ACA Compliance Checkup (2014 Strategies Deployed)

 

As the 2014 open enrollment season comes to a close (bringing an overwhelming sense of relief and joy to HR professionals and Benefits Brokers/Consultants throughout the land!), I thought I’d review the major Affordable Care Act (ACA) related compliance issues addressed in preparation for the new (benefits) year. 

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

People in federal high-risk insurance pool get extra month of coverage

President Obama’s administration announced yesterday that people who participate in the federal Pre-Existing Condition Insurance Plan will be covered through Jan. 31, 2014. The extension affects about 443 Washington residents and about 135,000 nationwide. The pool covers people who were previously ineligible for health insurance because of chronic pre-existing health conditions including cancer, heart disease and other serious illnesses. The extension allows people in the pool more time to find coverage under the Affordable Care Act (ACA).

Approximately 3,675 Washington residents are covered under the Washington State Health Insurance Pool (WSHIP), which is the state’s insurance plan for people with chronic health conditions. People in that plan will keep their coverage through the end of 2017. Both the federal and state high-risk insurance pools are closed to enrolling new members.

WashingtonHealthplanfinder, Washington’s health benefit exchange, has been unavailable for many people this month. Yesterday, Washington Insurance Commissioner Mike Kreidler advised people who are not eligible for a subsidy and are still tyring to find insurance before Jan. 1 to find health insurance from a private broker or agent. Washington residents with incomes of up to $45,960 for an individual and up to $94,200 for a family of 4 are eligible for subsidized insurance plans through the Washington health benefit exchange. Read the news release.

Are all of the contents of my home covered by my insurance policy?

Maybe, maybe not. Some policies offer limited coverage for items such as jewelry, art, coins, stamp collections, furs, guns or business-related property. If you own these types of items, talk to your agent to determine if you need to buy increased coverage or a separate policy to cover the value of those items.

You will be expected to prove your ownership of the items with receipts or with photos of the damaged or missing items. Don’t wait until you have a loss to find out what your policy covers and requires.

Read more about understanding your homeowners insurance.

ACA's Essential Health Benefits, Minimum Essential Coverage, & Minimum Value

Given the enormous complexity of the Affordable Care Act (ACA), it’s understandable that there’s confusion about the terms used to describe 3 key provisions scheduled to take effect in 2014. They are: Essential Health Benefits (EHB), Minimum Essential Coverage (MEC), and Minimum Value (MV).  Each of these provisions has an important impact on employers, employees, and individuals. This week's post defines these terms and describes their impact in 2014 and beyond.

Essential Health Benefits

Starting in 2014, all non-grandfathered, fully insured individual and small-group health plans (covering up to 50 people) offered on and off the public health insurance Marketplaces/Exchanges must cover what the ACA classifies as Essential Health Benefits, which consist the following health benefit categories:

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Witness smokes out insurance fraud by business owner

A Renton business owner has been sentenced after being found guilty of insurance fraud and first-degree theft, both felonies.

Cassk Thomas, Jr., owner of Sams Pitt II Mobile BBQ, filed a claim in August 2011 with American Family Insurance that the barbecue smoker and trailer he used to operate his mobile barbecue business were stolen. He sought reimbursement for $24,668 in lost business and $32,243 that he said he paid for the smoker and trailer. American Family Insurance paid him a total of nearly $56,000 – $30,474 for the smoker and trailer and the full amount he claimed for lost business. A witness later provided proof that the smoker and trailer were purchased by a former business partner for $9,740.

Mr. Thomas was sentenced to 30 days in jail, 120 hours of community service, and faces restitution to American Family Insurance. The full restitution amount will be determined by May 2014.

The Office of the Insurance Commissioner’s Special Investigations Unit investigates insurance fraud. You can report suspected insurance fraud on our website.

Pipes freeze and break, tree hits your roof – does insurance cover these?

Winter conditions are setting in around the state, so now is a good time to prepare for cold, snow and ice and familiarize yourself with what your homeowner’s or renter’s insurance covers in the event of weather-related damage.

We have a page of frequently asked questions about winter weather and insurance coverage on our website.

