Posted on August 28, 2013 | Comments Off
A study released by the National Bureau of Economic Research (NBER) stated that small businesses operating in competitive health insurance agent and broker markets are more apt to offer premiums to their employees at lower costs. The Role of Agents and Brokers in the Market for Health Insurance, funded by a grant from the Agency for Healthcare Research and Quality (AHRQ), also found that as competition increases amongst brokers and agents in the market, variation in premium costs amongst plans is reduced. The study incorporated agent and broker information from the National Association for Health Underwriters.
Posted on August 27, 2013 | Comments Off
A final rule released by the Internal Revenue Service (IRS) explains the individual shared responsibility payment for not obtaining basic insurance coverage, or minimum essential coverage, under the Affordable Care Act (ACA). By 2014, most Americans are expected to possess minimum essential coverage or face a tax penalty under Section 5000A of the Internal Revenue Code. Individuals without minimum essential coverage will pay an annual fine of $95 in 2014, $325 or 2% of their income in 2015, and $695 or 2.5% of their income in 2016 and beyond. Since many Americans will be exempt from this provision for a multitude of reasons (hardship, unaffordability, religious beliefs, etc.), the Congressional Budget Office (CBO) estimates that only 2% of Americans will face the penalty.
In addition to the final rule, the IRS released a fact sheet that highlights several of the key points addressed in the rule. The fact sheet discusses how the rule clarifies hardship exemptions and partial month coverage (i.e. an individual has maintained minimum essential coverage as long as he or she has coverage for at least one day of the month). Specific coverage categories to which minimum essential coverage provisions apply are enumerated, and the processes for obtaining an exemption are also described.
Posted on August 26, 2013 | Comments Off
The Centers for Medicare and Medicaid Services (CMS) released a manual designed to educate Navigators on the standard operating procedures (SOP) of their roles in federally-facilitated Marketplaces. The Affordable Care Act (ACA) enlists Navigators to provide information and guidance on the plans available to consumers within health insurance Marketplaces. The SOP manual, which is 217 pages in length, explains how Navigators should carry out their prescribed duties under the ACA, including procedures regarding:
- outreach and education;
- impartial selection, completion and submission of a qualified health plan (QHP); and
- communication and customer service strategies to meet the needs of the Navigator’s target enrollment population.
Additionally, the SOP manual outlines specific means by which Navigators can protect the personally identifiable information of their consumers and prevent fraudulent activities.
Posted on August 23, 2013 | Comments Off
In a new proposed rule released today, the Internal Revenue Service (IRS) outlined stipulations for small businesses to receive tax credits under the Affordable Care Act (ACA). The rule states that small businesses will only be eligible for a tax credit if they have 25 or fewer full-time employees receiving health insurance through the small business health options program (SHOP) Exchanges. Under the ACA, SHOP Exchanges comprise the small group market in which small businesses are able to enroll their employees to receive health benefits coverage.
Posted on August 21, 2013 | Comments Off
A new survey conducted by the Commonwealth Fund stated that young adults, specifically those aged 19-29, actually want and enroll in health insurance. This age group, referred to as the “young invincibles,” is the targeted demographic for the Affordable Care Act (ACA), as their perceived invincibility resulting from young age and generally good health typically causes them to forgo health insurance. The Commonwealth Fund found this notion to not be factual, as two-thirds of individuals in this age group accepted health insurance offered by their employers. Additionally, 7.8 million of the 15 million young adults enrolled in their parents’ health plans gained this coverage from the dependent coverage provision of the ACA, which allows dependents to remain on a parent’s insurance plan until the age of 26. In spite of this coverage surge, the Commonwealth Fund found that only 27% of young invincibles surveyed are actually aware of the health insurance Marketplaces.
Implementation Brief Reporting to the National Instant Criminal Background Check System and the HIPAA Privacy Rule
Posted on August 21, 2013 | Comments Off
On January 16, 2013, in the wake of the Newtown shootings, President Obama announced 23 executive orders aimed at reducing gun violence, including an instruction to the Department of Health and Human Services (HHS) to address any potential legal barriers to reporting to the National Instant Criminal Background Check System (NICS). On April 23, 2013, HHS issued an Advance Notice of Proposed Rulemaking (ANPRM) requesting public comments on whether the HIPAA Privacy Rule presents a barrier to reporting of individuals who should be prohibited from possessing firearms for specified mental health reasons (such as involuntary commitment to a mental institution).
Posted on August 20, 2013 | Comments Off
The Centers for Medicare and Medicaid Services (CMS) released the latest in their series of federal data service hubs agreements. This particular agreement requires state-based Marketplaces (SBM) to alert the the Center for Consumer Information and Insurance Oversight (CCIIO) within one hour of detecting possible breaches of personally identifiable information on the data hub. CCIIO will then contact the appropriate agency responsible for the information that may have been leaked (i.e. the Internal Revenue Service (IRS) would be notified if the SBM determined that income tax information was hacked). In addition to alerting the SBM of important security practices, this agreement was issued to help assuage concerns about the security and privacy of the information channeled through the hub.
Posted on August 19, 2013 | Comments Off
In a report, the Congressional Research Service (CRS) provides an explanation of the medical loss ratio (MLR). Under the Affordable Care Act (ACA), the MLR requires that insurers in the individual and small group market spend at least 80%, or 85% in the large group market, of premium dollars received on medical expenses for plan beneficiaries. If the insurer does not spend 80%, they must return the difference to beneficiaries in the form of a rebate. The MLR was instituted as a way to promote accountability and transparency for insurance company allocation of premium dollars. The CRS document clarifies that beneficiaries will only receive the rebate if the company as a whole does not meet the MLR threshold, not if the individual did not meet the threshold in his or her policy. Additionally, the MLR provisions only apply to fully-funded insurance plans. The CRS report also clarifies that some states do not have to adhere to MLR provisions if the US Department of Health and Human Services (HHS) determined that doing so would be detrimental to the state’s health insurance market.
Posted on August 19, 2013 | Comments Off
On August 15th, the Internal Revenue Service (IRS) launched a website explaining the various tax components of the Affordable Care Act (ACA). The homepage of the website is divided into three sections, each tailored to a specific entity impacted by the ACA tax provisions. Some of the featured topics on the website include: premium tax credits on the individual market, new responsibilities for employers, and tax provisions for insurers, tax-exempt organizations, and other businesses. IRS also published a list of other ACA resources to assist individuals on issues not addressed on the website.
Posted on August 15, 2013 | Public Comment (1)
The US Department of Health and Human Services (HHS) announced today the entities receiving grants to serve as Navigators in federally-facilitated and state-partnership Marketplaces. As required by the Affordable Care Act (ACA), navigators are individuals and businesses tasked with assisting applicants in their plan selection within the health insurance Marketplaces. HHS stated that $67 million in grants will be dispersed amongst 105 Navigators, which consist of various care providers, schools, community groups, health departments, Planned Parenthood, and other groups.