Tri-agency rules address 90-day waiting period limit
Posted by Nikki Hurt on February 20, 2014
The US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released several rules today concerning the 90-day waiting period limitation before insurance coverage can become effective. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days beginning January 2015. The proposed rule clarifies the 90-day limitation in terms of the length of employment-based orientation periods, stating that one month is the reasonable limit for employment-based orientation periods.
HHS releases new FPL guidelines
Posted by Nikki Hurt on January 27, 2014
The US Department of Health and Human Services (HHS) updated the federal poverty level (FPL) guidelines for 2014. The guidelines, which are slightly higher than the 2013 levels, will not impact the eligibility thresholds used to determine subsidy eligibility for health insurance enrollment for 2014. For an individual, the the FPL is now set at $11,670, which represents a 1.6% increase from 2013.
HHS releases enrollment figures
Posted by Nikki Hurt on January 13, 2014
The US Department of Health and Human Services (HHS) recently released enrollment figures from October 1st, 2013 to December 28th, 2013 for the Affordable Care Act’s (ACA) health insurance marketplace. Below are several of the key findings:
- Nearly 2.2 million Americans have enrolled in health insurance;
- About 24% of these individuals are between the ages of 18 and 34;
- 60% of enrollees selected a silver plan; and
- 79% of individuals selected a plan with financial assistance.
The most recent Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief provides a detailed breakdown and explanation of the enrollment figures.
HHS submits marketplace verification report to Congress
Posted by Nikki Hurt on January 2, 2014
On the last day of the year, US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius submitted a report to Congress certifying that Marketplaces are verifying applicants receiving premium support and cost-sharing reductions for their insurance under the Affordable Care Act (ACA) are in fact eligible for that assistance. The report, Verification of Household Income and Other Qualifications for the Provision of Affordable Care Act Premium Tax Credits and Cost-Sharing Reductions, contains information on “statutory, regulatory, and policy requirements that both State-based Marketplaces and Federally-facilitated Marketplaces must follow” in regards to verification requirements and the associated procedures.
HHS allows individuals with canceled plans to claim hardship exemptions
Posted by Nikki Hurt on December 30, 2013
The US Department of Health and Human Services (HHS) has permitted individuals whose insurance plans were canceled under the Affordable Care Act (ACA) to qualify for a hardship exemption and not be subject to the individual mandate for 2014. Hardship exemptions were created for individuals that experienced “financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan,” and the new decision by HHS places individuals with canceled health plans under this classification. The policy change, announced both in a letter to several senators and through official guidance from the Centers for Medicare and Medicaid Services (CMS), requires individuals with canceled plans to submit a hardship exemption form and proof of plan cancellation. Individuals choosing to claim a hardship exemption may forgo insurance for 2014 without a penalty or choose to enroll into catastrophic plans, which are bare-bones plans typically reserved for individuals under the age of 30.
HHS releases progress and performance report for HealthCare.gov
Posted by Nikki Hurt on December 2, 2013
Yesterday, the US Department of Health and Human Services (HHS) released a progress report on the administration’s recent efforts to fix and improve the Affordable Care Act’s (ACA) website, healthcare.gov. The website has been plagued with issues and errors since its debut on October 1st. The document, HealthCare.gov: Performance and Progress Report, outlines all of the improvements and changes made to the website over the past two months. Some of these improvements include fixing over 400 bugs and software issues and updating the server so that the site may be able to host 800,000 visitors a day. The report cites management and collaborations issues, as well as inadequate systems and a multitude of technical software bugs, as key causes of the early site malfunction.
HHS releases proposed rule on changes to the “triple r”
Posted by Nikki Hurt on November 26, 2013
In response to changes made by the administration’s new transitional policy, which continues plans slated for cancellation under the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) issued a proposed rule to modify the health insurance risk pool. The proposed rule, 255 pages in length, outlines changes in payment parameters and oversight for the “triple r”- risk adjustment, risk corridors, and reinsurance.
In addition to changes to the “triple r,” this rule formally announces the administration’s decision to delay annual open enrollment for 2015, which will now be held November 15, 2014 through January 15, 2015. HHS also delayed the Exchange blueprint submission deadline for states choosing to operate their own health insurance marketplace in future years. States applying to create their own Exchange must submit their materials to HHS by June 1st of the year prior to opening the Exchange, and HHS will certify the Exchange by June 15.
Will People Who Enroll in Health Insurance Marketplace QHPs be Able to Qualify for Premium Assistance if they Enroll Directly through an Insurer’s Website?
Posted by Mark Dorley on November 20, 2013
The Administration recently announced that its improvements to Healthcare.gov, the federal Health Insurance Marketplace, will include a new direct purchase feature that enables individuals to buy an Exchange-certified qualified health plan (QHP) directly at the website of the insurer who sells the plan. A question has arisen as to whether such an arrangement is lawful from a subsidy perspective: that is, whether direct enrollment at the QHP issuer website counts as…
106,185 enroll in health plans through ACA during October
Posted by Nikki Hurt on November 13, 2013
Today, the US Department of Health and Human Services (HHS) issued the first set of enrollment statistics for health insurance plans offered through the Affordable Care Act’s (ACA) Marketplaces. The report stated that 106,185 individuals signed up for coverage during the first month of open enrollment. About 75% of these individuals enrolled through State-Based Marketplaces. The remainder, about 26,000 people, reside in a state in which the Marketplace is operated by the federal government. While these individuals have completed the enrollment process, they have not necessarily purchased a plan.
CMS releases draft application for ACA exemptions
Posted by Nikki Hurt on October 16, 2013
The Centers for Medicare and Medicaid Services (CMS) issued a draft application and a corresponding data collection comment request concerning exemptions from the individual mandate. Under the Affordable Care Act (ACA), certain groups of individuals, such as those experiencing financial hardships or those that belong to a religious organization that opposes the use of insurance, are deemed exempt from the individual mandate and are therefore not required to pay the $95 penalty in 2014. This specific draft application, which is for individuals requesting a hardship exemption, is 6 pages in length and requires applicants to provide the type of hardship they are experiencing and their tax information. CMS anticipates that more than 12 million individuals will apply for the individual mandate exemption. The data collection comment request outlines options for states to rely on the Department of Health and Human Services (HHS) to determine eligibility exemptions, and asks the Office of Management and Budget (OMB) to approve the annual information collection requirements associated with the application.