You can read more about winter weather preparedness and holiday safety on the Washington Emergency Management Division’s website.

Health Insurance and the Tax Code

For years, politicians, policy wonks, and various health insurance stakeholders have debated the merits of how the tax code encourages employer provided coverage, yet seemingly discourages the individual purchase of coverage outside of the workplace.  



The primary example of this confounding situation is the fact that health insurance is tax deductible to an employer, yet not so to an individual who purchases coverage on their own, outside of the workplace.  There are numerous tax incentives and benefits available to individuals who purchase health insurance, but virtually all of these incentives are attached to the purchase of employer based, group coverage.  With the relatively recent introduction of so called “defined contribution” health plan offerings to the benefits world (see Walgreens, Sears, Darden Restaurants, etc.), you can expect more pressure on the federal government to expand and change the current tax code. 

Interestingly, the IRS recently issued guidance (Notice 2013-54) affecting two (2) tax advantaged spending accounts – Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs).  (See http://www.irs.gov/pub/irs-drop/n-13-54.pdf) The guidance places strict requirements on the use of these tax advantaged savings arrangements in conjunction with health insurance plans.  In short, the guidance ties these arrangements to GROUP HEALTH INSURANCE PLANS, and indirectly discourages the establishment of INDIVIDUAL HEALTH INSURANCE PLANS.

Key provisions of this guidance affecting HRAs and FSAs follow:

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Commissioner Kreidler to testify before U.S. House of Representatives

Washington Insurance Commissioner Mike Kreidler will testify before the U.S. House of Representatives Ways and Means Subcommittee on Health on Dec. 4  about the Affordable Care Act and how it’s working in Washington state.

The Affordable Care Act is the first major step toward making changes that will improve the lives of millions of Americans. For the first time, people have access to affordable, comprehensive medical insurance that doesn’t penalize them for their gender or for having existing medical conditions. Americans will not be subject to limits on their lifetime or annual medical benefits, which unfairly targets people with chronic medical conditions. 

Commissioner Kreidler, a board member of Washington’s Health Benefit Exchange, will touch on our state’s experience in enrolling more than 100,000 citizens through Washington Healthplanfinder.

The hearing starts at 7 a.m. Pacific time and will stream live online.  

 

ACA's Top 10 Misconceptions (Nos. 6 - 10)

Last week's post revealed the first 5 of my "Top 10 List of ACA Misconceptions".  This week I finish out the Top 10 list with nos. 6 - 10.  There's a tremendous amount of information pertaining to the Affordable Care Act (ACA) that must be read, understood, translated, and communicated.  I will continue informing and communicating as much as possible on this site; and I encourage readers to reach out to me with questions, comments, and suggestions.

Here are nos. 6 - 10 of my "Top 10 List of ACA Misconceptions"...

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

We're looking for a Deputy Commissioner of Operations

We're currently recruiting for a Deputy Commissioner of Operations. This in an executive level exempt position that manages 35 employees in the following areas: Human resources, budget and fiscal, facilities and telecommunications, information technology and public records.

The successful candidate will be an active member of the Executive Management Team (EMT), setting the strategic direction of the agency, developing legislative priorities, ensuring fiscal responsibility and creating an inclusive, performance-based work environment.

Here's the full job announcement. Please share with anyone you think could be interested.

The job is open until Dec. 9, 2014.

ACA's Top 10 Misconceptions

Over the course of the last 3 years, I have had both the honor and pleasure of discussing the Affordable Care Act (ACA) with a number of organizations, clubs, groups, and even a local radio show.  Throughout this time, and unfortunately it persists, I have encountered a number of misconceptions and misunderstandings relative to several provisions of the law.  So I decided to assemble a list of...you guessed it...the top 10 most common ACA misconceptions that I have come across to date. Here are the first 5:

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Why the commissioner decided against allowing canceled policies back into Washington

President Obama’s announcement this week that previously canceled individual health-insurance policies for 2014 could be reinstated – at the discretion of insurance commissioners – drew a lot of attention.

Washington state Insurance Commissioner Mike Kreidler acted quickly, deciding against allowing the previously discontinued policies to be put back into effect. The reasons are straightforward: The proposal does not make sense for Washington because of the overall negative effect on the stability of the health-insurance market.

