st day of their open enrollment and at critical decision-points (i.e. upon application for coverage, by the first day of coverage, if the information has changed, upon renewal, and upon request) without charge. According to the recently enacted legislation, the responsibility
Beginning January 1, 2013, employees will be limited to $2500 per plan year for contributions to Flexible Spending Accounts. For those employees who are used to higher contributions, this change may facilitate re-evaluation of the sufficiency of the reimbursement level.
The Medical Loss Ratio (MLR) is the percentage of premiums spent by the health plan on reimbursement for clinical services and activities that improve health care quality. This is all about ensuring that companies are spending enough money on preventative health care. For individual and small groups (groups of 1-50, though some states will use 1-100), the MLR is to be 80%, while
The Patient Protection and Affordable Care Act (also known as Obamacare), mandates that all health insurance plans are now required to cover all FDA Approved and prescribed contraceptive services for women. There are two possible exceptions outlined below. A. Religious Employer Exemption (REE) for certain religious employers if they meet the following requirements: 1. Has the inculcation of religious values as its purpose,