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.