To learn more about Commissioner Kreidler’s decision, please check his statement.

You can also see what is really happening with those canceled policies and how many consumers can qualify for more comprehensive coverage at less cost.

***SPECIAL EDITION - Individual Plans May Offer Non-ACA Compliant Coverage in '14!***

Earlier today (11/14/13) the President announced that he will "allow 2014 sales of previously cancelled Individual Health Plans that don't meet Affordable Care Act (ACA) guidelines".  Administration officials clarified that the exception would only be available to those who have lost their [individual health] insurance coverage. 





The announcement was lacking many of the details that are necessary in order to move forward with this exception.  Among the few details mentioned were that Insurers will...

• NOT be allowed to offer the non-ACA compliant plans to "...other Americans as it would threaten the ACA's financial viability".
• Be required to notify customers that "alternatives exist" under the ACA, including the availability of tax credits.
• Have to point out the areas where their plans fall short of government (i.e., ACA) standards.
• Have to get permission from state insurance commissioners.

The exception, which has no direct impact on group health plans, is a de facto extension of the grandfather clause that was already a provision of the ACA.  Insurers have the choice of whether or not to continue offering the (formerly) non-compliant plans in 2014.  The other challenge would be reaching out to the millions of insureds (like me) that have already received notice of the cancellation of their current plan, and the automatic conversion to an ACA compliant plan.  With only 6 weeks left until the new year, and the various considerations involved in taking advantage of this relaxation of the rules (i.e., cost, technology, impact on rates, etc.), there might not be very many takers on the insurance company side.

I just received an email from the largest issuer of Individual Health Insurance coverage in the state of Nebraska - Blue Cross Blue Shield of Nebraska - which read in part - "...leaders are analyzing the impact of the President's proposal, and will give further information soon about how we will proceed".

Once again I want to stress that although this announcement does not directly affect or pertain to the Group Health Insurance market; to the extent that a significant number of individual health insurers decide to "un-do and/or re-do" policies could impact open enrollment.  In other words, if fewer individuals are forced to accept higher premiums and/or reduced coverage (like me) associated with some of the 2014 renewal offers, there will be fewer "group insurance eligible" individuals wanting to enroll in employer coverage during open enrollment.

Stay tuned!

 

#####

FSA Rollover…An Early Christmas Present From the IRS!

When people hear or see the acronym – IRS – they generally do not associate it with gift giving.  But that is precisely what the IRS delivered on October 31, 2013 in the form of Notice 2013–71, which allows for a partial carryover of unused FSA funds (click - http://www.irs.gov/pub/irs-drop/n-13-71.pdf). The often cited “use it or lose it” rule deters many otherwise eligible Flexible Spending Account (FSA) enrollees from setting aside funds on a pre-tax basis for future use.  However, with the issuance of Notice 2013-71, the IRS is allowing the option of a rollover of up to $500 at the end of the FSA plan year…even for 2013 plan years!  This is great news for FSA plan participants and employers alike.

Back in 2005, the IRS issued a similar relaxation of the code, which allowed for a 2.5 month grace period in which plan participants could continue to incur FSA reimbursable expenses (see IRS Notice 2005-42; click - http://www.irs.gov/pub/irs-drop/n-05-42.pdf ).

Since plan participants still faced the prospect of forfeiting unused balances at the conclusion of the grace period, this provision seemingly had little impact on increasing FSA plan participation.  The allowance of up to a $500 rollover, if effectively communicated, should have the effect of increasing FSA plan participation, thus saving eligible individuals, and their employers, valuable tax dollars. (Note: according to a recent CNN Money article, approximately 14 million families participate in FSAs.)

Here is a summary of the IRS notice, and some things for employers and plan participants alike to keep in mind:

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Is Your Company CDH Ready?

Over the course of the last several years, Consumer Driven Health (CDH) has grown in popularity, and effectiveness, as a way for employers to reduce their health insurance and health care related costs.  CDH's evolution has not come easy or without its detractors.  However, both the empirical and anecdotal data collected over the last ten years point to CDH as a proven and effective method of true - "health care reform"!  According to the Kaiser Family Foundation (KFF), the number of employers offering CDH plans has jumped from 4% in 2005 to 31% in 2012.  KFF also released data indicating the average cost of family coverage is $1,500 less per employee on a CDH plan than a traditional PPO plan.  And benefits consulting firm Aon Hewitt's health care survey revealed that CDH plans had a 2 percent lower cost trend in 2012, versus all other health plan types (i.e., PPO, HMO, EPO).

Today's post provides a list of "CDH Readiness Considerations" for employers who are contemplating implementing some form/level of CDH into their organization.  Employers that presently offer a CDH plan(s) might also benefit from a review of these considerations...

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Canceled health plans? What's really happening.

There's been a lot of news lately about insurers cancelling some health plans and changing others. Consumers have been getting the word through  'discontinuation' notices.

So what's really going on? This is happening in the individual market - where people who don't get coverage from their employer - buy their own health plans.   Most likely, the existing plans being canceled or changed, failed to meet new federal standards for benefits.  The reality about most of these previous plans is that they provided extremely limited benefits - no maternity care or coverage for prescription drugs, for example.

Beginning Jan. 1, 2014, plans must provide everyone basic essential benefits, such as maternity care, prescription drug coverage and mental health services.  And no longer can insurance companies ask you about previous illnesses you may have had. They must accept everyone.

Premiums will change for some plans. But if you received a notice from your insurance company, it does not mean you have to stay with whatever they offer. You can shop around for plans, either in the new Exchange - www.wahealthplanfinder.org or from insurers selling outside of the Exchange.

Here's a map of all individual plans available by county.

For more details about insurers cancelling policies, check out this piece by Kaiser Health News.

"Where do I get a detailed review of my auto and homeowners premiums?"

We recommend that you get a policy-specific premium breakdown directly from your agent (or insurer, if you buy direct). Specifically, you might want to ask for a rate worksheet comparison between your last year's premium and your current annual premium. That's a good way to get an apples-to-apples comparison of what your rates are doing.

While you're at it, it's a good idea to make sure that the type and level of coverage is what you want. If you're driving a new car, you'll likely want comprehensive and collision coverage as well as liability (the latter is required by law.) If you're driving a $1,000 car, on the other hand, maybe liability coverage is enough. These are good things to discuss with your agent or company, particularly if you have changes in your life (new car, change in household members, moving, etc.)

Our home was damaged by a windstorm. We're worried. What's next?

We get this question a lot. It's very important that you try to safeguard your home from further damage. Depending on the type of damage, you may be able to safely do this yourself or you may need to hire someone - especially if you need to get a tarp on the roof if you're dealing with utilities or damaged and unstable structures.

 

You'll also want to contact your insurance agent or your insurer directly to let them know what’s going on, and to get any necessary instructions from them. They can also tell you how your coverage will apply. Most importantly, stay safe!

 

Here's some more insurance tips to help you get ready for stormy weather.

 

ACA Reset...Let's All Take a Deep Breath!

 

This week’s post is meant to be sort of a “deep breath” or reset on where we’re at with respect to the Affordable Care Act (ACA). Clearly much is being said and written about the law, and in particular, its implementation. Those of us who are charged with explaining and implementing the various requirements of the law don’t have the luxury of questioning its content, complaining about its impact, or bemoaning its "unintended consequences". It’s full speed ahead with implementation and compliance, unless or until Congress, HHS, DOL, CMS, IRS, or someone in a position of authority tells us to STOP…and that is highly unlikely.

So here are some important points to keep in mind as we take stock of where we are at, now some 3 ½ years since the law was signed. More importantly, for the Human Resource managers, Benefits Consultants, CFO’s, CEO’s, Executive Directors, and other stake holders charged with ACA compliance, the following points are meant to help keep “moving the implementation ball forward".

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

"The insurance company came out and looked at my car. Doesn't that commit them to paying the claim?"

No. Insurers are required to investigate claims, but the fact that they start an investigation doesn't obligate them to pay a claim that they wouldn't otherwise pay. Once the facts are gathered and reviewed, the insurer can then make a coverage decision.

That said, if you feel your claim has been wrongly denied, is delayed, isn't fair, etc., our consumer advocacy staff may be able to help you. (We're the state agency that regulates insurance in Washington state.) Email us at AskMike@oic.wa.gov or call us at 1-800-562-6900.

Not in Washington state? Here's a handy map to help you contact your own state's insurance regulator.

Self Funding Overview/Summary

As medical costs and insurance premiums continue to escalate, and health care reform poses new and additional cost pressures, employers are seeking innovative ways to reduce the costs associated with group insurance programs.  The solution for many employers has been the implementation of some form of self-funding.
[IMPORTANT: A previous blog post listed the specific Affordable Care Act (ACA) provisions that DO NOT APPLY to self funded plans.  Click here to access this blog - http://sstevenshealthcare.blogspot.com/2013/08/aca-compliance-understanding.html]
SELF-FUNDING ALLOWS THE EMPLOYER TO ASSUME ONLY AS MUCH RISK OR EXPOSURE AS THE COMPANY CAN WITHSTAND, WITHOUT CAUSING FINANCIAL DISTRESS.

To access complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Why does my insurer ask such tough questions about my claim?

We get this question a lot. The insurance industry experiences millions of dollars of claims regularly, year after year. Many of the claims are legitimate, but unfortunately, many involve fraud.

 

Whether or not a claim is legitimate or fraudulent, it is important that insurance companies perform complete investigations and gather all supportive documentation to be able to evaluate a claim.

 

Of course, the claim process is not a fun thing to experience, but it is necessary that you cooperate with the insurer to help facilitate your claim. Expect them to want supporting documentation and to ask questions - it may take a bit of time. But, after you've answered their questions and provided the necessary information, you should expect a timely decision and a clear explanation of their decision. If you don't that you've been treated fairly, call us at 1-800-562-6900 or file a complaint. Maybe we can help!

Having trouble reaching the Exchange's call center?

We know Washington's Exchange, www.wahealthplanfinder.org is still experiencing high call volumes at most times of the day. If you need help getting started, consider calling a navigator or an insurance broker. You can find both in your area by entering your zip code. Here's the info. for finding a navigator and the broker information.

"I've invented a new medical treatment. How can I get insurers to cover this?"

Our consumer hotline gets this question periodically. Someone will have come up with a new way of treating some ailment, only to find that insurance companies don't want to cover it.

Insurance companies are far more likely to cover a treatment is it's "evidence-based. Typically, a treatment is deemed evidence-based after extensive clinical trials, for which the inventor (or inventor's company, actually) usually pays. In the scientific community, evidence-based treatments are considered more reliable, and therefor a better value for insurance companies' money -- and more likely to lead to success for the patient.

That said, insurance companies can pay for any treatment, so there's nothing stopping them from covering a treatment that's not evidence-based. However, with many health conditions, there are already numerous treatments available.

If you're a patient, and your insurer is refusing to pay for a particular treatment that you think would be effective, see our "How to appeal a health insurance denial" guide. You can win an appeal, but it takes some work.

Also, here in Washington state, the health plans we regulate -- which are about 37 percent of them -- must, by law, must include access to every type of licensed medical provider. Meaning that if you want to see a naturopathic physician, chiropractor, physician, acupuncturist, etc. for treatment, the choice is yours, so long as the treatment is within the scope of their practice. The law doesn't change what health conditions are covered by your plan, but it gives you more choice in who -- i.e. which kind of provider -- will treat you.

Medicare open enrollment started this week and ends Dec. 7

Medicare's open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 - Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage.

If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state.

Remember, if you want to enroll in  new plan, you must contact Medicare. You cannot sign up through the state's new health benefit exchange, www.wahealthplanfinder.org.

If you have limited income and need help paying prescription drugs, check out Medicare's "Extra Help" program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov.

For more help, contact a local SHIBA office in your area.

Job seekers - We're looking for a legislative liaison and a policy/rules manager

Two jobs at the Insurance Commissioner's office just posted this week - a Legislative Liaison and a Policy and Rules Manager. Both positions are exempt, open until filled and salary depends on experience.

The Legislative Liaison is responsible for developing and managing our legislative and policy strategy, including developing our legislative agenda, legislative testimony, bill analysis, and stakeholder management. They're also the principal policy advisor to the executive management team on legislative and budget proposals impacting the agency.

The Policy and Rules Manager supervises staff in our Policy and Legislative Affairs division, prepares position briefs, decision memos, reports, coordinates rule-making for the agency, and drafts and adopts rules on behalf of the agency.

If you're interested or know someone who might be, encourage them to apply soon!


 

Health Reimbursement Arrangements (HRAs) - HSA's 1st Cousin

Last week's post provided an overview of Health Savings Accounts or HSAs.  This week's post is meant to provide an in depth understanding of the HSA's 1st cousin - the Health Reimbursement Arrangement or HRA.

In June of 2002 the IRS issued an important revenue ruling which created the HRA (through a tweaking of existing IRC section 105).  The ruling created tremendous flexibility for the use of employer funded dollars set aside to pay for specific health care items.  As this week's blog title suggests, HRAs are similar to HSA's, but are actually much more similar to Flexible Spending Accounts (FSAs).  However, HRAs have distinct advantages for both employer and employee, over FSAs and HSAs.

So exactly what is an HRA?  HRAs are defined as accounts that:

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

See most recent earthquakes in our area - are you ready for the big one?

 

We're getting ready for tomorrow's Great ShakeOut Earthquake Drill by cleaning out all the stuff under our desk - how about you? It's been a long time since the Nisqually Quake, but if you lived in Washington state then, you probably remember where you were and what it felt like. 

 

Some of us here in Olympia - only miles from the epicenter - heard what sounded like a freight train. Others saw the ground move like water. Are you ready for the next one? 

 

Check out the earthquake tracker on KIRO's mynorthwest.com. It'll show you the most recent quake, how big it was and where it occurred.  

And don't forget about earthquake insurance - here's what you need to know.

How to report insurance fraud in Washington state

Our agency -- Washington state's insurance regulator -- handles a wide variety of complaints about insurance fraud by individuals and by businesses.

To report insurance fraud or scams, please see our online reporting form.

We also offer tips to avoid insurance scams, starting with the old-but-true advice that if it sounds too good to be true, it probably is.

We also have some tips on how to identify and report Medicare fraud and abuse, such as being billed for services you didn't receive.

I know the new health subsidies are based on your household income, but how do they define 'household'?

“Household” only includes you, your spouse, and anyone you can legally claim as a dependent on your tax return.

 It generally wouldn’t include a non-marital relationship (such as a boyfriend or girlfriend), except under very limited circumstances.

To get more details, see page 16 of the IRS instructions for filling out Form 1040 or call the IRS (after the government shutdown ends) at 1-800-829-1040.

Health Savings Accounts (HSAs) ~ Summary/Overview

 

 Last week's blog post recognized (and celebrated!) the upcoming 10th birthday of Health Savings Accounts (HSAs) in 2014.  Recognizing that some readers don't necessarily understand all the "in's and out's" of HSA's, this week's post offers an in depth overview, and addresses many of the key requirements, limitations, benefits, etc.  Once again, HAPPY BIRTHDAY HSAs!

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

When your insurance renews, remember to look at the statement

When you get a new insurance policy or your current policy renews, be sure to review the statement. You need to be sure that you're getting the type and level of coverage you asked for. 

Most people simply file away the information -- or toss it. But take a few minutes to look it over first. You really don't want to find out after the fact that a) you were paying for coverage you didn't want or need, or b) worse, that you didn't have coverage for something important.

If you see something that doesn't look correct, contact your agent or insurer immediately, before a loss occurs. If you wait until afterward, you'll likely be stuck with whatever coverage was in force at the time of the loss.

It's also a good idea to periodically review your coverage with your agent or insurer. You may want to add or eliminate coverage as changes occur in your life situation.

Hole-in-one insurer pleads guilty to three felonies

Kevin Kolenda, a Connecticut businessman who insurers golf tournament hole-in-one prizes but has a history of not paying, pleaded guilty today in King County Superior Court to two counts of selling insurance without a license and one count of first-degree theft.

Kolenda started Golf Marketing in 1995 and sold hole-in-one insurance coverage to charity golf tournaments across the country including in Washington state. He repeatedly failed to pay winning golfers, leaving charities to come up with the prize money. To skirt prosecution, he also changed the name of his business several times.

Other states where Kolenda sold bogus insurance including: Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.

Kolenda paid $10,000 in restitution today. He will pay another $5,000 in four months, when he returns to Seattle for sentencing.

What to do if your Medicare Advantage plan is going away

Medicare open enrollment starts Oct. 15. Some people may have already received a notice saying their Medicare Advantage plan is going away. If you or someone you know has received a notice, here's some steps to take:

• Check with your medical providers and find out what Medicare Advantage plans they accept in 2014.
• Read about your rights
• Avoid a gap in coverage by selecting a new plan before Dec. 31
• If you can't decide between a Medicare Advantage plan or returning to Original Medicare, see page 59 of the Medicare and You 2014 booklet for help

Need more help? Contact our free Statewide Health Insurance Benefits Advisors (SHIBA), They can  help your evaluate and compare plans. 

WAhealthplanfinder will be down tonight for system improvements

Washington's Exchange - the Wahealthplanfinder.org - is up and running, but some people are still experiencing slow loading times and difficulty submitting their applications. The Exchange is taking the website down tonight starting at 10 p.m. until 6 a.m. tomorrow morning to work on system improvements. Want an update on their progress? Check www.wahbexchange.org often.

I hear new health plans must meet 'actuarial value' standards - what's that mean?

All individual and small employer health plans sold inside and outside the new Health Benefit Exchange - Wahealthplanfinder.org - must have an actuarial value of at least 60 percent.

This means the plan must pay for least 60 percent of your medical costs for essential health benefits. Sixty percent is the standard for the new 'bronze level' plans. You also can choose from a silver level or gold metal level plan. Silver plans pay for 70 percent of your costs and gold pay for 80 percent.

Here's answers to additional questions about how the new 'actuarial value' works:

If my plan has an actuarial value of 70 percent  does that mean I will not have to pay more than 30 percent of my entire insurance costs?

No, the actuarial value is only based on the level of coverage the plan provides for essential health benefits.  If your plan has an actuarial value of 60 percent, for example, that means that the plan will pay 60 percent of your covered expenses for essential health benefits and you pay 40 percent of the covered expenses for essential health benefits. 

Although the actuarial value of your covered expenses for essential health benefits will be covered, you may have other costs such as deductibles, copays and coinsurance, as well as costs for services that are excluded or are not covered benefits.

Make sure you read your policy to see what services are excluded services.  Benefits that are not covered would be subject to the terms of your insurance policy, so it is important to read your policy before getting the service or treatment. 

What are essential health benefits? As of Jan. 1, 2014, all individual and small employer health plans must cover these 10 benefits:

1. ambulatory patient services
2. emergency services
3. hospitalization
4. maternity and newborn car
5. mental health and substance use disorder services including behavioral health treatment
6. prescription drugs
7. rehabilitative and habilitative services and devices
8. laboratory services
9. preventive and wellness services, chronic disease management
10. pediatric services ‐ including oral and vision care

 

HAPPY BIRTHDAY HSAs!

HEALTH SAVINGS ACCOUNTS (HSAs)

  

The attractiveness and establishment of HSAs continues to grow, as HSAs approach their 10^th birthday.  For many, it has long since been forgotten how they came to be, save for those “consumer driven health care geeks” like yours truly.  While many realize that HSAs or Health Savings Accounts, replaced MSAs (Medical Savings Accounts) starting in January of 2004, how they came to be is rather interesting, if not disjointed.  Actually, HSAs were created by the very law that gave us the largest expansion of Medicare since its origin in 1965 - the Medicare Prescription Drug Improvement and Modernization Act of 2003 (later referred to as the MMA), signed by then President George W. Bush on December 8, 2003.  HSAs offer a significant improvement over their predecessor – MSAs – on several levels; not the least of which was a significant increase in the amount of money that could be set aside, tax preferred in the account, for future health care related use.

This week’s blog post is a “celebration” of HSAs (see previous reference to “CDH Geek”), by sharing some insights on the numbers, their application, and their future.

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

Washington's Healthplanfinder now up and running

After a few hours of technical difficulties earlier today, Wahealthplanfinder.org is now up and running. There may be a few more glitches as additional issues are fixed, so if you're filling out an application, be sure to save your information. Also, the website will be down temporarily tonight at 8 p.m.

Eight health insurers have been approved to sell 46 different plans inside the Exchange. Remember, the Exchange is the only place you can go to receive federal tax subsidies to help lower your monthly premium - and there's only one official Exchange for our state - www.wahealthplanfinder.org.

If you earn more than the cut-off for a subsidy (about $46,000 for an individual and $94,200 for a family of four), you also can shop for insurance outside the Exchange. To see all of the plans available in your county - both inside and outside the new Exchange - check out this map.

Five things you should know about flood insurance

1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.

2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."

3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")

4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.

5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.

We're looking for a communications and social media manager

Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.

This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.

Here's the full job announcement. Please share with anyone you think might be interested.

We're taking applications through Oct.8.

10 Health Care Cost Reducing Strategies for Employers

Since the launch of this blog site earlier this year, the majority of posts have been focused on compliance issues. This week, I'm changing things up, and shifting the focus to strategies that can help employers and employees REDUCE the cost of their health insurance.  These strategies are not merely theoretical, conceptual ideas, but rather, time tested and proven ways to reduce the cost of health insurance.  And depending on the type of coverage you offer today, there may be no better time than NOW to consider making some changes!

Unlike any other form of insurance, health insurance has a high claims loss ratio.  In fact, approximately 80 cents of every dollar of premium collected is paid back out in claims to the policyholder. (Note: The Affordable Care Act includes a provision known as “minimum loss ratio”, or MLR, which requires health insurers to pay out 80% or 85% (depending on the size of the insured company) of every dollar of collected premium in claim benefits, or rebate the shortage.)  Health insurance is expensive because health care is expensive, and becoming ever increasingly so. There are a number of strategies that employers can consider to reduce the cost of health insurance.  Here are ten (10):

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx

How to contact Washington's Health Benefits Exchange

Earlier this month, the Washington Healthplanfinder (our state's health insurance exchange) opened its toll-free hotline to start answering questions about health coverage options, how to access financial help and what you need to know about the Exchange's enrollment process. The phone number is 1-855-923-4633 or TTY/TDD 1-855-627-9604. They're available from 7:30 a.m. to 8 p.m., Monday through Friday.

The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.

"I'm on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy"

Don't do it.

That's worth saying again: Do Not Do This.

Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.

Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.

And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)

"I just got a letter from my insurer saying that I have to switch health plans because of Obamacare. What can I do?"

Tens of thousands of Washingtonians are -- or will be soon -- getting letters from their health insurers telling them that their plans are going away and that they'll need to pick a new one.

"In order to comply with the new health care law, your current health plan will be discontinued on Dec. 31, 2013," reads one of the letters, which are being sent out by about half a dozen insurers. "But don't worry. You have lots of options."

What's going on? Under health care reform, each health plan has to cover 10 essential benefits. Some of those benefits -- such as prescription drug coverage -- aren't included in many health individual health plans today. The new plans also have to include numerous preventive services, and meet standards for what they'll cover.

In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.

So what can you do?

1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).

In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.

2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.

What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.

3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.

"I was turned down for life insurance due to my health. Does this mean I can't get life insurance at all?"

Not necessarily. Different life insurers have different underwriting standards, so another company might insure someone with your health condition.

So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.

Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.

Medicare Part D Disclosure Notices - DEADLINE LOOMING!

It seems as though the entire employee benefits/human resource universe has been transfixed on the upcoming, October 1 deadline for the ACA Marketplace Notice requirement (now deemed optional).  In fact, this very blog site thoroughly addressed the Marketplace Notice requirement a mere two weeks ago, and provided guidance and compliance assistance!  Meanwhile, another notice requirement, the 8th anniversary no less, looms...

To access the complete article, click - https://smstevensandassociates.com/ResourceLibrary/tabid/192/Default.aspx